CONTENTS
СОДЕРЖАНИЕ
Address to the readers
Russ J Cardiol 2014, 2 (106): 4
CLINICAL MEDICINE NEWS
Clinical medicine updates: a review of international news
Russ J Cardiol 2014, 2 (106): 5
CLINICAL GUIDELINES
NATIONAL RUSSIAN GUIDELINES ON APPLICATION OF THE METHODS OF HOLTER MONITORING IN CLINICAL PRACTICE
The joint working group for the management of guidelines of the Russian society of cardiology, Russian society for Holter monitoring and noninvasive electrophysiology, Russian Association of specialists in functional diagnosis, all-Russian scientific society of specialists on clinical electrophysiology, arrhythmology and pacing, Society of specialists in heart failure.
Russ J Cardiol 2014, 2 (106): 6-71
ORIGINAL ARTICLES
CARDIAC MAGNETIC RESONANCE IMAGING AND POSITRON EMISSION TOMOGRAPHY IN THE PREDICTION OF LEFT VENTRICULAR DYSFUNCTION REVERSIBILITY IN PATIENTS WITH CHRONIC TOTALLY OCCLUDED CORONARY ARTERIES
Ryzhkova D. V.1, Kostina I. S.1,2
Abstract
Aim. To compare the prognostic value of cardiac positron emission tomography (PET) and contrast-enhanced magnetic resonance imaging (ceMRI) for the prediction of reversibility of regional left ventricular (LV) dysfunction after endovascular recanalization of chronic totally occluded (CTO) coronary arteries (CA).
Material and methods. The study included 26 patients with chronic coronary heart disease and angiographically confirmed CTO CA. All participants underwent cardiac ceMRI and PET with 13N-ammonia and 18F-fluorodeoxyglucose (18F-FDG). Successful CTO CA recanalization was achieved in 20 patients. The standard for prognostic value assessment was the improvement of regional LV contractility at the control ceMRI.
Results. The values of scar tissue extension and scar tissue volume were significantly higher in the segments with irreversible dysfunction, compared to the respective values for viable myocardium (73,0±37% vs. 20,4±33,7% (p<0,0001) and 54,1±33,4% vs. 9,8±16,2% (p<0,0001), respectively). An opposite tendency was observed for the 18F-FDG uptake (51,8±17% vs. 67±11,6% (p<0,001)). The ROC analysis demonstrated that the maximal cut-off values of scar tissue extension and scar tissue volume, assessed by ceMRI (≤50% and ≤37,5%, respectively), predicted the improvement in the regional LV contractility with sensitivity, specificity, and accuracy of 80,2%, 78%, 79,6%, and 92,7%, 73,2%, and 86,9%, respectively. The minimal cut-off value of ≥56,4% for the 18F-FDG uptake and the patterns of perfusion-metabolism match/mismatch provided sensitivity of 81,1% vs. 91%, specificity of 67,5% vs. 65,5%, and accuracy of 75,2% vs. 83,3%, respectively.
Conclusion. Compared to cardiac PET, ceMRI has superior prognostic value and accuracy in the prediction of reversibility of the regional LV dysfunction after endovascular revascularization of CTO CA. In patients with ceMRI contraindications, a complex PET assessment of myocardial perfusion and metabolism is recommended. PET with 18F-FDG only is less effective in the prediction of the LV dysfunction reversibility, but can still detect the presence of viable cardiomyocytes in the severely affected myocardial segments.
Russ J Cardiol 2014, 2 (106): 72-78
Key words: myocardial viability, cardiac magnetic resonance imaging, positron emission tomography, chronic total occlusion, left ventricular dysfunction.
1V.A. Almazov Federal Centre of Heart, Blood, and Endocrinology, St. Petersburg; 2Russian Research Centre for Radiology and Surgical Technologies, St. Petersburg, Russia.
TISSUE DOPPLEROGRAPHY AND THE ASSESSMENT OF RIGHT HEART STRUCTURE AND FUNCTION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Bart B. Ya.1, Kulbachinskaya O. M.2, Dergunova E. N.2, Vartanyan E. A.1
Abstract
Aim. To assess the status of right heart structure and function in patients with mild chronic obstructive pulmonary disease (COPD).
Material and methods. The study included 56 COPD patients and 26 healthy volunteers. All participants underwent lung function assessment and echocardiography.
Results. Based on the analysis of the Doppler spectrum of transtricuspid flow, the signs of disturbed right ventricular (RV) relaxation were identified. A reduction in the total RV output was detected, based on the assessment of tricuspid annular amplitude and velocity.
Conclusion. In patients with mild COPD but without increased pulmonary vascular resistance or precapillary pulmonary hypertension, a silent global longitudinal (systolo-diastolic) RV dysfunction could be detected by tissue dopplerography.
Russ J Cardiol 2014, 2 (106): 79-83
Key words: COPD, echocardiography, right ventricular function.
1N.I. Pirogov Russian Medical Research University, Moscow; 2Diagnostic and Clinical Centre No. 1, Healthcare Department of the Moscow City South-Western Administrative Region, Moscow, Russia.
HEART-TYPE FATTY ACID BINDING PROTEIN-BASED EXPRESS TEST IN THE DIAGNOSTICS OF ACUTE MYOCARDIAL INFARCTION
Ryabov V. V., Kirgizova M. A., Markov V. A.
Abstract
Aim. To compare the effectiveness of two express tests — CardioFABP and Troponin I WB-Check-1 in the diagnostics of acute myocardial infarction (AMI).
Material and methods. The study included 38 patients who were hospitalised with the acute coronary syndrome (ACS) diagnosis within the first 12 hours after the pain onset. At the admission, the peripheral blood levels of CK-MB and troponin I were qualitatively assessed using the immunochemiluminescent analyser “Access-2” (Beckman Coulter, USA). In addition, the express test Troponin I WB-Check-1 (VEDALAB, France; sensitivity 1 ng/ml) was used. Qualitative assessment of hearttype fatty acid binding protein (hFABP) was performed with the express test “CardioFABP” (Biotest, Russia; sensitivity 15 ng/ml). For all tests, diagnostic sensitivity, diagnostic specificity, positive and negative predictive value, and diagnostic effectiveness were assessed.
Results. The express tests for hFABP and troponin I demonstrated high positive predictive value and diagnostic specificity (100%). However, both tests also had false negative results, and, therefore, negative predictive value was low for both the hFABP test (23,5%) and the troponin I test (17,4%). Diagnostic sensitivity was 35,4% for the troponin I express test and 57,6% for the hFABP express test. Diagnostic effectiveness was higher for the hFABP express test (62,2%). All positive results of the hFABP express test were confirmed by the other tests, which resulted in high positive predictive value (100%) and high diagnostic specificity (100%). In patients within the first 6 hours of ACS, diagnostic sensitivity of the hFABP express test was significantly higher than in those with a longer ACS duration (83,3% vs. 42,8%, respectively).
Conclusion. The higher diagnostic sensitivity and diagnostic effectiveness of the hFABP-based express test in the first 6 hours of ACS, compared to a qualitative assessment of troponin I and a later assessment of hFABP, agrees with the earlier obtained data and confirms the status of hFABP as the earliest marker of myocardial necrosis.
Russ J Cardiol 2014, 2 (106): 84-88
Key words: fatty acid binding protein, acute myocardial infarction, troponin I.
Research Institute of Cardiology, Siberian Branch, Russian Academy of Medical Sciences, Tomsk, Russia.
CLINIC AND PHARMACOTHERAPY
AFOBAZOLE EFFECTIVENESS IN THE COMPLEX TREATMENT OF PATIENTS WITH ARTERIAL HYPERTENSION
Chumakova E. A.2, Gaponova N. I.1, Berezina T. N.3
Abstract
Aim.To study the potential increase in the treatment effectiveness due to accounting for psychological and emotional status features of patients with arterial hypertension (AH).
Material and methods. Psychological status features were assessed in 300 patients with essential AH, aged 35 years and older, who attended the Moscow City Polyclinics No. 9. The main group (n=264) was administered antihypertensive therapy and Afobazole (30 mg/d), while the control group (n=36) received only antihypertensive therapy. The number of ambulance calls and the regularity of antihypertensive pharmacological therapy over the last 3 years were assessed. The Spielberger-Khanin and Strelau scales were used for the questionnaire-based assessment of psychological and emotional status. All participants underwent Holter blood pressure (BP) monitoring at baseline and 6 and 18 months after the start of the treatment.
Results. Our variant of antihypertensive therapy was clinically effective and associated with normalised BP parameters, decreased levels of state and trait anxiety, and reduced number of hospital admissions due to the main disease and comorbidities.
Conclusion. Adding Afobazole to the long-term complex treatment of AH patients facilitates stable positive dynamics of BP parameters, normalisation of psychological characteristics, increased duration (up to 6–12 months) of clinical stability periods, and a halved number of hospital readmissions over the following 1,5 years.
Russ J Cardiol 2014, 2 (106): 89-95
Key words: arterial hypertension, psychological features, treatment, Afobazole.
1A.I. Evdokimov Moscow State Medico-Stomatological University; 2Moscow City Polyclinic No. 9; 3Moscow City University of Psychology and Pedagogics, Moscow, Russia.
LECTURE
QUANTITATIVE ANALYTICAL METHODS IN STRESS ECHOCARDIOGRAPHY
Bobrov A. L., Bobrov L. L.
The paper discusses various methods of quantitative analysis used in stress echocardiography (EchoCG). For each method, its key characteristics, specifics of applications, strengths, and weaknesses are described. The emphasis is on the methods widely recommended by the professional community for routine use in stress EchoCG. The application of these methods provides an opportunity to qualitatively assess the degree of myocardial contractility and relaxation disturbances, to identify early sings of heart failure, to calculate coronary flow reserve, and to assess the status of cardiac valves.
Russ J Cardiol 2014, 2 (106): 96-103
Key words: stress echocardiography, quantitative analysis, coronary heart disease.
S. M. Kirov Military Medical Academy, St. Petersburg, Russia.
OBITUARY
Ad memoriam. Kuznetsov Gennady Petrovich
Russ J Cardiol 2014, 2 (106): 104