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Russian Journal Of Cardiology, 2019, 24 (5)

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Russian Journal of Cardiology. 2019;24(5):5

CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news
Russian Journal of Cardiology. 2019;24(5):6

ORIGINAL ARTICLES

REGISTER OF PATIENTS WITH FAMILIAL HYPERCHOLESTEROLEMIA AND PATIENTS OF VERY HIGH CARDIOVASCULAR RISK WITH LIPID-LOWERING THERAPY UNDERPERFORMANCE (RENESSANS)
Yezhov M. V.1, Bliznyuk S. A.1, Tmoyan N. A.1, Rozhkova T. A.1, Duplyakov D. V.2, Salchenko V. A.2, Kachkovsky M. A.3, Shaposhnik I. I.4, Genkel V. V.4, Gurevich V. S.5, Urazgildeeva S. A.5, Tregubov A. V.5, Muzalevskaya M. V.5, Bazhan S. S.6, Timoshchenko O. V.6, Urvantseva I. A.7, Kozhokar K. G.7, Sokolov A. A.8, Tishko V. V.8, Boyeva O. I.9, Bolotova E. V.10, Namitokov A. M.10, Kushnaryova Yu. B.11, Kuznetsova T. Yu.12, Korneva V. A.12, Bogdanov D. Yu.13, Chichina E. E.14, Solovyov V. M.15, Ershova A. I.16, Meshkov A. N.16, Makogonenko V. I.16, Galyavich A. S.17, Sadykova D. I.17, Pomogaybo B. V.18, Barbarash O. L.19, Kashtalap V. V.19, Shutemova E. A.20, Isaeva I. G.20, Khokhlov R. A.21, Oleynikov V. E.22, Avdeeva I. V.22, Malakhov V. V.1, Chubykina U. V.1, Konstantinov V. O.23, Aliyeva A. S.24, Ovsyannikova V. V.25, Furmenko G. I.25, Chernykh T. M.25, Abashina O. E.26, Dzhanibekova A. R.27, Slastnikova E. S.28, Galimova L. F.28, Duplyakova P. D.29, Voyevoda M. I.6

Abstract
Aim. Russian multicenter register of familial hypercholesterolemia (FH) was transformed into Register of patients with FH and very high cardiovascular risk with insufficient effect of hypolipidemic therapy (RENESSANS Registry) in 2017. The aim of RENESSANS was maximal inclusion of patients not only with FH, but also those with atherosclerotic cardiovascular diseases (CVD), who did not achieve targeted level of low density lipoprotein cholesterol (LDL-C) using hypolipidemic drug therapy.
Material and methods. The RENESSANS Registry is an open, national, observing study that includes patients with definite and probable (according to Dutch lipid clinic network and Simon Broome Registry criteria) heterozygous and homozygous FH, as well as patients of very high cardiovascular risk. There were designed two register forms: for patients with FH and for very high cardiovascular risk patients. Doctors filled out forms in paper and electronic variants. They took into consideration the risk factors of atherosclerosis and anamnesis of CVD, adherence to diet and hypolipidemic therapy. Concentrations of total cholesterol (TC),
triglycerides (TG), high density lipoprotein cholesterol (HDL-C) were measured in blood serum in all centers. LDL-C level was defined according to Friedewald formula: LDL-C=TC-HDL-C-TG/2,2 (mmol/l).
Results. The Registry consisted of 1208 FH patients and 497 patients with very high risk (average age 54±13 and 61±8, respectively, 37% men). Baseline levels of lipids were 9,4±2,3 and 6,9±1,5 mmol/l for TC, 6,6±2,1 and 4,5±1,3 mmol/l for LDLC,
respectively. The frequency of hypolipidemic therapy in both groups is 70%, while targeted level of LDL-C was achieved extremely rarely.
Conclusion. The results show insufficient adherence and low effectiveness of standard hypolipidemic therapy both in patients with FH and very high cardiovascular risk. PCSK9 inhibitors are recommended for resistant hypercholesterolemia treatment. The RENESSANS Registry allows to improve FH diagnostics, to assess treatment effectiveness and choose patients who need treatment with PCSK9 inhibitors.

Russian Journal of Cardiology. 2019;24 (5):7–13
dx.doi.org/10.15829/1560-4071-2019-5-7-13

Key words: familial hypercholesterolemia, registry, atherosclerotic cardiovascular diseases, very high risk.

Conflicts of Interest. This study was supported by Amgen and Sanofi-Aventis Group.

1National Medical Research Center of Cardiology of the Ministry of Health of Russia, Moscow; 2Samara Region Clinical Cardiology Dispensary, Samara; 3Medical University “Reaviz”, Samara; 4South-Ural State Medical University, Chelyabinsk; 5Center of Atherosclerosis and Disorders of Lipid Metabolism, St. Petersburg State University, St. Petersburg; 6Research Institute for treatment and preventive medicine, Novosibirsk; 7District Cardiac Dispensary, Center for Diagnostic and Cardiovascular Surgery, Surgut; 8Military medical academy of S. M. Kirov, St. Petersburg; 9Stavropol State Medical University, Ministry of Health of Russia, Stavropol; 10SRI — S. V. Ochapovsky Regional Clinical Hospital № 1, Ministry of Health of Krasnodarsky Krai, Krasnodar; 11A. A. Vishnevsky Central Military Clinical Hospital № 3, Moscow Region; 12Petrozavodsk State University, Petrozavodsk; 13Vladivostok Clinical Hospital № 1, Vladivostok; 14Sakhalin Regional Clinical Hospital, Yuzhno-Sakhalinsk; 15Yu. E. Veltischev Research and Clinical Institute for Pediatrics, N. I. Pirogov Russian National Research Medical University (RNRMU), Moscow; 16National Medical Research Center for Preventive Medicine, Moscow; 17Kazan State Medical University, Ministry of Health of Russia, Kazan; 18413 Military hospital, Volgograd; 19Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo; 20Cardiology Dispensary, Ivanovo; 21Voronezh Regional Clinical Consulting and Diagnostic Center, Voronezh; 22Penza State University, Penza; 23I. I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, St. Petersburg; 24Almazov National Medical Research Center, St. Petersburg; 25N. N. Burdenko Voronezh State Medical University, Ministry of Health of Russia, Voronezh; 26V. D. Seredavin Samara Regional Clinical Hospital, Samara; 27City Clinical Hospital № 3, Stavropol; 28Republican Children’s Clinical Hospital, Ministry of Health of Tatarstan, Kazan; 29Samara State Medical University, Ministry of Health of Russia, Samara, Russia.

Yezhov M. V. ORCID: 0000-0002-1518-6552, Bliznyuk S. A. ORCID: 0000-0002-2619-1592, Tmoyan N. A. ORCID: 0000-0002-3617-9343, ResearcherID: E-3371-2018, Rozhkova T. A. ORCID: 0000-0003-3971-2606, Duplyakov D. V. ORCID: 0000-0002-6453-2976, Salchenko V. A. ORCID: 0000-0001-9254-3544, Kachkovsky M. A. ORCID: 0000-0002-3628-5146, Shaposhnik I. I. ORCID: 0000-0002-7731-7730, Genkel V. V. ORCID: 0000-0001-5902-3803, Gurevich V. S. ORCID: 0000-0002-6815-444X, Urazgildeeva S. A. ORCID: 0000-0003-3046-372X, Tregubov A. V. ORCID: 0000-0002-9118-5850, Muzalevskaya M. V. ORCID: 0000-0002-7954-8567, Bazhan S. S. ORCID: 0000-0001-6170-3883, Timoshchenko O. V. ORCID: 0000-0001-7226-3043, Urvantseva I. A. ORCID: 0000-0002-5545-9826, Kozhokar K. G. ORCID: 0000-0002-5638-1696, Sokolov A. A. ORCID: 0000-0001-7004-0903, Tishko V. V. ORCID: 0000-0003-4696-3569, Boyeva O. I. ORCID: 0000-0002-1816-8309, Bolotova E. V. ORCID: 0000-0001-6257-354X, Namitokov A. M. ORCID: 0000-0002-5866-506X, Kushnaryova Yu. B. ORCID: 0000-0002-1931-5390, Kuznetso-va T. Yu. ORCID: 0000-0002-6654-1382, Korneva V. A. ORCID: 0000-0003-2231-4695, Bogdanov D. Yu. ORCID: 0000-0002-8388-5566, Chichina E. E. ORCID: 0000-0002-1884-053X, Solovyov V. M. ORCID: 0000-0003-4608-0168, Ershova A. I. ORCID: 0000-0001-7989-0760, Meshkov A. N. ORCID: 0000-0001-5989-6233, Makogonenko V. I. ORCID: 0000-0002-5375-7328, Galyavich A. S. ORCID: 0000-0002-4510-6197, Sadykova D. I. ORCID: 0000-0002-6662-3548, Pomogaybo B. V. ORCID: 0000-0003-0093-0868, Barbarash O. L. ORCID: 0000-0002-4642-3610, Kashtalap V. V. ORCID: 0000-0003-3729-616X, Shutemova E. A. ORCID: 0000-0002-5324-3570, Isaeva I. G. ORCID: 0000-0001-6738-3518, Khokhlov R. A. ORCID: 0000-0002-3539-026X, Oleynikov V. E. ORCID: 0000-0002-7463-9259, Avdeeva I. V. ORCID: 0000-0003-4266-5900, Malakhov V. V. ORCID: 0000-0002-6379-5694, Chubykina U. V. ORCID: 0000-0003-2760-2792, Konstantinov V. O. ORCID: 0000-0003-0805-1593, Aliyeva A. S. ORCID: 0000-0002-9845-331X, Ovsyannikova V. V. ORCID: 0000-0003-0715-5905, Furmenko G. I. ORCID: 0000-0001-9112-505X, Chernykh T. M. ORCID: 0000-0003-2673-091Х, Abashina O. E. ORCID: 0000-0002-5302-6381, Dzhanibekova A. R. ORCID: 0000-0002-4719-9980, Slastnikova E. S. ORCID: 0000-0002-1732-
7443, Galimova L F. ORCID: 0000-0001-5576-5279, Duplyakova P. D. ORCID: 0000-0003-2773-1682, Voyevoda M. I. ORCID: 0000-0001-9425-413X.

Received: 24.04.2019
Revision Received: 06.05.2019
Accepted: 15.05.2019

THE PROGNOSTIC VALUE OF VARIOUS MARKERS OF LOWER LIMB ATHEROSCLEROTIC LESIONS IN PATIENTS WITH HIGH AND VERY HIGH CARDIOVASCULAR RISK
Genkel V. V., Shaposhnik I. I.

Abstract
Aim. To study the prognostic significance of markers of atherosclerosis of lower limb arteries (LLA) in patients with high and very high cardiovascular risk (CVR).
Material and methods. The study included 108 patients with high and very high CVR, the median age of which was 62,0 (55,7; 67,0) years. All patients underwent duplex scanning of the LLA, as well as measurement of the ankle-brachial index (ABI) by the Doppler method. The combined end point was cardiovascular death, nonfatal myocardial infarction or unstable angina, requiring hospitalization, nonfatal stroke, coronary revascularization.
Results. Atherosclerotic plaques in LLA were detected in 69,4% of cases, while a decrease in ABI was detected in 22,2% of patients, and LLA stenosis more than 50% — in 36,1%. The follow-up duration was 25,0 (14,5; 35,5) months. The adverse cardiovascular events occurred in 41 (37.9%) patients. According to the Cox regression results, the following indicators had an independent predictive value in relation to the development of adverse cardiovascular events: a decrease in ABI ≤0,9 (RR 2,23; 95% CI 1,01-4,94; p=0,048), LLA stenosis ≥40% (RR 3,17; 95% CI 1,27-7,92; p=0,013) and the presence of plaque in the popliteal arteries (RR 2,49; 95% CI 1,27-7,92; p=0,013).
Conclusion. In the group of patients with high and very high CVR, among ultrasonographic markers of lower limb arteriosclerosis, independent predictive value regarding the development of adverse cardiovascular events had a decrease in ABI ≤0,9, the presence of plaque in the popliteal arteries and LLA stenosis was more than 40%.

Russian Journal of Cardiology. 2019;24 (5):14–19
dx.doi.org/10.15829/1560-4071-2019-5-14-19

Key words: atherosclerosis, lower limb arteries, cardiovascular risk, adverse cardiovascular events, ankle-brachial index.

Conflicts of Interest: nothing to declare.

South Ural State Medical University, Chelyabinsk, Russia.

Genkel V. V. ORCID: 0000-0001-5902-3803, Shaposhnik I. I. ORCID: 0000-0002-7731-7730, ResearcherID: O-3864-2018.

Received: 29.03.2019
Revision Received: 26.04.2019
Accepted: 06.05.2019

EVALUATING OF THE ACCURASY OF CARDIOVASCULAR EVENTS PREDICTING USING SCORE SCALE AND ULTRASOUND VISUALIZATION OF ATHEROSCLEROTIC PLAQUE IN PATIENTS OF MULTI-DISCIPLINARY HOSPITAL IN SAINT-PETERSBURG: MEDIUM-TERM MONITORING DATA
Bershtein L. L., Golovina A. E., Katamadze N. O., Bondareva E. V., Saiganov S. A.

Abstract
Aim. To compare the accuracy of predicting the risk of fatal and non-fatal cardiovascular events (CVE) based on SCORE scaling and ultrasound imaging of carotid atherosclerotic plaque (AP) in patients without manifested atherosclerotic cardiovascular disease (ACVD) in a multidisciplinary hospital.
Material and methods. We examined 841 patients (353 men) (avearage age 54,9±8), with at least 1 traditional cardiovascular risk factor without manifested ACVD. Ultrasound examination of the carotid arteries was performed in all patients. Patients with nonstenotic AP constituted the AP+ group, and without AP — the APgroup (356 and 485 people, respectively). Median of follow-up time was 4 years, (minimum — 2, maximum — 6 years). The endpoints included: a verified diagnosis of acute coronary syndrome, chronic coronary artery disease, planned coronary revascularization, ischemic stroke, and/or transient ischemic attack, cardiac death.
Results. Nonstenotic AP of carotid arteries was detected in 352 people (42%), including 64 (23%) in low and 182 (46%) in moderate SCORE risk. 127 CVE (17,8%) occurred during the follow-up, 84 (66% of the total) of them in the AP+ group. The actual frequency of development of the cumulative endpoint was significantly higher than the calculated rate (the ratio of actua predicted events was 1,6, 5,1 and 7,9 for high, moderate and low SCORE risk, respectively). According to the multivariate regression analysis, the OR for AP as a predictor of cardiovascular events cardiovascular events CVE was 2,54 (95% CI 1,6-4,04), and was significantly higher than the SCORE index (1,04, 95% CI 0,01-1,07). As a predictor of CVE, AP had the greatest value in the low SCORE risk group (the number of CVE in the low SCORE risk group was14 among patients with AP vs 10 among patients without AP, p=0,001).
Conclusion. The use of SCORE scale underestimates the actual risk of CVE especially in patients with low and moderate calculated SCORE risk. Ultrasound visualization of AP of the carotid arteries in these patients predicts the risk of cardiovascular disease much more accurately.

Russian Journal of Cardiology. 2019;24 (5):20–25
dx.doi.org/10.15829/1560-4071-2019-5-20-25

Key words: atherosclerotic plaque, ultrasound of carotid arteries, cardiovascular risk.

Conflicts of interest: nothing to declare.

I. I. Mechnikov North-Western State Medical University, St. Petersburg, Russia.

Bershtein L. L. ORCID: 0000-0002-9444-159X, Golovina A. E. ORCID: 0000-0002-3807-5994, Katamadze N. O. ORCID: 0000-0002-3172-0305, Bondareva E. V. ORCID: 0000-0001-7436-3048, Saiganov S. A. ORCID: 0000-0001-7319-2734.

Received: 07.10.2018
Revision Received: 09.01.2019
Accepted: 02.02.2019

ASSOCIATION OF ENDOTHELIAL DYSFUNCTION FACTORS WITH THE PRESENCE OF UNSTABLE ATHEROSCLEROTIC PLAQUES IN THE CORONARY ARTERIES
Ragino Yu. I.1, Stryukova E. V.1, Murashov I. S.2, Polonskaya Ya. V.1, Volkov A. M.2, Kashtanova E. V.1, Kurguzov A. V.2, Chernyavsky A. M.2

Abstract
Aim. To study factors of endothelial dysfunction in order to find their associations with coagulation factors, inflammatory markers and unstable atherosclerotic plaques in the coronary arteries in men with coronary atherosclerosis.
Material and methods. The study included men with coronary atherosclerosis without acute coronary syndrome. We assessed blood concentrations of endothelial dysfunction factors (endothelin 1, monocyte chemoattractant protein-1 (MCP-1), adhesion molecules sVCAM-1, asymmetric dimethylarginine, homocysteine, plasminogen activator inhibitor-1) blood coagulation (factor II, factor VII, factor XII, antithrombin III), biomarkers of inflammation (tumor necrosis factor alpha, interleukins (IL-1-beta, IL-6, IL-8), C-reactive protein).
Results. The presence of unstable atherosclerotic plaques was associated with an increased blood level of MCP-1 (1,9 times higher; p<0,05) and a reduced concentration of sVCAM-1 (1,4 times lower; p<0,05) compared with men who without unstable plaques in the coronary arteries. The largest number of correlations was found between the level of MCP-1 in blood, concentrations of factor VII, antithrombin III, IL-8, C-reactive protein, IL-1 beta and the presence of unstable atherosclerotic plaques in men.
Conclusion. The results showed that the relative risk of unstable atherosclerotic plaques in the coronary arteries is associated with an increased level of MCP-1 in the blood.

Russian Journal of Cardiology. 2019;24 (5):26–29
dx.doi.org/10.15829/1560-4071-2019-5-26-29

Key words: endothelial dysfunction, monocyte chemoattractant protein-1, adhesive molecules sVCAM-1, stable and unstable atherosclerotic plaques in the coronary arteries, blood.

Conflicts of Interest: nothing to declare.

Funding. The work was carried out within the framework of State tasks № 0324-2018-0002, № 0324-2017-0048 and with the financial support of the RFBR Grant № 17-04-02120а.

1Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk; 2E. N. Meshalkin National Research Medical Center, Novosibirsk, Russia.

Ragino Yu. I. ORCID: 0000-0002-4936-8362, Stryukova E. V. ORCID: 0000-0001-5316-4664, Murashov I. S. ORCID: 0000-0002-3712-1258, Polonskaya Ya. V. ORCID: 0000-0002-3538-0280, Volkov A. M. ORCID: 0000-0001-9697-7091, Kashtanova E. V. ORCID: 0000-0003-2268-4186, Kurguzov A. V. ORCID: 0000-0003-1345-2199, Chernyavsky A. M. ORCID: 0000-0001-9818-8678.

Received: 12.02.2019
Revision Received: 18.03.2019
Accepted: 25.03.2019

THE ECHOGENICITY OF ATHEROSCLEROTIC PLAQUES IN THE CAROTID ARTERIES IN PATIENTS WITH ACUTE CORONARY SYNDROME AND ITS EFFECT ON THE PROGNOSIS OF CARDIOVASCULAR EVENTS
Guchaeva D. A., Tripoten M. I., Pogorelova O. A., Kheimets G. I., Shakhnovich R. M., Balakhonova T. V.

Abstract
Some studies have shown that the echogenicity of atherosclerotic plaques (AP) in the carotid arteries (CA) plays an important role in evaluating the risk of cardiovascular events (CVE). The method of calculating the Gray Scale Median (GSM) is currently used to quantify the echogenicity of the CA plaque.
Aim. To study GSM assessment of CA AP in patients with acute coronary syndrome (ACS) and the effect of GSM on the prognosis of CVE.
Material and methods. We examined 143 patients with ACS (32-83 years old). Duplex scanning was performed on “Philips iU 22” for 1-3 days after hospitalization, the second — in 1-1,5 years. The echogenicity of the detected APs was assessed on a gray scale using a modified GSM method at the Multivox workstation.
Results. We analyzed 378 CA AP in patients with ACS. The GSM analysis on the first and repeated surveys showed a significant increase in the average GSM by 2,2% (p<0,05). During follow-up, 23% of patients had various cardiovascular diseases (death, MI, exacerbation of coronary artery disease, repeated coronary artery revascularization, stroke). Results of GSM analysis of patients with and without CVE revealed statistically significant changes: GSM AP decrease in patients with CVE by 7,8% (p<0,05), and an increase in GSM in patients without CVE by 6,1% (p<0,05). ROC analysis showed that a relative decrease in GSM ≥6,96% with a sensitivity of 53,5% and a specificity of 71,1% determines the development of an unfavorable outcome (the area under the curve is 0,628±0,0465; 95% CI 0,55-0,7), p=0,006). The risk of CVE developing increased by 2,16 times with a decrease in GSM dynamics by more than 6,96% (RR 2,16; 95% CI 1,3-3,5; p=0,009).
Conclusion. The results of study show the importance of assessing the echogenicity of CA AP in patients with ACS. A decrease in the echogenicity of AP in such patients over time may indicate an increase in the risk of CVE developing and may be the reason to correct the therapy.
Russian Journal of Cardiology. 2019;24 (5):30–36
dx.doi.org/10.15829/1560-4071-2019-5-30-36

Key words: ACS, ultrasound, atherosclerotic plaque, echogenicity, GSM, prognosis.

Conflicts of Interest: nothing to declare.

National Medical Research Center of Cardiology, Moscow, Russia.

Guchaeva D. A. ORCID: 0000-0002-3977-0112, Tripoten M. I. ORCID: 0000-0003-4462-3894, Pogorelova O. A. ORCID: 0000-0001-7897-4727, Kheimets G. I. ORCID: 0000-0003-3672-1830, Shakhnovich R. M. ORCID: 0000-0003-3248-0224, Balakhonova T. V. ORCID: 0000-0002-7273-6979.

Received: 15.04.2019
Revision Received: 24.04.2019
Accepted: 06.05.2019

MODEL FOR CALCULATING THE RISK OF VENOUS THROMBOSIS
Golub A. V.1, Bokarev I. N.2, Popova L. V.3, Gerasimov A. N.3, Kanevskaya M. Z.4, Khlevchuk T. V.3, Kondratieva T. B.3, Aksenova M. B.3, Patrushev L. V.4, Kovalenko T. F.4, Belenkov Yu. N.3

Abstract
Aim. To develop a model for calculating the risk of venous thrombosis, taking into account the presence of known risk factors, comorbidity and congenital thrombophilia.
Material and methods. During the study (2015 to 2017), 79 patients with venous thrombosis were examined (36 men and 43 women, mean age — 56,76±15,570). The control group consisted of 83 patients and healthy volunteers without thrombosis at the moment and in history (35 men and 48 women, average age — 43,95±18,136). All individuals included in the study were analyzed
for the presence of G1691A mutations in the factor V gene, G20210A in the prothrombin gene, C677T polymorphism in the 5,10-methylenetetrahydrofolate reductase gene, and polymorphism in the SERPINE1 gene of plasminogen activator inhibitor. Real-time polymerase chain reaction was used to identify mutations. To create a risk calculation model, a linear regression analysis was performed.
Results. We have developed a model for calculating the risk of venous thrombosis. The resulting formula showed high prognostic accuracy (the area under the ROC curve is 95,9%). For patients who do not have data on the presence of these mutations, a short version of the risk calculation model was developed (the area under the ROC curve is 94,6%).
Conclusion. We have developed a risk calculation model taking into account the presence of known risk factors, congenital thrombophilia and comorbidities. Thromboprophylaxis is necessary in >0,45 individual risk, which corresponds to a high risk of developing venous thrombosis. Patients who have not previously been diagnosed with thrombophilia and are in the middle risk group for venous thrombosis, according to a short version of the model, must be screened for congenital thrombophilia to clarify the risk.

Russian Journal of Cardiology. 2019;24 (5):37–43
dx.doi.org/10.15829/1560-4071-2019-5-37-43

Key words: congenital thrombophilia, overweight, obesity, venous thrombosis of the lower extremities, pulmonary embolism, risk calculation model.

Conflicts of Interest: nothing to declare.

1A. K. Eramishantsev City Clinical Hospital, Moscow; 2A. A. Schmidt-B. A. Kudryashov All-Russian Association for the Study of thrombosis, hemorrhage and vascular pathology, Moscow; 3I. M. Sechenov First Moscow State Medical University, Moscow; 4M. M. Shemyakin and Yu. A. Ovchinnikov Institute of Bioorganic Chemistry, Moscow, Russia.

Golub A. V. ORCID: 0000-0002-2029-8268, Bokarev I. N. ORCID: 0000-0001-5331-2655, Popova L. V. ORCID: 0000-0002-3496-6466, Gerasimov A. N. ORCID: 0000-0003-4549-7172, Kanevskaya M. Z. ORCID: 0000-0001-9935-2126, Khlevchuk T. V.
ORCID: 0000-0003-1453-7290, Kondratieva T. B. ORCID: 0000-0001-7938-1763, Aksenova M. B. ORCID: 0000-0003-4802-6544, Patrushev L. V. ORCID: 0000-0001-6228-8722, Kovalenko T. F. ORCID: 0000-0001-6091-892X, Belenkov Yu. N. ORCID: 0000-0002-3014-6129.

Received: 12.12.2018
Revision Received: 04.02.2019
Accepted: 18.02.2019

NICORANDIL IN THE PREVENTION OF CARDIAC DAMAGE AND TYPE 4A MYOCARDIAL INFARCTION WITH PLANNED PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH ATHEROSCLEROSIS OF CORONARY ARTERIES
Soboleva G. N., Gostishchev R. V., Rogoza A. N., Kotkina T. I., Samko A. N.

Abstract
Aim. To study the possibility of reducing the risk of intraoperative cardiac damage and 4a type myocardial infarction (MI) by administering the oral nicorandil in patients with a stable form of coronary artery disease (CAD) before planned percutaneous coronary intervention (PCI).
Material and methods. The study included 182 patients with stable CAD who were randomized to the nicorandil treatment group (n=90) and the control group with a standard treatment (n=92). Nicorandil was prescribed 2 days before PCI (30 mg/day); on the day of PCI — 2 hours before surgery (20 mg orally), 6-12 hours after PCI — 10 mg, later — 30 mg/day within 30 days. The analysis of highly sensitive troponin I (hs-troponin) and creatine kinase-MB (CK-MB) was carried out before PCI and 24, 72 hours after the procedure, the type 4a diagnosis of MI was established according to fourth universal definition.
Results. The rate of hs-troponin after 24 hours exceeded the 99th percentile from the upper limit of normal in 146 patients (80%). In the control group, there was a statistically significant more frequent increase in hs-troponin by more than 2000 ng/ml (10% of patients in the control group versus 1% of the patient in the nicorandil group, p=0,038). Type 4a MI was detected in 12% of patients in the control group, and it decreased to 3% of patients in the nicorandil group (p=0,05), and in women it was observed in 21% in the control group and in 3% in the nicorandil group. Among women (n=61), the increment of hs-troponin 24 hours after PCI was statistically significantly lower (287 versus 1135 pg/ml, p=0,04) in the nicorandil group compared to the control group.
Conclusion. Reducing the risk of cardiac damage and 4a type MI by nicorandil using before PCI, compared with standard antianginal therapy, is an effective tool in cardioprotection of patients with stable CAD before planned PCI.

Russian Journal of Cardiology. 2019;24 (5):44–51
dx.doi.org/10.15829/1560-4071-2019-5-44-51

Key words: nicorandil, coronary angioplasty, coronary artery disease.

Conflicts of Interest: nothing to declare.

National Medical Research Center of Cardiology, Moscow, Russia.

Soboleva G. N. ORCID: 0000-0002-6484-5884, Gostishchev R. V. ORCID: 0000-0002-2379-5761, Rogoza A. N. ORCID: 0000-0002-0543-3089, Kotkina T. I. ORCID: 0000-0002-5483-7143, Samko A. N. ORCID: 0000-0003-1808-3484.

Received: 06.05.2019
Revision Received: 20.05.2019
Accepted: 24.05.2019

EFFECT OF ATORVASTATIN AND ROSUVASTATIN ON THE PCSK9 BLOOD CONCENTRATION IN STATIN-NAIVE PATIENTS WITH ATHEROSCLEROSIS
Filatova A. Yu., Arefieva T. I., Klesareva E. A., Afanasieva O. I.

Abstract
Statins are currently the main group of lipid-lowering drugs used in clinical practice. However not all patients manage to achieve ‘target’ levels of LDL. A possible cause is statin-induced increase of expression of hepatocyte PCSK9 which regulates LDL uptake.
Aim. The aim of the study was to determine whether the changes of parameters of lipid spectrum depend on the changes of PCSK9 concentration in blood during treatment with rosuvastatin or atorvastatin.
Material and methods. 20 patients (9 men), median age 63 (57;72) years referred for the examination at NMRCC with coronary and carotid atherosclerosis and with the indications for statin therapy were included. In 9 patients the therapy with atorvastatin (40-80 mg/day) was initiated. 11 patients started taking rosuvastatin (10-40 mg/day). The parameters of lipid spectrum, Lp(a) and PCSK9 blood levels were determined at baseline and after 1 month after the initiation of statin therapy.
Results. Atorvastatin and rosuvastatin intake were accompanied by the decrease in the levels of total cholesterol, triglycerides, LDL. The level of Lp(a) did not change. In patients receiving rosuvastatin a significant increase in the PCSK9 serum concentration was achieved while atorvastatin therapy was associated with much less pronounced and not statistically significant increase in PCSK9 levels.
Conclusion. We suggest that the lipid-lowering activity of statins does not depend on their effect on PCSK9 expression. The limitation of this study is the small sample size and short observation time.

Russian Journal of Cardiology. 2019;24 (5):52–55
dx.doi.org/10.15829/1560-4071-2019-5-52-55

Key words: statins, PCSK9, atherosclerosis.

Conflicts of Interest: nothing to declare.

Funding. The work was partially supported by RFBR grant № 17-04-00127 and on the topic of state assignment № AAA-A18-118021690085-7 “Study of molecular and cellular mechanisms of atherothrombogenicity of lipoprotein(a) as an independent risk factor for cardiovascular diseases”.

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

Filatova A. Yu. ORCID: 0000-0001-8911-1628, Arefieva T. I. ORCID: 0000-0002-9500-1940, Klesareva E. A. ORCID: 0000-0002-0682-8699, Afanasieva O. I. ORCID: 0000-0001-8909-8662.

Received: 16.04.2019
Revision Received: 30.04.2019
Accepted: 14.05.2019

EXPERIMENTAL STUDY

MONOMERIC C-REACTIVE PROTEIN AND LOCAL INFLAMMATORY REACTION IN THE WALL OF THE CORONARY ARTERIES IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE
Melnikov I. S.1,2, Kozlov S. G.1, Chumachenko P. V.1, Saburova O. S.1, Guseva O. A.1, Prokofyeva L. V.1, Gabbasov Z. A.1

Abstract
Aim. To study the phenotype of microvesicles circulating in the blood plasma of patients with stable coronary artery disease (CAD), carrying monomeric C-reactive protein (mCRP) on their surface, and to detect tissue accretions of mCRP in coronary artery of patients with CAD.
Material and methods. Blood samples obtained from 20 patients with stable CAD and from 7 healthy volunteers were examined. The phenotype of microvesicles of cell origin was studied by flow cytometry. Microparticles were identified by their level of binding to annexin-V, and exosomes by binding to the monoclonal antibodies to CD63. The accretion of mCRP in the coronary arteries’ walls was investigated by immunohistochemical analysis of their fragments obtained from 7 men during coronary endarterectomy surgery. Samples were stained with monoclonal antibodies to native CRP (nCRP) and mCRP.
Results. More than half of the mCRP-positive blood microparticles were CD45-positive. At the same time, the mCRP+/CD45+ microparticles were CD63 positive and annexin-V negative, which makes it possible to characterize them as exosomes secreted into the extracellular space by activated leukocytes. Microparticles of platelet and erythrocyte origin were mainly annexin-V positive. It was very weakly or not at all associated with antibodies to mCRP. The amount of blood mCRP+/CD45+exosomes was significantly higher in patients with CAD (8749+2683 particles per μL, n=20) than in healthy people (1454+350 particles per μL, n=7, p=0,00). An analysis of coronary arteries’ material has shown that mCRP is found in atherosclerotic plaques, while intact arterial wall samples were mCRP negative.
Conclusion. An increase of exosomes carrying on their surface mCRP and characteristic leukocyte markers, as well as the appearance of mCRP in areas of atherosclerotic arterial wall lesions, in patients with CAD, may indicate the involvement of proinflammatory mCRP molecules in the pathogenesis of coronary atherosclerosis. Since exosomes are specific transporters of signaling molecules of the parent cells, it can be assumed that mCRP is transported to damaged areas by activated leukocytes.

Russian Journal of Cardiology. 2019;24 (5):56–61
dx.doi.org/10.15829/1560-4071-2019-5-56-61

Key words: atherosclerosis, C-reactive protein, coronary artery disease.

Conflicts of Interest: nothing to declare.

Funding. This work was supported by a grant from the Russian Science Foundation (project № 16-15-10098-P).

1National Medical Research Center of Cardiology, Moscow; 2Federation State Research Center Institute of Biomedical Problems, Moscow, Russia.

Melnikov I. S. ORCID: 0000-0001-5241-3091, Kozlov S. G. ORCID: 0000-0001-8800-1670, Chumachenko P. V. ORCID: 0000-0002-1162-6055, Saburova O. S. ORCID: 0000-0002-5702-9037, Guseva O. A. ORCID: 0000-0003-0353-8482, Prokofyeva L. V. ORCID: 0000-0002-4045-2402, Gabbasov Z. A. ORCID: 0000-0003-3878-2573.

Received: 19.04.2019
Revision Received: 24.04.2019
Accepted: 06.05.2019

DIAGNOSTIC METHODS

ABBREVIATED PROTOCOL FOR ULTRASOUND DUPLEX SCANNING OF THE CAROTID ARTERIES IN THE EVALUATION OF PRECLINICAL ATHEROSCLEROSIS IN ORDER TO CLARIFY CARDIOVASCULAR RISK
Balakhonova T. V.1, Pogorelova O. A.1, Tripoten M. I.1, Ershova A. I.2, Koshurnikova M. V.1, Rogoza A. N.1

Abstract
Aim. To develope and justify the use of the abbreviated protocol of ultrasound duplex scanning (DS) of the carotid arteries (CA) to detect atherosclerotic changes in the carotid system in various groups of cardiovascular risk and to reduce the time of DS, based on solving a “narrow” task — identifying an atheroma.
Material and methods. Ultrasound CA examination was carried out in the department of ultrasound studying methods in National Medical Research Center of Cardiology. Forty three patients aged 32 to 81 years (mean 56±13 years) who are hospitalized in A. L. Myasnikov Institute of Clinical Cardiology Institute of Clinical Cardiology were examined. DS was performed with the use of the ultrasonic system “IU 22” (Philips) with a linear sensor with 3-9 MHz. Three types of DS protocol were used — standard protocol (with automatic measurement of intima-media thickness (IMT) of common carotid artery (CCA)), abbreviated protocol 2 (atheroma and IMT of CCA), abbreviated protocol 1 (atheroma).
Results. The work showed a decrease in DS time when conducting a abbreviated protocol 2 by 32,1% or 1,5 times, a shortened protocol 1 — by 72,1% or approximately 3,5 times compared with the standard DS protocol, while the efficiency of atheroma detecting has not decreased. A decision-making algorithm has been developed on the basis of conducting an ultrasound SA examination using abbreviated protocols.
Conclusion. The introduction of a abbreviated protocol of ultrasound DS will significantly reduce the time and increase the cost-effectiveness of early diagnosis of atherosclerosis.

Russian Journal of Cardiology. 2019;24 (5):62–68
dx.doi.org/10.15829/1560-4071-2019-5-62-68

Key words: vascular wall, atheroma, intima-media complex thickness, carotid artery, duplex scanning.

Conflicts of Interest: nothing to declare.

1National Medical Research Center of Cardiology, Moscow; 2National Medical Research Center for Preventive Medicine, Moscow, Russia.

Balakhonova T. V. ORCID: 0000-0002-7273-6979, Pogorelova O. A. ORCID: 0000-0001-7897-4727, Tripoten M. I. ORCID: 0000-0003-4462-3894, Ershova A. I. ORCID: 0000-0001-7989-0760, Koshurnikova M. V. ORCID: 0000-0002-3292-6823, Rogoza A. N. ORCID: 0000-0002-0543-3089.

Received: 24.04.2019
Revision Received: 13.05.2019
Accepted: 20.05.2019

CLINICAL CASES

GIANT AUTOVENOUS SHUNT ANEURYSM, HYBRID TREATMENT APPROACH
Ilina L. N., Galyautdinov D. M., Vasilyev V. P., Dzybinskaya E. V., Vlasova E. E., Kurbanov S. K., Merkulov E. V., Fedotenkov I. S., Kurilina E. V., Shiryaev A. A., Akchurin R. S.

Russian Journal of Cardiology. 2019;24 (5):69–71
dx.doi.org/10.15829/1560-4071-2019-5-69-71

Key words: giant autovenous shunt aneurysm, occluder, recurrent coronary artery bypass surgery.

Conflicts of Interest: nothing to declare.

National Medical Research Center of Cardiology, Moscow, Russia.

Ilina L. N. ORCID: 0000-0003-2789-4844, Galyautdinov D. M. ORCID: 0000-0002-0257-1398, Vasilyev V. P. ORCID: 0000-0002-2297-6026, Dzybinskaya E. V. ORCID: 0000-0002-1849-442Х, Vlasova E. E. ORCID: 0000-0003-2925-244X, Kurbanov S. K. ORCID: 0000-0001-7767-1695, Merkulov E. V. ORCID: 0000-0001-8193-8575, Fedotenkov I. S. ORCID-0000-0003-1387-8958, Kurilina E. V. ORCID: 0000-0002-3208-534Х, Shiryaev A. A. ORCID: 0000-0002-3325-9743, Akchurin R. S. ORCID: 0000-0002-6726-4612.

Received: 17.04.2019
Revision Received: 24.04.2019
Accepted: 06.05.2019

SEVERE HYPERLIPOPROTEINEMIA(A) AS A FACTOR OF RAPIDLY PROGRESSIVE CORONARY ARTERY DISEASE IN A YOUNG WOMAN WITH HETEROZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA
Chubykina U. V., Afanasieva O. I., Khachatryan N. T., Kukava N.G., Vasiliev V. P., Ezhov M. V.

Russian Journal of Cardiology. 2019;24 (5):72–73
dx.doi.org/10.15829/1560-4071-2019-5-72-73

Key words: familial hypercholesterolemia, lipoprotein(a), acute coronary syndrome, coronary artery disease, apheresis.

Conflicts of Interest: nothing to declare.

National Medical Research Center of Cardiology, Moscow, Russia.

Chubykina U. V. ORCID: 0000-0003-2760-2792, Afanasieva O. I. ORCID: 0000-0001-8909-8662, Khachatryan N. T. ORCID: 000-0002-0945-9665, Kukava N. G. ORCID: 0000-0001-5550-6090, Vasiliev V. P. ORCID: 0000-0002-2297-6026, Ezhov M. V. ORCID: 0000-0002-1518-6552.

Received: 19.04.2019
Revision Received: 24.04.2019
Accepted: 06.05.2019

LITERATURE REVIEWS

SECONDARY HYPERLIPIDEMIAS: ETIOLOGY AND PATHOGENESIS
Ershova A. I.1, Al Rashi D. O.2, Ivanova A. A.2, Aksenova Yu. O.2, Meshkov A. N.1

Abstract
In accordance with modern clinical guidelines, the main aim of therapy for cardiovascular risk reducing is achievement of target level of lipid parameters. Some common diseases, medications prescribed in routine clinical practice, as well as dietary disorders can cause the development of lipid metabolism disorders, called secondary hyperlipidemias. Identification and treatment (or elimination) of secondary causes of hyperlipidemia may contribute to the effectiveness of treatment of patients with lipid metabolism disorders. This review presents the underlying conditions and pathogenetic mechanisms responsible for the development of secondary hyperlipidemia.

Russian Journal of Cardiology. 2019;24 (5):74–81
dx.doi.org/10.15829/1560-4071-2019-5-74-81

Key words: secondary hyperlipidemia, diabetes mellitus, hypothyroidism, chronic kidney disease, cholestasis.

Conflicts of Interest: nothing to declare.

1National Medical Research Center for Preventive Medicine, Moscow; 2I. M. Sechenov First Moscow State Medical University, Moscow, Russia.

Ershova A. I. ORCID: 0000-0001-7989-0760, Al Rashi D. O. ORCID: 0000-0001-9821-3925, Ivanova A. A. ORCID: 0000-0002-2812-959X, Aksenova Yu. O. ORCID: 0000-0002-6546-2535, Meshkov A. N. ORCID: 0000-0001-5989-6233.

Received: 26.04.2019
Revision Received: 13.05.2019
Accepted: 20.05.2019

THE ROLE OF DIETARY MINERALS IN THE DEVELOPMENT OF ATHEROMA
Polonskaya Ya. V., Kashtanova E. V.

Abstract
The article presents an overview of foreign and domestic studies aimed to study the role of elemental imbalance in the development of cardiovascular pathology. The pathogenetically significant mechanisms of the influence of diselementosis on the
development of atherosclerotic changes in the walls of blood vessels are discussed. Particular attention is paid to such elements as iron, copper, zinc, selenium, cadmium.

Russian Journal of Cardiology. 2019;24 (5):90–94
dx.doi.org/10.15829/1560-4071-2019-5-90-94

Key words: pathogenetically, atherosclerosis, cardiovascular diseases, microelements.

Conflicts of Interest: nothing to declare.

Funding. The review was carried out within the framework and with the financial support of the RFBR grant № 19-015-00055, State task № 0324-2018-0002.

Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia.

Polonskaya Ya. V. ORCID: 0000-0002-3538-0280, Kashtanova E. V. ORCID: 0000-0003-2268-4186.

Received: 01.03.2019
Revision Received: 15.04.2019
Accepted: 29.04.2019

ROLE OF CLINICAL EVALUATION IN THE IDENTIFICATION OF CORONARY OBSTRUCTIVE DISORDERS IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE. PART I
Sumin A. N.

Abstract
To make a decision on choice the type of myocardial revascularization in patients with coronary artery disease (CAD), an invasive coronary angiography (CAG) is necessary. However, in clinical practice, a significant number of patients during CAG fails to detect coronary obstructive disorders, there is the so-called problem of “clean” coronary arteries. Indeed, in the Russian Federation in approximately 50% of cases, CAG does not end with myocardial revascularization, and in patients with suspected CAD, non-obstructive coronary artery lesions are detected in 67% of cases. In the first part of the review, a critical analysis of the clinical evaluation of patients in the selection of patients for CAG was conducted. First stages of the diagnostic process based on clinical evaluation are considered. The review discusses the use for diagnostic purposes more complete set of routine assessment methods and the expanded use of laboratory tests using memetic algorithms.

Russian Journal of Cardiology. 2019;24 (5):95–100
dx.doi.org/10.15829/1560-4071-2019-5-95-100

Key words: clinical evaluation, obstructive disorders, coronary arteries.

Conflicts of Interest: nothing to declare.

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

Sumin A. N. ORCID: 0000–0002–0963–4793.

Received: 02.03.2019
Revision Received: 14.04.2019
Accepted: 20.05.2019

LECTURE

HYPERLIPOPROTEINEMIA(A) AS A DANGEROUS GENETICALLY DETERMINED VIOLATION OF LIPID METABOLISM AND A RISK FACTOR FOR ATHEROTHROMBOSIS AND CARDIOVASCULAR DISEASES
Afanasieva O. I., Pokrovsky S. N.

Abstract
Lipoprotein(a) (Lp(a)) is a complex supramolecular complex belonging to apoB100 lipoproteins. Lp(a) consists of a particle of similar low-density lipoprotein, in which the apoprotein molecule В100 is covalently linked by a disulfide bond with a unique
polymorphic apoprotein(a) molecule. The concentration of Lp(a) is genetically controlled and varies over a very wide range. An elevated level of Lp(a) is an independent risk factor for atherosclerosis of the coronary, carotid and peripheral arteries, coronary artery disease and aortic stenosis, concomitant cardiovascular complications, and complications after myocardial revascularization. Despite this, the level of Lp(a) is still not taken into account in the stratification of the risk of cardiovascular diseases. In part, this may be due to the fact that neither modern drug therapy, nor new generations of biological lipid-lowering drugs have virtually no effect on the concentration of Lp(a), with the exception of a 20-30% decrease in Lp(a) by nicotinic acid and inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9). The lecture consecrates the modern understanding of Lp(a) as a risk factor for cardiovascular diseases, the possibility and feasibility of its definition, and is also devoted to the modern possibilities of correcting hyperlipoproteinemia(a).

Russian Journal of Cardiology. 2019;24 (5):101–108
dx.doi.org/10.15829/1560-4071-2019-5-101-108

Key words: lipoprotein(a), atherosclerosis, atherothrombosis, cardiovascular diseases, cardiovascular complications.

Conflicts of Interest: nothing to declare.

National Medical Research Center of Cardiology, Institute of Experimental Cardiology, Moscow, Russia.

Afanasieva O. I. ORCID: 0000-0001-8909-8662, Pokrovsky S. N. ORCID: 0000-0001-5944-6427.

Received: 17.04.2019
Revision Received: 24.04.2019
Accepted: 06.05.2019

22 июня 2019 г.

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