Russian Journal of Cardiology 2020, 25 (12)

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ORIGINAL ARTICLES

BIOMARKERS OF INFLAMMATION IN PATIENTS WITH MYOCARDIAL INFARCTION AND HEART FAILURE WITH PRESERVED AND MID-RANGE EJECTION FRACTION: 5-YEAR PROSPECTIVE FOLLOW-UP

Musikhina N. A., Petelina T. I., Kostousova A. I., Gapon L. I., Gorbatenko E. A., Bessonov I. S.

Abstract

Aim. To evaluate the effect of biomarkers of inflammation on the long-term prognosis in patients with myocardial infarction (MI) and heart failure (HF) with preserved and mid-range ejection fraction according to a registry of percutaneous coronary interventions (PCI).

Material and methods. A total of 135 patients with MI included in the PCI registry in 2012-2013 were examined. Group 1 included 89 patients with HF with mid-range ejection fraction (HFmrEF) — 40-49%; group 2 included 46 patients with HF with

preserved ejection fraction (HFpEF) — ≥50%. Biomarkers of inflammation were determined at admission to the hospital, after 12 and 60 months.

Results. Eighteen people died during the follow-up period. The survival rate of patients in the compared groups after 60 months did not differ (group 1 — 85,0%; group 2 — 89,1%, p=0,492). Mortality predictors were the platelet count (HR, 1,011; 95% CI, 1,003-1,019; p=0,010), homocysteine level (HR 1,172; 95% CI, 1,008-1,364; p=0,040), MMP-9 >249 ng/ml (HR, 7,052; 95% CI, 1,346-36,950; p=0,021). In both groups there was a decrease in survival in patients with high levels of MMP-9 (>249 ng/ml). In group 1, mortality was higher among patients with platelet count >245*10⁹/l. In both groups the levels of inflammatory markers

exceeded the standard values for the entire period of follow-up. The dynamics of NT-proBNP, hs-CRP, TNF-α and homocysteine had a unidirectional pattern, in particular, a decrease in parameters after 12 months, followed by their increase after 60 months.

Conclusion. Levels of MMP-9, homocysteine, and platelets were the factors that influenced 5-year survival in the general group of patients after MI and PCI. In the group with HFmrEF, MMP-9 and platelets had a negative impact on the prognosis. In patients with HFpEF, reduced survival was associated only with high levels of MMP-9. The dynamics of markers of systemic inflammatory response and NTproBNP indicates the prolonged inflammatory process in both groups of patients, persisting for 5 years after MI.

Key words: myocardial infarction, heart failure, markers of inflammation, 5-year follow-up.

Relationships and Activities: none.

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

Musikhina N. A.* ORCID: 0000-0002-8280-2028, Petelina T. I. ORCID: 0000-0001-6251-4179, Kostousova A. I. ORCID: 0000-0002-7268-3467, Gapon L. I. ORCID: 0000-0002-3620-0659, Gorbatenko E. A. ORCID: 0000-0003-3675-1503, Bessonov I. S. ORCID: 0000-0003-0578-5962.

*Corresponding author: musihina@infarkta.net

Received: 24.01.2020

Revision Received: 26.04.2020

Accepted: 30.04.2020

For citation: Musikhina N. A., Petelina T. I., Kostousova A. I., Gapon L. I., Gorbatenko E. A., Bessonov I. S. Biomarkers of inflammation in patients with myocardial infarction and heart failure with preserved and mid-range ejection fraction: 5-year prospective follow-up. Russian Journal of Cardiology. 2020;25(12):3726. (In Russ.) doi:10.15829/1560-4071-2020-3726

CONCENTRATION OF HIGH-SENSITIVITY CARDIAC TROPONIN I IN THE ORAL FLUID IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION: A PILOT STUDY

Chaulin A. M.^1,2, Duplyakova P. D.², Bikbaeva G. R.¹, Tukhbatova A. A.1^, Grigorieva E. V.¹, Duplyakov D. V.^1,2

Abstract

Aim. To assess the potential of using oral fluid as a non-invasive diagnostic material in patients with myocardial infarction (MI).

Material and methods. The pilot, single-center, prospective study included 47 patients with documented MI, among whom there were 33 men (71%) and 14 women (29%) (mean age, 61,72±12,09 years). All patients successfully treated with reperfusion therapy. The control group consisted of 15 people in whom MI was not confirmed. The concentration of high-sensitivity cardiac troponin I (hs-cTnI) in blood and oral fluid was determined using chemiluminescence enzyme immunoassay (CLEIA) on a PATHFAST analyzer (LSI Medience Corporation). Medium sensitivity cardiac troponin I (ms-cTnI) was determined in blood using an Access 2 immunoassay system analyzer (Beckman Coulter, USA). Levels of total bilirubin, creatinine, glucose, rheumatoid factor, alkaline phosphatase and other biochemical parameters were determined on a Furuno CA-400 analyzer (Japan).

Results. The levels of hs-cTnI in patients with MI were significantly higher than in healthy patients both in blood (8,73±1,17 ng/ml vs 0,012±0,03 ng/ml, p<0,001) and oral fluid (0,41±0,11 ng/ml vs 0,004±0,001 ng/ml, p<0,001). In patients with-AMI, there was a moderate correlation between the concentration of hs-cTnI in the serum and the oral fluid (r=0,319; p<0,05). The serum level of hs-cTnI in patients with Q-wave (n=33) and non-Q-wave (n=14) MI was 10,11±1,53 ng/ ml vs 5,48±1,29 ng/ml, respectively (p=0,025). The oral fluid concentration of hs-cTnI in patients with W-wave (n=33) and non-Q-wave (n=14) MI was 0,42±0,14 ng/ml vs 0,40±0,16 ng/ml, respectively (p=0,925). The serum level of hs-cTnI in anterior MI (n=19) was 8,92±2,06 ng/ml vs 8,91±1,81 ng/ml in posterior one (n=23) (p=0,997). The concentration of hs-cTnI in the oral fluid was 0,21±0,06 ng/ml vs 0,57±0,21 ng/ml, respectively (p=0,107). The oral fluid concentrations of hs-TnI in patients with MI using conventional plastic

tubes (n=26) and special Sarstedt microtubes (n=21) were 0,56±0,19 ng/ml and 0,22±0,10 ng/ml, respectively (p=0,12).

Conclusion. This pilot study has proven the possibility of detecting hs-cTnI in the oral fluid of patients with MI. There was a moderate correlation between the level of hs-cTnI in blood serum and oral fluid. Further research is needed to determine the hs-cTnI reference values in the oral fluid of patients with MI.

Key words: high-sensitivity cardiac troponin I, myocardial infarction, non-invasive diagnostics, oral fluid.

Relationships and Activities: none.

¹Samara Regional Clinical Cardiology Dispensary, Samara; ²Samara State Medical University, Samara, Russia.

Chaulin A. M.* ORCID: 0000-0002-2712-0227, Duplyakova P. D. ORCID: 0000-0003-2773-1682, Bikbaeva G. R. ORCID: 0000-0002-6725-7180, Tukhbatova A. A. ORCID: 0000-0002-8061-6766, Grigorieva E. V. ORCID: 0000-0002-5146-1566, Duplyakov D. V. ORCID: 0000-0002-6453-2976.

*Corresponding author: alekseymichailovich22976@gmail.com

Received: 30.03.2020

Revision Received: 24.04.2020

Accepted: 30.04.2020

For citation: Chaulin A. M., Duplyakova P. D., Bikbaeva G. R., Tukhbatova A. A., Grigorieva E. V., Duplyakov D. V. Concentration of high-sensitivity cardiac troponin I in the oral fluid in patients with acute myocardial infarction: a pilot study. Russian Journal of Cardiology. 2020;25(12):3814. (In Russ.) doi:10.15829/1560-4071-2020-3814

PROGNOSTIC SIGNIFICANCE OF A COMBINATION OF NOVEL BIOMARKERS IN THE LONG-TERM STRATIFICATION OF ADVERSE OUTCOMES IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION

Gareeva D. F.¹, Khamitova A. F.¹, Lakman I. A.², Ronzhin R. P.2, Zulkarneev R. Kh.1,2, Plotnikova M. R.1, Tulbaev E. L.1, Motlokh L. D.3, Zagidullin N. Sh.1,2

Abstract

A multi-marker approach for assessing the prognosis of patients with ST-segment elevation myocardial infarction (STEMI) is a promising strategy.

Aim. To assess the potential prognostic power of soluble growth stimulation gene-2 (sST2), pentraxin 3 (PTX3), and N-terminal pro-brain natriuretic peptide (NT-proBNP) in stratification of the risk of major cardiovascular events (CVE) during 2-year follow-up after STEMI.

Material and methods. In 154 patients with STEMI, serum concentrations of NT-proBNP, sST2, and PTx-3 were determined upon admission to hospital. During the two-year follow-up period (734,2±61,2 days), correlation of biomarker concentrations with the risk of a composite endpoint (myocardial infarction + stroke + hospitalization due to cardiovascular disease + cardiovascular death) was analyzed.

Results. In the 2-year follow-up, CVE were observed in 81 (55,1%) patients (CV death (n=33; 22,1%), recurrent MI (n=28; 18,.8%), stroke (n=8; 5,4%), hospitalization due to cardiovascular disease other than MI, stroke or cardiovascular death (n=12; 8,2%)). NT-proBNP (HR, 1,19; 95% CI, 1,018-1,32, p<0,001) and sST2 (HR, 1,000013; 95% CI, 1,00-1,001, p=0,007) correlated with CVE in contrast to PTX-3 (HR, 1,178; 95% CI, 0,798-1,73, p=0,434). The most accurate prediction of CVE was shown in the model with three biomarkers (AIC=831, BIC=843, LR=12,45, p=0,033).

Conclusion. After STEMI, NT-proBNP and sST2, but not PTX-3, predicted CVE, while 3-marker analysis showed higher accuracy compared to single- and doublemarker.

Key words: STEMI, cardiovascular events, cardiovascular death, risk stratification, sST2, NT-proBNP, pentraxin-3.

Relationships and Activities: none.

¹Bashkir State Medical University, Ufa, Russia; ²Ufa State Aviation Technical University, Ufa, Russia; ³University Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria.

Gareeva D. F.* ORCID: 0000-0002-1874-8661, Khamitova A. F. ORCID: 0000-0002-7496-7172, Lakman I. A. ORCID: 0000000198769202, Ronzhin R. P. ORCID: 0000-0002-7290-6480, Zulkarneev R. Kh. ORCID: 0000-0002-9749-7070, Plotnikova M. R. ORCID: 0000-0001-9627-5508, Tulbaev E. L. ORCID: 0000-0002-1105-7542, Motlokh L. D. ORCID: 0000-0003-2832-6582, Zagidullin N. Sh. ORCID: 0000-0003-2386-6707.

*Corresponding author: Danika09@mail.ru

Received: 04.06.2020

Revision Received: 09.07.2020

Accepted: 17.07.2020

For citation: Gareeva D. F., Khamitova A. F., Lakman I. A., Ronzhin R. P., Zulkarneev R. Kh., Plotnikova M. R., Tulbaev E. L., Motlokh L. D., Zagidullin N. Sh. Prognostic significance of a combination of novel biomarkers in the long-term stratification of adverse outcomes in patients with ST-segment elevation myocardial infarction. Russian Journal of Cardiology. 2020;25(12):3948. (In Russ.) doi:10.15829/1560-4071-2020-3948

EFFECT OF INTRAMYOCARDIAL HAEMORRHAGE ON STRUCTURAL AND FUNCTIONAL ECHOCARDIOGRAPHIC PARAMETERS OF MYOCARDIUM AFTER ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION WITH

Alekseeva Ya. V.^1,2, Vyshlov E. V.^1,2, Mochula O. V.¹, Usov V. Yu.^1,2, Ryabov V. V.^1,2

Abstract

Aim. To analyze the effect of intramyocardial haemorrhage (IMH) on the structural and functional echocardiographic parameters of myocardium in patients with primary ST-segment elevation myocardial infarction (STEMI).

Material and methods. The study included 60 patients with primary STEMI reperfused within 12 hours after symptom onset. On the second day after the event, all subjects underwent gadolinium-enhanced cardiac magnetic resonance imaging (MRI). IMH was visualized as T2-weighted hypointense areas. Subsequently, all patients underwent the standard echocardiography on the 7th day after MI.

Results. IMH was revealed in 31 patients (51,6%). In 22 patients (70,9%), IMH was accompanied by microvascular obstruction (MVO). In the remaining 9 patients (29%), an isolated IMH phenomenon was visualized. Lower values of left ventricular ejection fraction (LVEF) and LV volume parameters were associated with a combination of MVO and IMH. At the same time, the indices of volumetric characteristics and LVEF in isolated IMH were the same as in the group without IMH and MVO. It was demonstrated that the IMH occupies 1% (1-3%) of the LV myocardium. Correlation analysis showed a moderate inverse correlation between the IMH area and LV contractile function: the larger the area, the lower the LVEF (R=-0,35; p=0,007).

Conclusions. The analysis of the influence of different IMH phenotypes on the structural and functional echocardiographic parameters of myocardium in the short-term period after STEMI has shown that the combination of IMH with MVO and isolated IMH have different effects on LV contractile function. The combination of IMH with MVO is a predictor of a decrease in LVEF and increase of end-systolic volume (ESV), while an isolated IMH does not affect these parameters. Correlations between the IMH area and a decrease in LVEF, as well as an increase in ESV, have been demonstrated.

Key words: microvascular injury, intramyocardial haemorrhage, STEMI, myocardial infarction.

Relationships and Activities. This work was supported by a fellowship of the President of the Russian Federation for young scientists and post-graduate students “The influence of microvascular myocardial injury on the course of the inflammatory response in myocardial infarction”.

ClinicalTrials.gov Identifier: NCT03677466

¹Research Institute of Cardiology, Tomsk National Research Medical Center, Tomsk; ²Siberian State Medical University, Tomsk, Russia.

Alekseeva Ya. V.* ORCID: 0000-0003-0903-0102, Vyshlov E. V. ORCID: 0000-0002-3699-4807, Mochula O. V. ORCID: 0000-0002-7502-7502, Ussov V. Yu. ORCID: 0000-0001-7978-5514, Ryabov V. V. ORCID: 0000-0002-4358-7329.

*Corresponding author: marckova.yanochka@yandex.ru

Received: 23.07.2020

Revision Received: 12.09.2020

Accepted: 18.09.2020

For citation: Alekseeva Ya. V., Vyshlov E. V., Mochula O. V., Usov V. Yu., Ryabov V. V. Effect of intramyocardial haemorrhage on structural and functional echocardiographic parameters of myocardium after ST-segment elevation myocardial infarction with. Russian Journal of Cardiology. 2020;25(12):4032. (In Russ.) doi:10.15829/1560-4071-2020-4032

FORMATION OF CALCIUM PHOSPHATE BIONS IN PATIENTS WITH CAROTID AND CORONARY ATHEROSCLEROSIS

Kutikhin A. G., Shishkova D. K., Khryachkova O. N., Frolov A. V., Shabaev A. R., Zagorodnikov N. I., Markova V. E., Bogdanov L. A., Osyaev N. Yu., Indukaeva E. V., Gruzdeva O. V.

Abstract

Aim. To study the formation of calcium phosphate bions (CPB), a trigger of endothelial dysfunction in the patients with coronary and carotid atherosclerosis as compared to healthy blood donors.

Material and methods. The study included 264 individuals: 88 patients with cerebrovascular disease who underwent carotid endarterectomy due to ischemic stroke (n=44) or chronic cerebral ischemia (n=44)); 88 patients with coronary artery disease (44 patients with stable angina requiring coronary artery bypass graft surgery and 44 patients with myocardial infarction); 88 healthy volunteers enrolled into Prospective Urban Rural Epidemiology (PURE) study who did not have symptomatic coronary or hemodynamically relevant carotid atherosclerosis as measured by ultrasound. We further measured serum parameters defining mineral homeostasis: total and ionized calcium, phosphate, total protein, albumin, and fetuin-A. We also determined serum calcification propensity by means of supersaturation (+2 mmol/L) with CaCl₂ and Na₂HPO₄ followed by incubation at 37º С for 24 hours.

Results. Patients with carotid atherosclerosis (either with ischemic stroke or chronic cerebral ischemia) or myocardial infarction were characterized by an increased calcification propensity in combination with reduced total protein and albumin and elevated

ionized calcium. Correlation analysis revealed that serum calcification was associated with a decrease in serum total protein and albumin. Therefore, depletion of serum protein mineral depot leads to the elevation of ionized calcium which is further aggregated into calcium phosphate bions, a secondary mineral depot.

Conclusion. Formation of CPB in the serum is induced by an elevation of ionized calcium caused by a reduction of total protein and albumin and is associated with increased risk and progression of atherosclerosis.

Key words: atherosclerosis, endothelial dysfunction, mineral homeostasis, calcium phosphate, calcium phosphate bions.

Relationships and Activities. The work (design, experiments, analysis and interpretation of data) was carried out as part of an exploratory research № 2020_419_29 “Determination of the propensity of blood serum of patients with coronary and multifocal atherosclerosis to form endogenous calcium-phosphate nanoparticles, a trigger of endothelial dysfunction and atherosclerosis”, performed by the Research Institute for Complex Issues of Cardiovascular Diseases.

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

Kutikhin A. G. ORCID: 0000-0001-8679-4857, Shishkova D. K.* ORCID: 0000-0002-1518-3888, Khryachkova O. N. ORCID: 0000-0002-6620-5960, Frolov A. V. ORCID: 0000-0003-2366-6545, Shabaev A. R. ORCID: 0000-0002-9734-8462, Zagorodnikov N. I. ORCID: 0000-0003-3539-0291, Markova V. E. ORCID: 0000-0002-6652-5745, Bogdanov L. A. ORCID: 0000-0003-4124-2316, Osyaev N. Yu. ORCID: none, Indukaeva E. V. ORCID: 0000-0002-6911-6568, Gruzdeva O. V. ORCID: 0000-0002-7780-829X.

*Corresponding author: shishkovadk@gmail.com

Received: 05.05.2020

Revision Received: 20.05.2020

Accepted: 06.06.2020

For citation: Kutikhin A. G., Shishkova D. K., Khryachkova O. N., Frolov A. V., Shabaev A. R., Zagorodnikov N. I., Markova V. E., Bogdanov L. A., Osyaev N. Yu., Indukaeva E. V., Gruzdeva O. V. Formation of calcium phosphate bions in patients with carotid and coronary atherosclerosis. Russian Journal of Cardiology. 2020;25(12):3881. (In Russ.) doi:10.15829/1560-4071-2020-3881

PREDICTION OF CORONARY ATHEROSCLEROSIS IN YOUNG PATIENTS WITH CORONARY ARTERY DISEASE USING A NON-INVASIVE BIOMARKER

Oleinikov V. E.¹, Salyamova L. I.¹, Khromova A. A.¹, Kupriyanova S. N.¹, Kvasova O. G.¹, Ilyasov I. B.²

Abstract

Aim. To develop a combined biomarker for non-invasive diagnostics of the severity of coronary artery (CA) atherosclerosis in patients with coronary artery disease (CAD) and in those without clinical manifestations of atherosclerosis under 50 years of age

using structural and functional parameters of large arteries and the lipid profile.

Material and methods. A total of 92 patients with CAD and 28 healthy ones were included. Depending on the results of coronary angiography, patients with CAD were divided into 3 groups: without hemodynamically significant stenosis (HSS) (HSS_1<50%, n=30), with HSS of one CA (HSS_1>50%, n=37), with HSS of 2 and more CA (HSS_2>50%,n=25). The subjects underwent a biochemical blood test, carotid duplex ultrasound, volumetric sphygmography.

Results. In individuals with HSS_1<50%,lipid metabolism disorders were diagnosed in 63,3% (n=19), in HSS_1>50% group — 78,4% (n=29), in HSS_2>50% group — 92% of cases (n=23) (p_1-3<0,05). Carotid intima-media thickness exceeding the threshold level was found in 40% of patients with HSS_1<50%, in 51% of patients with HSS_1>50% and 64% of patients with HSS_2>50% (p_1-3<0,05). According to the results of volumetric sphygmography, the severity of CA atherosclerosis was associated with a higher pulse wave velocity and L-/CAVI₁. At the next stage, a complex parameter for predicting coronary atherosclerosis (CA biomarker) was developed, including sex, structural and functional indicators of the arteries (intima-media thickness, β-stiffness index, L-/CAVI₁) and biochemical parameters (total cholesterol, triglycerides, low density lipoproteins). In healthy people, the level of CA biomarker was 2,7 (95% CI, 2,3-3,9); in patients with CAD with any degree of CA lesion — 6,4 (95% CI, 5,2-9,6). The CA biomarker threshold of 5 points with a sensitivity of 87,5% and a specificity of 90,5% was determined as the optimal cut-off point; area under the curve — 0,965 (95% CI, 0,943-0,987) (p<0,0001).

Conclusion. In patients with CAD, the presence and degree of coronary atherosclerosis are associated with the deterioration of most structural and functional artery parameters. The developed complex CA biomarker is of interest for non-invasive screening of preclinical CA atherosclerosis in patients with a low relative risk.

Key words: coronary artery disease, coronary atherosclerosis, biomarker, arterial stiffness, biochemical parameters.

Relationships and Activities: none.

¹Penza State University, Penza; ²N.N. Burdenko Penza Regional Clinical Hospital, Penza, Russia.

Oleinikov V. E.* ORCID: 0000-0002-7463-9259, Salyamova L. I. ORCID: 0000-0001-7130-0316, Khromova A. A. ORCID: 0000-0001-7239-6620, Kupriyanova S. N. ORCID: 0000-0002-2683-3022, Kvasova O. G. ORCID: 0000-0001-7008-6995,

Ilyasov I. B. ORCID: 0000-0002-8070-5515.

*Corresponding author: v.oleynikof@gmail.com

Received: 22.05.2020

Revision Received: 25.05.2020

Accepted: 16.06.2020

For citation: Oleinikov V. E., Salyamova L. I., Khromova A. A., Kupriyanova S. N., Kvasova O. G., Ilyasov I. B. Prediction of coronary atherosclerosis in young patients with coronary artery disease using a non-invasive biomarker. Russian Journal of Cardiology. 2020;25(12):3924. (In Russ.) doi:10.15829/1560-4071-2020-3924

CENTRAL AND PERIPHERAL HEMODYNAMIC RESPONSES TO ORTHOSTASIS IN HYPERTENSIVE MALES

WITH CHRONIC VENOUS DISORDERS TAKING COMBINED THERAPY WITH A CALCIUM CHANNEL BLOCKER AND AN ANGIOTENSIN-CONVERTING ENZYME INHIBITOR

Letyagina S. V.¹, Baev V. M.², Agafonova T. Yu.²

Abstract

Aim. To study the characteristics of central and peripheral hemodynamic responses to orthostasis in hypertensive (HTN) males with chronic venous disorders (CVD) taking combined therapy with a calcium channel blocker (CCB) and an angiotensinconverting enzyme (ACE) inhibitor.

Material and methods. In 46 men 30-50 years old with uncontrolled HTN taking antihypertensive therapy, a comparative assessment of the dynamics of systolic blood pressure (SBP), diastolic blood pressure (DBP), peripheral venous pressure (PVP), lumen diameter and area, blood flow velocity of superficial and deep veins of the left leg in response to orthostasis. Venous hemodynamics was studied by duplex ultrasound. PVP was assessed by oscillometry on the thigh and ultrasound of the great superficial vein. A comparative dynamic analysis of these parameters was carried out in patients of two groups: 23 hypertensive patients without CVD and 23 patients with HTN and CVD. CVD was assessed using Comprehensive Energy Assistance Program (CEAP). Orthostasis was performed before and after 14 days of antihypertensive therapy with a combination of CCB and ACE inhibitors.

Results. Central and peripheral hemodynamic responses to orthostasis before treatment in patients of both groups was the same — a decrease in SBP, DBP and PVP, expansion of superficial and deep veins, and a decrease in venous blood flow velocity. As a result of treatment, 43 patients achieved the first target office SBP (<140 mm Hg). Of these, there were 21 HTN patients without CVD and 22 patients with CVD. After treatment, most responses to orthostasis in both groups was similar to pre-treatment ones. However, differences were also noted — in both groups, the DBP increased; SBP decreased only in men with CVD. In patients with CVD, the posterior tibial vein (PTV) dilated and blood flow velocity decreased after treatment in response to orthostasis, while in patients without CVD, there was a narrowing of PTV and blood flow acceleration. After treatment, patients with CVD were characterized by a larger diameter and area of the lumen of superficial and deep veins than those without CVD in response to orthostasis.

Conclusion. Orthostasis before antihypertensive therapy in patients both with and without CVD is characterized by an identical hemodynamic response — a decrease in SBP, DBP, PVP expansion of superficial and deep veins, and a decrease in venous blood flow velocity. After 14-day antihypertensive therapy, there were differences in hemodynamic response between the study groups. In patients with HTN and CVD, CCB and ACE inhibitors therapy leads to a redistribution of central and peripheral circulation and increases the dilatation of the veins in response to orthostasis.

Key words: hypertension, chronic venous disorders, antihypertensive therapy, orthostasis.

Relationships and Activities: none.

¹Medical Unit of the Ministry of Internal Affairs of Russia in the Perm Krai, Perm; ²E. A. Wagner Perm State Medical University, Perm, Russia.

Letyagina S. V. ORCID: 0000-0002-1635-7149, Baev V. M.* ORCID: 0000-0001-9283-8094, Agafonova T. Yu. ORCID: 0000-0001-9935-0040.

*Corresponding author: VMBaev@Hotmail.com

Received: 28.05.2020

Revision Received: 02.07.2020

Accepted: 09.07.2020

For citation: Letyagina S. V., Baev V. M., Agafonova T. Yu. Central and peripheral hemodynamic responses to orthostasis in hypertensive males with chronic venous disorders taking combined therapy with a calcium channel blocker and an angiotensin-converting enzyme inhibitor. Russian Journal of Cardiology. 2020;25(12):3934. (In Russ.) doi:10.15829/1560-4071-2020-3934

CALCIUM METABOLISM, ARTERIAL STIFFNESS AND 24-HOUR BLOOD PRESSURE MONITORING DATA IN POSTMENOPAUSAL WOMEN WITH MAGNESIUM DEFICIENCY, HYPERTENSION, AND HEART FAILURE

Maylyan D. E., Kolomiets V. V.

Abstract

Aim. To assess the calcium metabolism, arterial stiffness and 24-hour blood pressure (BP) monitoring data in postmenopausal women with magnesium deficiency, hypertension, and heart failure with preserved ejection fraction (HFpEF).

Material and methods. The study involved 140 female patients with hypertension complicated by HFpEF, aged 52 to 76 years. Depending on the results of magnesium-tolerance test, 2 groups were selected. The first group consisted of 72 females with magnesium deficiency, and the second (control) group (n=68) — without magnesium deficiency. Calcium metabolism was assessed using calciumtolerance test. Twenty-four-hour blood pressure monitoring and arterial stiffness was determined using an automatic blood pressure monitor.

Results. Patients with magnesium deficiency had a lower calcium excretion and return to baseline blood calcium levels compared with group 2 (p<0,001). The presence of magnesium deficiency was associated with an increase in 24-hour BP variability (16,9 [13,3; 20,69] mm Hg vs 12,9 [11,7; 17,42] mm Hg; p=0,001), rate of morning BP rise (12,5 [9,7; 13,6] mm Hg/h vs 9,5 [8,1; 10,9]

mm Hg/h; p<0,001) and indexed systolic BP (21,2 [19,5; 25,1] mm Hg vs 19,5 [16,5; 23,9] mm Hg; p=0,007). In women with magnesium deficiency, BP profiles of non-dipper and night-peaker were more common (p<0,05). Pulse wave velocity (11,92 [10,06; 14,47] m/s vs 10,87 [8,41; 13,20] m/s; p=0,005) and central pulse pressure (70,2±13,3 mm Hg vs 63,5±12,5 mm Hg; p=0,003) were also higher in group 1. Also, a correlation (ρ=-0,610, p<0,001) was found between the rate of exercise-induced decrease in blood calcium and the pulse wave velocity.

Conclusion. In women with hypertension and HFpEF, there were no differences in mean 24-hour BP values, while more unfavorable BP profiles and arterial stiffness indicators were revealed, which is mediated by impaired сalcium metabolism.

Key words: magnesium, calcium, hypertension, heart failure, blood pressure profile, arterial stiffness.

Relationships and Activities: none.

Donetsk National Medical University, Donetsk, DPR.

Maylyan D. E.* ORCID: 0000-0003-4428-022X, Kolomiets V. V. ORCID: 0000-0003-1074-4479.

*Corresponding author: majlyan@narod.ru

Received: 08.07.2020

Revision Received: 03.08.2020

Accepted: 14.08.2020

For citation: Maylyan D. E., Kolomiets V. V. Calcium metabolism, arterial stiffness and 24-hour blood pressure monitoring data in postmenopausal women with magnesium deficiency, hypertension, and heart failure. Russian Journal of Cardiology. 2020;25(12):3984. (In Russ.) doi:10.15829/1560-4071-2020-3984

CHANGES OF NT-PROBNP AND SST2 LEVELS FOR PREDICTING ISOLATED EPISODES OF VENTRICULAR TACHYARRHYTHMIAS AND ELECTRICAL STORM IN PATIENTS WITH SYSTOLIC HEART FAILURE AND VARIOUS IMPLANTED DEVICES

Gasparyan A. Zh., Guseva E. V., Tarasovsky G. S., Kashtanova S. Yu., Utsumueva M. D., Sharf T. V., Mironova N. A., Sokolov S. F., Masenko V. P., Skvortsov A. A., Shlevkov N. B.

Abstract

Aim. To study the changes in N-terminal pro-brain natriuretic peptide (NT-proBNP) and growth stimulation gene-2 (sST2) to predict isolated episodes of ventricular tachyarrhythmias (VTA) and electrical storm (ES) in patients with systolic heart failure and implanted cardioverter-defibrillators, cardiac resynchronization therapy (CRT) defibrillators, as well as cardiac contractility modulation (CCM) devices.

Material and methods. The study included 69 patients (mean, 59; women, 10; mean age, 59±13 years) with class I-III systolic HF and ischemic (n=36) or nonischemic (n=33) cardiomyopathy. The survey was carried out at baseline, as well as 1, 3, 6 and 12 months after device implantation. This included data collection, physical examination, determination of NT-proBNP and sST2, 6-minute walk test, electrocardiography (ECG), 24-hour Holter monitoring, echocardiography, assessment of device performance. Predictors of isolated VTA and ES were identified using ROC and multivariate analyzes.

Results. According to the follow-up (median, 28 months) results, 3 groups of patients were formed: group 1 — without VTA (n=45); group 2 — isolated VTA (n=15); group 3 — ES (n=9). According to multivariate analysis, predictors of isolated VTA were as follows: 1) baseline NT-proBNP >3200 pg/ml; 2) minimum NTproBNP >1100 pg/ml during 12-month follow-up; 3) sST2 >26 ng/ml 3 months after device implantation; 4) presence of old myocardial infarction; 5) no echocardiographic signs of response to CRT or CCM therapy. There were following predictors of ES: 1) left ventricular end-systolic dimension >7,0 cm; 2) presence of VTA runs according to 24-hour Holter monitoring; 3) no echocardiographic signs of response to CRT or CCM therapy.

Conclusion. The results obtained indicate that NT-proBNP and sST2 assessment in patients with systolic heart failure is promising for predicting isolated VTA, but not ES. Cardiac reverse remodeling as a result of effective CRT or CCM therapy is associated with a significant risk reduction for isolated VTA and ES.

Key words: biomarkers, NT-proBNP, sST2, ventricular tachyarrhythmias, sudden cardiac death, heart failure.

Relationships and Activities: none.

National Medical Research Center of Cardiology, Moscow, Russia.

Gasparyan A. Zh.* ORCID: 0000-0001-9984-6505, Guseva E. V. ORCID: 0000-0001-6500-3649, Tarasovsky G. S. ORCID: 0000-0002-2143-8912, Kashtanova S. Yu. ORCID: 0000-0003-4731-0818, Utsumueva M. D. ORCID: 0000-0003-0746-8012, Sharf T. V. ORCID: 0000-0003-1993-9264, Mironova N. A. ORCID: 0000-0002-2374-3718, Sokolov S. F. ORCID: 0000-0001-5418-7796, Masenko V. P. ORCID: 0000-0003-3280-3521, Skvortsov A. A. ORCID: 0000-0003-2712-927X, Shlevkov N. B. ORCID: 0000-0003-3956-1860.

*Corresponding author: armen_ui@inbox.ru

Received: 25.09.2020

Revision Received: 09.11.2020

Accepted: 15.11.2020

For citation: Gasparyan A. Zh., Guseva E. V., Tarasovsky G. S., Kashtanova S. Yu., Utsumueva M. D., Sharf T. V., Mironova N. A., Sokolov S. F., Masenko V. P., Skvortsov A. A., Shlevkov N. B. Changes of NT-proBNP and sST2 levels for predicting isolated episodes of ventricular tachyarrhythmias and electrical storm in patients with systolic heart failure and various implanted devices. Russian Journal of Cardiology. 2020;25(12):4123. (In Russ.) doi:10.15829/1560-4071-2020-4123

EXPERIENCE IN USING FOCUSED CARDIAC ULTRASOUND IN PATIENTS WITH ACUTE HEART FAILURE

IN THE INTENSIVE CARE UNIT

Drapkina O. M.¹, Dzhioeva O. N.¹, Kuzub A. A.^1,2, Dadaev V. S.^1,2

Abstract

Portable ultrasound devices in initial cardiac patient examination in intensive care units are seen as an essential addition to conventional physical examinations.

Aim. To assess the potential of using focused cardiac ultrasound for patients admitted in the intensive care unit with a clinical performance of acute heart failure.

Material and methods. The study included 180 patients, 110 of whom were men. The mean age was 57 (40; 74) years. The patients included in the study were divided into 2 groups: group 1 consisted of patients who, upon admission, underwent a general clinical examination and an ultrasound with a portable device; group 2 — patients who, upon admission, underwent only a conventional examination. Using portable ultrasound scanners, the doctors evaluated ventricular contractility, the presence of significant valve regurgitation, the diameter and degree of inferior vena cava collapse, as well as the presence, prevalence and number of B-lines. The differences in the time required for the diagnosis using various methods were determined. Structural changes in the heart and lungs, identified using a portable ultrasound device, were also assessed.

Results. In the group of patients who underwent focused cardiac ultrasound, the time from admission to initiation of therapy was 11 (7; 18) minutes. In the group 2, the median time from admission to initiation of intravenous diuretic administration was 86 (52; 116) min (p<0,001). According to the results of an ultrasound with a portable device, the following changes were noted: significant left ventricular contractility decrease were found in 32,4% of patients; a decrease in right ventricle contractility — in 16,2%. In 50% of patients, the left ventricular contractility was sufficient. In 43,3% of patients, bilateral B lines were identified as a sign of interstitial pulmonary syndrome; in 38,8%, there were signs of hypervolemia when assessing the inferior vena cava. Hemodynamically relevant mitral regurgitation was noted in 28,8% of cases; hemodynamically relevant tricuspid regurgitation — 21,1%; relevant aortic regurgitation — 6,6%. In 10% of patients, there was restricted mobility of aortic valve leaflets, which was suspected as aortic stenosis. In 18% of cases, no significant intracardiac hemodynamic changes were noted.

Conclusion. It has been shown that examination with focused cardiac ultrasound in the intensive care unit reduces decision time by more than an hour. Initial examination of a patient with acute heart failure using pocket cardiac ultrasound devices reveals clinically relevant intracardiac hemodynamic disorders.

Key words: focused cardiac ultrasound, assisted examination, acute heart failure, portable ultrasound systems.

Relationships and Activities: none.

¹National Research Center for Therapy and Preventive Medicine, Moscow; ²S. S. Yudin City Clinical Hospital, Moscow, Russia.

Drapkina O. M. ORCID: 0000-0002-4453-8430, Dzhioeva O. N.* ORCID: 0000-0002-5384-3795, Kuzub A. A. ORCID: 0000-0002-7727-3942, Dadaev V. S. ORCID: 0000-0002-1294-7803.

*Corresponding author: dzhioevaon@gmail.com

Received: 01.09.2020

Revision Received: 06.10.2020

Accepted: 14.10.2020

For citation: Drapkina O. M., Dzhioeva O. N., Kuzub A. A., Dadaev V. S. Experience in using focused cardiac ultrasound in patients with acute heart failure in the intensive care unit. Russian Journal of Cardiology. 2020;25(12):4082. (In Russ.) doi:10.15829/1560-4071-2020-4082

NON-COMPACTION CARDIOMYOPATHY. PART II: LIMITATIONS OF IMAGING TECHNIQUES AND GENETIC SCREENING, CLINICAL OBSERVATIONS

Vaikhanskaya T. G.¹, Sivitskaya L. N.², Kurushko T. V.¹, Rusak T. V.¹, Levdansky O. D.², Danilenko N. G.², Davydenko O. G.²

Abstract

Improvement of high-tech methods of cardiac imaging and new generation sequencing with their introduction into widespread practice has significantly expanded the potential of diagnosis of rare cardiomyopathies. Modern imaging methods make it easy to reveal the myocardial non-compaction. However, in clinical practice, significant difficulties remain in the differentiation of normal/borderline patterns of increased ventricular trabecularity, morphology of myocardial noncompaction and non-compaction cardiomyopathy (NCM). After three decades of research, verifying the NCM is still a major clinical challenge. A key aspect of this

problem is the lack of generally accepted recommendations on the diagnostic criteria for NCM and low number of long-term multicenter studies with segregation analysis on familial NCMs. A promising solution is the development of a multistep algorithm for the diagnosis of NCM with the integration of familial, morphological, genetic and clinical data. The article presents a brief literary review on NCM diagnosis with a discussion of own research and comparative characteristics of clinical and genetic data. To confirm the clinical and molecular heterogeneity of NCM, there are brief clinical observations of mixed phenotypes with a detailed presentation of overlap NCMs in the MOGE(S) classification.

Key words: myocardial non-compaction, non-compaction cardiomyopathy, genetics, heart failure, cardiac arrhythmias, sudden cardiac death.

Relationships and Activities: none.

¹Republican Science-Practical Centre “Cardiology”, Minsk; ²Institute of Genetics and Cytology, Minsk, Belarus.

Vaikhanskaya T. G.* ORCID: 0000-0002-2127-8525, Sivitskaya L. N. ORCID: 0000-0001-6359-4967, Kurushko T. V. ORCID: 0000-0001-5727-3219, Rusak T. V. ORCID: 0000-0003-4318-9977, Levdansky O. D. ORCID: 0000-0002-3325-0917, Danilenko N. G. ORCID: 0000-0002-3270-3080, Davydenko O. G. ORCID: 0000-0002-9790-2953.

*Corresponding author: tat_vaikh@mail.ru

Received: 30.04.2020

Revision Received: 06.05.2020

Accepted: 13.05.2020

For citation: Vaikhanskaya T. G., Sivitskaya L. N., Kurushko T. V., Rusak T. V., Levdansky O. D., Danilenko N. G., Davydenko O. G. Non-compaction cardiomyopathy. Non-compaction cardiomyopathy. Part II: limitations of imaging techniques and genetic screening, clinical observations. Russian Journal of Cardiology. 2020;25(12):3873. (In Russ.) doi:10.15829/1560-4071-2020-3873

Information about previous publications: Vaikhanskaya T. G., Sivitskaya L. N., Kurushko T. V., Rusak T. V., Levdansky O. D., Danilenko N. G., Davydenko O. G. Noncompaction cardiomyopathy. Part I: clinical and genetic heterogeneity and predictors of unfavorable prognosis. Russian Journal of Cardiology. 2020;25(11):3872. (In Russ.) doi:10.15829/1560-4071-2020-3872

LONG-TERM RESULTS OF AORTIC VALVE REPLACEMENT WITH XENOGENIC PERICARDIAL STENTLESS PROSTHESIS BIOLAB KB/A

Babenko S. I., Muratov R. M., Soboleva N. N., Titov D. A., Bakuleva N. P., Fedoseikina M. I.

Abstract

Aim. To evaluate long-term results of using xenogenic pericardial stentless prosthesis BioLAB KB/A.

Material and methods. From 2007 to 2014, 57 xenogenic pericardial stentless prostheses BioLAB KB/A were implanted. The mean age of operated patients was 70±4 (49-80 years of age); 6 patients were younger than 65 years old. The mean follow-up period was 8 years (4-11 years). The mean age of patients at the time of examination was 79 (70-89) years.

Results. Five- and ten-year survival rates were 73,82±7,99% and 51,01±11,23%, respectively. Four patients underwent long-term reoperation due to bioprosthetic valve dysfunction. Freedom from reoperation associated with infective endocarditis after a year was 95,1±2,4%, three years — 92,65±4,1%, five years — 89,1±5,2%, and seven years — 89,1±5,2%. Freedom from prosthetic valve dysfunction due to structural degeneration was 9,58±1,83 years.

Conclusion. We consider it possible to use the xenogenic pericardial stentless prostheses BioLAB KB/A for aortic valve replacement in elderly patients, especially with a narrow aortic root. However, using a technically more complex technique for a larger geometric opening is not justified. Significant regurgitation at 7 years after surgery requires considering reoperation, but already in older patients and with a number of comorbidities.

Key words: xenogenic pericardial stentless prostheses, bioprosthetics, aortic valve.

Relationships and Activities: none.

Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia.

Babenko S. I. ORCID: 0000-0002-2621-4504, Muratov R. M. ORCID: 0000-0003-3321-9028, Soboleva N. N. ORCID: none, Titov D. A. ORCID: 0000-0002-0943-5727, Bakuleva N. P ORCID: 0000-0002-1119-5435, Fedoseikina M. I.* ORCID: 0000-0003-4122-8565.

*Corresponding author: maryilinishna@yandex.ru

Received: 11.06.2020

Revision Received: 10.08.2020

Accepted: 21.08.2020

For citation: Babenko S. I., Muratov R. M., Soboleva N. N., Titov D. A., Bakuleva N. P., Fedoseikina M. I. Long-term results of aortic valve replacement with xenogenic pericardial stentless prosthesis BioLAB KB/A. Russian Journal of Cardiology. 2020;25(12):3966. (In Russ.) doi:10.15829/1560-4071-2020-3966

COMPARATIVE ANALYSIS OF CARDIOPROTECTIVE EFFECTS OF TWO RENAL DENERVATION TECHNIQUES

Ripp T. M.¹, Pekarskiy S. E.¹, Baev A. E.¹, Ryabova T. R.¹, Yaroslavskaya E. I.², Falkovskaya A. Yu.¹, Sitkova E. S.¹, Lichikaki V. A.¹, Zyubanova I. V.¹, Manukyan M. A.¹, Gapon L. I.², Mordovin V. F.¹

Abstract

Aim. To compare cardioprotective effects of two renal denervation (RD) techniques: main renal artery or its branches after bifurcation in patients with resistant hypertension (RH).

Materials and methods. This randomized double-blind clinical (ClinicalTrials. gov. identifier: NCT02667912) study with a follow-up of 12,3±1,6 months included 55 patients with RH, which was divided into 2 groups: group 1 (n=27) — main renal artery denervation; group 2 — RD of branches. Mean age of patients was 57,3±9,5 and 56,4±9,3 years, respectively. We assessed structural and functional cardiac characteristics using two-dimensional speckle-tracking echocardiography (STE).

Results. Initially, the patients in the groups did not differ in terms of studied parameters and therapy. After RD in both groups, the levels of myocardial stress significantly decreased; 95% confidence interval: after main renal artery denervation — systolic [-4802; -2896], diastolic [-3264; -2032] dyne/cm²; after RD of branches — [-6324; -5328] and [-4021; -2521] dyne/cm2, respectively (p=0,001 and 0,024, respectively). After main renal artery denervation, there was a decrease in the left ventricular (LV) wall thickness (interventricular septum [1,06; -0,62] and posterior wall [0,12; -0,62]) in comparison with RD of branches ([-0,68; -1,28] and [-0,68; -1,06], respectively). These differences were significant: p=0,023 and 0,021, respectively. After distal RD, decrease in the LV mass was observed more often by 21,2%, an increase in the LV mass was 2 times less frequent. Restoration of diastolic

function was more common in patients after distal RD than main renal artery denervation (26% vs 13%, respectively). According to pilot analysis, STE parameters was also improved.

Conclusion. Twelve months after distal RD, compared with the main renal artery denervation, the LV wall thickness, number of patients with LV hypertrophy, and diastolic dysfunction decreased significantly greater. Two-dimensional STE revealed improvement of cardiac parameters. The results require further research.

Key words: heart, hypertension, renal denervation, diastolic function.

Relationships and Activities. State assignment of Tomsk National Medical Research Center (state registration: АААА-А17-117052310076-7 dated 23.05.2017).

Acknowledgments. The authors are grateful to the resident Bukharova E. K. for partially done work with speckle-tracking echocardiography.

ClinicalTrials.gov Identifier: NCT02667912 (https://clinicaltrials.gov/ct2/show/NCT02667912).

¹Research Institute of Cardiology, Tomsk National Research Medical Center, Tomsk; ²Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tomsk, Russia.

Ripp T. M.* ORCID: 0000-0001-5898-0361, Pekarskiy S. E. ORCID: 0000-0002-4008-4021, Baev A. E. ORCID: 0000-0002-8163-1618, Ryabova T. R. ORCID: 0000-0001-8573-5695, Yaroslavskaya E. I. ORCID: 0000-0003-1436-8853, Falkovskaya

A. Yu. ORCID: 0000-0002-5638-3034, Sitkova E. S. ORCID: 0000-0002-0988-3642, Lichikaki V. A. ORCID: 0000-0003-4066-869X, Zyubanova I. V. ORCID: 0000-0001-6995-9875, Manukyan M. A. ORCID: 0000-0003-3577-1895, Gapon L. I. ORCID: 0000-0002-3620-0659, Mordovin V. F. ORCID: 0000-0002-2238-4573.

*Corresponding author: ripp@cardio-tomsk.ru

Received: 02.07.2020

Revision Received: 08.08.2020

Accepted: 09.08.2020

For citation: Ripp T. M., Pekarskiy S. E., Baev A. E., Ryabova T. R., Yaroslavskaya E. I., Falkovskaya A. Yu., Sitkova E. S., Lichikaki V. A., Zyubanova I. V., Manukyan M. A., Gapon L. I., Mordovin V. F. Comparative analysis of cardioprotective effects of two renal denervation techniques. Russian Journal of Cardiology. 2020;25(12):3994. (In Russ.) doi:10.15829/1560-4071-2020-3994

DECREASED ARTERIAL COMPLIANCE ASSESSED BY AORTIC PULSE WAVE VELOCITY IS AN IMPORTANT PARAMETER FOR MONITORING OF BLOOD PRESSURE IN PATIENTS WITH CHRONIC INFLAMMATORY DISEASES

Yilmaz Ak. H.¹, Ozsahin Y.¹, Baskurt Aladag N.², Gencoglu F.¹, Sahin Yildiz B.², Haberal I.¹, Koyuncu A. O.¹, Yildiz M.¹

Abstract

Aim. Patients with chronic inflammatory diseases (CID), such as rheumatoid arthritis (RA) and familial Mediterranean fever (FMF) are more likely to have higher risk of cardiac events. Pulse wave velocity (PWV) can be used to measure the aortic distensibility and it is known as inversely related to the arterial compliance. Increased aortic stiffness which is assessed by PWV, is seem to be associated with arterial blood pressure. In this study, we investigated the arterial compliance by PWV in patients with CID including RA and FMF.

Material and methods. We studied 25 patients with RA, 33 patients with FMF and 31 healthy subjects without a history of any cardiovascular risk factors such as hypertension, diabetes mellitus, hyperlipidaemia (89 subjects in total). We measured the arterial compliance by automatic carotid-femoral (aortic) PWV using Complior Colson (France) device. PWV (m/s) = distance (m)/transit time(s).

Results. It is seen that, patients with CID have higher carotid-femoral (aortic) PWV (8,76±2,09 vs 8,07±0,94 m/s) compared to control groups (p=0,03). There were significant correlations between PWV and age, body-mass index, systolic blood pressure, diastolic blood pressure and mean blood pressure. (p<0,001, r=0,65; p<0,001, r=0,36; p<0,001, r=0,42; p<0,001, r=0,46; p<0,001, r=0,48, respectively).

Conclusion. Arterial compliance, which is assessed by carotid-femoral (aortic) PWV, is decreased in patients with CID such as RA and FMF when it is compared to healthy control group.

Key words: arterial elasticity, pulse wave velocity, chronic inflammatory disease.

Relationships and Activities: none.

¹Istanbul University-Cerrahpasa Cardiology Institute, Istanbul; ²Dr. Lutfi Kirdar Kartal Educational and Research Hospital, Istanbul, Turkey.

Yilmaz Ak. H.* — Department of Anesthesiology and Reanimation, ORCID: 0000-0002-8682-6254, Ozsahin Y. — Department of Anesthesiology and Reanimation, ORCID: none, Baskurt Aladag N. — Department of Internal Medicine, ORCID: none, Gencoglu F. — Department of Cardiovascular Surgery, ORCID: none, Sahin Yildiz B. — Department of Internal Medicine, ORCID: none, Haberal I. — Department of Cardiovascular Surgery, ORCID: none, Koyuncu A. O. — Department of Cardiovascular Surgery. ORCID: none, Yildiz M. — Department of Cardiology, ORCID: none.

*Corresponding author: hlyyilmazz@hotmail.com

Received: 28.07.2020

Revision Received: 01.09.2020

Accepted: 02.09.2020

For citation: Yilmaz Ak. H., Ozsahin Y., Baskurt Aladag N., Gencoglu F., Sahin Yildiz B., Haberal I., Koyuncu A. O., Yildiz M. Decreased arterial compliance assessed by aortic pulse wave velocity is an important parameter for monitoring of blood pressure in patients with chronic inflammatory diseases. Russian Journal of Cardiology. 2020;25(12):4036. (In Russ.) doi:10.15829/1560-4071-2020-4036

METHODS FOR ASSESSING INTEGRAL PARAMETERS OF ARTERIAL STIFFNESS: COMPARATIVE ANALYSIS AND NEW POTENTIAL

Teregulov Yu. E.^1,2, Atsel E. A.¹, Maksimova M. S.¹, Maksumova N. V.¹, Prokopyeva S. N.¹, Chuvashaeva F. R.^1,2

Abstract

Aim. To develop a new method for calculating integral parameter of arterial stiffness — volume elastic modulus (Ev).

Material and methods. A retrospective analysis of integral hemodynamic parameters of 1660 patients (women, 60%, 58,6±16 (M±σ) years of age; men, 40%; 53,5±17,7 (M±σ) years of age) was carried out. The first group consisted of 898 patients with normal blood pressure (BP) (<140/90 mm Hg). The second group included 762 patients with hypertension (HTN). We studied following parameters: systolic and diastolic BP, stroke volume (SV), heart rate (HR). Calculation of Ev, total peripheral resistance (TPR), mean arterial pressure (MAP), systemic arterial compliance (SAC) and total bulk modulus (ЕΣ) was carried out.

Results. The analysis showed that BP, SV, TPR and all parameters of the integral stiffness (Ev, SAC, and ЕΣ) were significantly higher in hypertensive patients. Ev had a strong positive correlation with SAC (r=0,996, p<0,001) and ЕΣ (r=0,985, p<0,001). This made it possible to calculate the dependence of Ev on SAC and ЕΣ using regression analysis.

Conclusion. Using linear regression, the formula for calculating the Ev using SAC was obtained, which has a high accuracy at a heart rate of 60 to 90 bpm (error, no more than ±5%). With tachycardia and bradycardia, the error exceeds ±5%. In these cases, it is necessary to calculate the Ev using the mathematical model of A. E. Teregulov. Calculation of Ev from ЕΣ using the diastolic duration calculated by the Karpman formula does not give a sufficiently reliable result. Thus, a direct measurement of diastolic duration using echocardiography is required.

Key words: integral arterial stiffness, systemic arterial compliance, volume elastic modulus, hypertension.

Relationships and Activities: none.

¹Kazan State Medical Academy, Kazan; ²Republican Clinical Hospital, Kazan, Russia.

Teregulov Yu. E.* ORCID: 0000-0001-9120-142X, Atsel E. A. ORCID: 0000-0002-1640-5411, Maksimova M. S. ORCID: 0000-0002-1510-4940, Maksumova N. V. ORCID: 0000-0003-3235-5706, Prokopyeva S. N. ORCID: 0000-0003-0134-0472, Chuvashaeva F. R. ORCID: 0000-0002-8571-2685.

*Corresponding author: tereg2@mail.ru

Received: 02.09.2020

Revision Received: 03.10.2020

Accepted: 02.11.2020

For citation: Teregulov Yu. E., Atsel E. A., Maksimova M. S., Maksumova N. V., Prokopyeva S. N., Chuvashaeva F. R. Methods for assessing integral parameters of arterial stiffness: comparative analysis and new potential. Russian Journal of Cardiology. 2020;25(12):4089. (In Russ.) doi:10.15829/1560-4071-2020-4089

PULMONARY HYPERTENSION AS A RISK ASSESSMENT FACTOR FOR UNFAVORABLE OUTCOME IN PATIENTS WITH COVID-19

Golukhova E. Z.¹, Slivneva I. V.¹, Rybka M. M.¹, Mamalyga M. L.¹, Alekhin M. N.², Klyuchnikov I. V.¹, Antonova D. E.¹, Marapov D. I.³

Abstract

Aim. To determine the predictive role of estimated pulmonary artery systolic pressure (ePASP) in COVID-19 patients.

Material and methods. A retrospective study of inpatients with documented COVID-19 infection was carried out. Maximal follow-up period was 63 days. The study included 108 patients (men, 62; women, 46; mean age, 62,9±15,5 years). At admission, mean NEWS score was 6,0, blood oxygen saturation — 92%. Echocardiography was performed according to standard protocol using Vivid E9 ultrasound system (GE Healthcare). Quantitative measurements were performed according to the current ASE and EACVI guidelines. Statistical analysis was performed using the IBM SPSS Statistics v.26 software (developed by IBM Corporation).

Results. Using the CHAID technique, a classification tree was developed and the strongest predictor of an unfavorable outcome was determined (ePASP). Threshold ePASP values, associated with an increased mortality risk were established (42 mm Hg and 50 mm Hg). Three groups of patients were selected based on the main predictor (≤41,0 mm Hg, 42-49 mm Hg and ≥50 mm Hg). The increased mortality risk was noted in groups 2 and 3 compared to group 1 of patients and amounted to 31,8% and 70% versus 3,9%, respectively. There was also a correlation between the severity of CT lung parenchymal lesions according to computed tomography and the study groups of patients (36% [30-49%] — group 1, 50% [36-76%] — group 2, and 84% [56-92%] — group 3, p=0,001). In groups 2 and 3, the following complications were significantly more frequent: acute respiratory distress syndrome, acute heart failure, multiple organ system failure, venous thrombosis, disseminated intravascular coagulation. In group 3, acute renal failure and systemic inflammatory response syndrome developed significantly more often than in group 1.

Conclusion. A comprehensive echocardiography has proven its availability and safety in assessing the condition of COVID-19 patients, allowing to obtain relevant information on pulmonary hemodynamics. Transthoracic echocardiography reduced the risk of complications from invasive diagnostic methods and allowed to abandon the use of the Swan-Ganz pulmonary artery catheter in the studied group of patients. As a result, a relationship was noted between the increase of ePASP and the severity of clinical performance and lung tissue damage according to computed tomography, changes in laboratory blood tests, the severity of the comorbid profile, an increase in respiratory support need.

Key words: transthoracic echocardiography, echocardiography, estimated pulmonary artery systolic pressure, COVID-19, predictor of unfavorable outcome, prognostic model, pulmonary hypertension.

Relationships and Activities: none.

¹Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow; ²Central State Medical Academy of the Presidential Administration of the Russian Federation, Moscow; ³Kazan State Medical University, Kazan, Russia.

Golukhova E. Z. ORCID: 0000-0002-6252-0322, Slivneva I. V.* ORCID: 0000-0001-7935-7093, Rybka M. M. ORCID: 0000-0003-2663-2236, Mamalyga M. L. ORCID: 0000-0002-7444-9930, Alekhin M. N. ORCID: 0000-0002-9725-7528, Klyuchnikov I. V. ORCID: 0000-0002-8652-9639, Antonova D. E. ORCID: 0000-0002-4682-1440, Marapov D. I. ORCID: 0000-0003-2583-0599.

*Corresponding author: slivneva@mail.ru

Received: 06.10.2020

Revision Received: 16.11.2020

Accepted: 19.11.2020

For citation: Golukhova E. Z., Slivneva I. V., Rybka M. M., Mamalyga M. L., Alekhin M. N., Klyuchnikov I. V., Antonova D. E., Marapov D. I. Pulmonary hypertension as a risk assessment factor for unfavorable outcome in patients with COVID-19. Russian Journal of Cardiology. 2020;25(12):4136. (In Russ.) doi:10.15829/1560-4071-2020-4136

CLINIC AND PHARMACOTHERAPY

EFFECT OF TICAGRELOR IN PATIENTS WITH ACUTE CORONARY SYNDROME ON THE ACHIEVEMENT OF THE TARGETS OF FEDERAL PROJECT ON THE PREVENTION OF CARDIOVASCULAR DISEASES: 3-YEAR PERSPECTIVE ESTIMATES

Zhuravleva M. V.^1,2, Paleev F. N.³, Zyryanov S. K.⁴, Yakovlev A. N.⁵, Marin T. V.², Gagarina Yu. V.²

Abstract

Aim. To assess the additional effect of ticagrelor as part of dual antiplatelet therapy (DAPT) compared with DAPT with clopidogrel and acetylsalicylic acid (ASA) monotherapy on the achievement of goals of federal project on the prevention of cardiovascular diseases: “reduction of cardiovascular mortality” and “reduction of mortality from myocardial infarction (MI)”.

Material and methods. In the first year of treatment, all adult Russian patients with documented acute coronary syndrome (ACS), who had indications for DAPT, were considered as the target population. In the second and third years, treatment was continued only by patients with a high risk of thrombotic events. The calculation of the number of deaths that can be prevented using DAPT with ticagrelor 90 mg + ASA instead of clopidogrel + ASA during the first year was based on the data of the PLATO trial. To calculate the number of deaths that can be prevented using DAPT with ticagrelor 60 mg + ASA instead of ASA monotherapy, we used the data of PEGASUS trial for patients with a history of MI within the past 2 years. Then the proportion of goals that can be achieved in 2020-2023 was calculated when using DAPT with ticagrelor instead of clopidogrel or ASA monotherapy.

Results. The use of ticagrelor within DAPT for patients with ACS will allow (compared to DAPT with clopidogrel and ASA monotherapy): — to prevent an additional 5389, 5702 and 6009 deaths in 2021, 2022, and 2023, respectively, achieving the target of federal project on the prevention of cardiovascular diseases “reduction of cardiovascular mortality” by 18,4, 19,4 and 20,5%, respectively. In addition, the use of ticagrelor within DAPT for patients with ACS compared with clopidogrel or ASA monotherapy will also allow: — to prevent an additional 957, 1013 and 1067 deaths due to MI in 2021, 2022, and 2023, respectively, achieving the target of federal project on the prevention of cardiovascular diseases “reduction of mortality from MI” by 50,2%, 49,3% and 51,9%, respectively.

Conclusion. The use of ticagrelor in patients with ACS will reduce cardiovascular mortality.

Key words: ticagrelor, secondary prevention of cardiovascular disease, targets, cardiovascular mortality, mortality from myocardial infarction, federal project on the prevention of cardiovascular diseases.

Relationships and Activities. The study was supported by AstraZeneca.

¹Scientific Center for Expert Evaluation of Medicinal Products, Moscow; ²I. M. Sechenov First Moscow State Medical University, Moscow; ³National Medical Research Center of Cardiology, Moscow; ⁴Peoples’ Friendship University of Russia, Moscow; ⁵Almazov National Medical Research Center, St. Petersburg, Russia.

Zhuravleva M. V.* ORCID: 0000-0002-9198-8661, Paleev F. N. ORCID: 0000-0001-9481-9639, Zyryanov S. K. ORCID: 0000-0002-6348-6867, Yakovlev A. N. ORCID: 0000-0001-5656-3978, Marin T. V. ORCID: 0000-0002-8974-4457, Gagarina Yu. V.

ORCID: 0000-0002-4459-3034.

*Corresponding author: doc@pharmset.ru

Received: 27.11.2020

Revision Received: 07.12.2020

Accepted: 15.12.2020

For citation: Zhuravleva M. V., Paleev F. N., Zyryanov S. K., Yakovlev A. N., Marin T. V., Gagarina Yu. V. Effect of ticagrelor in patients with acute coronary syndrome on the achievement of the targets of federal project on the prevention of cardiovascular diseases: 3-year perspective estimates. Russian Journal of Cardiology. 2020;25(12):4223. (In Russ.) doi:10.15829/1560-4071-2020-4223

CLINICAL AND INVESTIGATIVE MEDICINE

ASSESSMENT OF PREVALENCE AND MONITORING OF OUTCOMES IN PATIENTS WITH HEART FAILURE IN RUSSIA

Shlyakhto E. V., Zvartau N. E., Villevalde S. V., Yakovlev A. N., Solovyeva A. E., Fedorenko A. A., Karlina V. A., Avdonina N. G., Endubaeva G. V., Zaitsev V. V., Neplyueva G. A., Pavlyuk E. I., Dubinina M. V., Medvedeva E. A., Erastov A. M., Panarina S. A., Soloviev A. E.

Abstract

The increasing prevalence of heart failure (HF) serves as a reverse side of the effective treatment for cardiovascular diseases (CVD) and increasing patient survival. Data on the epidemiology of HF and related mortality in Russia are limited. According to the EPOCHA trial (hospital phase), the prevalence of HF in the Russian Federation is 7%. HF can significantly contribute to cardiovascular mortality. However, its recognition is limited by the peculiarities of the mortality coding system in Russia. The article presents the authors’ view on the registration of HF-related morbidity and mortality cases and perspectives of using left ventricular ejection fraction <50% for statistical reporting.

Key words: heart failure, prevalence, morbidity, mortality, left ventricular ejection fraction.

Relationships and Activities: none.

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

Shlyakhto E. V. ORCID: 0000-0003-2929-0980, Zvartau N. E.* ORCID: 0000-0001-6533-5950, Villevalde S. V. ORCID: 0000-0001-7652-2962, Yakovlev A. N. ORCID: 0000-0001-5656-3978, Solovyeva A. E. ORCID: 0000-0002-0013-0660, Fedorenko A. A. ORCID: 0000-0002-9836-7841, Karlina V. A. ORCID: 0000-0001-9912-7789, Avdonina N. G. ORCID: 0000-0001-9871-3452, Endubaeva G. V. ORCID: 0000-0001-8514-6436, Zaitsev V. V. ORCID: 0000-0003-1905-2575, Neplyueva G. A. ORCID: 0000-0001-8811-2450, Pavlyuk E. I. ORCID: 0000-0002-0108-5996, Dubinina M. V. ORCID: 0000-0001-7980-4279, Medvedeva E. A. ORCID: 0000-0002-5130-5192, Erastov A. M. ORCID: 0000-0003-3218-3502, Panarina S. A. ORCID: 0000-0003-3450-9916, Soloviev A. E. ORCID: 0000-0003-2378-9940.

*Corresponding author: zvartau_ne@almazovcentre.ru

Received: 20.11.2020

Revision Received: 27.11.2020

Accepted: 04.12.2020

For citation: Shlyakhto E. V., Zvartau N. E., Villevalde S. V., Yakovlev A. N., Solovyeva A. E., Fedorenko A. A., Karlina V. A., Avdonina N. G., Endubaeva G. V., Zaitsev V. V., Neplyueva G. A., Pavlyuk E. I., Dubinina M. V., Medvedeva E. A., Erastov A. M., Panarina S. A., Soloviev A. E. Assessment of prevalence and monitoring of outcomes in patients with heart failure in Russia. Russian Journal of Cardiology. 2020;25(12):4204. (In Russ.) doi:10.15829/1560-4071-2020-4204

ELECTROPHYSIOLOGICAL CHARACTERISTICS OF TELOCYTES OF THE ATRIOVENTRICULAR NOTE AND SINOATRIAL NODE PERIFOCAL AREA IN HUMANS AND PIGS

Mitrofanova L. B.¹, Bobkov D. E.^2,3, Oganesyan M. G.¹, Karpushev A. V.¹, Koshevaya E. G.¹, Gorshkov A. N.^1,2,3, Fedotov P. A.¹, Bortsova M. A.¹, Grebennik V. K.¹

Abstract

Little is known about the electrophysiological characteristics of telocytes found in the working myocardium and sinoatrial node (SAN). Telocyte expression of HCN4 suggests the ability to generate pacemaker potentials. To prove the impulse conduction, the presence of voltage-gated sodium channels is required. It is assumed that telocytes are also located in the atrioventricular node (AVN).

Aim. Morphological and electrophysiological study of AVN and SAN telocytes.

Material and methods. Fragments of the right atrium, AVN of 7 hearts of recipients and 3 hearts of pigs were taken, respectively, during heart transplantation and after the experiment. Isolation of telocyte cultures, histological, immunohistochemical tests with anti-CD117, anti-NaV1.5 (SCN5A), anti-CD34 antibodies, intravital confocal laser microscopy were carried out. The patch-clamp technique was used.

Results. In AVN cultures, CD117⁺ cells with long processes were found. There was a potassium current with a density of 700 pA/pF during membrane depolarization up to +90 mW in humans and pigs using the patch-clamp technique. Calcium oscillations

with a period of about 200 seconds in a pig with an increase in calcium concentration. In elongated cells located between cardiomyocytes and among the fibrous tissue of SAN perifocal zone, the co-expression of anti-NaV1.5 and anti-CD34 antibodies was revealed.

Conclusion. In AVN, telocytes were found, in whose cultures potassium current and calcium oscillations were determined. SCN5A sodium channels were found in telocytes of the perifocal area of human SAN. This fact indicates the ability of cells to conduct an electrical impulse.

Key words: telocytes of the atrioventricular node and right atrium, laser confocal microscopy of cultures and tissue sections, patch-clamp, calcium oscillations.

Relationships and Activities: none.

¹Almazov National Medical Research Center, St. Petersburg; ²Smorodintsev Research Institute of Influenza, St. Petersburg; ³Institute of Cytology, St. Petersburg, Russia.

Mitrofanova L. B.* ORCID: 0000-0003-0735-7822, Bobkov D. E. ORCID: 0000-0002-0358-9266, Oganesyan M. G. ORCID: 0000-0002-3542-0692, Karpushev A. V. ORCID: 0000-0001-8437-6424, Koshevaya E. G. ORCID: 0000-0002-9656-1704, Gorshkov A. N. ORCID: 0000-0003-2303-1144, Fedotov P. A. ORCID: 0000-0002-7452-1971, Bortsova M. A. ORCID: 0000-0002-9694-7850, Grebennik V. K. ORCID: 0000-0003-4353-4160.

*Corresponding author: lubamitr@yandex.ru

Received: 24.05.2020

Revision Received: 20.06.2020

Accepted: 21.06.2020

For citation: Mitrofanova L. B., Bobkov D. E., Oganesyan M. G., Karpushev A. V., Koshevaya E. G., Gorshkov A. N., Fedotov P. A., Bortsova M. A., Grebennik V. K. Electrophysiological characteristics of telocytes of the atrioventricular note and sinoatrial

node perifocal area in humans and pigs. Russian Journal of Cardiology. 2020;25(12):3927. (In Russ.) doi:10.15829/1560-4071-2020-3927

MACHINE LEARNING AS A TOOL FOR DIAGNOSTIC AND PROGNOSTIC RESEARCH IN CORONARY ARTERY DISEASE

Geltser B. I., Tsivanyuk M. M., Shakhgeldyan K. I., Rublev V. Yu.

Abstract

Machine learning (ML) are the central tool of artificial intelligence, the use of which makes it possible to automate the processing and analysis of large data, reveal hidden or non-obvious patterns and learn a new knowledge. The review presents an analysis of literature on the use of ML for diagnosing and predicting the clinical course of coronary artery disease. We provided information on reference databases, the use of which allows to develop models and validate them (European ST-T Database, Cleveland Heart Disease database, Multi-Ethnic Study of Atherosclerosis, etc.). The advantages and disadvantages of individual ML methods (logistic regression, support vector machines, decision trees, naive Bayesian classifier, k-nearest neighbors) for the development of diagnostic and predictive algorithms are shown. The most promising ML methods include deep learning, which is implemented using multilayer artificial neural networks. It is assumed that the improvement of ML-based models and their introduction into clinical practice will help support medical decision-making, increase the effectiveness of treatment and optimize health care costs.

Key words: machine learning, coronary artery disease, diagnostic and predictive models.

Relationships and Activities. This work was supported by grants from the Russian Foundation for Basic Research within the projects № 18-29-03131 and № 19-29-01077.

Far Eastern Federal University, Vladivostok, Russia.

Geltser B. I. ORCID: 0000-0002-9250-557X, Tsivanyuk M. M.* ORCID: 0000-0003-3545-3862, Shakhgeldyan K. I. ORCID: 0000-0002-4539-685X, Rublev V. Yu. ORCID: 0000-0001-7620-4454.

*Corresponding author: m_tsivanyuk@list.ru

Received: 07.07.2020

Revision Received: 10.08.2020

Accepted: 28.08.2020

For citation: Geltser B. I., Tsivanyuk M. M., Shakhgeldyan K. I., Rublev V. Yu. Machine learning as a tool for diagnostic and prognostic research in coronary artery disease. Russian Journal of Cardiology. 2020;25(12):3999. (In Russ.) doi:10.15829/1560-4071-2020-3999

OPINION ON A PROBLEM

DIAGNOSTIC SIGNIFICANCE OF COMPLETE BLOOD COUNT IN CARDIOVASCULAR PATIENTS

Chaulin A. M.^1,2, Grigorieva Yu. V.², Pavlova T. V.², Duplyakov D. V.^1,2

Abstract

This article discusses the relationship between parameters of complete blood count (CBC) and cardiovascular diseases (CVD). The main advantages of CBC over other methods of CVD diagnostics are low cost and wide availability. At the same time, the low specificity of CBC is an important disadvantage, limiting its diagnostic value. After analyzing the results of numerous clinical studies, we concluded that the most important CBC are red cell distribution width, mean platelet volume, total leukocyte count, neutrophil to lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte to high-density lipoprotein ratio. We discuss the diagnostic value of each of the above indicators in CVD. Careful attention to these parameters by clinicians can, to a certain extent, improve the therapeutic and diagnostic process in patients with CVD.

Key words: complete blood count, cardiovascular diseases, red cell distribution width, mean platelet volume, leukocytes, neutrophil to lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte to high-density lipoprotein ratio.

Relationships and Activities: none.

¹Samara Regional Clinical Cardiology Dispensary, Samara; ²Samara State Medical University, Samara, Russia.

Chaulin A. M.* ORCID: 0000-0002-2712-0227, Grigorieva Yu. V. ORCID: 0000-0002-7228-1003, Pavlova T. V. ORCID: 0000-0003-3301-1577, Duplyakov D. V. ORCID: 0000-0002-6453-2976.

*Corresponding author: alekseymichailovich22976@gmail.com

Received: 22.05.2020

Revision Received: 20.06.2020

Accepted: 13.09.2020

For citation: Chaulin A. M., Grigorieva Yu. V., Pavlova T. V., Duplyakov D. V. Diagnostic significance of complete blood count in cardiovascular patients. Russian Journal of Cardiology. 2020;25(12):3923. (In Russ.) doi:10.15829/1560-4071-2020-3923

NONFLUOROSCOPIC CATHETER ABLATION IN PATIENTS WITH ATRIAL FIBRILLATION

Sapelnikov O. V.¹, Ardus D. F.¹, Kostin V. S.¹, Uskach T. M.^1,2, Cherkashin D. I.¹, Grishin I. R.¹, Bogatyreva K. B.¹, Emelyanov A. V.¹, Kulikov A. A.¹, Nikolaeva O. A.³, Akchurin R. S.¹

Abstract

The article demonstrates available literature data on the nonfluoroscopic catheter ablation of atrial fibrillation (AF). The main disadvantages of standard fluoroscopic catheter ablation are shown. The research results on the use of intracardiac echocardiography are presented. The first experience of using the fluoroscopyfree procedure in Russia as a pilot study is also presented. During the period from December 2017 to December 2019, 28 radiofrequency ablations and 40 pulmonary vein cryoballoon ablations were performed without fluoroscopy using threedimensional imaging and intracardiac echocardiography. Despite the small number of large studies in this area, clinical cases described in the literature, as well as their own results, demonstrate the safety of using three-dimensional imaging in combination with intracardiac echocardiography as an alternative to fluoroscopy. Application of the approach is of undoubted practical interest and requires further study in large studies.

Key words: atrial fibrillation, radiofrequency ablation, cryoballoon ablation, nonfluoroscopic ablation.

Relationships and Activities: none.

¹National Medical Research Center of Cardiology, Moscow; ²Russian Medical Academy of Continuous Professional Education, Moscow; ³I. V. Davydovsky City Clinical Hospital, Moscow, Russia.

Sapelnikov O. V. ORCID: 0000-0002-5186-2474, Ardus D. F.* ORCID: 0000-0001-8305-1855, Kostin V. S. ORCID: 0000-0001-5438-3965, Uskach T. M. ORCID: 0000-0003-4318-0315, Cherkashin D. I. ORCID: 0000-0003-1679-1719, Grishin I. R. ORCID: 0000-0001-5839-1858, Bogatyreva K. B. ORCID: 0000-0002-2464-8210, Emelyanov A. V. ORCID: 0000-0002-4027-2524, Kulikov A. A. ORCID: 0000-0003-0043-6472, Nikolaeva O. A. ORCID: 0000-0001-6833-8938, Akchurin R. S. ORCID: 0000-0002-6726-4612.

*Corresponding author: darina.ardus@gmail.com

Received: 24.05.2020

Revision Received: 14.08.2020

Accepted: 21.08.2020

For citation: Sapelnikov O. V., Ardus D. F., Kostin V. S., Uskach T. M., Cherkashin D. I., Grishin I. R., Bogatyreva K. B., Emelyanov A. V., Kulikov A. A., Nikolaeva O. A., Akchurin R. S. Nonfluoroscopic catheter ablation in patients with atrial fibrillation. Russian Journal of Cardiology. 2020;25(12):3928. (In Russ.) doi:10.15829/1560-4071-2020-3928

LITERATURE REVIEW

ELECTROCARDIOGRAPHIC SIGNS OF THE LEFT MAIN CORONARY ARTERY DISEASE IN ACUTE CORONARY SYNDROME

Eniseeva E. S.^1,2, Protasov K. V.¹, Gurtovaya G. P.²

Abstract

Myocardial infarction (MI) due to the left main coronary artery (LMCA) disease is a life-threatening condition. Evaluation of ECG signs of LMCA occlusion is important because of revascularization emergency. There is no single ECG pattern for LMCA occlusion. The purpose of the present literature review is to reveal ECG potential in diagnosing LMCA occlusion in acute coronary syndrome. Variability of ECG abnormalities was noted depending on the degree of LMCA occlusion, collateral blood flow from the right coronary artery, and concomitant stenosis. ST elevation in aVR is an evident predictor of LMCA lesion. Electrophysiological mechanisms of its formation were described. Diagnostic significance of additional ECG signs of LMCA disease was presented. Diagnostic and treatment strategies for patients with ECG signs of severe LMCA disease were summarized.

Key words: ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, left main coronary artery, ECG.

Relationships and Activities: none.

¹Irkutsk State Medical Academy of Postgraduate Education — Branch of Russian Medical Academy of Continuous Professional Education, Irkutsk; ²Irkutsk State Medical University, Irkutsk, Russia.

Eniseeva E. S.* ORCID: 0000-0002-9069-3570, Protasov K. V. ORCID: 0000-0002-6516-3180, Gurtovaya G. P. ORCID: 0000-0002-2025-5751.

*Corresponding author: eniseeva-irk@yandex.ru

Received: 29.07.2020

Revision Received: 01.09.2020

Accepted: 19.09.2020

For citation: Eniseeva E. S., Protasov K. V., Gurtovaya G. P. Electrocardiographic signs of the left main coronary artery disease in acute coronary syndrome. Russian Journal of Cardiology. 2020;25(12):4038. (In Russ.) doi:10.15829/1560-4071-2020-4038

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