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Russian Journal Of Cardiology, 2018, 5 (23)

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Address to the readers

Russ J Cardiol 2018; 23 (5): 5

CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russ J Cardiol 2018; 23 (5): 6

EDITORIAL

VISCERAL ADIPOSITY AS A GLOBAL FACTOR OF CARDIOVASCULAR RISK

Chumakova G. A.1, Kuznetsova Т. Yu.2, Druzhilov М. А.3, Veselovskaya N. G.1,4

Abstract

Obesity becomes one of the main risk factors of development and progression of cardiovascular diseases. Association of the high values of body mass index with overall and cardiovascular mortality is confirmed by the results of meta-analyses of multiple prospective studies. On the other hand, the two most global problems of this relationship — “obesity paradox” and heterogeneity of obesity phenotypes by cardiometabolic risk, released multiple discussions on the issues of predictive value of body overweight and obesity, and worth of correction in patients under the secondary prevention framework. Nowadays, the fact became obvious that maximum role in the risk raise plays a specific type of adipous tissue, and morphological changes in visceral adipous tissue within the processess of remodeling and inflammation, with further dysfunction. In the article, an assessment provided of the ethiopathogenetic role of visceral adipous tissue in cardiovascular continuum; a review provided of the verification approaches to visceral obesity, and a strategy proposed for cardiovascular risk stratification in association with obesity, in a broad clinical framework.

Russ J Cardiol 2018; 23 (5): 7–14

http://dx.doi.org/10.15829/1560-4071-2018-5-7-14

Key words: visceral obesity, visceral adipous tissue, cardiovascular risk.

1Altai State Medical University of the Ministry of Health, Barnaul; 2Petrozavodsk State University, Petrozavodsk; 3Medical-sanitary Institution of the FSS in Karelia Republic, Petrozavodsk; 4Altaiskiy Kray Cardiological Dispensary, Barnaul, Russia.

ORIGINAL ARTICLES

PREDICTIVE SIGNIFICANCE OF ARTERIAL STIFFNESS PARAMETERS IN EVALUATION OF CARDIOMETABOLIC RISK IN OBESITY PATIENTS

Druzhilova O. Yu.1, Druzhilov М. А.2, Kuznetsova Т. Yu.1

Abstract

Aim. To evaluate a possibility to apply the arterial stiffness parameters as prediction instrument for cardiometabolic risk stratification in obesity patients.

Material and methods. Totally, 274 normotensive males investigated (mean age 44,8±5,0 y. o.), with no clinical signs of cardiovascular disorders and type 2 diabetes, with the SCORE risk <5% and abdominal obesity. The analysis of metabolic risk factors was done, echocardiography, triplex scanning of brachiocephalic arteries, ultrasound assessment of abdominal adipose tissue thickness, bifunctional 24 hour blood pressure monitoring (BP) with assessment of mean 24 hour pulse wave velocity (PWV) in aorta, augmentation index and systolic BP in aorta.

Results. The association revealed, of the arterial stiffness parameters with ultrasound marker of visceral obesity, metabolic risk factors and parameters of cardiovascular remodeling. Patients with the PWV in aorta equal or higher than 75th percentile for respective age (7,7 m/s for 35-45 y. o. and 8,2 m/s for 46-55 y. o.) were different (comparing to the group in general) by higher rate of hypertrophy existence (28,4% vs 11,7%, p<0,001) and diastolic dysfunction of the left ventricle (42,0% vs 16,8%, p<0,001), hypertrophy of the intima-media of carotid artery (50,0% vs 29,2%, p<0,001), carotid atherosclerosis (48,9% vs 18,2%, p<0,001) and higher prevalence of the persons with the relation of abdominal visceral adipose tissue to subcutaneous fat layer ≥3,0 (56,8% vs 28,1%, p<0,001).

Conclusion. The “high” values of PWV in aorta for the respective age diapason (7,7 m/s for 35-45 y. o. and 8,2 m/s for 46-55 y. o.) witness on higher probability of metabolic disorders and subclinical cardiovascular remodeling, hence the higher cardiometabolic risk. Bifunctional BP 24 hour monitoring with the arterial wall stiffness evaluation in obesity patients is more preferable method making for additional information gather for further risk stratification.

Russ J Cardiol 2018; 23 (5): 15–20

http://dx.doi.org/10.15829/1560-4071-2018-5-15-20

Key words: arterial stiffness, pulse wave velocity, visceral obesity, cardiometabolic risk.

1Petrozavodsk State University, Petrozavodsk; 2Medical and Sanitary Institution of the FSS in Karelia Republic, Petrozavodsk, Russia.

CLINICAL SPECIFICS OF PATIENTS STATE AFTER REVASCULARIZED MYOCARDIAL INFARCTION, DEPENDING ON THE BASELINE OBESITY STATUS

Chumakova G. A.1,2, Pokutnev А. P.3, Veselovskaya N. G.2,3

Abstract

Aim. Evaluation of comparable clinical specifics of patients after ST elevation myocardial infarction (STEMI) and primary percutaneous intervention, with various grade of obesity.

Material and methods. To the study, consequently 105 males included, post STEMI and primary percutaneous intervention (PCI). In all patients, general obesity (GO) was assessed by body mass index (BMI) and visceral epicardial obesity (EO) by the thickness of epicardial adipose tissue by echocardiography. According to the values, 6 groups of patients were formed with various combination of GO and EO. All patients underwent coronary arteriography in acute stage of MI, levels of adipokines, leptin receptors measured, as the glomerular filtration rate and urine albumin level.

Results. It was found that the baseline clinical parameters in patients’ groups significantly correlated with GO and EO and various combination. In EO comparing to non-EO groups there were high prevalence of 2-3-vessel coronary lesion, life threatening rhythm disorders in acute period of myocardial infarction, leptin resistance, albuminuria. In comparison of the groups by presence and absence of GO, there was no clear relation of the same parameters with BMI. Most commonly multifocal atherosclerosis, rhythm disorders, dysadipokinemia and albuminuria were found in the group with GE and EO, that is probably related to higher amount of visceral fat.

Conclusion. Our study confirmed that obesity is a very heterogenic condition, and depending on the criteria chosen for patients groups comparison, it is possible to get different results of cardiovascular risks, of presentation and complications, from the classical view on GE as a negative factor, to a positive “obesity paradox”. Therefore there is no “paradox” of obesity, but the paradox of assessment criteria for the grade and type of obesity.

Russ J Cardiol 2018; 23 (5): 21–26

http://dx.doi.org/10.15829/1560-4071-2018-5-21-26

Key words: myocardial infarction, general obesity, epicardial obesity.

1Altai State Medical University of the Ministry of Health, Barnaul; 2Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo; 3Altaiskiy Kray Cardiological Dispensary, Barnaul, Russia.

INTERPLAY OF INFLAMMATION AND METABOLIC FACTORS IN COMORBID OBESITY AND ARTERIAL HYPERTENSION OF HIGH AND VERY HIGH RISK

Kologrivova I. V., Koshelskaya O. A., Suslova T. E., Vinnitskaya I. V., Kravchenko E. S., Trubacheva O. A.

Abstract

Aim. Evaluation of the FoxP3+ T-regulatory lymphocytes (Treg) content in overweight and obesity in arterial hypertension (AH) patients of high and very high risk, and relation of Treg amount with the parameters of lipid and carbohydrate metabolism.

Material and methods. A momentary cross sectional study was done, that included 39 patients with AH of high and very high cardiovascular risk with anthropometric signs of overweight and grade 1 obesity. For identification of Treg, intracellular expression of FoxP3 transcriptional factor was assessed. In the blood serum, high sensitive C-reactive protein (hsCRP) was measured, with leptin, adiponectin, parameters of lipid and carbohydrate metabolism.

Results. By the ROC-analysis, the content of FoxP3+ Treg below 3,18% makes it to identify patients with hsCRP ≥3 mg/L (sensitivity — 74%; specificity — 68%). Subgroups were selected that differ by the content of FoxP3+ of T-regulatory lymphocytes (subgroup 1: patients with the level of FoxP3+ Treg <3,18%; subgroup 2: patients with FoxP3+ Treg >3,18%). In subgroup 1 patients there was direct correlation revelaed of FoxP3+ Treg-lymphocytes content and HDL cholesterol (Rs=0,564; p=0,012). Females of subgroup 1 were characterized by higher waist circumference comparing to the females of subgroup 2 (p=0,025); in males, however, there were no differences in waist circumference. In subgroup 1 male patients were characterized by lower HDL cholesterol comparing to women (p=0,005), however such difference was absent in the subgroup of patients with FoxP3+ Treg >3,18%. Among the patients of subgroup 2 the content of FoxP3+ Treg in males showed tendency to higher values comparing with females.

Conclusion. In AH patients of high and very high risk, overweight and obesity grade 1, first time an association revealed of Treg lymphocytes and HDL concentration, that is related to higher rate of subclinical inflammation. Gender specifics is found for potential mechanisms of increase of FoxP3+ Treg-lymphocytes. The relations that revealed in our study underscore an opportunity to develop novel approaches to cardiometabolic risk stratification.

Russ J Cardiol 2018; 23 (5): 27–33

http://dx.doi.org/10.15829/1560-4071-2018-5-27-33

Key words: arterial hypertension, obesity, FoxP3+ T-regulatory lymphocytes, high density lipoproteines, C-reactive protein, gender difference.

Scientific-Research Institute of Cardiology, Tomsk National Research Medical Center of RAS, Tomsk, Russia.

RISK FACTORS OF CORONARY ARTERIES RESTENOSIS AFTER STENTING IN POSTMENOPAUSAL

WOMEN WITH OBESITY

Osipova E. S.1,3, Veselovskaya N. G.1,2,3, Chumakova G. А.1,2,3, Elykomov V. А.1

Abstract

Aim. To assess the preoperational risk factors (RF) most significantly related to coronary arteries (CA) restenosis in postmenopausal women with obesity.

Material and methods. To the study, 94 women included, age 44-70 y. o. (55,44±6,3 y. o.) with obesity of I-III grade by WHO (2003), and CHD: stable angina II-IV functional class, with indicated stenting of one of CA. Group 1 (n=19) consisted of restenosis patients with restenosis in the zone CA stenting; group 2 (n=65) — no restenosis and no other cardiovascular complications (CVC). In the comparison groups, analysis of the main and additional RF was done, and with the logistic regression — search for the most adverse RF combination related to CA restenosis in women with obesity and post-menopause.

Results. In the group 1 patients, during the post-surgery period, the highest levels of glucose were found (р=0,044), of blood insulin (р=0,036), index HOMA-IR (р=0,052), lipoprotein(а) (р=0,003), interleukin-6 (р=0,003), tumor necrosis factor α (р=0,001), leptin (р=0,003), and older age (p=0,01). Most adverse RF combination related to CA restenosis, were epicardial fat tissue thickness, insulin and age.

Conclusion. The revealed RF combination makes it to select most perspective and rational schemes of medication and non-medication prevention of CA restenosis. The data is a worthy material for further research on the roles of neurohumoral and pro-inflammatory activity of visceral fat tissue in CVC risk in obesity patients.

Russ J Cardiol 2018; 23 (5): 34–39

http://dx.doi.org/10.15829/1560-4071-2018-5-34-39

Key words: obesity, coronary restenosis, menopause, risk factors.

1Altai State Medical University of the Ministry of Health, Barnaul; 2SRI of Complex Issues of Cardiovascular Diseases SD RAS, Kemerovo; 3Altaiskiy Kray Cardiological Dispensary, Barnaul, Russia.

PRE-SURGERY STATUS AND IN-HOSPITAL COMPLICATIONS OF CORONARY BYPASS GRAFTING

IN PREDIABETES AND TYPE 2 DIABETES PATIENTS

Sumin А. N.1, Bezdenezhnykh N. А.1, Bezdenezhnykh А. V.1, Osokina А. V.1, Kuzmina А. А.1, Gruzdeva О. V.1,2, Barbarash О. L.1,2

Abstract

Aim. Investigation of pre-operational status and the rate of in-hospital complications of coronary bypass surgery in patients with prediabetes comparing to diabetes type 2 (DM2) and normoglycemia.

Material and methods. Totally, 708 consecutive patients included, post coronary bypass grafting (CBG) in 2011-2012 in the SRI CICVS. If there was no established DM2 diagnosis, but borderline hyperglycemia had existed, patients underwent oral glucose tolerance test (GTT). Its results were interpreted in accordance with the recommended diagnostic criteria for DM2 and other glycemia disorders.

Results. Screening before the CBG made it to additionally reveal DM2 in 8,9% (n=63) of the investigated patients, prediabetes — in 10,4% (n=74). This increased the number of patients with established DM2 from 15,2% (n=108) to 24,1% (n=171), with prediabetes — from 3,0% (n=21) to 13,4% (n=95), overall number of persons with glucose metabolism disorder from 18,2% (n=129) to 37,5% (n=266). All participants were then selected to 3 groups by glycemia status: group 1 — no disorders (n=442), group 2 — prediabetes patients (n=95), group 3 — diabetes type 2 (n=171). In analysis of in-hospital complications, the following attracts an attention: in the prediabetes group, specifically, an urgent operation on lower limbs arteries was done more frequently comparing to two other groups (р1-2=0,002 and р1-3=0,023). Also, the highest rate of wound complications was in the prediabetes group (р1-2 =0,012). There was clear trend of comparability of prediabetes and DM2 by the rate of in-hospital complications (odds ratio (ОR) 1,731, 95% confidence interval (CI) 1,131-2,626, р=0,012), longer hospitalization (ОR 2,229, 95% CI 1,412-3,519, р<0,001), risk of urgent operation on the lower extremities arteries (OR 1,638, 95% CI 1,009-15,213, р=0,020), multiorgan failure (ОR 2,911, 95% CI 1,072-7,901, р=0,039), and the need for extra-corporal hemostasis correction (ОR 3,472, 95% CI 1,042-11,556, р=0,044). With addition of prediabetes to the regression model and regard of any glucose tolerance disorder as possible predictor of in-hospital complications, all the listed above remained significant, and there was additional relation of prediabetes and diabetes with the risk of acute kidney injury (ОR 1,700, 95% CI 1,067-2,612, р=0,024) and wound complications (ОR 1,547, 95% CI 1,073-2,231, р=0,019).

Conclusion. Prediabetes is the same adverse as diabetes in its influence on inhospital prognosis of CBG, that underscores the importance of active preoperational screening of glucose intolerance.

Russ J Cardiol 2018; 23 (5): 40–48

http://dx.doi.org/10.15829/1560-4071-2018-5-40-48

Key words: myocardial revascularization, coronary bypass, pre-diabetes, diabetes mellitus, pre-surgery status, screening for glucose intolerance, in-hospital adverse outcomes.

1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo; 2Kemerovo State Medical University, Kemerovo, Russia.

THE ROLE OF FATTY ACID CONTENTS OF ERYTHROCYTES MEMBRANES IN CARDIOHEMODYNAMICS DISORDER IN GOUT PATIENTS WITH INSULIN RESISTANCE SYNDROME

Kushnarenko N. N., Medvedeva T. A., Govorin A. V., Mishko M. Yu.

Abstract

Aim. To assess the specifics of fatty acidic contents of erythrocyte membranes, and morpho-functional disorder of the left ventricle (LV) in gout patients depending on the syndrome of insulin resistance (IR).

Material and methods. In the study, 117 males participated, age 39 to 55 y. o., with gout. Among them, 43.6% presented with normal HOMA-IR, and the rest had IR. Fatty acid content of membrane lipids assessed, as the morphofunctional properties of the LV, with the types of LV geometry and its diastolic function assessment, according to presence or absence of IR.

Results. Changes of fatty acid contents in IR and gout patients cells membranes are characterized by increased amount of saturated fatty acids and decreased — of unsaturated, and in the pool of unsaturated acids there is increase of monoenic, but significant decrease of polyenic acids. In the pool of polyunsaturted acids there is increased amount of γ-linoleic and dihomo-γ-linoleic and significant decrease of arachidonic and docosapentaenoic acids. It is found, that cardiohemodynamics parameters in gout patients do significantly differ with IR. In males with gout and IR the prevailing variant of the LV architectonics was concentric hypertrophy (49,3%; p<0,05). Patients with the normal parameters of glucose-insulin homeostasis more commonly showed normal geometry (26,6%; p<0,05) and eccentric hypetrophy of LV (46,8%; p<0,05). Diastolic dysfunction of the LV was registered 2,8 times more frequently in the insulin resistant patients. There were correlations found of hyperuricaemia, increased insulin level and changes of fatty acidic content and cardiohemodynamics parameters.

Conclusion. The found relations of the fractional contents of fatty acids, morphofunctional disorder of the LV and parameters of carbohydrate metabolism might impact significantly the development of cardiovascular complications in this category of patients.

Russ J Cardiol 2018; 23 (5): 49–55

http://dx.doi.org/10.15829/1560-4071-2018-5-49-55

Key words: gout, insulin resistance, cardiohemodynamics, left ventricle remodeling, fractional content of fatty acids, diastolic dysfunction.

Chita State Medical Academy, Chita, Russia.

EFFECTS OF OMEGA-3 POLYUNSATURATED FATTY ACIDS ON THE CIRCADIAN RHYTHM OF HEART RATE VARIABILITY PARAMETERS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND CARDIOVASCULAR AUTONOMIC NEUROPATHY

Serhiyenko V. A.1, Segin V. B.2, Serhiyenko A. A.1

Abstract

Aim. The aim of the study was to analyze the effect of ω-3 polyunsaturated fatty acids (ω-3 PUFAs) on the heart rate variability (HRV) parameters in patients with type 2 diabetes mellitus (T2DM) and advanced stage of cardiovascular autonomic neuropathy (CAN).

Material and methods. We have examined 36 patients with T2DM and advanced stage of CAN, aged between 50-59 years with disease duration 1-6 years and median glycated hemoglobin A1c 7,1%±0,12%. Patients with T2DM and advanced stage of CAN were divided into 2 groups. The first group received traditional antihyperglycemic therapy (n=15, control) for three mo; patients in group 2 (n=21) received in addition 1 g/day of the ω-3 PUFAs for three months.

Results. Prescription of the ω-3 PUFAs to the patients with T2DM and advanced stage of СAN was accompanied by a statistically significant increase of the timedomain HRV parameters; the spectral HRV parameters during the active and passive periods compared to the control group.

Conclusion. Obtained results suggest that the efficacy of ω-3 PUFAs is the result of a direct effect of the ω-3 PUFAs on the investigated indexes.

Russ J Cardiol 2018; 23 (5): 56–60

http://dx.doi.org/10.15829/1560-4071-2018-5-56-60

Key words: type 2 diabetes mellitus, cardiovascular autonomic neuropathy.

1Lviv National Medical University named after Danylo Halytsky, Lviv; 2Lviv Regional State Clinical Treatment and Diagnostic Endocrinology Center, Lviv, Ukraine.

Serhiyenko V. A.* — MD, PhD, Associate Professor of the Department of Endocrinology, Segin V. B. — MD, Serhiyenko A. A. — MD, Professor, Professor of the Department of Endocrinology.

PREDICTION OF MULTIFOCAL ATHEROSCLEROSIS IN WOMEN WITH RHEUMATOID ARTHRITIS

Osipova I. V.1, Starodubova Yu. N.1,2, Antropova О. N.1

Abstract

Aim. To define the most common localization and risk factors for multifocal atherosclerosis in females with rheumatoid arthritis (RA).

Material and methods. At first stage, retrospectively an analysis of medical documentation was done, of 245 RA female patients. For the second stage conducted as a prospective observation, case histories of 105 women included, comparable by age, duration of RA. Participants were selected to 2 groups: 1st (n=49) — with clinically manifest atherosclerosis, 2nd (n=56) — with none. Analysis of cardiovascular risk factors was done and chronic inflammation markers.

Results. In all atherosclerosis patients there was multifocal lesion (n=49). Common localizations are coronary arteries (81,7%) with involved lower extremities lesion (59,2%) and/or carotid arteries (69,3%). In the 1st group, there were more common arterial hypertension (AH) (100 and 64%, p=0,009), psychosocial risk factors (39 and 5%, p=0,001), pre-eclampsia or eclampsia anamnesis (38 and 11%, p=0,01), raise of total cholesterol (TC) (67 and 55%, p=0,01). In the 1st group, the markers of inflammation were raised more commonly, p<0,05. As a statistically significant predictors of multifocal atherosclerosis development in RA female patients play role age, AH, sleep disorder, depression, high activity of RA, early menopause, raise of TC, prednisolone intake. There was negative correlation revealed of low density lipoproteides cholesterol increase and atherosclerosis development, p=0,04.

Conclusion. The specifics of atherosclerosis in RA is its multifocal lesion. Mathematic model that has been introduced, is based upon multifactorial analysis and can be recommended as a method for prediction of multifocal atherosclerosis. Predictor complex revealing for multivessel lesion and correction of modifiable risk factors should be the fundamental of prevention and cardiovascular risk reduction in RA female patients.

Russ J Cardiol 2018; 23 (5): 61–67

http://dx.doi.org/10.15829/1560-4071-2018-5-61-67

Key words: rheumatoid arthritis, atherosclerosis, risk factors.

1Altai State Medical University of the Ministry of Health, Barnaul; 2City Hospital № 4, Barnaul, Russia.

OPINION ON A PROBLEM

FIXED COMBINATIONS IN ARTERIAL HYPERTENSION TREATMENT: NOVEL OPPORTUNITIES

Podzolkov V. I., Tarzimanova A. I.

Abstract

Arterial hypertension (AH) remains one of the most prevalent cardiovascular disorder in the world, as one of the main risk factors of myocardial infarction and stroke development. Monotherapy of AH is effective in no more than one half of patients even with moderate increase of blood pressure. Combinational antihypertension treatment does influence pathogenetic mechanisms of AH being an optimal solution. It is worthful to apply a fixed combination of telmisartan and hydrochlorothiazide. Such combination provides additional antihypertensive effect with more significant decrease of blood pressure than for the components separately. Also it is protective for organs and tissues that makes it to prescribe such combination to a broad range of patients.

Russ J Cardiol 2018; 23 (5): 68–73

http://dx.doi.org/10.15829/1560-4071-2018-5-68-73

Key words: systemic hypertension, combination treatment, telmisartan, hydrochlorothiazide.

I. M. Sechenov First Moscow State Medical University of the Ministry of Health, Moscow, Russia.

CLINICAL CASE

SUCCESSFUL CORRECTION OF REFRACTORY ARTERIAL HYPERTENSION AND MORBID OBESITY IN PATIENT WITH SEVERE OBSTRUCTIVE APNEA SYNDROME

Tsygankova O. V.1,2, Kalinina Е. М.2,3, Latyntseva L. D.2, Voevoda М. I.2

Russ J Cardiol 2018; 23 (5): 74–80

http://dx.doi.org/10.15829/1560-4071-2018-5-74-80

Key words: obstructive sleep apnea, refractory arterial hypertension, morbid obesity, clinical case.

1Novosibirsk State Medical University of the Ministry of Health, Novosibirsk; 2Scientific-Research Institute of Therapy and Preventive Medicine, branch of the Institute of Cytology and Genetics SD RAS, Novosibirsk; 3LLC “Sanitas+ Clinics”, Novosibirsk, Russia.

LITERATURE REVIEWS

THE MECHANISMS OF HEART FAILURE DEVELOPMENT IN OBESITY

Gritsenko О. V.1, Chumakova G. А. 2,3, Shevlyakov I. V.3, Trubina Е. V.3

Abstract

The epidemic of obesity impacts significantly the prevalence of cardiovascular diseases, including heart failure. Obesity facilitates proinflammatory status onset, that leads to changes in metabolism of free fatty acids, lipids, glucose, influencing myocardial function and heart failure progression from diastolic to systolic. Also, there is data confirming influence of obesity on central and peripheral hemodynamics. To understand these mechanisms is necessary for development of prevention activities against chronic heart failure and other cardiovascular events.

Russ J Cardiol 2018; 23 (5): 81–86

http://dx.doi.org/10.15829/1560-4071-2018-5-81-86

Key words: obesity, heart failure.

1Altaiskiy Kray Cardiological Dispensary, Barnaul; 2Altaiy State Medical University of the Ministry of Health, Barnaul; 3Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia.

THE ROLE OF PULSE REDUCTION THERAPY IN ADDITIONAL IMPROVEMENT OF CLINICAL EFFECTS OF MYOCARDIAL REVASCULARIZATION IN CORONARY HEART DISEASE STABLE ANGINA PATIENTS

Aronov D. M., Bubnova M. G.

Abstract

The review is focused on the role of ivabradine in percutaneous coronary intervention (PCI) and coronary bypass grafting (CBG) in coronary heart disease patients (CHD) with stable angina. The data provided, on insufficient clinical effect of PCI revascularization with modern medication therapy. Authors argue for improvement of the clinical effect of PCI and CBG by addition of ivabradine together with sufficient (up to maximal) dosages of beta-adrenoblockers (BAB). Inhibition of If-channels of cardiomyocytes with ivabradine makes positive influence on the main clinical endpoints. The role of multiple effect of ivabradine is highlighted, that increase efficacy of the drug.

Russ J Cardiol 2018; 23 (5): 87–96

http://dx.doi.org/10.15829/1560-4071-2018-5-87-96

Key words: coronary bypass, percutaneous coronary intervention, myocardial revascularization, stable angina, angina functional class, life quality.

National Research Center for Preventive Medicine of the Ministry of Health, Moscow, Russia.

TORASEMIDE IN PREVENTION OF MITRAL REGURGITATION AND CHRONIC HEART FAILURE WORSENING IN POSTINFARCTION PERIOD

Abdullaev A. A., Ibragimova I. B., Islamova U. A., Gafurova R. M., Baytemirova N. N.

Abstract

In the review, the results of scientific research provided, conducted with aim to study influence of ischemic mitral regurgitation (IMR) on the development and progression of chronic heart failure (CHF). The opportunities considered, of torasemide implementation in prevention of the raise of mitral regurgitation grade, development of desadaptive remodelling of the heart, decrease of its electrical instability that presents itself with various cardiac rhythm disorders, and of prevention of development and progression of the CHF. Benefits of torasemide over furosemide are revealed in management of congestive CHF at the background of IMR in postinfarction patients.

Russ J Cardiol 2018; 23 (5): 97–102

http://dx.doi.org/10.15829/1560-4071-2018-5-97-102

Key words: torasemide, ischemic mitral regurgitation, postinfarction period, chronic heart failure.

Dagestan State Medical University of the Ministry of Health, Makhachkala, Russia.

CLINICAL GUIDELINES

2017 ESC GUIDELINES FOR THEMANAGEMENT OF ACUTEMYOCARDIAL INFARCTION IN PATIENTS PRESENTING WITH ST-SEGMENT ELEVATION

The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)

Russ J Cardiol 2018; 23 (5): 103–158

http://dx.doi.org/10.15829/1560-4071-2018-5-103-158

Key words: Guidelines, Acute coronary syndromes, Acute myocardial infarction, Antithrombotic therapy, Antithrombotics, Emergency medical system, Evidence, Fibrinolysis, Ischaemic heart disease, Primary percutaneous coronary intervention, Quality indicators, MINOCA, Reperfusion therapy, Risk assessment, Secondary prevention, ST-segment elevation.

31 мая 2018 г.
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