Russian Journal Of Cardiology, 2018, 23 (9)

Address to the readers

Russ J Cardiol 2018; 23 (9): 5

CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russ J Cardiol 2018; 23 (9): 6

ORIGINAL ARTICLES

PREVALENCE ASSOCIATIONS OF VARIOUS RISK FACTORS AND ARTERIAL HYPERTENSION IN MALE OPEN URBAN POPULATION (BY A ONE STAGE EPIDEMIOLOGICAL STUDY)

Akimova Е. V.¹, Akimov М. Yu.², Gakova Е. I.¹, Kayumova М. М.¹, Gafarov V. V.³, Kuznetsova V. А.¹

Abstract

Aim. Revealing of the associations of various cardiovascular psychosocial risk factors prevalence — vital exhaustion (VE) and hostility — with arterial hypertension (AH) in open male population, age 25-64 y. o., of moderately urbanized Siberian city.

Material and methods. One stage epidemiological study was conducted on representative selection, shaped from election lists of males 25-64 y. o., from one of Tymen city districts. For the analysis of AH the data from cardiological screening was used, and surveying by psychosocial methods in algorithms of MONICA-MOPSY.

Results. The prevalence of psychocosical risk factors was found as following: VI — 54,5%, hostility — 46,4%. With the age, higher levels of VE and hostility become more prevalent, achieving maximum at 55-64 y. o. Populational variation of systolic

and diastolic blood pressure in males 25-64 y. o. is shifted to the right, with high prevalence of AH. In AH groups there are low and moderate levels of VE and high hostility.

Conclusion. The data points on high demand on AH prevention in economically active citizens that have psychosocial risk factors; this requires interventions from the healthcare institutions of the region.

Russ J Cardiol. 2018;23(9):7–11

dx.doi.org/10.15829/1560-4071-2018-9-7-11

Key words: arterial hypertension, vital exhaustion, hostility, open population, males.

Conflicts of Interest: nothing to declare.

¹Tyumen Cardiological Scientific Centre, Tomsk National Research Medical Centre of RAS, Tomsk; ²Tyumen Industrial University, Tyumen; ³SRI of Therapy and Prevention Medicine — branch of the Federal Research Centre Institute of Cytology and Genetics of SD RAS, Novosibirsk, Russia.

Akimova Е. V. ORCID: 0000-0002-9961-5616, Akimov М. Yu. ORCID: 0000-0003-1016-7560, Gakova Е. I. ORCID: 0000-0002-0255-697X, Kayumova М. М. ORCID: 0000-0001-5326-119X, Gafarov V. V. ORCID: 0000-0001-5701-7856, Kuznetsova V. А. ORCID: 0000-0002-1970-2606.

THE SPECIFICS OF CLOTTING AND ENDOGENIC FIBRINOLYSIS IN ACUTE CORONARY SYNDROME PATIENTS

Kalinskaya A. I., Savvinova P. P., Vasilieva E. Yu., Shpektor A. V.

Abstract

Aim. To assess the processes of clot formation in relation to endogenic fibrinolysis in patients with various types of acute coronary syndrome (ACS).

Material and methods. To the study, 89 persons (40 males) included: 59 with ACS, 30 — control group. Among the ACS patients, 28 were ST-elevation (STEMI), 31 with non-ST-elevation ACS (NSTEACS). All participants were assessed for clotting formation parameters and thrombus lysis with rotational elastometry on ROTEM equipment (Germany) and “Hemacore” Thrombodynamics (Russia), before coronary arteriography.

Results. Clot density and its size in 10 minutes were significantly higher in ACS comparing to control patients (2867 units vs 25084 units, p<0,001; 41,8 mm vs 36,4 mm, p<0,05, respectively). The time from onset of thrombus lysis was lower in ACS (79,4 min vs 69,3 min, p<0,05). The percent of lysis by the end of process registration was lower in ACS (20,1% vs 23,1%, p<0,05). Amplitude of clot formation in 20 minutes from the onset of clotting, as the maximum density of clot were significantly higher in NSTEACS comparing to STEMI (56,2 mm vs 49,7 mm, p=0,018; 59 mm vs 53,2 mm, p=0,011; respectively). Thrombus lysis was slower in NSTEACS patients comparing to STEMI (62,26 min vs 45,5 min, p=0,02).

Conclusion. With the measurement in vitro, the process of clotting and thrombus lysis is more active in ACS patients comparing to controls, that point on a baseline activated hemostasis. Within the ACS group, higher the existing clot in vessel lumen, more active the shift of the balance to anticoagulation and fibrinolysis.

Russ J Cardiol. 2018;23(9):12–16

dx.doi.org/10.15829/1560-4071-2018-9-12-16

Key words: acute coronary syndrome, endogenic fibrinolysis, spontaneous reperfusion.

Conflicts of Interest: nothing to declare.

A. I. Evdokimov Moscow State University of Medicine and Dentistry (MSUMD), Moscow, Russia.

Kalinskaya A. I. ORCID: 0000-0003-2316-4238, Savvinova P. P. ORCID: 0000-0001-8596-5212, Vasilieva E. Yu. ORCID: 0000-0002-6310-7636, Shpektor A. V. ORCID: 0000-0001-6190-6808.

INFLAMMATION MARKERS IN CORONARY HEART DISEASE PATIENTS WITH AORTIC VALVE STENOSIS

Afansieva O. I., Tmojan N. A., Klesareva E. A., Razova O. A., Afanasieva M. I., Burdeynaya A. L., Saidova M. A., Ezhov M. V., Pokrovsky S. N.

Abstract

Raised level of lipoproteide (a) (Lpa) is an independent risk factor of coronary heart disease (CHD) and is also a monogenic predictor (there is growth of prevalence) of aortic stenosis (AS) with the increase of Lpa in population. Lysophosphatide acid, secreted by an enzyme with phospholipase D activity — autotaxin (ATX) is an inflammatory mediator. Humoral immunity involvement in inflammatory processes in coronary arteries and aortic valve might present with the presence of circulating autoantibodies and shifts in the values of cellular immunity.

Aim. To assess the relation of Lpa, ATX and immunity with the presence of AS in chronic CHD patients.

Material and methods. To a single moment study, 210 patients were included, with chronic CHD. Patients were selected to two groups by the presence (main group, n=47) or absence (controls, n=163) of degenerative AS by echocardiography. Patients were taking standard CHD therapy. All patients underwent clinical blood count, lipids concentration and Lpa. ATX, C-reactive protein, autoantibodies to ApoB-100 lipoproteides and their Cu2+-oxidated modifications. Phenotypes of apoprotein (a) were assessed in 168 patients.

Results. CHD patients with degenerative AS were older (74,2±7,8 versus 67,6±9,4 y., p=0,0007), but did not differ by the clinical and biochemical characteristics, level of Lpa and high sensitive С-reactive protein (hsCRP). Concentration of АТХ in plasma was significantly higher (554±95 and 497±105 ng/mL, p=0,001), but the level of IgM autoantibodies against the oxidated lipoproteid (а) (oxLpa) — significantly lower (10,8 [7,9;15,1] and 13,4 [11,4;16,7] relative units, p<0,001) in the main group comparing to control. Neutrophilic-lymphocytal index also differed significantly in the AS group and non-AS (2,04 [1,56;3,14] and 1,72 [1,39;2,14]). By the results of logistic analysis, the age, level of ATX, titer of autoantibodies to oxLpa and neutrophilic-limphocytal index were significant independent predictors of the degenerative AS.

Conclusion. In the patients with chronic CHD, undergoing statin therapy, the levels of ATX, autoantiboides IgM against the oxLpa and relation of neutrophils to lymphocytes, but not the concentration of Lpa and low molecular phenotype of apo(a), were related to AS presence.

Russ J Cardiol. 2018;23(9):17–22

dx.doi.org/10.15829/1560-4071-2018-9-17-22

Key words: lipoproteide (a), apoprotein (a), aortic valve stenosis, autotaxin, autoantibodies, neuthrophilic-lymphocytal relation.

Conflicts of Interest: nothing to declare.

National Medical Research Center of Cardiology of the Ministry of Health, Moscow, Russia.

Afansieva O. I. ORCID: 0000-0001-8909-8662, Tmojan N. A. ORCID: 0000-0002-3617-9343, Klesareva E. A. ORCID: 0000-0002-0682-8699, Razova O. A. ORCID: 0000-0002-1132-2529, Afanasieva M. I. ORCID: 0000-0002-5725-3805, Burdeynaya A. L. ORCID: 0000-0003-0517-7828, Saidova M. A. ORCID: 0000-0002-3233-1862, Ezhov M. V. ORCID: 0000-0002-1518-6552, Pokrovsky S. N. ORCID: 0000-0001-5944-6427.

RISK ASSESSMENT SCORE FOR DRUG ELUTING STENT RESTENOSIS

Gabbasov Z. А.¹, Melnikov I. S.^1,2, Byazrova S. V.¹, Kozlov S. G.¹

Abstract

Aim. To evaluate most significant risk factors of stent restenosis in coated stents, to develop a logistic model and invent prediction score of restenosis for real clinical practice application.

Material and methods. Totally, 126 patients included, age 40 to 75 y. o. with chronic coronary heart disease, who had undergone repeated coronary arteriography within 6 to 12 month after percutaneous intervention with drug eluting stents implantation. Patients were selected to 2 groups: with restenosis (n=53) and with the none (n=73). Assessment of 35 clinical, laboratory and angiographic properties was done with logistic regression analysis.

Results. There were 4 main risk factors found for restenosis risk: type 2 diabetes, low diameter of stented artery (<2,75 mm), number of simultaneously implanted stents and increased rate of neutrophil to lymphocyte numbers. A logistic model was built that combinates the parameters. ROC-analysis showed high predictive value of the model (square under curve ROC 0,78, p<0,001). Based on the logistic model, a score was invented for prediction of restenosis probability for clinical practice introduction.

Conclusion. The proposed score shows high predictive power and is easy in use, that make it suitable for clinical practice in assessment of the risk of coated stents restenosis.

Russ J Cardiol. 2018;23(9):23–27

dx.doi.org/10.15829/1560-4071-2018-9-23-27

Key words: drug eluting stents, restenosis, coronary heart disease, restenosis risk prediction.

Conflicts of Interest: nothing to declare.

¹National Medical Research Center for Cardiology of the Ministry of Health, Moscow; ²Institute of Medical and Biological Issues of RAS, Moscow, Russia.

Gabbasov Z. А. ORCID: 0000-0003-3878-2573, Melnikov I. S. ORCID: 0000-0001-5241-3091, Byazrova S. V. ORCID: 0000-0003-0741-4372, Kozlov S. G. ORCID: 0000-0001-8800-1670.

RESULTS OF QUALITATIVE TEST ON FATTY ACID BINDING CARDIAC PROTEIN IN SUSPECTED ACUTE CORONARY SYNDROME AND VARIOUS KIDNEY FUNCTION LEVEL

Kokorin V. А.¹, Kochmareva Е. А.², Arefiev М. N.², Gordeev I. G.¹

Abstract

Aim. To evaluate diagnostic properties of qualitative tests for cardiac fraction of the fatty acid binding protein (cFABP) in patients hospitalized with suspected acute coronary syndrome (ACS), depending on glomerular filtration rate (GFR) level.

Material and methods. Totally, 465 patients included, admitted with ACS within 24 hours from onset. All patients underwent cFABP test with immune chromatographic express tests “CardioFABP” (Novosibirsk, Russia) and/or “CARD-INFO” (Obninsk,

Russia), as the levels of serum creatinine with further GFR calculation. Assessment of diagnostic characteristics was done by the values of specificity, sensitivity, and diagnostic correctness, as well as overall positive and negative test results according to GFR.

Results. The analysis did not reveal significant difference in the number of positive and negative results of cFABP with the “CARD-INFO” (χ²=6,822, р=0,146), “CardioFABP” 10 ng/mL (χ²=4,968, р=0,291) and “CardioFABP” 15 ng/mL (χ²=8,673,

р=0,07) in comparison by GFR. With coupled comparison, in the groups of patients by GFR there were differences in specificity for “CARD-INFO” (Fischer criteria =0,017, р˂0,05) and precision for “CardioFABP” (10 ng/mL) (χ²=5,793, р=0,017) in patients by GFR levels 60-90 and 30-59 mL/min/1,73 m². For the other parameters of diagnostical efficacy there were no differences by GFR. In severe renal dysfunction (GFR ˂15 mL/min/1,73 m²) results of qualitative cFABP were false positive in 10 cases among 11 (90,9%).

Conclusion. In patients hospitalized for suspected ACS, the results and diagnostic characteristics of the express-tests for cFABP “CARD-INFO” and “CardioFABP” depended mildly on GFR level with its values ≥15 mL/min/1,73 m². Low number of patients with GFR ˂15 mL/min/1,73 m² made not possible to acquire significant data on cFABP in this category of patients, however the data available make it not to apply the test in this category of patients.

Russ J Cardiol. 2018;23(9):28–32

dx.doi.org/10.15829/1560-4071-2018-9-28-32

Key words: fatty acid binding cardiac protein, express-test, acute coronary syndrome, renal function, glomerular filtration rate.

Conflicts of Interest: nothing to declare.

¹Pirogov Russian National Research Medical University of the Ministry of Health, Moscow; ²Filatov O. M. City Clinical Hospital № 15 of Moscow Healthcare Department, Moscow, Russia.

Kokorin V. А. ORCID: 0000-0001-8614-6542, Kochmareva Е. А. ORCID: 0000-0002-6614-6251, Arefiev М. N. ORCID: 0000-0002-6675-5794, Gordeev I. G. ORCID: 0000-0002-3233-4369.

EXPERIMENTAL STUDY

CALCIUM-PHOSPHATE BIONS DO SPECIFICALLY INDUCE HYPERTROPHY OF DAMAGED INTIMA IN RATS

Shishkova D. K., Velikanova E. A., Krivkina E. O., Mironov A. V., Kudryavtseva Yu. A., Kutikhin A. G.

Abstract

Aim. To evaluate specificity of endothelial toxicity of calcium-phosphate bions (CPB) in vivo.

Material and methods. Toxicity of calcium-phosphate bions and magnesiumphosphate bions (MPB) in relation to intima of abdominal aorta of the Wistar rats, was assessed by single intravenous injection after balloon angioplastics with further explanting of aortas in five weeks. Bioptates were analyzed: 1) with classical histological methods (hematoxilin-eosine, alizarin red, van Gison, Russell-Movat) with light microscopy; 2) immune fluorescence coloring of cryoslices (combinational coloring for marker of mature endothelial cells CD31 and marker of progenitory CD34, for CD31 and marker of vascular smooth muscle cells α-smoothmuscle actin (α-SMA), for vimentin and α-SMA, for extracellular matrix marker collagen type IV and α-SMA, after all colorings there was additional nuclear 4’,6-diamidine-2-phenylindol color) with further confocal microscopy. In all animals the blood was collected with serum extraction for systemic inflammation molecules analysis, as chemoattractant protein (МСР-1/CCL2) and ceruloplasmin via the immune enzyme analysis.

Results. With the difference from CPB, MPB did not lead to intimal hypertrophy in abdominal aorta in rats. Shaping of neointima in aorta is related with CPB-induced endothelium damage that induces a phenotype shift in mesenchymal cells (smooth muscle cells and fibroblasts) from contractile (for smooth muscle) and non-active (for fibroblasts) towards synthetizing.

Conclusion. Intravenous load of MPB did not lead to intimal hypertrophy that witness on specificity of endothelial toxicity of CPB, with phenotypical shift of the mesenchymal cells in neointima.

Russ J Cardiol. 2018;23(9):33–38

dx.doi.org/10.15829/1560-4071-2018-9-33-38

Key words: atherosclerosis, bions, nanoparticles, toxicity, endothelium, intimal hypertrophy.

Conflicts of Interest: funded by Russian Foundation for Fundamental Research, grant № 17-04-00570.

Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia.

Shishkova D. K. ORCID: 0000-0002-1518-3888, Velikanova E. A. ORCID: 0000-0002-1079-1956, Krivkina E. O. ORCID: 0000-0002-2500-2147, Mironov A. V.ORCID: 0000-0002-8846-5077, Kudryavtseva Yu. A. ORCID: 0000-0002-6134-7468, Kutikhin A. G. ORCID: 0000-0001-8679-4857.

METHODS OFSTUDY

ULTRASOUND EXAMINATION OF ACHILLES TENDONS IN PATIENTS WITH FAMILIAL HYPERCHOLESTEROLEMIA

Genkel V. V., Kolyadich M. I., Lebedev E. V., Kuznetsova A. S., Portnova R. G., Shaposhnik I. I.

Abstract

Aim. To assess the morphometric characteristics of Achilles tendons in patients with familial hypercholesterolemia (FH) and to identify factors associated with an increase in their size.

Material and methods. Totally, 100 patients included, with severe primary hyperlipidemia, defined as an increase in total cholesterol ≥7,5 mM/L and/or lowdensity lipoprotein cholesterol ≥4,9 mM/L. All patients underwent duplex scanning of carotid arteries. Ultrasound examination of the Achilles tendons was carried out on an expert class ultrasound equipment Samsung Medison EKO 7 (Japan) with a linear sensor, frequency of 7-16 MHz. Thickness of the Achilles tendon (anteriorposterior dimension (APD)) was measured during scanning in the longitudinal section, width (transverse dimension (TD)) — scanning in the cross section. The measurements were made 2 cm proximal to the calcaneus.

Results. Among the participants, 32 (32,0%) had definite/probable diagnosis of FH. In patients with definite/probable FH the mean values of APD were significantly higher in comparison with patients scored 5 or less points (DLCN) — 5,50 (4,70-6,10) mm vs. 5,00 (4,50-5,40), respectively (p=0,04). TD of Achilles tendons among this category of patients was also statistically significantly higher in comparison with the rest of patients — 14,0 (12,9-15,4) mm and 13,2 (12,2-14,2) mm, respectively (p=0,04). In correlation analysis, the relationship between the growth of patients and the APD of the Achilles tendons (r=0,34, p=0,001), the TD of the Achilles tendon (r=0,28, p=0,009), CIMT and TD of the Achilles tendons (r=0,21, p=0,05), amount of carotid plaques and TD of the Achilles tendon (r=0,26, p=0,01), total percentage of stenosis of the carotid arteries and the TD of the Achilles tendons (r=0,27, p=0,01), maximum percentage of stenosis of the carotid arteries and the TD of the Achilles tendons (r=0,28, p=0,007). According to regression analysis, factors associated with an increase in thickness of the Achilles tendons for more than 75 percentiles were male sex, diabetes mellitus, height, myocardial infarction in relatives, total percentage of stenosis of the carotid arteries and high-density lipoproteide cholesterol.

Conclusion. In patients with definite/probable FH, mean values of width and thickness of the Achilles tendons were significantly higher in comparison with the rest of the patients. According to regression analysis, the factors associated with the increase in thickness of the Achilles tendons fro more than 75 percentiles were male sex, diabetes mellitus, height, myocardial infarction in relatives, total percentage of stenosis of the carotid arteries and HDL high-density lipoproteide cholesterol.

Russ J Cardiol. 2018;23(9):39–44

dx.doi.org/10.15829/1560-4071-2018-9-39-44

Key words: familial hypercholesterolemia, Achilles tendons, carotid atherosclerosis, diabetes mellitus.

Conflicts of Interest: nothing to declare.

South-Ural State Medical University of the Ministry of Health, Chelyabinsk, Russia.

Genkel V. V. ORCID: 0000-0001-5902-3803, Kolyadich M. I. ORCID: 0000-0002-0168-1480, Lebedev E. V. ORCID: 0000-0002-7954-2990, Kuznetsova A. S. ORCID: 0000-0002-0357-5702, Portnova R. G. ORCID: 0000-0003-1952-2215, Shaposhnik I. I. ORCID: 0000-0002-7731-7730.

CLINICAL CASES

RADIATION HEART DISEASE IN A PATIENT POST TREATMENT OF HODGKIN’S LYMPHOMA

Eniseeva Е. S.^1,2, Protasov К. V.¹, Chernysheva N. L.³, Bagadaeva Е. Yu.³, Stefanenkova А. А.⁴

Abstract

A clinical case of radiation induced heart disease in 43 year old female patient after 15 years since radiation therapy of Hodgkin’s lymphoma. During clinical and instrumental investigation, a post-radiation constrictive pericarditis was found, comorbid with lesion of aortic, mitral and tricuspid valves. Surgical treatment of pericarditis was applied. Morphology confirmed the diagnosis.

Russ J Cardiol. 2018;23(9):45–47

dx.doi.org/10.15829/1560-4071-2018-9-45-47

Key words: Hodgkin’s lymphoma, radiation therapy, constrictive pericaditis, radiation induced heart damage, pericardectomy.

Conflicts of Interest: nothing to declare.

¹Irkutsk State Medical Academy of Postgraduate Education — branch of the Russian Medical Academy of Continuing Professional Education of the Ministry of Health, Irkutsk, Russia; ²Irkutsk State Medical University of the Ministry of Health; ³Irkutsk Regional Clinical Hospital of the “Award of Honor”, Irkutsk; ⁴Irkutsk Regional Pathomorphology Bureau, Irkutsk, Russia.

Eniseeva Е. S. ORCID: 0000-0002-9069-3570, Protasov К. V. ORCID: 0000-0002-6516-3180, Chernysheva N. L. ORCID: 0000-0003-4725-8597, Bagadaeva Е. Yu. ORCID: 0000-0001-9038-149Х, Stefanenkova А. А. ORCID: 0000-0003-2492-3531.

HYPERTROPHIC CARDIOMYOPATHY COMORBID WITH CORONARY HEART DISEASE: 6-YEAR FOLLOW-UP

Kovalevskaya Е. А.^1,2, Krylova N. S.^1,2, Poteshkina N. G.^1,2, Fettser D. V.², Vanyukov А. Е.²

Abstract

A clinical case presented, of 6-year follow-up of a patient with apical hypertrophic cardiomyopathy (HCMP) and angina syndrome. The challenges discussed, of differential diagnostics of HCMP and coronary heart disease (CHD) in patient with angina and repolarization disorder on ECG. Specifics of the case presented, was hyperdiagnostics of CHD at the onset of clinical presentation, and intact coronary arteries. In 6 years of follow-up this patient developed coronary lesions required the stenting of left anterior descending artery. Comorbid CHD in older age with apical CHD worsened clinical picture and underlined the issue of comorbidity in CHD and HCMP.

Russ J Cardiol. 2018;23(9):48–53

dx.doi.org/10.15829/1560-4071-2018-9-48-53

Key words: apical hypertrophic cardiomyopathy, angina pectoris, coronary arteriography, ventriculography, coronary lesion.

Conflicts of Interest: nothing to declare.

¹Pirogov Russian National Research Medical University of the Ministry of Health, Moscow; ²City Clinical Hospital № 52 of Moscow Healthcare Department, Moscow, Russia.

Kovalevskaya Е. А. ORCID: 0000-0002-0787-4347, Krylova N. S. ORCID: 0000-0003-0310-0771, Poteshkina N. G. ORCID: 0000-0001-9803-2139, Fettser D. V. ORCID: 0000-0002-4143-8899, Vanyukov А. Е. ORCID: 0000-0002-8478-2198.

MANAGEMENT TRAJECTORY FOR DYSCIRCULATORY ENCEPHALOPATHY GRADE I, ASSOCIATED WITH IDIOPATHIC INTRACRANIAL HYPERTENSION: A CARDIONEUROLOGICAL CASE

Gorshkov-Cantacuzene V. A.^1,2

Abstract

The article presents clinical case of a young woman with dyscirculatory encephalopathy grade I associated with idiopathic intracranial hypertension, with lability of arterial pressure and hypochondria. The uniqueness of the case presented, is in multidisciplinarity of disorders and difficulty in patient management trajectory formulation.

Russ J Cardiol. 2018;23(9):54–57

dx.doi.org/10.15829/1560-4071-2018-9-54-57

Key words: cardioneurology, dyscirculatory encephalopathy, idiopathic intracranial hypertension, lability.

Conflicts of Interest: nothing to declare.

¹Hypertension Research Foundation, Pontifical Georgian College, Raleigh; ²American Institute of Clinical Therapeutics, Frankfort, USA.

Gorshkov-Cantacuzene V. A. ORCID: 0000-0002-4691-4719.

EXPERT CONSENSUS

CARDIOVASCULAR DEATH RISK REDUCTION IN TYPE 2 DIABETES PATIENTS WITH CONFIRMED CARDIOVASCULAR DISEASES

Shlyakhto Е. V.¹, Shestakova М. V.² on behalf of the workgroup.

Russ J Cardiol. 2018;23(9):58–64

dx.doi.org/10.15829/1560-4071-2018-9-58-64

Key words: cardiovascular diseases, type 2 diabetes mellitus, glucose lowering therapy, empagliflozin.

Conflicts of Interest: nothing to declare.

Chairs of the Workgroup: Shlyakhto E. V., Shestakova M. V.

Workgroup: Arutyunov G. P., Babenko A. Yu., Barbarash O. L., Boytsov S. A., Galstyan G. R., Grineva E. N., Drapkina O. M., Duplyakov D. V., Karpov Yu. A., Koziolova N. A., Konradi A. O., Lopatin Yu. M., Martynov A. I., Nedogoda S. V., Nedoshivin A. O., Ratova L. G., Sukhareva O. Yu., Tereshchenko S. N., Khalimov Yu. Sh.

¹Almazov National Research Medical Centre of the Ministry of Health, Saint-Petersburg; ²National Medical Research Endocrinology Centre of the Ministry of Health, Moscow, Russia.

Shlyakhto Е. V. ORCID: 0000-0003-2929-0980, Shestakova М. V. ORCID: 0000-0003-3893-9972.

LITERATURE REVIEWS

TICAGRELOR AND THROMBOLYSIS IN MYOCARDIAL INFARCTION: WHAT DOES THE TREAT STUDY CHANGE?

Averkov O. V., Vechorko V. I.

Abstract

Primary percutaneous intervention (PCI) is a preferable reperfusion method in patients with STEMI. If on-time PCI is not possible, pharmacoinvasive approach is recommended that includes urgent systemic thrombolysis. Regardless the broad usage of ticagrelor in MI patients, its safety in combination with thrombolysis (first 24 hours from STEMI onset) before the year 2018 was unknown. In the TREAT study the patients 18-75 year old with STEMI (symptom onset within 24 hours), received thrombolytic drug, were randomized to ticagrelor or clopidogrel group. In 30 days from randomization it was shown that hemorrhagic safety of ticagrelor, at the level of major bleedings, was non-inferior than of clopidogrel. Therefore the TREAT study results, together with PLATO, make it to widen the indications for ticagrelor (and shift from clopidogrel) within first 24 hours of MI onset in patients received thrombolysis as a method of primary reperfusion.

Russ J Cardiol. 2018;23(9):65–70

dx.doi.org/10.15829/1560-4071-2018-9-65-70

Key words: thrombolysis, reperfusion therapy, ST elevation myocardial infarction, ticagrelor.

Conflicts of Interest: nothing to declare.

¹O. M. Filatov City Clinical Hospital №15, Moscow; ²Pirogov Russian National Research Medical University, Moscow, Russia.

Averkov O. V. ORCID: 0000-0002-3010-755X, Vechorko V. I. ORCID: 0000-0003-3568-5065.

MYOCARDIAL FIBROSIS AND ATRIAL FIBRILLATION

Grigoryan S. V.^1,2, Azarapetyan L. G.^1,2, Adamyan K. G.^1,2

Abstract

Atrial fibrillation is the most prevalent arrhythmia, and tends to progress. Any structural changes in the heart may lead to its progressive remodelling with increased deposition of connective tissue and fibrosis. Predominance of collagen types I and III synthesis over its degradation leads to accumulation of fibers and to fibrosis. Increase of atrial fibrosis is usually found on autopsy and biopsy. There is relation revealed, of atrial fibrosis grade and postsurgery atrial fibrillation. The mechanisms participating in the structural remodelling and progression of atrial fibrosis are not studied well enough, but there is known role of renin-angiotensinaldosterone system, transforming growth factor, inflammation and matrix metalloproteases. As an alternative, one should consider non-invasive diagnostic methods: magnetic resonance imaging of the heart and biomarkers level measurement. Hyperactivation of the renin-angiotensin-aldosterone system facilitates structural remodelling of the heart and progression of atrial fibrosis. Hyperexpression of the transforming growth factor leads to selective atrial fibrosis, heterogeneity of excitation conduction and fibrillation onset. Matrix metalloproteases are the marker of extracellular degradation. Study of fibrosis biomarkers makes it to increase significantly the efficacy of atrial fibrillation course prediction.

Russ J Cardiol. 2018;23(9):71–76

dx.doi.org/10.15829/1560-4071-2018-9-71-76

Key words: atrial fibrillation, renin-angiotensin-aldosterone system, myocardial fibrosis, inflammation.

Conflicts of Interest: nothing to declare.

¹M. Geratsi Erevan State Medical University (ESMU), Erevan; ²L.A.Oganesyan SRI of Cardiology, Erevan, Armenia.

Grigoryan S. V. ORCID: 0000-0001-9628-106X, Azarapetyan L. G. ORCID: 0000-0003-1811-5108, Adamyan K. G. ORCID: 0000-0003-4965-4593.

HIGH SYMPATHETIC TONE IN DEVELOPMENT OF THE LEFT VENTRICLE HYPERTROPHY AND BETA-BLOCKERS FOR REGRESSION

Ostroumova О. D.^1,2, Kochetkov А. I.¹, Lopukhina М. V.³, Pavleeva Е. Е.¹

Abstract

The review is focused on clinical significance of the left ventricle hypertrophy (LVH) — presentation of heart lesion as a target organ for systemic hypertension (SH). Various LVH development mechanisms are presented, and special attention is paid to sympathic nervous system and β-adrenoreceptors in pathogenesis. Fundamental methods of diagnostics are described for LVH, in comparison. The pathology is classified from the perspective of recent guidelines on echocardiographic diagnostics. Epidemiology provided. Taken current evidence, the prognostic role of LVH is described as a factor increasing the risk of fatal and non-fatal cardiovascular, cerebrovascular and renal complications in SH patients. Trials data presented that points on LVH regression with highly selective β1-blocker bisoprolol treatment. Pathophysiology of LVH regression is discussed for β1-blocker treatment.

Russ J Cardiol. 2018;23(9):77–88

dx.doi.org/10.15829/1560-4071-2018-9-77-88

Key words: left ventricle hypertrophy, arterial hypertension, prognosis, echocardiography, high sympathic tone, beta-blockers, bisoprolol.

Conflicts of Interest: nothing to declare.

¹A. I. Evdokimov Moscow State University of Medicine and Dentistry (MSUMD), Moscow; ²I. M. Sechenov First Moscow State Medical University of the Ministry of Health (Sechenov University), Moscow; ³E. O. Mukhin City Clinical Hospital of Moscow Healthcare Department, Moscow, Russia.

Ostroumova О. D. ORCID: 0000-0002-0795-8225, Kochetkov А. I. ORCID: 0000-0001-5801-3742, Lopukhina М. V. ORCID: 0000-0002-0229-5055, Pavleeva Е. Е. ORCID: 0000-0002-2923-6450.

STATINS ASSOCIATED DIABETES: STATE OF THE PROBLEM IN 2018

Kobalava Zh. D.¹, Lazarev P. V.¹, Villevalde S. V.²

Abstract

Statin therapy is highly effective and obligatory method of cardiovascular risk reduction in primary and secondary prevention. It is well tolerated by patients. However the risk of new diabetes cases onset, associated with statins, remains discussed actively. The review is focused on recent data on the prevalence of this adverse event, risk/benefit ratio, possible mechanisms and patients populations with the highest risk of development of statin related diabetes. Practitioners tactics analyzed in diabetes development when taking statins. The article goes with recent international guidelines data, as the consensus letters; also, a comparison provided with novel medications used in cardiovascular prevention.

Russ J Cardiol. 2018;23(9):89–99

dx.doi.org/10.15829/1560-4071-2018-9-89-99

Key words: statins, diabetes, cardiovascular risk.

Conflicts of Interest: nothing to declare.

¹Peoples’ Friendship University of Russia, Moscow; ²Almazov National Research Medical Center of the Ministry of Health, Saint-Petersburg, Russia.

Kobalava Zh. D. ORCID: 0000-0002-5873-1768, Lazarev P. V. ORCID: 0000-0003-4769-5834, Villevalde S. V. ORCID: 0000-0001-7652-3962.

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