CONTENTS
СОДЕРЖАНИЕ
Address to the readers
Russ J Cardiol 2014, 4 (108): 4
CLINICAL GUIDELINES
2013 ESC GUIDELINES ON CARDIAC PACING AND CARDIAC RESYNCHRONIZATION THERAPY
The Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA).
Russ J Cardiol 2014, 4 (108): 5–63
CLINICAL MEDICINE NEWS
Clinical medicine updates: a review of international news
Russ J Cardiol 2014, 4 (108): 64
ORIGINAL ARTICLES
POLYMORPHISM OF PREDISPOSITION GENES IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ARTERIAL HYPERTENSION IN GERIATRIC PATIENTS
Shpagina L. A.1, Voevoda M. I.3, Maximov V. N.3, Pospelova T. I.1, Shpagin I. S.1, Gerasimenko O. N.1,2, Panacheva L. A.1, Alicheva Ya.M.1,2
Abstract
Aim. To assess the associations between predisposition genes (TGF-β1, HHIP, IL6R, SOD3, and CHRNA3), in relation to peripheral vascular structure and function, endothelial dysfunction, and cytokine status, in geriatric patients with chronic obstructive pulmonary disease (COPD) and arterial hypertension (AH).
Material and methods. In total, 154 geriatric patients with either isolated AH or the combination of AH and COPD underwent clinical, functional, laboratory, ultrasound, and cytogenetic examination.
Results. The key associations between predisposition genes, in relation to peripheral vascular structure and function, endothelial dysfunction, and cytokine status, were identified in geriatric patients with COPD and AH who received short- or long-acting inhaled M-cholinolytics and steroids combined with perindopril monotherapy (10 mg/day; Prestarium, Servier Laboratories, France).
Conclusion. The combination of COPD and AH was characterised by significantly different distribution of genotypes and alleles (TGFB1 gene rs1804470 allele and HHIP gene rs1828591 allele), in relation to geriatric age. Patients with the COPD and AH combination had more severe endothelial dysfunction, cytokine activation, and disturbed structure and function of peripheral vessels (distal-proximal type). There were significant differences in peripheral vascular remodelling parameters among elderly vs. very elderly patients with COPD and AH.
Russ J Cardiol 2014, 4 (108): 65–74
Key words: mononucleotide genetic polymorphism, geriatric age, arterial hypertension, chronic obstructive pulmonary disease, vascular remodelling, endothelial dysfunction.
1Novosibirsk State Medical University; 2Novosibirsk City Clinical Hospital No. 2, Novosibirsk; 3Institute of Internal and Preventive Medicine, Siberian Branch, Russian Academy of Medical Sciences, Novosibirsk, Russia.
MANAGEMENT OF IN-PATIENTS WITH UNCONTROLLED ARTERIAL HYPERTENSION
Logacheva I. V.1, Safronova V. V.2, Maximov N. I.1, Baranova S. P.2
Abstract
Aim. To investigate the antihypertensive effectiveness of a fixed perindopril/amlodipine combination (Prestans) and its effects on the visit-to-visit variability of blood pressure levels and quality of life (QoL) among in-patients with uncontrolled arterial hypertension (AH).
Material and methods. The study included 35 patients (15 men and 20 women; mean age 50,4±8,9 years) who were hospitalised due to uncontrolled AH. The previously administered ineffective antihypertensive therapy was cancelled and replaced by Prestans (5/5, 10/5, 5/10, or 10/10 mg/day, subject to AH severity). The in-hospital monitoring lasted for 14 days and included daily assessment of office, systolic and diastolic BP (SBP, DBP), mean and pulse BP, intra-visit and visit-to-visit BP variability, and QoL (SF-36 questionnaire).
Results. All hospitalised patients had Stage III AH, including 31,4% with Degree 2 AH and 68,6% with Degree 3 AH. During the in-hospital course of Prestans treatment, the levels of SBP and DBP decreased from 184,2±14,6 to 142,1±13,8 mm Hg (p<0,05) and from 104,6±7,2 to 84,3±5,7 mm Hg (p<0,05), respectively. Mean and pulse BP levels also reduced significantly. The intra-visit variability of office SBP significantly decreased from Day 1 (5,07±0,9 mm Hg) to Day 14 (1,5±0,1 mm Hg; p<0.05). The visit-to-visit SBP variability also decreased, from 11,6±2,5 to 2,1±1,2 mm Hg, respectively (p<0,01). At baseline, the patients demonstrated a substantial reduction in both physical and mental health QoL parameters. The treatment was associated with a significant improvement in the psychological health domain (emotional and social functioning).
Conclusion. In patients with uncontrolled AH, the in-hospital treatment with Prestans resulted in a mean reduction of SBP/DBP levels by 38,4/19,6 mm Hg, a significant decrease in mean and pulse BP levels, and achievement of target BP levels in 82.9% of the patients as early as at Day 14 of the treatment. The amlodipine/perindopril treatment was also associated with reduced intra-visit and visit-to-visit BP variability, as well as with improved BP control, emotional status, and QoL.
Russ J Cardiol 2014, 4 (108): 75–81
Key words: perindopril/amlodipine, visit-to-visit variability, quality of life.
1Izhevsk State Medical Academy; 2Udmurt Republic Clinical Diagnostic Centre, Izhevsk, Russia.
IVABRADINE EFFECTIVENESS IN PATIENTS WITH CORONARY HEART DISEASE AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE AFTER CORONARY ARTERY BYPASS GRAFT SURGERY
Kochetkova I. V., Minakov E. V., Streletskaya G. N.
Abstract
Aim. To study the anti-anginal effects of ivabradine in patients with effort angina and chronic obstructive pulmonary disease (COPD) after coronary artery bypass graft surgery (CABG).
Material and methods. In total, 120 men with Functional Class II–III stable effort angina, who underwent CABG approximately 3 years ago, underwent a complex examination using the devices “Eton” and “Holter-DMS”.
Results. Coraxan therapy was associated with a tendency towards reduced state index, decreased heart rate, and improved heart rate variability (HRV) parameters.
Conclusion. Coraxan (Servier Laboratories, France) can be recommended to patients with coronary heart disease and COPD after CABG, due to its anti-anginal effects as manifested in the reduced number of anginal attacks, improved quality of life, and improved HRV parameters.
Russ J Cardiol 2014, 4 (108): 82–85
Key words: Coraxan, chronic obstructive pulmonary disease, coronary artery bypass graft surgery.
N. N. Burdenko Voronezh State Medical Academy, Voronezh, Russia.
REDUCED RENAL GLOMERULAR FILTRATION AND SHORT- AND LONG-TERM PROGNOSIS IN PATIENTS AFTER CORONARY ARTERY BYPASS GRAFT SURGERY
Iskenderov B. G., Sisina O. N.
Abstract
Aim. To identify the risk factors and clinical features of acute kidney injury (AKI) in patients with chronic kidney disease (CKD) who underwent coronary artery bypass graft surgery (CABG); to assess the impact of reduced renal glomerular filtration on the short- and long-term prognosis in these patients.
Material and methods. The study included 487 patients (294 men and 193 women) aged 45–68 years (mean age 58,0±7,6 years), who underwent planned CABG. Before the intervention, CKD was registered in 330 patients (Group 1), while in 157 patients, no clinical, laboratory, or instrumental evidence of CKD was observed (Group 2). AKI within the first 24 hours after CABG was diagnosed according to the RIFLE criteria (serum creatinine levels). The follow-up period was 3 years after CABG.
Results. In the early post-intervention period, Group 1 developed AKI significantly more often than Group 2: 59,4% vs. 25,1%, respectively (p<0,001). The main risk factors of AKI were arterial hypertension (AH), Type 2 diabetes mellitus, congestive chronic heart failure (CHF), and persistent atrial fibrillation for Group 1 and AH and congestive CHF for Group 2. Moreover, Group 1, in contrast to Group 2, was characterised by moderate and severe AKI, as well as by persistent and irreversible AKI. In-hospital lethality was higher for Group 1 than for Group 2 (16,1% vs. 6,0%, respectively; p<0,001), although this difference in AKI patients was not statistically significant (21,4% for Group 1 vs. 15,3% for Group 2; p>0,05). In patients with preexisting CKD (Group 1), 3-year survival was significantly lower than in Group 2 patients, irrespective of AKI development (p<0,001).
Conclusion. Reduced renal glomerular filtration affects both short- and long-term prognosis after CABG and increases the risk of AKI.
Russ J Cardiol 2014, 4 (108): 86–91
Key words: coronary artery bypass graft surgery, acute kidney injury, chronic kidney disease.
Penza Institute of Post-diploma Medical Education, Penza, Russia.
TYPE D PERSONALITY AND QUALITY OF LIFE ONE YEAR AFTER CORONARY ARTERY BYPASS GRAFT SURGERY
Sumin A. N., Raikh A. N., Gaifullin R. A., Mos’kin M.G., Korok E. V., Bezdenezhnykh A. V., Ivanov S . V., Barbarash O. L.
Abstract
Aim. To investigate the effects of Type D personality traits on psychological status (PS) and quality of life (QoL) in patients with coronary heart disease one year after coronary artery bypass graft surgery (CABG).
Material and methods. PS was assessed at baseline and after CABG in 408 patients, who were divided into two groups: with Type D personality traits (n=93; Group 1) and without these traits (n=315; Group 2). The Spielberger-Khanin, depression, SF-36, and DS-14 scales were used for PS assessment.
Results. One year after CABG, fewer patients reported high levels of anxiety, and there was an improvement in physical functioning and physical status QoL domains (p<0,05). The percentage of patients with Type D personality traits did not change over time, suggesting that this chronic psychological risk factor is relatively stable. Type D personality traits negatively affected the levels of anxiety, depression, and QoL one year after CABG. According to the results of multivariate logistic regression analyses, type D personality and elevated levels of trait anxiety and depression independently predicted lower levels of psychological and physical QoL parameters.
Conclusion. The tendency towards psychological distress, a stable personality trait observed both before and one year after CABG, was associated with reduced psychological and physical QoL parameters. The pre-CABG assessment of personality traits could optimise the complex management strategy and improve QoL.
Russ J Cardiol 2014, 4 (108): 92–99
Key words: coronary artery bypass graft surgery, psychological distress, quality of life, Type D personality.
Research Institute for Complex Cardiovascular Disease Issues, Siberian Branch, Russian Academy of Medical Sciences, Kemerovo, Russia.
EFFECTS OF RENAL ARTERY DENERVATION ON LEFT VENTRICULAR DEFORMATION AND BLOOD FLOW VELOCITY IN THE DISTAL SEGMENT OF ANTERIOR DESCENDING CORONARY ARTERY AMONG PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION
Pavlukova E. N., Mordovin V. F., Pekarskyi V. V., Lichikaki V. A., Karpov R. S.
Abstract
Aim. To assess the dynamics of left ventricular (LV) longitudinal deformation and blood flow velocity in the distal segment of anterior descending coronary artery (ADCA) among patients with resistant arterial hypertension (AH) 12 months after renal artery denervation.
Material and methods. In seven patients with resistant AH (mean age 52,00±6,59 years), bilateral renal artery denervation was performed. Five out of seven patients had concentric LV hypertrophy. The complex clinical and instrumental examination included the assessment of office and 24-hour blood pressure (BP) levels, echocardiography, speckle tracking imaging (2D strain), and transthoracic visualisation of the distal segment of ADCA.
Results. Twelve months after renal artery denervation, office BP levels decreased by 31/20 mm Hg. Mean 24-hour, mean daytime, and mean nighttime BP levels reduced by 15,58/14,62 mm Hg, 17,1/14,9 mm Hg, and by 21,1/14,47 mm Hg, respectively. There was an increase in global longitudinal LV deformation and local LV deformation (basal septal segment, basal and middle segments of anterior and posterior walls, and middle and apical segments of lateral wall). The improvement in longitudinal systolic LV function was associated with reduced linear velocity of diastolic blood flow in the distal ADCA segment, without similar systolic changes.
Conclusion. Our results suggest that renal artery denervation is linked to improved LV function; therefore, this method could be widely recommended for the management of patients with resistant AH.
Russ J Cardiol 2014, 4 (108): 100–107
Key words: resistant arterial hypertension, renal artery denervation, left ventricular deformation, speckle tracking imaging (2D strain), coronary blood flow.
Research Institute of Cardiology, Siberian Branch, Russian Academy of Medical Sciences, Tomsk, Russia.
CAROTID ARTERY DUPLEX SCAN IN DIAGNOSING CORONARY ATHEROSCLEROSIS AND ASSESSING ITS SEVERITY
Gavrilova N. E., Meletskaya V. A., Yarovaya E. B., Boytsov S . A.
Abstract
Aim. To assess the role of carotid artery duplex scan in diagnosing coronary atherosclerosis of varied severity.
Material and methods. The study included 194 patients (126 men and 68 women) aged 33–85 years who were hospitalised to the State Research Centre for Preventive Medicine and underwent coronary artery angiography and carotid artery duplex scan. The severity of coronary atherosclerosis at coronary artery angiography was assessed by the Gensini score.
Results. The combination of carotid and coronary artery atherosclerosis was observed in 74,7% of the patients. Among those with carotid atherosclerosis, coronary atherosclerosis was registered in 92,4%. This suggests that carotid artery duplex scan is highly sensitive in diagnosing coronary atherosclerosis, despite its low specificity (27,0% patients without carotid atherosclerosis had coronary atherosclerosis). Positive predictive value (likelihood of disease in those with positive test results) of carotid artery duplex scan was 84%. Patients with carotid atherosclerotic plaques had significantly higher Gensini scores than patients with atherosclerosis-free carotid arteries (32 vs. 3,5, respectively; p=0,012), which suggests more severe coronary atherosclerosis in the presence of carotid atherosclerotic plaques. The intima-media thickness values over 0,9 mm were associated with higher Gensini scores (11 vs. 32,5, respectively; p=0,003), confirming more severe coronary atherosclerosis in these patients. Participants with severe coronary atherosclerosis had 3 or more carotid atherosclerotic plaques (p<0,01), typically of heterogeneous structure (p=0,03). The highest Gensini scores were observed in patients with atherosclerotic plaques in common carotid arteries.
Conclusion. The results obtained suggest that carotid artery duplex scan is highly informative in diagnosing coronary atherosclerosis and assessing its severity.
Russ J Cardiol 2014, 4 (108): 108–112
Key words: atherosclerosis, duplex scan, coronary artery angiography, carotid arteries, atherosclerotic plaques.
State Research Centre for Preventive Medicine, Moscow, Russia.
LITERATURE REVIEW
DIHYDROPYRIDINE CALCIUM ANTAGONISTS AND THE TREATMENT OF ARTERIAL HYPERTENSION AND OBESITY PATIENTS IN ACCORDANCE WITH THE MODERN CLINICAL GUIDELINES
Gilyarevskyi S. R.1, Goldschmidt M. V.1, Kuzmina I. M.2
Abstract
This review discusses the potential of a combination antihypertensive therapy with lercanidipine, a dihydropyridine calcium antagonist, for the achievement of target blood pressure levels.
Russ J Cardiol 2014, 4 (108): 113–119
Key words: blood pressure, lercanidipine.
1Russian Medical Academy of Post-diploma Education; 2N.V. Sklifosovskyi Research Institute of Emergency Medicine, Moscow, Russia.