Contents of Russian Journal of Cardiology 2019, 24 (11)

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Russian Journal of Cardiology. 2019;24(11):9

CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russian Journal of Cardiology. 2019;24(11):8

ORIGINAL ARTICLES

DETECTION RATE AND CLINICAL SIGNIFICANCE OF LATENT INFECTIVE ENDOCARDITIS IN PATIENTS WITH AORTIC STENOSIS

Irtyuga O. B.1, Chistyakova V. I.2, Tenchurina A. O.2, Solntsev V. N.1, Kushnareva E. A.1, Zhiduleva E. V.1, Malev E. G.1, Antonova I. V.1, Gordeev M. L.1, Demchenko E. A.1

Abstract

Aim. To assess the detection rate of infective endocarditis (IE) in postoperative period in patients with aortic stenosis (AS) and analyze the impact of late diagnosis on disease outcomes.

Material and methods. A retrospective analysis of the register of 1764 patients with AS, formed on the basis of transthoracic echocardiographic (echo) tests in 2009-2011, was performed. During the 8-year follow-up period, 679 patients were operated on; IE was diagnosed in 131 people. Patients were divided into subgroups depending on the valve morphology and the time of IE verification before or after surgery. IE, first detected in the postoperative period, was considered as latent IE.

Results. Among patients with AS, the proportion of people with IE was only 3,7%, however, pathomorphological examination revealed IE signs in 19,3%. In 58,8% of cases, IE was detected for the first time in the postoperative period. In 66,2% of cases, latent IE was diagnosed in patients with congenital heart disease (CHD) — bicuspid aortic valve (BAV). In the group of patients with known IE before surgery, there were lower levels of hemoglobin, erythrocytes and a higher level of creatinine. According to the results of a histological examination, inactive IE was diagnosed in 28% of cases. In 26,5% of patients stage 3 activity IE was defined, among which latent course was recorded in 16%. Single-agent antibiotic therapy (ABT) was carried out in 40,5% of patients, dual-agent ABT — in 50,0%, triple-agent — in 9,5%. The median duration of ABT was 14 days (7 to 42). The eight-year survival rate for patients with IE was 91,2%. Of the 9 deaths, only 5 (56%) had a diagnosis of IE before surgery.

Conclusion. More than half of the patients operated on for AV defects had a latent course of IE and, as a result, late diagnosis, which could affect medium-term survival. Most of the people with latent IE included in the analysis had CHD-BAV, which requires the development of IE preventive measures in this patient population. Various approaches to the ABT of latent IE in clinical practice determine the relevance of additional studies aimed at unification the ABT approaches in this clinical setting.

Key words: infective endocarditis, aortic stenosis, bicuspid aortic valve.

Conflicts of interest: nothing to declare.

Funding. This work was supported by a grant from the Russian Foundation for Basic Research (project 17-03-013-18).

1Almazov National Medical Research Center, St. Petersburg; 2First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia.

Irtyuga O. B. ORCID: 0000-0002-8656-3191, Chistyakova V. I. ORCID: 0000-0002-0783-2112, Tenchurina A. O. ORCID: 0000-0001-9641-2656, Solntsev V. N. ORCID: 0000-0002-2066-6542, Kushnareva E. A. ORCID: 0000-0002-8723-2765, Zhiduleva E. V. ORCID: 0000-0003-4715-7585, Malev E. G. ORCID: 0000-0002-6168-8895, Antonova I. V. ORCID: 0000-0002-0996-4119, Gordeev M. L. ORCID: 0000-0002-8199-0813, Demchenko E. A. ORCID: 0000-0002-0009-9106.

Received: 18.07.2019

Revision Received: 24.09.2019

Accepted: 01.10.2019

For citation: Irtyuga O. B., Chistyakova V. I., Tenchurina A. O., Solntsev V. N., Kushnareva E. A., Zhiduleva E. V., Malev E. G., Antonova I. V., Gordeev M. L., Demchenko E. A. Detection rate and clinical significance of latent infective endocarditis in patients with aortic stenosis. Russian Journal of Cardiology. 2019;24(11):10–15. (In Russ.) doi:10.15829/1560-4071-2019-11-10-15.

LINEAR AND VOLUMETRIC PARAMETERS OF LEFT ATRIUM IN PATIENTS WITH ISOLATED AORTIC STENOSIS

Gendlin G. E., Kovaleva A. I., Emelina E. I., Nikitin I. G.

Abstract

Aim. To study volumetric and linear parameters of the left atrium (LA) in operated and non-operated patients with severe aortic stenosis (AS) in comparison with the control group of a similar age and gender.

Material and methods. Eighty-one patients with AS were examined, 49 patients — in the long term after aortic valve replacement (AVR), and 30 patients of similar age and gender — without a heart defect. Echocardiography was performed using an Acuson Sequia 512 ultrasound scanner.

Results. The volumetric parameters of LA (LA volume index (LAVI)) and the ratio of the minimum LA with LV volume at this time point (LAVmin/LV) were the most sensitive parameter when evaluating the LV diastolic function in patients with isolated AS when comparing non-operated and operated patients and the control group. The study of association of non-operated AS patients with LAVI (greater than or less than 32 ml/m2) showed only a slight divergence between the Kaplan-Meyer curves with a log-rank test of 0,15. Only the values of the LV ejection fraction (LVEF) differed from parameters of died (n=21) and alive patients at the time of the study (n=60): 61,0 (56,4-69,3)% in alive versus 46,4 (39,1-55,4)% in dead ones (p<0,0001). The time elapsed from the diagnosis to the date of the examination also differed: 0,5 (0,4-11,0) years in alive versus 7,0 (3,0-19,0) years in dead ones (p=0,004). With multiple regression, the highest and statistically significant beta coefficient was found only in LVEF (beta — -0,52, p=0,002).

Conclusion. Linear and volumetric parameters of LA slightly associate with the age and gender of operated and non-operated AS patients. These parameters statistically significantly differ in the groups of non-operated AS patients and patients after AVR compared with the control group, including patients without heart disease. The values of linear and volumetric LA parameters in patients with AS after AVR are close to those in the control group.

Key words: aortic stenosis, diastolic dysfunction, volume indicators, left atrium.

Conflicts of Interest: nothing to declare.

Pirogov Russian National Research Medical University, Moscow, Russia.

Gendlin G. E. ORCID: 0000-0002-7846-1611, Kovaleva A. I. ORCID: 0000-0001-9054-5378, Emelina E. I. ORCID: 0000-0002-3100-8342, Nikitin I. G. ORCID: 0000-0003-1699-0881.

Received: 10.06.2019

Revision Received: 05.07.2019

Accepted: 16.07.2019

For citation: Gendlin G. E., Kovaleva A. I., Emelina E. I., Nikitin I. G. Linear and volumetric parameters of left atrium in patients with isolated aortic stenosis. Russian Journal of Cardiology. 2019;24(11):16–21. (In Russ.) doi:10.15829/1560-4071-2019-11-16-21

POSTPERICARDIOTOMY SYNDROME: THE ROLE OF GENETIC FACTORS IN THE PATHOGENESIS OF A SYSTEMIC INFLAMMATORY RESPONSE AFTER OPEN-HEART SURGERY

Nakatseva E. V.1,2, Runov A. L.1,3, Vonsky M. S.1,3

Abstract

Aim. To assess the predictive value of polymorphic variants analyzing of interleukin-6 (IL-6) gene in patients with postpericardiotomy syndrome (PPS) during open-heart surgery.

Material and methods. The study included 200 patients. All patients were analyzed for acute phase parameters in serum, effusion fluid and region of IL-6 gene promoter sequence.

Results. When analyzing the effusion fluid, in 15% of patients with early PPS, in accordance with the Light RW criteria, transudate was detected. Application of the Roth BJ criteria increased this proportion to 32%. An increase in the level of C-reactive protein (CRP), procalcitonin, and adenosine deaminase (ADA) activity indicated a systemic inflammatory response. The viral genome of cardiotropic viruses was detected in the effusion fluid in 10-12% of patients with PPS. Scanning mutations in the IL-6 500 bp region revealed one polymorphism of -174G>C. The frequency of PPS in patients with different genotypes (-174GC, -174GG and -174CC) did not significantly differ. An association of the -174GG genotype of the IL-6 gene with a high risk of developing systemic inflammation in open-heart surgery and more frequent postoperative infectious complications has been established. In addition, the -174GG genotype was more often detected in patients with late PPS (p=0,017). There was no correlation between the occurrence of genotypes, as well as the distribution of IL-6 gene and coronary obstruction index. However, carriage of the G allele was more often detected in patients with injury of left main coronary artery.

Conclusion. The presence of the -174GG genotype of the IL-6 gene and cardiotropic viruses contribute to the systemic inflammation during cardiosurgical interventions in extracorporeal circulation, but do not have predictive value for the PPS development.

Key words: postpericardiotomy syndrome, systemic inflammatory response, openheart surgery, IL-6 gene polymorphism.

Conflicts of Interest: nothing to declare.

1Almazov National Medical Research Center. St. Petersburg; 2Republican Cardiology Center, Nalchik; 3Mendeleev All-Russian Institute for Metrology, St. Petersburg, Russia.

Nakatseva E. V. ORCID: 0000-0002-2247-3541, Runov A. L. ORCID: 0000-0001-9496-4414, Vonsky M. S. ORCID: 0000-0003-4061-7411.

Received: 02.10.2019

Revision Received: 25.10.2019

Accepted: 01.11.2019

For citation: Nakatseva E. V., Runov A. L., Vonsky M. S. Postpericardiotomy syndrome: the role of genetic factors in the pathogenesis of a systemic inflammatory response after open-heart surgery. Russian Journal of Cardiology. 2019;24(11):22–27. (In Russ.) doi:10.15829/1560-4071-2019-11-22-27

CLINICAL, PATHOGENETIC, AND DIAGNOSTIC FEATURES OF HEART FAILURE IN PATIENTS WITH CORONARY HEART DISEASE AND THYROTOXICOSIS

Chesnikova A. I.1, Pashchenko E. V.2, Terentyev V. P.1, Kudinov V. I.1

Abstract

Aim. To assess the diagnostic significance of chronic heart failure (CHF) criteria and to study the features of structural and functional remodeling of the left heart in patients with coronary artery disease (CAD) and thyrotoxicosis.

Material and methods. We examined 131 patients aged 45-65 years with CAD, CHF and/or thyrotoxicosis. The clinical state of patients, exercise tolerance, NTproBNP level were evaluated. Holter ECG monitoring and Doppler echocardiography (echo) were performed.

Results. Heart rhythm disturbances (atrial fibrillation, sinus tachycardia, supraventricular extrasystole), more severe vegetative imbalance with sympathetic predominance in patients with CAD, CHF and thyrotoxicosis were determined more often than in patients with CAD and CHF without thyrotoxicosis. Elevated levels of NT-proBNP (more than 125 pg/ml) were found in both patients with CHF and patients with thyrotoxicosis, regardless of the presence of cardiovascular disease. NT-proBNP levels in patients with CAD and thyrotoxicosis without CHF has exceeded the threshold value of 2,8 times (p=0,001). The highest level of NTproBNP was found in patients with CAD, CHF and thyrotoxicosis. A higher threshold value of NT-proBNP (556,4 pg/ml according to the results of this study) in HFpEF and HFmrEF patients with CAD and thyrotoxicosis was determined. Analysis of echo parameters in patients with CAD, CHF and thyrotoxicosis revealed significantly lower values of linear and volumetric LV parameters, type I LV diastolic dysfunction (100%), HFmrEF (48%), more frequent occurrence of LV concentric hypertrophy (84%).

Conclusion. For HF diagnosis in patients with CAD and thyrotoxicosis, it is necessary to take into account the clinical features, heart rate variability, LV remodeling, as well as to use a higher threshold level of NT-proBNP.

Key words: chronic heart failure, coronary artery disease, thyrotoxicosis, vegetative imbalance, threshold level of NT-proBNP, left ventricular remodeling.

Conflicts of Interest: nothing to declare.

1Rostov State Medical University, Rostov-on-Don; 2Rostov Regional Clinical Hospital, Rostov-on-Don, Russia.

Chesnikova A. I. ORCID: 0000-0002-9323-592Х, Pashchenko E. V. ORCID: 0000-0003-2754-3382, Terentyev V. P. ORCID: 0000-0003-3607-5832, Kudinov V. I. ORCID: 0000-0002-2132-988Х.

Received: 05.03.2019

Revision Received: 19.04.2019

Accepted: 26.04.2019

For citation: Chesnikova A. I., Pashchenko E. V., Terentyev V. P., Kudinov V. I.

Clinical, pathogenetic, and diagnostic features of heart failure in patients with coronary heart disease and thyrotoxicosis. Russian Journal of Cardiology. 2019;24(11):28–34. (In Russ.) doi:10.15829/1560-4071-2019-11-28-34

THE CLINICAL USE OF THE MOGE(S) CLASSIFICATION IN THE DIFFERENTIAL DIAGNOSIS BETWEEN IDIOPATHIC HYPERTROPHIC CARDIOMYOPATHY AND ITS PHENOCOPIES

Polyakova A. A.1,2, Krutikov A. N.2, Semernin E. N.1,2, Kostareva A. A.1,2, Gudkova A. Ya.1,2

Abstract

Aim. To determine the relation between idiopathic hypertrophic cardiomyopathy (HCM) and HCM phenocopies, as well as to study the etiological pattern of HCM phenocopies in patients of the North-Western region of Russia in different age groups.

Material and methods. The study included 321 patients with left ventricular hypertrophy ≥15 mm according to an echocardiography. All the necessary clinical, laboratory and instrumental diagnostic methods for verification of HCM and HCM phenocopies was carried out. In the diagnosis, the MOGE(S) classification was used.

Results. At a young age, idiopathic HCM accounts for 92% (n=62), HCM phenocopies — 8% (Danon disease (n=1 (2%)), isolated cardiac sarcoidosis (n=1 (2%)) and systemic AL amyloidosis (n=3(4%)). Idiopathic HCM is also found in the vast majority of middle-aged patients — in 85% of cases (n=86). HCM phenocopies (15%) were in isolated cardiac sarcoidosis (n=3 (3%)), systemic amyloidosis variants (n=12 (12%)) — AL amyloidosis with predominant cardiac injury (n=11,11%), hereditary transthyretin amyloidosis (n=1,1%). Of the 153 examined patients with HCM aged ≥60 years old, 85% (n=131) were diagnosed with idiopathic HCM. HCM phenocopies were detected in 15% of cases (n=22). In the etiological pattern of HCM phenocopies, transthyretin amyloidosis was 10%: non-hereditary transthyretin amyloidosis — 6% (n = 9), hereditary transthyretin amyloidosis — 4% (n=6); AL amyloidosis — 4% (n=6). In 1 patient, acromegalic cardiomyopathy (1%) was verified. In this article, we present 3 clinical cases that demonstrate the difficulty of differential diagnosis between idiopathic HCM and various HCM phenocopies.

Conclusion. In all age groups, idiopathic HCM predominates. Lysosomal storage diseases classify as rare diseases. Isolated cardiac injury with amyloidosis and sarcoidosis is widely met but less often diagnosed. We determined a high frequency of isolated cardiac injury with amyloidosis under the age of 45 years. The etiological pattern of HCM phenocopies in the elderly is represented mainly by transthyretin cardiomyopathic amyloidosis of hereditary and non-hereditary variants.

Key words: idiopathic hypertrophic cardiomyopathy, phenocopies of hypertrophic cardiomyopathy, Danon disease, isolated cardiac sarcoidosis, AL amyloidosis with predominant cardiac injury.

Conflicts of Interest: nothing to declare.

1Pavlov First Saint Petersburg State Medical University, St. Petersburg; 2Almazov National Medical Research Center, St. Petersburg, Russia.

Polyakova A. A. ORCID: 0000-0002-6655-5274, Krutikov A. N. ORCID: 0000-0001-6897-6171, Semernin E. N. ORCID: 0000-0001-8447-6919, Kostareva A. A. ORCID: 0000-0002-9349-6257, Gudkova A. Ya. ORCID: 0000-0003-0156-8821.

Received: 31.01.2019

Revision Received: 06.02.2019

Accepted: 08.02.2019

For citation: Polyakova A. A., Krutikov A. N., Semernin E. N., Kostareva A. A., Gudkova A. Ya. The clinical use of the MOGE(S) classification in the differential diagnosis between idiopathic hypertrophic cardiomyopathy and its phenocopies. Russian

Journal of Cardiology. 2019;24(11):35–41. (In Russ.) doi:10.15829/1560-4071-2019-11-35-41

CARDIOVASCULAR REMODELING IN PATIENTS WITH DIABETIC СARDIOMYOPATHY

Karavaev P. G., Veklich A. S., Koziolova N. A.

Abstract

Aim. To assess cardiovascular remodeling in patients with diabetic cardiomyopathy (DCM) and compare it with healthy individuals.

Material and methods. Among outpatients with newly diagnosed type 2 diabetes (T2D), according to inclusion and exclusion criteria, a group of participants with diabetic cardiomyopathy (DCM) with left ventricular diastolic dysfunction (LV DD) was made before treatment. The second group consisted of healthy individuals of the corresponding age. The structural and functional state of the heart was studied using echocardiography and determination of the N-terminal prohormone of the brain natriuretic peptide (Nt-proBNP) in the blood; of the arteries — using volume sphygmoplethysmography. Markers of fibrosis were determined in the blood: tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) and C-terminal telopeptide 1 (CTP-1).

Results. The DMC prevalence in patients with newly diagnosed T2D was 18,7%. LV DD was associated not only with T2D, but also with obesity (r=0,48; p=0,029), blood pressure even in the normal range ((r=0,42; p=0,031 for systolic blood pressure; (r=0,39; p=0,042) for diastolic blood pressure). The Nt-proBNP levels in the normal range and TIMP-1 were higher in the DCM group compared with the group of healthy individuals (p<0,001 and p<0,001, respectively). CTP-1 was lower in the first group compared with the second (p<0,001). In the DCM group, a higher cardioankle vascular index (CAVI1) was recorded compared to the group of healthy individuals (p<0,001).

Conclusion. LV DD cannot be presented as a pathognomonic criterion for DCM. Nt-proBNP levels in the normal range of 76,23+14,47 pg/ml, which do not reach the diagnostic criteria for heart failure, an increase in TIMP-1 and a decrease in CTP-1 can be considered as additional markers of DCM. Given the fact that two parallel processes occur during the DCM formation, manifested by cardiac and arteries’ remodeling, the CAVI1 can also be considered as an additional DCM marker.

Key words: diabetic cardiomyopathy, fibrosis, arterial stiffness.

Conflicts of Interest: nothing to declare.

Wagner Perm State Medical University, Perm, Russia.

Karavaev P. G. ORCID: 0000-0003-1103-3812, Veklich A. S. ORCID: 0000-0002-8769-7335, Koziolova N. A. ORCID: 0000-0001-7003-5186.

Received: 04.03.2019

Revision Received: 02.04.2019

Accepted: 09.14.2019

For citation: Karavaev P. G., Veklich A. S., Koziolova N. A. Cardiovascular remodeling in patients with diabetic сardiomyopathy. Russian Journal of Cardiology. 2019;24(11):42–47. (In Russ.) doi:10.15829/1560-4071-2019-11-42-47

CLINICAL VARIANTS, OUTCOMES AND PROGNOSIS OF HYPERTROPHIC NON-OBSTRUCTIVE CARDIOMYOPATHY: RESULTS OF LONG-TERM FOLLOW-UP

Bogdanov D. V., Shaposhnik I. I.

Abstract

Aim. Based on the results of a long-term follow-up, to determine the clinical variants of hypertrophic non-obstructive cardiomyopathy (HNOCM) and develop criteria for the progression of the disease.

Material and methods. The results of long-term follow-up were evaluated for 97 patients with HNOCM, men — 57 (58,8%), women — 40 (41,2%), average age — 42,5±1,52 years (M±σ). The average follow-up was 11,0±5,73 years. Research methods were physical examination, electrocardiography (ECG), 24-hour ECG monitoring with assessment of heart rate variability, Doppler echocardiography (echo). Physical and instrumental re-examination of patients was used for determining of changes.

Results. Clinical progression was detected in 46 (47,4%) patients. The most common progression variants were deterioration of chronic heart failure (54,3%), cardiac arrhythmias (45,7%) and a combined one (37%). The aggravation of echo data was found in 43 (44,3%) patients. The most frequent progression variants were combination of different dynamics scenarios (79,1%), including a decrease in the mobility of left ventricle walls (67,4%), an increase of left atrium dimension (58,1%), and diastolic dysfunction deterioration (67,4%). Aggravation of myocardial hypertrophy was noted in only 3 cases. In 5 (5,15%) cases, the dilation stage of HNOCM was recorded. A scoring model for assessing of progression risk were proposed. It includes the duration of HNOCM >20 years, baseline ≥II FC chronic heart failure, ≥2 clinical manifestations of the disease, left ventricular myocardial mass index >200 g/m2, left atrial volume index >34,0 ml/m2, cardiac output <5 l/min, decrease in heart rate variability.

Conclusion. HNOCM is a disease with a complicated prognosis, progressing in 64% of patients, more often with a long course. The clinical progression of HNOCM was manifested by the diverse dynamics of complaints. Structural and functional progression was manifested mainly by a combination of different dynamics variants (in 79,1% of cases), including a decrease in the mobility of left ventricular walls, an increase of left atrium dimension, aggravation of diastolic dysfunction, but not deterioration of myocardial hypertrophy. The main criteria for progression: disease duration >20 years, baseline ≥II FC chronic heart failure, ≥2 clinical manifestations of the disease, increase of left ventricular myocardial mass index and left atrial volume index, decrease of cardiac output and heart rate variability.

Key words: hypertrophic non-obstructive cardiomyopathy, chronic heart failure, cardiac arrhythmias.

Conflicts of Interest: nothing to declare.

South Ural State Medical University, Chelyabinsk, Russia.

Bogdanov D. V. ORCID: 0000-0002-6641-6178, ResearcherID: Y-1854-2019, Shaposhnik I. I. ORCID: 0000-0002-7731-7730.

Received: 12.09.2019

Revision Received: 09.10.2019

Accepted: 21.10.2019

For citation: Bogdanov D. V., Shaposhnik I. I. Clinical variants, outcomes and prognosis of hypertrophic non-obstructive cardiomyopathy: results of long-term follow-up. Russian Journal of Cardiology. 2019;24(11):48–54. (In Russ.) doi:10.15829/1560-4071-2019-11-48-54

OPINION ON A PROBLEM

MASSIVE TUBERCULOUS EXUDATIVE PERICARDITIS UNDER THE GUISE OF HYDROPERICARDIUM IN A PATIENT WITH NON-COMPACTION CARDIOMYOPATHY: DIAGNOSIS AND TREATMENT

Blagova O. V.1, Alieva I. N.1, Senchikhin P. V.1,2, Nazarova L. D.2, Chernyavsky S. V.1, Sorokin G. Yu.1, Pavlenko E. V.1, Sedov V. P.1, Gagarina N. V.1, Sarkisova N. D.1

Abstract

The first presentation of the combination of non-compaction cardiomyopathy with a restrictive-dilated phenotype and massive chronic tuberculous pericarditis, which for a long time was under the guise of hydropericardium in congestive heart failure in a patient of 30 years, is performed. The absence of congestion signs in a large circle of blood circulation became the reason for diagnosis of agnogenic pericarditis and pericardial puncture. A large volume (>1 l) and lymphocytic nature of effusion, its bilateral character, post-tuberculous changes and calcifications in the lungs, and intrathoracic lymphadenopathy testified in favor of the tuberculous etiology of the process. The negative result of all laboratory tests for tuberculosis (Diaskintest, exudate PCR test, fluorescence microscopy, inoculation on liquid media, Ziehl-Neelsen stain) and the high risk of thoracoscopic biopsy did not allow to immediately verify the diagnosis. It was made only after repeated elimination of 3,5 l of hemorrhagic exudate and the detection of mycobacterial DNA by PCR. As a result of quadruple tuberculostatic therapy, a remission of the process was achieved (there is no fluid in the pericardial cavity).

Key words: pericardial effusion, tuberculosis, pericardial puncture, pleurisy, noncompaction myocardium, cardiomyopathy.

Conflicts of interest: nothing to declare.

1I.M. Sechenov First Moscow State Medical University, Moscow; 2Research Institute of Physiopulmonology, Moscow, Russia.

Blagova O. V. ORCID: 0000-0002-5253-793X, Alieva I. N. ORCID: 0000-0002-3338-0762, Senchikhin P. V. ORCID: 0000-0003-0496-4504, Nazarova L. D. ORCID: 0000-0001-9328-0942, Chernyavsky S. V. ORCID: 0000-0003-0284-9318, Sorokin G. Yu. ORCID: 0000-0002-5274-287X, Pavlenko E. V. ORCID: 0000-0002-3323-9080, Sedov V. P. ORCID: 0000-0003-2326-9347, Gagarina N. V. ORCID: 0000-0003-4563-3277, Sarkisova N. D. ORCID: 0000-0002-5979-1180.

Received: 22.04.2019 Revision Received: 14.05.2019 Accepted: 28.05.2019

For citation: Blagova O. V., Alieva I. N., Senchikhin P. V., Nazarova L. D., Chernyavsky S. V., Sorokin G. Yu., Pavlenko E. V., Sedov V. P., Gagarina N. V., Sarkisova N. D. Massive tuberculous exudative pericarditis under the guise of hydropericardium in a patient with non-compaction cardiomyopathy: diagnosis and treatment. Russian Journal of Cardiology. 2019;24(11):55–62. (In Russ.) doi:10.15829/1560-4071-2019-11-55-62

COMPLETE ATRIOVENTRICULAR BLOCK AS A CLINICAL MANIFESTATION OF CARDIAC SARCOIDOSIS

Serova M. V.1,2, Poltavskaya M. G.2, Garmash Yu. Yu.3, Ivanova D. A.3, Pershina E. S.4, Zyuzya Yu. R.5, Sazonova Yu. S.1, Lukin M. Yu.1, Samoilenko I. V.1,2, Uyanaeva M. A.1, Syrkin A. L.2, Melkonyan G. G.1

Abstract

Cardiac involvement in sarcoidosis is considered quite rare, but it can cause the first significant disease manifestations and patient’s death. Timely disease detection improves the effectiveness of treatment and prognosis. The article presents modern approaches to the diagnosis and management of patients with cardiac sarcoidosis using clinical case of a patient hospitalized by ambulance with a first revealed symptomatic third-degree atrioventricular block. We described methods of examining this patient, as well as difficulties in differential diagnosis.

Key words: cardiac sarcoidosis, atrioventricular block, permanent cardiac pacing.

Conflicts of Interest: nothing to declare.

1City Clinical Hospital № 4, Moscow; 2I.M. Sechenov First Moscow State Medical University, Moscow; 3Moscow City Scientific and Practical Center control for Tuberculosis, Moscow; 4Pirogov City Clinical Hospital № 1, Moscow; 5Research Institute of Human Morphology, Moscow, Russia.

Serova M. V. ORCID: 0000-0003-0608-9205, Poltavskaya M. G. ORCID: 0000-0003-4463-2897, Garmash Yu. Yu. ORCID: 0000-0001-6501-7944, Ivanova D. A. ORCID: 0000-0001-5686-536X, Pershina E. S. ORCID: 0000-0002-3952-6865, Zyuzya Yu.

R. ORCID: 0000-0003-2814-4826, Sazonova Yu. S. ORCID: 0000-0002-7825-3513, Lukin M. Yu. ORCID: 0000-0002-7521-6047, Samoilenko I. V. ORCID: 0000-0002-1163-1014, Uyanaeva M. A. ORCID: 0000-0003-2091-5120, Syrkin A. L. ORCID: 0000-0002-6452-1222, Melkonyan G. G. ORCID: 0000-0002-4021-5044.

Received: 06.05.2019

Revision Received: 03.06.2019

Accepted: 18.09.2019

For citation: Serova M. V., Poltavskaya M. G., Garmash Yu. Yu., Ivanova D. A., Pershina E. S., Zyuzya Yu. R., Sazonova Yu. S., Lukin M. Yu., Samoilenko I. V., Uyanaeva M. A., Syrkin A. L., Melkonyan G. G. Complete atrioventricular block as a clinical manifestation of cardiac sarcoidosis. Russian Journal of Cardiology. 2019;24(11):63–68 doi:10.15829/1560-4071-2019-11-63-68

HEALTHCARE MANAGEMENT

CARDIOVASCULAR RISK MANAGEMENT SYSTEM: PREREQUISITES FOR DEVELOPING, ORGANIZATION PRINCIPLES, TARGET GROUPS

Shlyakhto E. V., Zvartau N. E., Villevalde S. V., Yakovlev A. N., Soloveva A. E., Alieva A. S., Avdonina N. G., Medvedeva E. A., Fedorenko A. A., Kulakov V. V., Karlina V. A., Endubaeva G. V., Zaitsev V. V., Soloviev A. E.

Abstract

Cardiovascular morbidity and mortality are associated with high demographic and economic losses. Their decrease is one of the main lines of development and improvement of the world health systems. An analysis of the current situation in the Russian Federation (RF) demonstrates that the areas of concern in system for cardiovascular diseases (CVD) patients’ care are the insufficient and untimely identification of cardiovascular risk factors, as well as their ineffective management due to the incomplete implementation of existing risk stratification guidelines and decision making. To achieve the aim of reducing mortality from cardiovascular diseases by 2024 and further preserving of this tendency, along with the introduction of a long-term population-based strategy for creating a healthy lifestyle, it is necessary to shift the focus from emergency care and performing high-tech interventions to long-term management of cardiovascular risks. The introduction of a new model of specialized care for cardiovascular diseases, the cardiovascular risk management system, is aimed at the efficient use of healthcare resources and providing the reduction in cardiovascular mortality.

Key words: cardiovascular risk, cardiovascular disease, morbidity, mortality, cardiovascular risk management.

Conflicts of Interest: nothing to declare.

Almazov National Medical Research Centre, St. Petersburg, Russia.

Shlyakhto E. V. ORCID: 0000-0003-2929-0980, Zvartau N. E. ORCID: 0000-0001-6533-5950, Villevalde S. V. ORCID: 0000-0001-7652-2962, Yakovlev A. N. ORCID: 0000-0001-5656-3978, Soloveva A. E. ORCID: 0000-0002-0013-0660, Alieva A. S. ORCID: 0000-0002-9845-331X, Avdonina N. G. ORCID: 0000-0001-9871-3452, Medvedeva E. A. ORCID: 0000-0002-5130-5192, Fedorenko A. A. ORCID: 0000-0002-9836-7841, Kulakov V. V. ORCID: 0000-0001-8633-1852, Karlina V. A. ORCID: 0000-0001-9912-7789, Endubaeva G. V. ORCID: 0000-0001-8514-6436, Zaitsev V. V. ORCID: 0000-0003-1905-2575, Soloviev A. E. ORCID: 0000-0003-2378-9940.

Received: 30.09.2019

Revision Received: 09.10.2019

Accepted: 21.10.2019

For citation: Shlyakhto E. V., Zvartau N. E., Villevalde S. V., Yakovlev A. N., Soloveva A. E., Alieva A. S., Avdonina N. G., Medvedeva E. A., Fedorenko A. A., Kulakov V. V., Karlina V. A., Endubaeva G. V., Zaitsev V. V., Soloviev A. E. Cardiovascular risk management system: prerequisites for developing, organization principles, target groups. Russian Journal of Cardiology. 2019;24(11):69–82. (In Russ.) doi:10.15829/1560-4071-2019-11-69-82

HEART STEM CELLS: FACT OR FANTASY?

Parfenova E. V.1,2

Abstract

In the spring of 2018, Harvard Medical School and the Brigham and Women’s Hospital reported the retraction of 31 articles of Dr. Piero Anversa lab, who have been studying heart stem cells for more than 15 years, due to the fact that these articles “included falsified and/or fabricated data”. This extremely unpleasant incident cast suspicion on other research groups studying regenerative effects of cells harvested from the myocardium. It contributed to skeptical opinion about the possibilities of regenerative technologies in cardiology in general and the complete denial of any regenerative potential of heart. This review presents an analysis of Dr. Piero Anversa lab studies and other works devoted to the study of regenerative processes in the heart, a modern view on the mechanisms of the heart regenerative potential and the regenerative effects of progenitor cells harvested from the myocardium, and the prospects for the development of cellular technologies in cardiology.

Key words: stem cells, regeneration, heart, myocardial infarction, cell therapy.

Conflicts of Interest: nothing to declare.

Funding. This study was supported by a grant from the Russian Science Foundation № 19-15-00384.

1National Medical Research Center of Cardiology, Moscow; 2Moscow State University, Moscow, Russia.

Parfenova E. V. ORCID: 0000-0002-0969-5780, ResearcherID: B-9307-2014.

Received: 06.05.2019

Revision Received: 03.06.2019

Accepted: 22.09.2019

For citation: Parfenova E. V. Heart stem cells: fact or fantasy? Russian Journal of Cardiology. 2019;24(11):84–90. (In Russ.) doi:10.15829/1560-4071-2019-11-84-90

EXPERT COUNCIL OPINION

PLACE OF PRASUGREL, P2Y12 RECEPTOR ANTAGONIST, IN AN EARLY INVASIVE TREATMENT OF PATIENTS WITH ACUTE CORONARY SYNDROME (ACCORDING TO THE RESULTS OF MULTICENTER RANDOMIZED CONTROLLED TRIAL ISAR-REACT 5)

Resolution of Expert Council was conducted on the initiative of the Russian Society of Emergency Cardiology

The Presidium of the Expert Council: Tereshchenko S. N., Glezer M. G.

Expert Council Committee: Abugov S. A., Averkov O. V., Antipov S. I., Galyavich A. S., Gilyarov M. Yu., Duplyakov D. V., Efremushkina A. A., Zateyshchikov D. A., Ivanenko V. V., Kosmacheva E. D., Krestyaninov O. V., Lopatin Yu. M., Panchenko E. P., Ryabov V. V., Samokhvalov E. V., Staroverov I. I., Ustyugov S. A., Khripun A. V., Shalaev S. V., Shakhnovich R. M., Yavelov I. S., Yakovlev A. N., Yakushin S. S.

Abstract

The conclusion of the Expert Council reports an agreement on the place of the P2Y12 receptor blocker prasugrel in the early invasive treatment of patients with acute coronary syndrome ACS, according to the results of the multicenter randomized controlled study ISAR-REACT 5. Prasugrel should be considered the preferred P2Y12 receptor blocker in the planned primary percutaneous coronary intervention and early invasive management of patients with ST segment elevation ACS. Herewith, prasugrel intake in patients with non-ST segment elevation ACS is preferable after coronary angiography and decision for coronary stenting.

Key words: acute coronary syndrome, prasugrel, P2Y12 receptor blocker.

Conflicts of Interest: nothing to declare.

Tereshchenko S. N. (Moscow) ORCID: 0000-0001-9234-6129, Glezer M. G. ORCID: 0000-0002-0995-1924, Abugov S. A. (Moscow) ORCID: 0000-0001-7636-4044, Averkov O. V. (Moscow) ORCID: 0000-0002-3010-755X, Antipov S. I. (Tomsk) ORCID: 0000-0002-1216-4964, Galyavich A. S. (Kazan’) ORCID: 0000-0002-4510-6197, Gilyarov M. Yu. (Moscow) ORCID: 0000-0002-2870-3301, Duplyakov D. V. (Samara) ORCID: 0000-0002-6453-2976, Efremushkina A. A. (Barnaul) ORCID: 0000-0003-4688-0739, Zateyshchikov D. A. (Moscow) ORCID: 0000-0001-7065-2045, Ivanenko V. V. (Volgograd) ORCID: 0000-0003-0823-5501, Kosmacheva E. D. (Krasnodar) ORCID: 0000-0001-8600-0199, Krestyaninov O. V. (Novosibirsk) ORCID: 0000-0001-5214-8996, Lopatin Yu. M. (Volgograd) ORCID: 0000-0003-1943-1137, Panchenko E. P. (Moscow) ORCID: 0000-0002-9158-2522, Ryabov V. V. (Tomsk) ORCID: 0000-0002-4358-7329, Samokhvalov E. V. (Krasnoyarsk) ORCID: no, Staroverov I. I. (Moscow) ORCID: 0000-0002-0049-6101, Ustyugov S. A. (Krasnoyarsk) ORCID: no, Khripun A. V. (Rostov-on-Don) ORCID: 0000-0001-6765-2837, Shalaev S. V. (Tyumen’) ORCID: 0000-0003-2724-4016, Shakhnovich R. M. (Moscow) ORCID: 0000-0003-3248-0224, Yavelov I. S. (Moscow) ORCID: 0000-0003-2816-1183, Yakovlev A. N. (St. Petersburg) ORCID: 0000-0001-5656-3978, Yakushin S. S. (Ryazan’) ORCID: 0000-0002-1394-3791.

Received: 25.10.2019

Revision Received: 07.11.2019

Accepted: 07.11.2019

For citation: Tereshchenko S. N., Glezer M. G., Abugov S. A., Averkov O. V., Antipov S. I., Galyavich A. S., Gilyarov M. Yu., Duplyakov D. V., Efremushkina A. A., Zateyshchikov D. A., Ivanenko V. V., Kosmacheva E. D., Krestyaninov O. V., Lopatin Yu. M., Panchenko E. P., Ryabov V. V., Samokhvalov E. V., Staroverov I. I., Ustyugov S. A., Khripun A. V., Shalaev S. V., Shakhnovich R. M., Yavelov I. S., Yakovlev A. N., Yakushin S. S. Place of Prasugrel, P2Y12 receptor antagonist, in an early invasive treatment of patients with acute coronary syndrome (according to the results of multicenter randomized controlled trial ISAR-REACT 5). Russian Journal of Cardiology. 2019;24(11):92–97. (In Russ.) doi:10.15829/1560-4071-2019-11-92-97

LITERATURE REVIEWS

THE MODERN PARADIGM OF PATHOPHYSIOLOGY, PREVENTION AND TREATMENT OF HEART FAILURE IN TYPE 2 DIABETES MELLITUS

Kobalava Zh. D.1,2, Medovchshikov V. V.1, Yeshniyazov N. B.1, Khasanova E. R.1

Abstract

Prevention and choice of therapeutic strategies in patients with type 2 diabetes (T2D) and heart failure (HF) is an urgent problem. This review presents a modern concept for HF development from early stages of T2D. Glucose-lowering and cardiac medications for the prevention and treatment of HF depending on its phenotypes were considered.

Key words: diabetes, heart failure, subclinical myocardial dysfunction, diabetic cardiomyopathy, diabetic nephropathy, preserved ejection fraction, pathophysiology, SGLT2 inhibitors.

Conflicts of Interest: nothing to declare.

1Peoples’ Friendship University of Russia (RUDN University), Moscow; 2Vinogradov City Hospital Moscow, Moscow, Russia.

Kobalava Zh. D. ORCID: 0000-0003-1126-4282, eLibrary SPIN: 9828-5409, Medovchshikov V. V. ORCID: 0000-0001-5996-8305, eLibrary SPIN: 6328-4279, Yeshniyazov N. B. ORCID: 0000-0002-5389-754X, eLibrary SPIN: 3153-2533, Khasanova E. R. ORCID: 0000-0001-8388-2413.

Received: 13.10.2019

Revision Received: 08.11.2019

Accepted: 15.11.2019

For citation: Kobalava Zh. D., Medovchshikov V. V., Yeshniyazov N. B., Khasanova E. R. The modern paradigm of pathophysiology, prevention and treatment of heart failure in type 2 diabetes mellitus. Russian Journal of Cardiology. 2019;24(11):98–111. (In Russ.) doi:10.15829/1560-4071-2019-11-98-111

MODERN STRATEGY OF TREATING PATIENTS WITH CORONARY ARTERY DISEASE: COMPLEMENTARITY PRINCIPLE IN THERAPY AND NEW IDEAS ABOUT ITS ROLE AND COMPONENTS Gilyarevskiy S. R.1, Golshmid M. V.1, Kuzmina I. M.2

Abstract

The article discusses modern ideas about the role of mechanical revascularization and anti-ischemic therapy in the treatment of patients with stable coronary heart disease (CAD). Modern data on the comparative effectiveness of anti-ischemic drugs are presented, which became the basis for the development of “diamond approach” in the treatment of stable CAD. It is proposed instead of standard tactics using a hierarchical approach to the choice of anti-ischemic drugs. The features of the anti-ischemic drugs use in certain clinical situations, in patients with the most common comorbidities or complications of CAD, as well as in CAD variants, in the development of which specific pathophysiological elements play a role, are considered.

Key words: coronary artery disease, treatment strategy, mechanical revascularization.

Conflicts of Interest: nothing to declare.

1Russian Medical Academy of Continuing Professional Education, Moscow; 2Sklifosovsky Research Institute of Emergency Medicine, Moscow, Russia.

Gilyarevskiy S. R. ORCID: 0000-0002-8505-1848, Golshmid M. V. ORCID: 0000-0002-9865-4998, Kuzmina I. M. ORCID: 0000-0001-9458-7305.

Received: 14.10.2019

Revision Received: 26.10.2019

Accepted: 15.11.2019

For citation: Gilyarevskiy S. R., Golshmid M. V., Kuzmina I. M. Modern strategy of treating patients with coronary artery disease: complementarity principle in therapy and new ideas about its role and components. Russian Journal of Cardiology. 2019;24(11):112–121. (In Russ.) doi:10.15829/1560-4071-2019-11-112-121

MYOCARDIAL INJURY AFTER NON-CARDIAC SURGERY: CURRENT STATE OF THE PROBLEM AND UNRESOLVED ISSUES

Protasov K. V.1, Bolshedvorskaya O. A.2

Abstract

The survey based on the last decade literature, guidelines of international and national professional communities summarizes data on myocardial injury after non-cardiac surgery (MINS). It reflects the growing interest in this interdisciplinary problem aroused by MINS widespread occurrence and its close association with after surgery mortality. Observational studies devoted to a search for risk factors and mechanisms of after surgery myocardial injury were scrutinized. The role of asymptomatic increase in cardiac troponins which is stiffly competitive in its clinical and prognostic significance with after surgery myocardial infarction was highlighted. Modern approaches to MINS diagnostics and prevention were set out. The possibilities and prospects for MINS treatment were discussed with regard for the results of the recently completed randomized controlled study MANAGE (2018). Unresolved issues and avenues of further investigations in the field were specified.

Key words: myocardial injury, non-cardiac surgery, troponin.

Conflicts of Interest: nothing to declare.

1Irkutsk State Medical Academy of Postgraduate Education, a branch of Russian Medical Academy of Continuing Professional Education, Irkutsk; 2Regional Oncology Center, Irkutsk, Russia.

Protasov K. V. ORCID: 0000-0002-6516-3180, Bolshedvorskaya O. A. ORCID: 0000-0002-8993-2503.

Received: 14.10.2019

Revision Received: 26.10.2019

Accepted: 15.11.2019

For citation: Protasov K. V., Bolshedvorskaya O. A. Myocardial injury after noncardiac surgery: current state of the problem and unresolved issues. Russian Journal of Cardiology. 2019;24(11):122–132. (In Russ.) doi:10.15829/1560-4071-2019-11-122-132

DABIGATRAN ETEXILATE IN PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION: BENEFITS OF APPLICATION IN CERTAIN CLINICAL SITUATIONS

Baranova E. I.1,2, Kobalava Zh. D.3

Abstract

The review discusses the problem of patient-oriented choice of anticoagulants for nonvalvular atrial fibrillation (AF). The efficacy and safety profile of dabigatran etexilate and a group of patients with advantage of dabigatran application: patients with a high risk or history of ischemic stroke, patients who are indicated for combination antithrombotic therapy, and patients with a high risk of emergency surgical interventions and procedures, as well as with a high risk of bleeding, etc. The place of idarucizumab, a direct dabigatran etexilate antagonist, is shown.

Key words: atrial fibrillation, bleedings, dabigatran etexilate, idarucizumab.

Conflicts of Interest: the article was prepared with the support of Boehringer Ingelheim. The fact of support did not influence on the opinion of the author.

1Pavlov First Saint-Petersburg State Medical University, St. Petersburg; 2Almazov National Medical Research Center, St. Petersburg; 3The Peoples’ Friendship University of Russia, Moscow, Russia.

Baranova E. I. ORCID: 0000-0002-8788-0076, Kobalava Zh. D. ORCID: 0000-0003-1126-4282.

Received: 15.10.2019

Revision Received: 23.10.2019

Accepted: 15.11.2019

For citation: Baranova E. I., Kobalava Zh. D. Dabigatran etexilate in patients with nonvalvular atrial fibrillation: benefits of application in certain clinical situations. Russian Journal of Cardiology. 2019;24(11):133–141. (In Russ.) doi:10.15829/1560-4071-2019-11-133-141

A MODERN VIEW ON THE MECHANISMS OF DIABETIC CARDIOMYOPATHY DEVELOPMENT AND THE ITS MODIFICATION OPTIONS

Sorokina A. G., Orlova Ya. A.

Abstract

The article is an analytical review of clinical studies of structural and functional cardiac changes in patients with diabetes. Modern data on the mechanisms of the diabetic cardiomyopathy development, the options of its prevention and treatment are summarized. Particular attention is paid to the features of myocardial energy metabolism and replicative aging in this pathology, as promising targets for therapeutic interventions.

Key words: diabetic cardiomyopathy, diabetic cardiopathy, diabetes, chronic heart failure.

Conflicts of Interest: nothing to declare.

Funding. This study was conducted within the framework of the State Assignment of Medical Research and Educational Center of Moscow State University.

LomonosovMoscow State University, Moscow, Russia.

Sorokina A. G. ORCID: 0000-0003-2310-936X, IRID: 164541088, Orlova Ya. A. ORCID: 0000-0002-8160-5612, IRID: 42211081, Scopus Author ID: 24503460300.

Received: 01.03.2019

Revision Received: 07.10.2019

Accepted: 21.10.2019

For citation: Sorokina A. G., Orlova Ya. A. A modern view on the mechanisms of diabetic cardiomyopathy development and the its modification options. Russian Journal of Cardiology. 2019;24(11):142–147. (In Russ.) doi:10.15829/1560-4071-2019-11-142-147

HIV-ASSOCIATED CARDIOVASCULAR PATHOLOGY

Goryacheva O. G., Koziolova N. A., Terekhina N. A.

Abstract

The review presents the rationale for studying cardiovascular disease in HIVinfected patients, as well as the importance of specific therapy. The embrace of this problem is due the widespread use of antiretroviral therapy in the world over the past 20 years has led to an increase in the life expectancy of HIV patients, while cardiovascular diseases have become a mortality and disability leader. The review presents the most frequently reported cardiovascular pathology and cardiac complications in HIV patients that occur both against the background of virusmediated action and as a result of antiretroviral therapy. Some pathogenetic mechanisms of HIV influence on cardiomyocytes and the extracellular matrix have been demonstrated, resulting in early heart failure and pulmonary hypertension. Information is given on the role of statins in the management of HIV patients with the clinically significant atherosclerosis.

Key words: cardiovascular pathology, human immunodeficiency virus.

Conflicts of Interest: nothing to declare.

Wagner Perm State Medical University, Perm, Russia.

Goryacheva O. G. ORCID: 0000-0002-3336-228X, Koziolova N. A. ORCID: 0000-0001-7003-5186, Terekhina N. A. ORCID: 0000-0002-0168-3785.

Received: 28.02.2019

Revision Received: 26.03.2019

Accepted: 29.03.2019

For citation: Goryacheva O. G., Koziolova N. A., Terekhina N. A. HIV-associated cardiovascular pathology. Russian Journal of Cardiology. 2019;24(11):148–154. (In Russ.) doi:10.15829/1560-4071-2019-11-148-154

IDIOPATHIC RECURRENT PERICARDITIS — A PARADIGM SHIFT?

Myachikova V. Yu., Titov V. A., Maslyanskiy A. L., Moiseeva O. M.

Abstract

Idiopathic recurrent pericarditis (IRP) is a relatively rare inflammatory disease of the pericardium, often requiring emergency medical care, associated with a high percentage of temporary disability and significant economic costs. The review presents various points of view on the pathogenesis of recurrent pericarditis, discusses the role of autoinflammation. It touches on treatment issues based on modern data on the IRP immunopathogenesis, and considers promising areas of laboratory diagnostics.

Key words: recurrent idiopathic pericarditis, pathogenesis, autoinflammation, autoimmunity, laboratory diagnosis, treatment.

Conflicts of Interest: nothing to declare.

Almazov National Medical Research Center, St. Petersburg, Russia.

Myachikova V. Yu. ORCID: 0000-0002-7590-742X, Titov V. A. ORCID: 0000-0001-7923-0084, Maslyanskiy A. L. ORCID: 0000-0003-2427-4148, Moiseeva O. M. ORCID: 0000-0002-7817-3847.

Received: 15.09.2019

Revision Received: 11.10.2019

Accepted: 18.10.2019

For citation: Myachikova V. Yu., Titov V. A., Maslyanskiy A. L., Moiseeva O. M. Idiopathic recurrent pericarditis — a paradigm shift? Russian Journal of Cardiology. 2019;24(11):155–163. (In Russ.) doi:10.15829/1560-4071-2019-11-155-163

A MODERN VIEW ON THE PATHOGENESIS, DIAGNOSIS AND TREATMENT OF ALCOHOLIC CARDIOMYOPATHY

Kobalava Zh. D.1, Lazarev P. V.1, Goncharov A. S.2

Abstract

Dilatation of the left ventricle cavity and its contractility decrease with the subsequent heart failure development against the background of prolonged excessive alcohol consumption is commonly called alcoholic cardiomyopathy (ACM). The direct toxic effect of ethanol and its metabolites on the myocardium, neuroendocrine disorders, other manifestations of alcoholism and a genetic predisposition play a significant role in the development of this pathology. The purpose of this review is to study modern ideas about the mechanisms of development and course of ACM. In particular, special attention is paid to discussing the doses of alcohol necessary for the onset of symptoms and its regression. Actual data are presented in relation to a survey aimed at confirming alcohol abuse and the exclusion of alternative causes of myocardial injury, as well as treating patients and determining the prognosis.

Key words: toxic cardiomyopathy, dilated cardiomyopathy, alcoholic heart disease, ethanol.

Conflicts of Interest: nothing to declare.

1The Peoples’ Friendship University of Russia, Moscow; 2City Clinical Hospital, Moscow, Russia.

Kobalava J. D. ORCID: 0000-0003-1126-4282, Lazarev P. V. ORCID: 0000-0003-4769-5834, Goncharov A. S. ORCID: 0000-0002-7221-2710.

Received: 13.09.2019

Revision Received: 07.10.2019

Accepted: 21.10.2019

For citation: Kobalava Zh. D., Lazarev P. V., Goncharov A. S. A modern view on the pathogenesis, diagnosis and treatment of alcoholic cardiomyopathy. Russian Journal of Cardiology. 2019;24(11):164–172. (In Russ.) doi:10.15829/1560-4071-2019-11-164-172

CARDIAC SHOCK CARE CENTER — THE NEXT STAGE IN THE TREATMENT OF CARDIOGENIC SHOCK

Boytsov S. A., Akchurin R. S., Pevzner D. V., Shakhnovich R. M., Ruda M. Ya.

Abstract

The key step in achieving a significant reduction in mortality in patients with myocardial infarction (MI) was the organization of a wide network of specialized PCI-centers that provide care for patients with acute coronary syndrome (ACS) on the 24/7 mode in accordance to clear protocols. However, currently inhospital mortality of MI patients, complicated by cardiogenic shock (CS), remains extremely high and averages 50 %. The formation of a system of highly specialized centers seems to be the most promising opportunity to improve the prognosis of patients with CS. The article discusses the world scientific and clinical experience in organizing cardiac shock care centers, the features of their internal structure, as well as the administrative and logistical aspects of entire system operation.

Key words: cardiogenic shock, myocardial infarction, mechanical circulatory support, cardiac shock care center, Impella, ECMO.

Conflicts of Interest: nothing to declare.

Acknowledgments. The authors are grateful to the residents of the emergency cardiology department of the National Medical Research Center of Cardiology: Merkulova I. A., Avetisyan E. A.

National Medical Research Center of Cardiology, Moscow, Russia.

Boytsov S. A. ORCID: 0000-0001-6998-8406, Akchurin R. S. ORCID: 0000-0002-2105-8258, Pevzner D. V. ORCID: 0000-0002-5290-0065, Shakhnovich R. M. ORCID: 0000-0003-3248-0224, Ruda M. Ya. no.

Received: 27.08.2019

Revision Received: 06.09.2019

Accepted: 13.09.2019

For citation: Boytsov S. A., Akchurin R. S., Pevzner D. V., Shakhnovich R. M., Ruda M. Ya. Cardiac shock care center — the next stage in the treatment of cardiogenic shock. Russian Journal of Cardiology. 2019;24(11):173–181. (In Russ.) doi:10.15829/1560-4071-2019-11-173-181

29 ноября 2019 г.

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