RUSSIAN JOURNAL OFCARDIOLOGY, 2017, 3 (143)
Address to the readers
Russ J Cardiol 2017, 3 (143): 5
COMORBIDITY IN CORONARY HEART DISEASE PATIENTS UNDERGOING BYPASS GRAFTING: AN EXPERIENCE OF TWO SURGERY CENTERS
Barbarash O. L.1,4, Semjonov V. Yu.2, Samorodskaya I. V.3, Evseeva М. V.1, Rozhkov N. А.2, Sumin А. N.1, Barbarash L. S.1
Aim. To evaluate the prevalence of comorbidities in patients undergoing coronary bypass grafting (CBG) in two surgery clinics of Russia.
Material and methods. Into retrospective study, done based upon the charts data of A. N. Bakulev Scientific Center for Cardiovascular Surgery (A. N. Bakulev SCCVS) and Research Institute for Complex Issues of Cardiovascular Diseases, 1702 patients included (1358 males, 344 females) from Bakulev SCCVS and 1159 (895males, 264 females) patients from RICICD, who had underwent CBG, including multiple surgeries, during 2014-2015. Comparative analysis was performed of the prevalence of comorbidity and combination pathology.
Results. The main background pathology in general group of patients was arterial hypertension (AH) — 2322 (81,2%) cases. In more than a half of cases, in anamnesis there was myocardial infarction (MI) — 1719 (60,1%), of those in 250 (8,7%) patients — with left ventricle aneurysm. Lower extremities atherosclerosis was found in 13,8% cases. Stroke anamnesis had 5,6% patients. Prior carotid endarterectomy (CEE) was found in 30 (1,0%) cases, percutaneous intervention — 190 (6,6%) patients. The most common comorbidity in general group was type 2 diabetes — 505 (17,6%) cases. Chronic obstructive pulmonary disease (COPD) was found in 352 (12,3%) patients, erosions and ulceration of gastro-intestinal tract (GIT) — in 10,6% cases. Patients of RICICD were older (62,5±7,8 vs 60,8±8,5 y. o., p=0,003), had AH more commonly (83,1 vs 79,8%, p=0,02), as stroke anamnesis (7,2 vs 4,5%, p=0,002), prior MI (66,8 vs 55,5%, p<0,05), prior PCI (12,9 vs 2,4%, p<0,05), COPD (13,8 vs 11,3%, p=0,044), GIT ulceration (15,2 vs 7,5%, p<0,05) in comparison to Bakulev SCCVS. Bakulev SCCVS patients had 1,5 times more prevalently the atherosclerotic lesion of lower extremities (15,9 vs 10,6%, p<0,05), prior CEE was done 3,7 times more prevalently than in RICICD (1,5 vs 0,4%, p=0,007), more commonly the combination intervention was done: CBG with valvular correction (11,3 vs 6,7%, p<0,05).
Conclusion. The prevalence of comorbidity is determined by the age of patient, as regional specifics of morbidity in population hospitalizing to one or another surgical center.
Russ J Cardiol 2017, 3 (143): 6–13
Key words: comorbidity, coronary bypass grafting, cardiosurgery center.
1 Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo; 2A.N. Bakulev Scientific Center for Cardiovascular Surgery of the Ministry of Health, Moscow; 3National Research Center for Preventive Medicine of the Ministry of Health, Moscow; 4Kemerovo State Medical University of the Ministry of Health, Kemerovo, Russia.
COMPLIANCE TO CLINICIAN PRESCRIPTIONS IN ISCHEMIC HEART DISEASE PATIENTS (BY THE DATA FROM OUTPATIENT REGISTRY PROFILE)
Lukina Yu. V., Kutishenko N. P., Dmitrieva N. A., Martsevich S. Yu.
Workgroup of the PROFILE registry: Voronina V. P., Dmitrieva N. A., Zakharova A. V., Zagrebelny A. V., Kutishenko N. P., Lerman O. V., Lukina Yu. V., Martsevich S. Yu., Tolpygina S. N.
Aim. Based on the data of outpatient registry PROFILE, with addition of questionnaires, to analyze treatment compliance and influencing factors, in coronary heart disease (CHD) patients.
Material and methods. 688 patients of the PROFILE registry who had come to a primary visit in scientific department of the investigation center at time between 1 January 2014 to 31 August 2015, were asked to complete an original compliance to clinician prescriptions (CP) questionnaire with integrated Morisky-Green test (MG). It was filled by 479 patients (70,1%). In 250 of answerers there was CCHD: 65 women (26%) and 175 men (74%). Mean age of CCHD patients was 63,6±12,5 y. o. 72,1% of them in the PROFILE registry, had higher education, 16 (6,4%) — scientific degree. Diagnosis of CHD was verified as anamnesis of myocardial infarction (MI), coronary arteriography (CAG) or exercise test in 231 (92,4%) participants.
Results. As the patients charts show, 12 patients with CCHD from 250 participants did not receive any medication treatment, 15 took medications irregularly, and other 223 regularly, by CP. This data is confirmed by the results of original questionnaires: 193 patients responded that do strictly adhere all CP on medications, and 49 (among 238) — had misused some prescriptions. By the results of 4-unit MG test, only 47 from 230 of responders were completely adherent to the treatment, and other 71 made at least ne positive response, being relatively adherent. In multifactorial logistic regression, it was found that stable angina and scientific degree do increase adherence 3 times (р=0,006; OR 2,9; CI 95% [1,4;6,0]) and more than 6 times, respectively (р=0,003; OR=6,3; CI 95% [1,9;21,0]). Also, it was shown that treatment adherence (by our original questionnaire) depends on the regularity of clinician follow-up, and office visits once per year and more do increase it more than 5 times (р=0,019, OR=5,1 CI 95% [1,3;19,9]).
Conclusion. Clinical symptoms of CHD (stable angina), scientific degree, as well as regular clinician follow-up at least once per year, are the factors increasing overall patients adherence to CP and medication treatment compliance.
Russ J Cardiol 2017, 3 (143): 14–19
Key words: adherence, physician prescriptions, outpatient registry, original questionnaire, chronic CHD.
National Research Center for Preventive Medicine of the Ministry of Health, Moscow, Russia.
A ROLE OF SUPEROXIDE DISMUTASE IN DEVELOPMENT OF POST-OPERATION ATRIAL FIBRILLATION IN CORONARY HEART DISEASE PATIENTS
Rubanenko О. А.1,2, Fatenkov О. V.1, Khokhlunov S. М.1,2, Limareva L. V.1
Aim. To evaluate the level of superoxide dismutase (SOD) in coronary heart disease (CHD) patients underwent coronary bypass (CBG), and to estimate its importance in development of post-surgery atrial fibrillation (PSAF).
Material and methods. Totally, 96 patients studied, with CHD, admitted for CBG. Patients were selected to 2 groups: 1 group — non-PSAF (67 patients, 80,6% males, mean age 57,9±7,3 y. o.), 2 group — with first time AF in early period of CBG (29 patients, 86% males, mean age 64,0±8,4 y. o.).
Results. During study period PSAF developed in 30,2% cases, mean on 4,9±3,8 day after surgery. Comparing with group 1, level of SOD was higher in group 2 patients (2589,8±1999,3 U/g vs 1572,8±1275,2 U/g, р=0,034). Patients of group 2 were older 4 years in average (64,0±8,4 vs 57,9±7,3 y., р=0,048), had longer duration of cardiovascular pathology (86,9±76,1 months vs 44,3±38,4 m., р=0,002). Patients with PSAF had III functional class of angina (72,4% vs 47,8%, р=0,028) and III functional class of congestive heart failure (38,0% vs 7,5%, р=0,006), they had larger left atrium (43,5±4,1 mm vs 37,9±3,4 mm, р<0,001). After multifactorial analysis, predictive value remained for the following: left atrium larger than 41 mm — 5,1 (95% CI, 2,1-9,8, р=0,0005), SOD more than 2948 U/g — 4,4 (95% CI, 1,1-8,9, р=0,04).
Conclusion. The study showed that CBG operation is followed by activation of oxidation stress which is followed by the decrease of SOD concentration, probably due to its consumption. However, among patients with PSAF there is higher activity of this enzyme.
Russ J Cardiol 2017, 3 (143): 20-24
Key words: atrial fibrillation, coronary bypass, superoxide dismutase.
1 Samara State Medical University of the Ministry of Health, Samara; 2Samara Regional Clinical Cardiological Dispensary, Samara, Russia.
REGISTRY MANAGEMENT PROGRAM FOR ISCHEMIC HEART DISEASE IN ALTAISKY KRAY
Nomokonova Е. А.1, Elykomov V. А.1,2, Efremushkina А. А.1,3, Nikulina Е. G.3, Nedoseko К. V.1
Aim. To evaluate the results of the program for management of ischemic heart disease registry in Altaisky kray in 2011-2015 y.
Material and methods. The system was developed and implemented in 2011 as a pilot project, with software named “Monitoring + [Registry of CIHD]”. The project was planned as retro-, prospective observational cohort study. The registry was primarily tested on the bases of Regional Clinical Hospital and Altai Regional Cardiological Dispensary. From the beginning of 2014, other 28 institutions were involved into the registry. The work is being done continuously, with patients admission and investigation if fulfill the registry criteria. For statistics the descriptory methods were applied.
Results and discussion. From 2011 to 2015, the data of 12886 patients was entered to the registry, with the diagnosis “ischemic heart disease”. Mean age — 65,1±9,9 y. o. Region capital citizens were 35,5% of the registry, and inhabitants of the Region — 64,5%. Two thirds were males. By the anamnesis data, there was significantly more persons after myocardial infarction — 7094 (p<0,01). Hightechnology care under “Cardiovascular surgery” unit was provided to 6115 (47,4%) patients. Medication treatment was done according to guidelines and standards for ischemic heart disease patients management. With the implementation of registry, availability of cardiovascular care for rural inhabitants improved: three times increased the volumes of outpatient stage high-technology care, and cardiosurgery increased 1,8 times. The decrease of cardiovascular mortality during last 5 years reached 18,6%.
Conclusion. A universal approach has been formulated for a unified base of patients suffering from ischemic heart disease, that makes it to follow-up the epidemiological situation in districts of Region by disease, to find out the risk factors and correct them. With the Registry of CIHD, it is possible to analyze the performance of cardiological care, to influence on its qualitative and quantitative parameters. The necessity is shown, for the development of this monitoring system in all treatmentprevention institutions of the Region for equality in specialized care accessibility, including high-technology care.
Russ J Cardiol 2017, 3 (143): 25–29
Key words: registry, ischemic heart disease, high-technology medical care, specialized cardiological care.
1 Regional Clinical Hospital, Barnaul; 2Altai State Medical University, Barnaul; 3Altai Regional Cardiological Dispensary, Barnaul, Russia.
GALECTIN-3 LEVEL IN PATIENTS WITH METABOLIC SYNDROME AND CORONARY HEART DISEASE
Drapkina О. М.1, Shepel R. N.1, Deeva Т. А.2
Aim. To assess the level of galectin-3 in blood serum of patients with metabolic syndrome (MS), including comorbidity with coronary heart disease (CHD), for evaluation of its significance as fibrosis marker in MS.
Material and methods. Totally, 43 MS patients studied with CHD signs, and 33 patients non-MS of comparable age, of those CHD was diagnosed in 17. Mean age in MS group was 62,7±10,3 y. o. at baseline, in controls (non-MS) — 60±14,7 y. o. Galectin-3 level was measured via immune-enzyme assay on “Platinum ELISA”.
Results. Mean level of galectin-3 in MS group was significantly higher and reached 1,89±1,71 ng/mL, comparing to non-MS group — 1,03±0,22 ng/mL (р=0,006). There were positive correlations of galectin-3 and CHD functional class by NYHA (r=0,346, р=0,012): in absence of CHD signs galectin-3 level was 1,05±0,26 ng/mL; in CHD of 1 functional class (FC) — 1,06±0,18 ng/mL; 2 FC — 1,7±1,59 ng/mL; 3 FC — 2,15±1,85 ng/mL.
Conclusion. The level of fibrosis marker galectin-3 are higher in MS patients than in non-MS, and in MS+CHD is higher than in those without this pathology. Finding of high level of galectin-3 in MS and CHD patients might witness on the severity of myocardial fibrosis, supporting prognosis.
Russ J Cardiol 2017, 3 (143): 30–36
Key words: galectin-3, fibrosis marker, coronary heart disease, metabolic syndrome.
1 National Research Center for Preventive Medicine of the Ministry of Health, Moscow; 2I.M. Sechenov First Moscow State Medical University of the Ministry of Health, Moscow, Russia.
DIASTOLIC DYSFUNCTION OF THE RIGHT VENTRICLE IN CORONARY HEART DISEASE PATIENTS
Arkhipov O. G.1, Sumin А. N.2
Aim. Evaluation of the prevalence of the right ventricle diastolic dysfunction (RVDD) in coronary heart disease patients (CHD), and factors associated with its diagnostics.
Material and methods. Totally, 691 CHD patient included (412 males) at the age 36-85 y. o. (mean age 61,0 y. o.). Patients were selected to 2 groups: with saved diastolic RV function (n=478) and with RVDD (n=199). All participants underwent echocardiography with diastolic function assessment of the left ventricle (LV) and RV in impulse-wave dopplerometry of atrioventricular flows, spectral tissue Doppler of the mitral and tricuspid anuli, and color-M-modal scan.
Results. The prevalence of diastolic dysfunction of RV in CHD patients was 29%. Most significant was the decline of velocity of tricuspid flow in group 2, being 22% lower than group 1 (p<0,0001). From the diastolic part of spectrum of tricuspid annulus there was significant decrease of the velocity of its early diastolic motion е’t in RVDD patients by 16% (Z=4,5; p<0,0001). Relation е’t /а’t significantly decreased in group 2 (p=0,001). Relation Еt /е’t increased significantly only in group 2, by 14% (p=0,001).
The independent factors associated with RVDD were age (p=0,02), diabetes (p=0,021), clinical picture of angina III functional class (p=0,00011), decrease of LV ejection fraction (p<0,0001) and diastolic dysfunction of LV (LVDD) (p<0,0001 and p=0,0069 with different parameters).
Conclusion. RVDD was found in 29% CHD patients, investigated outpatient. With RVDD there was association of age, diabetes, angina III class, decreased LV ejection fraction and LVDD. In RVDD assessment it is purposeful to apply complex approach with the parameters of intraventricular currents.
Russ J Cardiol 2017, 3 (143): 37–45
Key words: coronary heart disease, diastolic dysfunction of the right ventricle.
1 Center for Rehabilitation of SIF RF “Topaz”, Myski, Kemerovskaya Region; 2Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia.
THE IMPACT OF INDOOR CYCLING TRAINING ON HEMODYNAMIC PARAMETERS OF THE LEFT VENTRICLE OF MEN WITH ISCHAEMIC HEART DISEASE OR AFTER MYOCARDIAL INFARCTION
Gloc D. D.1, Nowak Z.2
Aim. Younger age of the cardiac patients somehow necessitates the use of modern forms of physical training, which become alternative and interesting means to provide effective rehabilitation. One such form is endurance Indoor Cycling training. In the present study attempts to determine the impact of 1-month Indoor Cycling training on hemodynamic left ventricle parameters of men with ischemic heart disease or after myocardial infarction were made.
Material and methods. The study group consisted of 50 men under the model A of the 2nd phase of cardiac rehabilitation (20 men of the Indoor Cycling group, IC, 20 men rehabilitated accordingly to the recommendations of the Polish Cardiac Society — a standard group, ST and 10 people who did not participate in any cardiac rehabilitation program — a control group, C). The average age of all patients was 56,60±8,25 years, the average left ventricular ejection fraction was 56%±4,00.
Results. Echocardiogram did not show significant changes after 1-month of training in both groups undergoing comprehensive cardiac rehabilitation. Paralleled to the preliminary study in the group of patients who refused to participate in the cardiac rehabilitation, results showed a reduction in all echocardiographic parameters, including a significant decrease in the left ventricular end diastolic diameter (52,80 vs 50,50 mm) and volume (134,85 vs 121,88 ml; both variables at p<0,001), as well as in the left ventricular mass (239,46 vs 208,61 g; p=0,002) and the left ventricular mass index (123,52 vs 107,61 g/m2; p=0,001).
Conclusion. No negative influence of the Indoor Cycling training on morphological parameters of the left ventricle was observed. Indoor Cycling training in the second phase of cardiac rehabilitation in patients with ischemic heart disease or after myocardial infarction is a safe form of therapy and therefore may be an interesting alternative method to the classic bicycle ergometer exercise in the stage of an early cardiac rehabilitation.
Russian Journal of Cardiology 2017, 3 (143): 46–53
Key words: comprehensive cardiac rehabilitation, coronary heart disease, Indoor Cycling, Percutaneous Coronary Intervention, myocardial infarction.
1 Silesian Centre of Rehabilitation and Prevention, Ustroń; 2 Academy of Physical Education, Katowice, Poland.
PROGNOSTIC VALUE OF ENDOTHELIAL DYSFUNCTION IN CORONARY AND BRACHIAL ARTERIES, AND COMMON RISK FACTORS IN DEVELOPMENT OF CARDIOVASCULAR COMPLICATIONS IN PATIENTS WITH MICROVASCULAR ANGINA
Soboleva G. N., Fedulov V. K., Samko A. N., Levitsky I. V., Rogoza A. N., Balakhonova T. V., Karpov Yu. A.
Aim. To study prognostical significance of vasomotor disorder of coronary and brachial arteries, and traditional risk factors in development of cardiovascular complications in patients with microvascular angina (MVA) and cardial syndrome X;
a retrospective 12-year observation.
Material and methods. Totally, 41 patient included, with MVA (40 females/1 male), mean age at the moment of inclusion 43±4,1 y. o., 15% smokers). Endotheliumdependent vasodilation (EDV) of coronary arteries was assessed via intracoronary acetylcholine load, EDV of brachial artery — via high-resolution ultrasound in active hyperemia test.
Results. It was found that in brachial EDV <4,7% group the risk of cardiovascular complications (p<0,05) is higher for 9-18 years of observation. Baseline EDV of coronary arteries in the study did not influence survival rate in MVA patients.
Conclusion. Significant influence on cardiovascular events occurring in long-term follow-up of MVA patients, had the risk factors as smoking and brachial artery endothelial dysfunction.
Russ J Cardiol 2017, 3 (143): 54–58
Key words: microvascular angina prognosis, endothelial dysfunction, endotheliumdependent vasodilation, acetylcholine test.
A. L. Myasnikov Institute of Clinical Cardiology, Russian Cardiological Research-and-Production Complex, Moscow, Russia.
LEVOSIMENDAN IN PREOPERATION THERAPY FOR CARDIOSURGERY IN PATIENTS WITH CHRONIC HEART FAILURE
Babaev M. A., Eremenko A. A., Dymova O. V., Polyakova P. V., Fedulova S. V., Frolova Yu. V.
Aim. To evaluate the efficacy of action of the calcium sensitizer levosimendan (LS) in patients with various grade of heart failure (HF) severity before cardiosurgery.
Material and methods. LS was applied as a part of HF treatment while preparing patients for surgery in 2-4 days. Performed dose was 0,025 — 0,1 μg/kg/min. The drug was not administered in bolus. Preoperation group of participants included 108 patients (62% — men, 38% — women, aged 20 — 72 years (53±13)) with CHF III-IV FC by NYHA, with ejection fraction of the left ventricle (LVEF) about in average 27±8%.Mean level of natriuretic B-type peptide was 1129 (Me 854, Q25 396, Q75 1419) pg/mL. Main etiology of chronic HF in participants was dilation cardiomyopathy: noncoronary cardiomyopathy in 30 patients (27,7%), ischemic cardiomyopathy (ischemic heart disease, postinfarction cardiosclerosis) in 72 patients (66,7%) and acquired valve defects in 6 patients (5,6%). For assessment of efficacy of the drug in various grade of HF severity, patients were selected to subgroups according to the level of LVEF decrease (less 20%, 21-30%, 31-40%, more 40%), and pulmonary artery pressure (PAWP) (less 40 mmHg, 40-70 mmHg, more 70 mmHg).
Results. Infusion of the drug led to statistically significant increase of LVEF comparing to the baseline (57%), decrease of PAWP (64%) and BNP concentration in 77% cases.
Conclusion. The LS is an effective medication which can be applied with the aims to prepare HF patients to cardiosurgical operations. Most sensitive parameters of LS efficacy are PAWP, LVEF and BNP concentration. The highest efficacy of the drug was observed in subgroup with EF ≤40%, PAWP ≥40 mmHg and BNP ≥600 pg/mL. LS, applied in HF patients before cardiosurgery, can be used for assessment of reserves of myocardial capacity.
Russ J Cardiol 2017, 3 (143): 59–62
Key words: heart failure, levosimendan, myocardial reserve, left ventricle ejection fraction, pulmonary artery pressure, natriuretic B-type peptide.
V. B. Petrovskiy Russian National Research Centre of Surgery, Moscow, Russia.
OPINION ON A PROBLEM
STATISTICAL, CLINICAL AND MORPHOLOGICAL CLASSIFICATIONS OF CORONARY HEART DISEASE — POSSIBLE TO UNITE?
Boytsov S.A.1, Samorodskaya I.V.1, Galyavich A.S. 2, Belyalov F.I.3, Vaisman D.Sh.4, Yavelov I.S.1, Nikulina N.N.5, Yakushin S.S. 5, Zayratiants O. V.6, Kakorina E. P.7
A problem of synonymy and synonyms legitimation is of big importance in practice, as multiple classifications lead to problems of organization and provision of medical care, and incorrect statistics. The article is a consensus of experts on the issue of agreement/implementation of clinical classifying of synonyms of terms listed in ICD-10, agreement on the modern clinical and morphological terms.
Russ J Cardiol 2017, 3 (143): 63–71
Key words: cardiovascular diseases, international classification of diseases.
1 National Research Center for Preventive Medicine of the Ministry of Health, Moscow; 2Kazan State Medical University of the Ministry of Health, Kazan; 3Irkutsk State Medical Academy of Postgraduate Education, Irkutsk; 4Federal Research Institute for Health Organization and Informatics of Ministry of Health, Moscow; 5 Ryazan State Medical University of the Ministry of Health, Ryazan; 6A. I. Evdokimov Moscow State University of Medicine and Dentistry (MSUMD), Moscow; 7I. M. Sechenov First Moscow State Medical University of the Ministry of Health, Moscow, Russia.
THE SPECIFICS OF ISCHEMIC HEART DISEASE MANAGEMENT IN ELDERLY
Belyalov F. I.
Ischemic heart disease impacts greatly the morbidity and mortality of population. The article focuses on the specifics of diagnostics and treatment of chronic coronary heart disease in patients of older age. Management of this kind of patients is complicated with comorbidity, cognition decline, increased risk of side effects, reduced range of treatment options.
Russ J Cardiol 2017, 3 (143): 72–76
Key words: ischemic heart disease, elderly, geriatrics.
SBEI APE Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia.
CLINIC AND PHARMACOTHERAPY
CEREBRAL CIRCULATION AND COGNITION IN PATIENTS WITH CORONARY HEART DISEASE UNDERWENT CORONARY BYPASS OPERATION
Petrova М. М.1, Prokopenko S. V.1, Eremina О. V.1, Mozheyko Е. Yu.1, Kaskaeva D. S.1, Gankin М. I.2
Aim. To assess the condition of cerebral circulation and cognitive functions in patients with coronary heart disease (CHD), underwent coronary bypass (CBG) operation under on-pump conditions and to evaluate the influence of citicoline on the higher brain functions at earlier and delayed periods post-surgery.
Material and methods. In the Federal center of cardiosurgery (Krasnoyarsk city) 66 patients studied, with diagnosis CHD. Patients selected to 2 groups. Main group (n=36) as a medium for cerebral neuroprotection we used citicoline (Ceraxon): intravenous, 1 day before surgery, 1000 mg on 200 mL of saline, and then for 7 days after surgery, with further intake of the drug 900 mg/daily for 2 months. In comparison group (n=30) there was no neuroprotection in peri-operation period.
Results. By the 12th month after surgery, cognition returned to baseline values. In controls, by 12 months after CBG, cognition returned to baseline only by the test “visual memory” of 5 words (direct remembering).
Conclusion. Neuroprotection by citicoline might be a method for improvement of cognition in patients after such damaging events as on-pump operation, and therefore make it to reach higher level of daily functioning of post-CBG patients.
Russ J Cardiol 2017, 3 (143): 77–84
Key words: coronary heart disease, cognition impairment, coronary bypass, transcranial Doppler study.
1 V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk; 2Federal Center of Cardiovascular Surgery, Krasnoyarsk, Russia.
EVALUATION OF TRANSITION EFFICACY TO ANGIOTENSINE CONVERTING ENZYME INHIBITORS IN PATIENTS WITH INSUFFICIENT BLOOD PRESSURE CONTROL. THE RESULTS FROM REGIONAL PROGRAM “SARA”
Yakushin S. S., Seleznev S. V.
Aim. To evaluate an additional antihypertension efficacy and tolerability of perindopril comparing to sartans in real clinical practice.
Material and methods. The study had been designed, that included 208 patients. Main inculsion criteria was arterial hypertension (AH) with insufficient blood pressure (BP) control on treatment by angiotensine receptor blocker (ARB) as monotherapy, with 1 or 2 risk factors by SCORE system and on treatment by a free ARB combination with other drugs classes. In inclusion to program, instead of ARB perindopril (Prestarium A) 10 mg was added or its disperging form 10 mg in the morning. Duration of program lasted for 3 months. The evaluation of BP decrease was done, as the target BP levels reach and treatment response.
Results. On treatment with perindopril, in 2 weeks there was statistically significant (p<0,05) decrease of BP, and this positive dynamics remained for all follow-up period. Target BP was reached in 42,4% patients. Assessment of efficacy criteria of SARA program revealed in all participants BP decrease from baseline level, with median of systolic BP decrease as 30 [25;42] mmHg, diastolic — 20 [10;20] mmHg. Target BP was reached in 42,4%.
Conclusion. Transition from non-effective former sartans treatment to perindopril makes for successful BP control with high treatment tolerance. Such approach can be recommended for patient’s management in real clinical practice.
Russ J Cardiol 2017, 3 (143): 85–90
Key words: arterial hypertension, Prestarium A, perindopril, efficacy.
FSBEI HE RyazSMU of the Ministry of Health, Ryazan, Russia.
THE INFLUENCE OF IF-CHANNEL INHIBITION ON HEART RATE VARIABILITY IN PATIENTS POST CORONARY BYPASS SURGERY BY THE TEST WITH FIXED RESPIRATION TEMPO
Kochetkova I. V., Chernykh T. M.
Aim. To assess the dynamics of heart rate variability (HRV) parameters under treatment by ivabradine in patients with stable angina after coronary bypass surgery (CBG) with test of fixed respiration tempo (FRT).
Material and methods. Totally, 26 males studied, with stable angina II-III functional class, after CBG, using hardware-software complexes.
Results. The FRT test in postCBG patients under ivabradine treatment reveals 2 main types of reaction: 1 — positive stable increase of HRV parameters during the test, 2 — U-shaped pattern of parameters’ dynamics: decrease in 6-second test, and increase further in 12-second test.
Conclusion. The FRT test has practical value, making physician, by the parameters as SDNN or mean rhythmogram variation, to derive conclusions on the adequacy of rehabilitation of patients and to correct the dosage of medication.
Russ J Cardiol 2017, 3 (143): 91–96
Key words: ivabradine, coronary heart disease, coronary bypass surgery, test with fixed respiration tempo.
N. N. Burdenko Voronezh State Medical University, Voronezh, Russia.
ASSESSMENT OF ANTIISCHEMIC AND ANTIANGINAL EFFECTS OF NICORANDIL BY TREADMILL TEST, UNDER THE FRAMEWORK OF KVAZAR STUDY
Voronina V. P., Martsevich S. Yu., Kutishenko N. P., Deev A. D. on behalf of the KVAZAR study workgroup
Aim. Under the framework of KVAZAR study, to assess antianginal and antiischemic effects of nicorandil therapy with exercise test on treadmill in chronic coronary heart disease patients (CCHD) with stable angina.
Material and methods. Randomized, double blind, placebo-control study, conducted in 2 parallel groups, multicenter. Totally, 120 patients included, all were taking metoprolol tartrat 50 mg b. i.d. After randomization, main group was added nicorandil 10 mg b. i.d., in 2 weeks the dosage was increased to 20 mg b. i.d., control took placebo. Duration of the study 6 weeks. For the evaluation of efficacy of nicorandil therapy 10-20 mg b. i.d., exercise test was used, done at randomization visit (V0) and in 6 weeks (V6).
Results. Intake of nicorandil, in 6 weeks was followed by a significant increase of the time before the onset of angina (p<0,0001), time to ST depression appearance for 1 mm (p<0,005) and time for angina attack of moderate severity development (p<0,005). In placebo group, only the angina onset tolerance parameter improved (p<0,01), but duration of exercise test and time for ST depression 1 mm did not change significantly. In the subgroup of patients having ischemic ECG changes during exercise test, it was showed significant increase of these changes in nicorandil vs placebo (p<0,05); which confirms the anti-ischemic action of nicorandil during the day in double dosing regimen.
Conclusion. Nicorandil did statistically significantly improve the parameters of exercise tolerance in CCHD patients with stable angina. The results of the study make it to conclude on the additional and clinically significant impact of the drug 10-20 mg b.i.d. as an effective antianginal medication of second-line therapy for treatment of patients with CCHD with stable angina.
Russ J Cardiol 2017, 3 (143): 97–103
Key words: exercise tests, ischemic heart disease, stable angina, nicorandil, antianginal effect, antiischemic effect.
National Research Center for Preventive Medicine of the Ministry of Health, Moscow, Russia.
CLINICAL MEDICINE NEWS
Clinical medicine updates: a review of international news
Russ J Cardiol 2017, 3 (143): 104
2016 ESC POSITION PAPER ON CANCER TREATMENTS AND CARDIOVASCULAR TOXICITY DEVELOPED UNDER THE AUSPICES OF THE ESC COMMITTEE FOR PRACTICE GUIDELINES
The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC)
Russ J Cardiol 2017, 3 (143): 105–139
Key words: European Society of Cardiology, chemotherapy, cardiotoxicity, cardiooncology, myocardial dysfunction, arrhythmias, ischemia, early detection, surveillance, cancer therapy.
ACUTE CORONARY SYNDROME IN MALIGNANCY PATIENTS
Luboyatnikova E. S.1, Duplyakov D. V.1,2
Acute coronary syndrome (ACS) during the time after diagnosis of oncologic disease, develops in 1,9-4,2% patients, and not seldom in intact coronary arteries. In ACS morbidity structure there is mostly non-ST elevation ACS (>85%). Specific factors for its development are thrombocytopenia, incl. the one caused by chemotherapy, and radiotherapy. Patients with active oncologic process have higher risk of death during ACS treatment than patients already “cured”. Tactics of ACS in oncology remains outside current guidelines; as such patients were not included in randomized trials. Still, some studies showed efficacy of acetylsalicylic acid, double antiplatelet therapy, percutaneous interventions. However, hemostasis system shifts, cardiotoxicity of chemotherapeutic agents, radiotherapy risks make the multidisciplinary approach necessary in management of ACS in this sort of patients.
Russ J Cardiol 2017, 3 (143): 140–144
Key words: acute coronary syndrome, oncology, reperfusion, thrombocytopenia, radiation therapy.
1 Samara State Medical University, Samara; 2Samara Region Clinical Dispensary of Cardiology, Samara, Russia.
MODERN VIEW ON CARDIOTOXICITY OF CHEMOTHERAPEUTICS IN ONCOLOGY INCLUDING ANTHRACYCLINES
Gendlin G. E.1, Emelina Е. I.1, Nikitin I. G.1, Vasyuk Yu. А.2
High efficacy of contemporary chemical and radiation treatments made it to success in treatment of oncohematological diseases. The fundamentals of many schemes of polychemotherapy of the first line are anthracyclines. Effective treatment of the main disease in many cases is followed by a variety of cardiovascular complications, including severe ones and fatal. It is necessary to consider the possibility not only for development of acute cardiotoxicity, but various complications from cardiovascular system after cessation of antitumor treatment. Algorithm of patients preparing for such treatment must include cardiovascular assessment before the start of drugs, and follow-up during the treatment course. Prevention and treatment of cardiotoxicity are complicated clinical issues due to irreversible and progressing character of most disorders of cardiovascular system. An important issue is a close collaboration of cardiologist and oncologist in patient’s management. It is necessary to have longterm dynamic follow-up of patients after chemotherapy for maximally early diagnostics of cardiovascular complications in long-term period after finishing
of antitumor treatment.
Russ J Cardiol 2017, 3 (143): 145–154
Key words: cardiotoxicity, anthracyclines, complications of tumor drug treatment, consequences of chemical and radiation therapy, anthracycline cardiomyopathy, chronic heart failure, prevention and treatment of cardiotoxicity.
1 N. I. Pirogov Russian National Research Medical University (RNRMU), Moscow; 2A. I. Evdokimov Moscow State University of Medicine and Dentistry (MSUMD), Moscow, Russia.
LIFE QUALITY, MEDICAL AND SOCIAL CHARACTERISTICS OF CORONARY HEART DISEASE PATIENTS
Nagibina Yu. V., Zakharova L. A.
The article focuses on the review of the main parameters defining the standard and quality of life (LQ). An argument for importance provided of LQ assessment in patients with ischemic heart disease as a task of medical and social significance. A conclusion in done, that LQ can be treated as quite reliable parameter for assessment of patients condition with coronary heart disease, which can be applied for objectivity increase in clinical condition evaluation. Also, it is possible, having revealed medical and social specifics of patients, to influence them and improve LQ.
Russ J Cardiol 2017, 3 (143): 155–159
Key words: life quality, life standard, evaluation, health.
I. M. Sechenov First Moscow State Medical University of the Ministry of Health, Moscow, Russia.
MODERN HIGH-SENSITIVE TROPONIN DIAGNOSTIC METHODS IN ASSESSMENT OF MYOCARDIAL ISCHEMIA AND PROGNOSTICAL VALUE FOR CHRONIC CORONARY HEART DISEASE
Kremneva L. V.1, Suplotov S. N.1, Shalaev S. V. 2
While using the highly sensitive tests of troponins (hs-CTn), increased levels above the lower limit can be found in most of patients, and levels more than 99th percentile — in about 10-15% patients with stable angina. The grade of hs-cTn increase correlates with severity of coronary lesion and level of myocardial ischemia. Elevated levels of hs-cTn are associated with increased risk of general and cardiovascular mortality, as hospitalizations due to chronic heart failure.
Russ J Cardiol 2017, 3 (143): 160–164
Key words: stable angina, high-sensitive troponin tests, myocardial ischemia, prognosis.
Tyumen State Medical University, Tyumen, Russia.