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Russian Journal of Cardiology 2020, 25 (2)

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Оглавление

CLINICAL MEDICINE NEWS

ORIGINAL ARTICLES

METHODS OF STUDY

CLINIC AND PHARMACOTHERAPY

CLINICAL CASES

EXPERT CONSENSUS

DISCUSSION ARTICLE

LITERATURE REVIEW

CLINICAL GUIDELINES.

Address to the readers

Russian Journal of Cardiology. 2020;25(2):7

CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russian Journal of Cardiology. 2020;25(2):8

ORIGINAL ARTICLES

ASSESSMENT OF THE EFFECTIVENESS OF TREATMENT IN PATIENTS AFTER ACUTE CORONARY SYNDROME

Shvets D. A.1, Povetkin S. V.2, Karasev A. Yu.1, Vishnevsky V. I.3

Abstract

Aim. To assess the effectiveness of secondary drug prevention and surgical myocardial revascularization in patients with coronary artery disease (CAD) during long-term follow-up after acute coronary syndrome (ACS).

Material and methods. The study involved 400 patients with ACS discharged from the hospital in 2012-2016. The diagnosis was verified according to the European Society of Cardiology (ESC) guidelines. There were no exclusion criteria. We analyzed the data of medical records (complaints, medical history, physical examination, laboratory and instrumental data). Repeated data collection was carried out by distance survey and during a face-to-face examination during 2018. According to the clinical course of CAD, all patients were divided into 2 groups. Group 1 consisted of 151 patients with complicated course of CAD, group 2 — 249 patients with stable CAD. We analyzed drug therapy recommended at hospital discharge and taken at the time of the repeated examination. The drug names and daily dosage used for the secondary prevention of CAD were recorded. Assessment of survival without cardiovascular complications was carried out according to the Kaplan-Mayer analysis.

Results. Seven-year mortality was 22,5%. The total number of cardiovascular events was 37,7%. The main reason for the frequent complications was the insufficient secondary prevention of CAD after ACS. We found that the drugs and their dosage did not have a significant effect on survival. Statin use is associated with a paradoxical increase in the number of complications. The increased frequency of use and dosage of statins are a consequence of unfavorable course of CAD and do not have the proper preventive effect. For some groups of drugs, we observed irregular intake over the observation period. The low effectiveness of therapy is not only due to insufficient doses, but also in the frequent use of generic drugs. The significant effect of coronary angiography on the probability of cardiovascular complications compared with stenting is due to high proportion of coronary angiography use without revascularization.

Conclusion. The combination of following factors of drug therapy can explain the low effectiveness of secondary CAD prevention: low dose (26,1±2,8 mg for atorvastatin), irregular intake and common use of generic drugs (97,6% for statins), present in different ratios. The contribution of surgical treatment to reducing cardiovascular complications is lower, the more significant residual coronary artery stenosis.

Key words: acute coronary syndrome, prevention, prediction of complications.

Relationships and Activities: not.

1Orel Regional Clinical Hospital, Orel; 2Kursk State Medical University, Kursk; 3I.S. Turgenev Orel State University, Orel, Russia.

Shvets D. A. ORCID: 0000-0002-1551-9767, Povetkin S. V. ORCID: 0000-0002-1302-9326, Karasev A. Yu. ORCID: 0000-0002-8334-0988, Vishnevsky V. I. ORCID: 0000-0002-3004-9687.

Received: 03.07.2019

Revision Received: 24.08.2019

Accepted: 06.09.2019

For citation: Shvets D. A., Povetkin S. V., Karasev A. Yu., Vishnevsky V. I. Assessment of the effectiveness of treatment in patients after acute coronary syndrome. Russian Journal of Cardiology. 2020;25(2):3405. (In Russ.) doi:10.15829/1560-4071-2020-2-3405

NOVEL SCORE FOR MORTALITY RISK PREDICTION 6 MONTHS AFTER ACUTE CORONARY SYNDROME

Erlikh A. D.

Abstract

Aim. To create a prediction score for assessing the mortality risk 6 months after hospitalization with acute coronary syndrome (ACS).

Material and methods. Based on the results of ACS RECORD-3 register (Russia), we determined independent mortality predictors 6 months after ACS by performing multivariate regression analysis in patients discharged alive from the hospital with known outcomes.

Results. The following predictors were obtained during the analysis: non-prescription of aspirin at discharge (odds ratio (OR) 5,8; 95% confidence interval (CI) 2,3-15,0; p<0,0001), newly diagnosed heart failure, pulmonary edema or shock in a hospital (OR 5,7; 95% CI 2,6-12,7; p<0,0001), age ≥75 years (OR 5,3; 95% CI 2,7-10,6; p<0,0001), non-prescription of beta-blockers at discharge (OR 5,0; 95% CI 2,3-10,8; p<0,0001), in-hospital management without immediate percutaneous coronary intervention (PCI) (primary PCI during ST-segment elevation ACS or PCI during the first 72 hours with non-ST-segment elevation ACS) (OR 3,9; 95% CI 1,6-9,8; p=0,004), the initial serum creatinine ≥100 μmol/L (OR 3,1; 95% CI 1,6-6,1; p=0,001), body mass index <30 kg/m2 (OR 2,8; 1,2-6,3; p=0,014). Each of them was evaluated at one point and was a component of the RECORD-6 score. Prediction sensitivity and specificity for the new score were 73,3% (95% CI 60,1-83,5) and 71,4% (95% CI 68,9-73,7), respectively; prediction accuracy, estimated as the area under the ROC curve was 0,931 (95% CI 0,897-0,964). The cut-off point was considered 3 points, which had the best ratio of prediction sensitivity and specificity. The mortality after 6 months with a value of <3 points was 1,6%, and with a value of ≥3 points — 10,1% (relative risk (RR) 0,16; 95% CI 0,09-0,28; p<0,0001), and the mortality after 12 months was 7,8% and 22,5%, respectively (RR 0,35; 95% CI 0,25-0,49; p<0,0001). Relative to the GRACE risk score for 6-month mortality showed that the prediction value of the RECORD-6 score was at least no worse.

Conclusion. The novel RECORD-6 risk score is an accurate and simple prediction tool for assessing the mortality risk 6 months after discharge from the hospital. The prediction accuracy of the RECORD-6 risk score is not lower the GRACE risk score.

Key words: acute coronary syndrome, prediction score, 6 months, RECORD, GRACE, long-term outcomes, death.

Relationships and Activities: not.

N. E. Bauman City Clinical Hospital № 29, Moscow, Russia.

Erlikh A. D. ORCID: 0000-0003-0607-2673.

Received: 07.07.2019

Revision Received: 24.09.2019

Accepted: 27.10.2019

For citation: Erlikh A. D. Novel score for mortality risk prediction 6 months after acute coronary syndrome. Russian Journal of Cardiology. 2020;25(2):3416. (In Russ.) doi:10.15829/1560-4071-2020-2-3416

CARDIAC STRAIN IN RIGHT VENTRICULAR MYOCARDIAL INFARCTION AND PULMONARY EMBOLISM

Mazur E. S.1, Mazur V. V.1, Rabinovich R. M.2, Myasnikov K. S.2, Orlov Yu. A.1

Abstract

Aim. To study the prospects of using parameters of right ventricle (RV) longitudinal strain (LS) during systole for the differential diagnosis of RV myocardial infarction (RVMI) and pulmonary embolism (PE).

Material and methods. The study included 83 patients who were hospitalized with RVMI or PE in the period from December 2017 to May 2019. The study of RV LS using the two-dimensional speckle-tracking echocardiography was carried out in 30 patients with RVMI (group 1), 15 patients with high-risk PE (group 2), and 38 patients with intermediate-risk PE (group 3).

Results. The mean values of RV global LS in patients of groups 1 and 2 did not differ (12,8±2,69 and 12,0±2,56%, respectively) and were significantly lower than in patients of group 3 (15,9±3,03%). The ratio of the interventricular septum (IVS) LS to the RV free wall (FW) LS in the group 1 (1,04±0,43) was significantly lower than in the groups 2 (1,61±0,52) and 3 (1,29±0,38). The ratio of the LS of the RVFW basal segment to the apical segment in group 1 (0,60±0,37) was also significantly lower than in groups 2 (1,69±1,57) and 3 (1,67±1,33).

Conclusion. In patients with RVMI, there is a comparable decrease in the LS of the RVFW and IVS, and the LS of the basal segment decreases to a greater extent than the apical one. In patients with PE, the decrease in the LS of the RVFW is more pronounced than in IVS, and the LS of the apical segment decreases to a greater extent than the basal one. These differences can be used for the differential diagnosis of RVMI and PE.

Key words: right ventricular strain, right ventricular myocardial infarction, pulmonary embolism.

Relationships and Activities: not.

1Tver State Medical University, Tver; 2Regional Clinical Hospital, Tver, Russia.

Mazur E. S. ORCID: 0000-0002-8879-3791, Mazur V. V. ORCID: 0000-0003-4818-434X, Rabinovich R. M. ORCID: 0000-0002-1562-6212, Myasnikov K. S. ORCID: 0000-0002-0784-5845, Orlov Yu. A. ORCID: 0000-0001-9114-0436.

Received: 30.01.2020

Revision Received: 14.02.2020

Accepted: 16.02.2020

For citation: Mazur E. S., Mazur V. V., Rabinovich R. M., Myasnikov K. S., Orlov Yu. A. Cardiac strain in right ventricular myocardial infarction and pulmonary embolism. Russian Journal of Cardiology. 2020;25(2):3731. (In Russ.) doi:10.15829/1560-4071-2020-2-3731

PREDICTORS OF MYOCARDIAL FIBROSIS AND LOSS OF EPICARDIAL ADIPOSE TISSUE VOLUME IN THE LONG-TERM PERIOD AFTER MYOCARDIAL INFARCTION

Barbarash O. L.1, Gruzdeva O. V.1, Pecherina T. B.1, Akbasheva O. E.2, Borodkina D. A.1, Kashtalap V. V.1, Karetnikova V. N.1, Kokov A. N.1, Brel N. K.1, Dyleva Yu. A.1, Belik E. V.1, Uchasova E. G.1, Bychkova E. E.1, Kuzmina A. A.1

Abstract

Aim. To assess the changes of biochemical markers in hospitalization, the relationship with the severity of myocardial fibrosis and the epicardial adipose tissue (EAT) thickness one year after myocardial infarction (MI).

Material and methods. A total of 88 patients (65 men and 23 women) with MI were examined. The percentage of cicatricial changes in the myocardium and the EAT thickness were measured using the magnetic resonance imaging (MRI) one year after MI. In the hospitalization (days 1 and 12) and 1 year after MI, the concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP), stimulating growth factor (ST2), interleukin-33 (IL-33) and type I collagen (COL-1). The data were analyzed using descriptive statistics, correlation and ROC analysis, and logistic regression (Statistica 9.0).

Results. One year after MI, cicatricial changes were detected in 68 (77%) patients: 27 people had myocardial fibrosis <5%, 22 patients — 5-15%, and 19 patients >15%. We established that myocardial fibrosis after MI is associated with unfavorable medical history, a complicated course during in-hospital period and higher concentrations of ST2, NT-proBNP, COL-1 compared with patients without myocardial fibrosis. High levels of ST2, NT-proBNP increase the risk of myocardial fibrosis by 1,2 and 1,8 times after hospitalization, respectively. In patients with myocardial fibrosis >15%, IL-33 level was significantly lower in the 1st day of MI. It was found that the EAT thickness increases with fibrosis of 5-15%. An increase in the left (LV) and right ventricular (RV) EAT thickness by 1,33 times and 1,34 times, respectively, increases the risk of myocardial fibrosis (LV EAT thickness, mm (OR 1,33; 95% CI (1,08-1,4), AUC 0,75; RV EAT thickness, mm (OR 1,34; 95% CI (1,15-1,43), AUC 0,79). In patients with myocardial fibrosis >15%, EAT thickness decreases and correlates with NT-proBNP increase in the acute period and a one year after MI.

Conclusion. The development of myocardial fibrosis one year after MI is associated with an increase in ST2, NT-proBNP, COL-1, both in the hospitalization and 1 year after MI. The decrease in IL-33 concentration during hospitalization with MI is accompanied by the development of fibrosis >15% of the myocardium.

Key words: epicardial adipose tissue, markers of myocardial fibrosis, markers of inflammation.

Relationships and Activities: the study was conducted as part of the fundamental theme “Multifocal atherosclerosis and comorbid conditions. Features of diagnosis, risk management in a large industrial region of Siberia”.

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

Barbarash O. L. ORCID: 0000-0002-4642-3610, Gruzdeva O. V. ORCID: 0000-0002-7780-829X, Pecherina T. B. ORCID: 0000-0003-3996-3325, Akbasheva O. E. ORCID: 0000-0003-0680-8249, Borodkina D. A. ORCID: 0000-0002-6221-3509, Kashtalap V. V. ORCID: 0000-0003-3729-616X, Karetnikova V. N. ORCID: 0000-0002-9801-9839, Kokov A. N. ORCID: 0000-0002-7573-0636, Brel N. K. ORCID: 0000-0002-5643-4022, Dyleva Yu. A. ORCID: 0000-0002-6890-3287, Belik E. V. ORCID: 0000-0003-3996-3325, Uchasova E. G. ORCID: 0000-0003-4321-8977, Bychkova E. E. ORCID: 0000-0002-0500-2449, Kuzmina A. A. ORCID: 0000-0002-0500-2449.

Received: 29.08.2019

Revision Received: 10.11.2019

Accepted: 15.11.2019

For citation: Barbarash O. L., Gruzdeva O. V., Pecherina T. B., Akbasheva O. E., Borodkina D. A., Kashtalap V. V., Karetnikova V. N., Kokov A. N., Brel N. K., Dyleva Yu. A., Belik E. V., Uchasova E. G., Bychkova E. E., Kuzmina A. A. Predictors of myocardial fibrosis and loss of epicardial adipose tissue volume in the long-term period after myocardial infarction. Russian Journal of Cardiology. 2020;25(2):3474. (In Russ.) doi:10.15829/1560-4071-2020-2-3474

LEVELS OF PROPROTEIN CONVERTASE SUBTILISIN/KEXIN TYPE 9 IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

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

Abstract

Aim. To study the levels of proprotein convertase subtilisin/kexin type 9 (PCSK9) in patients with acute myocardial infarction (MI).

Material and methods. The study included 74 patients with acute MI. PCSK9 was determined by enzyme-linked immunosorbent assay.

Results. The mean PCSK9 levels were 479,7±15,4 ng/ml. No significant correlation was found between PCSK9 and total cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglycerides. In the group of smokers, a significant inverse correlation was found between the levels of PCSK9 and HDL-C (-0,45; p=0,039). In the group of patients with body mass index <25 kg/m2, a significant inverse correlation of PCSK9 levels with total cholesterol (-0,45, p=0,008), HDL-C (-0,42; p=0,029) and LDL-C (-0,47; p=0,003) was found.

Conclusion. In patients with MI, a correlation of PCSK9 levels with lipid profile was found in smokers, as well as in patients with a low body mass index.

Key words: proprotein convertase subtilisin/kexin type 9, myocardial infarction.

Relationships and Activities: not.

Kazan State Medical University, Kazan, Russia.

Gimadeeva A. D. ORCID: 0000-0001-7644-7587, Galyavich A. S. ORCID: 0000-0002-4510-6197, Galeeva Z. M. ORCID: 0000-0002-9580-3695, Baleeva L. V. ORCID: 0000-0002-7974-5894.

Received: 21.01.2020

Revision Received: 03.02.2020

Accepted: 10.02.2020

For citation: Gimadeeva A. D., Galyavich A. S., Galeeva Z. M., Baleeva L. V. Levels of proprotein convertase subtilisin/kexin type 9 in patients with acute myocardial infarction. Russian Journal of Cardiology. 2020;25(2):3724. (In Russ.) doi:10.15829/1560-4071-2020-2-3724

IN-HOSPITAL CHANGES OF ECHOCARDIOGRAPHIC PARAMETERS AND THEIR RELATIONSHIP WITH THE PROCOLLAGEN I C-TERMINAL PROPEPTIDE IN PATIENTS WITH MYOCARDIAL INFARCTION AND PRESERVED LEFT VENTRICLE SYSTOLIC FUNCTION

Osokina A. V.1, Karetnikova V. N.1,2, Polikutina O. V.1, Ivanova A. V.1, Gruzdeva O. V.1, Ryzhenkova S. A.2, Artemova T. P.2, Barbarash O. L.1,2

Abstract

Aim. To study the changes of echocardiographic parameters and their relationship with the procollagen I C-terminal propeptide (PICP) during hospitalization of patients with ST-segment elevation myocardial infarction (STEMI) and preserved left ventricular (LV) systolic function.

Material and methods. A total of 120 (100%) patients hospitalized with STEMI were examined. Upon admission, all patients underwent standard examinations to verify myocardial infarction (MI), including coronary angiography and, if necessary, coronary stent implantation. The mean values of LV ejection fraction (LVEF) were 40-49% in 3 patients (2,5%), <40% — in 31 patients (26%), LVEF was. We also analyzed patients with LVEF ≥50%, n=86 (71,6%); mean age was 57,8 years. During the hospitalization, all patients received standard therapy; on the 1st and 12th day of MI, the PICP levels in venous blood serum was determined by enzyme-linked immunosorbent assay. In order to compare PICP values, a control group of healthy volunteers n=20 (100%) was formed, which were comparable by gender and age. In this group, the concentration of PICP was 179,2 [163.5; 194.9] ng/ml.

Results. By the 12th day, a significant decrease in the following parameters of the transmitral flow was revealed: DT (p=0,049), dE (0,012), Em (0,029), Em/ Am (p=0,000), Em/PICP (p=0,001). This indicates diastolic function deterioration. At the same time, by the end of hospitalization, systolic function deterioration was recorded in 15,1% of cases. Initially, a higher PICP on the 1st day relative to the control group tended to decrease the concentration by the 12th day, but the differences did not reach statistical significance (p=0,466). Correlation analysis showed a relationship between PICP and echocardiography (Tei index, p=0,026, and mitral annulus velocity, p=0,049).

Conclusion. At the hospital stage of treatment of patients with STEMI and preserved LVEF, a negative changes of echocardiography parameters characterizing diastolic dysfunction was revealed. Positive correlation was established between the concentration of PICP with mitral annulus velocity and the Tei index, indicating an association between the myocardial fibrosis and diastolic dysfunction.

Key words: myocardial infarction, markers of fibrosis, diastolic dysfunction.

Relationships and Activities: not.

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

Osokina A. V. ORCID: 0000-0002-7784-5824, Karetnikova V. N. ORCID: 0000-0002-9801-9839, Polikutina O. V. ORCID: 0000-0001-7458-6962, Ivanova A. V. ORCID: 0000-0001-7993-5789, Gruzdeva O. V. ORCID: 0000-0002-7780-829Х, Ryzhenkova S. A. ORCID: 0000-0002-2168-2106, Artemova T. P. ORCID: 0000-0003-0210-3145, Barbarash O. L. ORCID: 0000-0002-4642-3610.

Received: 09.10.2019

Revision Received: 09.11.2019

Accepted: 20.01.2020

For citation: Osokina A. V., Karetnikova V. N., Polikutina O. V., Ivanova A. V., Gruzdeva O. V., Ryzhenkova S. A., Artemova T. P., Barbarash O. L. In-hospital changes of echocardiographic parameters and their relationship with the procollagen I C-terminal propeptide in patients with myocardial infarction and preserved left ventricle systolic function. Russian Journal of Cardiology. 2020;25(2):3553. (In Russ.) doi:10.15829/1560-4071-2020-2-3553.

MECHANISMS AND PREDICTORS OF ISCHEMIC MITRAL REGURGITATION AT REST AND ON EXERTION IN PATIENTS AT EARLY STAGE OF MYOCARDIAL INFARCTION

Adamyan K. G.1.2, Chilingaryan A. L.1, Mkrtchyan N. G.2, Tunyan L. G.1,2

Abstract

Aim. Determination of the mechanisms and predictors of ischemic mitral regurgitation (IMR) at rest and on exertion in patients at early stage of myocardial infarction (MI).

Material and methods. Seventy-seven patients with inferoposterior MI and 79 patients with anteroseptal apical MI were examined on the 7th day at rest and after exertion. We determined the degree of IMR (according to the PISA method), posteromedial and anterolateral papillary muscle (PM) displacement, closure height of the mitral valve (MV), systolic and diastolic mitral valve orifice area, volume of the left ventricle (LV), LV contractility index, deformation of the infarction regions, general LV deformation, deformation and systolic dyssinchrony of the PM.

Results. IMR was more common in inferior MI (42% vs 28%). LV volumes in cases with anteroseptal apical MI and IMR were greater and LV deformation was less than in patients without IMR. In inferoposterior MI and IMR, differences were observed in the index of local contractility and function of the posteromedial PM. The differences in MI of both localizations and IMR compared with MI without IMR were the areas of the mitral orifice and dyssinchrony of the PM. The degree of IMR after exertion did not depend on the degree of IMR at rest. Predictors of IMR at rest in MI of both localizations were the apical displacement of MV closure and the area of the mitral orifice. In inferoposterior, posteromedial PM displacement, deformation of the infarcted areas, PM dyssinchrony were also predictors. In anteroseptal apical MI, the area of the mitral orifice was the predictor of IMR. Predictors of anteroseptal apical MI after physical exertion after inferior MI were mitral orifice areas, contractility index, displacement and deformation of the posteromedial PM. In anteroseptal apical MI, the IMR predictors were MV closure height and systolic area of mitral orifice.

Conclusion. The study confirms the significance of changing the spatial orientation of the MV structures in MI of both localizations, impaired regional contractility in inferoposterior MI and LV volume in anteroseptal apical MI at early stage of the disease.

Key words: ischemic mitral regurgitation; longitudinal deformation; papillary muscle dyssinchrony.

Relationships and Activities: not.

1M. Heratsi Yerevan State Medical University, Yerevan; 2Research Institute of Cardiology, Yerevan, Republic of Armenia.

Adamyan K. G. ORCID: 0000-0001-8838-3269, Chilingaryan A. L. ORCID: 0000-0002-9821-7114, Mkrtchyan N. G. ORCID: 0000-0001-6447-2283, Tunyan L. G. ORCID: 0000-0002-3469-6144.

Received: 08.12.2018

Revision Received: 03.02.2019

Accepted: 17.04.2019

For citation: Adamyan K. G., Chilingaryan A. L., Mkrtchyan N. G., Tunyan L. G. Mechanisms and predictors of ischemic mitral regurgitation at rest and on exertion in patients at early stage of myocardial infarction. Russian Journal of Cardiology. 2020;25(2):3098. (In Russ.) doi:10.15829/1560-4071-2020-2-3098

EFFECTS OF CHRONIC AIRWAY OBSTRUCTION AND ATRIAL FIBRILLATION ON THE CARDIAC STRUCTURE AND FUNCTION IN PATIENTS WITH HEART FAILURE

Chesnikova A. I.1, Dzurich T. A.1, Safronenko V. A.1, Kolomatskaya O. E.1, Batalina A. Yu.2

Abstract

Aim. To study the cardiac remodeling in heart failure (HF) patients with atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD).

Material and methods. The study included 120 patients who were divided into 4 groups: the experimental group — patients with HF, AF and COPD (n=29), group 1 — patients with COPD, without cardiovascular disease (n=28), group 2 — patients with HF and COPD, without AF (n=30), group 3 — patients with HF and AF, without COPD (n=33). All patients underwent echocardiography using the MyLab70 Ultrasound System (Esaote, Italy).

Results. In comparison with patients of group 3, patients of the experimental group had lower left and right atrial volumes (p=0,001 and p=0,004, respectively), higher right ventricular (RV) wall thickness (p<0,001), lower RV end-diastolic area index (p=0,007) and fractional area change (FAC) (p=0б011), which indicates the effect of chronic airway obstruction on cardiac remodeling in patients with combination of these pathologies. In comparison with patients of group 2, patients of the experimental group had significantly larger RV dimension (p=0,012) and higher RV endsystolic area index (p<0,001), as well as lower systolic RV function (ejection fraction (p=0,002), FAC (p<0,001), tricuspid annular plane systolic excursion (p=0,012)) and higher pressure in the pulmonary circulation (p=0,001). This is due to high hemodynamic load on the RV related to AF and chronic airway obstruction.

Conclusion. The results of the study revealed features of cardiac remodeling pathogenesis in HF patients with AF and COPD. Comparative analysis of the results made it possible to indicate different mechanisms underlying AF, to assess the effects of both AF and chronic airway obstruction on the cardiac structure and function in patients with HF and combination of these pathologies.

Key words: heart failure, cardiac remodeling.

Relationships and Activities: not.

1Rostov State Medical University, Rostov-on-Don; 2Rostov Regional Vascular Center, Rostov-on-Don, Russia.

Chesnikova A. I. ORCID: 0000-0002-9323-592Х, Dzurich T. A. ORCID: 0000-0002-3045-2820, Safronenko V. A. ORCID: 0000-0002-6965-5019, Kolomatskaya O. E. ORCID: 0000-0003-2888-3194, Batalina A. Yu. ORCID: 0000-0001-5086-8930.

Received: 12.01.2020

Revision Received: 03.02.2020

Accepted: 14.02.2020

For citation: Chesnikova A. I., Dzurich T. A., Safronenko V. A., Kolomatskaya O. E., Batalina A. Yu. Effects of chronic airway obstruction and atrial fibrillation on the cardiac structure and function in patients with heart failure.

Russian Journal of Cardiology. 2020;25(2):3713. (In Russ.) doi:10.15829/1560-4071-2020-2-3713

FIVE-YEAR CHANGES OF SOMATIC RISK FACTORS AND COMORBIDITIES IN PATIENTS WITH ANGINA OF EFFORT

Ugurchieva P. O.1, Didigova R. T.1, Khudyakov M. B.2, Mamedov M. N.2

Abstract

Aim. To assess five-year changes of somatic risk factors and comorbidities in patients with angina of effort.

Material and methods. The study included 320 patients (143 men and 177 women aged 40-69 years) with coronary artery disease (CAD), class I-III angina of effort. Patients underwent examinations in 2012 in three medical centers of the Republic of Ingushetia (Russia), and in 2017 they were invited for a second complex examination with questionnaires, biochemical analysis, and instrumentation.

Results. Over the five-year follow-up, there was an increase of men with class III effort angina up to 45%; a similar trend was observed in women. Both men and women experienced a three-fold increase in the incidence of type 2 diabetes. Initially and during the follow-up, chronic obstructive pulmonary disease was diagnosed 2 times more often in men than in women, which may be associated with smoking. A small increase in the total cholesterol level was recorded in the cohort; among women, these changes were significant. Target levels reach no more than 20% of patients. A significant increase of blood glucose levels over the 5-year period was observed in a cohort of men and women with effort angina.

Conclusion. Over the 5-year follow-up, there was a clinical deterioration of the effort angina, which is associated with an increase in the incidence of some somatic diseases and the severity of the main behavioral and biological risk factors.

Key words: angina of effort, changes, risk factors, somatic comorbidities.

Relationships and Activities: not.

1Ingush State University, Magas; 2National Medical Research Center for Preventive Medicine, Moscow, Russia.

Ugurchieva P. O. ORCID: 0000-0001-5465-4526, Didigova R. T. ORCID: 0000-0003-2441-0146, Khudyakov M. B. ORCID: 0000-0002-7869-2030, Mamedov M. N. ORCID: 0000-0001-7131-8049.

Received: 28.01.2020

Revision Received: 06.02.2020

Accepted: 14.02.2020

For citation: Ugurchieva P. O., Didigova R. T., Khudyakov M. B., Mamedov M. N. Five-year changes of somatic risk factors and comorbidities in patients with angina of effort. Russian Journal of Cardiology. 2020;25(2):3730. (In Russ.) doi:10.15829/1560-4071-2020-2-3730

METHODS OF STUDY

EVALUATION OF MYOCARDIAL BLOOD FLOW AND CORONARY FLOW RESERVE — THE PHYSIOLOGICAL FOUNDATION AND CLINICAL SIGNIFICANCE OF MYOCARDIAL PERFUSION SCINTIGRAPHY IN THE EXAMINATION OF PATIENTS WITH CHRONIC CORONARY SYNDROME

Mochula A. V., Maltseva A. N., Shipulin V. V., Zavadovsky K. V.

Abstract

Non-invasive cardiovascular imaging plays an important role in examination of patients with chronic coronary syndrome. Positron emission tomography (PET) has the highest diagnostic accuracy and prognostic significance due to the ability to assess myocardial blood flow (MBF) and coronary flow reserve (CFR). These physiological processes provide myocardial oxygen demand, both at rest and stress, as well as maintaining sufficient myocardial circulation during coronary artery constriction. At the same time, the high cost and low availability of assessing MBF and CFR by PET do not allow widespread use of this approach in clinical practice. The use of modern gamma cameras with cadmium zinc telluride detectors can be an alternative to PET. The aim of the review is to present fundamental information about MBF and CFR, as well as about the possibilities of using scintigraphy for determination of these parameters and their clinical significance.

Key words: dynamic single photon emission computed tomography, myocardial blood flow, coronary flow reserve, coronary artery disease, coronary artery atherosclerosis.

Relationships and Activities: the work was supported by a grant from the President of the Russian Federation, MK-1347.2020.7.

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

Mochula A. V. ORCID: 0000-0003-0883-466X, Maltseva A. N. ORCID: 0000-0002-1311-0378, Shipulin V. V. ORCID: 0000-0001-9887-8214, Zavadovsky K. V. ORCID: 0000-0002-1513-8614.

Received: 05.12.2019

Revision Received: 11.12.2019

Accepted: 11.12.2019

For citation: Mochula A. V., Maltseva A. N., Shipulin V. V., Zavadovsky K. V. Evaluation of myocardial blood flow and coronary flow reserve — the physiological foundation and clinical significance of myocardial perfusion scintigraphy in the examination of patients with chronic coronary syndrome. Russian Journal of Cardiology. 2020;25(2):3649. (In Russ.) doi:10.15829/1560-4071-2020-2-3649

CLINIC AND PHARMACOTHERAPY

LATENT OPPORTUNITIES FOR THE PREVENTION OF ISCHEMIC STROKE IN PATIENTS WITH ATHEROSCLEROSIS-RELATED DISEASES: ADDITIONAL ANALYSIS OF RANDOMIZED TRIALS ON RIVAROXABAN

Gilyarevskiy S. R.

Abstract

Practical introduction of drugs requires determining the relationship between the benefits of its use and adverse effects, as well as identifying clinically significant additional benefits of new treatment approaches by analyzing additional parameters or reanalyzing data of randomized controlled trials. Despite the lack of evidence of such analyzes, they often affect the prospects of using drugs in a particular clinical situation. The article discusses new data on the prospects for the use of low-dose rivaroxaban (2,5 mg 2 times a day), which were obtained not only in initial analyzes, but also secondary analyzes of data obtained in randomized trials involving patients with atherosclerosis-related cardiovascular diseases and sinus rhythm.

Key words: ischemic stroke, rivaroxaban, low doses.

Relationships and Activities: this study was supported by AO Bayer, PP-XARRU-0290-1.

Russian Medical Academy of Continuing Professional Education, Moscow, Russia.

Gilyarevskiy S. R. ORCID: 0000-0002-8505-1848.

Received: 31.01.2020

Revision Received: 17.02.2020

Accepted: 18.02.2020

For citation: Gilyarevskiy S. R. Latent opportunities for the prevention of ischemic stroke in patients with atherosclerosis-related diseases: additional analysis of randomized trials on rivaroxaban. Russian Journal of Cardiology. 2020;25(2):3747. (In Russ.) doi:10.15829/1560-4071-2020-2-3747

MYOCARDIAL CONTRACTILITY DYSFUNCTION IN PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA RECEIVING CHEMOTHERAPY AND THEIR TREATMENT WITH ENALAPRIL

Davydkin I. L., Kuzmina T. P., Zolotovskaya I. A., Tereshina O. V., Danilova O. E., Khairetdinov R. K., Rogozina L. A.

Abstract

Aim. To assess eft ventricular (LV) contractility dysfunction in patients with chronic lymphocytic leukemia (CLL) receiving chemotherapy with fludarabine, cyclophosphamide, and rituximab (FCR), and to determine the enalapril.effectiveness for their treatment.

Material and methods. The study included 49 patients with newly diagnosed Binet stage B CLL in combination with class I-II stable angina, stage 1-2 hypertension and LV ejection fraction (EF) >50%. All subjects did not take angiotensin converting enzyme inhibitors (ACE inhibitors), had no clinical signs of heart failure (HF), and all had indications for FCR combination use before study start. Patients underwent two-dimensional echocardiography initially, before starting chemotherapy (period V1) and after three (84±5 days) (V2) and six (168±7 days) (V3) courses of chemo therapy. In period V2, patients were divided into two groups. Cardioprotective therapy (enalapril) was added to the treatment regimen in the experimental group.

Results. After the third course of chemotherapy, a relative percentage decrease in global longitudinal strain (GLS) was noted in the experimental and control groups — by 16,16±0,80 and 16,2±0,79, respectively (p=0,764). These changes are considered a cardiotoxicity predictor. At the same time, LVEF values remained within the normal range: 63,4% [65; 68] in the experimental group and 63,9% [61,6; 67] in the control group (p=0,960). After the sixth course, LVEF values significantly differed (p=0,002): in the control group, five patients (21%) had cardiotoxicity; in experimental group, there were no patients with cardiotoxicity.

Conclusion. A clinically significant decrease in GLS is a marker of subclinical LV contractile dysfunction and is a cardiotoxicity predictor in CLL patients receiving chemotherapy with FCR. The timely addition of enalapril to the treatment regimen can prevent cardiotoxicity in such patients. The need for early assessment of GLS during FCR courses for the detection and prevention of cardiotoxicity has been proved.

Key words: chronic lymphocytic leukemia, subclinical left ventricle contractile dysfunction, cardiotoxicity, chemotherapy, enalapril.

Relationships and Activities: not.

Samara State Medical University, Samara, Russia.

Davydkin I. L. ORCID: 0000-0003-0645-7645, Kuzmina T. P. ORCID: 0000-0002-5378-5687, Zolotovskaya I. A. ORCID: 0000-0002-0555-4016, Tereshina O. V. ORCID: 0000-0003-0382-3363, Danilova O. E. ORCID: 0000-0002-4322-0447, Khairetdinov R. K. ORCID: 0000-0002-7983-642Х, Rogozina L. A. ORCID: 0000-0001-6597-3872.

Received: 05.09.2019

Revision Received: 09.11.2019

Accepted: 17.12.2019

For citation: Davydkin I. L., Kuzmina T. P., Zolotovskaya I. A., Tereshina O. V., Danilova O. E., Khairetdinov R. K., Rogozina L. A. Myocardial contractility dysfunction in patients with chronic lymphocytic leukemia receiving chemotherapy and their treatment with enalapril. Russian Journal of Cardiology. 2020;25(2):3480. (In Russ.) doi:10.15829/1560-4071-2020-2-3480

CLINICAL CASES

VASOSPASTIC ANGINA — VASOSPASTIC MYOCARDIAL INFARCTION

Galyavich A. S.1, Baleeva L. V.1, Galeeva Z. M.1, Galimzyanova L. A.2

Key words: myocardial infarction, vasospasm.

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

Galyavich A. S. ORCID: 0000-0002-4510-6197, Baleeva L. V. ORCID: 0000-0002-7974-5894, Galeeva Z. M. ORCID: 0000-0002-9580-3695, Galimzyanova L. A. ORCID: 0000-0003-4359-4657.

Relationships and Activities: not.

Received: 12.01.2020

Revision Received: 27.01.2020

Accepted: 02.02.2020

For citation: Galyavich A. S., Baleeva L. V., Galeeva Z. M., Galimzyanova L. A. Vasospastic angina — vasospastic myocardial infarction. Russian Journal of Cardiology. 2020;25(2):3709. (In Russ.) doi:10.15829/1560-4071-2020-2-3709

INFECTIVE ENDOCARDITIS WITH SEVERE BRAIN LESION

Obrezan A. G.1,2, Ostanina N. G.1,3, Obrezan A. A.1,2

Key words: infective endocarditis, Staphylococcus aureus, multifocal cerebral embolism.

1St. Petersburg State University, St. Petersburg; 2Sogaz International Medical Center, St. Petersburg; 3City Aleksander Hospital, St. Petersburg, Russia.

Relationships and Activities: not.

Obrezan A. G. ORCID: 0000-0001-6115-7923, Ostanina N. G. ORCID: 0000-0002-9889-2209, Obrezan A. A. ORCID: 0000-0001-6007-3824.

Received: 15.08.2019

Revision Received: 11.12.2019

Accepted: 11.12.2019

For citation: Obrezan A. G., Ostanina N. G., Obrezan A. A. Infective endocarditis with severe brain lesion. Russian Journal of Cardiology. 2020;25(2):3459. (In Russ.) doi:10.15829/1560-4071-2020-2-3459

EXPERT CONSENSUS

EMERGENCY CARE IN A SUDDEN INDIVIDUALLY SIGNIFICANT BLOOD PRESSURE INCREASE WITHOUT CLINICALLY OVERT TARGET ORGAN DAMAGE: RATIONALE FOR CAPTOPRIL USE. EXPERT COUNCIL OPINION

Created upon an initiative of Russian Society of Specialists in Emergency Cardiology

Chairman of the Expert Council: Tereshchenko S. N.1

Committee of the Expert Council: Arutyunov G. P.2, Galyavich A. S.3, Gaponova N. I.4, Gilyarevskiy S. R.5, Duplyakov D. V.6,7, Zhirov I. V.1,5, Skibitskiy V. V.8, Tkacheva O. N.2,9, Shaposhnik I. I.10

Abstract

Expert Council opinion describes emergency care in a sudden individually significant blood pressure (BP) increase without clinically overt target organ damage. In the new guidelines of the Russian Society of Cardiology, the term “hypertensive urgency” was abolished, and the management of a sudden BP increase was changed. At the same time, a sudden individually significant BP increase may be accompanied by symptoms that reduce patients’ quality of life and ability to work. According to experts, individually significant BP increase accompanied by symptoms requires outpatient treatment using oral rapid-onset drugs with an optimal duration of action, in particular captopril. It has a much evidence-based data on the BP increase use and sublingual administration, and also has a favorable safety profile, which allows prescribing to patients with comorbid diseases. The rationale for the use of angiotensin-converting enzyme inhibitor Capoten (captopril) as a drug for self-management of a sudden individually significant BP increase accompanied by symptoms in hypertension patients is describes.

Key words: clinical practice guidelines, hypertensive crisis, uncontrolled hypertension, angiotensin converting enzyme inhibitor, captopril, Capoten.

Relationships and Activities: not.

1National Medical Research Center of Cardiology, Moscow; 2Pirogov Russian National Research Medical University, Moscow; 3Kazan State Medical University, Kazan; 4Moscow State University of Medicine and Dentistry, Moscow; 5Russian Medical Academy of Continuing Professional Education, Moscow; 6Samara Regional Clinical Cardiology Dispensary, Samara; 7Samara State Medical University, Samara; 8Kuban State Medical University, Krasnodar; 9Russian Clinical and Research Center of Gerontology, Moscow; 10South Ural State Medical University, Chelyabinsk, Russia.

Tereshchenko S. N. ORCID: 0000-0001-9234-6129, Arutyunov G. P. ORCID: 0000-0002-6645-2515, Galyavich A. S. ORCID: 0000-0002-4510-6197, Gaponova N. I. ORCID: 0000-0003-4274-6401, Gilyarevskiy S. R. ORCID: 0000-0002-8505-1848, Duplyakov D. V. ORCID: 0000-0002-6453-2976, Zhirov I. V. ORCID: 0000-0002-4066-2661, Skibitskiy V. V. ORCID: 0000-0002-7750-7358, Tkacheva O. N. ORCID: 0000-0002-4193-688X, Shaposhnik I. I. ORCID: 0000-0002-7731-7730.

Received: 31.01.2020

Revision Received: 17.02.2020

Accepted: 18.02.2020

For citation: Tereshchenko S. N., Arutyunov G. P., Galyavich A. S., Gaponova N. I., Gilyarevskiy S. R., Duplyakov D. V., Zhirov I. V., Skibitskiy V. V., Tkacheva O. N., Shaposhnik I. I. Emergency care in a sudden individually significant blood pressure increase without clinically overt target organ damage: rationale for captopril use. Expert Council opinion. Russian Journal of Cardiology. 2020;25(2):3748. (In Russ.) doi:10.15829/1560-4071-2020-2-3748

DISCUSSION ARTICLE

DISCUSSION OF A NEW CLASSIFICATION FOR CORONARY ARTERY DISEASE

Galyavich A. S.

Abstract

The article discusses the creation of a new classification for coronary artery disease. The classification of acute and chronic forms of coronary artery disease is proposed as one of the variants.

Key words: coronary artery disease, atherosclerosis, angina, myocardial infarction.

Relationships and Activities: not.

Kazan State Medical University, Kazan, Russia.

Galyavich A. S. ORCID: 0000-0002-4510-6197.

Received: 28.01.2020

Revision Received: 06.02.2020

Accepted: 07.02.2020

For citation: Galyavich A. S. Discussion of a new classification for coronary artery disease. Russian Journal of Cardiology. 2020;25(2):3727. (In Russ.) doi:10.15829/1560-4071-2020-2-3727

LITERATURE REVIEW

ACUTE CORONARY SYNDROME: HOW TO REDUCE THE RESIDUAL INFLAMMATORY RISK?

Shalnev V. I.

Abstract

Inflammatory mediators play an important role in the pathogenesis of acute coronary syndrome (ACS). The results of experimental and randomized clinical trials on the role of various inflammation inhibitors in the treatment of coronary artery disease (CAD), in particular CANTOS and COLCOT, mark a new stage that can significantly change the clinical course and outcomes of the disease. We analyze our own experience in studying this problem. There are much prospects for the use of immunomodulatory and anti-inflammatory drugs reducing the residual inflammatory risk, but additional studies are needed to determine their role in the treatment of CAD.

Key words: acute coronary syndrome, atherothrombosis, inflammation, statins, immunomodulators.

Relationships and Activities: not.

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

Shalnev V. I. ORCID: 0000-0002-6369-8237, ResearcherID: P-1672-2014.

Received: 21.01.2020

Revision Received: 03.02.2020

Accepted: 06.02.2020

For citation: Shalnev V. I. Acute coronary syndrome: how to reduce the residual inflammatory risk? Russian Journal of Cardiology. 2020;25(2):3720. (In Russ.) doi:10.15829/1560-4071-2020-2-3720

CLINICAL GUIDELINES

2019 ESC GUIDELINES FOR THE DIAGNOSIS AND MANAGEMENT OF CHRONIC CORONARY SYNDROMES

The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology

(ESC)

Russian Journal of Cardiology. 2020;25(2):3757

dx.doi.org/10.15829/1560-4071-2020-2-3757

Key words: guidelines, chronic coronary syndromes, angina pectoris, myocardial ischaemia, coronary artery disease, diagnostic testing, imaging, risk assessment, lifestyle modifications, anti-ischaemic drugs, antithrombotic therapy, lipid-lowering drugs, myocardial revascularization, microvascular angina, vasospastic angina, screening.

12 марта 2020 г.

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