Download Eurasian heart journal №3 2018

SERUM ALDOSTERONE LEVEL DYNAMICS AND CARDIAC REMODELING IN MYOCARDIAL INFARCTION PATIENTS WITH UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA TREATED WITH SELECTIVE ALDOSTERONE RECEPTOR BLOCKER
Miroshnichenko E.P., Dranenko N.Y., Goryanskaya I.Y., Gagarina A.A., Ushakov A.V.

SUMMARY
Aim. To study serum aldosterone level dynamics and cardiac remodeling characteristics in myocardial infarction (MI) patients with undifferentiated connective tissue dysplasia (UCTD) treated with selective aldosterone receptors antagonist eplerenone.
Study population and methods. A total of 110 MI patients with and without UCTD and 32 healthy controls without cardiovascular pathology and without signs of UCTD were enrolled in the study. Clinical examination, phenotyping, echocardiography and serum aldosterone levels evaluation were performed. MI patients were divided into 3 groups: I (n=20) – patients with UCTD who was treated by eplerenone additionally to basic therapy of MI; II (n=60) – patients without UCTD treated by basic therapy of MI; III (n=30) – patients with UCTD treated by basic therapy of MI only.
Results. All MI patients regardless of UCTD presence had increased serum aldosterone in the first day of MI. In 28 days the significant increase of serum aldosterone level in group I in comparison with groups II, III and control group was observed. Analysis of structural and functional characteristics of the heart in MI patients in a 6 month after MI had shown more significant left ventricle enlargement and decrease of cardiac pump function in group III compared to group I.
Conclusion. Presence of UCTD in MI patients does not affect serum aldosterone levels dynamics. Inclusion of eplerenone in the treatment of MI patients with UCTD during 6 months inhibits left ventricular dilatation and attenuates reduction of its ejection fraction.
Keywords: myocardial infarction, undifferentiated connective tissue dysplasia, aldosterone, cardiac remodeling.

 

DEVELOPMENT OF CONCEPTS NOMENCLATURE FOR CLINICAL DECISION SUPPORT SYSTEM IN DIAGNOSTICS OF ANGINA PECTORIS
Kiselev K.V., Potekhina A.V., Osyaeva M.K., Noeva E.A., Vyborov O.N., Zorin A.V., Shvyrev S.L., Martynyuk T.V., Zarubina T.V., Chazova I.Ye.

SUMMARY
Introduction. Since 2000th CHD morbidity in Russia is growing constantly, especially, angina pectoris morbidity. Increasing workload on physicians due to high number of patients makes us find the ways to optimize human resource applying. One of the possible ways is development of clinical decision support systems, particularly, ontology-based systems. These ontologies must adopt semantic interoperability for the concepts included, to be clearly interpreted by physicians of different medical schools.
Research target. Develop the concepts nomenclature for building of angina pectoris ontology.
Methods. For primary concepts extraction we used state clinical recommendations “Stable coronary heart disease” issued in 2016. Development and filling of the nomenclature were performed in MS Excel and MS Excel Online. The work through the primarily extracted concepts was performed with expert-cardiologists by cross-validation method and common voting on final inclusion of the concept in the nomenclature. The final nomenclature validation was performed by semi-automatic method on anonymized 610 electronic health records of the patients.
Results. After primary extraction of the concepts without experts, we could extract 336 basic concepts and 144 synonyms, keeping in mind the aspects of this nomenclature development. The shared work through this nomenclature with the expertcardiologists let us increase the number of the basic concepts up to 409 and the number of the synonyms up to 619. The nomenclature validation on electronic health records showed compliance of the concepts in aspects of diagnostics methods and medicine prescriptions and 92% compliance in diagnostic signs, which doctors evaluate in diagnostics results. Percentages of primarily extracted concepts in draft nomenclature and after being worked through by the experts and also validation results based on electronic health records, let us make a conclusion that clinical recommendations can be used as a basic data source for concepts extraction, but the draft result must be evaluated by the experts and also filled up with the usage of additional knowledge sources about angina pectoris, and after that the nomenclature can be used for angina pectoris ontology development.
Conclusion. The usage of clinical recommendations is proved to be the basic data source for concepts of subject area extraction. However, the draft nomenclature must be evaluated and filled up with additional synonyms and validated on electronic health records. After that, the extracted concepts and their synonyms can be used for ontology development.
Keywords: angina, clinical decision support systems, CDSS, ontology, clinical guidelines.

 

THE HEMODYNAMICS AND RENAL FUNCTION BEFORE AND AFTER PULMONARY THROMBOENDARTERECTOMY
Tsyrenov D.D., Tabakyan E.A., Mershin K.V., Buldakova N.A., Akchurin R.S.

SUMMARY
Objective: to study the pulmonary hemodynamics and kidney function in patients with chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary thromboendarterectomy (PTE). To analyze the main results of PTE.
Material and methods: among 51 patients with CTEPH undergoing PTE, the group with chronic kidney disease (CKD) was identified. The main parameters of hemodynamics, such as cardiac output (CO), cardiac index (СI), pulmonary arterial pressure (PAP), pulmonary vascular resistance (PVR), were determined. The cases of acute kidney injury (AKI) after PTE were identified. The correlation between hemodynamics and renal function was analyzed.
Results: there was decrease of mean PAP, PVR and increase of CO and CI after PTE. In cases of AKI 1–2, the complete recovery of renal function were observed. Glomerular filtration rate (GFR) increased before discharge in patients with CKD and in other patients.
Conclusion: the positive dynamics of renal function in patients with CTEPH after PTE is more probably associated with an increase in the СI and renal perfusion.
Key words: рulmonary thromboendarterectomy, hypothermic circulatory arrest, glomerular filtration rate, acute kidney injury.

 

OMPARISON OF THE INTEGRAL INDICES OF THE VECTORCARDIOGRAM WITH CLINICAL DATA IN PATIENTS WITH CHRONIC CORONARY HEART DISEASE
Sakhnova T.A., Blinova E.V., Dotsenko Yu.V., Yurasova E.S., Sumarokov A.B.

SUMMARY
The aim of the work was to compare the integral parameters of the vectorcardiogram (VCG) – spatial QRS-T angle and electrocardiographic ventricular gradient (VG) – with clinical data in patients with chronic coronary heart disease (CHD). The study included 213 patients with CHD (165 men and 48 women, mean age 62.1Ѓ}9.8 years) who underwent a comprehensive clinical and instrumental examination. The control group consisted of 50 practically healthy persons (30 women and 20 men, mean age 56.5Ѓ}8.8 years). The QRS-T angle and VG were calculated on the VCG, derived from the 12-lead digital ECG. In patients with CHD, the VG module and VG-X, VG-Y, VG-Z components were significantly smaller, and the QRS-T angle was significantly higher than in healthy individuals of the same sex. The presence of arterial hypertension, hyperlipidemia, diabetes mellitus, chronic heart failure and obesity was associated with increased QRS-T angle. In patients who had a history of anterior myocardial infarction, compared to patients without myocardial infarctions, the VG module and its components VG-X and VG-Z were significantly decreased and the QRS-T angle was increased. In patients who had a history of inferior-posterior myocardial infarction, the VG-Y component was significantly decreased and the VG-Z component was increased. The threshold value VGY≤10 ms allowed to detect the old inferior-posterior myocardial infarction with a sensitivity of 63% and a specificity of 75%; threshold values of VG-X≤14 ms and VG-Z<10 ms allowed to diagnose old anterior myocardial infarction with a sensitivity of 67-77% and specificity of 85-79%, respectively. In CHD patients, higher QRS-T angle values were associated with the presence of traditional risk factors – arterial hypertension, hyperlipidemia, diabetes and obesity. Changes in VG in myocardial infarctions of different localizations were different.
Keywords: synthesized vectorcardiogram, QRS-T spatial angle, ventricular gradient, chronic ischemic heart disease.

 

MODERN APPROACHES TO DETECTING EARLY SUBCLINICAL CARDIOTOXICITY INDUCED BY CHEMOTHERAPY IN PATIENTS WITH BREAST CANCER
Avalyan A.A., Saidova M.A., Oshchepkova E.V., Chazova I.Ye.

SUMMERY
In recent decades, developed countries of the world have made progress in the treatment of breast cancer, both because of the early detection of cancer and the use of modern methods of treatment (target therapy and chemotherapy, radiation therapy and surgical treatment). Due to this, the time of disease-free course of cancer and the duration of life of patients have increased. However, a number of antitumor drugs have cardiotoxicity [1]. It is shown that cardiovascular diseases are the second leading cause of death among women who have undergone breast cancer [27]. Reduction of systolic function of the heart is the most common manifestation of cardiotoxicity of antitumor therapy [7]. Other manifestations of cardiotoxicity include arterial hypertension (AH), acute coronary syndrome, arrhythmias and thromboses. In recent years, methods such as electrocardiography (ECG); echocardiography (EchoCG) with the classical definition of the left ventricular ejection fraction (LVEF) by the method of Simpson's biplane and the global longitudinal strain of the left ventricular (GLS) using data from the 2D Speckle Tracking Imaging; determination of the level of biomarkers of myocardial damage and magnetic resonance imaging (MRI) of the heart have been used to detect the cardiotoxicity of antitumor therapy. Thus, the early diagnosis and timely detection of cardiotoxic effects of antitumor drugs are among the tasks of cardiooncology – an area in medicine formed in recent years [1].
Key words: cardiooncology, arterial hypertension, cardiotoxicity, technology speckle tracking, chemotherapy, breast cancer.

 

TIME-DEPENDENT FACTORS OF EFFECTIVENESS AND TOLERABILITY OF STATINS: SCIENTIFIC AND PRACTICAL ASPECTS
Giliarevskii S.R.

Summary
The article considers modern approaches to analyzing the effectiveness of interventions in relation to time, that is, the length of the period after the beginning of their application. The role of the analysis of the Kaplan-Meier curves for the evaluation of the effects of compared interventions depending on the time is discussed. Various options of the relative layout of the Kaplan-Meier curves in the course of the study are examined. The results of a recent analysis of the duration of the period between the onset of statin use and the development of clinical benefits of therapy are presented. In particular, the possibility of using the TTB indicator of intervention and TTH indicator, caused by the intervention, is discussed in making a clinical decision about the validity of the choice of a particular treatment method, in particular the indicator of number of patients who need to be treated with a particular drug. Opinions that emphasize the importance of evaluating the effectiveness of interventions with absolute rather than relative risk of adverse clinical outcomes are mentioned. Clinical situations in which the duration of the TTB is of particular importance, in particular, in patients with a very high risk of developing complications of cardiovascular diseases (for example, after an acute coronary syndrome) and in patients who in most cases have limited life expectancy are considered. The role of atorvastatin in clinical situations is emphasized, in which the earlier achievement of the clinical advantages of lipid-lowering therapy is important. Data on the role of statins, in particular atorvastatin, are given in the early stages after the development of acute coronary syndrome.
Key words: time factors, Kaplan-Meier curves, atorvastatin, cardiovascular diseases.

 

RESISTANT ARTERIAL HYPERTENSION
Esaulova T.E., Aksenova A.V., Sivakova O.A., Chazova I.Ye.

SUMMARY
Resistant hypertension is defined as a lack to lower 140 mmHg (systolic blood pressure) and 90 mmHg (diastolic blood pressure) values of ambulatory blood pressure (BP) response using 3 antihypertensive agents of different classes, one of which should be a diuretic in patients fully adherent to antihypertensive therapy. Prevalence of resistant hypertension is ranging from about 5 to 50 % in various cohorts. Initial management requires identification of true treatment resistance by out-of-office BP measurements, assessment of adherence and screening for treatable causes of uncontrolled BP. Recent studies try to indicate possible biomarkers of resistance hypertension. Treatment include lifestyle changes, enhancing treatment adherence and optimization of the doses. An invasive approach to resistant hypertension should be kept for persistently severe cases managed in a specialized hypertension center. This article aims to familiarize readers with the evaluation and management of resistant hypertension by outlining the most recent evidence-based treatment options.
Key words: blood pressure, arterial hypertension, resistant hypertension, treatment of resistant hypertension, biomarkers of resistance hypertension, invasive approach.

 

THE ROLE OF ACTIVATION OF THE SYMPATHETIC NERVOUS SYSTEM IN THE PATHOGENESIS OF ARTERIAL HYPERTENSION AND THE CHOICE OF A METHOD FOR THE TREATMENT OF ARTERIAL HYPERTENSION
RozanovA.V., KotovskayaYu.V., Tkacheva O.N.

SUMMARY
The basis for the successful treatment of any disease is a clear understanding of its cause, the mechanisms of its development, and their relationship to symptoms. The article considers one of the links in the pathogenesis of arterial hypertension – an increase in the activity of the sympathetic nervous system, describes the main methods for detecting hypersympathicotonia, approaches to the selection of drug therapy.
Key words: arterial hypertension, sympathetic nervous system, hypersympathicotonia, beta-blockers, heart rate variability.

Download Eurasian heart journal №2 2018

EVALUATION OF DEFORMATION OF THE LEFT VENTRICLE AND LEFT ATRIUM, AND THE ROTATIONAL PROPERTIES OF THE LEFT VENTRICLE IN PATIENTS WITH CHF ACCORDING TO THE ECHOCARDIOGRAPHIC TECHNOLOGY OF NON-DOPPLER IMAGING IN TWO AND THREE-DIMENSIONAL REGIMENS SUMMARY
Sohibnazarova V. Kh., Saidova M.A., Tereshchenko S.N., Belevskaya A.A.

To study the peculiarities of deformation, rotation properties, twisting and untwisting of the left ventricular(LV) , evaluation of the function of left atrium in patients with CHF with preserved and reduced ejection fraction of the left ventricular according to Echocardiography technology Non Doppler imaging in two and three-dimensional regimes (2D and 3D Speckle tracking imaging). The study included 70 patients with chronic heart failure (CHF) with preserved (Group I) and reduced (Group II) ejection fraction (EF) of the left ventricular (LV). In addition to the standard Transthoracic echocardiography, all patients were assessed the deformation of the left ventricle (LV) and left atrium (LA) as well as the rotational properties of the LV using the technology of myocardial image in two and threedimensional regimen. Studies show that patients CHF deformation of the left ventricular (LV) and left atrium (LA), and the rotational properties, twisting and unwinding of the (LV) according to the two methods were lower than the control group (CG). In both groups there was a reliable increase the size and volume of LA, as well as a decrease the deformation of the LA in it phases and global longitudinal deformation. The values of the global longitudinal deformation of the LA in patients group I and II (-6,68Ѓ}3.0% and-6,63Ѓ}3.3%, respectively) were reliably lower compared to CG (-9.3Ѓ}7.3%) (p < 0.001). A good correlation was found between LV deformation and LV EF in patients group I (r = -0.39) ( p <0.001) and in group II (r = 0.35)(p <0.001). When estimating the deformation of the leftventricular according to the data of two technologies, the threedimensional mode demonstrated lower myocardial deformation in comparison with the three dimensional regime, which may be associated with a fuller assessment of the deformation of the left ventricular myocardium. Also increased global longitudinal deformation of LA can be an early predictor of diagnostics of CHF.
Keywords: Chronic heart failure, left ventricular ejection fraction, deformation, rotation properties, twisting, untwisting

 

DEPENDENCE OF MORTALITY FROM CARDIOVASCULAR SYSTEM DISEASES ON METEOROLOGIC FACTORS AMONG POPULATION OF BAKU AND GUBA SUMMARY
Azizov V.A., Hatamzade E.M., Rahimova A.S., Alekperova A.K., Sadigova T.A., Mamedzade A.Y.

The article presents the results of study dependence of mortality from cardiovascular system diseases on meteorologic factors among population of Baku and Guba. Air temperature and rainfall have been taken as the main meteorological indicator for months. Increased risk of death from cardiovascular diseases in both cities was observed more in the spring-winter months than in the summer, which was associated with a high amount of precipitation at this time of the year and with a lower temperature.
Keywords: meteorological factors,diseases of the cardiovaskulyar system,the risk of death,air temperature,rainfall,population of Guba and Baku.

 

ROSUVASTATIN – THE MOST POTENT STATIN IN CARDIOVASCULAR DISEASE PREVENTION
Semenova А.Е., Sergienko I.V.

Rosuvastatin is a statin with maximum hypolipidemic effect, to date, which makes it one of the most frequently prescribed lipid-lowering medications. The drug has been widely studied in large international randomized clinical trials and proven to be highly effective. Administration of rosuvastatin at doses of up to 40 mg/day allows to decrease low-density lipoprotein cholesterol (LDL-C) levels by 55-63%, triglyceride levels by 28% and to significantly increase the level of high-density lipoprotein cholesterol by 10-14%. The effectiveness of rosuvastatin for primary prevention of CV complications has been indicated in high and very high risk patients, as well as in intermediate-risk persons and patients with mildly elevated base LDL-C level. The ability of rosuvastatin to suppress the progression of atherosclerosis has been demonstrated by intravascular ultrasound of coronary arteries and by magnetic resonance imaging of carotid arteries. Rosuvastatin is a hydrophilic statin with high hepatoselectivity, low systemic bioavailability (very limited penetration of rosuvastatin into extrahepatic tissues and, hence, lower risk of myotoxicity) and minimal involvement of P450 cytochrome in its metabolism (mostly mediated by 2C9 enzyme), which provides for good tolerability of the drug. High hepatoselectivity and the absence of any significant interaction with cytochrome P450 system mitigate the likelihood of side effects and drug interactions. The above mentioned characteristics of rosuvastatin enable its effective and safe use in treating a wide range of patients.
Key words: rosuvastatin, hypercholesterolemia, atherosclerosis, cardiovascular disease, cardiovascular risk.

 

CLINICAL CASE OF REPLACEMENT OF ENDOTHELIN RECEPTOR ANTAGONIST (BOSENTAN) BY SOLUBLE GUANYLATE CYCLASE STIMULATOR (RIOCIGUAT) IN THE PATIENT WITH PULMONARY ARTERIAL HYPERTENSION
Devetyarova E.A., Dyuzhikov A.A., Dyuzhikova A.A., Sobin S.V., Sumin A.V., Pashchenko E.V.

Pulmonary arterial hypertension (PAH) is a life-threatening disease characterized by progressive increase in pulmonary vascular resistance (PVR), higher pulmonary arteries mean pressure (mPAP), decrease in cardiac minute output (CMO) and other hemodynamic, functional and biochemical disorders. Existing PAH therapeutic algorithm, described in the European and Russian clinical guidelines, mainly suggest strategy of sequential combination therapy in the case of inadequate response to initial monotherapy. At this, switching from one PAH-specific drug to another is studied to a lesser extent. At the present similar approach (switching) has already been tested, for example, in switching from one endothelin receptor antagonist (ERA) to another, or from phosphodiesterase type 5 inhibitor (iPDE-5) to soluble guanylate cyclase stimulator (sGC). There are virtually no data about change of monotherapy when drugs target different molecular pathways of vascular tone regulation, in particular, in the pulmonary circulation vessels. This article describes clinical case of female patient with FC III pulmonary arterial hypertension (WHO) switched from therapy by endothelin-1 receptor antagonist (bosentan) to soluble guanylate cyclase stimulator (riociguat). Female, 37 years old, with verified by the right heart catheterization (RHC) diagnosis of idiopathic PAH (iPAH) received PAH-specific monotherapy of bosentan. Due to condition deterioration on the background of bosentan dose increase, medical conference decided to switch this patient to another class of PAH-specific therapy (sGC stimulator riociguat) with consequent follow-up. As a result of such approach positive changes in patient`s condition, improvement of hemodynamic parameters, increased tolerance of physical exercise was demonstrated in comparison with previous therapy. This clinical case demonstrates safe and successful transfer from bosentan to riociguat in the patient with idiopathic PAH. Similar tactic for the change of therapy should be studied in further clinical trials.
Keywords: pulmonary hypertension, pulmonary arterial hypertension, riociguat, bosentan, therapy.

 

PECULIARITIES AND SURGICAL TREATMENT TACTICS OF POSTERO-BASAL LEFT VENTRICULAR ANEURYSMS
Сhragyan V.A., Arutyunyan V.B., Kadyraliev B.K, Mialiuk P.A., Vronskiy A.S., Lilothia S.H.

The literary review reflects the main current data on the problem of surgical treatment of postero-basal left ventricular aneurysms. It is shown that, despite the small percentage of these aneurysms in patients with coronary heart disease (CHD), their importance for surgical treatment is significant, since the effective correction of detected disorders of cardiac structures, myocardium and coronary arteries has not been sufficiently developed to date, and many issues of surgical tactics are contradictory. This applies both to the type of geometric reconstruction of the left ventricle, and the feasibility of mitral regurgitation correction, which due to dysfunction of the papillary muscles is observed in almost all patients with postero-basal aneurysms of the heart. The question of the combined correction of the interventricular septum rupture in patients with postero-basal aneurysms remains complex and unresolved until now. The relevant problem is the choice of surgical tactics of left ventricular reconstruction using two patches in the presence of anteroposterior aneurysms. All of the above reflects the need for further research on the problem of surgical treatment of postero-basal aneurysms of the heart.
Keywords: coronary heart disease, left ventricular postero-basal aneurysms, surgical treatment.

 

ANTICOAGULANT THERAPY FOR CHRONIC KIDNEY DISEASE AND ATRIAL FIBRILLATION: THE AXIS OF ROTATION BETWEEN THE POLES OF RISK SUMMARY
Kobalava Zh.D., Shavarov A.A.

The frequent comorbidity of atrial fibrillation (AF) and chronic kidney disease (CKD) in the general population is demonstrated in many epidemiological studies. Most patients with an established diagnosis of AF are recommended to use constant anticoagulant therapy (ACT) to prevent ischemic stroke and thromboembolic complications (TEC). With renal dysfunction, changes in the hemostatic system are observed at all stages of CKD, both related to an increase in prothrombogenic activity as well as to development of coagulopathy, which increases the threat of bleeding. Therefore, in patients with CKD and AF, an important aspect of ACT is the choice of the optimal anticoagulant, that will provide a balance between the risks of stroke and hemorrhagic complications, to which this article is dedicated.
Key words: atrial fibrillation, chronic kidney disease, anticoagulants, warfarin-induced nephropathy, dabigatran

 

A BRIEF SUMMARY OF THE RESULTS OF THE 6TH WORLD SYMPOSIUM ON PULMONARY HYPERTENSION IN NICE IN 2018: VIEW OF A YOUNG SCIENTIST
Taran I.N.

REPORT ON THE VI EURASIAN CONGRESS OF CARDIOLOGISTS MOSCOW, APRIL 18-19, 2018
ON THE 65TH ANNIVERSARY OF ALEXANDER G. MROCHEK
SCHEDULE OF SCIENTIFIC ACTIVITIES

Download Eurasian heart journal №1 2018

FEATURES OF THE RESPONSE OF ARTERIAL BLOOD FLOW TO THE ORTHOSTATIC LOAD IN YOUNG WOMEN WITH IDIOPATHIC ARTERIAL HYPOTENSION
Agafonova T.Yu., Baev V.M., Samsonova O.A., Dusakova R.Sh.

The aim of the study was to evaluate the response of arterial blood flow to the orthostatic load in young women with idiopathic arterial hypotension (IAH). A comparative analysis of systemic hemodynamics and peripheral arterial blood flow parameters was performed for orthostasis between two groups of women aged 18-25: test with IAH (n = 73) and control (n=37). The SBP level in the test group was 90-98 mm Hg, in the control group - 120-129 mm Hg. BP, heart rate and angio-scanning were performed twice: at rest, lying after 15 minutes rest and during the first minute of orthostasis. Blood flow was studied in the right vertebral, radial and posterior tibial arteries. The following parameters were evaluated: diameter during diastole, peak systolic and terminal diastolic blood flow velocity. In young women with IAH, as those with normal arterial pressure, orthostasis was accompanied by an increase in SBP, DBP and an increase in heart rate. With hypotension, an increase in the diameter of the vertebral artery and a decrease in the diameter of the posterior tibial artery were detected. In both groups, orthostasis was accompanied by a decrease in the rate of blood flow, both during systole and diastole. Orthostasis with IAH is accompanied by an increase in SBP, DBP and heart rate. The response of peripheral arteries to orthostasis is characterized by a change in the diameter of the vessels, which indicates a pronounced adaptive response to the physiological stress load.
Keywords: young women, idiopathic arterial hypotension, arterial blood flow, orthostasis.

 

METEOSENSITIVITY AMONG MENTAL WORKERS
Bekhbudova J.A., Bakhshaliyev A.B., Akhmedova T.A.

This study investigates the incidence of meteosensitivity (MS) and its manifestations among intellectual workers, and the correlation between MS and psychological states of the patients. Patients were administered a standardized questionnaire of risk factors (RF) of cardiovascular disease (CVD), including MS; CES-D questionnaire to reveal depression; and self-monitoring map. Incidence of MS was established in 99 of 196 intellectual workers (50.5%): 34 men (40%) and 65 women (58.6%). In a group of 33 volunteers with MS, 45.5% were revealed to have various degrees of depression. Among people who exhibited manifestations of depression, the number of days of feeling unwell in relationship to weather conditions significantly exceeded that of people who exhibited no depressive signs. Most people in the observation group complained of worsening in self-perceived well-being during the days in which the combination of northern or southern winds, high atmospheric pressure, and high humidity was registered. Sensitivity to showers was recorded in 69.7% of individuals with MS. Results of this study confirm the potential utility of providing self-management education to patients with MS and development of personalized programs for alleviating severity of individual’s reaction to fluctuations in certain meteorological parameters.
Keywords: meteosensitivity, depression, prevention.

 

EFFICIENCY OF MEDICAL REHABILITATION IN ARTERIAL HYPERTENSION AS A PART OF THE SPA RESORT TREATMENT SUMMERY
Ivashchenko A.S., Mizin V.I., Severin N.A., Prokopenko N.A.

Medical rehabilitation (MR) has become one of the important tasks of treatment in patients with arterial hypertension (AH). The aim – assessment of the effectiveness of spa resort MR in patients with AH under spa resort treatment (SRT) in view of the provisions of the "International Classification of Functioning, Disability and Health" (ICF). The study included 103 AH patients treated with SRT at Yalta resort. Selection of patients for the study was carried out with informed consent of patients and duration of treatment of at least 18 days. Methods of investigation and treatment were applied in accordance with the features of the functional state of the patient, the individual indications and the standards of SRT at AH. Psychological research and evaluation of quality of life (by the tests of Reeder, Beck, Spielberger-Hanin, SF-36) were additionally conducted. The analysis of the results was carried out by methods of variation statistics. Spa resort MR in patients with AH is characterized by high efficiency. Reliable positive trends were set for a number of domains: the sensation of pain and dizziness (b280 and b2401), heart function (b410), blood pressure (b420), tolerance to physical exercises (b455) and the sensations associated with the functioning of the cardiovascular and respiratory systems (b4601). Statistically significant (p<0,05) reduction of six domain’s value by the end of the course of treatment indicates positive rehabilitation potential of SRT in patients with AH.
Key words: medical rehabilitation, arterial hypertension, resort.

 

ADAPTATION OF ELECTRONIC SYSTEM FOR ISCHEMIC HEART DISEASE PREDICTION AS A STEP TO COMMON INFORMATION SPACE IN CARDIOLOGIC HEALTHCARE
Trigulova R.Kh., Tashkenbayeva N.F., Аzimova N.А., Аkhmedov D.D., Bazarov R.K., Shek А.B.

Electronic version of a patient’s individual card protocol forming “Analytic system for monitoring and predicting various clinical variants of ischemic heart disease (CHD DM2)” database № BGU 00314 is combined with the computer system № DGU 01035 to assess yearly risk of adverse events by diagnostic coefficients; up-to-date prognostic signs, such as pre-test probability, Duke treadmill score and ventricular ejection fraction participating in the formation of prognostic conclusion were added. The database is a complex of program products intended for automation of dynamic management processes for both inpatients and outpatients with various clinical IHD forms and concurrent type 2 diabetes mellitus based on assessment of the disease course dynamics, completeness of prescriptions and patient’s compliance. The proposed model is of high clinical practical significance since it can be transformed into electronic medical history or used as a database in chronic IHD registry to improve medical care quality.
Keywords: analytic system for monitoring, complex of program products.

 

SOME EARLY PREDICTORS OF A RECURRENCE OF FIBRILLATION OF AURICLES IN PATIENTS WHO HAVE UNDERGONE RFA OPERATION
Mostovnek M.V., Shokhzodaeva Z.O., Ryabikina G.V., Shedrina E.V., Volkov V.E.

The aim of this study was to identify possible ECG predictors of atrial fibrillation (AF) recurrence in the early period after radiofrequency catheter ablation (RCA). We compare P-waves parameters before and after radiofrequency catheter ablation. In total 12 lead surface ECG of forty-two patients with paroxysmal and persistent atrial fibrillation were analyzed before and after catheter ablation. The 12 lead surface ECG was recorded on sinus rhythm before and within 24-48 h after RCA . 13 patients out of 42 had atrial fibrillation recurrence. Patients with early AF recurrence were significantly older than patients with sinus rhythm. In the group of patients with AF recurrence, the duration of P wave was longer than in the group without AF recurrence. After RCA in both groups there were observed reducing of PQ interval and increasing of heart rate.
Key words: surface12 lead ECG, R-wave, atrial fibrillation (AF), predictors of AF recurrence, radiofrequency catheter ablation.

 

TACTICS FEATURES OF CONDUCTING AND CHOOSING SPECIFIC THERAPY FOR ADULT PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION ASSOCIATED WITH CONGENITAL HEART DISEASE SUMMARY
Arkhipova O.A., Martynyuk T.V., Chazova I.Ye.

PAH associated with CHD according to the Russian Register of Pulmonary Arterial Hypertension (PAH) and Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is highly prevalent and ranks second after idiopathic pulmonary hypertension (IPH) in terms of prevalence among all forms of PAH and the first among associated forms. With the development of PAH, patients with congenital heart disease (CHD) require the appointment of a constant PAH-specific therapy. The article presents an overview of clinical trials of medications currently registered in the Russian Federation for this cohort of patients, including endothelin receptor antagonists (bosentan, macitentan, ambrisentan), phosphodiesterase type 5 inhibitors (sildenafil), soluble guanylate cyclase stimulants (riociguat) and prostacyclin analogues (iloprost).
Key words: PAH associated with CHD; therapy of PAH associated with CHD; antagonists of endothelin receptors; bosentan;macitentan; ambrisentan; phosphodiesterase type 5 inhibitors; sildenafil; soluble guanylate cyclase stimulants; riociguat; analogs of prostacyclin; iloprost.

 

RIGHT VENTRICULAR MYOCARDIAL INFARCTION IN A PATIENT WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION AGAINST THE BACKGROUND OF SMALL CORONARY ARTERIES
Arkhipova O.A., Kuznetsova E.G., Martynyuk T.V., Chazova I.Ye.

Most often acute myocardial infarction of the right ventricle is diagnosed in patients with acute left ventricular lesion and is associated with an atherosclerotic process in the coronary arteries. Isolated acute myocardial infarction of the right ventricle is rarely diagnosed and is often detected only during autopsy. Previously it was believed that in the absence of a significant lesion of the coronary arteries, an acute myocardial infarction of the right ventricle is associated with hypertrophy of the right ventricular myocardium. The results of a study in which acute myocardial infarction of the right ventricle were found in patients who died due to acute massive pulmonary embolism and who did not have right ventricular hypertrophy appeared later. There are many questions regarding the tactics of therapy for this complication, especially in patients with pulmonary hypertension who are on treatment with pulmonary arterial vasodilators. The article describes a rare clinical case of postmortem detection of myocardial infarction of the right ventricle against the background of small coronary arteries in a 41-year-old patient with a diagnosis of chronic thromboembolic pulmonary hypertension, the difficulties of intravital diagnosis and the restriction of drug therapy.
Keywords: acute myocardial infarction of right ventricle, chronic thromboembolic pulmonary hypertension, myocardium ischemia in the absence of a coronary atherosclerosis.

 

CASE REPORT: THE POSSIBILITY OF SPECIFIC THERAPY OPTIMIZATION BY SWITCHING FROM BOSENTAN TO MACITENTAN IN A PATIENT WITH CONGENITAL HEART DISEASE AND EISENMENGER SYNDROME
Gratsianakaya S.Ye., Arkhipova O.A., Ananicheva N.A., Belkorey O.S., Davydov A.I., Martynyuk T.V., Chazova I.Ye.

A patient with pulmonary arterial hypertension (PAH) associated with congenital heart disease (ventricular septal defect) and Eisenmenger syndrome was started on an endothelin receptor antagonist bosentan. With treatment, the patient's condition had been stable, however, by the second year, worsening shortness of breath, reduced exercise tolerance and an increase of the right heart were noted. Bosentan was switched to macitentan. After a year of this pathogenetic therapy, an improvement in functional status was registered. Moreover, while on macitentan, the patient has successfully undergone a gynecological surgical procedure under general anesthesia.
Key words: eisenmenger syndrome, macitentan.

 

TO THE QUESTION OF EFFICACY AND SAFETY OF FORTELYZIN® THERAPY ON ACUTE CORONARY SYNDROME: TWO CLINICAL CASES
Yunevich D.S., Aksentiev S.B.

The article presents two clinical cases of successful reuse thrombolytic drug Fortelyzin® in the total dose of 25-30 mg observed by the authors in patients with acute coronary syndrome with ST-segment elevation, treated in the urgent cardiology department of the State budget institution of Ryazan region «Regional clinical hospital». Patients belonged to different gender and age groups and had various short term forecast on the scale TIMI or GRACE, different duration of ischemic damage of the myocardium until reperfusion. The above observations confirm the high safety and efficiency of Fortelyzin® in acute coronary syndrome.
Key words: acute coronary syndrome, thrombolytic therapy, Fortelyzin.

 

COMPLICATED CLINICAL CASE: CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION IN PATIENT WITH RECIDIVOUS CARDIAC MYXOMA
Zykova A.M., Arkhipova O.A., Martynyuk T.V., Demchenkova A.U., Danilov N.M., Korobkova I.Z., Chazova I.Ye.

The clinical case demonstrates the difficulties of differential diagnosis and the determination of treatment tactics in a patient with chronic thromboembolic pulmonary hypertension, recidivous cardiac myxoma and radiographic pattern of dissemination in lung tissue.
Key words: сhronic tromboembolic pulmonary hypertension, cardiac myxoma, syndrome of dissemination in the lungs, guanylatcyclase stimulators, riociguat.

 

To the 60th anniversary of the professor Dzhishambaev E.D.
To the 60th anniversary of the professor Shiryaev Andrey Andreevich
SCHEDULE OF SCIENTIFIC ACTIVITIES

Download Eurasian heart journal №3 2017

Greeting of the Secretary General of the Eurasian Association of Cardiology

Book of Abstracts of the V Eurasian Congress of Cardiologists, September 11-12, 2017, Bishkek, Kyrgyzstan

National Center of Cardiology and Therapy (NCCIM) named after academician Mirsaid Mirrakhimov under the Ministry of Health of the Kyrgyz Republic, Bishkek

Download Eurasian heart journal №2 2017

ANEMIA OF CHRONIC DISEASE AS A RISK FACTOR IN PATIENTS WITH CORONARY ARTERY DISEASE AND LESION OF THE LEFT MAIN CORONARY ARTERY
Abdullaeva S.Ya., Nikishin A.G., Pirnazarov M.M., Yakubbecov N.T., Khasanov M.S., Yuldashev N.P., Ganiev A.A., Bobojonova N.J.

Aim: The authors assess anemia as a predictor of poor outcome in patients with lesions of the left main coronary artery.<
Material and methods. The study included 112 patients of both sexes with a lesions of the left main coronary artery, in combination with the defeat another one coronary artery, according coronary angiography, were hospitalized in RSCC in the 2015-2016 years.
Result. The authors found that in most cases, anemia in patients with coronary heart disease is not of iron and therefore iron administration is useless. In addition, anemia is an independent predictor of adverse outcomes in patients with coronary artery disease with lesions of the left main coronary artery. In the complex groups of patients needed correction and monitoring of hemoglobin levels, in order to prevent a decrease and increase it above the recommended values.
Key words: coronary heart disease, left main coronary artery, anemia, predictors of adverse outcomes

 

OPTIMIZATION OF SPECIFIC THERAPY FOR PULMONARY ARTERIAL HYPERTENSION: THE POSSIBILITIES OF USING ENDOTHELIN RECEPTOR ANTAGONISTS
Martynyuk T.V., Nakonechnikov S.N., Chazova I.Ye.

Modern concepts of pulmonary arterial hypertension (PAH)pathogenesis focus on the key role of endothelial dysfunction of pulmonary vessels.
To control the activation of endothelin-1 system, endothelin receptor antagonists (ERA) are сurrently used. Until recently, this class of drugs in our country and abroad was represented by two drugs: the sulfonamide derivative – a nonselective ERA bosentan and a non-sulfonamide derivative – ambrisentan, which blocks only ETA-receptors. Not the selectivity of ERAs, but their pharmacokinetic characteristics determine the differences in the profile of efficacy and safety. In 2015, in our country there appeared a new dual antagonist macitentan, which was created to optimize the tissue effects by increasing lipophilicity. In randomized SERAPHIN study, the use of macitental 10 mg compared with placebo contributed to a reduction of the risk of morbidity and mortality in patients with PAH by 45%, and the effect of therapy was not dependent on whether the patients received concomitant specific therapy with inhibitors of phosphodiesterase type 5, oral or inhaled prostanoids.
In the paper there summarized indications for prescribing ERA, the data of the evidence base, as well as the concept of switching to optimize the ERA treatment. It is important to emphasize that in case of a satisfactory clinical response with ERA therapy, correction of therapy seems discrete. In the European guidelines 2015, this issue is not considered as having no extensive evidence base. On the other hand, it cannot be ruled out that the use of generic bosentan may lead to a decrease in the treatment effecacy and to provoke the clinical deterioration. At present clinical data intensively accumulate in favor of the strategy of switching from bosentan or ambrisentan to macitentan in PAH patients. It is necessary to assess the potential benefits associated with ERA switching to macitentan, in comparison with the possibilities of combination therapy.
Keywords: pulmonary arterial hypertension, endothelin receptor antagonists, bosentan, ambrisentan, macitentan, switching strategy

 

THE EFFECTIVENESS OF MEDICAL REHABILITATION IN CORONARY HEART DISEASE AS A PART OF THE SPA RESORT TREATMENT
Ivashchenko A.S., Iezhov V.V., Severin N.A., Prokopenko N.A.

Medical rehabilitation (MR) has become one of the important tasks of treatment in patients with coronary heart disease (CHD). The aim - assessment of the effectiveness of spa resort MR in patients with CHD under spa resort treatment (SRT) in view of the provisions of the "International Classification of Functioning, Disability and Health" (ICF).
Material and methods. The study included 117 CHD patients treated with SRT at Yalta resort. Selection of patients for the study was carried out with informed consent of patients and duration of treatment of at least 18 days. Methods of investigation and treatment were applied in accordance with the features of the functional state of the patient, the individual indications and the standards of SRT at CHD. Psychological research and evaluation of quality of life (by the tests of Reeder, Beck, Spielberger-Hanin, SF-36) were additionally conducted. The analysis of the results was carried out by methods of variation statistics.
Results and its discussion. Spa resort MR in patients with CHD is characterized by high efficiency. Reliable positive trends were set for a number of domains: the sensation of pain and dizziness (b280 and b2401), blood pressure (b420), tolerance to physical exercises (b455), general metabolic functions (b540) and the sensations associated with the functioning of the cardiovascular and respiratory systems (b4601).
Conclusions. Statistically significant (p<0,05) reduction of six domain’s value by the end of the course of treatment indicates positive rehabilitation potential of SRT in patients with CHD.
Key words: medical rehabilitation, coronary heart disease, resort

 

EFFICACY OF A FIXED COMBINATION OF LOSARTAN AND AMLODIPINE IN PATIENTS WITH ARTERIAL HYPERTENSION: SEASONAL FEATURES
Smirnova M.D., Fofanova T.V., Blankova Z.N., Vitsenya M.V., Tsybulskaya T.V., Dianova Yu.F., Ageev F.T.

The goal is to evaluate the efficacy and security of treatment of patients with arterial hypertension (AH) during the heat wave of a fixed combination of ARBS+ACC (losartan+amlodipine).
Materials and methods. Included 26 patients with hypertension 1 and 2 degrees from 42 to 81 years. All patients underwent measurement of office blood pressure, 24h ambulatory BP monitoring, Self-measurement of BP (Home BP ), electrocardiography, biochemical analysis of blood, estimation of osmolarity of blood, questionnaire: visual analogue scale, a questionnaire for patients exposed to heat, the test of adherence to treatment Moriscos–Green. Estimated diaries of self-control of blood pressure. The inclusion visit took place in spring 2016, 1st visit was in May-June 2016, 2nd – during heat waves, 3rd – September-October 2016.
Results. The observed decrease in systolic blood pressure and diastolic blood pressure (p=0.000) to the target values, preserved for the whole period of observation. According to the diaries of self-control of blood pressure controlled blood pressure 81% of patients. During a heat wave, this value decreased to 58%, in autumn – to 63%. The 3rd visit achieved a reduction in heart rate at -6.0 (-11.1; and 2.8) beats/min; p=0.007; the decline in uric acid level c of 415.3 to 346.2 mmol/l (p=0.04) and creatinine on the 2nd visit compared to baseline (p=0.02). According to 24h ambulatory BP monitoring, 24h ambulatory BP monitoring, during a single visit, the mean SBP decreased from 139 to 121 mm Hg. (P=0.04) and DBP from 88 to 76 mm Hg. (P=0.04) in the daytime and the tendency to decrease SBP variability from 12 to 10 mm (p=0.07). At the end of the study, the indicators remained stable. The mean value of SBP decreased at night to the third visit from 116 to 110.5 mm Hg. (P=0.04). During the heat wave, a larger mean SBP and DBP was recorded compared with the third visit (p=0.04). A correlation was found between the mean DBP value (r=0.725, p=0.03), the SBP time index (r=0.695, p=0.04) and the SBP time (r=0.787, p=0.02) at night and Quality of life Electrolyte shifts and increasing the osmolarity of the blood during heat waves have not been identified. There is a growing commitment therapy (p=0.04) and quality of life to 20.0 (7.4; 23.3); p=0.000 by visual analogue scale.
Conclusion. Fixed combination of losartan and amlodipine (Lorenza) is an effective, safe and may be recommended for hypertensive patients during heat wave and seasonal cold snap.
Key words: arterial hypertension, heat wave, amlodipine, losartan. Home BP, 24h ambulatory BP monitoring, seasonal dynamics

 

APPLICATION OF NEW ECHOCARDIOGRAPHIC TECHNOLOGIES OF NON-DOPPLER MYOCARDIAL IMAGES IN 2D AND 3D MODES IN PATIENTS WITH CHRONIC HEART FAILURE WITH PRESERVED AND REDUCED EJECTION FRACTION
Sohibnazarova V.Kh., Saidova М.А., Tereshenko S.N.

According to the recommendations of the European Society of Cardiologists, transthoracic echocardiography (TTE) is the most informative diagnostic method in patients with chronic heart failure (CHF) [3]. Echocardiography provides accurate information on the size of heart chambers, wall thickness and indices of systolic and diastolic function. Nowadays, in view of the new technological development, the most perspective technologies for the integrated assessment of the functional condition of the myocardium of the left ventricle (LV) are the ones that assess not only the ejection fraction (EF), but also the deformation parameters and rotational properties of the LV myocardium, including technologies of non-Doppler myocardial images in 2D and 3D modes (2D and 3D Speckle Tracking Echocardiography or STE). Based on the 2D Speckle Tracking Echocardiography data, reduction of the global longitudinal deformation has more prognostic significance in risk of death assessment in patients with heart failure than the EF of LV and the index breach of the local contractility of LV. However, the method of evaluating myocardial deformation in 3D mode STE and its advantages over the 2D mode STE is insufficiently explored. Thus, for the assessment of LV systolic and diastolic dysfunctions in patients with CHF with preserved and reduced EF of LV, a great interest represents the application of the new echocardiographic technologies, such as the 2D and 3D Speckle Tracking Echocardiography.
Key words: chronic heart failure, strain of the left ventricle, rotational properties of the left ventricle, non-Doppler myocardial imaging.

 

THE EFFICIENCY OF BOSENTAN BASED ON THE DATA OF THE REGISTER OF PATIENTS WITH PULMONARY HYPERTENSION IN THE VORONEZH REGION
Korolkova O.M.

Introduction. To improve the diagnosis, to examine the prevalence, structure, evaluation of effectiveness of therapy it is necessary to create register of pulmonary hypertension. The purpose of the study: to study the efficacy, the safety of the drug bosentan in patients with idiopathic pulmonary hypertension (ILG) according to the register of the Voronezh region.
Material and methods. The Material was the data base of the register.
Results. Analyses the prevalence, the incidence of ILG. Peculiarities of clinical course depending on the hemodynamic and functional status of patients of ILG.
Conclusion. The efficacy and safety of the drug bosentan in ILG.
Key words: pulmonary hypertension, bosentan, pulmonary hypertension register of the Voronezh region.

 

CLINICAL CASE OF COMBINATION THERAPY INCLUDING AMBRIZENTAN IN THE PATIENT WITH SEVERE IDIOPATHIC PULMONARY ARTERIAL HYPERTENSION
Movsisyan G.A., Arkhipova O.A., Korobkova I.Z., Matchin Yu.G., Saidova M.A., Martynyuk T.V., Chazova I.Ye.

Idiopathic pulmonary hypertension (IPAH) is a rare cardiovascular disease of unknown etiology, but the most common form of pulmonary arterial hypertension, defined as mean pulmonary arterial pressure >25 mmHg and pulmonary vascular resistance >3 Wood Units. Endothelial dysfunction seems to play an integral role in the pathogenesis of IPAH: the activation of endothelin-1 causes the hypertrophy of smooth muscle cells and endothelial cells, fibrotic changes, immune inflammation and vasoconstriction which leads to small pulmonary arteries and arterioles remodeling. The endothelial system activation is the reason for using endothelin receptor antagonists (ERA) to block the endothelin receptors type A (ETA) or both types (ETA, ETB). ERA, as the main class of PAH-specific therapy, is presented by bosentan and macitentan, dual endothelin receptor antagonists, and ambrisentan, non-sulfonamide, ETA-selective ERA. This clinical case demonstrates the successful treatment with ambrisentan as the part of combination therapy in the patient with severe IPAH.
Key words: idiopathic pulmonary hypertension, endothelin-1, endothelin receptor antagonists, ambrizentan

Download Eurasian heart journal №1 2017

FEATURES OF CURRENT ACUTE CORONARY OF A SYNDROME/ACUTE MYOCARDIAL INFARCTION AT THE WOMEN IN ONE OF AREAS OF CITY OF TASHKENT (fragment of the register ACS/AMI)
Abidova D.E., Mamutov R.Sh., Urinov O.U., Bekbulatova I.R.

Objective. The questions of female health last years get the increasing urgency cardiovascular disease occupy a leading place in structure смертности from the women in the different countries. Often risk of development cardiovascular disease at the women is underestimated, mainly because their first displays at the women develop approximately for 10 years later, than at the men. However given Fremingem of research testify to that that, despite of smaller frequency ишемической of coronary heart disease (CHD) at the women, mortality at them is higher, than at the men.
Aim. To study features of development and current acute coronary syndrome and acute myocardial infarction at the women in various age groups in one of areas of. Tashkents (on the data of the register).
Methods. 219 women, which average age = 59,48±7,51 years were switched on in research. The data received in past research" The Register acute coronary syndrome and a acute myocardial infarction in one of areas of were analyzed. Tashkents " for 2009 - 2010 years. The preventive, statistical, mathematical methods of research were used.
Results. The results of our research have shown, that asymptomatic the debut of disease was marked in 1 (0,7%) case the isolated pain in thoracal to a crate was fixed at 3 (2,1%) пациенток, the combination of this symptom with dyspnea met at 7 (4,9%), weakness – at 20 (13,9%), and with cold then – at 1 (0,7%) patient. The presence dyspnea, in a combination to weakness was registered at 10 (6,9%), and dyspnea with cold then – at 2 (1,4%) patients. The weakness as the isolated symptom met at 2 (1,4%) patients. A combination of four symptoms: pain in a breast, dyspnea, weakness and cold sweat were registered at 16 (11,1%) patients. Pain, dyspnea, syncope and cold sweat marked 1 (0,7%) woman.
Conclusion.The results of our research have shown, that in process of increase of age at the women the growth acute coronary of pathologies is observed. Most often ACS/AMI develops at the women in age group 60-64 and 65-69 years. The analysis on risk factor (RF) as a whole on group has shown, that most widespread from them were AH and superfluous weight of a body. At the young women conducting risk factors have appeared smoking and obesity. With age the role such a RF, as AH, diabetes mellitus (DM) and hypercholesterolemia is increased. The low adherence to treatment and low level of knowledge is shown concerning acute coronary of a pathology.
Key words: acute coronary syndrome, acute myocardial infarction, woman, risk factors

 

HOW TO SELECT CORONARY WIRE FOR ANTEGRADE RECANALIZATION OF CHRONIC TOTAL OCCLUSIONS
Stelmashok V.I., Polonetsky O.L., Strygo N.P., Zatsepin A.O., Mrochek A.G.

Aim. To define principles of coronary wire choice during coronary artery chronic total occlusion (CTO) recanalization by antegrade approach.
Material and methods. From 2009 to 2013 the attempt of coronary artery CTO recanalization by antegrade approach was undertaken for 217 patients. Depending on success of CTO crossing by coronary wire patients were divided into 2 groups: group 1 (n=164) – successful wire crossing, group 2 (n=53) – unsuccessful attempt of CTO recanalization by coronary wire.
Results. In the group 2 there were more frequent CTO localization in the right coronary artery (p<0,05 as compared to group 1), presence of blunt stump, higher frequency of side branches in the zone of proximal CTO cup, and large CTO length (p<0,001 as compared to group 1). CTO recanalization in 47% cases begun from soft wire with polymeric coating and tapered tip, successful recanalization by these wire type was achieved in 49,02% patients. Using non-tapered tip intermediate stiffness wire as the first choice wire was associated with the failure of recanalization (p=0,0440 in intergroup comparison). At impossibility of CTO recanalization by soft wire with polymeric coating and tapered tip used as a first choice, it replacement on non-tapered tip intermediate stiffness wire allowed to achieve successful recanalization in 36,67% patients. In the cases of this strategy uneffectiveness using stiff wire with polymeric coating and tapered tip as a third choice allowed additionally to attain successful recanalization in 60% cases. Replacement of the soft wire with polymeric coating and tapered tip on stiff wire with polymeric coating and tapered tip, executable at presence of meaningful rigidity in the proximal CTO cup zone associated with the achievement the successful recanalization in 60% cases.
Conclusion. On the basis of the obtained data it was created the conception of step-up wire stiffness increase during the CTO recanalization by antegrade approach.
Key words: chronic total occlusions, coronary arteries, antegrade approach, coronary wire.

 

DISTRIBUTION OF POLYMORPHISMS OF GENES OF STATINS METABOLISM AND TRANSPORT IN THE LIVER IN PATIENTS WITH CORONARY ARTERY DISEASE ETHNIC UZBEKS WITH SIMVASTATIN INTOLERANCE
Shek A.B., Kurbanov R.D., Abdullayeva G.J., Nagai A.V., Abdullaev A.A., Ahmedova S.S., Hoshimov S.U., Ziyaeva A.V.

Background. It is well-known that in majority of cases treatment with statins can be safe and well tolerated, but in some patients observed statin-induced adverse liver or muscle symptoms - the main reasons for statin discontinuation. Asian ethnicity – is one of the predisposing factors for statin-associated adverse effects.
Objective. To study possible effects of CYP3A5 (6986A>G), CYP2C9 (430C>T), CYP2C9 (1075A>C), SLCO1B1 (521T>C) and BCRP (ABCG2, 421C>A) genetic polymorphism on simvastatin tolerance and safety in ethnic Uzbek patients with Coronary Artery Disease (CAD).
Material and methods. The prospective case-control research included 100 patients with CAD. Group "case" were 50 patients who demonstrated statin-induced adverse liver effects (transaminase level increases 3 times and more – in 37 cases) or statin-induced elevations in serum CK (of >3×UNL – in 4 cases) at treatment with simvastatin with the dose of 20 mg/day for 3 months of treatment and 13 with myopathy, associated with increased levels of total creatine phosphokinase (CPK) 3 times or more. In 4 patients with adverse effects on the liver, along with an increase in the enzymes, while there was an increase of CPK levels. Control group contained 50 patient with CAD treated with simvastatin with the dose of 20-40 mg/day for one year without side effects. The both groups of patients were similar in gender, age, original index of kidney function and serum CK level. The comparison group consisted of healthy ethnic Uzbeks (n = 41) of comparable age and sex, with the absence of a family history of coronary artery disease. The research was performed by means of PCR-RFLP method.
Results. As a whole, all genotypes (except for CYP2C9 * 2 in patients) were in Hardy–Weinberg equilibrium. Among patients with simvastatin intolerance, compared to the control group, the following genotypes were observed more frequently with high level of confidence: CYP3A5 *3/*3, compared to genotype variants *1/*3 and *1/*1 (OR 9.33; 95% CI 3,37-25,9; P = 0.0001) and BCRP CA (patients with BCRP CC genotype were not observed among those examined) (OR 3.22; 95% CI 1,25-8,30, P = 0.024).
Conclusions. Genotypes CYP3A5 *3/*3 (6986A>G) and BCRP CA (ABCG2, 421C>A) are accompanied with the increase of statin-induced adverse effects in ethnic Uzbek patients with Coronary artery disease.
Key words: statin intolerance, polymorphisms of genes CYP3A5, CYP2C9, SLCO1B1, BCRP.

 

THE EFFICACY OF SILDENAFIL THERAPY IN PATIENTS WITH PULMONARY HYPERTENSION OF DIFFERENT ETIOLOGY: INFLUENCE ON THE CLINICAL, FUNCTIONAL, HEMODYNAMIC STATUS, STRUCTURE AND FUNCTION OF THE RIGHT AND LEFT HEART, RIGHT VENTRICULAR-ARTERIAL COUPLING
Martynyuk T.V., Dadacheva Z.H., Paramonov V.M., Saidova M.A., Nakonechnikov S.N., Chazova I.Ye.

Aim: to study the efficacy of sildenafil therapy in pulmonary hypertension of different etiology, its influence on the clinical, functional, hemodynamic status, structure and function of the right and left heart, right ventricular-arterial coupling (RVAC) in pts with idiopathic pulmonary hypertension (IPAH) and chronic thromboembolic pulmonary hypertension (CTEPH).
Materials and methods: in the study we included 29 IPAH pts aged 42.8±10.6 yrs, 28 CTEPH pts aged 43.4±10.4 yrs II-IV functional class (FC) (WHO), receiving stable standard therapy (anticoagulants, diuretics, glycosides) and calcium channel blockers for at least 3 months.
Sildenafil was started at the dose of 10 mg TID to assess the tolerability for further titration after 1 wk to 20 mg 3 times a day. The treatment duration was 16 wks. At baseline and at wk 16 FC (WHO), 6-minute walking test (6-MWT), transthoracic echocardiography (Echo) and right heart catheterization (RHC) were performed.
Results: both groups were comparable in baseline functional parameters: FC, the distance in 6-MWT, Borg index. The analysis of baseline structural and functional cardiac parameters by Echo in IPAH and CTEPH pts revealed pronounced cardiac remodeling as compared to the control group. All pts had criteria precapillary PH by RHC with comparable systolic pulmonary artery pressure (SPAP), mean pulmonary artery pressure (PAPm), cardiac output (CO) and index (CI), pulmonary vascular resistance (PVR) except for diastolic PAP (DPAP), which was higher in IPAH group (38.3±13.7 mm Hg vs 31.5±8.9 mm Hg in CTEPH group (p<0.05).
Sildenafil therapy resulted in the marked improvement of functional and hemodynamic status, cardiac remodeling parameters in both groups. To wk 16 IPAH pts achieved the 114m increase in 6-MWT as compared with 108m in CTEPH group. IPAH pts demonstrated the significant decrease in SPAP, PAPm, reduce of right ventricular (RV) size and improvement of contractile function - FAC and TAPSE, increase of RVAC by reducing LV stiffness. Eccentricity index of LV improved significantly only in CTEPH pts. Positive dynamic in RHC data (significant decrease of SPAP, PAPm, DPAP, PVR, increase of CO,CI, stroke volume). CTEPH pts showed a greater reduction in PVR, SPAP and significant SvO2 improvement.
Conclusion: 1. In pts with IPAH and CTEPH of comparable baseline clinical, functional and hemodynamic status we found no significant differences in the severity of cardiac remodeling, RV and LV systolic and diastolic function. Regardless of etiology RVAC was reduced due to the significant increase of LV stiffness- Es. 2. 16-wk sildenafil therapy in pts with IPAH and CTEPH resulted in the positive dynamic of 6-MWT distance, dyspnea index, Echo data including LV stiffness. 3. In CTEPH group as compared with IPAH pts we found the more marked reduction in PVR, PASP and significant improvement SvO2 by RHC. The significant decrease in Es was observed only in CTEPH pts.
Key words: idiopathic pulmonary arterial hypertension, chronic thromboembolic pulmonary hypertension, phosphodiesterase type 5 inhibitors, sildenafil

 

THE PROGNOSTIC IMPORTANCE OF RISK FACTORS AND MEDICAL HISTORY DATA ON THE MORTALITY OF PATIENTS OF STABLE ANGINA AT 5 YEARS PROSPECTIVE STUDY (FRAGMENT OF THE REGISTER ACS/AMI)
Mamutov R. SH., Mamaradjapova D.A.

Aim: Studying of outcomes of stable angina during five years' prospective study according to the Register of an acute coronary syndrome and an acute myocardial infarction (ACS/AMI) with an assessment of the prognostic importance of risk factors and medical history data on mortality.
Material and Methods: In this paper we studied the results of 5-year prospective study of 196 patients suffering from stable angina, with the assessment of the impact of risk factors and medical history data on mortality from stable angina according to register ACS / AMI.
Results. The most common risk factor for CHD among hospitalized patients with stable angina, hypertension was (80.6%) and GC (39.3%). Prior to admission in more than ¾ patients had angina before, more than 2/5 suffered MI earlier, there were ¼ signs of CHF, ¼ suffered from diabetes.
During the period of the five-year prospective study of 196 patients with stable angina in 54 patients (29.6%) developed acute myocardial infarction and of which 24% was observed in death. Five-year mortality in patients with stable angina - 23.5%, with the main cause of death (63%) were acute heart failure. For 5 years of prospective study, the presence of heart failure and diabetes, and patients with a history of myocardial infarction is associated with a poor prognosis for mortality with stable angina.
Key words: stable angina, prognosis, five-year prospective study, myocardial infarction.

 

NUCLEAR IMAGING IN PULMONARY HYPERTENSION
Sergienko V.B., Valeeva E.G.

The review describes current possibilities of nuclear imaging methods in different types of pulmonary hypertension (PH): lung ventilation-perfusion scintigraphy and single photon emission computed tomography (SPECT), radionuclide ventriculography and angiography, as well as new potentials of myocardial perfusion SPECT for the evaluation of right ventricle.
Keywords: pulmonary hypertension, nuclear imaging.

 

CLINICAL CASE: CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION IN A CHILD
Sadykova D.I., Sabirova D.R., Firsova N.N., Kustova N.V., Nurmeev I.N., Pigalova S.A.

The article deals with a rare clinical case of chronic thromboembolic pulmonary hypertension in children. This case demonstrates the difficulty of identifying of chronic thromboembolic pulmonary hypertension and masking it under the community-acquired pneumonia. In the diagnosis of the leading methods were echocardiography of the heart and radiopaque tomography of the chest. Etiology of the disease has been established. The use of anticoagulants in the treatment led to positive dynamics: to re radiopaque tomography of the chest imaging of blood clots is not more than 1 mm, decrease in pulmonary artery pressure.
Key words: thromboembolism, pulmonary hypertension, children

Download Eurasian heart journal №4 2016

CARDIAC ARRHYTHMIAS AFTER TRANSCATHETER CORRECTION IN PATIENTS WITH SECONDARY ATRIAL SEPTAL DEFECT
Abdyzhaparova E.K., Dzhishambaev E.D.

In order to study the dynamics of cardiac arrhythmias in patients with secondary atrial septal defect (ASD) examined 50 patients in the age of from 3 to 68 (mean age 24,2±2,1 years) with secondary defect investigated arrhythmias changes in the nearest (till 3 months) and remote (till 1 year) the periods after transcatheter closings of arial septal defect using the amplatzer septal occluder were examined. Already in 3 day after transcatheter correction marked decrease frequent (67,8 ±29,4 till 62,5±25 in hour) group supraventricular extrasystoles, disappear episodes paroxysmal atrial fibrillation and paroxysmal supraventricular taxycardias. By 6 months the disappearance of the group and reduction of frequent supraventricular extrasystoles. In relation to ventricular arrhythmias on day 3 observations marked deerease in the number of VEs (254,1±171,2 till 32,6±3,6 in hour), the complete disappearance of VEs high grade to 12 months.
Thus, after transcatheter closure of ASD in the coming secondary (3 hours) and long-term (6-12 months). Deadlines are not observed occurrence of serious cardiac arrhythmias, and available undergoing a significant improvement towards a significant reduction in the number of premature beats until their complete disappearance. This fact confirms the effectiveness and safety of this method of treatment of secondary ASD.
Key words: secondary interatrial septum defect, electrocardiographia, Amplatzer occluder, supraventricular and ventricular extrasystols.

 

THE ROLE OF ECHOCARDIOGRAPHY IN ASSESSMENT OF HEART REMODELING IN PATIENTS WITH CTEPH
Belevskaya A.A., Saidova M.A., Martynyuk T.V., Chazova I.Ye.

The study included 40 patients with CTEPH of different severity. All patients underwent 2D and 3D echocardiography to assess structure and function of right and left heart chambers, ventricular interaction, and ventricular-vascular coupling. The study showed that patients with CTEPH had right and left ventricle remodeling with systolic and diastolic dysfunction. We also observed impairment of right and left ventricular-vascular coupling.
Key words: CTEPH, echocardiography, heart remodeling, ventricular interaction, ventricular-vascular coupling.

 

THE MODERN VIEW OF THE ADDITIONAL THERAPY, CORRECTING METABOLIC PARAMETERS IN PATIENTS WITH PULMONARY HYPERTENSION: TRIMETAZIDINE IN FOCUS
Valeeva E.G., Martyniuk T.V., Ivanov K.P., Sergienko V.B., Nakonechnikov S.N., Chazova I.Ye.

According to the Russian data 34% of patients with pulmonary hypertension (PH) have complaints of chest pain. Currently, the cause of this symptoms can be as coronary heart disease, compression of the coronary arteries (usually the left main coronary artery) dilated pulmonary artery, coronary insufficiency due to low cardiac output is relatively weak development of coronary collaterals in the hypertrophy RV wall or a reflex constriction of the coronary arteries due to distension of the pulmonary artery, to the reduction of blood oxygen saturation in the late stages of the disease. Myocardial ischemia and chest pain reduce the quality of life of patients, and to be predictors of adverse outcomes. Therefore, treatment of these patients should be comprehensive and include PAH -specific and additional metabolic therapy. The therapy of the last group – trimetazidine – being actively researched in various pathologies, and shows the positive side in studies: the Cochrane meta-analysis of patients with ischemic heart disease. Trimetazidine has a pronounced anti-anginal efficacy and good tolerability in combination with other treatment, which will improve the quality of life of patients.
Keywords: pulmonary hypertension, myocardial ischemia, chest pain, trimetazidine, metabolic modulator.

 

THE INFLUENCE OF CELL AND PLASMA HEMOSTASIS AND BIOMARKER LEVELS ON CLINICAL OUTCOMES IN PATIENTS WITH UNSTABLE ANGINA AND RESISTANCE TO ANTIPLATELET AGENTS
Gelis L.G., Medvedeva E.A, Russkich I. I., Lazareva I.V., Rusak T., Tamashevsky A.V.

Objective: to assess the impact of cell plasma hemostasis disorders and the level of biomarkers on clinical outcomes and to develop laboratory diagnostic criteria forecast recurrent coronary events in patients with unstable angina.
Material and Methods: the study included 124 patients with unstable angina. All patients were performed: complete blood count, to determine the level for TnI, the determination of inflammatory markers (hs C-reactive protein (CRP)), the level of myeloperoxidase, von Willebrand factor, the level of thrombin, fibrinogen (FG), antithrombin III (AT III), D-dimer, factor Xa), agregatogramm was performed an impedance aggregometer Multiplate and determining platelet activation by flow cytometry. All patients underwent ECG, echocardiogram, 24-hour ECG monitoring, coronary angiography.
Results: developed independent predictors of the risk of recurrent coronary events in patients with unstable angina: the threshold values for evaluating platelet aggregation analyzer Multiplate-ASPI-test (AUC) >52 U, ADP-test (AUC) >60 U; the peak concentration of thrombin ≥294,5 nM, platelet size – MPV >9,6 fl, myeloperoxidase level >316 pmol/l, hsCRP >3.8 g/l, and troponin I >0,07 ng/ml. We created the scale of the prediction of recurrent coronary events after suffering unstable angina.
In patients included to the study it was found that 18 patients (14.5%) recorded a decrease of sensitivity to aspirin (ASA)in the standard dose of 75 mg, in 24 patients (19.4%) to clopidogrel 75 mg and in 8 patients (6,5%) – both to ASA and clopidogrel. It was found that the resistance to ASA and/or clopidogrel more than 2.5 [CI, 2.0; 2.8] once increases the relative risk of recurrent ischemic events.
Conclusions: developed by independent predictors of the risk of recurrent coronary events in patients with unstable angina: AUC ASPI- test>52 U, AUC ADP- test>60 U; the peak concentration of thrombin≥294,5 nM, platelet size - MPV>9,6 fl, myeloperoxidase >316 pmol/l, high-sensitivity CRP >3.8 g/l, the level of troponin I>0,07 ng/ml.
Keywords: unstable angina, resistance to antiplatelet agents, agregatogramm, cell and plasma hemostasis

 

OPTIMAL CUT-OFF POINTS OF INSTANTANEOUS WAVE-FREE RATIO IN THE ASSESSMENT OF THE FUNCTIONAL SIGNIFICANCE OF CORONARY ARTERY STENOSES USING NONINVASIVE METHODS AS REFERENCE
Darenskiy D.I., Gramovich V.V., Zharova E.A., Mitroshkin M.G., Atanesyan R.V., Bakashvili G.N., Matchin Y.G.

Objective: the aim of our study was to determine the optimal instantaneous wave-free ratio (iFR) cut-off points in assessing the functional significance of intermediate coronary artery stenoses in patients with chronic coronary artery diseases (CAD) using non-invasive methods of myocardial ischemia verification as reference.
Methods: 60 patients with chronic CAD or suspected CAD and intermediate coronary stenoses (50-70%) were included in the study. 92 borderline coronary stenoses were investigated. iFR measurement was carried out within 10 days after the non-invasive stress test (a combination of stress echocardiography and SPECT).
Results: stress-induced myocardial ischemia was detected in 18 patients (30%). iFR values are in the range 0.68 to 1.0, median of iFR - 0.95 [0.9; 0.99]. Area under iFR ROC-curve – 0.95 ± 0.02 (95%CI: 0.885-0.985). The iFR cut-off point 0.92 is optimal and has a sensitivity of 100%, a specificity of 83% and a negative predictive value (NPV) of 100%. The iFR cut-off point 0.86 is associated with a specificity of 100%, a sensitivity of 33% and a positive predictive value of 100%. The values of iFR «grey» zone ranged from 0.87 to 0.92.
Conclusion: using non-invasive methods of verification of myocardial ischemia as a reference, iFR cut-off point 0.92 excludes the functional significance of coronary artery stenosis with a NPV of 100%. iFR cut-off point 0.86 confirms the functional significance of the stenosis with a PPV of 100%. It is recommended to measure the fractional flow reserve in the case of obtaining the iFR values of «grey» zone (0,87-0,92).
Key words: iFR, CAD, stress-echo, SPECT.

 

POLYMORPHISM C(-344)T OF THE ALDOSTERONE SYNTHASE GENE AND ESSENTIAL ARTERIAL HYPERTENSION
Pavlova O.S., Ogurtsova S.E., Liventseva M.M., Kovsh E.V., Afonin Yu.V., Mrochek A.G.

Objective. To study the association the aldosterone synthase gene (CYP11B2) C(-344)T polymorphism in ethnic Belarussians with essential hypertension (EH).
Materials and methods. Genotyping of polymorphic marker C(-344)T of the CYP11B2 was performed by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) in 585 people (391 patients with EH and 194 subjects with normal or optimal blood pressure (BP)).
Results. The prevalence of C(-344)T polymorphism genotypes of the CYP11B2 gene did not differ between the groups of hypertensive patients - CC, CT, TT genotypes were detected in 105 (26.8%), 182 (46.6%), 104 (26.6%), and healthy people – in 48 (24.7%), 97 (50.0%), 49 (25.3%), respectively. There were not obtained differences in the level of BP, grade of EH depending on the mutant allele T polymorphism C(-344)T of the CYP11B2 gene among the group of 208 patients without the antihypertensive treatment.
Conclusions. In patients with EH of Belarusian ethnicity it was observed equilibrium distribution of the C (50.1%) and T (49.9%) alleles polymorphism C(-344)T of the CYP11B2 gene. The genetic polymorphism C(-344)T of the gene CYP11B2 was not associated with the development of EH in the groups as well as under or after 45 years and taking into account gender differences.
Key words: essential arterial hypertension, aldosterone synthase gene, genetic polymorphism.

 

THE EFFECTIVENESS OF COMBINATION THERAPY WITH BOSENTAN AND SILDENAFIL IN PATIENTS WITH THE CLINICAL WORSENING OF IDIOPATHIC PULMONARY HYPERTENSION ON THE BACKGROUND OF SPECIFIC MONOTHERAPY
Paramonov V.M., Martynyuk T.V., Matchin Yu.G., Masenco V.P., Nakonechnikov S.N., Chazova I.Ye.

Objective: to evaluate the combination therapy efficacy and safety of bosentan and sildenafil in patients with idiopathic pulmonary hypertension (IPAH) in the case of clinical worsening of the underlying disease. To analyze the dynamics of clinical and functional status, the parameters of central hemodynamics and neurohumoral profile against the background of the appointment of combination of specific therapy.
Material and Methods: the study included 50 patients with IPAH nonresponders functional class (FC) II-III (WHO). Patients were randomized into 2 groups of 1: 1 bosentan therapy at the starting dose of 125 mg/day titrated up to 250 mg across 4 weeks and sildenafil 60 mg/day. Of the 50 pts, 11 had marked clinical worsening IPAH to 3-10 months. Conducted 5 visits: within the framework of the initial and final visit, and the visit of clinical deterioration underwent a comprehensive examination, including right heart catheterization and research level neurohumoral status. At visit 2 in addition to test 6-minute walk surveyed the level of NT-proBNP.
Results: clinical deterioration is characterized not only by deterioration FC 9% increase of the frequency of clinical symptoms and a decrease in distance in the test 6-minute walk (D6MH) by an average of 10 meters, but also an increase in systolic pulmonary artery pressure (SPAP) by 3,7 mm Hg. .st, right atrium area on 1,5 m2.; increase in pulmonary vascular resistance (PVR) to 233 dyn*sec/cm-5, slight decrease in cardiac output (CO), cardiac index (CI) and stroke volume (SV), according to right heart catheterization (RHC), as well as increase in NT-proBNP levels at 572 pg/ml, Tx B2 – 295 pg/ml, noradrenaline 128 pg/ ml and ET-1 0.4 fmol/l, a reduction of 6-keto pG F1α 82 pg/ml, adrenaline on. 18 pg/ ml, NO 13 pg/ml.
Appointment of combination therapy resulted in improved clinical and functional status in the form of reduced weakness and shortness of breath, improve FC and D6MH growth by an average of 18 m., A significant decrease in SPAP by 9,5 mm Hg and PVR 336 din*sek/sm-5, some increasing CO, CI and SV, as well as the positive dynamics of indicators of neurohumoral status: NT-proBNP reduction of 400 pg/mL, Tx B2 to 432 pg/ml, norepinephrine at 115 pg/ml increase in NO metabolites level of 17 pg/ml. Appointment of combination therapy well tolerated.
Conclusion: assigning specific combination therapy when the required criteria of clinical deterioration in 20% of patients with primary therapy bosentan±3 to 9 months. In 27% of patients in the group of sildenafil to 8±2 months. Combination therapy with bosentan and sildenafil for 7±2 months. from the beginning of the treatment leads to a significant improvement in functional class, a distance of 6MW test, central hemodynamic parameters; reduction of SPAP, lower NT-proBNP levels and increase levels of NO metabolites, 6-keto-PG F1α, adrenaline.
Key words: idiopathic pulmonary hypertension, bosentan, sildenafil, combination therapy.

 

ATOMIC FORCE MICROSCOPY OF NEUTROPHILS IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH PULMONARY HYPERTENSION
Gaynitdinova V.V., Sharafutdinova L.A. , Kamaltdinov I.M. , Avdeev S.N.

Using atomic force microscopy performed morphofunctional state analysis (morphometry, adhesion strength and stiffness of the membrane) of neutrophils in patients with chronic obstructive pulmonary disease, depending on the presence of pulmonary hypertension. In mode power spectroscopy performed quantification of elastic modulus (Young's modulus) and strength of a cell membrane adhesion of neutrophils. The study showed that in patients with chronic obstructive pulmonary disease with pulmonary hypertension observed neutrophil activation (reduction in cell size, cell nucleus, increasing the number and height of the granules in the cytoplasm), a significant increase in the stiffness of the membrane (increase in the Young modulus) and strength of adhesion of neutrophils compared with the control and COPD patients without pulmonary hypertension
Keywords: chronic obstructive pulmonary disease, pulmonary hypertension, atomic force microscopy, neutrophils, morphometry, the stiffness of the membrane, the adhesive force.

 

PREVENTION OF STROKE IN ATRIAL FIBRILLATION: THE APPROACHES TO THE CHOICE OF ANTICOAGULANT, DEPENDING ON AGE
Ardashev A.V., Zotova I.V.

The main objective of the management of patients with atrial fibrillation (AF) is an effective prevention of ischemic stroke. For this purpose indirect and direct oral anticoagulants may be used. The choice of anticoagulant should be based on a comprehensive assessment of a number of factors – the presence of significant valvular disease, kidney function, potential drug interactions, risk of complications of anticoagulant therapy. Individual assessment of the profile of thromboembolic and hemorrhagic risks are largely determined by the age, can help choose an efficient anticoagulant with minimal risk of complications. In patients younger than 75 years, in the absence of contraindications to the use of direct oral anticoagulants, the drug of choice can be dabigatran, administered at a dose of 150 mg 2 b.i.d.
Keywords: prevention of stroke, atrial fibrillation, cardiovascular disease, new oral anticoagulants.

 

HIGH ALTITUDE PULMONARY HYPERTENSION («MIRRAKHIMOV’S DISEASE»)
Sarybaev A.Sh., Sydykov A.S., Sartmyrzaeva M.A, Maripov A.M., Mamazhakypov A.T., Akunov A.Ch.

It is estimated, that more than 140 million people reside at altitudes above 2500 m in 35 countries worldwide. High altitude residents display moderate erythrocytosis and mild-to-moderate elevation in pulmonary artery pressure. Howevere, in some indivudals, severe pulmonary hypertension develop with ensuing right ventricular hypertrophy and failure and thus representing a major public health problem in mountainous regions around the world. In this review, we discuss the history of discovery, clinical findings, diagnostic, treatment and prevention of the disease.
Key words: hypoxia, high altitude, pulmonary artery pressure, pulmonary hypertension, right ventricular hypertrophy.

 

CLINICAL CASE: OPPORTUNITY OF THERAPY OPTIMIZATION DUE TO TRANSITIONING FROM SILDENAFIL TO RIOCIGUAT IN PATIENT WITH IDIOPATHIC PULMONARY HYPERTENSION
Taran I.N., Paramonov V.M., Valieva Z.S., Saidova M.A., Nakonechnikov S.N., Martynyuk T.V., Chazova I.Ye.

The patient with diagnosis of idiopathic pulmonary hypertension, functional class III (WHO) was treated by anticoagulants, diuretics. After 6 months of treatment with phosphodiesterase type 5-inhibitor sildenafil, there was observed the negative dynamic with systolic pulmonary arterial pressure, intolerance to exercises. The treatment goals were not achieved with sildenafil therapy. The transitioning from sildenafil to riociguat therapy was done. By 6 months of the riociguat therapy there was achieved the significant improvement of the functional and hemodynamic status. Аcording to the stratification risk scale the treatment goals were reached.
Keywords: idiopathic pulmonary hypertension, phosphodiesterase type 5 inhibitor, sildenafil, soluble guanylate cyclase stimulators, riociguat, risk assessment.

 

Resolution of the IV Eurasian Congress of Cardiology 10 - October 11, 2016 in Yerevan

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ELECTROPULSE THERAPY IN PUBLIC PLACES

 

ARTERIAL HYPERTENSION ASSOCIATED WITH METABOLIC SYNDROME: FOCUS ON DAILY PROFILES OF CENTRAL AORTIC PRESSURE AND VASCULAR STIFFNESS
Panchenkova L.A., Andreeva L.A., Khamidova K.A., Yurkova T. E., Martynov A.I.

Purpose: to evaluate the parameters of the central aortic pressure and arterial stiffness during the day in patients with arterial hypertension (AH) with metabolic syndrome (MS)
Material and methods: The study included 48 subjects divided into 2 groups: 23 (47,9%) subjects with AH, 25 (52,1%) subjects with AH with MS (AH+MS). Control group (CG) were 22 practically healthy subjects. All the subjects underwent examination ABPM with oscillometric sensor (BPLabVasotens, Russia) with assessment CAP (systolic blood pressure, SBPao; diastolic blood pressure DBPao; pulse pressure,PPao; Augmentation index, Alxao; amplification of pulse pressure, PPA) and arterial stiffness (pulse wave velocity, PWVao; Reflected Wave Transit Time, RWTT; Arterial Stiffness Index, ASI; Augmentation index, AIx).
Results: Analysis of CAP demonstrated significant differences between the day / night SBP ao, DBP ao., mean BP ao in AH and AH + MS groups compared to the CG. No significant differences in the parameters of pulse pressure (PP) during the day in these groups are not mentioned, but PP is higher in AH + MS group. Augmentation Index for 24 hours significantly higher, amplification of pulse pressure was significantly lower in the AH + MS compared to CG and AH group. Evaluation of daily arterial stiffness parameters revealed significantly higher rates in PWVao in AH + MS group comparison with the CG and AH group. RWTT statisticaly significant lower in AH + MS and AH groups compared to CG.
Conclusion: 24-hour monitoring of CAP and AS revealed a deterioration of the elastic properties of central arteries in hypertensive subjects with metabolic syndrome. Thus, the results of our study confirm the importance of the study of arterial stiffness and the CAP and in the long term could be considered as markers in hypertensive patients, especially in the presence of comorbid pathology.
Keywords: hypertension, comorbid, metabolic syndrome, central aortic pressure, arterial stiffness

 

COMPARE THE EFFECTIVENESS OF NEBIVOLOL AND SOTALOL IN PATIENTS WITH HYPERTENSIVE DISEASE AND VENTRICULAR ARRHYTHMIAS
Shubitidze I.Z., Tregubov V.G., Pokrovsky V.M.

Aim. Compare the effectiveness of nebivolol and sotalol in patients with hypertensive disease (HD) and ventricular arrhythmias (VA) taking into account its effect on regulatory adaptive status (RAS).
Materials and methods. 49 patients with HD of stages II-III and VA of grade I-IV based on the В.Lown grading system, II-III groups based on J.Bigger grading system took part in the research, they were randomized into two groups for treatment with nebivolol (6,9±1,8 mg/day) or sotalol (159,1±47,4 mg/day). As part of combination therapy, patients were administered lisinopril (13,9±3,7 mg/day and 13,7±4,5 mg/day), acetylsalicylic acid when required (90,0±14,6 and 95,0±16,2 mg/day), atorvastatin (18,7±4,1 mg/day and 15,6±4,9 mg/day), respectively. Initially and 6 months after therapy, the following was done: quantitative assessment of RAS (by cardio-respiratory synchronism test), echocardiography, triplex scanning of common carotid arteries, treadmill test, six-minute walk test, all-day monitoring of blood pressure and electrocardiogram, subjective assessment of quality of life.
Results. Both drug regimens comparably improved structural and functional condition of the heart, increased controlled arterial hypertension, effectively suppressed ventricular arrhythmia, improved the quality of life. Nebivolol positively affected the RAS and increased exercise tolerance more.
Conclusion. In patients with HD of stages II-III and VA as part of combination therapy the use of nebivolol may be preferable to sotalol due to its positive impact on the RAS.
Key words: regulatory adaptive status, hypertensive disease, ventricular cardiac arrhythmias, nebivolol, sotalol.

 

NEW FRONTIERS FOR RETROGRADE RECANALIZATION OF CHRONIC TOTAL OCCLUSIONS
Stelmashok V.I., Polonetsky O.L., Strygo N.P., Zatsepin A.O., Belsky E.V., Zakharevich A.N., Mrochek A.G.

In article it was resumed modern concepts of interventional chronic total occlusion retrograde recanalization. It was introduced advantages and disadvantages of particular approaches. It was described created by authors new way of retrograde CTO recanalization (CART-M method) and clinical presentation of this method was shown. It was announced potential advantages of CART-M method comparing with other methods of CTO recanalization.
Key words: chronic total occlusion, coronary arteries, retrograde approach, method CART-M.

 

USING NON-INVASIVE METHODS FOR EVALUATING MYOCARDIAL ISCHEMIA IN ASSESSMENT OF THE FUNCTIONAL SIGNIFICANCE OF INTERMEDIATE CORONARY ARTERY STENOSES IN PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE
Darenskiy D.I., Gramovich V.V., Zharova E.A.

Key points of using non-invasive methods for evaluating myocardial ischemia (exercise electrocardiogram, stress echocardiography, single photon emission computed tomography and myocardial perfusion imaging with stress-test) in clinical practice to determine the functional significance of intermediate coronary artery stenoses (50-70% of the vascular lumen) are discussed in the review.
Key words: non-invasive methods, IHD, intermediate coronary stenoses.

 

ABSTRACTS OF THE IV EURASIAN CONGRESS OF CARDIOLOGISTS, OCTOBER 10-11, 2016, YEREVAN, ARMENIA

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CLINICAL GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION

 

THE PREVALENCE OF HYPERTENSION IN THE FEMALE POPULATION DEPENDING ON GESTATIONAL HYPERTENSION IN ANAMNESIS
Azizov V., Rzayeva A., Agayeva K., Chatamzade E.,Mamedova S.

The prevalence of hypertension in the female population, depending on the presence of gestational hypertension history, set the sensitivity, specificity, and predictive value of gestational hypertension as a predictor of hypertension. The observation was carried out during the mandatory preventive examinations, the volume of which amounted to 643 women. The questionnaire for the study of obstetric history included a chronological description of all the pregnancies of more than 22 completed weeks of gestation. Inclusion in the object of study only workers of the railway system made it possible to clarify and supplement the personal information about gestational hypertension according to the history of the birth, which are stored in the archives of the railway hospital. Women aged 49-54 years with gestational hypertension often observed significant increase in blood pressure. Probability of high blood pressure in women aged 49-53 years, significantly increases depending on the number of pregnancies associated with gestational hypertension. Gestational hypertension is a highly sensitive (≥ 56,5%) and specific (≥46,0%) predictor of hypertension aged 49-53 years, the predictive value which is greater than 42.9%.
Keywords: hypertension, gestational hypertension, prevalence.

 

THE RESULTS OF PSYCHOLOGICAL TESTING OF HEALTHY YOUNG MEN AND WITH A FAMILY HISTORY OF CORONARY ARTERY DISEASE AND DIABETES MELLITUS
Behbudova D.A.

Current study was designed to investigate the frequency of the incidence of type A personality and high levels of neuroticism in groups of healthy young men and women with a family history of coronary artery disease (CAD) and diabetes mellitus (DM).
The study was performed using psychological questionnaires of Jenkins and Aizenk.
The high frequency of type A behavior, high levels of neuroticism, as well as the combination of the two, was established in the groups of healthy men with family history of CAD and DM.
Women's groups were characterized by a lower frequency of type A personality and also lower incidence of the combination of type A personality with high levels of neuroticism.
Thus, among the groups of healthy young men with a family history of CAD and DM, a sufficient number of individuals with a high risk of CAD, who need preventive measures with involvement of professional psychologists was found.
Key words: healthy young men and women, type A personality, neuroticism, coronary artery disease, prevention.

 

SURGICAL TREATMENT OF CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION: MODERN TRENDS AND OWN EXPERIENCE
Akchurin R.S., Mershin K.V., Tabakyan E.A., Latypov R.S., Gazizov V. V., Tsyrenov D.D.

Pulmonary endarterectomy (PEA) is the method of choice in treatment of chronic thromboembolic pulmonary hypertension (CTEPH). There are a lot of factors still restricting the widespread use of these operations. Among them are the difficulties of diagnosing and patient selection, the peculiarities of operation and postoperative treatment, the unawareness of cardiological community about surgical outcomes. We discuss the preparation of the patient to PEA, standards of the surgery and postoperative treatment. The results of preoperative diagnostics and PEA-operations at our center are presented. The possible causes of postopreative mortality and adverse outcomes are also discussed.
Key words: chronic thromboembolic pulmonary hypertension, CTEPH, pulmonary trombendarterectomy , endarterectomy of the pulmonary artery, angiopulmonography, pulmonary vascular resistance, pulmonary vascular resistance.

 

THE RESULTS OF LONG-TERM PAH-SPECIFIC MONOTHERAPY WITH BOSENTAN IN PATIENTS WITH IDIOPATHIC PULMONARY HYPERTENSION
Paramonov V.M., Martynyuk T.V., Danilov N.M., Matchin Yu.G., Chazova I.Ye.

Objective. To evaluate the dynamics of clinical and functional status, the parameters of central hemodynamics and tolerability of bosentan therapy lasting more than 12 months in patients with idiopathic pulmonary hypertension (IPAH).
Materials and methods. In the study we included 20 IPAH non-responders with functional class II-III (WHO). All patients were assigned to treatment with bosentan in the initial dose of 125 mg/day, which was increased to 250 mg/day after 4 wks. The mean FU duration was 15±3 months. Conducted 5 visits: at baseline and visit 5, all patients underwent a comprehensive examination, including right heart catheterization (RHC). Transthoracic echocardiography was performed additionally at visit 3. 6-minute walking (6MW) test was assessed every 3 months. For safety reasons hepatic transaminases were analyzed monthly.
Results. Bosentan therapy resulted to significant improvement of functional class (FC (I/II/III) with 0%/45%/55% to 30%/45%/25%, p<0.05) to 15±3 month. Mean 6MW distance increases by 54 m. In 9 pts during extension period the achieved clinical and functional status remained stable to 54±6 months.
We showed the significant decrease of right ventricle and atrium sizes. At 15±3 months RHC revealed a significant decrease in SPAP, PVR, increase of cardiac output / cardiac index, oxygen saturation of mixed venous and arterial blood. During follow-up period we found the maximal increase of liver enzymes of 1.5 ULN. Adverse events (headache and flushing) were reported in 1 pt. without requirement of treatment discontinuation.
Conclusion. Bosentan therapy was highly effective in IPAH patients with FC II-III for 15±3 months. Stable functional and hemodynamic status of patients was maintained to 54±6 months with good tolerability of the treatment.
Keywords: bosentan, idiopathic pulmonary hypertension, right heart catheterization.

 

FEATURES OF CUTANEOUS MICROCIRCULATORY BLOOD FLOW IN PATIENTS WITH IDIOPATHIC PULMONARY ARTERIAL HYPERTENSION ASSESSED BY LASER DOPPLER FLOWMETRY DEPENDING ON VASOREACTIVITY STATUS ON INHALED NITRIC OXIDE
Dolgova E.V., Fedorovich A.A., Martynyuk T.V., Rogoza A.N., Chazova I.Ye.

Aim: To evaluate features of the functional state of microvascular bed of the skin in patients with idiopathic pulmonary arterial hypertension (IPAH) depending to acute vasoreactivity testing on inhaled nitric oxide.
Methods: in study included 28 patients with IPAH (mean age 39,8±13,2 years) and 25 healthy volunteers (39,3±10,1 years). All the patients underwent 6-minuts walking test (6-MWT), transthoracic echocardiography, thorax organs radiography, right heart catheterization (RHC) with acute pharmacological test (APT), laser Doppler flowmetry (LDF) with functional tests. Patients were divided into 2 groups by results of APT.
 Results: according to the LDF the APT+ patients didn’t differ from control group on any of the parameters. The APT-patients according to the basal perfusion also were comparable with control group, but had significantly higher constrictory reactions for all types vasoconstrictor stimulations (at activation of sympathetic nervous system in respiratory and cold tests, and in the development venule-arteriolar constrictory response on venous occlusion) and elongation of time development post-occlusive reactive hyperemia. We identified significant correlation of the amplitude of respiratory section of blood flow modulation, which reflected degree of venule plethora, with the RHC parameters and functional status of patients.
Conclusion: In the APT-patients on against a background the of uncharged basal perfusion parameters noticed increased constrictory activity smooth muscle cells of resistive microvessels for all type vasoconstrictor stimulations, but expression of constrictory reactions correlated with indications of patients functional status.
Key words: idiopathic pulmonary arterial hypertension, acute pharmacological test, microcirculation, laser Doppler flowmetry.

 

ATHEROMATOSIS OF ARTERIAL INTIMA AS A RESULT OF THE BIOLOGICAL FUNCTION OF ENDOECOLOGY, BIOLOGICAL REACTION OF INFLAMMATION AND UTILIZATION OF NON-LIGAND PALMITIC VERY LOW DENSITY→LOW DENSITY LIPOPROTEINS
Titov V.N., Shoybonov B.B.

Phylogenetically late intima of elastic arteries has no proteins for transportation of non-ligand oxidized low density lipoproteins (LDL) adsorbed on the matrix to resident macrophages. Phylogenetically early cells realize the reaction of extracellular digestion by secreting the proteolytic enzymes metalloproteases in the matrix. They hydrolyze matrix proteoglycans, adsorbed and non-ligand LDL, absorb detritis, and terminate hydrolysis of the most hydrophobic polyenic cholesterol esters (poly-CE) in lysosomes. Smooth muscle cells migrate from arterial media, change their phenotype from contractile to synthetic and produce in situ de novo matrix proteoglycans. Elastic arterial wall consists of three layers: a) endothelial monolayer, b) intima + media (smooth muscle cells) and b) adventitia. It seems reasonable to define functional differences between phylogenetically early resident macrophages and phylogenetically late monocytes→macrophages. They may be associated with scavenger receptors, CD36 translocase activity, production of acid hydrolases for poly-CE or realization of the biological reaction of extracellular digestion. We suppose that atheromatous masses are formed in the matrix of arterial intima but not in lysosomes when the ability of monocytes→macrophages to provide endocytosis of non-ligand LDL from the matrix is limited. If atheromatosis is a syndrome caused by intracellular deficiency of essential polyenic fatty acids (PFA), intimal atheromatosis is associated with partial utilization of excess PFA in the matrix of elastic arteria. At late stages of phylogenesis the intima formed from smooth muscle cells of the media.
Key words: atherosclerosis, atheromatosis, intima, macrophages, monocytes.

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LAMIN A/C GENE (LMNA) MUTATIONS IN PATIENTS WITH DILATED CARDIOMYOPATHY AND THEIR PHENOTYPIC MANIFESTATION
Vaikhanskaya T.G., Sivitskaya L.N., Danilenko N.G., Kurushka T.V., Davydenko O.G.

This article presents the current view on the structure and functions of nuclear lamin proteins, pathological phenotypes of persons with LMNA mutations and clinical problems of lamin-related dilated cardiomyopathy diagnostics and management. Dilated cardiomyopathy (DCM) caused by mutations in the LMNA gene is often associated with conduction disorders, cardiac arrhythmias and extracardiac features with discrete muscle disruption. This disease is characterized by a poor prognosis and high risk of sudden cardiac death due to conduction disturbances (life-threatening blockade) or ventricular tachyarrhythmias (fatal ventricular tachycardiasfibrillation). We describe here 2 cases of lamin-type DCM associated with definite LMNA mutations. Educational focus for reader-cardiologist is а recognition of potential carriers followed by molecular genetic testing for diagnostics of LMNA mutation and tissues regarding optimal management of patients, especially timing for prophylactic cardioverter-defibrillator.
Key words: nuclear lamin proteins, LMNA gene mutations, dilated cardiomyopathy (DCM), life-threatening arrhythmias, cardioverter-defibrillator.

 

CLINICAL AND HEMODYNAMIC PROFILE AND NEUROHORMONAL INDICATORS IN PATIENTS WITH IDIOPATHIC PULMONARY HYPERTENSION, DEPENDING ON VASOREACTIVITY RESERVE OF PULMONARY ARTERIES
Paramonov V.M., Martynyuk T.V., Dadacheva Z.H., Danilov N.M., Masenko V.P., Chazova I.Ye.

Clinical and hemodynamic profile and neurohormonal indicators in patients with idiopathic pulmonary hypertension, depending on vasoreactivity reserve of pulmonary arteries.
Objective: the main objective of our research work was an evaluation of clinical and hemodynamic profile, neurohormonal indicators in patients with IPH, depending on the results of vasoreactivity testing.
Methods: the study included 131 patients with IPH (mean age 32,4±3,2 years. All the patients underwent the routine laboratory tests, 6-minuts walking test (6-MWT), transthoracic echocardiography, thorax organs radiography, right heart catheterization (RHC) with acute pharmacological test (APT) using one or two vasodilators (VD) In order to study neurohumoral status the analysis of the 6-keto-PgF1b, NO, ET-1, norepinephrine, epinephrine levels, NT-proANP, NT-proBNP (NUP), renin activity, AII, aldosterone (RAAS) activity was conducted.
Results: significant differences of clinical and hemodynamic profile and neurohormonal indicators in patients with IPH depending on the availability (APT +) and absence (APT-) of the vasoreactivity reserve of pulmonary arteries (PA) were established. Among the APT- patients the number of patients belonging to FC III was significantly greater in comparison with APT+ patients. FC IV refered only to the APT- patients. Significantly more patients with APT+ belonged to FC I and II. The 6-MWT revealed that patients with IPH with intact vasodilation reserve overcame significantly longer distance. Doppler echocardiography showed that in APT- group a greater level of systolic pressure in the pulmonary artery (SPPA). When comparing the RHDC data all the hemodynamic parameters in the groups varied considerably, prognostically better data marked APT+ group. According to thorax organs radiography APT- group had significantly higher leel of KTI. Comparative evaluation of neurohumoral status, regardless of the outcome of the APT, showed a significant difference in the groups.
Conclusion: the group of responders in comparison with the APT- patients group indicated more safe clinical-hemodynamic and functional status, and neurohumoral rates in the responders group were closer to the outcome in the control group.
Keywords: idiopathic pulmonary hypertension, acute pharmacological testing, right heart catheterization, neurohormonal indicators.

 

MONTHLY AND SEASONAL DYNAMICS OF DEATH CASES CAUSED BY THE DISEASES OF THE CIRCULATORY SYSTEM IN BAKU
Azizov V.A., Hatamzadeh E.M., Ibrahimova Sh.S., Efendiyeva L.G., Sadygova T.A.

Purpose: to assess the dynamics of the seasonal risk of death cases in metropolis on example of Baku city.
Materials: medical certificates of all death cases registered in Baku during 2013 year (totally 12241, including 7971 cases connected diseases of the cir­culatory system).
Methods: descriptive statistics of the average daily death cases, analysis methods of quality share signs of the circulatory system diseases amoung causes of death, correlation and regression of the relationship between with the possibility of death and the seasonal dynamics.
Results: average monthly cases of death from all reasons and from BCSD made respectively: 1020±34,2 and 664,3±28,3. BCSD share among causes of death in a year made 65,1±0,4%. Average daily quantities of death cases from all reasons and from BCSD respectively made: 33,5±1,24 and 21,8±1,04. Higher than a median (33,4) average daily cases of death from all reasons were observed in February (43,0), March (37,2), April (34,9) and November (36,5). Above a median average daily cases of death owing to BCSD (20,0) were noted in February (29,3), March (24,3), April (26,6), June (25,5), October (20,1) and November (20,4).
Average daily cases of death from all reasons for winter and spring period (35,8±1,57) statistically significantly (Р <;0,05) differed from average daily cases of death from all reasons for the summer-autumn period (31,3±1,49).
The average daily quantity of death cases owing to BCSD was maximum in spring, and is minimum in fall (respectively: 23,6± 1,2 and 19,8±0,4; Р<0,05). It is obvious that the risk of mortality owing to BCSD is more in winter and spring period, especially in spring.
The final result: despite the fact that the climate of Baku city is relatively mild, increasing of death risks in the winter and spring seasons are common. 
Keywords: blood circulatory system, death, monthly and seasonal dynamics.

 

psycho-emotional CHANGES In patients with CHRONIC HEART FAILURE
Маtskevich S.А., Barbuk О.А., Belskaya M.I., Zharankov K.S.

Objectives. To define the presence and severity of anxiety and depression stress and assess the impact produced on the life quality in subjects with CHF secondary to registered macrofocal (Q wave) myocardial infarction in medical history.
Material and methods. General clinical examinations, psychological testing.
Results. A total of 118 patients with II, III FC NYHA chronic heart failure were examined. Anxiety and depression events were defined in 46.6% of cases. As heart failure progresses, anxiety and depression symptoms increase, with the prevalence of anxiety in the presence of FC II and depression in the presence of FC III. Life quality in patients with concomitant anxiety and depression stress is significantly worse compared to patients with normal psychoemotional state.
Conclusion. Thus, individuals with CHF showed psychoemotional changes including anxiety and depression stress, which may adversely affect CHF course. Anxiety and depression symptoms increase as heart failure progresses.
Keywords: chronic heart failure, myocardial infarction, anxiety and depression stress, depressions, anxiety, life quality.

 

ATRIAL ASYNCHRONY AS A RISK FACTOR FOR ATRIAL FIBRILLATION
Djishambaev E.D., Sulaymanova S.K.

This article reviews the possibility of evaluating intracardiac intervals using two-dimensional echocardiography and tissue Doppler study of the heart in predicting the likelihood of atrial fibrillation. It is shown that the determination of the duration of the aforementioned interval is sufficiently informative method of assessment of inter – and intra-arterial conductivity, which in turn makes it possible to determine the risk of new cases of arrhythmia or progression of paroxysmal atrial fibrillation in chronic form.
Key words: atrial fibrillation, interatrial conduction time, intraatrial conduction time, atrial electromechanical interval, tissue Doppler echocardiography.

 

THE INFLUENCE OF OBSTRUCTIVE SLEEP APNEA AND PRIMARY SNORING ON CARDIAC ARRHYTHMIAS AND HEART RHYTHM VARIABILITY IN PATIENTS WITH ISCHEMIC HEART DISEASE
Tarasik E.S., Bulgak A.G., Zatoloka N.V.

The aim. The study and analysis of cardiac arrhythmias, heart rhythm variability in patients with ischemic heart disease, obstructive sleep apnea and primary snoring.
Material and methods. 65 patients aged 40-68 with ischemic heart disease, obstructive sleep apnea and primary snoring have been included in research.
Results. Obstructive sleep apnea and primary snoring leads to an increase in sympathetic and parasympathetic activity of autonomic nervous system on sinus node in patients with ischemic heart disease, obstructive sleep apnea and primary snoring.
Key words: cardiac arrhythmias, heart rhythm variability, ischemic heart disease, obstructive sleep apnea, primary snoring.

 

LIMITATIONS ON PRIMARY PERCUTANEOUS CORONARY INTERVENTION FOR ST-SEGMENT ELEVATION ACUTE MYOCARDIAL INFARCTION IN THE CLINICAL PRACTICE
Kashtalap V.V., Kochergina A.M., Makarov S.A., KHERASKOV V.Yu., Barbarash O.L.

Purpose: to assess the non-performance rate of primary PCI in STEMI patients and determine the factors influencing the choice of approach for the management of patients based on Kemerovo Cardiology Clinic’s experience in 2012.
Material and Methods: 492 patients aged 30 to 92 years, admitted to the MBHI "Kemerovo Cardiology Dispensary" (the Regional Vascular Center in 2012 with a diagnosis of ST-segment elevation myocardial infarction) were included in the single-center prospective registry study. The mean age of patients was 64.42 ± 10.86 years.
Results: over 20% of STEMI patients admitted to the Kemerovo Cardiology Dispensary did not undergo emergency coronary angiography (CAG). These patients were older, predominantly female (64%), commonly with repeated MI (44%) and with the presence of renal and myocardial dysfunction. The group of patients, who were not selected for CAG, had significant patient delay between onset of symptoms and hospital admission (9 hours from onset of symptoms to hospital admission in the group of patients who were selected to emergency CAG and 30 hours - in patients who were not selected for CAG).
Conclusion: according to the results of the study, we determined a group of patients (up to 20%), who did not receive high-tech medical services because of time delay and had less favorable outcomes after STEMI. Therefore, the development of algorithms is particularly important as they can reduce the time delay in the pre-hospital period, as well as active patient selection for coronary angiography during the in-hospital period.
Keywords: myocardial infarction, advanced age, primary percutaneous coronary intervention.

 

CLINICAL EFFICACY OF COMBINATION THERAPY WITH PERINDOPRIL AND INDAPAMIDE IN PATIENTS WITH MILD AND MODERATE ARTERIAL HYPERTENSION
Abdullayeva G.J., Khalikova A.B., Khamidullaeva G.A., Kurbanov R.D.

Aim: to study hypotensive and organo-protective efficacy of combination therapy with perindopril and indanamide in patients with mild and moderate arterial hypertension.
Material and methods. According to the protocol in the study included 23 patients with I-II grade of arterial hypertension (ESC/ESH 2013), of both genders. All patients took the combination preparation Amra forte (GMP, Georgia), containing 4 mg of perindopril and 1.25 mg of indapamide. At the stage before the treatment and 12 weeks of therapy was measured an office blood pressure by Korotkov’s method and carried out ambulatory blood pressure monitoring (ABPM) (“BR-102 plus Recorder” (SCHILLER, Switzerland)). Antiremodeling efficacy was assessed by the dynamics of cardiac echo geometry and ultrasound (US) of vessels parameters. Also was evaluated the clinical tolerance and metabolic effects of the drug. The parameters of central hemodynamics and vascular stiffness were measured by applanation tonometry. Results are presented as M±SD.
Results of research. 12-week combination therapy with perindopril and indapamide is characterized by high antihypertensive efficacy, with a decrease in mean blood pressure to 18%, and achievement the target level of blood pressure in 100% patients with mild and moderate arterial hypertension. According to the ABPM showed a significant decrease of average daily SBP and DBP, as well as a significant decrease in the speed of morning SBP surge. Thus it was not marked episodes of hypotension at night. Reliable antiremodeling efficacy of perindopril and indapamide is expressed in reducing LVMI, reducing of EDD and reliably reducing the thickness of IMC against the background of 12-week treatment. 12-week combination therapy with perindopril and indapamide showed renal protection efficiency, expressing in a significant decrease in blood creatinine level and almost twofold reduction of MAU level. Perindopril and indapamide in the mode of combination therapy in patients with mild and moderate arterial hypertension showed metabolic neutrality in relation to lipid and carbohydrate metabolism, clinical safety. A side effect as dry cough was observed in one patient only at the end of 12-weeks treatment (4.3%).
Conclusion. Therefore, our research showed a high antihypertensive efficacy of combination therapy with perindopril and indapamide with the available cardio-, vaso-, and nefroprotection, metabolic neutrality and clinical safety that recommends the preparation for the treatment of patients with mild and moderate arterial hypertension.
Key words: аrterial hypertension, left ventricular mass index, left ventricular hypertrophy, intimae-media thickness, microalbuminuria, perindopril, indapamide.

 

THE ALCOHOL CHOLESTEROL, ITS BIOLOGICAL ROLE DURING PHYLOGENESIS, MECHANISMS OF STEROL PRODUCTION BY STATINS, PHARMACOGENOMIC FACTORS AND DIAGNOSTIC VALIDIDTY OF LOW DENSITY LIPOPROTEIN CHOLESTEROL
Titov V.N.

The article was retracted on 11.11.2019

Hypolipidemic activity of statins is realized by inhibition of the alcohol cholesterol (CL) local pool production in hepatocyte endoplasmic reticulum. Before secretion of very low density lipoproteins (VLDL) into hydrophilic medium of the blood, CL covers the total hydrophobic mass of triglycerides (TG). The smaller the CL content in the monolayer between the enzyme (lipase) and substrate (TG), the higher the parameters of hydrolysis of palmitic and oleic VLDL. Statins act as follows: а) block hepatocyte production and decrease plasma content of nonesterified CL; b) activate TG hydrolysis in palmitic and oleic VLDL, formation of ligand VLDL and their uptake by insulin-dependent cells via apoЕ/В-100 endocytosis; c) activate TG hydrolysis in linolic and linolenic low density VLDL, formation of ligand low density lipoproteins (LDL) and their uptake by apoВ-100 endocytosis; d) reduce blood content of equimolary esterified by the alcohol CL polyenic fatty acids, CL esters and CL-VLDL. Nonphysiological effect of impaired function of trophology (nutrition) on fatty acid (FA) metabolism in a population cannot be abolished by prescribing medicines. For lowering cardiovascular morbidity it is necessary to modify environmental factors, i.e., reduce dietary content of saturated FA (primarily of palmitic), trans-FA and palmitoleic FA to physiological levels and increase dietary content of unsaturated FA. Saturated FA block cellular uptake of unsaturated FA. Deficiency of unsaturated FA and excess of palmitic FA lead to the development of atherosclerosis.
Key words: cholesterol, statins, saturated fatty acids, polyenic fatty acids, palmitic acid.

Download Eurasian heart journal №4 2015

ACCORDING TO THE RESULTS OF THE EUROPEAN CONGRESS OF CARDIOLOGY 2015: NEW VERSION OF GUIDELINES FOR DIAGNOSIS AND TREATMENT OF PULMONARY HYPERTENSION
Chazova I.Ye., Martynyuk T.V., Nakonechnikov S.N.

 

INNOVATION IN PHARMACEUTICAL TREATMENT OF PULMONARY ARTERIAL HYPERTENSION: STIMULATOR OF SOLUBLE GYANYLATE CYCLASE – RIOCIGUAT
Taran I.N., Martynyuk T.V., Nakonechnikov S.N., Chazova I.Ye.

Pulmonary arterial hypertension (PAH) is a rare disease, diagnosed at a late stage with low functional class III or IV (WHO). PAH leads to severe right heart failure and ultimately, death.
The modern researches aim at exploring the potential therapeutic targets, as at developing new drugs that can affect the previously set target. Impaired NO production plays an important role in PAH pathogenesis; this is determined by the powerful vasodilatory action, as well as anti-inflammatory, anti-proliferative, and antiaggregatory effects.
Riociguat is the first in a new class of soluble guanylatecyclase stimulators to have proved efficacy in phase II of clinical trials. In the randomized, double-blind, placebo-controlled phase III study PATENT-1 (Pulmonary Arterial Hypertension soluble Guanilatcyclase-Stimulator Trial) study, 443 patients with PAH symptoms were randomized to receive placebo of riociguat in a single dose of 2,5 mg (with a dose titration based on tolerability to 2,5 mg TID a day) or a dose of 1,5 mg (with a dose titration according to portability to 1,5 mg TID three times a day). The study included naïve patients treated with endothelin receptor antagonists or prostanoids (except for parenteral ones). To 12wk of riociguat treatment the mean distance in 6-MWT increased by an average of 30 m in the group treated with the maximum single dose of 2,5 mg TID, or decreased by an average of 6m in the placebo group (difference between groups, 36 m, 95% confidence interval 20–52 m, p p<0,001). Riociguat improved 6-MWT in patients not previously treated with PAH-specific therapy (38 m), and in patients, taking endothelin receptor antagonists or prostanoids (36 m). In riociguat groups compared with placebo a decrease in PVR and PAPm (p<0,01) was noted, as well as an increase in cardiac index (p<0,0001) , a reduction in NT-proBNP (p<0,0001) , FC (p=0,003) and in the Borg index (p=0,002), ), the time of development of clinical deterioration (p=0,005) prolonged as well. Riociguat therapy was also characterized by good tolerance. Efficacy of treatment was maintained during long-term observation of PATENT-2study. The mean value of 6-MWT changed to 51±74?м one year after observation, functional class (WHO) was increased in 33% , the stabilization of functional class was observed in 61 % patients and deterioration in 6 % patients, compared with baseline of PATENT-1.
Key words: pulmonary arterial hypertension, nitric oxide, guanylatecyclase stimulators, riociguat, phosphodiesterase type 5 inhibitors.

 

PERFUSION LUNG SCINTIGRAPHY IN PATIENTS WITH A PULMONARY HYPERTENSION OF A VARIOUS ETIOLOGY
Arkhipova O.A., Martynyuk T.V., Samoilenko L.E., Sergienko V.B., Chazova I.Ye.

The pulmonary hypertension is characterized by increase of pulmonary vascular resistance, pressure in a pulmonary artery, remodeling of heart and vessels and the lowest survival of patients. It agrees offered in 2009 the European society of cardiologists to algorithm a ventilation/perfusion scintigraphy takes the central place in differential diagnostics between various forms of a pulmonary hypertension. The scintigraphic picture is well studied at patients with the pulmonary hypertension which has developed owing to the transferred thromboembolism of branches of a pulmonary artery. The distributions of RFP given direct comparison and nature of changes of perfusion depending on a genesis of pulmonary hypertension and gravity of a disease in literature aren't presented. At the same time the knowledge of features of scintigrams can be useful in differential diagnostics and a forecast assessment at patients with a pulmonary hypertension of a various etiology.
Keywords: perfusion lung scintigraphy, pulmonary hypertension, quantitative assessment of scintigrams.

 

THE ROLE OF N-TERMINAL PRO-C-TYPE NATRIURETIC PEPTIDE AS A DIAGNOSTIC BIOMARKER OF PULMONARY HYPERTENSION IN COPD PATIENTS
Gaynitdinova V.V., Sharafutdunova L.А., Avdeev S.N.

Objective. Available data on the diagnostic value of determination of the concentration N-terminal pro-C-type natriuretic peptide (Nt-proCNP) to predict pulmonary hypertension (PH) in patients with COPD are few.
Aim. To determine the concentration of NT-proCNP in COPD patients and evaluate its diagnostic value for the prediction of PH in COPD.
Methods. The study involved 47 patients with COPD (GOLD II-IV, age 59,49±0,63 years, disease duration 13,7±0,63 years, smoking history 23,09±0,93 packs/years). NT-proCNP concentration in serum was assessed by ELISA technique (test Biomedica Medizinprodukte GmbH & Co KG, Austria). The pulmonary artery systolic pressure (SPAP) was analyzed by using a color-Doppler technique.
Results. Concentrations of NT-proCNP were significantly higher in COPD patients with PH (SPAP 40-55 mmHg, n=16) or severe PH (SPAP ≥55 mmHg, n=10) than in patients without PH (SPAP < 40 mmHg, n=21): 4.14±0.51 pg/ml, 5.26±0.21 pg/ml and 1.42±0.03 pg/ml (p<0.001), respectively. A significant correlation was found between the concentration of NT-proCNP and SPAP (r=0.53; p<0.05). The AUC for Nt-proCNP levels to predict PH and severe PH in COPD were 0.928 and 0.932, respectively.
Conclusion. The present study shows that the serum levels of NT-proCNP are significantly elevated in COPD patients with PH and can be used as a non-invasive specific biomarker for predicting PH in COPD.
Key words: chronic obstructive pulmonary disease, pulmonary hypertension, N-terminal pro-C-type natriuretic peptide (Nt-proCNP).

 

PULMONARY ARTERIAL HYPERTENSION ASSOCIATED WITH A SYSTEMIC SCLEROSIS: REVIEW OF LITERATURE
Yudkina N.N., Volkov A.V.

The review is devoted to a problem of the pulmonary arterial hypertension associated with a systemic sclerosis. Data on prevalence, genetic aspects, clinical features and the diagnostic algorithms used for early diagnostics of this fatal manifestation of a system sclerosis are submitted.
Key words: systemic sclerosis, pulmonary arterial hypertension.

 

CLINICAL CASE: THERAPY WITH SILDENAFIL IN THE TREATMENT OF IDIOPATHIC PULMONARY HYPERTENSION
Valieva Z.S, Dadachеva Z.H., Martynyuk T.V., Danilov N.M., Saidova M.A., Chazova I.Ye.

The patient with the verified diagnosis of idiopathic pulmonary hypertension, negative acute vasoreactivity testing by RHC, functional class III (WHO) was treated by phosphodiesterase type 5 inhibitor sildenafil. After one year there was achieved the significant improvement of the functional and hemodynamic status.
Keywords: idiopathic pulmonary hypertension, phosphodiesterase type 5 inhibitor, sildenafil.

 

CLINICAL CASE OF SUCCESSFUL 10-YEAR AMBRIZENTAN TREATMENT OF THE PATIENT WITH IDIOPATHIC PULMONARY ARTERIAL HYPERTENSION
Martynyuk T.V., Saidova M.A., Danilov N.M., Lazutkina V.K., Chazova I.Ye.

Idiopathic pulmonary arterial hypertension (IPAH) is a rare cardiovascular disease of unknown etiology, characterized by pulmonary vascular resistance (PVR) and pulmonary artery pressure (PAP) increase due to pronounced remodeling of small pulmonary arteries and arterioles, with progressive deterioration and the rapid development of right ventricle failure. The key pathogenetic feature is the endothelial dysfunction, which leads to the development of vasoconstriction, thrombosis in situ, proliferative and inflammatory changes in the lung microvasculature.
Optimization of drug therapy is associated with the clinical implementation of highly effective pathogenetic drugs which act on the main disease targets - activation of endothelin-1 (ET-1) system, the lack of endogenous prostacyclin and nitric oxide. The role of ET-1 as a powerful vasoconstrictor that induces cell proliferation and differentiation, production of cytokines, growth factors, biologically active substances.
Endothelin receptor antagonists (ERA) represents the important class of PAH-specific therapy, including two non-selective ERAs- nonselective bosentan and selective ambrizentan. Presented clinical case demonstrates the long-term reliable efficacy and safety of ambrizentan for 10 years in the IPAH patient with the baseline functional class III (WHO).
Key words: idiopathic pulmonary hypertension, endothelin-1, endothelin receptor antagonists, ambrisentan.

Download Eurasian heart journal №3 2015

CLINICAL GUIDELINES ON DIAGNOSIS AND TREATMENT OF MYOCARDITIS
PROGNOSTIC SIGNIFICANCE OF TISSUE DOPPLER IMAGING IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY
Komissarova S.M., Zacharova E.Y., Ustinova I.B., Sevruk T.V., Krasko O.V.

Objective: To assess the value of tissue Doppler (TD) imaging in predicting the clinical course of patients with hypertrophic cardiomyopathy (HCM).
Material and methods. Clinical and demographic data were analyzed in 212 subjects with HCM (141 males and 107 females, mean-age 45 yo). Median follow-up was 3,2 years (0,7-12,5 years). Patients were stratified into two groups: with present or absent adverse outcomes.
Results. Over the follow-up period, 7 fatal cases were registered due to SCD, and 4 successfully resuscitated subjects who experienced SCD received implantable pacemaker, 6 patients developed a stroke, cardiovascular death (1 patient) or hospitalization due to worsening of heart failure symptoms developed 7 patients. A statistically significant factor associated with adverse outcomes in cohort examined was возраст (ОR 0,94; 95% CI 0,90 -0,98; p<0,001); LV outflow tract gradient (ОR 1,04; 95% CI 1,01 -1,04; p<0,001); LAV/BSA (ОР 1,06; 95% CI 1,02 – 1,10; p<0,004) и Е/Еm lat (ОR 1,37; 95% CI 1,12-1,67; p<0,002.
Conclusion. There has been shown in our study that ratio E/Em lat was the most significant prognosis factor: increasing of E/Em by 1 CU followed by 37% increasing of relative risk of adverse effect appearance.
Keywords: hypertrophic cardiomyopathy, tissue Doppler imaging, cardiac and cerebrovascular events.

 

THE PREDICTIVE VALUE OF THE INDEX BAEVSKY AND ITS RELATIONSHIP WITH CLINICAL AND FUNCTIONAL DATA IN PATIENTS WITH ISCHEMIC HEART DISEASE
Nagaeva G.A., Kurbanov R.D., Yuldashev N.P., Mirzaliyevа N.B.

Objective. To evaluate the prognostic significance Baevsky-index (BI), during the bicycle exercise test, in comparison with the data of coronary angiography (CAG) in patients with chronic ischemic heart disease.
Material and methods. The study involved 116 patients with chronic ischemic heart disease (men – 84.5%) of them with angina pectoris functional class 2 – 47 (40.5%), functional class 3 – 69 (59.5 %) patients. The average age of the subjects = 56,99±9,29 years. From the 116 surveyed 62 (53.4%) patients had a history of myocardial infarction.
More than 80% of the patients in the subsequent CAG were performed. Depending on the values of the BI patients were divided into 4 groups: 1gr. – 37 (31.9%) patients with BI <2.6; 2gr. – 31 (26.7%) patients with BI = 2.6-2.9; 3gr. – 40 (34.5%) of persons with BI = 3.0-3.5 and 4gr. – 8 (6.9%) patients with BI > 3.5.
Results. More than 85% of the patients were characterized by the presence of excess weight, and in 4gr. – 100% of patients. Also in 4gr. patients, lipid profile, in comparison with those in groups 1-3, were slightly lower and atherogenic index (AI) – was the smallest. Analysis of the echocardiographic parameters, in addition to the relative left ventricular dilatation, testified about reducing the contractile function of the heart muscle, and a more severe diastolic dysfunction in patients 4gr. According bicycle exercise tests, it was found that patients 4gr. characterized by the lowest level of maximal oxygen consumption (MOC 4gr. = 3,46 ± 0,94 MET, that is 22.9%, 16.6% and 12.6% was lower than in groups 1-3, respectively), and with the growth of values ??BI noted decline in the index of Duke. According to the CAG, the average score on the SYNTAX score reaches a maximum value in people 4gr. Correlation analysis found an inverse relationship between the BI and the index of Duke (p>0,05). At the same time, by comparing the value of BI and CAG data, in particular the amount of vascular lesions, direct correlation was observed (p<0.05).
Conclusion. Baevsky index has a direct correlation with the quantitative coronary lesion vessels and can be recommended as a predictor of more severe coronary lesions in patients with chronic ischemic heart disease in the outpatient practice.
Keywords: Baevsky index, bicycle stress test; Index of Duke; coronary angiography.

 

SERELAXIN IN THE STRATEGY OF MANAGEMENT THE PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE: FROM DECREASING OF SYMPTOMS TO THE IMPROVEMENT OF SURVIVAL
Zhirov I.V., Tereschenko S.N.

In this review data of clinical investifation of serelaxin were briefly outlined. In these trials administration of serelaxin just after admission in the hospitals was acoompanied by middle-term improvement of survival of patients with acute decompensated heart failure.
Keywords:acute decompensated heart failure, serelaxine.

 

OUT-PATIENT METHODS OF REGISTRATION OF BLOOD PRESSURE IN CLINICAL PRACTICE
Kotovskaya Yu.V., Kobalava J.D.

In spite of the fact that clinical measurement of blood pressure which meets methodical requirements is still a basis for diagnostics of arterial hypertension and assessment of treatment efficiency, it is widely recognized that proper diagnostics and management of patients with arterial hypertension are impossible based only on the measurements of blood pressure which are carried out by doctor.
The out-patient methods of blood pressure monitoring – daily monitoring (ABPM) and measurement of blood pressure at home (home blood pressure monitoring (HBPM)) – enable to overcome restrictions of clinical measurement of blood pressure. The combined use of clinical and out-patient measurement of blood pressure significantly expands understanding of Blood Pressure phenotype at the stage of diagnostics and assessment of treatment efficiency, especially at discordance of their results. Only by means of these methods it is possible to detect white-coat hypertension and masked hypertension.
The existing out-patient methods of blood pressure monitoring, its description, comparison, advantages and disadvantages, its places in modern recommendations and clinical practice guidelines as requirements to technique are provided in this article.
Keywords: HBPM (home blood pressure monitoring), ABPM (ambulatory blood pressure monitoring), arterial hypertension, Guidelines, Antihypertensive treatment, Blood pressure, Blood pressure, Measurement, Validation

 

Complex evaluation parameters of central aortic blood pressure AND MAIN ARTERIES STIFFNESS IN PATIENTS WITH CORONARY ARTERY DISEASE, DEPENDING ON THE PREVALENCE OF ATHEROSCLEROSIS
Nizamov UI, Bekmetova FM, Khoshimov ShU, Shek AB, Kurbanov RD

Objective: to study the parameters of central aortic blood pressure and main arteries stiffness in patients with coronary artery disease (CAD) depending on the prevalence of atherosclerotic lesions.
Material and methods. The study involved 90 patients with a diagnosis of unstable angina class II B (E. Braunwald et al., 1989) the control group consisted of 27 healthy people. The method of applanation tonometry using the apparatus of SphygmoCor («AtCor Medical», Australia) studied the performance stiffness: pulse wave velocity (PWV) and augmentation index (AIx). Coronary angiography was performed at the facility Allura CV-20 (Philips, The Netherlands), the state of the carotid arteries was studied by duplex ultrasonography, evaluation of involvement of femoral arteries was based on ankle-brachial index <0.9, in case of doubt, underwent ultrasound duplex scanning. In the main group, patients were divided into 3 subgroups: subgroup A defined patients with isolated coronary lesion; subgroup B was presented by patients who diagnosed combined lesion: coronary arteries with carotid arteries or coronary arteries with femoral arteries; subgroup C was presented with multifocal atherosclerosis patients who had atherosclerosis lesion in three vascular beds: the carotid, coronary and femoral arteries.
Results. Values PWV (11,2±1,5 m/s), and AIx (19,8±5,0%) in patients with CAD were, respectively, 1.5 (p<0.001) and 2.4 (p<0.001) times higher than in healthy persons. During the intra-group analysis in all three subgroups PWV was accelerated, with maximum values in the subgroup C (13,3±1,5 m/s), which significantly exceeds the value of this index in the subgroup A (10,1±0,6, p<0.01) and B (11,0±0,9, p<0.05). The value of augmentation index AIx was also highest in the subgroup C 26,8±6,4%, relative to the subgroup A (13,7±2,9%, p<0.001) and subgroup B (18,9±4,3%, p<0, 01).
Conclusion. The obtained results allow to recommend studied parameters of vascular stiffness as surrogate markers to assess the prevalence and progression of atherosclerosis, as well as efficacy of pharmacological interventions.
Keywords: coronary artery disease, pulse wave velocity, coronary and multifocal atherosclerosis.

 

INVERSION OF THE CONCEPT ABOUT BIOLOGICAL ROLE OF RENIN→ ANGIOTENSIN-II→ ALDOSTERONE SYSTEM AND FUNCTION OF ARTERIAL BLOOD PRESSURE AS A METABOLISM REGULATOR
Titov V.N.

The phylogenetic theory of general pathology postulates an inversion of the concept about the role of arterial blood pressure (AP) in physiology and pathology. Activation of the synthesis of the renin→angiotensin-II (AG-II) system components by nephron and increase in aldosterone secretion are not aimed at elevating AP, but at maintaining the volume of extracellular medium, part of the Third Word Ocean where all cells still live as millions of years ago. Phylogenetically early internal organs cannot regulate the effects of phylogenetically late AP, a physical factor of metabolism. AP is not increased by kidneys, but by the vasomotor center that attempts to reanimate nephronal function, the biological function of endoecology and biological reaction of excretion by increasing AP in proximal and, subsequently, hydrodynamic pressure in the distal region of arterial bed. In addition to the major role in the realization of the biological function of locomotion, AP is a physical factor involved in compensation of impaired functions of homeostasis, trophology, endoecology and adaptation. Levels of metabolism regulation have developed during phylogenesis. Biochemical reactions are specifically regulated at the autocrine level. In paracrine-regulated cell communities of distal arterial bed, metabolism is regulated by millions of local peristaltic pumps by compensating the biological reactions of endothelium-dependent vasodilation, microcirculation, effects of humoral messengers and hormones. In vivo metabolism is regulated nonspecifically from the vasomotor center level by a physical factor (AP) by sympathetic activation of the heart; AP in proximal and distal regions of arterial bed overcomes peripheral resistance and «squeezes through» the arterioles where microcirculation is impaired. AG-II acts as a vasoconstrictor only in the distal arterial bed. In essential (metabolic) arterial hypertension, paracrine cell communities of nephrons and kidneys are involved in realization of pathologic compensation in the second turn and often “suffer being innocent” , similar to other “target” organs”, such as brain, lungs and heart.
Key words: phylogenesis, extracellular medium, angiotensin-II, aldosterone, microcirculation, arterial pressure.

 

WAYS TO IMPROVE TREATMENT EFFICIENCY OF PATIENTS WITH HIGH CARDIOVASCULAR RISK
Baryshnikova G.A., Chorbinskaya S.A., Stepanova I.I.

Отозвана 11.11.2019 г.

To reduce the overall cardiovascular risk it is advisable to use a combination of drugs – the poly-pill that will increase the effectiveness of therapy and patient compliance. The company «Gedeon Richter» has created a polypill – the Ekvamer medication, which in addition to amlodipine and lisinopril includes rosuvastatin – one of the most powerful and safe statins to date that will provide hosting and primary and secondary prevention of cardiovascular diseases and their complications.
Keywords: cardiovascular risks, polypill, therapy effectiveness, compliance, Ekvamer.

Download Eurasian heart journal №2 2015

CLINICAL GUIDELINES ON DIAGNOSTICS AND TREATMENT OF ARTERIAL HYPERTENSION
Developed by experts of the Russian Medical Society of hypertension approved at the plenary meeting of the Russian Medical Society of Arterial Hypertension 28 November 2013 and the profile commission on cardiology November 29, 2013

 

CHARACTERISTICS OF CORONARY ATHEROSCLEROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS
Azizov V.A., Soltanova M.D., Sadiqova T.A.

Purpose of this study was examination of the features of coronary vessels in patients with rheumatoid arthritis (RA) using CT angiography. Materials and Methods: results of CT angiographic studies of 60 patients with varying degrees of coronary vessels pathology were retrospectively analyzed. 27 of them had a history of RA. The control group included 33 patients who had no medical history and clinical symptoms of rheumatic disease. The degree of calcification of the coronary arteries was calculated according to the Agatston degree. Processing of the results was carried out on Excel and Statistica 6.0. Results: The study found that coronary calcification in the control group patients averaged 289, and in patients with RA 305 HU (p<0.05). In addition, the dependence of the Agatston degree, patient's age, smoking and diabetes history was revealed. Conclusions: comparing to the control group coronary calcification was higher in patients with rheumatoid arthritis. A direct correlation between the value of the calcification index and RA activity, as well as risk factors such as age, smoking, and diabetes was revealed.
Key words: coronary atherosclerosis , rheumatoid arthritis, CT angiography.

 

CLINICAL ASPECTS OF MYOCARDIAL ELECTRICAL INSTABILITY IN CHRONIC IHD
Karpova I.S., Manak N.A.

The aim of the study was to assess associations between myocardial electrical instability estimates (heart rhythm turbulence, T- wave microvolt alternation, QT dispersion) and structural and functional changes in heart in the settings of IHD with ventricular premature beats. Eighty two subjects with exertional angina (NYHA FC II-III) and Lown Grade 3-5 class ventricular arrhythmia were examined. Controls included 28 pts. with chronic IHD with no arrhythmias. Heart rhythm turbulence, T- wave alternation and QT dispersion were defined based on 12- lead ECG data with record duration of 5 minutes using Intecard-7 apparatus. All patients underwent common clinical examination, 60-lead electrocardiogram (ECTG-60), ECG daily monitoring test (SMECG) (Cardian, Belarus), bicycle ergometric test, short ECG recording vagal sympathetic balance was estimated (using Briz Program Package and SMECG). IHF subjects who had Lown Grade III-V class ventricular arrhythmia had a higher frequency of heart rhythm turbulence disturbance, higher T microvolt alternation estimates and QT dispersion. Close relationship between myocardial electrical instability parameters (heart rhythm turbulence, T microvolt alternation and QT dispersion) and myocardial ischemic signs, LVEF, and heart rhythm variability in chronic IHD have been identified.
Key words: heart rhythm turbulence, T microvolt alternation, QT dispersion, exertional angina, chronic IHD.

 

APPLICATION OF PHOSPHODIESTERASE TYPE 5 INHIBITORS SILDENAFIL IN PATIENTS WITH PULMONARY HYPERTENSION
Martynyuk T.V., Dadacheva Z.H., Paramonov V.M., Arkhipova O.A., Nakonechnikov S.N., Chazova I.Ye.

The key component of the pathogenesis of pulmonary hypertension (PH) is endothelial dysfunction with imbalance between vasodilators and vasoconstrictors and activation of the blood coagulation system. Randomized trials showed a beneficial effect of phosphodiesterase type 5 (PDE-5) inhibitors on vascular remodelling and vasodilatation in pulmonary arterial hypertension (PAH). Sildenafil is the only PDE-5 inhibitor that is officially approved by Pharmacological Commitee in our country. PDE-5 inhibitors by blocking the breakdown of cyclic guanosinemonophosphate (cGMP) resulted in prolongation of the action of vasoactive mediators including nitric oxide (NO) that cause vasodilation and antiproliferation in the lung. Sildenafil demonstrated the efficacy in uncontrolled clinical studies in pts with idiopathic pulmonary hypertension, PAH due to systemic connective tissue disease, congenital heart defects, with pulmonary embolism. 25-75mg at doses 2-3 times a day in patients with improved pulmonary hemodynamics, exercise tolerance. Basis for the authorization of this drug in the setting of PAH was a large randomized, placebo-controlled trial in which different doses of sildenafil were assessed in 278 patients presenting with idiopathic PAH, PAH related to connective tissue disease or congenital systemic to pulmonary shunts surgically corrected. After three months of treatment significant hemodynamic and functional class improvements were noted in every sildenafil group as compared to placebo. An approved dose is 20 mg three times a day, but in clinical practice often higher doses of 40-80 mg to 3 times per day are in need. Stable long-term efficacy of Sildenafil was observed with the dose of 80 mg 3 times a day in SUPER-2 trial. PACES trial demonstrated the efficacy of sildenafil in combination with intravenous epoprostenol.
Key words: pulmonary hypertension, pulmonary arterial hypertension, nitric oxide, cyclic guanosine-monophosphate, PDE-5 inhibitors, sildenafil.

 

CARDIAC REHABILITATION IN BELARUS: CURRENT STATUS OF THE PROBLEM
Sujayeva V.A., Sudzhayeva S.G.

Authors brought historical way of cardiac rehabilitation as sciences. There was described evolution terms and intensity of physical rehabilitation since XVIII century and so far. The separate attention was paid on social importance of cardiac rehabilitation and on its influence on resistant and temporary disability. There was provided not only historical review of cardiac rehabilitation status in countries of Western Europe and the USA but also data about cardiac rehabilitation in the USSR. In USSR in the 90th years of the XX century scientifically based program of physical rehabilitation and after myocardial infarction was created. Separate attention was paid on formation of cardiac rehabilitation in Republic of Belarus taking into account changes of organizational model rehabilitation help and also new medical, diagnostic and cardiosurgical technologies have been developed. Scientific researches in the field of cardiac rehabilitation have started in Republic of Belarus since 80th years of the XX century. Authors described newly created rehabilitation classification of patients after myocardial infarction and percutaneous coronary intervention. They studied the influence of thrombolytic therapy, percutaneous coronary intervention and developed rehabilitation programs on outcomes in patients after myocardial infarction. Significant effect of developed program of cardiac rehabilitation revealed by authors dictate the necessity of development and widespread similar rehabilitation programs for all categories of cardiac patients.
Keywords: complex cardiac rehabilitation, organization, staging, rehabilitation classification, mortality, disability.

 

PERSONALIZED STATIN THERAPY IN IMPROVING THE TREATMENT OF CORONARY ARTERY DISEASE AND ATHEROSCLEROSIS
Makhmudova U.R., Hoshimov Sh.U., Abdullayeva G.J., Shek A.B., Kurbanov R.D.

This review examines the possibility of personalized pharmacotherapy with statins, based on the genotype of the individual patient. Identification of polymorphism of genes, responsible for the metabolism of the liver CYP3A5, CYP2C9 and transport of statins into the liver SLCO1B1, BCRP allows differentiated approach to their appointment and choice. This will not only increase the effectiveness of statins, but also to avoid serious side effects, primarily statin-induced myopathy and toxic hepatitis.
Key words: statins, hepatic metabolism genes polymorphisms, personalized pharmacotherapy.

Download Eurasian heart journal №1 2015

RECOMMENDATIONS FOR THE DISPENSARY OBSERVATION OF PATIENTS WITH CARDIOVASCULAR DISEASE
Ageev F.T., Akchurin R.S., Buza V.V.,Vlasova E.E., Golitsyn S.P., Efremova Yu. Ye., Karpov Yu.A., Kukharchuk V.V., Malkina T.A., Martynyuk T.V., Mironova N.A., Nakonechnikov S.N., Oshchepkova E.V., Ruda M.Ya., Sorokin E.V., Skvortsov A.A.,Tereshchenko S.N., Chazova I.Ye., Chihireva L.N., Chikhladze N.M., Sharipova G.H., Yuricheva Yu.A.

 

INFLUENCE OF THE FACTOR FAMILY HISTORY ON THE RISK OF CORONARY HEART DISEASE
Behbudova J.A.

For the purpose of investigating the correlation between incidence of myocardial infarction (MI) and family history of cardiovascular disease (CVD), the study of prevalence of CVD among the first-degree relatives of patients with a known MI episode has been conducted. Medico-genetic files of two groups of patients with evidence of MI on ECG at rest have been analyzed: first group comprising patients who had an episode of MI before 55 years of age and second group comprising patients who had an episode after 55 years of age. A fairly high percentage of CVD in families of majority of patients with a known episode of MI has been noticed. However, this study has demonstrated a relatively low prevalence of coronary artery disease (CAD) and MI, including MI episodes before the age of 55, among fathers of patients from both groups. Moreover, occurrence of CAD and MI in fathers of the subgroup of patients who suffered from MI before 50 years of age of these patients practically showed no difference from that of subgroups of patients with episodes of MI at an older age. A fairly large amount of patients in both groups had no history of CAD in their families (41,5% and 41,2%, respectively). Considering the results mentioned above, there is no evidence to suggest that a predisposition of patients to MI episode at a younger age increases with existence of this disease in fathers of such patients. Results of our study suggest that increased presence of CVD and risk factors in first-degree relatives increases the probability of MI CAD in most patients of both groups regardless of the age of development of an MI episode.
Key words: cardiovascular diseases, myocardial infarction, family history

 

THE ESTIMATION OF INDICATORS OF CENTRAL HAEMODYNAMICS IN INTERRELATION WITH TOLERANCE TO PHYSICAL ACTIVITY AT PREGNANT WOMEN WITH MYOCARDITIS
Zakirova F.A., Bekbulatova I.R., Yusupbaev R.B.

Within the limits of research indicators of central hemodynamics in interrelation with tolerance to physical activity at pregnant women with myocarditis were estimated. 109 pregnant women from 19-35 years in 2 trimester gestosis are surveyed. Spent an electrocardiogram, EhoKG with definition a myocardial working index, test with physical activity. Results have shown that frequency of heartbeat, average pulmonary pressure, the sizes left ventricle authentically higher in group of pregnant women with myocarditis that is accompanied by decrease contractile abilities of a myocardium and an index myocarditis a reserve. The length of the passed distance the walking 6 minute test is more in group of healthy women. Direct correlation dependence between the passed distance and factor myocarditis a reserve in group of pregnant women with myocarditis is defined.
Keywords: pregnancy, myocarditis, the test with physical activity, an echocardiography, frequency of heartbeat, myocardial a working index.

 

THE DISTURBANCES OF THE RHYTHM AND CONDUCTIVITY IN MITRAL VALVE PROLAPSED OF I DEGREE AT YOUNG AGED PEOPLE
Mukhiddinov B.I., Abdullayev T.A.

Aim. Examine the frequency and nature rhythm and conduction disorders of a heart in young people with I degree mitral valve prolapse. Material and methods. Examined 85 men aged 18-38 with I degree mitral valve prolapse without mitral regurgitation. Investigation program included medical examination, registration of ECG room on a 12 – lead «Hellidge», Holter ECG monitoring, echocardiogram. Results. Holter ECG can detect rare forms of rhythm and conduction disorders of a heart, uncommitted during ECG recording in 12 standard leads. In patients with MVP 1 degree high grade ventricular arrhythmias recorded in 12% of cases. AV blockade of I and II degrees are three times more likely to occur when HM ECG compared with the registration of standard 12-lead ECG. Most often it is identified AV blockade of II degrees according to daily ECG monitoring during the night. Conclusion. In the examination of young people of military age involvement into broad practice of Holter ECG is prospective direction.
Key words: mitral valve prolapse of I degree, Holter ECG monitoring, rhythm and conduction disorders.

Download Eurasian heart journal №4 2014

NATIONAL CLINICAL GUIDELINE ON DIAGNOSIS AND TREATMENT OF PULMONARY HYPRTENSION
National clinical guidelines on diagnosis and treatment of pulmonary hypertension working group: Chair of working group – corresponding Member of the Russian Academy of Sciences, prof. Chazova IYe (Moscow), deputy chair of working group – PhD Martynyuk TV (Moscow), prof. Avdeev SN (Moscow), PhD Volkov AV (Moscow), prof. Nakonechnikov SN (Moscow)

 

CLINICAL CASE: COMBINATION THERAPY WITH BOSENTAN AND SILDENAFIL IN THE TREATMENT OF IDIOPATHIC PULMONARY HYPERTENSION
Bystrov V. V., Arkhipova O. A., Martynyuk T.V., Saidova M. A., Stukalova O. V., Danilov N. M., Sakhnova T.A., ChazovaI.Ye.

The patient with the verified diagnosis of idiopathic pulmonary hypertension, functional class III (WHO) was treated by anticoagulants, diuretics, calcium channel blocker. After one year of adding endothelin receptor antagonist bosentan there was noticed the negative dynamic with right heart chambers dilation, appearing of heart failure signs. By 11 months of the combined pathogenetic therapy with bosentan and phosphodiesterase type 5 inhibitor sildenafil there was achieved the significant improvement of the functional and hemodynamic status. This positive dynamics remained within the next 3 years of observation.
Keywords: phosphodiesterase type 5 inhibitor, sildenafil, idiopathic pulmonary hypertension, endothelin receptor antagonists, bosentan.

 

SUCCESSFUL TREATMENT OF INOPERABLE THROMBOEMBOLIC PULMONARY HYPERTENSION PATIENT WITH SILDENAFIL IN HIGH DOSES
DadachеvaZ.H., MartynyukT.V., SaidovaM.A., DanilovN.M., MershinK.V, ChazovaI.Ye.

The currentguidelines on chronic thromboembolic pulmonary hypertension (CTEPH) treatment consider pulmonary thrombendarterectomy as the first therapy choice. In case of inoperability due to severe patient`s condition, distal lesions of pulmonary vessels, extremely high pulmonary vascular resistance, medical treatment for CTEPH includes life-long anticoagulation therapy and reduction of heart failure symptoms. This clinical case of the 59-y-old patient M. with inoperable CTEPH demonstrates the efficacy of phosphodiеsterase-5 inhibitor Sildenafil usedin high doses. The diagnosis was confirmed by the results of the complete diagnostic process including right heart catheterization and pulmonary angiography. The initial functional class was assessed as III in accordance with WHO classification. Sildenafil 60 mg daily was added tothe standard therapy (anticoagulant, calcium channel blocker) for initial four weeks. To the 4wk visit Sildenafil dose was increased to 240 mgdailytaking into account good tolerance of the treatment.The significant improvement of functional class, positive dynamic ofhemodynamic and echo parameters were found to 4 month of follow-up.
Keywords: pulmonary hypertension, chronic thromboembolic pulmonary hypertension, phosphodiesterase type 5 inhibitor, sildenafil.

 

FEATURES OF PULMONARY ARTERIAL HYPERTENSION IN THE RUSSIAN REGISTER
ArkhipovaO.A., ValievaZ.S., MartynyukT.V., NakonechnikovS.N., ChazovaI.Ye.

The aim of the multicenter prospective open study: to assess demographic and clinical characteristics of PAH patients, regions of their accommodation, features of diagnostic and medical strategy, and survival. Materials and methods. In the study we included PAH patients (group 1) aged >18 years observed in 10 expert centers of the Russian Federation from 01.01.2012 to 30.04.2014. Patients' data were brought in the electronic forms on the registry site www. pul-hyp.medibase.ru. Results. 198 patients (160 women/38 men) from 44 regions of the country were included in the study: 55.0% – IPAH, 35.9% – PAH associated with congenital heart disease, 7,6% – PAH associated with connective tissue disease, 1.0% – heritable PAH, 0.5% – PAH associated with portal hypertension. At the time of including in the register the patients' age median was 38.1 (28.7- 53.8) years, the disease duration median was 5.9 (2.3-13.7) years. The 6MW distance was 394.84 ± 111.10 meters, dyspnea Borg index – 3.34 ± 1.41 points. 9.2% had FC I, 43.7% of FC II, 36.2% of FC III, 10.9% of FC IV. According to RHC mean PAP was 55 (43.25-64.0) mm Hg, CV 3.5 (2.9-4.33) l/min, CI 2.0 (1.8- 2.3) l/min/m2 , PVR 1079 (762-1424.8) din×с/см5 . Positive acute vasodilator testing was found in 25% of patients. The spectrum of the most frequent associated diseases included gastrointestinal diseases (27%), arterial hypertension (14%), urolithiasis (9%) were. PAH-specific therapy was prescribed to 68% of patients (sildenafil – 75.4%, bosentan – 40.4%, iloprost – 9.5%). 9.6% of patients were observed in clinical trials. PAH monotherapy was prescribed to 66.7% of pts, the combined two-component therapy was recommended to 31.7% of pts, triple therapy- to 1.6% of pts. 51% of pts were treated with calcium channel blockers, 59% – diuretics, 82% – antitrombotic drugs. In PAH group the 1-y survival was 98%, the 2-y survival – 96%. Conclusion. Harmoniously built system network of expert centers will allow to improve early diagnostic of PAH, providing proper observation and lowering mortality rate.
Keywords: the registry, pulmonary arterial hypertension, the PAH – specific therapy.

 

INFLUENCE EVALUATION OF LОNG-TERM THERAPY WITH EКVATOR® AND PREDISIN® ON MORPHOFUNCTIONAL RATES AND PAINLESS MYOCARDIAL ISCHEMIA IN PREMENOPAUSAL WOMEN WITH HYPOESTROGENEMIA AND HYPERTENSION
Habibulina M.M.

The results of influence of long-term therapy with Eкvator® and Predisin® on morphofunctional rates and painless myocardial ischemia in 57 premenopausal women with hypoestrogenemia and hypertension of 2 stagesare presented. The results of the present study show that this therapy in premenopausal women with hypertension can stop or even cause regression of left ventricular myocardial hypertrophy, endotelian disfunction, left heart dilations and has positive effect on frequency of painless myocardial ischemia (PMI) events.
Key words: hypertension, premenopause, left heart morphofunctional rates, painless myocardial ischemia, Ekvator®, Predisin®

 

EFFICACY OF INDAPAMIDE AND VALSARTAN COMBINED THERAPY PATIENTS WITH ARTERIAL HYPERTENSION AND METABOLIC DISORDERS
Khamidullaeva G.A., Srojidinova N.Z., Abdullaeva G.J., Shakirova N. Sh., Khafizova L.Sh.

Aim of the study: to study antihypertensive and organprotective efficacy of indapamide and valsartan combined therapy hypertensive patients with high cardiovascular risk and metabolic disorders. Methods: The studyincluded 37 patients with stage I-III hypertension (ESH 2007), with an average age of 47.67±10.02 years, 48.6% men and 51.4% woman. Blood pressure was measured by Korotkov method. All patients were performed by M- and B-mode echocardiography. Flow-mediated endothelium dependent vasodilatation was measured during reactive hyperaemia due to 5 minute brachial occlusion.A 7.5 MHz highresolution ultrasound was used to measure carotid artery intimaemedia thickness (IMT). Blood lipid and glucose level, serum creatinin and uric acid level were estimated by enzyme assay method on biochemical analyzer “Daytona TM”. Results: 12-weekly combined therapy with indapamide and valsartan were shown very good antihypertensive efficacy in average daily doses 2.5 mg and 80±40.6 mg respectively, with reducing average blood pressure on 19.7±7.0% and attained goal level of BP in 92% cases. During the treatment were found significantly regress of left ventricular hypertrophy by reducing left ventricular mass index on 16.2±11.3%, effective vasoprotection, without significantly changes of metabolic disorders, which characterized indapamide and valsartan combination like metabolic neutral drug combination. Conclusion: Indapamide and valsartan combined therapy characterize with high antihypertensive, cardio- and vasoprotective efficacy andmetabolic neutrality choosing for treatment hypertensive patients with high cardiovascular risk and metabolic disorders.
Key words: hypertehsion, indapamide, valsartan, combination therapy.

Download Eurasian heart journal №3 2014

NATIONAL CLINICAL GUIDELINE ON DIAGNOSIS AND TREATMENT OF HYPERTROPHIC CARDIOMYOPATHY
Developed on the instructions of the Russian Health Ministry, approved by the Society of Emergency Cardiology and the leading committee of Cardiology
National clinical guidelines on diagnosis and treatment of hypertrophic cardiomyopathy working group: Chair of working group – prof. Ageev PhT (Moscow), deputy chair of working group – MD Gabrusenko SA (Moscow), MD Postnov AY (Moscow), RAS Academician Akchurin RS (Moscow), PhD Smirnova MD (Moscow) The Expert Committee: prof. Karpov RS (Tomsk), prof. Shaposhnik II (Chelyabinsk), prof. LopatinYuM (Volgograd), prof. Barbarash OL (Kemerovo), prof. Galyavich AS (Kazan)

 

SYSTEMIC DISORDERS IN PATIENTS WITH CARDIOMYOPATHY: BIOCHEMICAL PROFILE DEPENDING ON THE CLINICAL FORM OF THE DISEASE
Ya.R. Ahmatov, T.A. Abdullaev, B.U. Mardanov, N.A. Kurbanov, I.A. Tsoy

Actuality. Condition of hepatopathy being quite common in patients with dilated cardiomyopathy has a special, pathognomonic value at right ventricular cardiomyopathy, as hepatic congestion develops already in the early stages of the disease. Its development was greatly exacerbates the underlying disease, increases symptoms and worsens the general state of patients. The aim. Explore the features of deviations in the biochemical analysis, and the relationship between impaired liver function and the type of damage to the heart in various forms of cardiomyopathy . Materials and methods. The study included 52 patients with CHF II-IV of NYHA classes, due to idiopathic dilated ( DCM ) and right ventricular (RV DCM ) dilated cardiomyopathies. All patients were assessed a clinical status, transthoracic echocardiography and blood biochemical investigation. Results. It has been shown that RVDCM in 2 times more common in women, is characterized by more frequent occurrence of signs of hepatopathy (81.8 % vs. 43.3 %), in the form of increased levels of bilirubin (mainly due to indirect fractions 14,82 ± 16 , 21mkmol / l vs. 6,76 ± 3,51 mkmol / l) , transaminases ( 36.3 % and 30 %) and the relative hypoalbumin (2,9 ± 0,6 g / dl vs. 3,16 ± 0,48 g / dl ), hypocholesterolemia in this group of patients.
Keywords: right ventricular dilated cardiomyopathy, transthoracic echocardiography, liver function.

 

FEATURES OF CORONARY ARTERIES LESION AT UNSTABLE ANGINA PATIENTS DEPENDING ON DISTRIBUTION OF APO С-III GENE POLYMORPHISM AND TYPE OF DISLIPIDEMIA
A.S. Eshpulatov, S.U. Hoshimov, L.E. Kan, S.S. Ahmedova, S.A. Aminov, R.H. Trigulova, A.B. Shek, R.D. Kurbanov

Aim. To study features of coronary arteries atherosclerotic lesions in unstable angina (UA) patients depending on distribution of APO С-III gene polymorphism and type of dislipidemia. Material and methods. There were examined 141 patients of Uzbek nationality with UA class IIB (Braunwald E. et al., 1989). The control group consisted of 50 healthy persons. DNA allocation made from blood by means of a set «DiatomTM DNA Prep 200» under the standard report of firm of the manufacturer (laboratory Isogene Russia). For carrying out PCR of amplification used a set (laboratory SibEnzyme, Russia). The sequence primers was used, according to recommendations Ahmad Reza Bandegi et al, 2011. Results. At the comparative analysis thedistributionof S2 allelesSstI polymorphism of gene АРО C-III among the patients with UA in comparison with healthy persons, has been founda more prevalence ofS2allelecarriers (HR 2,58, 95% CI 1,2-5,7, Р230 mg/dl) also prevailed S2 alleles carriers (HR 2,31, 95% CI 1,1-4,7, p <0,05). Conclusion. Presence of three-vessel coronary arteries lesion among unstable angina patientsassociated with S2 alleles SstI polymorphism of gene АРО C-III carriage and hypertriglyceridemia.
Key words: APO С-III gene polymorphism, dislipidemia, unstable angina, coronary arteries lesion.

 

CHRONOLOGICAL FEATURES OF ACUTE CORONARY SYNDROME / ACUTE MYOCARDIAL INFARCTION (MATERIALS TO REGISTER)
O.U. Urinov

Purpose: studying influence chronobiological factors on frequency of occurrence ACS/ AMI Material and methods: Epidemiological features of AMI and ACS were studied among the constant population of one of districts of Tashkent. The research was carried during one year (from 1.07.2009 to 30.06.2010). Results: the register were included 683 patients with AMI/ACS, of them men – 67,9 % and women – 32,1 %. According to our data January and December appeared to be the less favourable months, and Mаy and June were the most favourable. The analysis of the incidence rate of ACS/AMI with regards to seasons of year showed, that the greatest quantity of patients as well as of lethal outcomes (23,0 % and 33,9 %, respectively) at the prehospital stage was noted on the autumn-winter period. Lethal outcomes at a pre-hospital stage on time of days were registered in night (0.00 till 5.59 o'clock) and morning (6.00 till 11.59 o'clock) hours (29,6 % and 27,1 % accordingly) is slightly more often. Conclusion. Thus, our researches have confirmed a universal tendency that episodes ACS/ AMI on time of days meet in the morning is more often, and night time of days is interfaced to higher probability lethality at a pre-hospital stage.
Keywords: acute myocardial infarction, lethality, acute coronary syndrome, a pre-hospital stage, chronobiological factors.

 

EFFECTIVENESS OF THE MINIMALLY INVASIVE MYOCARDIAL REVASCULARIZATION WITH AORTIC NO-TOUCH TECHNIQUE
A.A. Zenkov

Objectives. To estimate immediate and long term results of the minimally invasive coronary surgery (MICS) at the multiple lesions of the coronary arteries depending on completeness of the achieved myocardium revascularization for optimization of the surgical treatment of the patients with coronary heart disease (CHD). Materials and methods. From 2011 up to 2013 at the cardiac surgery department of ME “Vitebsk regional clinical hospital” 151 patients with the CHD underwent minimally invasive myocardium revascularization (MIMR) at the multiple lesions of coronary arteries. MIMR strategy was directed to avoid artificial cardiopulmonary bypass with cardioplegia and manipulations on the ascending aorta, usage of the left minithoracotomy access and tendency to perform complete or functionally reasonable arterial myocardium revascularization. 84 patients underwent complete MIMR, 67 patients - functionally reasonable incomplete MIMR. Results. Immediate results of the MIMR were found satisfactory (complete angina retrogression and absence of the major cardiovascular complications) in 99,3% patients and were compared in groups of patients who underwent complete (98,8%) or functionally reasonable (100%) MIMR (р>0,05). Operation time was longer and emergency conversion to the assist extracorporeal circulation (AECC) was more frequent in the complete MIMR group of patients in comparison with functionally reasonable MIMR group (р0,05). There were no major differences in the frequency of the recrudescent angina and major cardiovascular complications (combined adverse patient outcome) between complete and functionally reasonable MIMR groups of patients during long-term follow-up - 2,41% and 5,97% respectively (р>0,05). Conclusion: MICS with aortic no-touch technique can be applied for majority of multivessel CHD patients as a complete, functionally reasonable or hybrid revascularization with or without AECC, saving the effectiveness and clinical effect duration of the coronary procedures.
Keywords: minimally invasive myocardial revascularization, functionally reasonable incomplete revascularization, compositesequential bypass grafting.

 

INTERVIEW OF PROFESSOR I.Ye. CHAZOVA ABOUT HYPERTENSION, RUSSIAN REALITY AND PROSPECTS
About hypertension, Russian reality and prospects
MD, professor, corresponding member of the Russian Academy of Sciences, chief cardiologist freelance Ministry of Health of the Russian Federation, Director of the Institute of Clinical Cardiology named AL Myasnikov, Russian Cardiology Research and Production Complex Ministry of Health of Russia

Download Eurasian heart journal №2 2014

CLINICAL GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF CHRONIC AND ACUTE HEART FAILURE

 

THE POSSIBILITIES OF COMPUTED TOMOGRAPHY IN DIAGNOSE OF THE STATE OF CORONARY ARTERIES IN PATIENTS WITH ISCHEMIC HEART DISEASE
Azizov V.A., Sultanova M.J., Uludag K.I., Ephendieva L.G.

This research was aimed to study the possibilities of multislice computed (MSCT) tomography to diagnose status of coronary arteries at the patients with ischemic heart diseases. Material and methods. The research includes the results of complex study of 70 patients, which were send to the cardiology department for the verification of ischemic heart disease, as well as for examination and correction of provided therapy at this category. All patients had been provided traditional invasive coronary angiography and MSCT of coronary arteries. Results. At the 29 (76,3%) patients of 1 group stenosis of coronary arteries were not revealed, in 6 (15,8%) patients were revealed insignificant hemodynamic stenosis. In 3 (7,9%) patients revealed significant hemodynamic stenosis and in 1 (2,6%) critical stenosis (narrowing coronary artery lumen КА > 90 %). By data of MSCT and coronary angiography was revealed strong correlative relationship in diagnosis of stenosis. These factors argue about high comparability of both methods. The greatest correlation relationship was revealed for trunk of left coronary artery, right descending artery and circumflex artery and was 9,2; 0,84 and 0,81 accordingly. Analogical indexes were less for the right coronary artery and was 0,71. Though, large part of the patients in main group was not needed in intracoronary intervention and surgical revascularization. Conclusion. MSCT can use as noninvasive alternative method of coronary angiography in patients with high risk of ischemic heart disease. Comparative analysis of MSCT of coronary arteries and invasive coronary angiography revealed that MSCT has sensitivity of 91%, specificity of 89%.
Keywords: coronary heart disease, coronary angiography, coronary arteries, multislice computed tomography.

 

GLOMERULAR FILTRATION RATE AS A MARKER OF KIDNEY DAMAGE IN PATIENTS WITH ARTERIAL HYPERTENSION
Zelveian P.H., Dheryan L.G.

In the recent years there is a tendency for progressive increase in the number of patients with chronic kidney failure (CKF) in the world and, importantly, that this growth does not tend to slow down in the future. Numerous studies have proven a clear relationship between the degree and duration of arterial hypertension (AH) and incidence of CKF. In this view during AH glomerular filtration rate (GFR) reflects early, intermediate and also late stages of kidney damage and in this case changes of GFR have diverse character. So, an increase of absolute values of GFR is typical for early stages of AH and a decrease of GFR is typical for the late stages of AH. In the same time during AH GFR can be presented as a predicting risk factor for other target organ damage and cardiovascular morbidity and mortality development as well. Thus the evaluation of GFR should be more widely introduced in the clinical practice with the purpose of revelation of other cardiovascular risk factors and associated pathological conditions, continuous monitoring and prevention of target organ damage.
Key words: arterial hypertension, chronic kidney failure, glomerular filtration rate.

 

CLINICAL ASSESSMENT OF INVASIVE TECHNOLOGY TREATMENT OF PATIENTS WITH POST-INFARCTION ANGINA
Gelis L.G., Ostrovskiy Yu.P., Medvedeva E.A., Lazareva I.V., Shibeko N.A., Markov I.A., Chernoglaz P.F., Sevruk T.V.

The article presents a comparative analysis of the results obtained by the invasive treatment in patients with post-infarction angina. In own clinical material authors demonstrate high efficacy of endovascular and surgical treatment carried out in persons with urgent indications Q- myocardial infarction and unstable post-infarction angina. Furthermore, analysis of the frequency and nature of the main causes of complications in various kinds of surgery has been performed. The study found that the development of the final outcome is significantly affected not only by the initial severity of the patient's condition, but also by the selection of the most adequate method of myocardial revascularization. To increase the effectiveness of invasive treatment further improvement and implementation of new technologies of the restoration of coronary blood flow in patients with acute coronary syndrome is offered.
Keywords: unstable angina, acute coronary syndrome, coronary artery bypass grafting (CABG), stenting.

 

DIASTOLIC DYSFUNCTION AND REMODELING OF THE LEFT VENTRICULAR DEPENDING ON THE CONTROL OF GLYCEMIA IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
Kratnov A.E., Koroleva E.V.

The aim. Studying of influence of the control glycaemia on development of diastolic dysfunction and remodelling of left ventricular in patients with type 2 diabetes mellitus (DM) with presence or absence of essential arterial hypertension was evaluated. Material and methods. In 133 patients with DM aged 26 to 66 years without ischemic heart disease the echocardiography with estimation of diastolic properties and diagnostics of remodeling of left ventricular has been investigated. Results. The diastolic dysfunction in 25.9% and remodeling of left ventricular in 35.4% patients with DM without essential arterial hypertension were observed. Poor compensation of DM (level of HbAlc >7,5 %), which was accompanied by more often development of demyelinating neuropathy, resulted in weighting of diastolic dysfunction and remodelling of left ventricular as with presence, and absence of the essential arterial hypertension in patients with diabetes. Conclusion. Absence of indemnification of exchange of the carbohydrates in patients with MD irrespective of presence of arterial hypertension associates with more expressed remodelling of the hearts.
Key words: type 2 diabetes mellitus, diabetic cardiomyopathy, arterial hypertension.

 

ANGIOTENSIN-CONVERTING ENZYME GENE POLYMORPHISM, THE CLINICAL COURSE AND THE STRUCTURAL AND FUNCTIONAL STATE OF THE HEART AT THE UZBEK PATIENTS WITH DILATED CARDIOMYOPATHY
Kurbanov R.D., Kurbanov N.A., Abdullayev T.A.

Background. The study of genes polymorphism of angiotensinconverting enzyme (ACE) and their contribution to development and clinical course of dilated cardiomyopathy (DCM), and the possibility of early diagnostics and differentiated pharmacotherapy in early and advanced stages of the disease, is a promising new area of medical genetics and cardiology research. The aim. To study the genes polymorphism of angiotensinconverting enzyme (ACE) at DCM patients in the Uzbek population, to reveal the feature of heart remodeling depending on a genotype, and also an estimation of Lisinopril efficiency at these patients. Material and methods. It has been surveyed 102 DCM patients of the Uzbek nationality, with II-IV classes by NYHA. Besides an estimation of the clinical status (test of six-minute walking, clinical status estimation score (in Mareev modification) it has been spent 12-led ECG, EchoCG, Holter ECG, rentgenkardiometriya. These data were analyzed depending on the revealed genotype. Results. For the first time we have studied the genes polymorphism at Uzbek DCM patients. It has been showed feature of clinical and instrumental data depending on genotype, and also revealed unfavorable types of gene inheritance. It has been noted a high efficiency of Lisinopril application at DCM patients depending on the ACE- genes polymorphism.
Keywords: ACE gene polymorphism, dilated cardiomyopathy, the Uzbek nationality, lisinopril.

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2013 ESH/ESC GUIDELINES FOR THE MANAGEMENT OF ARTERIAL HYPERTENSION

 

MECHANISMS OF PARASYMPATHETIC INFLUENCES ON THE HEART IN THE DEVELOPMENT OF OF THE EFFECT ANTIISCHEMIC DISTANT CONDITIONING MYOCARDIUM
Mrochek A.G., Bulgak A.G., Basalay M.V., Barsukevich V.C., Gurin A.V.

The aim of the study: to investigate the involvement of distinct parasympathetic and sympathetic beta-adrenergic mechanisms in infarct-limiting effect of remote ischemic conditioning. Materials and methods. Experiments have been conducted on white male rats. Remote ischemic conditioning was performed as 15-min bilateral femoral arteries occlusion before the onset of myocardial ischemia (RIPC, n=8), on the 10-th minute of ischemia (RIPerC, n=8) or on the 10-th minute of reperfusion (RIPostC10', n=8). To study the role of vagal nerves in the development of remote ischemic conditioning femoral arteries occlusion was performed in conditions of bilateral vagotomy (Vagotomy+RIPC, n=8; Vagotomy+RIPerC, n=7; Vagotomy+RIPostC10', n=8). M-cholinoreceptors were blocked by atropine (groups Atropine+RIPC, n=10; and Atropine+RIPostC10', n=6). Beta-adrenoreceptors blockade was induced by injection of metoprolol or atenolol on the 1-st minute of reperfusion to animals with intact vagal nerves (groups MetR+RIPostC10', n=10; and AtenR+RIPostC10', n=10) or after bilateral vagotomy (groups Vagotomy+MetR+RIPostC10', n=10; Vagotomy+AtenR+RIPostC10', n=10). Results. RIPC, RIPerC и RIPostC10' limited infarct size by 56%, 58% and 49% respectively (all p М-cholynoreceptors stimulation is a key point in the development of both RIPC, as well as RIPostC10'.
Key words: remote ischaemic heart conditioning, parasympathetic heart innervation, myocardial ischaemia and reperfusion.

 

PREDICTION OF THROMBOEMBOLISM IN PATIENTS WITH LONG-LASTING ATRIAL FIBRILLATION
Kurbanov R.D., Zakirov N.U., Irisov D.B., Khusanov Sh.S.

The aim of the study. Comparative analysis of the risk assessment of thromboembolism by CHADS2 and CHA2DS2- VASc scores, and to study the preventive effectiveness of different antithrombotic agents in patients with long-lasting аtrial fibrillation (AF) at 1 year follow-up. Materials and methods. The study included 108 patients aged 38 to 78 years old (mean age 62,6±8,4 years) with persistent or permanent AF. In 93.5% of patients revealed coronary artery disease and / or arterial hypertension, in 6.5% – non-coronary heart diseases. The risk of tromboembolism assessed by CHADS2 and CHA2DS2-VASc scores. Results. Patients at low risk of tromboembolism, according to CHADS2 score was 2.8%, in their absence, on a CHA2DS2- VASc score. Patients with moderate risk of tromboembolism, in these scores were 63.9% and 7,4% (χ2=72.653; p=0.000) respectively, and a high risk of tromboembolism – 33,3% and 92,6% (χ2=78,796, p=0.000) respectively. Depending on the ways to prevent tromboembolism, patients were divided into 2 groups. 1st group included patients treated with warfarin (n=90), and the endpoints were observed in 5.6% of patients. 2nd group included patients (n=18) treated with acetylsalicylic acid (ASA) and the end point was observed in 27.8% of patients. Conclusion. The introduction of a new CHA2DS2-VASc score led to an increase number of patients, who need mandatory anticoagulant therapy by 2.8 times. In the group of patients with atrial fibrillation treated with warfarin compared with a group of patients treated with aspirin, where cases of ischemic stroke have developed less often, and their clinical manifestation are less pronounced and are characterized by a benign course.
Keywords: atrial fibrillation, thromboembolism, CHADS2, CHA2DS2-VASc warfarin, acetylsalicylic acid.

 

AMBRISENTAN: THE POSSIBILITY OF THE TREATMENT FOR PULMONARY ARTERIAL HYPERTENSION WITH THE SELECTIVE BLOCKADE OF THE ENDOTHELIN SYSTEM
Martynuk T.V., Nakonechnikov S.N., Chazova I. E.

The optimization of the drug therapy for pulmonary arterial hypertension (PAH) associated with the introduction into clinical practice of highly effective drugs of pathogenetic action affecting the main targets of disease - activating the endothelin (ET-1) system, deficiency of endogenous prostacyclin and nitric oxide. The role of ET-1 in the pathogenesis of PAH due to powerful vasoconstrictive action, the ability to induce cell proliferation and differentiation, production of growth factors, cytokines, biologically active substances. Endothelin receptor antagonists (ERAs) – is the most important class of PAH- specific therapies, including two drugs – nonselective ERA bosentan and selective ERA – ambrisentan. The evidence base related to the application ambrisentan in PAH includes three key studies: testing of different dose regimes of the drug; 2 randomized, placebo-controlled, double-blind clinical studies and the study with replacement of ERAs on ambrisentan in patients intolerant other ERAs. In the study on ambrisentan dosage regimes testing increase of the distance in 6 - minute walk distance (6-MWT) was dosedependent. Using the drug in doses ranging from 1mg to 10 mg to 12 wks. there achieved a significant increase in 6-MWT distance of 33.9 m with 1mg dose (p=0.003) to 38.1m with 5mg (p=0.001). In two 12wk randomized, placebo-controlled studies ARIES- 1 and ARIES- 2 (Ambrisentan in PAH-a phase III, Randomized, Double-blind, placebo-controlled, multicenter, Efficacy Study of ambrisentan on Subjects with pulmonary arterial hypertension) the treatment with ambrisentan resulted to the significant increase of exercise tolerance according to 6-MWT from 22 m to 59 m when using the dose of 2.5mg (p = 0.022) and 10mg (p < 0.001), respectively. Ambrisentan treatment helped to reduce the need for lung transplantation, atrial septostomy, hospitalization for PAH progression. Achieved improvement was maintained for 2-year treatment with ambrisentan. Ambrisentan therapy was well tolerated. By 12 weeks the frequency of transaminases and bilirubin elevations was significantly lower with ambrisentan than for placebo group (0.8% versus 2.3%, respectively). Long-term follow up in the open study in 383 patients treated with ambrisentan, 95% of patients were alive at 1 year and 94 % of patients continued the treatment. Patients with adverse events when receiving bosentan or sitaksentan after translation to ambrisentan had no increase of liver transaminases. Thus, treatment with ambrisentan in PAH pts. resulted in the improvement of clinical symptoms and hemodynamic parameters, the increase in exercise tolerance and the prolongation of the time to the development of clinical deterioration. Favorable effects of long-term therapy with ambrisentan are shown for at least 2 years. In 2012 ambrisentan was approved by the Russian National Pharmacological Committee for the treatment of patients with PAH (Functional Classes II-III) at the dose of 5 mg and 10 mg PO.
Keywords: pulmonary arterial hypertension, endothelin-1, endothelin receptor antagonists, ambrisentan.

 

VALUE OF VOLUME FRACTION OF COLLAGEN IN DEVELOPMENT OF MYOCARDIUM REMODELING ATTHE PATIENTS WITH INFLAMMATORY CARDIOMYOPATHY
Ahmedova D.M., Hojakuliyev B.G.

Objective. Studying of a possible role of interstitial fibrosis in remodeling of myocardium. Material and methods. For the purpose of estimation of fibrosis, depending on degree of dilatation of the left ventricle there has been carried out examination of 42 patients with inflammatory cardiomyopathy, (middle age 35,01±1,0). Patients have been divided into 2 groups. The first group was made of 23 patients with EDS 5,8 cm. To all patients has been carried out ECG and EchoCG research. Results. At the patients of the 1st group CFV has made – 9,1±2,2%, while in the 2nd group – 13,3±2,4%. By comparison of two groups of the patients substantial growth of collagen fraction volume at the patients with expressed dilatation of cavities of the left ventricles and its prevalence at the patients with heavy СI is revealed more. At the patients with inflammatory cardiomyopathy thus the average index of distribution of collagen faction volume has made 11,1±3,1 % with fluctuations from 6 to 16 %. It is necessary to notice that in process of increase of signs of cardiac insufficiency CFV increases. So, at the patients with I-II CI FC CFV has made 9,8±3,0 % (CI 7,9-11,6), and at III - IV CI FC this indicator has increased already to 12,7±2,5 % (CI 11,0-14,4). The data obtained by us testifies that myocardium fibrosis at the patients with expressed cardiac insufficiency with dilatation of LV cavities much more, than at the patients with moderated СН. Conclusion. Thus, correlation between IMMLV and LVBW, which specifies dependence of structural changes on degree of fibrosis, and also the factors, promoting development of fibrosis at the patients with inflammatory cardiomyopathy is revealed.
Keywords: inflammatory cardiomyopathy, myocardium remodeling, collagen fraction volume, cardiac insufficiency.

 

MEDICAL TREATMENT OF CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION
Mershin K.V., Martynuk T.V.

CTEPH is the only type of surgically curable pulmonary arterial hypertension. In spite that, up to 50% of all CTEPH patients are rejected of surgical treatment because of distal lesions of pulmonary arteries or because of other contraindications. Medical treatment was proven to be one of the options to support this cohort of patients. Recent clinical studies addressed some medication regimens for treatment of CTEPH patients and showed distinct changes of different PH-variables with time. We discuss the main principles of drug therapy for inoperable CTEPH as well as for patients awaiting surgery, during and after pulmonary thromboendarterectomy.
Key words: CTEPH, chronic thromboembolic pulmonary hypertension, PH-specific therapy, pulmonary thromboendarterectomy, PEA.

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