Russian Journal of Cardiology, 2019, 24 (2)
Статьи
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Russian Journal of Cardiology. 2019;24(2):5
CLINICAL MEDICINE NEWS
Clinical medicine updates: a review of international news
Russian Journal of Cardiology. 2019;24(2):6
ORIGINAL ARTICLES
FEATURES OF CHRONIC HEART FAILURE DEPENDING ON THE LEFT VENTRICULAR EJECTION FRACTION
Dushina A. G., Lopina E. A., Libis R. A.
Abstract
Aim. To assess clinical and demographic data, structural and functional features of the myocardium in patients with chronic heart failure (CHF) with a preserved ejection fraction in comparison with patients with CHF with an intermediate (CHFinEF) and a reduced ejection fraction (CHF-rEF).
Material and methods. The study included 186 patients with CHF I-IIB stages, I-III functional classes. One hundred and three patients had a preserved ejection fraction (EF) (≥50%), 43 - intermediate (40-49%) and 40 - reduced (<40%). All patients underwent a comprehensive clinical examination, as well as standard echocardiography.
Results. Among patients with CHF-rEF, remodeling of the left ventricular myocardium by the type of concentric hypertrophy was more often observed (69,9%), and among CHF-inEF and CHF-nEF patients - by the type of eccentric hypertrophy (88,4 and 87,5%, respectively). Restrictive diastolic dysfunction was observed in 2,0% of patients with CHF-rEF and in 21,7% of patients with EF less than 50%.
Conclusion. The severity of the clinical course of CHF does not depend on the left ventricular EF. Epidemiology and etiology of CHF-rEF has fundamental differences from CHF-inEF and CHF-nEF: CHF-rEF is more common among women over 60 years old with arterial hypertension and obesity. For patients with CHF-inFV, myocardial remodeling by the type of concentric hypertrophy and the prevalence of non-restrictive types of diastolic dysfunction are characteristic.
Russian Journal of Cardiology. 2019;24(2):7–11
dx.doi.org/10.15829/1560-4071-2019-2-7-11
Key words: chronic heart failure; ejection fraction.
Conflicts of Interest: nothing to declare.
Orenburg State Medical University, Orenburg, Russia.
Dushina A. G. ORCID: 0000-0001-5776-0295, Lopina E. A. ORCID: 0000-0001-7474-7922, Libis R. A. ORCID: 0000-0003-0130-990X.
Received: 10.01.2019
Revision Received: 24.01.2019
Accepted: 31.01.2019
REGISTER OF ADULT PATIENTS WITH NONCOMPACT LEFT VENTRICULAR MYOCARDIUM: CLASSIFICATION OF CLINICAL FORMS AND A PROSPECTIVE ASSESSMENT OF PROGRESSION
Pavlenko E. V.1, Blagova O. V.1, Varionchik N. V.1, Nedotup A. V.1, Sedov V. P.1, Polyak M. E.2, Zaklyazminskaya E. V.2
Abstract
Aim. To study clinical forms of noncompact myocardium (NCM) in adults, the features of their manifestation, course and progression.
Material and methods. The study included 116 adult patients with NCM of the left ventricle (LV) (67 men, mean age 46,3±15,1 years) and 42 patients with increased LV trabecularity (24 men, mean age 43,5±15,2 years). The mean LV end-diastolic diameter was 6,0±0,8 and 5,9±1,1 cm, LV ejection fraction was 38,6±14,0% and 44,6±18,3%, respectively. NCM was diagnosed using echocardiography, multispiral computed tomography (n=77) and magnetic resonance imaging (n=51), increased LV trabecularity was diagnosed according to echocardiography, multispiral computed tomography (n=11), multispiral computed tomography (n=24). DNA diagnostics was carried out according to the NGS method, followed by Sanger sequencing. The examination included the determination of anticardial antibodies, the genome of cardiotropic viruses by PCR, coronary angiography (n=29/2), scintigraphy (n=27/4). A morphological study of the myocardium was performed on 22/6 patients with NCM/increased LV trabecularity (14/6 endomyocardial biopsy, 1 intraoperative biopsy, 3 explanted heart studies, 6 autopsies).
Results. Pathogenic mutations were found in 12 (10,3%) patients (MYH7, MyBPC3, LAMP2, DES, DSP, TTNgenes), variants of uncertain clinical significance (VUCS) - in other 5 (4,3%) patients; we detected VUCS in 1 patient with increased LV trabecularity. Familial cardiomyopathy may be diagnosed in 24 patients (22%). The combination of NCM with congenital heart defects was diagnosed in 11 (9,5%) patients. We identified six clinical variants of NCM: asymptomatic (2%), arrhythmic (15%), ischemic (7%), NCM in patients with dilated cardiomyopathy (42%), NCM in patients with acute/subacute myocarditis (12%) and in combination with other primary cardiomyopathies (22%) - hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, restrictive cardiomyopathy, primary myodystrophy, cardiac sarcoidosis, Danon disease. Myocarditis was diagnosed in 51,7% of patients with various forms of NCM and in 59,5% of patients with increased LV trabecularity. The frequency of the main clinical manifestations of NCM (chronic heart failure, various cardiac arrhythmias, thromboembolic complications) and outcomes varied in groups of patients with different variants of the NCM course. In patients with increased LV trabecularity, similar clinical variants were noted with a less severe myocardial dysfunction, rare arrhythmias and embolism. A significant improvement in dynamics of EF and LV end-diastolic diameter was noted only in the group of patients with acute/subacute, most of which received basic myocarditis therapy. In other groups, there was an unreliable improvement.
Conclusion. NCM can be detected in a patient of any age with a previously diagnosed heart disease (coronary heart disease, arterial hypertension, congenital heart defects, cardiomyopathy, myocarditis, etc.), and in the absence of any symptoms. Stable clinical forms are characterized by stability over time with a tendency to improvement against the background of complex medical therapy.
Russian Journal of Cardiology. 2019;24(2):12–25
dx.doi.org/10.15829/1560-4071-2019-2-12-25
Key words: noncompact myocardium, clinical forms, idiopathic arrhythmias, DCMP, myocarditis, endomyocardial biopsy, hypertrophic cardiomyopathy, restrictive cardiomyopathy.
Conflicts of Interest: nothing to declare.
Acknowledgements. The authors are grateful to the radiodiagnosis specialists, Ph. D. N. V. Gagarina, Ph.D. S. A. Aleksandrova, Ph. D. E. A. Mershina, prof. V. E. Sinitsin, Head of the Department of Pathological Anatomy of the I. M. Sechenov First Moscow State Medical University prof. E. A. Kogan.
1I. M. Sechenov First Moscow State Medical University, Moscow; 2B. V. Petrovskiy Russian Scientific Center of Surgery, Moscow, Russia.
Pavlenko E. V. ORCID: 0000-0002-4510-7763, Blagova O. V. ORCID: 0000-0002-5253-793X, Varionchik N. V. ORCID: 0000-0002-8868-0623, Nedotup A. V. ORCID: 0000-0001-9587-6707, Sedov V. P. ORCID: 0000-0003-2326-9347, Polyak M. E. ORCID: 0000-0003-4923-1945, Zaklyazminskaya E. V. ORCID: 0000-0002-6244-9546.
Received: 14.01.2019
Revision Received: 01.02.2019
Accepted: 08.02.2019
ASSESSMENT OF THE FUNCTIONAL STATE OF LEFT HEART IN PATIENTS WITH CHRONIC HEART FAILURE WITH PRESERVED EJECTION FRACTION
Vdovenko D. V., Libis R. A.
Abstract
Aim. To research the myocardial function in patients with chronic heart failure with preserved left ventricular ejection fraction (CHF-PEF) by speckle tracking echocardiography and function of the left atrium.
Material and methods. Eighty patients aged from 50 to 68 years with verified CHFPEF with NYHA (New York Heart Association) class I-IIa and stage A-C of the ABCD classification of the American College of Cardiology, and 30 healthy persons were examined. CHF-PEF was initiated by arterial hypertension and coronary artery disease. In our study we use 6-minute walk test to evaluate the functional class of CHF-PEF, echocardiography and speckle-tracking echocardiography to examine left ventricle systolic, diastolic function and speckle tracking echocardiography to determine the parameters of the myocardial deformation.
Results. Patients were divided as followed: 27% had stage A of CHF, 47,9% - stage B, 25,1% - stage C. The average left ventricular ejection fraction (by Simpson’s method) was 63,3±4,43%. Indexed end systolic volume of the left atrium (LP) in CHF-SFV patients 45,2±8,1 ml/m2. All patients had the diastolic dysfunction: 60 patients had abnormal relaxation pattern, and 20 patients had pseudonormal pattern. Patients with CHF-PEF had reduced global longitudinal strain (GLS) -16,56±2,61% and GLS rate (GLSR) -0,75±0,11s-1 of the left ventricle and reduced segmental strain and strain rate in basal anteroseptal (-14,72±2,54% and -0,76±0,05s-1) and basal anterolateral (-14,27±3,29% and -0,79±0,12s-1) segments. Also patients with CHF-PEF has lower reduction of the circular strain and strain rate (-16,63±3,5% and -1,43±0,21s-1), (p<0,05) in comparison with the GLS. Changes of the radial strain and strain rate were not revealed. Positive correlation between GLS and left atrium volume (r=0,601, р<0,01) was found.
Conclusion. In patients with CHF-PEF we revealed abnormal relaxation pattern and pseudonormal pattern of the diastolic dysfunction. Reduced global and segmental strain and strain rate of the left ventricle were shown, circular strain was slightly reduced, radial strain was unchanged.
Russian Journal of Cardiology. 2019;24(2):26–30
dx.doi.org/10.15829/1560-4071-2019-2-26-30
Key words: speckle-tracking, echocardiography, heart failure, diastolic function, deformation.
Conflicts of Interest: nothing to declare.
Orenburg State Medical University, Orenburg, Russia.
Vdovenko D. V. ORCID: 0000-0003-1236-3290, Libis R. A. ORCID: 0000-0003-0130-990X.
Received: 10.01.2019
Revision Received: 24.01.2019
Accepted: 31.01.2019
TRANSCATHETER “VALVE-IN-VALVE” IMPLANTATION OF BIOPROSTHESIS IN FAILED SURGICAL TRICUSPID BIOPROSTHESIS (FIRST EXPERIENCE IN RUSSIA)
Imaev T. E., Komlev A. E., Romakina V. V., Lepilin P. M., Makeev M. I., Kolegaev A. S., Margolina A. A., Sapelnikov O. V., Fedotenkov I. S., Saidova M. A., Akchurin R. S.
Abstract
Aim. . In the issue we report first in Russia experience of transcatheter “valve-in-valve” implantation (TVIV) for treatment of severe tricuspid stenosis due to the structural deterioration of surgical tricuspid bioprosthesis.
Material and methods. TVIV was performed in 4 high-risk redo patients (1 to 3 previous sternotomies) of various ages across (18-68 years) with structural deterioration of surgical tricuspid bioprosthesis.
Results. Technical success was achieved in 100% cases. Diastolic gradients on tricuspid valve markedly decreased in all patients. Peak transtricuspidal gradient decreased from 20,4 to 10 mmHg in average. Clinical improvement as assessed by 6-minute walk test after TVIV was observed in 3 patients with congestive heart failure. In 1 patient with asymptomatic right ventricle dysfunction TVIV resulted in the enhancement of echocardiographic parameters.
Conclusion. TVIV is a mininvasive alternative to conventional surgical tricuspid valve redo replacement. Based on available data including own experience TVIV should be considered an effective and safe treatment option for failed TV bioprostheses in high-risk patients of different age. Further studies are needed to assess long-term results of the method.
Russian Journal of Cardiology. 2019;24(2):31–37
dx.doi.org/10.15829/1560-4071-2019-2-31-37
Key words: tricuspid bioprosthesis, structural valve deterioration, transcatheter valve replacement, “valve-in-valve”.
Conflicts of Interest: Imaev T. E. is a clinical specialist at Edwards Lifescience, Medtronic. The other authors have no potential conflict of interest to declare. The work had no additional sources of funding.
National Medical Research Center of Cardiology, Moscow, Russia.
Imaev T. E. ORCID: 0000-0002-5736-5698, Komlev A. E. ORCID: 0000-0001-6908-7472, Romakina V. V. ORCID: 0000-0002-0035-0794, Lepilin P. M. ORCID: 0000-0003-2979-2542, Makeev M. I. ORCID: 0000-0002-4779-5088, Kolegaev A. S. ORCID: 0000-0002-5054-1310, Margolina A. A. ORCID: 0000-0003-4243-4686, Sapelnikov O. V. ORCID: 0000-0002-5186-2474, Fedotenkov I. S. ORCID: 0000-0003-3344-4401, Saidova M. A. ORCID: 0000-0002-3233-1862, Akchurin R. S. ORCID: 0000-0002-2105-8258.
Received: 12.12.2018
Revision Received: 02.02.2019
Accepted: 06.02.2019
INFLUENCE OF CONCOMITANT CHRONIC OBSTRUCTIVE PULMONARY DISEASE ON LEFT VENTRICULAR-ARTERIAL INTERACTION IN PATIENTS WITH ISCHEMIC CARDIOMYOPATHY
Myasoedova E. I.1, Schwarz Yu. G.2, Polunina O. S.1, Voronina L. P.1
Abstract
Aim. To assess the influence of concomitant chronic obstructive pulmonary disease (COPD) on the parameters of left ventricular-arterial interaction in patients with ischemic cardiomyopathy (ICMP).
Material and methods. We examined 130 patients with ICMP and 42 patients with ICMP and COPD. All patients underwent transthoracic echocardiography using the MyLab 70 (Italy) according standard method, followed by calculation of the left ventricular-arterial interaction and left ventricular (LV) energy. Statistical data processing was performed using the program “Statistica 12.0” (Stat Soft, Inc., USA).
Results. We found that patients with isolated ICMP and in combination with COPD often have a functional imbalance between the activity of LV and arterial system, as evidenced by an increase in the left ventricular-arterial interaction ratio. The increase in the left ventricular-arterial interaction ratio is due to an insufficient increase in left ventricular stiffness, but not a change in the elastic properties of the arterial system. This is indicated by a pronounced decrease in left ventricular elasticity against the background of the relative constancy of arterial elasticity. At the same time, in patients with ICMP and COPD we detected significantly more severe impairment in the parameters of left ventricular-arterial interaction and LV energy than in isolated pathology.
Conclusion. The presence of COPD in patients with ICMP allows us to consider it as a significant negatively modifying factor that has a negative impact on the functionality of LV and parameters of left ventricular-arterial interaction.
Russian Journal of Cardiology. 2019;24(2):38–43
dx.doi.org/10.15829/1560-4071-2019-2-38-43
Key words: ischemic cardiomyopathy, chronic obstructive pulmonary disease, left ventricular-arterial interaction parameters.
Conflicts of Interest: nothing to declare.
1Astrakhan State Medical University, Astrakhan; 2V. I. Razumovsky Saratov State Medical University, Saratov, Russia.
Myasoedova E. I. ORCID: 0000-0001-6820-733X, Schwarz Yu. G. ORCID: 0000-0003-4790-3920, Polunina O. S. ORCID: 0000-0001-8299-6582, Voronina L. P. ORCID: 0000-0002-2395-745X.
Received: 04.05.2018
Revision Received: 23.07.2018
Accepted: 30.07.2018
THE RELATIONSHIP OF MICROCIRCULATION PARAMETERS OF THE BULBAR CONJUNCTIVA AND CORONARY ANGIOGRAPHY IN PATIENTS WITH CORONARY ARTERY DISEASE
Korneeva N. V.1, Syrotin B. Z.1, Bondar N. V.2, Rudman V. Ya.3
Abstract
Aim. To identify the associations between microcirculation parameters obtained using the method of bulbar conjunctiva videobiomicroscopy and coronary angiography in patients with acute coronary syndrome (ACS).
Material and methods. Fifty six patients with ACS underwent coronary angiography (CAG) and on days 7-10 of hospitalization - bulbar conjunctiva videobiomicroscopy. A comparison of micro- and macrocirculation parameters by methods of pair and canonical correlations has been carried out.
Results. Multiple positive and negative correlations of the average force between microcirculation parameters (arteriolar-venular ratio (AVR), capillary number per 1 mm2 of conjunctival surface, intravascular erythrocyte aggregation in the eye corner) conjunctival areas) and severity of coronary sclerosis. By the method of canonical correlations, strong (r=0,71), positive statistically significant (p=0,0256) correlation was observed.
Conclusion. Bulbar conjunctiva videobiomicroscopy can be used as non-invasive screening to identify individuals with a high risk of coronary sclerosis. Thus, the following parameters can be used: AVR, capillary number per 1 mm2 of conjunctival surface, intravascular erythrocyte aggregation in the eye corner and the number of conjunctival areas with identified intravascular erythrocyte aggregation. In case of low AVR values (0,2-0,3), reduction of the capillary bloodflow (reducing of the capillary number less than 4 units/mm2 of the conjunctival surface) and widespread intravascular erythrocyte aggregation in three and four areas of the bulbar conjunctiva, patients should underwent CAG because of high risk of coronary atherosclerosis.
Russian Journal of Cardiology. . 2019;24(2):44–52
dx.doi.org/10.15829/1560-4071-2019-2-44-52
Key words: microcirculation, bulbar conjunctiva videobiomicroscopy, coronary angiography, coronary atherosclerosis, acute coronary syndrome, canonical correlations.
Conflicts of Interest: nothing to declare.
1Far-Eastern State Medical University, Khabarovsk; 2Federal Center for Cardiovascular Surgery, Khabarovsk; 3Regional Clinical Hospital № 2, Khabarovsk, Russia.
Korneeva N. V. ORCID: 0000-0001-9878-180X, Syrotin B. Z. ORCID: 0000-0001-9158-2242, Bondar N. V. ORCID: 0000-0003-1780-5940, Rudman V. Ya. ORCID: 0000-0001-8438-8492.
Received: 03.07.2018
Revision Received: 05.09.2018
Accepted: 20.09.2018
CARDIOVASCULAR EVENTS FOLLOW-UP ANALYSIS IN PATIENTS WITH SINUS NODE DYSFUNCTION AND IMPLANTED PACEMAKER
Badykova E. A.1,2, Badykov M. R.1,2, Plechev V. V.2, Sagitov I. Sh.1, Luckman I. A.3, Zagidullin N. Sh.2,3
Abstract
Dysfunction of sinus node (DSN) is the syndrome, characterized by symptoms of tissue hypoperfusion and manifestations on the electrocardiogram and could potentially lead to sudden death. The various impact of different types of pacemakers on life quality and cardiovascular endpoints was shown.
Aim. To analyze follow-up cardiovascular endpoints in patients with DSN and installed pacemakers.
Material and methods. Six hundred and ten patients with DSN were analyzed in follow-up period (39,7±0,8 months) for unfavorable cardiovascular events (myocardial infarction, strokes, cardiovascular and non-cardiovascular hospitalizations).
Results. Mortality rate differed depending on DSN variant (p=0,041), and most unfavorable was “tachy-brady” and sinoatrial node arrest + sinus node block III types. Also, the difference in mortality rate was shown for pacing variants (p=0,049) with maximal rate number of deaths was in ventricular pacemakers (24,6%) less - in dual-chamber pacemakers (11,7%) and minimal - in atrial (5,5%). No changes in cardiovascular endpoints was found between groups with sinus and pacemaker’s rhythm (p>0,5).
Conclusion. In the follow-up analyze the difference between cardiovascular endpoints in patients in various types of pacemakers and regimen of stimulation was shown.
Russian Journal of Cardiology. 2019;24(2):53–57
dx.doi.org/10.15829/1560-4071-2019-2-53-57
Key words: dysfunction of sinus node, cardiovascular events, pacemaker, morbidity.
Conflicts of Interest: nothing to declare.
1Republican Cardiology Center of the Republic of Bashkortostan, Ufa; 2Bashkir State Medical University, Ufa; 3Ufa State Aviation Technical University, Ufa, Russia.
Badykova E. A. ORCID: 0000-0002-8167-4271, Badykov M. R. ORCID: 0000-0002-9397-6250, Plechev V. V. ORCID: 0000-0002-6716-4048, Sagitov I. Sh. ORCID: 0000-0002-5830-5056, Luckman I. A. ORCID: 0000-0001-9876-9202, Zagidullin N. Sh. ORCID: 0000-0002-7249-3364.
Received: 19.04.2018
Revision Received: 04.09.2018
Accepted: 11.09.2018
CLINIC AND PHARMACOTHERAPY
THE EFFECTIVENESS OF TRIMETAZIDINE AND FABOMOTIZOLE IN THE PREVENTION OF ANGINA PROGRESSION AND IMPROVEMENT OF LIFE QUALITY IN PATIENTS IN AREA OF ARMED CONFLICT
Shakhbiyeva Z. Yu.1,2, Abdullaev A. A.2, Islamova U. A.2, Abdulpatakhov D. D.2, Abdullaeva A. A.2
Abstract
Aim. To assess the effectiveness of trimetazidine and fabomotizole adding to standard treatment in prevention of stable angina progression and improving of quality of life (QOL) in patients in area of armed conflict.
Material and methods. One hundred and twelve patients with stable angina of II-III functional class (FC) living in the area of armed conflict in Chechen Republic. All participants were randomized into two groups. Within 6 months 54 patients from control group used standard therapy (isosorbide dinitrate 40 mg/day, metoprolol tartrate 50-100 mg/day, acetylsalicylic acid 100 mg/day, simvastatin 40 mg/day). In the study group 58 patients additionally took trimetazidine 70 mg/day and fabomotizole 30 mg/day. We used Seattle Angina Questionnaire initially and after 6 months of treatment to determine QOL: frequency of angina attacks, nitroglycerin taking per week and adverse events were evaluated.
Results. The frequency of angina attacks and nitroglycerin taking in patients of study group significantly decreased after treatment compared with control group (p<0,05). In the study group, as a result of treatment, there was a statistically significant increase in QOL compared with their initial values. In the control group there was a positive trend in following questionnaire scales: physical activity (p<0,01), angina frequency (p<0,001) and disease perception (p<0,05). According to scales of treatment satisfaction, physical limitation and disease perception, improvement of QOL in the study group were statistically significant comparing with control group (p=0,01; p<0,01 and p<0,01, respectively).
Conclusion. In the control group, there is a positive dynamics of QOL parameters on physical activity (p<0,01), frequency of angina attacks (p<0,001) and disease perception (p<0,05) scales. The inclusion of trimetazidine and fabomotizole to the standard treatment carries statistically significant improvement of treatment satisfaction, physical limitation and disease perception scales. The frequency of angina attacks and nitroglycerin taking in patients of study group significantly decreased after treatment compared with control group (p<0,05).
Russian Journal of Cardiology. 2019;24(2):58–63
dx.doi.org/10.15829/1560-4071-2019-2-58-63
Key words: trimetazidine, fabomotizole, quality of life, stable angina.
Conflicts of Interest: nothing to declare.
1Clinical Hospital № 3, Grozny; 2Dagestan State Medical University, Makhachkala, Russia.
Shakhbiyeva Z. Yu. ORCID: 0000-0001-8357-9369, Abdullaev A. A. ORCID: 0000-0001-5287-5827, Islamova U. A. ORCID: 0000-0002-1280-1505, Abdulpatakhov D. D. ORCID: 0000-0002-5184-9800, Abdullaeva A. ORCID: 0000-0002-3483-3380.
Received: 13.01.2019
Revision Received: 01.02.2019
Accepted: 08.02.2019
CONTRIBUTION OF ANTICOAGULANT THERAPY ADHERENCE TO THE RISK OF COMPLICATIONS OF ATRIAL FIBRILLATION
Skirdenko Yu. P., Nikolaev N. A.
Abstract
Aim. To study compliance and its role in the development of the fatal complications of anticoagulant therapy in patients with atrial fibrillation (AF).
Material and methods. Antithrombotic therapy and compliance were studied in an open observational controlled prospective study with 109 AF patients. The dynamics and presence of thromboembolic and hemorrhagic complications were recorded.
Results. For the first time in patients with AF, we detected a significantly high relative risk of development of life-threatening and lethal complications of anticoagulant therapy with warfarin with insufficient compliance (RR=8,0; [1,728;37,027]; p<0,05) and drug therapy (RR=7,0; [1,493;32,819]; p<0,05). At the same time, patients with AF could not detect any links between the level compliance and the risk of treatment with directly acting oral anticoagulants (DAOC) - patients who achieved a common primary endpoint had no association between the relative risk and the level of compliance (RR=1,0; [0,106;9,445]; p<0,05).
Conclusion. The study showed for the first time that in patients with AF, the most unfavorable prognostic factor in the development of life-threatening and lethal complications with warfarin taking is low adherence to lifestyle modification and drug therapy. At the same time, in patients with AF, who receive DAOK as anticoagulants, there was no connection between compliance and the development of hemorrhagic or thromboembolic complications.
Russian Journal of Cardiology. 2019;24(2):64–69
dx.doi.org/10.15829/1560-4071-2019-2-64-69
Key words: adherence, warfarin, directly acting oral anticoagulants, atrial fibrillation.
Conflicts of Interest: nothing to declare.
Omsk State Medical University, Omsk, Russia.
Skirdenko Yu. P. ORCID: 0000-0002-6225-2444, Nikolaev N. A. ORCID: 0000-0002-3758-4930.
Received: 17.06.2018
Revision Received: 24.07.2018
Accepted: 01.10.2018
GENETICS IN CARDIOLOGY
EXPRESSION OF MIRNA-27A IN THE SERUM OF PATIENTS WITH NON-ST ELEVATION ACUTE CORONARY SYNDROME WHO UNDERWENT PERCUTANEOUS CORONARY INTERVENTION
Draganova A. S.1,2, Polyakova E. A.1,2, Kolodina D. A.1, Mikheeva K. Yu.1, Belyaeva O. D.1,2, Zaraysky M. I.1, Berkovich O. A.1,2, Shlyakhto E. V.1,2
Abstract
Coronary artery disease (CAD) is a multifactorial disorder. Previously have been identified genes whose polymorphic variants are associated with an increased risk of CAD. Genetic control of the development of CAD at the post-transcriptional level is carried out using step-wise and multicomponent regulation of gene expression with the participation of specific molecules called micro-ribonucleic acids (miRNAs). Currently, many authors consider these molecules, in particular miRNA-27a, as potential sensitive diagnostic markers for acute coronary syndrome (ACS).
Aim. To assess the level of miRNA-27a expression in the serum of patients underwent percutaneous coronary intervention (PCI) after non-ST elevation ACS.
Material and methods. Forty patients with non-ST elevation ACS who underwent coronary artery stenting were examined. The comparison groups consisted of 80 patients with a stable CAD who underwent coronary artery bypass surgery, and 20 patients without clinical signs of CAD operated due to valvular disorders without atherosclerotic lesions. All patients underwent coronary angiography. The expression level of miRNA-27a was determined in serum by real-time polymerase chain reaction.
Results. In patients with non-ST elevation ACS, who underwent PCI, the expression level of miRNA-27a in serum was higher than in patients without atherosclerotic lesions (6,99±1,69 and 3,05±0,89, respectively; p<0,05). Moreover, patients with multivessel coronary lesions (3 or more arteries) had a higher level of miRNA-27a expression in serum than patients with a single or dual vascular lesion (8,00±2,19 and 5,87±2,64, respectively; p<0,05). In patients with non-ST elevation ACS and patients with a stable CAD, the expression level of miRNA-27a was not significantly different (6,99±1,69 and 8,57±3,90, respectively; p>0,05).
Conclusion. High levels of miRNA-27a expression can be considered as a marker of coronary lesion severity in patients with CAD, but not as a marker for ACS.
Russian Journal of Cardiology. 2019;24(2):70–75
dx.doi.org/10.15829/1560-4071-2019-2-70-75
Key words: micro-RNA, coronary artery disease, acute coronary syndrome.
Conflicts of Interest: nothing to declare.
1First Pavlov State Medical University of St. Petersburg, St. Petersburg; 2Almazov National Medical Research Centre, St. Petersburg, Russia.
Draganova A. S. ORCID: 0000-0002-9541-0947, Polyakova E. A. ORCID: 0000-0002-3231-6152, Kolodina D. A. ORCID: 0000-0003-2889-0706, Mikheeva K. Yu. ORCID: 0000-0001-9450-7758, Belyaeva O. D. ORCID: 0000-0002-5349-2227, Zaraysky M. I. ORCID: 0000-0002-7605-4369, Berkovich O. A. ORCID: 0000-0002-5358-5968, Shlyakhto E. V. ORCID: 0000-0003-2929-0980.
Received: 13.11.2018
Revision Received: 24.01.2019
Accepted: 31.01.2019
SUPPORTING A PRACTITIONER
USING OF QUESTIONNAIRE OF EUROPEAN SOCIETY OF CARDIOLOGY TO IDENTIFY NON-CONVENTIONAL RISK FACTORS IN PATIENTS WITH CORONARY ARTERY DISEASE IN THE KYRGYZ REPUBLIC
Zalesskaya Yu. V., Kydyralieva R. B.
Abstract
Aim. To analyze the results of using of the European Society of Cardiology (ESC) questionnaire regarding the assessment of non-conventional risk factors in patients with coronary artery disease (CAD).
Material and methods. Three hundred and ten patients with CAD (mean age 59,6±8,8 years, men 62,2) underwent a general clinical examination with the identification of conventional risk factors and assessing standard treatment goals. The cardiologist performed a two-stage assessment of non-conventional risk factors using the ESC questionnaire and validated questionnaires (DS-14, Hamilton Rating Scale for Depression and Anxiety) for clinical identification of anxiety, depression, type D personality.
Results.
In hospitalized patients, predominantly we noted severe clinical manifestations of the disease: acute coronary syndrome (51,6%), a decrease in the ejection fraction of less than 50% (40%), a history of acute myocardial infarction (29%), and a high frequency of conventional risk factors: arterial hypertension (75,8%), dyslipidemia (75,1%), obesity (40,9%). The majority of respondents did not reach the standard treatment goals: 13,8% of patients smoked, 30,9% did not follow the lipid-lowering diet, 81,3% did not follow recommendations regarding fish eating, 51,6% did not have recommended physical activity, 40,6% did not reached the target level of blood pressure, 59,3% - the target level of low-density lipoproteins, 59,8% - the target level of body mass index. We determined prevalence of following non-conventional risk factors: hostility (30,9%), type D personality (25,4%), low socio-economic status (12,2%) and anxiety (10%). Depression (5,1%), stress at work and in family life (4,5%), social exclusion (1,6%) were less common.Conclusion. The results are consistent with data obtained by foreign researchers. The use of the ESC questionnaire allows practitioners to focus on identifying nonconventional risk factors, receive data on the individual risk profile and expand the range of treatment and prevention strategies.
Russian Journal of Cardiology. 2019;24(2):76–80
dx.doi.org/10.15829/1560-4071-2019-2-76-80
Key words: coronary artery disease, non-conventional risk factors.
Conflicts of Interest: nothing to declare.
Acknowledgements. We express our gratitude for the consulting assistance in the development of the study design to Dzhumangulova A. S., director of M. Mirrakhimov National Center for Cardiology and Therapy, Ten V. I., Head of the Department of Psychology, Psychiatry and Psychotherapy at the Kyrgyz-Russian Slavic University and Nelyubova T. A., Associate Professor of the Department of Psychology, Psychiatry and Psychotherapy at the Kyrgyz-Russian Slavic University.
M. Mirrakhimov National Center for Cardiology and Therapy, Bishkek, Kyrgyz Republic.
Zalesskaya Yu. V. ORCID: 0000-0003-3776-2685, Kydyralieva R. B. ORCID: 0000-0003-4959-1449.
Received: 07.07.2018
Revision Received: 27.08.2018
Accepted: 20.09.2018
CLINICAL CASE
NEUROGENIC STRESSOR CARDIOMYOPATHY CAUSED BY ANEURYSMAL SUBARACHNOID HEMORRHAGE
Rasputina D.A.1, Rutkovsky R.V.1, Mertsalov S. A.1, Krupko T. A.1, Gulyaev M. E.1, Salogub E. D.1, Savello A. V.1, Yakovlev A. N.1, Zverev D. А.1, Kozlenok A. V.1, Savvina I. А.1,2
Abstract
Clinical demonstration of the development of acute non-coronarogenic myocardial lesion in a patient with intraoperative rupture of the arterial aneurysm of the basilar artery. Neurogenic cardiomyopathy should be considered in the differential diagnostics of acute heart failure in patients with acute cerebral lesion.
Russian Journal of Cardiology. 2019;24(2):81–85
dx.doi.org/10.15829/1560-4071-2019-2-81-85
Key words: cerebral vascular arterial aneurysm, subarachnoid hemorrhage, neurogenic stressor cardiomyopathy, takotsubo cardiomyopathy, clinical case.
Conflicts of Interest: nothing to declare.
1Almazov National Medical Research Centre, St. Petersburg; 2A. L. Polenov Russian Neurosurgical Institute, St. Petersburg, Russia.
Rasputina D. A. ORCID: 0000-0002-3343-0002, Rutkovsky R. V. ORCID: 0000-0002-9208-3741, Mertsalov S. A. ORCID: 0000-0002-5010-1833, Krupko T. A. ORCID: 0000-0002-6997-7886, Gulyaev M. E. ORCID: 0000-0003-1380-6575, Salogub E. D. ORCID: 0000-0003-3870-7063, Savello A. V. ORCID: 0000-0002-1680-6119, Yakovlev A. N. ORCID: 0000-0002-2922-664Х, Zverev D. А. ORCID: 0000-0002-1447-3509, Kozlenok A. V. ORCID: 0000-0001-6259-6039, Savvina I. А. ORCID: 0000-0001-5655-510X.
Received: 20.09.2018
Revision Received: 09.01.2019
Accepted: 16.01.2019
LITERATURE REVIEWS
SMOKE CESSATION IN CARDIOVASCULAR PATHOLOGY FROM THE PERSPECTIVE OF EVIDENCE-BASED MEDICINE
Sukhovskaya O. A.1,2, Kulikov N. V.3
Abstract
The effectiveness of smoking cessation methods has been studied in various studies. However, little is known about the peculiarities of treatment of nicotine dependence in patients with cardiovascular diseases. In the presented review, according to the literature, the prevalence and characteristics of smoking, the duration of abstinence from smoking in patients with cardiovascular diseases with different methods of quitting tobacco use are described. It is shown that smoking cessation not only shows long-term positive effects, but almost immediately the supply of cells with oxygen increases, platelet aggregation, fibrinogen synthesis decreases. Carrying out treatment for nicotine addiction, especially when combined with behavioral support, significantly increases the effectiveness of quitting smoking. With the cardiovascular pathology, the efficacy and safety of varenicline has been proven.
Russian Journal of Cardiology. 2019;24(2):86–91
dx.doi.org/10.15829/1560-4071-2019-2-86-91
Key words: smoking, cardiovascular diseases, treatment, nicotine dependence.
Conflicts of Interest: nothing to declare.
1Saint-Petersburg State Research Institute of Phthisiopulmonology, Saint-Petersburg; 2First Pavlov State Medical University of St. Petersburg, St. Petersburg; 3Saint-Petersburg University, Saint-Petersburg, Russia.
Sukhovskaya O. A. ORCID: 0000-0003-2907-9376, Kulikov N. V. ORCID: 0000-0003-3938-2061.
Received: 31.01.2019
Revision Received: 07.02.2019
Accepted: 14.02.2019
ANALYSIS OF MACROPHAGE TRANSCRIPTOME IN ATHEROGENESIS
Kubekina M. V.1,3, Nikiforov N. G.1,2,3, Karagodin V. P.4, Sobenin I. A.2, Orekhov A. N.3,5
Abstract
The accumulation of cholesterol under the influence of modified low density lipoprotein is a key cause of atherogenesis. It is known that atherosclerosis is accompanied by chronic local inflammation. Monocytes/macrophages, main cells of the innate immunity, may not only capturing and accumulating lipids in the vascular wall, but also secreting signaling molecules that affect the functions of other cells. An atherosclerotic lesion is characterized by the inability to complete the inflammatory response, as a result of which the inflammation becomes chronic. Intracellular lipid accumulation is a necessary condition for the initiation of atherogenesis, but it is not known whether it is sufficient. Analysis of the transcriptome allowed us to characterize the state of macrophages loaded with lipids. Studies presented in this review show that the reaction of innate immunity contributes to the accumulation of intracellular lipids and aggravates it.
Russian Journal of Cardiology. 2019;24(2):92–98
dx.doi.org/10.15829/1560-4071-2019-2-92-98
Key words: atherosclerosis, macrophages, transcriptome analysis, activation, low density lipoproteins, gene expression.
Conflicts of Interest: nothing to declare.
Funding. This work was supported by the Russian Foundation for Basic Research (№ 18-34-00997).
1Institute of Gene Biology, Moscow; 2National Medical Research Center of Cardiology, Moscow; 3The Institute of General Pathology and Pathophysiology, Moscow; 4Plekhanov Russian University of Economics, Moscow; 5Scientific Institute of Atherosclerosis Research, Skolkovo, Russia.
Kubekina M. V. ORCID: 0000-0002-8834-1111, Nikiforov N. G. ORCID: 0000-0002-2082-2429, Karagodin V. P. ORCID: 0000-0003-0501-8499, Sobenin I. A. ORCID: 0000-0003-0978-6444, Orekhov A. N. ORCID: 0000-0002-6495-1628.
Received: 01.07.2018
Revision Received: 28.08.2018
Accepted: 15.11.2018
