RUSSIAN JOURNAL OF CARDIOLOGY, 2013, 1 (99)

CONTENTS
СОДЕРЖАНИЕ

EDITORIAL

Russ J Cardiol 2013, 1 (99): 5

CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russ J Cardiol 2013, 1 (99): 6

ORIGINAL ARTICLES

HEREDITARY CONNECTIVE TISSUE DISORDERS AS A CARDIOLOGIC PROBLEM
SYSTEMIC CONNECTIVE TISSUE INVOLVEMENT AND CARDIAC INVOLVEMENT: THE 2010 REVISED GENT NOSOLOGY IN THE MARFAN SYNDROME DIAGNOSTICS

Zemtsovsky E. V. ^{1, 2}

The author presents his view on the problem of Marfan syndrome-related hereditary connective tissue disorders, in particular, primary mitral valve prolapse and Marfanoid habitus, as the most prevalent manifestations. The changes in the assessment of external and visceral manifestations of Marfan syndrome, according to the original Gent nosology and its 2010 revision, are discussed. The importance of the evaluation of systemic connective tissue involvement, with the systemic score calculation and cardiac extracellular matrix assessment, is emphasised. The author presents the evidence justifying the need for a wider use of the cardiac involvement concept, in order to assess the severity of structural and functional disturbances of cardiac extracellular matrix in patients with primary mitral valve prolapse and Marfanoid habitus. The cardiac involvement assessment should be based on the systemic score, minor cardiac criteria, the number and type of minor cardiac abnormalities, the results of clinical examination, and the serum levels of transforming growth factors (TGF) b1 and b2.

Russ J Cardiol 2013; 1 (99): 7-13
Key words: Marfan syndrome, Marfanoid habitus, primary mitral valve prolapse, systemic connective tissue involvement, cardiac involvement.
¹V. A. Almazov Federal Centre of Heart, Blood, and Endocrinology; ²St. Petersburg State Pediatric Medical University, St. Petersburg, Russia.

PATHOGENETIC MECHANISMS OF ASCENDING AORTIC ANEURYSM OF VARIED AETIOLOGY

Irtyuga O. B. ¹, Gavrilyuk N. D. ¹, Voronkina I. V. ², Uspenskyi V. E. ¹, Malashicheva A. B. ¹, Moiseeva O. M. ¹

Abstract

Aim. To assess the impact of disturbed extracellural matrix protein balance and matrix metalloproteinase (MMP) activity on the development of ascending aortic aneurysm (AAA) of varied aetiology.

Material and methods. The study included 38 patients with AAA and 17 controls without any aortic pathology. In intra-surgery biopsy samples, the levels and activity of MMP-2, MMP-9, fibrillin, elastin, and collagen were measured.

Results. Elevated levels of latent MMP-9 and MMP-2 forms were observed in patients with atherosclerosis and tricuspid aortic valve, compared to controls. In participants with bicuspid aortic valve, the levels of both latent and active MMP-9 forms were higher than in controls. In biopsy samples, the elastin-to-collagen ratio values were elevated in patients with atherosclerosis (1:1,7) and bicuspid aortic valve (1:1,6).

Conclusion. The difference in the MMP levels and activity and the increased collagen-to-elastin ratio could be related to the underlying mechanisms of the AAA development in patients with bi- and tricuspid aortic valve.

Russ J Cardiol 2013; 1 (99): 14-18
Key words: ascending aortic aneurysm, matrix metalloproteinases, extracellural matrix proteins.
¹V. A. Almazov Federal Centre of Heart, Blood, and Endocrinology; ²Cytology Institut, Russian Academy of Sciences, St. Petersburg, Russia.

CAUSAL FACTORS IN THE DEVELOPMENT OF THORACIC AORTIC ANEURYSM

Luneva E. B. ¹, Uspenskyi V. E. ¹, Mitrofanova L. B. ¹, Paidimirova M. I. ², Kandinskyi A. V. ¹, Zemtsovsky E. V. ^{1, 2}

Abstract

Aim. To assess the causal factors in the development of thoracic aortic aneurysm. Despite the existing screening programmes, widely used visualisation methods, and improved intervention techniques, aortic aneurysm remains one of the leading causes of sudden cardiac death. The existing evidence on the causal factors in the development of thoracic aortic aneurysm is contradictory.

Material and methods. We analysed medical histories of the patients hospitalized for thoracic aortic stenting from early 2011 to May 1 2012. The age and gender composition of the sample and the main causal factors resulting in the development of thoracic aortic aneurysm were assessed.

Results. In total, 90 patients underwent thoracic aortic stenting. The main causes for the development of thoracic aortic aneurysm were: bicuspid aortic valve (n=30, 34%), atherosclerosis (n=30, 34%), and Marfan syndrome (n=10, 95). In 45 intraintervention biopsy samples, cystic medial necrosis was found in 55%, atherosclerosis in 27%, and normal tissue in 15% (n=12).

Conclusion. The most common concomitant pathology in patients with thoracic aortic aneurysm was bicuspid aortic valve, aortic atherosclerosis, and hereditary connective tissue disorders. The main causal factor in the development of thoracic aortic aneurysm was cystic medial necrosis.

Russ J Cardiol 2013; 1 (99): 19-22
Key words: aortic aneurysm, cystic medial necrosis, atherosclerosis.
¹V. A. Almazov Federal Centre of Heart, Blood, and Endocrinology; ²St. Petersburg Pediatric Medical University, St. Petersburg, Russia.

AUTONOMOUS DYSFUNCTION IN YOUNG PATIENTS WITH MITRAL VALVE PROLAPSE AND MARFANOID HABITUS

Reeva S. V. ^{1, 2}, Malev E. G. ², Pankova I. A. ², Timofeev E. V. ^{1, 2}, Zemtsovsky E. V. ^{1, 2}

Abstract

Aim. To assess autonomous regulation status in young patients with mitral valve prolapse (MVP), Marfanoid habitus (MH), and signs of systemic connective tissue involvement (SCTP).

Material and methods. The study included 59 young men with MVP, MH, and SCTP. All participants underwent phenotypical and clinical examination, anthropometry, electrocardiography (ECG), echocardiography (EchoCG), Holter monitoring (HM) of ECG and blood pressure (BP), treadmill test, heart rate variability (HRV) assessment, and additional cardiovascular tests.

Results. In patients with MVP, MH, and particularly SCTI, a significant decrease in daytime parameters of sinus arrhythmia was observed. These individuals were also characterised by significantly reduced spectral HRV parameters. A pathologic reaction to active orthostatic test was registered in 50% of the participants with MVP and MH. The overall assessment of autonomous regulation tests demonstrated the presence of abnormal reactions in more than 50% of MH individuals and in 80% of MVP patients.

Conclusion. Autonomous dysfunction is common among young patients with MVP, MH, and SCTI.

Russ J Cardiol 2013; 1 (99): 23-27
Key words: autonomous dysfunction, mitral valve prolapse, Marfanoid habitus, systemic connective tissue involvement, heart rate variability, Ewing test battery.
¹St. Petersburg State Pediatric Medical University; ²V. A. Almazov Federal Centre of Heart, Blood, and Endocrinology, St. Petersburg, Russia.

MEDIATORS OF INTRACELLULAR INTERACTIONS AND ENDOTHELIAL FUNCTION IN MYXOMATOUS MITRAL VALVE PROLAPSE

Yagoda A. V. ¹, Gladkikh N. N. ¹, Gladkikh L. N. ², Novikova M. V. ³, Saneeva G. A. ¹

Abstract

Aim. To study the selected mediators of intracellular interactions and endothelial function in patients with myxomatous mitral valve prolapse (MVP).

Material and methods. In total, 25 patients with myxomatous MVP, aged 18–29 years, were examined. The comparison groups included patients with MVP but no echocardiographic signs of myxomatosis and healthy individuals. The blood levels of the following mediators were measured: interleukin 1b (IL-1b), IL-4, IL-10, tumour necrosis factor a (TFN-a), interferon y (IFN-y), basic fibroblast growth factor (FGF-b), transforming growth factor b1 (TGF-1b), endopteline-1 (ET-1), nitric oxide (NO), thromboxane B2 (TxB2), 6-keto-prostagladine F1a (6-keto-PGF1a), and von Willebrand (vWF) factor activity.

Results. MVP patients, regardless of the presence of myxomatosis, had elevated serum levels of TGF-b1 and FGF-b and decreased levels of TNF-a and vWF activity. In patients with myxomatous MVP, elevated levels of IL-1band ET-1 and decreased levels of IFN-y were registered, while the changes in the levels of FGF-b and vWF were the most pronounced. In both groups of participants with MVP, the levels of IL-6 and IL-10 were similar and close to the ones in controls. Among patients with myxomatous MVP, there was a tendency towards an increase in TxB2 and a decrease in NO and 6-keto-PGF1a levels.

Conclusion. The most pronounced changes in the levels of mediators of intracellular interaction and endothelial function were observed in patients with echocardiographic signs of myxomatous MVP.

Russ J Cardiol 2013; 1 (99): 28-32
Key words: myxomatous mitral valve prolapse, intracellular interactions, endothelial function.
¹Stavropol State Medical Academy; ²City Polyclinic No. 1; ³Stavropol Region Clinical Cardiology Dispanser, Stavropol, Russia.

FLAT FOOTEDNESS AS A MARKER OF SYSTEMIC CONNECTIVE TISSUE AND CARDIAC INVOLVEMENT IN YOUNG PATIENTS WITH MARFANOID HABITUS

Korshunova A. L. ^{1, 2}, Parfenova N. N. ^{1, 2}, Malev E. G. ², Smirnova L. M. ³, Zemtsovsky E. V. ^{1, 2}

Abstract

Aim. To assess the potential of plantography indices in the diagnostics of flat footedness, as a manifestation of Marfanoid habitus, systemic connective tissue involvement (SCTI), and cardiac involvement.

Material and methods. In total, 50 young patients (mean age 22,5±2,1 years) were examined. In some participants, Marfanoid habitus and/or signs of SCTI were registered. All patients underwent phenotypic examination, polyposition echocardiography, and plantography (Scan complex). The predictive potential of the visual method and plantography indices (PI) for flat footedness diagnostics in individuals with Marfanoid habitus and SCTI was assessed. The correlation between minor cardiac abnormalities and PI was also examined.

Results. The visual method was inadequately specific in the SCTI diagnostics, while PI were highly specific in diagnosing SCTI and Marfanoid habitus. Moreover, there was a strong correlation between the number of pathologic PI and the number of minor cardiac abnormalities, as well as an inverse correlation between PI and ejection fraction.

Conclusion. The visual method is highly sensitive, but inadequately specific in the diagnostics of SCTI and Marfanoid habitus, while PI are highly specific. The strong correlation between PI and minor cardiac abnormalities suggests that flat footedness could be regarded as an additional marker of cardiac extracellular matrix pathology in hereditary syndromes with Marfanoid phenotype.

Russ J Cardiol 2013; 1 (99): 33-36
Key words: Marfanoid habitus, systemic connective tissue involvement, cardiac involvement, flat footedness, plantography indices.

LEFT VENTRICULAR FUNCTION IN MITRAL VALVE PROLAPSE AND SEVERE MITRAL REGURGITATION

Malev E. G., Kim G. I., Mitrofanova L. B., Omelchenko M. Yu., Zemtsovsky E. V.

Abstract

Aim. To assess systolic left ventricular (LV) function in patients with mitral valve prolapse (MVP) and different morphological MV disorders.

Material and methods. The study included 233 patients (mean age 53,8±12,9 years), who underwent MV surgery due to MPV and severe mitral regurgitation (MR) at the V. A. Almazov Federal Centre of Heart, Blood, and Endocrinology in 2009-2011. The resected MV segments underwent a pathomorphological examination; preoperative strain and strain rate were assessed with the speckle tracking method (EchoPAC’08).

Results. Based on the pathomorphological data, Barlow’s disease was registered in 60 patients (25,8%), and fibroelastic deficiency in 173 patients (74,2%). The preintervention echocardiography did not demonstrate any significant difference between the two groups in terms of preoperative MR volume (70,5±9,6 ml vs. 71,6±8,5 ml, p=0,40), systolic LV function (ejection fraction 52,7±6,6% vs. 52,0±7,4%; p=0,53) and diastolic LV function (E/e’ 12,2±3,9 vs. 12,8±4,2; p=0,35). Despite no difference in ejection fraction, the Barlow’s disease group demonstrated a significant reduction in LV longitudinal systolic (-13,5±2,2% vs. -16,6±2,3%; p=0,008) and diastolic strain (1,14±0,20 s-1 vs. 1,34±0,18 s-1; p=0,04), as well as in strain rate (-0.89±0,15 s-1 vs. -1,14±0,15 s-1; p=0,002), compared to the fibroelastic deficiency group.

Conclusion. Patients with Barlow’s disease, compared to patients with fibroelastic deficiency, have a lower preoperative LV systolic function, which might affect the postoperative long-term survival rates. The deteriorated LV function could be due to the damage of endocardial and intramyocardial extracellular matrix in Barlow’s disease.

Russ J Cardiol 2013; 1 (99): 37-42
Key words: mitral valve prolapse, Barlow’s disease, fibroelastic deficiency, left ventricular function, severe mitral regurgitation.
V. A. Almazov Federal Centre of Heart, Blood, and Endocrinology, St. Petersburg, Russia.

LEFT VENTRICULAR REMODELLING EARLY AFTER SURGICAL CORRECTION OF MITRAL REGURGITATION: STROKE VOLUME MAINTENANCE

Ashikhmina E. A. ^1,2, Schaff H. V. ¹, Suri R. M. ¹, Enriquez-Sarano M. ¹, Abel M. D. ¹

Abstract

Aim. Mitral valve surgery results in the left ventricular (LV) remodelling and adjustment to the new preload and afterload. This study evaluated the dynamics of LV geometry and function immediately after surgical correction of mitral valve (MV) degenerative prolapse.

Material and methods. This prospective study included 40 patients: 25 after MV surgery and 15 after coronary artery bypass graft surgery. The latter group served as controls, in order to assess potential impact of cardiopulmonary bypass and cardioplegic

arrest on LV function. All participants underwent intraoperative transesophageal echocardiography, before and after cardiopulmonary bypass, after protamine infusion and hemodynamic stabilisation. Simultaneous pulmonary catheterisation ensured that the echocardiographic data were obtained in similar hemodynamic conditions.

Results. Immediately after MV surgery, LV fractional area change decreased from 65±7% to 52±% (p<0,001). End-diastolic LV area decreased from 21,3±5,3 to 19,4±4,5 cm 2 (p=0,005), while end-systolic LV area increased from 7,5±2,3 to 9,3±2,5 cm 2 (p<0,001). Stroke volume, measured by the thermodilution method, did not change (54±12% and 57±0%; p=0,5). In the control group, LV fractional area change (54±12% and 57±10%; p=0,19), end-diastolic LV area (16,6±6,2 and 15,7±5,0 cm 2; p=0,32), and stroke volume (72±29 and 65±19 ml; p=0,15) were similar before and after cardiopulmonary bypass; there was only some reduction in end-systolic LV area (7,9±4,4 and 6,9±3,2 cm 2; p=0,03).

Conclusion. Early after MR surgery, LV fractional area change statistically decreased, primarily due to an increase in end-systolic LV dimensions. It could be one of the compensatory mechanisms to prevent acute increase in stroke volume and subsequent MR after MV surgery.

Russ J Cardiol 2013, 1 (99): 43-49
Key words: mitral valve, left ventricular remodelling.
Mayo Clinic ¹, Rochester, USA; Brigham and Women’s Hospital ², Boston, USA.

HEREDITARY MECHANISMS IN THE DEVELOPMENT OF SCLEROTIC DEGENERATIVE DISORDERS OF AORTIC VALVE

Parfenova N. N. 1,2, Khasanova S. I. 1,2, Mitrofanova L. B. 2, Dubova E. V. 2, Zemtsovsky E. V. 1,2

Abstract

Aim. To investigate the role of hereditary mechanisms in the development of sclerotic degenerative disorders of aortic valve.

Material and methods. Clinical, phenotypical, and echocardiographic examination was performed in 180 middle-aged and elderly people (mean age 63,8±9 years; 102 men, 78 women), including 86 patients with calcific aortic stenosis (55 after aortic valve surgery) and 61 controls. The diagnostic criteria of the National Guidelines on hereditary connective tissue disorders (2009) were used. The valve biopsy samples were examined using histological, morphological, and immunohistochemical (TGF-bantibodies) methods.

Results. Marfanoid habitus is one of the most prevalent sings of dysplastic phenotypes. The larger number of osteodysplastic signs was associated with the more severe aortic stenosis. Mesenchymal dysplasia was observed in 36% of the critical aortic stenosis cases. In most aortic biopsy samples, the antigen TGF-b expression was detected.

Conclusion. The association between Marfanoid habitus and calcific aortic stenosis suggests a genetic link between these two conditions and a potential role of Marfanoid phenotype as a predictor of aortic valve calcification.

Russ J Cardiol 2013; 1 (99): 50-53
Key words: hereditary connective tissue disorders, Marfanoid habitus, calcific aortic stenosis.
¹St. Petersburg State Pediatric Medical University; ²V. A. Almazov Federal Centre of Heart, Blood, and Endocrinology, St. Petersburg, Russia.

HEART DISEASE OF ISCHEMIC AETIOLOGY

CAROTID ARTERY REMODELLING IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Akramova E.G.

Abstract

Aim. To assess the carotid artery (CA) remodelling, using the results of the duplex ultrasound and 24-hour blood pressure monitoring (BPM) in patients with chronic obstructive pulmonary disease (COPD).

Material and methods. In total, 131 participants (patients with COPD, patients with COPD and arterial hypertension (AH), patients with AH, and healthy volunteers) underwent an ultrasound examination (HD11XE scanner, Phillips, USA) and 24-hour BPM (Schiller, Switzerland).

Results. Among patients with isolated COPD, 61,5% had ultrasound signs of carotid angiopathy (increased intima-media thickness, IMT), which was associated with a statistically significant increase in common carotid artery (CCA) dilatation, CA deformation and atherosclerotic plaques, left ventricular concentric hypertrophy and diastolic dysfunction. According to the 24-hour BPM results, patients with isolated COPD had increased nighttime hypertensive index and disturbed circadian BP profile (non-dipper or night peaker types). IMT was increased only in every second patient with COPD and AH, and in every third AH patient.

Conclusion. Patients with COPD and AH, compared to participants with isolated AH, demonstrated lower daytime BP levels, disturbed circadian BP profile, increased nighttime hypertensive index, and normal values of BP variability.

Russ J Cardiol 2013, 1 (99): 54-57

Key words: Chronic obstructive pulmonary disease, arterial hypertension, echocardiography, 24-hour blood pressure monitoring.

City Central Clinical Hospital No. 18, Kazan, Russia.

ONE-YEAR RESULTS OF CORONARY ARTERY STENTING IN ELDERLY PATIENTS

Sumin A. N., Gaifullin R. A., Ivanov S. V., Korok E. V., Shcheglova A. V., Mos’kin M. G., Barbarash O. L., Barbarash L. S.

Abstract

Aim. To study the one-year survival after coronary artery stenting (CAS) across age groups and to identify the predictors of cardiovascular events registered during the follow-up period.

Material and methods. In total, 662 patients who underwent CAS were divided into 4 groups: Group I – under 60 years (n=363); Group II – 60–64 years (n=140); Group III – 65–69 years (n=88); Group IV – 70+ years (n=71). The end-points, registered during the one-year follow-period, included death, myocardial infarction (MI), stroke (S), repeat revascularisation, and their combinations. In addition, the pre- and peri-intervention predictors of the abovementioned cardiovascular events were analysed.

Results. Based on the one-year follow-up data, there was an insignificant increase in all-cause mortality among older patients. However, the difference in cardiovascular mortality across the groups was statistically significant (p for trend 0,04). In multivariate regression analyses, age was not independently associated with the risk of cardiovascular death, while atherogenic index, decreased left ventricular contractility, and post-intervention renal dysfunction were independent predictors of cardiovascular mortality. The independent predictors of combined end-point were circulatory support duration, peri-intervention S, and the lesions in two or more coronary arteries.

Conclusion. In one year after CAS, 65–69-year-old patients demonstrated higher cardiovascular mortality levels, with no apparent increase in all-cause mortality and the incidence of combined end-point. Age was not an independent predictor of the one-year risk of cardiovascular events.

Russ J Cardiol 2013; 1 (99): 58-64
Key words: coronary artery stenting, survival, long-term results, elderly.
Research Institute of Complex Cardiovascular Problems, Siberian Branch, Russian Academy of Medical Sciences, Kemerovo, Russia.

ASSOCIATION BETWEEN BIOMARKERS AND PROGRESSION OF POST-INFARCTION MYOCARDIAL REMODELLING

Kukharchik G. A., Pavlova A. M., Nesterova N. N., Mitrofanov N. A., Gaikovaya L. B.

Abstract

Aim. To study the association between the levels of inflammation and myocardial remodelling biomarkers and the progression of post-infarction left ventricular (LV) remodelling, based on the cardiac magnetic resonance tomography data.

Material and methods. The study included 60 patients with ST segment elevation myocardial infarction, who underwent the standard examination, measurement of serum biomarker levels, and cardiac magnetic resonance tomography, in order to assess the progression of myocardial remodelling.

Results. Progressing post-infarction myocardial remodelling was observed in 28,3% of the patients. There was an association between the levels of matrix metalloproteinase (MMP) 1 precursor, MMP-9, tissue inhibitor of MMP-1, N-terminal pro-brain natriuretic peptide (N-proBNP), interleukin-6 (IL-6), end-systolic and enddiastolic volume indices, LV ejection fraction, and damaged myocardial mass index.

Conclusion. The study emphasised the important role of the increased levels of MMP and their tissue inhibitor, N-proBNP, and IL-6 in the process of structural and functional post-infarction LV remodelling.

Russ J Cardiol 2013; 1 (99): 65-69

Key words: biomarkers, remodelling, myocardial infarction, magnetic resonance tomography.

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

LEFT VENTRICULAR REMODELLING TYPES IN ELDERLY PATIENTS WITH ARTERIAL HYPERTENSION

Gadzhieva L.Kh. ¹, Masuev K. A. ², Ibragimova M. I. ²

Abstract

Aim. To study left ventricular (LV) remodelling types and their association with age, gender, duration of arterial hypertension (AH), and cardiac arrhythmias in elderly patients with Stage II–III AH.

Material and methods. The study included 80 AH patients (23 men, 57 women) with different levels of cardiovascular risk (age 60–86 years; mean age 72,4±6,5 years). The mean AH duration was 19,6±6,8 years. All participants underwent echocardiography and long-term ECG monitoring. Statistical analyses were performed using “Statistica-6.0” software (StatSoft Inc., 1984–2001).

Results. In the study sample of elderly AH patients, the following geometric LV models were registered: concentric LV remodelling (n=30, 37,5%), concentric LV hypertrophy (n=36, 45,0%), and eccentric LV hypertrophy (n=36, 45,0%). The most prevalent cardiac arrhythmia was the combination of supraventricular (SVE) and ventricular (VE) extrasystoles, particularly in patients with concentric LV hypertrophy. In this group, atrial fibrillation was also prevalent. The second most prevalent cardiac arrhythmia was SVE, with the highest prevalence in patients with concentric LV remodelling.

Conclusion. Elderly patients with Stage II–III AH were characterised by the high prevalence of concentric LV hypertrophy. This clinical group had the highest levels of cardiovascular risk, as well as the highest prevalence of cardiac arrhythmias, including arrhythmias with poor prognosis. Echocardiographic parameters of LV remodelling were similar in patients aged 60–74 vs. 75+ years. There was a weak, albeit statistically significant, association between LV remodelling type and AH duration.

Russ J Cardiol 2013; 1 (99): 70-74
Key words: left ventricular remodelling, arterial hypertension, elderly patients.
¹Dagestan Republic Medical Centre; ²Dagestan State Medical Academy, Makhachkala, Russia.

CENTRAL AORTIC PRESSURE PARAMETERS IN PATIENTS WITH ISCHEMIC CHRONIC HEART FAILURE

Temirsultanova T. Kh. ^{1, 2}, Ilukhin O. V. ¹, Lopatin Yu. M. ^{1, 2}

Abstract

Aim. To evaluate the parameters of central aortic pressure in patients with chronic heart failure (CHF) of ischemic aetiology.

Material and methods. The study included 89 patients with ischemic CHF, aged from 41 to 73 years (mean age 56,1±0,8 years), and 15 controls, aged 39–56 years (mean age 49,4±1,5 years) without overt cardiovascular disease. All participants underwent the measurement of central aortic pressure (applanation tonometry, SphygmoCor) and the echocardiographic assessment of systolic and diastolic left ventricular function (ACUSON).

Results. An accurate interpretation of central aortic pressure parameters in patients with ischemic CHF requires taking into account the baseline levels of blood pressure (BP). In these patients, the complex assessment of all measured parameters is preferable (by contrast, in patients with arterial hypertension, the main parameter of interest is typically augmentation index).

Conclusion. The investigation of central aortic pressure parameters in patients with ischemic CHF provides an opportunity for non-invasive assessment of both peripheral and central pulse waves, for the measurement of central BP levels, for the identification of the BP-modifying factors (augmentation and amplification), and for the selection of a pathogenesis-based therapy.

Russ J Cardiol 2013; 1 (99): 75-78
Key words: heart failure, central aortic pressure, augmentation index, pulse pressure.
¹Volgograd State Medical University; ²Volgograd Region Clinical Cardiology Centre, Volgograd, Russia.

EFFECTS OF AMBULATORY SELF-CONTROL ON RENAL FUNCTION AND ELECTROLYTE METABOLISM IN PATIENTS WITH SEVERE HEART FAILURE

Berdnikov S. V. ^{1, 2}, Vishnevskyi V. I. ¹, Berdnikova O. A.²

Abstract

Aim. To investigate the effects of the ambulatory self-control treatment strategy on renal function, electrolyte metabolism, functional status, and the number of repeat hospitalisations in patients with chronic heart failure (CHF).

Material and methods. In total, 122 patients with severe CHF (NYHA class III-IV) were divided into 3 groups: Group I – ambulatory self-control after in-hospital education in the “CHF Patient School”; Group II – standard in-hospital education in the “CHF Patient School”; and Group III – controls. Group I participants could selfadminister torasemide (in pre-determined doses; under control of blood potassium, sodium, and creatinine) in case of oedema and dyspnoea development. If torasemide treatment was ineffective, Group I patients would have a telephone consultation with a doctor. During the in-hospital treatment, as well as after 3, 6, and 9 months of ambulatory treatment, the following parameters were assessed: the number of repeat hospitalisations, functional status (6-minute walking test), calculated glomerular filtration rate (GFR; CKD-EPI), morning microalbuminuria, serum levels of potassium and sodium, therapy compliance, and knowledge on CHF-related issues.

Results. The number of repeat hospitalisations in Group I, compared to Groups II and III, decreased by 37% and 45%, respectively. In the 6-minute walking test at 9 months, the distance in Group I increased from 174,5 m to 248,5 m, while in Groups II and III, it did not change significantly. Group I did not demonstrate any negative GFR dynamics, while this parameter progressively and similarly decreased in the other two groups. At 9 months, albuminuria levels in Group I (44,5±25,3 mg/l) were significantly lower than in Group II (58,7±32,5 mg/l) and Group III (62,8±36,9 mg/l). Among Group I patients, hyperkalaemia was not observed, and hyponatraemia was significantly less common than in Groups II and III. The CHF knowledge and therapy compliance were better in Group II, compared to Group III, only during the first 3 months of the follow-up; Group I demonstrated consistently high levels of these parameters throughout the study period.

Conclusion. The strategy of ambulatory self-control, compared to the standard ambulatory observation, significantly reduced the need for repeat hospitalisations, improved functional status, electrolyte metabolism, and therapy compliance parameters, and postponed the progression of renal dysfunction in CHF patients.

Russ J Cardiol 2013; 1 (99): 79-85
Key words: chronic heart failure, self-control, in-hospital education, ambulatory treatment.
¹Orel State University, Medical Institute; ²Orel Regional Clinical Hospital, Orel, Russia.

HEMODYNAMIC PARAMETERS IN PRE- AND POST-INTERVENTION PERIOD AMONG HYPERTENSIVE PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY

Shpak L. V., Galoshina E. S., Eremeev A. G.

Abstract

Aim. To compare the pre- and post-intervention hemodynamic parameters, assessed by volumetric compression oscillometry (VCO), in patients with arterial hypertension undergoing laparoscopic cholecystectomy.

Material and methods. The study included 80 patients with systolo-diastolic arterial hypertension (AH), examined before and after laparoscopic cholecystectomy. Group 1 included 38 patients (31 women, 7 men; mean age 60,2±1,8 years) with controlled blood pressure (BP) (120,1±1,3/75,2±1,2 mm Hg). Group 2 comprised of 42 patients (37 women, 5 men; mean age 63,4±1,5 years) with uncontrolled BP (151,6±2,4/87,4±1,8 mm Hg). The control group included 50 healthy people (25 women, 25 men; mean age 27,8±0,8 years) with normal BP levels (118,5±1,6/71,82±1,2 mm Hg). Hemodynamic parameters were assessed using VCO.

Results. Before the intervention, all hemodynamic parameters in Group 1 were within the normal physiological range; hyper- and eukinetic hemodynamic types were registered more often than combined and hypokinetic ones. In Group 2, all parameters were increased, including AH phenotypes, vascular characteristics (except peripheral vascular resistance, PVR), and cardiac parameters (except heart rate), which suggested the increased myocardial contractility due to elevated arterial wall tonus and peripheral resistance. Hyper- and eukinetic hemodynamic types were registered less often than combined and hypokinetic ones. After the intervention, both groups demonstrated a reduction in all AH phenotypes, vascular characteristics (linear blood flow velocity, pulse wave velocity, and factual-toworking PVR, with elevated working PVR), cardiac parameters (stroke volume, stroke index, minute blood volume, cardiac index, volume velocity of cardiac output, left ventricular contractility, and cardiac energy expenditure). Cardiac hemodynamic types changed from hyperkinetic, combined, and hypokinetic variants to eukinetic one.

Conclusion. Irrespective of baseline levels, post-intervention BP reduction was observed in all patients. However, in patients with controlled BP, it was due to a comparable reduction in both myocardial and vascular strain, while in participants with uncontrolled BP, it was primarily due to reduced myocardial strain.

Russ J Cardiol 2013; 1 (99): 86-92
Key words: arterial hypertension, peri-intervention period, volumetric compression oscillometry.

Tver State Medical Academy, Tver, Russia.

FITNESS CLUB MEMBERS: A “FORGOTTEN” TARGET GROUP FOR CARDIOVASCULAR PREVENTION?

Kutuzova A. E. ^{1, 2}, Kalinina E. A. ¹, Petrova N. N. ³, Nedoshivin A. O. ¹

Abstract

Aim. To assess physical and mental health status of the fitness club members.

Material and methods. The study included 156 fitness club members (125 women, mean age 31±1 years; 9 men, mean age 39±5,5 years) who were interviewed in order to assess their medical history and physical activity levels. All participants underwent anthropometry and 3-minute Tecumseh step test. The Hospital Scale of Anxiety and Depression, Haim questionnaire on coping strategies, and visual analogue scale were also used.

Results. The respondents considered themselves as having low levels of physical activity. “Heart disease” was reported by 16% of women. While 7,2% of women under 50 and 64% of women aged 50+ were aware of their high blood pressure, antihypertensive therapy was mentioned only by 9% of respondents. In women aged 50+ and in men, the values of body mass index were classified as obesity. Based on the step test results, “excellent” levels of exercise capacity were registered in 7,7%, “very good” in 6,5%, “good” in 7,7%, “satisfactory” in 26%, “poor” in 11,8%, and “very poor” in 40,3%. Hypertensive reaction to physical stress was observed in 27% and 5% of women aged under 50 and 50+, respectively. Almost one-fourth of women under 50 demonstrated affective disorders, predominantly anxiety, and a tendency towards non-constructive coping behaviour models. Individual goals of physical training were not always aligned with objective needs of the fitness club members.

Conclusion. The physically active population group which attends fitness clubs demonstrated the presence of such cardiovascular risk factors as high blood pressure, overweight and obesity, and affective disorders. Fitness club members should receive regular compulsory consultations of the sports medicine specialist, in order to individualise the training programme, to identify people with low exercise capacity and pathological stress reaction (“risk group”), and to increase the safety of the fitness training process. To identify potential additional measures of cardiovascular prevention in physically active population groups, further research is warranted on physical and mental health of fitness club members.

Russ J Cardiol 2013; 1 (99): 93-97

Key words: fitness, cardiovascular prevention.

¹V. A. Almazov Federal Centre of Heart, Blood, and Endocrinology, St. Petersburg; ²I. P. Pavlov St. Petersburg Medical University, St. Petersburg; ³St. Petersburg State University, St. Petersburg, Russia.

EFFECTS OF VARIOUS ANTIHYPERTENSIVE THERAPY STRATEGIES ON THE CIRCADIAN BLOOD PRESSURE PROFILE, HEMODYNAMICS, AND ENDOTHELIAL FUNCTION IN ADOLESCENTS WITH ESSENTIAL ARTERIAL HYPERTENSION

Logacheva I. V. ¹, Gunicheva E. A.²

Abstract

Aim. To assess the effect of graduated physical exercise and extended release indapamide on the main parameters of circadian blood pressure (BP) profile, hemodynamics, and endothelial function in adolescents with Stage I essential arterial hypertension (EAH).

Material and methods. The study included 114 adolescent boys with EHA (mean age 16,6±0,12 years) and 27 healthy boys. All EAH patients were divided into three groups. Group I (n=37) included adolescents with labile EAH, according to the 24-hour BP monitoring results. These participants were administered graduated aerobic physical exercise (GAPE). Groups II and III included patients with stable EAH. Group II (n=41) received indapamide retard (Arifon Retard, Servier, France; 1,5 mg once a day, in the morning). Group III (n=36) received the combination of GAPE and indapamide retard. The therapy duration was 6 months. All participants underwent 24-hour BP monitoring, echocardiography, veloergometry (VEM), assessment of endothelial function, and measurement of endothelin-1 levels.

Results. In adolescents with Stage I EAH, both labile and stable variants of hypertension were confirmed by the 24-hour BP monitoring data. GAPE improved circadian BP profile, endothelial function, and hemodynamic parameters in patients with labile EAH. In stable EAH, indapamide retard demonstrated a rapid and consistent BP normalisation and improvement in endothelial function, VEM parameters, and endothelin-1 levels. In high-risk patients with EAH, the antihypertensive effect of the combination of GAPE and indapamide retard was comparable to that of indapamide monotherapy.

Conclusion. Graduated physical exercise could be used in patients with labile EAH. In adolescents with stable EAH, indapamide retard (as monotherapy and in combination with GAPE) is both effective and safe in normalising circadian BP profile and delivering cardioprotective and vasoprotective effects.

Russ J Cardiol 2013; 1 (99): 98–103

Key words: adolescents, essential arterial hypertension, indapamide retard, physical exercise.

¹Izhevsk State Medical Academy, Hospital therapy Department, ²Udmurt Republic Clinical Diagnostic Centre, Izhevsk, Russia.

LITERATURE REVIEW

CLOPIDOGREL IN THE TREATMENT OF PATIENTS WITH ST-ELEVATION ACUTE MYOCARDIAL INFARCTION: STATE-OF-ART IN 2013

Averkov O. V.

This analytical paper presents the modern evidence on the dual antiplatelet therapy in ST-elevation myocardial infarction. A possible replacement of one dual therapy components – clopidogrel – with newer, more effective agents, such as ticagrelor and prasugrel, is discussed. For each of the latter medications, the existing evidence base is presented, together with the results of the studies comparing clopidogrel to ticagrelor and prasugrel. It is emphasized that only ticagrelor could potentially replace clopidogrel, and only as a part of the strategy based on primary percutaneous coronary intervention. For other strategies, such as thrombolytic therapy, pharmacoinvasive approach, and impossibility of reperfusion, clopidogrel remains a nonreplaceable element of the dual antiplatelet treatment in patients with ST-elevation myocardial infarction.

Russ J Cardiol 2013; 1 (99): 104-112
Key words: myocardial infarction, dual antiplatelet therapy, clopidogrel, ticagrelor, prasugrel.
O. M. Filatov City Clinical Hospital No. 15, Russian University of People’s Friendship, Moscow, Russia.

INFORMATION

AstraZeneca initiates a collaboration to create the first Russian biobank

Russ J Cardiol 2013; 1 (99): 69