Russian Journal of Cardiology, 2019, 24 (3)

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ORIGINAL ARTICLES

BLEEDING RISK FACTORS IN PATIENTS WITH ACUTE CORONARY SYNDROME: DATA FROM OBSERVATIONAL STUDIES ORACUL II

Brazhnik V. A.1,2, Minushkina L. O.1, Guliev R. R.3, Averkova A. O.1, Rogozhina A. A.1, Koroleva O. S.1, Zubova E. A.2, Karmanchikova E. A.4, Khasanov N. R.5, Chichkova M. A.6, Boeva O. I.7, Galyavich A. S.5, Zateyshchikov D. A.1,2

Abstract

Aim. To identify the risk factors for bleeding of BARC scale 2-5 types in patients after acute coronary syndrome (ACS).

Material and methods. The data of 1502 patients from the open multicenter study, ORACUL II, were used — 894 men (59,5%) and 608 women (40,5%), mean age — 65,7±12,9 years. Five hundred sixty (37,3%) patients had ACS with ST-segment elevation and 942 (62,7%) — ACS without ST-segment elevation. Bleeding was recorded in 164 patients (10,9%), including index admission — in 39 (2,6%) patients, of which severe (types 3-5) — 0,5%, significant — 1,7% (types 2-5).

Results. Within a year after discharge, bleeding was observed in 126 (8,4%) patients, large — 0,8%, significant — 2,4%. The development of bleeding type 2-5 was associated with the presence of gastric ulcer and duodenal ulcer, gastrointestinal bleeding in history, decreased creatinine, hemoglobin clearance, age of patients, the use of anticoagulants in the composition of triple or double antithrombotic therapy, conducting of percutaneous interventional procedures, the presence of heart failure 2-4 Killip class at admission. ROC analysis showed that the predictive value of the ORACLE bleeding risk scale is 0,762, sensitivity — 62%, specificity — 78%.

Conclusion. Thus, we based on routine clinical practice have created a simple scale for assessing the risk of bleeding in patients with ACS.

Russian Journal of Cardiology. 2019;24(3):7–16

http://dx.doi.org/10.15829/1560-4071-2019-3-7-16

Key words: acute coronary syndrome, bleeding, BARC, mortality, ORACLE risk scale.

Conflicts of Interest: nothing to declare.

1Central State Medical Academy of the Presidential Administration of the Russian Federation, Moscow; 2City Clinical Hospital № 51, Moscow; 3Institute for Biochemical Physics, Moscow; 4Stavropol Regional Clinical Psychiatric Hospital № 1, Stavropol; 5Kazan State Medical University, Kazan; 6City Clinical Hospital № 17, Moscow; 7Stavropol State Medical University, Stavropol, Russia.

Brazhnik V. A. ORCID: 0000-0003-4144-4719, Minushkina L. O. ORCID: 0000-0002-4203-3586, Guliev R. R. ORCID: 0000-0001-8910-4137, Averkova A. O. ORCID: 0000-0002-8867-117X, Rogozhina A. A. ORCID: 0000-0002-9742-359X, Koroleva O. S. ORCID: 0000-0001-5292-1336, Zubova E. A. ORCID: 0000-0001-8377-1350, Karmanchikova E. A. ORCID: 0000-0002-3991-2547, Khasanov N. R. ORCID: 0000-0001-8582-708X, Chichkova M. A. ORCID: 0000-0002-6962-3260, Boeva O. I. ORCID: 0000-0002-1816-8309, Galyavich A. S. ORCID: 0000-0002-4510-6197, Zateyshchikov D. A. ORCID: 0000-0001-7065-2045.

Received: 11.02.2019

Revision Received: 17.02.2019

Accepted: 25.02.2019

DIFFICULTIES OF DIAGNOSTICS OF ACUTE MYOCARDIAL INFARCTION IN ELDERLY AND SENILE PATIENTS AND THEIR INFLUENCE ON MANAGEMENT IN THE ACUTE PERIOD OF DISEASE

Tukish O. V., Garganeeva A. A.

Abstract

Aim. To study the features of disease progress and approaches to the diagnostics of acute myocardial infarction (MI) among elderly and senile patients and their influence on the management in the acute period of disease.

Materials and methods. The study was performed using the WHO program “Register of acute myocardial infarction” (Tomsk). The study included 410 patients (60 years and older), who had acute MI. The study group is represented by a comparable number of men (n=212) and women (n=198). The mean age of patients was 71 (66; 77) years (women are 5 years older than men (p<0,001)). Statistical processing was performed using the program Statistica V10.0.

Results. Most of the patients had history comorbid pathology. In one in five patients (17,8%), the disease had an atypical manifestations, which in 41% of cases was represented by the asymptomatic form. Atypical manifestation of MI lengthened the

prehospital phase of medical care due to a longer time before the first medical contact (p=0,005), as well as a late help-seeking (120 [49; 311,5] minutes). In 28% of patients, the level of creatine kinase-MB remained normal, and the indicator of troponin I exceeded the maximum values only in half of the cases. One fifth of the patients underwent acute MI treatment in non-core hospitals, which resulted in a low frequency of intervention (38%) and increasing by 2 times the chance of death within 5 years. The level of hospital mortality from acute MI in elderly patients in noncore hospitals was 3 times higher than in specialized departments (p<0,001).

Conclusion. Difficulties in diagnostics of MI in patients of older age groups is caused by the prevalence of comorbid pathology, an atypical manifestations of the disease and low information content of biochemical markers of myocardial necrosis. It leads to an increase in time delays at the prehospital phase and frequent hospitalization of patients in non-core hospitals, making it impossible for them to receive timely, preferred therapy.

Russian Journal of Cardiology. 2019;24(3):17–23

http://dx.doi.org/10.15829/1560-4071-2019-3-17-23

Key words: myocardial infarction, elders, diagnostics of myocardial infarction, troponin, non-core hospitals.

Conflict of interest: nothing to declare.

Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia.

Tukish O. V. ORCID: 0000-0002-7661-5808, Garganeeva A. A. ORCID: 0000-0002-9488-6900.

Received: 09.06.2018

Revision Received: 27.08.2018

Accepted: 20.09.2018

ANALYSIS OF DISTANT CARDIOVASCULAR EVENTS DEPENDING ON THE BIOMARKER PROFILE IN PATIENTS WITH MYOCARDIAL INFARCTION

Khamitova A. F.1, Zagidullin Sh. Z.1, Lakman I. R.2, Gareeva D. F.1, Zagidullin N. Sh.1,2

Abstract

Acute coronary syndrome (ACS) and its complications is one of the main reasons of mortality and invalidation in the world. New biomarkers, such as ST2, NT-proBNP и Pentraxin-3 (Ptx-3) present much more opportunities in the diagnostics of diseases and risk of its development.

Aim. To investigate standards and “new” biomarkers in different variants of MI and cardiovascular events in 1 year after MI.

Material and methods. In 180 patients with MI (61,4±1,7 years) we determined the serum concentration of standard and “new” (ST2, NT-proBNP, Ptx-3) biomarkers in groups with Q/non-Q, STEMI and NSTEMI and the endpoints (MI, strokes, repeated hospitalizations and sudden deaths) in 1 year (384,3±21,2 days) after MI.

Results. Patients with Q-MI and STEMI had higher risk of unfavorable cardiovascular events (p<0,05). Ptx-3 >43,9 ng/ml was shown to be risk factor for sudden death (sensitivity 70,0%, specificity 52,9%), and >125,9±0,06 ng/ml (74,1% and 44,1%) — of recurrent MI.

Conclusion. NT-proBNP, ST2 and Ptx-3 showed prognostic value in the diagnostics of unfavorable cardiovascular endpoints.

Russian Journal of Cardiology. 2019;24(3):24–31

http://dx.doi.org/10.15829/1560-4071-2019-3-24-31

Key words: myocardial infarction, long-term prognosis, stimulating growth factor ST2, N-terminal pro-brain natriuretic peptide (NT-proBNP), Pentraxin-3 (Ptx-3).

Conflicts of Interest: nothing to declare.

Funding. The following works were carried out with the support of the grant of the “Umnik Helsnet NTI”: design, information collection, analysis and interpretation of data, construction of statistical models.

Acknowledgments: Head of cardiology department of Clinical Hospital № 21, MD Tulbaev E. L., fifth-year student of the Belarusian State Medical University Dozhdev S. S., postgraduate student of Ufa State Aviation Technical University Akhmetvaleev R. R.

1Bashkir state Medical University, Ufa; 2Ufa State Aviation University, Ufa, Russia.

Khamitova A. F. ORCID: 0000-0002-7496-7172, Zagidullin Sh. Z. ORCID: 0000-0002-7249-3364, Lakman I. R. ORCID: 0000-0001-9876-9202, Gareeva D. F. ORCID: 0000-0002-1874-8661, Zagidullin N. Sh. ORCID: 0000-0003-2386-6707.

Received: 24.08.2018

Revision Received: 14.10.2018

Accepted: 29.11.2018

A NEW APPROACH IN CARDIOVERTER-DEFIBRILLATOR IMPLANTATION IN PATIENTS WITH CORONARY ARTERY DISEASE

Atabekov T. A., Batalov R. E., Krivolapov S. N., Sazonova S. I., Khlynyn M. S., Levintas A. D., Popov S. V.

Abstract

Aim. Defibrillation lead implantation technique optimization using cardiac scintigraphy in patients with coronary artery disease (CAD).

Material and methods. In this study 81 patients (male — 72, age 64,0±8,7 years with CAD and indications for the cardioverter-defibrillator (ICD) implantation were examined. Patients were divided into two groups. In 1-st group before ICD implantation, patients underwent cardiac 99mTc-methoxy-isobutyl-isonitrile scintigraphy for right ventricle wall perfusion disorders assessment. In this group defibrillating lead was implanted to the septal position, if the perfusion disorders were in the apical segments, and to the apical position, if perfusion disorders were in the septal segment. In 2-nd group lead was implanted using conventional approach. Defibrillating lead parameters (threshold, sense, impedance and shock impedance on 1-st, 7-th, 30-th and 180-th follow-up days) were compared.

Results. The 1-st group consisted of 45 (55,5%) patients (male — 41, age 62,2±8,8 years). In 28 (62,2%) cases in this group defibrillating lead was implanted to the apical and in 17 (37,8%) — to the septal position. The 2-nd group consisted of 36 (44,5%) patients (male — 31, age 66,3±8,2 years; p=0,03). In 20 (55,5%) cases in this group defibrillating lead was implanted to the septal and in 16 (44,5%) — to the apical position. There were significant differences between groups in terms of: threshold and sense

at all follow-up days (p=0,0001) and impedance on 1-st (p=0,003), 30-th (p=0,0001) and 180-th day (p=0,002), respectively.

Conclusion. Assessment of right ventricular perfusion before ICD implantation can reduce threshold and raise sense, thereby prolong the ICD longevity and improve life-threatening ventricular tachyarrhythmia detection in the early and long-term period in patients with CAD.

Russian Journal of Cardiology. 2019;24(3):32–38

http://dx.doi.org/10.15829/1560-4071-2019-3-32-38

Key words: cardioverter-defibrillator, 99mTc-methoxy-isobutyl-isonitrile, defibrillating lead, cardiac scintigraphy, threshold, sense, impedance.

Conflicts of Interest: nothing to declare.

Tomsk National Research Medical Center, Tomsk, Russia.

Atabekov T. A. ORCID: 0000-0003-2645-4142, Batalov R. E. ORCID: 0000-0003-1415-3932, Krivolapov S. N. ORCID: 0000-0001-8121-8287, Sazonova S. I. ORCID: 0000-0003-2799-3260, Khlynyn M. S. ORCID: 0000-0002-9885-5204, Levintas A. D.

ORCID: 0000-0003-4313-0975, Popov S. V. ORCID: 0000-0002-9050-4493.

Received: 12.10.2018

Revision Received: 05.12.2018

Accepted: 12.12.2018

RENAL FUNCTION AND NON-CORONARY ATHEROSCLEROSIS PROGRESSION IN PATIENTS WITH CORONARY ARTERY DISEASE ONE YEAR AFTER CORONARY ARTERY BYPASS

Bezdenezhnykh A. V.1, Sumin A. N.1, Bezdenezhnykh N. A.1, Kazachek Ya. V.1, Barbarash O. L.1,2

Abstract

Aim. To study associations of the estimated glomerular filtration rate (eGFR) with non-coronary atherosclerosis progression criteria and risk factors one year after coronary bypass surgery (CABG).

Material and methods. Of the 732 patients consecutively operated (586 men and 146 women, median age 59 years), 504 people visited the study center 1 year after CABG. At the preoperative and annual stages, all patients were assessed with the same set of clinical, instrumental and laboratory methods, and the ankle-brachial index (ABI) was measured. The eGFR was calculated by the CKD-EPI formula. Depending on the severity of non-cardiac arterial stenoses, the following groups were identified: <30%; 30-49%; 50-69%; 70-99%; occlusion; absence of stenosis. The criteria for the atherosclerosis progression was the presence of at least one of the following: the transition of stenosis from one group to another; decrease in initially normal ABI <0,9; decrease in ABI initially abnormal (<0,9) by more than 10%. For the analysis, two groups were identified: group 1 (n=375) without progression and group 2 (n=129) with progression of atherosclerosis.

Results. Preoperatively, the number of patients with eGFR <60 ml/min/1,73 m2 was equal in both groups. At both control points, eGFR was higher in 1 group (p=0,072 and 0,025, respectively). During the year, eGFR increased in both groups with significant differences among first one (p<0,001). One year after the operation, eGFR positively correlated with ABI (p=0,004) and with total and low-density lipoprotein cholesterol levels. Polyvascular disease determined from 30% of stenosis, was negatively associated with preoperative and annual eGFR (p=0,011 and p=0,004, respectively) and from 50% — with eGFR calculated one year after CABG (p=0,006).

Conclusion. In patients with progression of non-coronary atherosclerosis 1 year after CABG CKD-EPI eGFR was lower compared to patients without progression. In the long-term period the estimated values of renal function are significantly higher in patients without atherosclerosis progression.

Russian Journal of Cardiology. 2019;24(3):39–47

http://dx.doi.org/10.15829/1560-4071-2019-3-39-47

Key words: coronary artery bypass, renal dysfunction, estimated glomerular filtration rate, atherosclerosis progression.

Conflicts of Interest: nothing to declare.

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

Bezdenezhnykh A. V. ORCID: 0000-0002-4420-4350, Sumin A. N. ORCID: 0000-0002-0963-4793, Bezdenezhnykh N. A. ORCID: 0000-0002-9396-4575, Kazachek Ya. V. ORCID: 0000-0002-1491-0799, Barbarash O. L. ORCID: 0000-0002-4642-3610.

Received: 12.09.2018

Revision Received: 12.11.2018

Accepted: 19.11.2018

COMPARATIVE ASSESSMENT OF KIDNEYS’ FUNCTIONAL STATE IN PATIENTS WITH ACUTE CORONARY SYNDROME

Balashkevich N. A.1, Dyusenova L. B.1, Zhetpisbaev B. A.1, Kazymov M. S.1, Izbasarova I. A.2, Borovikova O. A.3, Shalgumbaeva G. M.1

Abstract

Aim. To determine the severity of chronic kidney disease (CKD) in patients after acute coronary syndrome (ACS).

Material and methods. The study was conducted in Semey (Semipalatinsk), East Kazakhstan region. The case histories of patients with ACS who were admitted to the University Hospital of the State Medical University (Semey State Medical University) of the East Kazakhstan Region for 1 year were studied. A total of 659 case histories were analyzed, of which 263 were patients with myocardial infarction (MI), and 396 were patients with unstable angina (UA). The diagnostic criteria for CKD were: proteinuria, levels of creatinine, glomerular filtration rate (GFR) <60 ml/min/1,73 m2. CKD stage was determined by the parameters of GFR.

Results. The average proteinuria in patients with MI (Me=0,033) were higher than in patients with UA (Me=0,00), U=39564,5, Z=-5,579 p=0,000. The average values of creatinine in patients with MI were 10,26 mmol/l higher than in patients with UA

(t=3,333, df=657, p=0,001). The mean GFR values in patients with MI were lower by 4,69 L/min/1,73 m2 than in patients with UA (t=-3,794, df=657, p=0,000. The highest percentage of CKD in patients with ACS were in stage 2-3, the second stage of CKD was more often diagnosed in patients with UA.

Conclusion. The results of study allowed us to characterize the severity of CKD in patients undergoing ACS. We consider that widespread introduction of international and national clinical guidelines on the diagnosis, treatment and prevention of CKD in patients undergoing ACS is needed.

Russian Journal of Cardiology. 2019;24(3):48–53

http://dx.doi.org/10.15829/1560-4071-2019-3-48-53

Key words: acute coronary syndrome, myocardial infarction, unstable angina, chronic kidney disease.

Conflicts of Interest: nothing to declare.

1State Medical University, Semey, Republic of Kazakhstan; 2Astana Medical University, Astana, Republic of Kazakhstan; 3Omsk Region Clinical Hospital № 9, Omsk, Russia.

Balashkevich N. A. ORCID: 0000-0002-7382-9245, Dyusenova L. B. ORCID: 0000-0002-6745-7342, Zhetpisbaev B. A. ORCID: 0000-0003-0602-0865, Kazymov M. S. ORCID: 0000-0002-7763-3960, Izbasarova I. A. ORCID: 0000-0001-7345-2196, Borovikova O. A. ORCID: 0000-0003-2720-0953, Shalgumbaeva G. M. ORCID: 0000-0003-3310-4490.

Received: 24.09.2018

Revision Received: 29.11.2018

Accepted: 02.02.2019

THE PREDICTIVE VALUE OF PREPROCEDURAL LABORATORY DATA IN PATIENTS WITH CORONARY ARTERY RESTENOSIS IN VARIOUS TYPES OF STENTS

Shames D. V., Galyavich A. S., Galeeva Z. M., Baleeva L. V.

Abstract

Aim. To identify the effect of preprocedural laboratory parameters on the occurrence of in-stent restenosis in various types of stents, to assess the significance of gender, age and various forms of coronary artery disease (CAD) as risk factors for coronary artery restenosis after stenting.

Material and methods. The study included 436 patients with CAD, which were divided into 2 groups. The study group included 218 patients with in-stent restenosis. The control group consisted of 218 patients with CAD without in-stent restenosis. Inclusion criteria were acute or chronic form of CAD, age 45-74 years, CAG and percutaneous coronary intervention (PCI) with emergency or planned stenting of the native coronary artery, repeated CAG in history due to signs/symptoms of myocardial ischemia. Exclusion criteria: age younger than 45 years and over 74 years, coronary artery bypass surgery (CABG), cancer, autoimmune disease, anemia, liver failure, chronic kidney disease S4-S5, recent blood transfusion, hypo-or hyperthyroidism.

Results. According to the study, the risk in-stent restenosis is 5,2 times higher in patients in the 65-69 years age group and 9,9 times higher in the 70-74 years age group compared with the group of young patients (45-49 years). In-stent restenosis is 2,7 times more common in men than in women. Predictors of restenosis were red cell distribution width, mean platelet volume, Gensini score with OR 1,5; 1,4; 1,1; 1,5, respectively.

Conclusion. Risk factors for coronary artery restenosis after stenting are markers of chronic inflammation, such as the red cell distribution width, mean platelet volume. The risk of restenosis is higher in the male population. In old age, the risk of restenosis increases, however, young people and middle-aged people do not differ in risk of in-stent restenosis.

Russian Journal of Cardiology. 2019;24(3):54–59

http://dx.doi.org/10.15829/1560-4071-2019-3-54-59

Key words: restenosis, coronary artery disease, percutaneous coronary intervention, holometallic stent, drug-eluting stent, predictors.

Conflicts of Interest: nothing to declare.

Kazan State Medical University, Kazan, Russia.

Shames D. V. ORCID: 0000-0002-7613-836X, Galyavich A. S. ORCID: 0000-0002-4510-6197, Galeeva Z. M. ORCID: 0000-0002-9580-3695, Baleeva L. V. ORCID: 0000-0002-7974-5894.

Received: 10.02.2019

Revision Received: 14.02.2019

Accepted: 21.02.2019

NONINVASIVE ASSESSMENT OF THE FRACTIONAL RESERVE OF CORONARY BLOOD FLOW WITH A ONE-DIMENSIONAL MATHEMATICAL MODEL. PRELIMINARY RESULTS OF THE PILOT STUDY

Gognieva D. G.1, Gamilov T. M.1, Pryamonosov R. A.1,2, Vasilevsky Yu. V.1, Simakov S. S.1, Liang F.1,3, Ternovoy S. K.1, Serova N. S.1, Tebenkova E. S.1, Sinitsyn E. A.4, Pershina E. S.5, Abugov S. A.6, Mardanyan G. V.7, Zakryan N. V.8, Kirakosyan V. R.8, Betelin V. B.9, Mitina Yu. O.10, Gubina A. Yu.1, Shchekochikhin D. Yu.1, Syrkin A. L.1, Kopylov F. Yu.1

Abstract

Aim. To evaluate the diagnostic accuracy of a noninvasive method of fractional flow reserve (FFR) assessment based on a one-dimensional hemodynamic model build on data obtained from the coronary computed tomography angiography (CCTA).

Material and methods. The study enrolled 57 patients: 16 of them underwent 64-slice computed tomography — included retrospectively, 34 — prospectively, with a 640-slice CT scan. Specialists from the Laboratory of Mathematical Modeling processed CT images and evaluated noninvasive FFR. Ischemia was confirmed if FFR <0,80 and disproved if FFR ≥0,80. After that the prospective group of patients was hospitalized for invasive FFR assessment as a reference standard; if ischemia was proved, patients underwent stent implantation. In the retrospective group, patients already had invasive FFR values estimated.

Statistical analysis was performed using R programming language packages (cran-r.project.com). Continuous variables are presented as mean values ± standard deviations, order variables are presented as medians with interquartile ranges in parentheses. We used the D’Agostino-Pearson omnibus test for the assessment of normality of distribution; a Q-Q Plot was also constructed. We performed the Bland-Altman analysis and ROC-analysis for comparison of these two methods, and the Pearson’s chi-squared to assess the degree of correlation.

Results. During data processing, 3 patients of the retrospective and 34 patients of the prospective group were excluded from the study. The sensitivity of our method was 90,91% (95% CI; 58,72-99,77), specificity — 86,67% (95% CI; 59,54-98,34), P<0,05, accuracy — 88,46 (95% CI; 69,85-97,55) — in per-vessel analysis. In perpatient analysis, the sensitivity was 91,67% (95% CI; 61,52-99,79), specificity — 80% (95% CI; 28,36-99,49), (P<0,05); accuracy 88,24 (95% CI; 63,56-98,54).

Conclusion. Our method has quite a high accuracy and can be successfully used in clinical practice in order to enhance the diagnostic efficiency of the CCTA.

Russian Journal of Cardiology. 2019;24(3):60–68

http://dx.doi.org/10.15829/1560-4071-2019-3-60-68

Key words: noninvasive assessment of the fractional flow reserve, coronary artery disease, coronary computed tomography angiography.

Conflicts of Interest: nothing to declare.

Funding. The work was supported by RFBR grants 17-51-53160, 18-31-20048, 18-00-01524, Phiyu Liang’s work was supported by the National Natural Science Foundation of China (grant № 81611530715, 11832003). The funds were used to develop a model and a program for mathematical modeling of blood flow, part of the funds was spent on publishing articles in foreign publications.

1I. M. Sechenov First Moscow State Medical University, Moscow, Russia; 2Institute of Numerical Mathematics, Moscow, Russia; 3Shanghai Jiao Tong University, Shanghai, China; 4Lomonosov Moscow State University, Moscow, Russia; 5N. I. Pirogov City

Clinical Hospital № 1, Moscow, Russia; 6Russian Medical Academy of Continuous Professional Education, Moscow, Russia; 7B. V. Petrovsky Russian Research Center of Surgery, Moscow, Russia; 8Clinical hospital № 1 (Volyn), Moscow, Russia; 9Scientific Research Institute of System Analysis, Moscow, Russia; 10Skolkovo Institute of Science and Technology, Moscow, Russia.

Gognieva D. G. ORCID: 0000-0002-0451-2009, ResearcherID: Y-7900-2018, Gamilov T. M. ORCID: 0000-0002-1914-3859, ResearcherID: K-5849-2013, Pryamonosov R. A. ORCID: 0000-0001-8475-3808, ResearcherID: V-5421-2018, Vasilevsky Yu. V. ORCID: 0000-0002-4718-1377, ResearcherID: A-6068-2016, Simakov S. S. ORCID: 0000-0003-3406-9623; ResearcherID: A-7619-2013, Liang F. ORCID: 0000-0001-5012-486X, ResearcherID: J-3442-2014, Ternovoy S. K. ORCID: 0000-0003-4374-1063, ResearcherID: O-2630-2017, Serova N. S. ORCID: 0000-0003-2975-4431, ResearcherID: Р-2100-2017, Tebenkova E. S. ORCID: 0000-0003-4991-675X, ResearcherID: Y-9161-2018, Sinitsyn E. A. ORCID: 0000-0002-5649-2193, ResearcherID: A-5417-2016, Pershina E. S. ORCID: 0000-0002-3952-6865, ResearcherID: Y-8343-2018, Abugov S. A. ORCID: 0000-0001-7636-4044, ResearcherID: O-2006-2016, Mardanyan G. V. ORCID: 0000-0002-7442-520X, ResearcherID: K-1254-2018, Zakryan N. V. ORCID: 0000-0002-6632-3211, ResearcherID: Y-8689-2018, Kirakosyan V. R. ORCID: 0000-0001-8982-2018, ResearcherID: Y-8318-2018, Betelin V. B. ORCID: 0000-0001-6646-2660, ResearcherID: J-7375-2017, Mitina Yu. O. ORCID: 0000-0003-3742-7959, ResearcherID: Y-7930-2018, Gubina A. Yu. ORCID: 0000-0001-5206-3191, ResearcherID: Y-7935-2018, Shchekochikhin D. Yu. ORCID: 0000-0002-8209-2791, ResearcherID: E-6188-2017, Syrkin A. L. ORCID: 0000-0002-6452-1222, ResearcherID: N-1789-2017, Kopylov F. Yu. ORCID: 0000-0001-5124-6383, ResearcherID: Y-8275-2018.

Received: 22.12.2018

Revision Received: 04.02.2019

Accepted: 11.02.2019

POSSIBILITIES OF MAGNETIC RESONANCE IMAGING IN PREDICTING OF THE CRITICAL REDUCTION OF LEFT VENTRICLE CONTRACTILE FUNCTION IN PATIENTS WITH CORONARY ARTERY DISEASE AFTER DIRECT MYOCARDIAL REVASCULARIZATION

Kryukov N. A., Ryzhkov A. V., Sukhova I. V., Ananyevskaya P. V., Fokin V. A., Gordeev M. L.

Abstract

Aim. To identify the criteria for reversibility of structural changes in the myocardium of patients with coronary artery disease after revascularization based on analysis of data obtained using magnetic resonance imaging (MRI).

Materials and methods. We studied the long-term results of surgical treatment of 53 patients with critical reduction of left ventricle contractile function (ejection fraction less than 30%) undergoing coronary bypass surgery. Before the operation, all patients underwent cardiac MRI and transthoracic echocardiography (EchoCG). Immediate and long-term results were assessed according to EchoCG.

Results. The average observation period was 25,0±15,4 months. We found that significant predictors of improving of left ventricle contractile function are diastolic interventricular septum thickness (according to EchoCG and MRI) >10,5 mm (p<0,05); diastolic posterior wall thickness (according to EchoCG and MRI) >9,5 mm (p<0,05); degree of initially scarred myocardium according to MRI <33 points (p<0,05).

Conclusion. Detection of a viable myocardium is a prognostically important sign of a possible improvement in the functional state of left ventricle after revascularization surgery in patients with coronary artery disease, complicated by a critical reduction of myocardium contractile function. Thus, this problem can be solved by contrasting MRI.

Russian Journal of Cardiology. 2019;24(3):69–75

http://dx.doi.org/10.15829/1560-4071-2019-3-69-75

Key words: coronary artery disease, ischemic cardiomyopathy, heart failure, coronary artery bypass surgery, direct revascularization, myocardial viability.

Conflicts of Interest: nothing to declare.

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

Kryukov N. A. ORCID: 0000-0001-6185-645X, ResearcherID: X-5522-2018, Ryzhkov A. V. ORCID: 0000-0001-5226-1104, ResearcherID: X-8943-2018, Sukhova I. V. ORCID: 0000-0002-7313-5307, ResearcherID: Y-7513-2018, Ananyevskaya P. V. ORCID: 0000-0003-4725-9477, ResearcherID: Y-4435-2018, Fokin V. A. ORCID: 0000-0002-0539-7006, ResearcherID: P-9511-2015, Gordeev M. L. ORCID: 0000-0001-5362-3226, ResearcherID: Y-6034-2018.

Received: 30.11.2018

Revision Received: 10.01.2019

Accepted: 17.01.2019

PREVENTION OF CHRONIC KIDNEY DISEASE PROGRESSION IN PATIENTS WITH ACUTE DECOMPENSATION OF CHRONIC HEART FAILURE

Davydov V. V.1, Arekhina E. L.2

Abstract

Aim. To assess the efficiency of the program of prevention of chronic kidney disease (CKD) progression in patients with acute decompensation of chronic heart failure (CHF). The program included the use of nitrendipine, a calcium channel antagonist, and the replacement of single intravenous bolus dosing of furosemide with a prolonged intravenous infusion in the early stage of the disease.

Material and methods. One hundred twenty five patients with decompensation of CHF were examined and divided into 2 groups. Group 1 received standard therapy. In the group 2, an additional prevention program was carried out. The criterion of CKD progression was the change in glomerular filtration rate (GFR) in accordance with the KDIGO guidelines (2012). GFR was calculated by two methods: serum creatinine and cystatin C levels. The parameters were monitored and compared with baseline levels at admission to the hospital and on the 10th day of therapy. For the initial level was taken the patient’s GFR, calculated by the serum creatinine level prior to the present hospitalization on the background of a satisfactory condition.

Results. At admission to the hospital, in group 1 CKD progression was established in 33,3% of patients, in group 2 — in 29,3%. On the 10th day, CKD progression was noted in 47,4% of patients in group 1, in group 2 — in 23,4%.

Conclusion. The prevention program allows to reduce the number of cases of CKD progression in patients with decompensation of CHF by 2 times.

Russian Journal of Cardiology. 2019;24(3):76–81

http://dx.doi.org/10.15829/1560-4071-2019-3-76-81

Key words: chronic kidney disease, chronic heart failure.

Conflicts of Interest: nothing to declare.

1Altai State Medical University, Barnaul; 2City Hospital № 8, Barnaul, Russia.

Davydov V. V. ORCID: 0000-0001-7667-910X, Arekhina E. L. ORCID: 0000-0002-7049-5585.

Received: 04.02.2019

Revision Received: 17.02.2019

Accepted: 19.03.2019

SUPPORTING A PRACTITIONER

POSSIBLE ASSOCIATIONS BETWEEN RECOVERY AEROBIC TRAINING AND INCREASING THE LENGTH OF TELOMERES

Aronov D. M.

Abstract

It is known that in recent decades, methods of cardiac rehabilitation have been widely used in patients after acute myocardial infarction, coronary syndrome and cardiac operations. The main active factor in cardiac rehabilitation is a program of physical training. On the other hand, it has been established that physical training and/or sufficient physical activity positively affects the length of human telomeres. It is assumed that under the influence of cardiac rehabilitation, the improvement in the course of the disease may be due to an increase in telomere length. We found studies with such positive associations. This primarily concerns people with prediabetes, overweight, multiple risk factors. We established the importance of training in physically active people, athletes, especially with great sports experience. It seems promising to perform studies (training/telomeres) in patients with history

of acute myocardial infarction, acute coronary syndrome and cardiac surgery.

Russian Journal of Cardiology. 2019;24(3):82–89

http://dx.doi.org/10.15829/1560-4071-2019-3-82-89

Key words: telomere, telomerase, physical training, cardiac rehabilitation.

Conflicts of Interest: nothing to declare.

National Medical Research Center for Preventive Medicine, Moscow, Russia.

Aronov D. M. ORCID: 0000-0003-0484-9805.

Received: 11.02.2019

Revision Received: 17.02.2019

Accepted: 25.02.2019

CLINIC AND PHARMACOTHERAPY

CONSEQUENCES OF ESCALATION AND DE-ESCALATION OF DOUBLE ANTIPLATELET THERAPY IN PATIENTS WITH ACUTE CORONARY SYNDROME IN REAL CLINICAL PRACTICE

Shamraev R. L.1,2, Ilyukhin O. V.2, Ivanenko V. V.1, Merzlyakov S. G.1, Lopatin Yu. M.2

Abstract

In recent years, the problem of P2Y12 inhibitor switching, called escalation and de-escalation of double antiplatelet therapy (DAPT), in patients with acute coronary syndrome (ACS) has been the subject of active discussion.

Aim. To assess the frequency and clinical consequences of transition from ticagrelor to clopidogrel and from clopidogrel to ticagrelor in real clinical practice in patients with ACS.

Material and methods. Three hundred eight patients with ACS were included in the open, observational study. 121 patients (39,3%) receive conservative treatment, and 187 (60,7%) had invasive management tactics — percutaneous coronary interventions (PCI). In the group of conservative treatment switching from ticagrelor to clopidogrel and back was performed in 7 (5,8%) and 12 (9,9%) patients, respectively. In the second group switching from ticagrelor to clopidogrel and back were observed in 42 (34,7%) and 41 (33,9%) patients, respectively. Switching from one P2Y12 inhibitor to another occurred on 2-4 months from the beginning of therapy. The frequency of the following adverse events was chosen as the primary end point: death, re-infarction, re-hospitalization due to the development of chest pain syndrome, the need for coronary angiography or PCI.

Results. In both groups of patients with ACS, the best survival was shown by patients who had an escalation of DAPT. In turn, during de-escalation, a significant decrease in survival cases was observed with the onset of one of the endpoint events (RR 2,88 with 95% CI 1,23-6,78; p<0,02).

Conclusion. The study indicates a high frequency of de-escalation and escalation of DAPT, carried out in the outpatient management of patients undergoing ACS. There is a need of additional issue-related studies.

Russian Journal of Cardiology. 2019;24(3):90–97

http://dx.doi.org/10.15829/1560-4071-2019-3-90-97

Key words: acute coronary syndrome, ticagrelor, clopidogrel, balloon dilatation angioplasty, percutaneous coronary intervention, coronary artery disease, acute myocardial infarction.

Conflicts of Interest: nothing to declare.

1Volgograd Regional Clinical Cardiology Center, Volgograd; 2Volgograd State Medical University, Volgograd, Russia.

Shamraev R. L. ORCID: 0000-0002-3337-7184, Ilyukhin O. V. ORCID: 0000-0002-4514-5145, Ivanenko V. V. ORCID: 0000-0003-3271-5257, Merzlyakov S. G. ORCID: 0000-0002-1762-1773, Lopatin Yu. M. ORCID: 0000-0003-1943-1137.

Received: 12.09.2018

Revision Received: 26.12.2018

Accepted: 03.03.2019

CLINICAL CASES

MYOCARDIAL INFARCTION AND TURNER SYNDROME

Galyavich A. S.1, Galeeva Z. M.1, Baleeva L. V.1, Safina E. G.2, Murzina E. A.2, Kuvshinova L. E.2, Gizatullina N. F.2

Russian Journal of Cardiology. 2019;24(3):98–100

http://dx.doi.org/10.15829/1560-4071-2019-3-98-100

Key words: myocardial infarction, Turner syndrome.

Conflicts of Interest: nothing to declare.

1Kazan State Medical University, Kazan; 2Interregional Clinical Diagnostic Center, Kazan, Russia.

Galyavich A. S. ORCID: 0000-0002-4510-6197, Galeeva Z. M. ORCID: 0000-0002-9580-3695, Baleeva L. V. ORCID: 0000-0002-7974-5894, Safina E. G. ORCID: 0000-0002-4315-3678, Murzina E. A. ORCID: 0000-0003-1275-2800, Kuvshinova L. E.

ORCID: 0000-0003-1196-3331, Gizatullina N. F. ORCID: 0000-0001-7677-2937.

Received: 12.02.2019

Revision Received: 18.02.2019

Accepted: 25.02.2019

STAGED APPROACH TO TREATING A PATIENT WITH CORONARY ARTERY DISEASE AND VENTRICULAR ARRHYTHMIAS

Artyukhina E. A., Strebkova E. D., Revishvili A. Sh.

Abstract

The presented clinical case demonstrates an individual choice of a staged comprehensive approach to interventional treatment of a patient with coronary artery disease and ventricular tachyrhythmias, focused on myocardial revascularization and interventional abolition of ventricular tachyrhythmias.

Russian Journal of Cardiology. 2019;24(3):101-105

http://dx.doi.org/10.15829/1560-4071-2019-3-101-105

Key words: ventricular tachyrhythmias, radiofrequency ablation, substrate mapping.

Conflicts of Interest: nothing to declare.

A. V. Vishnevsky National Medical Research Center of Surgery, Moscow, Russia.

Artyukhina E. A. ORCID: 0000-0001-7065-0250, Strebkova E. D. ORCID: 0000-0001-5837-7255, ResearcherID: C-3956-2019, Revishvili A. Sh. ORCID: 0000-0003-1791-9163.

Received: 16.01.2019

Revision Received: 02.02.2019

Accepted: 11.02.2019

EXPERT CONSENSUS

Fourth universal definition of myocardial infarction (2018)

Kristian Thygesen (Denmark), Joseph S. Alpert (USA), Allan S. Jaffe (USA), Bernard R. Chaitman (USA), Jeroen J. Bax (The Netherlands), David A. Morrow (USA), Harvey D. White (New Zealand): the Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction

Russian Journal of Cardiology 2019;24(3):107–138

http://dx.doi.org/10.15829/1560-4071-2019-3-107-138

Key words: Expert Consensus Document, myocardial infarction, Type 1 MI, Type 2 MI, Type 3 MI, Type 4a MI, Type 4b MI, Type 4c MI, Type 5 MI, cardiac troponin, high sensitivity cardiac troponin, myocardial injury, prior myocardial infarction, silent myocardial infarction, recurrent myocardial infarction, re-infarction, cardiac procedural myocardial injury, takotsubo syndrome, myocardial infarction with nonobstructive coronary arteries (MINOCA).

3 апреля 2019 г.
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