Russian Journal Of Cardiology, 2019, 24 (7)
СтатьиAddress to the readers
Russian Journal of Cardiology. 2019;24(7):5
CLINICAL MEDICINE NEWS
Clinical medicine updates: a review of international news
Russian Journal of Cardiology. 2019;24(7):6
ORIGINAL ARTICLES
ASSESSMENT OF THE EFFECT OF CARDIAC RHYTHM AND CONDUCTION DISORDERS ON THE COURSE AND OUTCOME OF PREGNANCY: DATA OF THE ARRHYTHMIA CENTER
Kirgizova M. A., Dedkova A. A., Kisteneva I. V., Borisova E. V., Popov S. V.
Abstract
Aim. To assess the effect of cardiac rhythm and conduction disorders on the course and outcome of pregnancy against the background of treatment.
Material and methods. We analyzed 44 case histories of pregnant women examined in the department of surgical treatment of severe cardiac rhythm and conduction disorders during the period from 2012 to 2017. The patients’ age averaged 31,2±5,04 years. The survey was conducted during pregnancy from 12 to 37 weeks (average 28,0±6,4).
Results. In most cases, rhythm disorders had idiopathic nature (57%), and in the remaining patients, diseases of the cardiovascular system were verified. Rhythm disorders before pregnancy were reported in 33 (75%) women. In two cases, ventricular tachycardia was hemodynamically significant. Therefore radiofrequency ablation was performed on 26 and 27 weeks of pregnancy. Radiofrequency ablation of supraventricular tachycardia was performed in three patients at the 27th, 29th and 31st week of pregnancy. One patient had an implanted pacemaker due to an atrioventricular block.
Conclusion. Rhythm disorders observed in the patients did not require termination of the pregnancy. Antiarrhythmic therapy, prescribed for symptomatic, hemodynamically significant and life-threatening disorders, and surgical treatment made it possible to effectively manage pregnant women before delivery. Most patients had delivery on time, rhythm disorders in labor were not observed. Newborns had high Apgar scores.
Russian Journal of Cardiology. 2019;24(7):7–11
dx.doi.org/10.15829/1560-4071-2019-7-7-11
Key words: cardiac arrhythmias, pregnancy, radiofrequency ablation.
Conflicts of Interest: nothing to declare.
Research Institute of Cardiology, Tomsk National Research Medical Center, Tomsk, Russia.
Kirgizova M. A. ORCID: 0000-0002-7264-9904, Dedkova A. A. ORCID: 0000-0002-9434-0748, Kisteneva I. V. ORCID: 0000-0002-8100-098X, Borisova E. V. ORCID: 0000-0002-8705-8533, Popov S. V. ORCID: 0000-0002-9050-4493.
Received: 03.10.2018
Revision Received: 29.11.2018
Accepted: 06.12.2018
ASSOCIATION OF ATRIAL FIBRILLATION WITH CORONARY BED LESIONS (ACCORDING TO THE CORONARY ANGIOGRAPHY REGISTER)
Yaroslavskaya E. I., Kuznetsov V. A., Bessonov I. S., Gorbatenko E. A., Marinskikh L. V.
Abstract
Aim. To identify the relationship of atrial fibrillation (AF) with features of lesions of the main coronary arteries or primary branches in patients with coronary artery disease (CAD).
Material and methods. From the local database of coronary angiography, 6978 patients with hemodynamically significant (50% of the lumen and more) coronary lesions were selected. The main group consisted of 205 patients with AF. To create an age-matched comparison group, 810 patients without AF were selected from the remaining 6773 patients using a method based on equalizing the frequency distributions.
Results. Patients with AF accounted for 2,9% of all patients with hemodynamically significant coronary stenosis. In patients with AF, obesity (56,6% vs 44,5%, p=0,002) and severe (III-IV) classes of chronic heart failure (CHF) according to NYHA classification (51,8% vs 22,8%, p<0,001) was more often detected. These patients had a higher mass index of the left ventricular (LV) (170,9±41,2 g/m2 vs 150,0±34,7 g/m2, p<0,001), higher size index of the right ventricle (RV) (13,8±2,1 mm/m2 vs 13,1±1,3 mm/m2, p<0,001); hemodynamically significant mitral (MR) (49,7% vs 15,9%, p<0,001) and aortic regurgitation (AR) (6,7% vs 1,5%, p<0,001) was also more often detected. Patients with AF more often had lesions of the right coronary artery (RCA) (90,2% vs 82,1%, p=0,005) and calcification of the coronary arteries (24,3% vs 14,8%, p=0,001), less often — the left type of coronary circulation (6,6% against 12,0%, p=0,029). According to the results of multivariate analysis, the presence of significant MR increased the risk of AF by 3,5 times, AR increased by 3,1 times. With CHF worsening to III-IV NYHA classes, the risk of AF increased by 2,1 times, with the presence of RCA — by 80%, obesity of 2 or 3 degrees — by 40%. An increase in the RV size indices for each mm/m2 increased the risk of AF by 14%; in the LV myocardium mass for each g/m2 — by 0,5%.
Conclusion. Angiographic predictor of AF in patients with CAD is the RCA lesion.
Russian Journal of Cardiology. 2019;24(7):12–18
dx.doi.org/10.15829/1560-4071-2019-7-12-18
Key words: atrial fibrillation, coronary artery disease, right coronary artery.
Conflicts of Interest: nothing to declare.
Tyumen Cardiology Research Center, Branch of Tomsk National Research Medical Center, Tomsk, Russia.
Yaroslavskaya E. I. ORCID: 0000-0003-1436-8853, Kuznetsov V. A. ORCID: 0000-0002-0246-9131, Bessonov I. S. ORCID: 0000-0003-0578-5962, Gorbatenko E. A. ORCID: 0000-0003-3675-1503, Marinskikh L. V. ORCID: 0000-0002-5305-0197.
Received: 15.04.2019
Revision Received: 29.04.2019
Accepted: 11.05.2019
TURBULENCE AND DECELERATION CAPACITY OF THE HEART RATE IN PATIENTS WITH CORONARY ARTERY DISEASE AND IMPLANTED CARDIOVERTER DEFIBRILLATOR
Melnik N. V., Tsaregorodtsev D. A.
Abstract
Aim. To study the possibility of using of heart rate turbulence (HRT) and deceleration capacity (DC) in the risk stratification of fatal events in patients with coronary artery disease (CAD) and implanted cardioverter defibrillator (ICD).
Material and methods. The study included 45 patients with sinus rhythm and verified CAD, who had indications for ICD. A 24-hour ECG monitoring was performed with the evaluation of non-invasive predictors of sudden cardiac death. The minimum observation period was 30 months (the average observation period was 48 (42;51) months). Two endpoints were assessed: the onset of deaths and the justified ICD actuations.
Results. During the observation period, 10 patients died (5 from progression of heart failure, 2 from recurrent myocardial infarction, 2 from non-cardiac pathology, and 1 died suddenly before implantation of a defibrillator). Arrhythmic events occurred in 13 people. Compared to the surviving patients, deceased patients’ mean DC value was significantly lower (1,25 (0,48;2,23) ms vs 3,3 (1,85;5,40) ms, p=0,016). There were significantly more frequent DC in the high-risk zone (80% vs 34%, p=0,024) and type 2 HRT disorders (80% vs 29%, p=0,009). When comparing patients with arrhythmic events and without them, no significant differences in DC and HRT were detected. According to univariate regression analysis, HRT and DC were risk factors for death (p=0,004 and p=0,006, respectively).
Conclusion. Electrophysiological markers reflecting vegetative imbalance (HRT and DC) in patients with CAD and ICD can identify patients with high risk of overall mortality, but it is not associated with the risk of ventricular tachyarrhythmias development.
Russian Journal of Cardiology. 2019;24(7):19–25
dx.doi.org/10.15829/1560-4071-2019-7-19-25
Key words: sudden cardiac death, cardiac rhythm turbulence, deceleration capacity of the heart rate, coronary artery disease, cardioverter defibrillator.
Conflicts of Interest: nothing to declare.
Acknowledgements. The authors express gratitude to Ilyich Ilya Leonidovich — head of Cardiac Surgery Department of V. M. Buyanov City Clinical Hospital and Hamnagadayev Igor Alekseevich — MD, Cardiovascular Surgeon of the Cardiac Surgery Department of Buyanov City Clinical Hospital.
I. M. Sechenov First Moscow State Medical University, Moscow, Russia.
Melnik N. V. ORCID: 0000-0003-0241-0137, Tsaregorodtsev D. A. ORCID: 0000-0002-6049-7819.
Received: 28.05.2019
Revision Received: 17.06.2019
Accepted: 21.06.2019
ANALYSIS OF ELECTROTHERAPY OF CARDIOVERTER DEFIBRILLATORS IMPLANTED FOR THE PRIMARY PREVENTION OF SUDDEN CARDIAC DEATH
Lebedeva V. K., Lyubimtseva T. A., Lebedev D. S.
Abstract
Aim. To assess various types of electrotherapy and the reasons for its use in patients with implanted cardioverter defibrillators (ICD) for primary prevention of sudden cardiac death (SCD).
Material and methods. A retrospective single-site study of 308 patients with implanted cardioverter defibrillators was conducted. Patients were divided into 2 groups: 1 — patients with persistent paroxysmal ventricular tachycardia (VT)/ventricular fibrillation (VF); 2 — patients without persistent paroxysms of VT/VF. The standard ICD programming protocol was carried out intraoperatively, at 3-4 days after the implantation, then 1 time in 12 months, as well as unscheduled on request. Primary data was collected about paroxysms of ventricular and supraventricular rhythm disturbances, episodes of unmotivated detection of tachyarrhythmias, adequacy of use and types of ICD electrotherapy. The period of dynamic observation was 7 years.
Results. The group with an increased risk of persistent paroxysmal VT/VF is patients with ischemic genesis of chronic heart failure (CHF), repeated myocardial infarction, persistent atrial fibrillation (AF), as well as with recorded episodes of unstable VT and ventricular extrasystoles at programming visits. In 54,1% of cases with persistent paroxysms of VT/VF, unjustified detection of ventricular arrhythmias was established. Its causes were: 1) AF with a high heart rate; 2) T-wave detection; 3) sinus tachycardia in the area of detection of VT; 4) atrial flutter with a high heart rate.
Conclusion. In patients with primary prophylaxis of SCD, the use of ICD electrotherapy takes place not only due to paroxysms of VT/VF, but also because of both paroxysms of supraventricular rhythm disturbances and other features of rhythm perception by the device. To reduce the number of unjustified triggers during the installation of ICD electrotherapy program in patients with AF/atrial flutter, it is advisable to use a dedicated area of monitor VT and programmed long-term tachycardia detection for adequate rhythm discrimination.
Russian Journal of Cardiology. 2019;24(7):26–32
dx.doi.org/10.15829/1560-4071-2019-7-26-32
Key words: implantable cardioverter defibrillator, sudden cardiac death, ventricular tachycardia, electrotherapy.
Conflicts of Interest: nothing to declare.
Funding. This study was supported by RF President grant for young scientists — candidates of medical sciences. Agreement № 075-02-2018-574 of November 16, 2018.
Almazov National Medical Research Center, St. Petersburg, Russia.
Lebedeva V. K. ORCID: 0000-0002-0507-096X, Lyubimtseva T. A. ORCID: 0000-0002-8651-7777, Lebedev D. S. ORCID: 0000-0002-2334-1663.
Received: 22.05.2019
Revision Received: 17.06.2019
Accepted: 21.06.2019
PREDICTORS OF SUSTAINED ISOLATION OF PULMONARY VEIN OSTIA WITH CRYOBALLOON ABLATION USING A SECOND-GENERATION CRYOBALLOON ARCTIC FRONT ADVANCE
Davtyan K. V., Topchyan A. Н., Kalemberg A. A., Simonyan G. Yu.
Abstract
Aim. To determine the electrophysiological and biophysical predictors of sustained isolation of pulmonary vein (PV) ostia, affecting the immediate and longterm results of interventional treatment of atrial fibrillation (AF) using cryoballoon ablation (CBA) with the second-generation cryoballoon Arctic Front Advance.
Material and methods. The analysis included 143 PV in 37 patients with a paroxysmal/persistent form of AF, which, after the primary CBA with the use of the second-generation cryoballoon, carried out additional interventions due to recurrence of AF and/or combined arrhythmia. During the primary CBA, the registration of biophysical and electrophysiological parameters of the procedure was performed. During the ablation in the right PV from the diagnostic electrode installed in the superior vena cava, the ipsilateral phrenic nerve was stimulated (2000 ms, 25 mA). When the phrenic nerve response to stimulation was decreased/disappeared, ablation ceased instantly. At the end of the procedure, isolation control of the PV was performed. A repeat/additional procedure was performed for the recurrence of AF and/or documented combined arrhythmia no earlier than 3 months after the initial ablation. The stability of the LV isolation was assessed using a circular mapping technique. According to the results of mapping, drugs were divided into 2 groups: isolated and with recurrent activity.
Results. The frequency of sustained isolation of PV was 67,8%. Recurrent spike activity was recorded in 46 PV (32,2%). Higher frequency of registration of electrical isolation of PV in real time (68% vs 50%, p=0,001), stability of occlusion with a cryoballoon (85,5% vs 69,5%, p=0,024), low values of the minimum cryoballoon temperatures reached (49,2±6,3 vs 44,0±4,9, p˂0,0001) and less need for additional applications (8,3% vs 34,7%, p˂0,0001) were registered in the group of chronic isolation of PV. Multi-factor analysis of these parameters confirmed the predictor role of the minimum cryoballoon temperature. According to the ROC analysis, the threshold minimum temperature was 45,5° C with a sensitivity of 68% and a specificity of 60,9%.
Conclusion. Cryoballoon isolation of PV ostia is an effective and safe method for achieving chronic isolation of PV. The minimum cryoballoon temperature with a threshold value of ˂-45,5° C is an independent predictor of long-term isolation of PV.
Russian Journal of Cardiology. 2019;24(7):33–39
dx.doi.org/10.15829/1560-4071-2019-7-33-39
Key words: atrial fibrillation, cryoballoon ablation, second generation cryoballoon, biophysical parameters, stable isolation.
Conflicts of Interest: K. V. Davtyan is a proctor of Medtronic company. The remaining authors declare no conflict of interest.
National Medical Research Center for Preventive Medicine, Moscow, Russia.
Davtyan K. V. ORCID: 0000-0003-3788-3997, Topchyan A. Н. ORCID: 0000-0001-7605-6316, Kalemberg A. A. ORCID: 0000-0002-1124-7426, Simonyan G. Yu. ORCID: 0000-0002-1118-5376.
Received: 22.11.2018
Revision Received: 01.02.2019
Accepted: 05.02.2019
HYPERTENSION SPECIFIC PATIENT-REPORTED OUTCOME MEASURE. PART II: VALIDATION SURVEY AND ITEM SELECTION PROCESS
Ionov M. V.1,2, Zvartau N. E.1,2, Dubinina E. A.3,4, Khromov-Borisov N. N.1, Konradi A. O.1,2
Abstract
Aim. Improvement of the health-related quality of life (HRQoL) is one of the basic principles of value-based medicine. HRQoL could be assessed by the patientreported outcome measures (PROMs) also in case of arterial hypertension (HTN). However for HTN patients only generic PROMs are still used. Previously the group of experts had created the primary version of HTN-specific PROM. The purpose of the second part was to conduct a validation survey and to select the items in a statistically-based manner.
Material and methods. Validation survey was conducted in a large multidisciplinary center among patients with HTN stages 1-3 and healthy volunteers. Inclusion criteria were age >18 years old, ability to understand or complete the scale themselves, absence of significant illness requiring hospitalization. The items were selected according to the principles of classical test theory (CTT) and item response theory (IRT). The criteria for CTT were sensitivity (standard deviation and coefficient of variation with corresponding confidence intervals), representativeness (item-total Pearson’s correlation coefficient), internal consistency (Cronbach’s α coefficient). In IRT analysis two methods were adopted — value of four degrees of difficulty and the discrimination estimate. Each question was evaluated according to 8 criteria. An item was considered for selection when it was retained by ≥4 criteria. The expert panel considered practical significance of each item.
Results. A total of 430 questionnaires were distributed and 407 (94,7%) of them were returned completed (from 359 hypertensive patients, mean age 62,3±11,7 y. o.; 48 healthy volunteers, mean age 38,8±10,5 y. o.). The average time for PROM filling was 24±4,2 minutes. Of 163 questions, 27 met all 8 criteria and 3 questions did not match any. Of the 36 HTN-specific questions, 11 matched ≥5 criteria and in the generic part there were 87 questions (33 in the PHY domain, 35 for PSY, 8 for SOC, 11 for THER). The symmetric distribution of criteria was seen in 25 questions, of which 11 were evaluated by experts and then retained. For 40 questions, <4 eligibility criteria were recorded, of which 9 were retained after expert review. The PROM draft contained 80 questions (19 questions in the physiology domain, 22 in psychology, 6 in social, 13 in therapy, 20 items are HTNspecific).
Conclusion. The methods of CTT and IRT allowed to reduce the PROM volume without losing the semantic richness and the need to reorganize the conceptual structure. The next step is the validation of the scale.
Russian Journal of Cardiology. 2019;24(7):40–46
dx.doi.org/10.15829/1560-4071-2019-7-40-46
Key words: arterial hypertension, patient-reported outcome measures, healthrelated quality of life, questionnaire, classical test theory, item response theory.
Conflicts of interest: nothing to declare.
Funding. The study was conducted by a grant from the Russian Science Foundation (project № 17-15-01177).
1Almazov National Medical Research Center, St. Petersburg; 2St. Petersburg National Research University of Information Technologies, Mechanics and Optics (ITMO University), St. Petersburg; 3A. I. Herzen Russian State Pedagogical University, St. Petersburg; 4V. M. Bekhterev National Medical Research Center of Psychiatry and Neurology, St. Petersburg, Russia.
Ionov M. V. ORCID: 0000-0002-3664-5383, Zvartau N. E. ORCID: 0000-0001-6533-5950, Dubinina E. A. ORCID: 0000-0003-1740-6659, Khromov-Borisov N. N. ORCID: 0000-0001-6435-7218, Konradi A. O. ORCID 0000-0001-8169-7812.
Received: 14.04.2019
Revision Received: 17.05.2019
Accepted: 24.05.2019
GENETICS IN CARDIOLOGY
ASSOCIATION OF POLYMORPHIC VARIANTS OF ADRB1 GENE WITH CONTRACTILE MYOCARDIAL DYSFUNCTION AND ERYTHROCYTE ADRENOREACTIVITY IN PATIENTS WITH RHYTHM DISORDERS
Afanasiev S. A., Rebrova T. Yu., Muslimova E. F., Borisova E. V.
Abstract
Aim. To study the association of the rs1801252 (A145G, Ser49Gly) and rs1801253 polymorphic variants (G1165C, Gly389Arg) of the β1-adrenoreceptor ADRB1 gene with the clinical manifestations of chronic heart failure (CHF) and the adrenoreactivity of their erythrocyte membranes in patients with cardiac arrhythmias.
Material and methods. The study included 47 patients with atrial fibrillation and I-III FC CHF. A standard clinical examination of patients was performed, including a six-minute walk test and an echocardiographic study. The rs1801252 (A145G, Ser49Gly), rs1801253 (G1165C, Gly389Arg) polymorphic variants of the β1-adrenoceptor ADRB1 gene and β-adrenoreactivity of erythrocyte membranes were determined.
Results. A statistically significant inverse correlation of β-adrenoreactivity of erythrocyte membranes with the left ventricular ejection fraction (r=-0,336, p=0,021) and a direct correlation with the end-systolic volume (r=0,320, p=0,039) were defined. Depending on the FC of CHF, there was a pronounced tendency (p=0,058) of β-adrenoreactivity increasing. In patients with I FC — 25,88 (12,07; 46,37) relative units, II FC — 30,54 (14,50; 43,36) relative units, III FC — 37,74 (33,67; 41,81) relative units. Diastolic dysfunction in patients was combined with a decrease in the adrenoreactivity of the organism. The median of β-adrenoreactivity of erythrocyte membranes in the group of patients with diastolic dysfunction was significantly (p=0,021) higher (33,04 (16,30; 47,29) relative units) than in the group without diastolic dysfunction (15,91 (11,10; 26,47) relative units). In the studied sample, there were no statistically significant differences in the frequency of diastolic dysfunction in carriers of different genotypes of the rs1801252 and rs1801253 polymorphic variants of the ADRB1 gene (p=1,0 and p=0,058, respectively). An association (p=0,042) of a carrier of the homozygous 145AA rs1801252 genotype with high β-adrenoreactivity of erythrocyte membranes (32,5 (14,6; 47,3) relative units) was detected in comparison with the heterozygous 145AG genotype (16,3 (11,7; 31,5) relative units). In the studied sample, there was no statistically significant association of β-adrenoreactivity with the carrier of homozygous and heterozygous genotypes of the rs1801253 variant of the ADRB1 gene.
Conclusion. The studied rs1801252 and rs1801253 variants of the ADRB1 gene have different associations with impaired diastolic function of the myocardium and desensitization of erythrocyte β-adrenoreceptors.
Russian Journal of Cardiology. 2019;24(7):47–52
dx.doi.org/10.15829/1560-4071-2019-7-47-52
Key words: atrial fibrillation, heart failure, adrenoreactivity, ADRB1 gene polymorphism.
Conflicts of Interest: nothing to declare.
Funding: The work was performed in the framework of fundamental research № AAAA-A15-115123110026-3.
Research Institute of Cardiology, Tomsk National Research Medical Center, Tomsk, Russia.
Afanasiev S. A. ORCID: 0000-0001-6066-3998, Rebrova T. Yu. ORCID: 0000-0003-3667-9599, Muslimova E. F. ORCID: 0000-0001-7361-2161, Borisova E. V. ORCID: 0000-0002-8705-8533.
Received: 05.04.2019
Revision Received: 11.04.2019
Accepted: 18.04.2019
EXPERIMENTAL STUDYES
MORPHOLOGICAL STUDY OF TELOCYTES IN THE LEFT ATRIUM IN PATIENTS WITH LONG-TERM PERSISTENT ATRIAL FIBRILLATION
Mitrofanova L. B.1, Khazratov A. O.1, Gurshchenkov A. V.1, Osadchii A. M.1, Gorshkov A. N.1,2, Galkovsky B. E.1
Abstract
The telocytes were found in the human atria in 2005. Atrial fibrillation (AF) is the most common heart rhythm disorder, accompanied by inflammation and fibrosis, however, the morphological analysis of telocytes in this pathology has not yet been performed.
Aim. To make morphological analysis of left atrial telocytes in patients with longterm persistent AF.
Material and methods. The study was based on the left atrial (LA) wall of 10 patients with AF, 10 without AF (autopsy material) and LP fragments of 2 patients with AF (surgical material). A histological, immunohistochemical, and ultrastructural study, telocyte culture isolation, and confocal laser microscopy were performed.
Results. The presence of telocytes in the LA was confirmed. Morphometric analysis revealed that the average number of telocytes in the LP was significantly less by 3 times in patients with AF than without it (2,7±1,1 vs 8,2±3,0 with x400). Correlation analysis revealed significant negative associations of the number of telocytes with AF, fibrosis, lipomatosis, and inflammation.
Conclusion. The development of inflammation and fibrosis in AF is accompanied by the loss of telocytes.
Russian Journal of Cardiology. 2019;24(7):53–62
dx.doi.org/10.15829/1560-4071-2019-7-53-62
Key words: left atrial telocytes, atrial fibrillation, confocal and electron microscopy, culture isolation.
Conflicts of Interest: nothing to declare.
1Almazov National Medical Research Center, St. Petersburg; 2Smorodintsev Research Institute of Influenza, St. Petersburg, Russia.
Mitrofanova L. B. ORCID: 0000-0003-0735-7822, Khazratov A. O. ORCID: 0000-0002-1739-2480, Gurshchenkov A. V. ORCID: 0000-0001-8494-0646, Osadchii A. M. ORCID: 0000-0003-4709-617X, Gorshkov A. N. ORCID: 0000-0003-2303-1144, Galkovsky B. E. ORCID: 0000-0002-5252-483X.
Received: 05.02.2019
Revision Received: 11.04.2019
Accepted: 18.04.2019
PREVENTION OF POST-INFARCTION CARDIAC REMODELING AFTER USING THE NON-CELLULAR BIOMATERIAL IN THE EXPERIMENT
Afanasiev S. A.1, Kondratyeva D. S.1, Usov V. Yu.1, Lebedeva A. I.2, Muslimov S. A.2, Popov S. V.1
Abstract
Aim. To assess the effect of non-cellular allogenic material (NAM) on post-infarction myocardial remodeling in the experiment.
Material and methods. We ligated left descending coronary artery of control Han Wistar rats in order to simulate post-infarction cardiosclerosis (PICS), and NAM was intramyocardially administered to the experimental animals at the same time as the coronary occlusion. The formation of PICS occurred within 45 days after myocardial infarction modeling. Exercise tolerance was assessed in rats before and after exposure. Magnetic resonance imaging (MRI) of the rat heart was performed on 7th, 14th, and 45th days after myocardial infarction modeling. Postinfarction remodeling of rat heart was assessed using morphometric research methods.
Results. An MRI study showed that on 7th day hearts of the rats of both groups had areas of damaged myocardium. However, on 14th day the area of damaged myocardium in rats with injection of NAM was 2 times less than in individuals with PICS, and on 45 day this difference increased 3,5 times. The increase in enddiastolic volume (EDV) of the left ventricle of control animals on 45 day amounted to 30%, whereas in rats of the experimental group, this figure was 8% of the initial values. Exercise tolerance in rats of both groups after the formation of PICS was lower than in the initial state. At the same time, in animals with injection of NAM, resistance to exercise was significantly higher than in rats of the control group. The results of morphometric studies of the heart showed that in the control group there were significantly more animals with morphologically visible infarction and left ventricular aneurysm than in the experimental group. In addition, animals of the control group were characterized by a statistically significantly higher value of heart mass/body weight ratio.
Conclusion. Based on the results obtained, it can be considered that intramyocardial injections of non-cellular allogenic biomaterial manufactured according to the Alloplant® technology create conditions for stimulating the regenerative processes in the myocardium and also prevent post-infarction heart remodeling.
Russian Journal of Cardiology. 2019;24(7):63–67
dx.doi.org/10.15829/1560-4071-2019-7-63-67
Key words: post-infarction cardiosclerosis, remodeling of the rat heart, noncellular allogenic biomaterial, exercise tolerance, end-diastolic volume, volume of damaged myocardium.
Conflicts of Interest: nothing to declare.
Funding. The work was performed in the framework of fundamental research № AAAA-A15-115123110026-3 of the Research Institute of Cardiology of Tomsk National Research Medical Center.
1Research Institute of Cardiology, Tomsk National Research Medical Center, Tomsk; 2All-Russia Eye and Plastic Surgery Center, Ufa, Russia.
Afanasiev S. A. ORCID: 0000-0001-6066-3998, Kondratyeva D. S. ORCID: 0000-0002-4004-2497, Usov V. Yu. ORCID: 0000-0002-7352-6068, Lebedeva A. I. ORCID: 0000-0002-9170-2600, Muslimov S. A. ORCID: 0000-0002-9076-0251, Popov S. V.
ORCID: 0000-0002-9050-4493.
Received: 21.12.2018
Revision Received: 02.02.2019
Accepted: 11.02.2019
CORRECTION OF CICATRICIAL CHANGES IN SUBACUTE STAGE OF MYOCARDIAL INFARCTION WITH USING OF DISPERSED ALLOGENIC BIOMATERIAL
Lebedeva A. I.1,2, Afanasiev S. A.3, Kondratyeva D. S.3, Gareev E. M.1, Muslimov S. A.1,2, Popov S. V.3
Abstract
Aim. To identify the features of myocardial remodeling after implantation of a dispersed allogenic biomaterial (DAB) in the subacute stage of experimental infarction and determine the role of decay products in the formation of regenerate.
Material and methods. Male rats in the control group (n=30) 5 days after coronary occlusion received physiological saline (intramyocardially), in the experimental group (n=30) — 3 mg of DAB. Myocardial tissues were examined after 7, 14, 50 days from the beginning of the experiment using histological, immunohistochemical and statistical methods.
Results. In the experimental group, the cicatrix area was reduced by 1,66 times. The products of DAB biodegradation were collagen, sulfated (dermatan- and keratin sulfate), as well as non-sulfated (hyaluronic acid) glycosaminoglycans. Used DAB served as a promoter of the early proliferative phase of inflammation and had an anti-inflammatory effect. DAB particles were a chemoattractant of stem and progenitor myocardial cells in the subacute stage of myocardial infarction. It contributed to their differentiation and integration into the tissue.
Conclusion. The products of biodegradation of allogeneic biomaterial, administered intramyocardially in the subacute stage of infarction, contribute to the formation of muscular-connective tissue regenerate and effectively prevent its cicatricial devolution.
Russian Journal of Cardiology. 2019;24(7):68–74
dx.doi.org/10.15829/1560-4071-2019-7-68-74
Key words: allogenic biomaterial, myocardial regeneration, glycosaminoglycans.
Conflicts of Interest: nothing to declare.
Funding. The study was conducted within the framework of the state assignment № 056-00110-18-00.
1All-Russian Eye and Plastic Surgery Center, Ufa; 2Bashkir State Medical University, Ufa; 3Research Institute of Cardiology, National Research Medical Center, Tomsk, Russia.
Lebedeva A. I. ORCID: 0000-0002-9170-2600, Afanasyev S. A. ORCID: 0000-0001-6066-3998, Kondratyeva D. S. ORCID: 0000-0002-4004-2497, Gareev E. M. ORCID: 0000-0002-6561-0892, Muslimov S. A. ORCID: 0000-0002-9076-0251, Popov S. V. ORCID: 0000-0002-9050-4493.
Received: 27.05.2019
Revision Received: 06.06.2019
Accepted: 19.06.2019
CLINIC AND PHARMACOTHERAPY
PREDICTION OF ANTIARRHYTHMIC THERAPY EFFECTIVENESS IN CHILDREN
Svintsova L. I.1, Dzhaffarova O. Yu.1, Plotnikova I. V.1,2
Abstract
Aim. To optimize treatment tactics in children with arrhythmias based on the evaluation and prediction of the therapy efficacy.
Material and methods. Prospective cohort study was performed from 2007 to 2017. A total of 100 patients aged 0 to 7 years with different types of significant arrhythmias received prophylactic antiarrhythmic therapy. Data of medical history, 12-lead electrocardiography (ECG), Holter ECG monitoring, and echocardiography were studied. To verify electrophysiological variant of tachycardia, some patients underwent transesophageal electrophysiologic study.
Results. The study showed that antiarrhythmic drug therapy was most efficacious in patients till one year old without signs of arrhythmogenic cardiomyopathy (ACM). Older age of children, the presence of pronounced ACM manifestations are factors that
increase the risk of ineffective AAT. Based on the data obtained, a multifactor model was developed to predict the effectiveness of prolonged antiarrhythmic therapy.
Conclusion. The study showed that age and intracardiac hemodynamic status affected the efficacy of antiarrhythmic therapy. Proposed model allowed to avoid unnecessary prolonged pharmacological load and to timely administer other methods of treatment in case when ineffective result of the antiarrhythmic therapy was predicted.
Russian Journal of Cardiology. 2019;24(7):75–82
dx.doi.org/10.15829/1560-4071-2019-7-75-82
Key words: children, arrhythmia, arrhythmogenic cardiomyopathy, prediction model, prolonged antiarrhythmic therapy.
Conflicts of Interest: nothing to declare.
1Research Institute of Cardiology, Tomsk National Research Medical Center, Tomsk; 2Siberian State Medical University, Tomsk, Russia.
Svintsova L. I. ORCID: 0000-0002-2056-4060, Dzhaffarova O. Yu. ORCID: 0000-0002-3947-4903, Plotnikova I. V. ORCID: 0000-0003-4823-4378.
Received: 22.03.2019
Revision Received: 14.05.2019
Accepted: 22.05.2019
EFFECT OF ATORVASTATIN ON THE MOST IMPORTANT MECHANISMS OF ARRHYTHMOGENESIS IN PATIENTS WITH ST-ELEVATED MYOCARDIAL INFARCTION
Oleynikov V. E., Lukianova M. V., Dushina E. V., Barmenkova Yu. A.
Abstract
Aim. To study the effect of the 48-week atorvastatin therapy on the mechanisms of arrhythmogenesis, determined during daily ECG monitoring, in patients with ST-elevated myocardial infarction (STEMI).
Material and methods. The study included 104 people. Patients were randomized into two groups: a high-dose statin therapy group who took 80 mg of atorvastatin per day, and a comparison group who received atorvastatin 20 mg/day for 48 weeks. Upon admission and every 12 weeks, the total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol and triglycerides were determined. At the 7-9th day, 24th and 48th weeks of STEMI the daily ECG monitoring on 12 leads using the Holter Analysis-Astrocard complex (Meditek CJSC, Russia) with an assessment of the circadian dynamics of the heart rate, late ventricular potentials, duration, variability and dispersion of the QT interval, temporal and spectral parameters of heart rate variability, heart rate turbulence and the frequency of ventricular arrhythmias. Various cardiovascular events in the postinfarction period were taken as the end points.
Results. Depending on the achievement/non-achievement of the LDL-С target level in the treatment process, two groups were identified: highly effective lipidlowering therapy “HET” — 51 people and relatively effective lipid-lowering therapy “RET” — 49 patients. In the HET group, QT dispersion regression was obtained from the 24th week of treatment; in the RET group, the dynamics of QTe disp, sdQTe, sdQTa values was not found. A positive transformation of all parameters characterizing the post-depolarization activity was revealed only in the HET group: a decrease in QRSf and HFLA, an RMS increase. Significant differences were obtained in the most of the parameters of both temporal and spectral analysis of HRV in the HET group. Clinically significant rhythm and conduction disturbances were more frequently recorded in patients of the RET group.
Conclusion. Achieving the target LDL values in atorvastatin therapy in patients with STEMI is associated with the electrophysiological stability of the myocardium and the clinical well-being of patients in the post-infarction period.
Russian Journal of Cardiology. 2019;24(7):83–90
dx.doi.org/10.15829/1560-4071-2019-7-83-90
Key words: ST-elevated myocardial infarction, 24-hour ECG monitoring, lipids, statins, late ventricular potentials, heart rate variability.
Conflicts of Interest: nothing to declare.
Funding. The study was financially supported by the project part of the state assignment in the field of scientific activities of the Ministry of Education and Science of the Russian Federation “New technologies for the systematic use of twodimensional tracking of spots in patients with acute myocardial infarction based on mathematical modeling” Contract № 574 dated 12.01.2017.
Study ID: ClinicalTrails.gov (NCT02590653).
Penza State University, Penza, Russia.
Oleynikov V. E. ORCID: 0000-0002-7463-9259, Lukianova M. V. ORCID: 0000-0002-2080-2639, Dushina E. V. ORCID: 0000-0001-9925-2096, Barmenkova Yu. A. ORCID: 0000-0001-5111-6247.
Received: 15.04.2019
Revision Received: 20.05.2019
Accepted: 26.05.2019
CLINICAL CASES
A CASE OF NON-INVASIVE TOPICAL DIAGNOSTICS WITH SUCCESSFUL ABLATION DURING PERSISTENT ATRIAL FIBRILLATION
Archakov E. A., Batalov R. E., Usenkov S. Yu., Khlynin M. S., Smorgon A. V., Kisteneva I. V., Popov S. V.
Abstract
Treatment of persistent and long-persistent forms of atrial fibrillation remains a pressing issue. Using a personalized approach can help to more successfully eliminate arrhythmias and reduce the return probability. One of these approaches is the use of radiofrequency ablation in conjunction with modern high-tech research methods. The article describes a clinical case of successful catheter ablation of persistent atrial fibrillation in a patient with a mechanical mitral valve prosthesis, due to the use of non-invasive topical diagnostics prior to surgery.
Russian Journal of Cardiology. 2019;24(7):91–95
dx.doi.org/10.15829/1560-4071-2019-7-91-95
Key words: radiofrequency ablation, atrial fibrillation, non-invasive topical diagnostics.
Conflicts of Interest: nothing to declare.
Research Institute of Cardiology, Tomsk National Research Medical Center, Tomsk, Russia.
Archakov E. A. ORCID: 0000-0002-2530-361X, Batalov R. E. ORCID: 0000-0003-1415-3932, Usenkov S. Yu. ORCID: 0000-0001-9553-9647, Khlynin M. S. ORCID: 0000-0002-9885-5204, Smorgon A. V. ORCID: 0000-0002-6531-7223, Kisteneva I. V. ORCID: 0000-0002-8100-098Х, Popov S. V. ORCID: 0000-0002-9050-4493.
Received: 09.11.2018
Revision Received: 27.12.2018
Accepted: 02.02.2019
STAGE SURGICAL AND CATHETER APPROACH TO THE TREATMENT OF LONG-PERSISTENT ATRIAL FIBRILLATION
Artyukhina E. A., Dedukh E. V., Yashkov M. V.
Russian Journal of Cardiology. 2019;24(7):96–98
dx.doi.org/10.15829/1560-4071-2019-7-96-98
Key words: catheter approach, atrial fibrillation, duration.
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, Dedukh E. V. ORCID: 0000-0002-4799-7456, Yashkov M. V. ORCID: 0000-0003-3997-8252.
Received: 21.05.2019
Revision Received: 06.06.2019
Accepted: 21.06.2019
SIGNIFICANT IMPROVEMENT OF CLINICAL COURSE AND REVERSE MYOCARDIAL REMODELING IN YOUNG PATIENTS WITH CHRONIC HEART FAILURE USING CARDIAC CONTRACTILITY MODULATION
Vander M. A., Lyasnikova E. A., Kim I. M., Lelyavina T. A., Sitnikova M. Yu., Lebedev D. S., Mikhailov E. N.
Abstract
Three clinical cases of 2-year follow-up of young patients with chronic heart failure with a low left ventricular ejection fraction of non-coronarogenic genesis after implantation of the cardiac contractility modulation system are presented. Significant positive dynamics of clinical course and reverse myocardial remodeling according to two-dimensional echocardiography and 2D speckle tracking echocardiography (STE) is shown. The 2D STE technique allowed us to demonstrate the improvement in local contractility of the interventricular septum in the area of implanted electrodes and the remote effect of global contractility improving during 1 year of observation with cardiac contractility modulation.
Russian Journal of Cardiology. 2019;24(7):99–102
dx.doi.org/10.15829/1560-4071-2019-7-99-102
Key words: modulation of cardiac contractility, chronic heart failure, 2D-speckle tracking echocardiography.
Conflicts of Interest: nothing to declare.
Almazov National Medical Research Centre, St. Petersburg, Russia.
Vander M. A. ORCID: 0000-0001-9708-7541, Lyasnikova E. A. ORCID: 0000-0003-0613-829X, Kim I. M. ORCID: 0000-0002-0438-0499, Lelyavina T. A. ORCID: 0000-0001-6796-4064, Sitnikova M. Yu. ORCID: 0000-0002-0139-5177, Lebedev D. S. ORCID: 0000-0002-2334-1663, Mikhailov E. N. ORCID: 0000-0002-6553-9141.
Received: 27.05.2019
Revision Received: 06.06.2019
Accepted: 19.06.2019
LITERATURE REVIEWS
ATRIAL FIBRILLATION AND GASTROOESOPHAGEAL REFLUX DISEASE: ASSOCIATION MECHANISMS,
TREATMENT APPROACHES
Antropova O. N., Pyrikova N. V., Osipova I. V.
Abstract
The article is devoted to assessing the relationship of atrial fibrillation (AF) and gastroesophageal reflux disease (GERD). We studied possible anatomical correlations, common risk factors and mechanisms of AF development in patients with gastroesophageal reflux. We demonstrated the problems of the treatment of such patients, since a number of studies have proved the possibility of using proton pump inhibitors in the treatment of AF. In other cases the arrhythmogenic effect of these drugs was obtained. Treatment of AF by catheter ablation most commonly worsens the course of GORD and can lead to the development of fatal complications. Large-scale prospective researches are needed for further detailed study of AF and GERD associations, as well as tactics for management of these patients.
Russian Journal of Cardiology. 2019;24(7):103–109
dx.doi.org/10.15829/1560-4071-2019-7-103-109
Key words: gastroesophageal reflux disease, proton pump inhibitors, radiofrequency ablation, atrial fibrillation.
Conflicts of Interest: nothing to declare.
Altai State Medical University, Barnaul, Russia.
Antropova O. N. ORCID: 0000-0002-6233-7202, Pyrikova N. V. ORCID: 0000-0003-4387-7737, Osipova I. V. ORCID: 0000-0002-6845-6173.
Received: 16.04.2019
Revision Received: 29.05.2019
Accepted: 06.06.2019
THE ROLE OF INFLAMMATORY THEORY IN THE PATHOGENESIS OF ATRIAL FIBRILLATION
Davtyan K. V.1, Kalemberg A. A.1, Tsareva E. N.1, Blagova O. V.2, Harlap M. S.1
Abstract
Based on the data available in the literature, it is obvious that inflammation plays a significant role in the initiation, support and progression of AF. However, it is important that AF by itself is a factor provoking the development of inflammation in the atrial myocardium, which leads to the further progression of the disease according to the principle of “AF produces AF.” The question of the primacy of the development and correlations of process links is still not fully understood: does inflammation leads to fibrillation or does fibrillation leads to inflammation? The authors analyzed the data of the world literature and tried to describe the main concepts of the inflammatory theory of AF and the practical aspects of its application.
Russian Journal of Cardiology. 2019;24(7):110–114
dx.doi.org/10.15829/1560-4071-2019-7-110-114
Key words: atrial fibrillation, inflammation markers, inflammation, pulmonary veins, myocardial biopsy.
Conflicts of Interest: nothing to declare.
1National Research Center for Preventive Medicine, Moscow; 2I. M. Sechenov First Moscow State Medical University, Moscow, Russia.
Davtyan K. V. ORCID: 0000-0003-3788-3997, Kalemberg A. A. ORCID: 0000-0002-1124-7426, Tsareva E. N. ORCID: 0000-0001-7199-0353, Blagova O. V. ORCID: 0000-0002-5253-793X, Kharlap M. S. ORCID: 0000-0002-6855-4857.
Received: 30.05.2019
Revision Received: 13.06.2019
Accepted: 19.06.2019
APENDIX
(text is available in electronic version doi:10.15829/1560-4071-2019-7-116-129)
CLINICAL GUIDELINES
2018 ESC Guidelines for the diagnosis and management of syncope
The Task Force for the diagnosis and management of syncope of the European Society of Cardiology (ESC)
Developed with the special contribution of the European Heart Rhythm Association (EHRA)
Endorsed by: European Academy of Neurology (EAN), European Federation of Autonomic Societies (EFAS), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), European Society of Emergency Medicine (EuSEM)
Russ Journal of Cardiology. 2019;24(7):130–194
dx.doi.org/10.15829/1560-4071-2019-7-130-194
Key words: guidelines, syncope, transient loss of consciousness, vasovagal syncope, reflex syncope, orthostatic hypotension, cardiac syncope, sudden cardiac death, electrophysiological study, prolonged ECG monitoring, tilt testing, carotid sinus massage, cardiac pacing, implantable, cardioverter defibrillator, syncope unit, emergency department.
