CONTENTS
СОДЕРЖАНИЕ

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RUSSIAN JOURNAL OF CARDIOLOGY, 2015, 7 (123)

Address to the readers

Russ J Cardiol 2015, 7 (123): 5

CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russ J Cardiol 2015, 7 (123): 6

CLINICAL GUIDELINES

2014 ESC GUIDELINES ON THE DIAGNOSIS AND TREATMENT OF AORTIC DISEASES

Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult

The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)

Russ J Cardiol 2015, 7 (123): 7–72

http://dx.doi.org/10.15829/1560-4071-2015-07-7-72

Key words: Guidelines, Aortic diseases, Aortic aneurysm, Acute aortic syndrome, Aortic dissection, Intramural haematoma, Penetrating aortic ulcer, Traumatic aortic injury, Abdominal aortic aneurysm, Endovascular therapy, Vascular surgery, Congenital aortic diseases, Genetic aortic diseases, Thromboembolic aortic diseases, Aortitis, Aortic tumours.

ORIGINAL ARTICLES

THE SIGNIFICANCE OF OSTEOPONTINE AND MATRIX METALLOPROTEASE-9 IN THORACAL AORTA ANEURYSM DEVELOPMENT

Irtyuga O.B., Druzhkova T.A., Gavrilyuk N.D., Krivonosov D.S., Uspensky V.E., Moiseeva O.M.

Abstract

Aim. To evaluate the significance of osteopontine and MMP-9 in the development of thoracal aorta aneurysm in patients with tricuspid (TAV) and bicuspid (BAV) aorta valve.

Material and methods. Totally 94 patients included with the dilation of thoracal aorta for more than 40 mm, and 50 patients without aorta pathology, that were the comparison group. All patients underwent echocardiographic study by Vivid 7 (GE, USA) device by standard protocol. The osteopontine concentration and MMP-9 were measured in blood serum with manual plate immune-enzyme assay.

Results. The concentration of MMP-9 in blood serum of the patients with aorta pathology and TAV did not differ significantly with the value in comparison group. Otherwise, in IHD the concentration of MMP-9 was significantly higher than in patients without aorta pathology (164,9±76,6 ng/ml and 106,8±82,7 ng/ml, respectively, p<0,01) and closely correlated with the Valsalva sinuses diameters (r=0,302, р=0,007). Comparative analysis of the osteopontine serum concentration did not show differences in the subgroups studied.

Conclusion. The positive correlation revealed of the aorta diameter and concentration of MMP-9 in blood serum of the patients with BAV confirms not only the differences in the pathogenesis of thoracal aorta aneurysm in TAV and BAV, but makes it possible to think on the usage of MMP-9 as biomarker of thoracal aorta dilatation.

Russ J Cardiol 2015, 7 (123): 73–77

http://dx.doi.org/10.15829/1560-4071-2015-07-73-77

Key words: thoracal aortic aneurysm, matrix metalloprotease-9, osteopontine.

FSBI North-Western Federal Medical Research Center of the Healthcare Ministry, Saint-Petersburg, Russia.

RISK FACTORS OF CARDIAL COMPLICATIONS OF THE EARLY POSTOPERATION PERIOD IN PATIENTS WITH ABDOMINAL AORTA ANEURYSM

Dzhalilova D. A.¹, Poteshkina N. G.¹, Khamitov F.F.², Troshina A. A.^1,3

Abstract

Aim. To find out the risk factors for cardial complications of the early postoperation period (EPP) in patients operated for non-complicated abdominal aorta aneurysm (AAA) of atherosclerosis origin.

Material and methods. Totally 95 patients studied, of those 88 (88,4%) males, mean age — 67,6±7,1 y. with non-complicated ААА of the atherosclerotic origin. All patients had cardiovascular comorbidities. At baseline all patients were selected into two groups: 1 group — 52 patients 46 (88,5%) men, mean age — 66,8±7,9 y., taking drugs with negative chronotropic effect (beta-blockers, non-dihydropyridine calcium channel antagonists); 2 group — 43 patients, 38 (88,4%) men, mean age 68,5±6,1 y., not taking these drugs. In the each of the groups were two subgroups according the operation approach: minilaparotomy (MLT) or median laparotomy (LT). As an endpoint, we used myocardial infarction (MI), acute heart failure (ACF), cardiac rhythm and conduction disorders. Patients with MI, ACF and cardiovascular mortality were regarded as combined endpoint. Patients with transient myocardium ischemia, without significant increase of the level of cardiospecific enzymes, were regarded as intermediate point of the study.

Results. Of 95 operated patients with EPP in 17 (18%) there was endpoint and in 30 (31,6%) — intermediate point. By the stepped discriminate analysis we set the risk factors for endpoint and intermediate point: left ventricle myocardium remodeling (LV), angina pectoris of III functional class, arterial hypertension of the 3 grade with target organs involvement (LV hypertrophy), heart rate ≥84 bpm in postoperation period.

Conclusion. In patients with non-complicated AAA of atherosclerotic origin the assessment of baseline cardial status, postoperation period pharmacotherapy, LV remodelling parameters (by EchoCG) and the use of MLT leads to the decrease of the risk of cardial complications of EPP.

Russ J Cardiol 2015, 7 (123): 78–83

http://dx.doi.org/10.15829/1560-4071-2015-07-78-83

Key words: abdominal aorta aneurysm, cardial complications, early postoperation period.

¹SBEI HPE Russian National Research Medical University n. a. N. I. Pirogov of the Healthcare Ministry, Moscow; ²City Clinical Hospital №81 MHD, Moscow; ³SBHI City Clinical Hospital №52 MHD, Moscow, Russia.

VEGETATIVE DYSFUNCTION AND REPOLARIZATION DISORDERS ON RESTING ECG AND IN EXERTION IN YOUNGER PERSONS WITH MARFANOID PHENOTYPE AND MITRAL VALVE PROLAPSE

Reeva S. V.^1,2, Malev E.G.², Timofeev E.V.^1,2, Pankova I.A.², Zaripov B.I.^1,2, Belousova T.I.¹, Zemtsovsky E.V.^1,2

Abstract

Aim. To estimate the prevalence of disordered repolarization and its relation with the character of vegetative dysfunction in younger persons with MP and MVP.

Material and methods. Totally 285 persons studied of the young age (mean age 19,4+1,4 y.). Phenotypical, anthropometric and clinical investigation performed, ECG, EchoCG, Holter monitoring (HM) of ECG and BP, treadmill test. The heart rate variability (HRV) was assessed, cardiovascular tests performed.

Results. MP and MVP are the most common dysplastic phenotypes in younger persons and have 15% ad 10% prevalence, respectively. The analysis of the treadmill test results, done for 140 of participants (80 males) showed that the youths studied had good tolerance of physical exertion (PET at the average or high level). In men with MVP and MP comparing to almost healthy individuals there was tendency to the decrease of PET and slowed down recovery of BP and pulse rate, that witnesses the decrease of adaptation abilities in the assessed persons of those groups. Disordered repolarization on resting ECG and during exercise test was found in MVP and MP, as in controls. However, the prevalence of T inversion during exercise test in MVP and MP was much higher, than in controls. HRV and vegetative tests analysis did not reveal significant differences in vegetative regulation in persons with EVRS on resting ECG and in the group of DR with PE.

Russ J Cardiol 2015, 7 (123): 84–88

http://dx.doi.org/10.15829/1560-4071-2015-07-84-88

Key words: vegetative dysfunction, mitral valve prolapse, marfanoid phenotype, early ventricle repolarization syndrome, treadmill test.

¹Saint-Petersburg State Pediatrician Medical University; ²FSBI NWFMIC, Saint-Petersburg, Russia.

RADIONUCLIDE EVALUATION OF CONTRACTILITY OF THE RIGHT HEART IN MITRAL VALVE STENOSIS

Zavadovsky K.V.^1,2, Evtushenko A.V.¹, Saushkin V.V.¹, Lishmanov Yu.B.^1,2

Abstract

Aim. With the use of radionuclide weight-adjusted tomoventriculography (RTVG), to assess the condition of the right heart chambers in mitral valve stenosis (MV) of rheumatic origin.

Material and methods. Totally, 20 patients studied (mean age — 54,2±8,22 y.) with rheumatic mitral valve lesion, of those 13 were investigated before and after correction of the defect. All patients, before and after correction of the defect were examined with the RTVG.

Results. In all patients with the MV defect, we found a decrease of regional contractility of the RV. Patients with MV defects, related to the comparison group, had significantly more statistically decreased EF, MCI and SSN/Z, EF and higher values of EDV of the RV. Valve defect correction led to statistically more significant decrease of ESV, increase of MCI and EF RV. The sizes of the right atrium, measured with RTVG, were significantly higher comparing to the controls, and after correction of the defect, they reduced.

Conclusion. The RTVG method could be applied for non-invasive assessment of the right heart chambers function in patients with MV stenosis of rheumatic origin.

Russ J Cardiol 2015, 7 (123): 89–93

http://dx.doi.org/10.15829/1560-4071-2015-07-89-93

Key words: right ventricle, mitral valve defect, radionuclide weight-adjusted ventriculography.

¹FSBISU Scientific-Research Institute of Cardiology, Tomsk; ²FSBEI HPE National Research Tomsk Polytechnic University, Tomsk, Russia.

COMPARISON OF THE LIFE QUALITY WITH MECHANICAL AND BIOLOGICAL MITRAL PROSTHESES

Rogulina N.V., Gorbunova E.V., Kondyukova N.V., Odarenko Yu.N., Barbarash L.S.

Abstract

Aim. To conduct comparative analysis of life quality (LQ) of the recipients of mechanical and biological prostheses in mitral valve defect after primary and repeat intervention.

Material and methods. By the continuous sampling method, with SF-36 questionnaire, we evaluated LQ in 245 patients, operated for mitral valve defect from 1996 to 2013 y. in FSBI SRICCDP. The groups of the recipients of mechanical, biological and “reoperated” patients were 82, 104 and 59, respectively.

Results. The parameters of the health physical component had maximum importance for bioprosteses recipients (рGH≤0,05; рRP≤0,05; рPF>0,05; рBP>0,05) and did not almost differ (excluding RF) in groups of mechanical valves and “reoperated” (р>0,050). Psychological health components (RE, VT, MH) had higher values in bioprostheses recipients (р≤0,050) and did not significantly differ in mechanical valves groups and in “reoperated”. There were no differences between the groups in social functioning assessment.

Conclusion. The usage of bioprosthesis in mitral valve defect increases LQ parameters. LQ of the recipients of mechanic valves and of the patients after reprosthesing of mitral valve does not differ significantly. Teaching of the patients in “School of the patients with prostheses cardiac valves” allows for the significant improvement of LQ, mostly by psychological component of the health.

Russ J Cardiol 2015, 7 (123): 94–97

http://dx.doi.org/10.15829/1560-4071-2015-07-94-97

Key words: life quality, mechanical valve prosthesis, biological valve prosthesis, SF-36 questionnaire.

FSBI Scientific-Research Institute of Complex Cardiovascular Diseases Problems of the Siberian Department RAMS, Kemerovo, Russia.

EVALUATION OF THE CALCIUM-PHOSPHOR HOMEOSTASIS AND PROINFLAMMATORY STATUS OF RECIPIENTS WITH CALCIUM DEGENERATION OF CARDIAC VALVES PROSTHESES

Rutkovskaya N.V., Khryachkova O.N., Golovkin A.S., Ponasenko A.V., Stasev A.N., Kuzmina O.K., Barbarash L.S.

Abstract

Aim. To study calcium-phosphor homeostasis and proinflammatory status of the cardiac valves bioprostheses (BP) recipients related to their interference with calcium degeneration of biomaterials.

Material and methods. A retrospective assessment was performed of the calcium-phosphor metabolism and markers of non-specific inflammatory response in recipients of BP in mitral position: with histologically confirmed calcification — group I (n=22) and with normal morphology and prosthesis function — group II (n=48).

Results. In patients with BP degeneration, comparing to the recipients of biological prostheses with normal function at the background of moderate hypovitaminosis D (34,0 [21,0; 49,4] versus 40 [27,2; 54,0] pmol/L, р>0,05), osteoprotegerine deficiency (82,5 [44,2; 115,4] versus 113,5 [65,7; 191,3] pg/ml, р>0,05) and osteopontine (4,5 [3,3; 7,7] versus 5,2 [4,1; 7,2] ng/ml, р>0,05) there was statistically significant decrease of the bone isoenzyme of alkaline phosphatase (17,1 [12,2; 21,4] versus 22,3 [15,5; 30,5] E/L, р=0,01), and significant decrease of IL-8 (9,74 [9,19; 10,09] pg/ml versus 13,17 [9,72; 23,1] pg/ml, р=0,045) with general increase of proinflammatory serum markers activity.

Conclusion. Into the group of probable predictors determining the tempos of BP calcification, the following could be included: specifics of recipient metabolic status defined by the activity of bone resorption processes, and local and systemic inflammation.

Russ J Cardiol 2015, 7 (123): 98–103

http://dx.doi.org/10.15829/1560-4071-2015-07-98-103

Key words: calcification, bioprostheses, inflammation, calcium-phosphor homeostasis.

FSBI Scientific-Research Institute of Complex Cardiovascular Diseases Problems of the Siberian Department RAMS, Kemerovo, Russia.

STENOSIS IN NONCORONARY AREAS AND LIFE QUALITY IN ISCHEMIC HEART DISEASE

Sumin A. N., Mos’kin M. G., Bezdenezhnykh A. V., Korok E . V., Shcheglova A. V., Barbarash O. L.

Abstract

Aim. To study the influence of noncoronary atherosclerotic stenosis on life quality (LQ) in patients with IHD.

Material and methods. Totally 804 patients studied with IHD, that were selected into 4 groups according to presence of noncoronary stenosis (30% and more). To the group without noncoronary stenosis 472 patients were included. Stenotic subgroups (multifocal — MFA) consisted of: 1 group (n=73) — coronary arteries (CA) + extracranial arteries (BCA) + lower extremities arteries (LE), 2 group (n=154) — CA + BCA, and 3 group (n=105) — CA + LE. LQ was assessed with SF-36 questionnaire, depression level — with the questionnaire “Depression scale”.

Results. In MFA groups the level of depression was significantly higher than in patients without MFA (p<0,001), the highest values were found in the group with three pools involved. Also in the MFA group’s values of LQ were significantly lower, than in those without MFA by the scales: general health, physical functioning, physical condition and emotional condition. Integral parameters of the LQ were significantly lower in MFA (p=0,0439 for physical component and p=0,0347 for psychological).

By the results of monofactor regression analysis, the negative influence on physical component of LQ had MFA, severity of CHF, and smoking, female gender, diabetes. In multifactor analysis the negative influence was confirmed for MFA (p=0,031) and for functional class of CHF (p<0,001). Negative influence on the psychological component of LQ by monofactor regression analysis had the severity of CHF, decrease of left ventricle ejection fraction, female gender and diabetes mellitus. In monofactor analysis the only independent factor that negatively influenced general psychological health was functional class of CHF (p<0,001).

Conclusion. In 41% of patients there are comorbid subclinical lesions of noncoronary arterial pools. Presence of MFA negatively influences physical and psychological components of life quality in IHD. In multifactor analysis, the independent factors related to general physical health were MFA and CHF severity, related to general psycho health only — just the severity of CHF.

Russ J Cardiol 2015, 7 (123): 104–109

http://dx.doi.org/10.15829/1560-4071-2015-07-104-109

Key words: multifocal atherosclerosis, life quality, ischemic heart disease.

FSBI Scientific-Research Institute of Complex Cardiovascular Diseases Problems of the Siberian Department RAMS, Kemerovo, Russia.

CLINIC AND PHARMACOTHERAPY

NOVEL APPROACH TO ANTITHROMBOTIC TREATMENT OF ACUTE CORONARY PATIENTS WITH RIVAROXABAN

Bokarev I.N., Golub A.V.

Abstract

Antithrombotic treatment of acute coronary syndrome leads to much better outcomes of the disease. The article focuses on the arguments and evidence for the addition to antiplatelet drugs the rivaroxaban 2,5 mg two times per day for secondary prevention of AMI.

Russ J Cardiol 2015, 7 (123): 110–115

http://dx.doi.org/10.15829/1560-4071-2015-07-110-115

Key words: acute coronary syndrome, antiplatelet, rivaroxaban.

First Moscow State Medical University n. a. I. M. Sechenov, Moscow, Russia.

LITERATURE REVIEW

TACTICS OF THE PATIENT MANAGEMENT IN THORACIC AORTA DILATION: SELECTION THE ASSESSMENT METHOD, RESULTS EVALUATION

Luneva E.B.¹, Malev E.G.¹, Rudoy A.S.², Zemtsovsky E.V.^1,3

Abstract

The article focuses on the review of the main methods of aorta visualization. The methods are described, as the algorithm of investigation method selection, strategy of patient’s management with aorta dilation. Special attention is paid for the patients

with genetic disorders that may cause aorta dilation.

Russ J Cardiol 2015, 7 (123): 116–119

http://dx.doi.org/10.15829/1560-4071-2015-07-116-119

Key words: aorta dilation, Marfan’s syndrome, echocardiography, computed tomography, magnet-resonance tomography.

¹FSBI North-Western Federal Medical Research Center of the Healthcare Ministry, Saint-Petersburg; ²EI Belorussian State Medical University, Minsk, Republic of Belorussia; ³FSBI Saint-Petersburg State Pediatrician Medical University of the Healthcare Ministry, Saint-Petersburg, Russia.

LECTURE

ROLE OF THE ANTIPLATELET DRUGS IN TREATMENT OF STABLE ANGINA: COMMON SENSE AND NON-RESOLVED ISSUES

Yakusevich V.V., Yakusevich V.Vl., Pozdnyakova E.M.

Abstract

Stable angina pectoris is the most prevalent type of ischemic heart disease. In its treatment, the main role play drugs that block adhesion and aggreagation of platelets — antiaggregants. Their role in prevention of cardiovascular complications in this kind of patients was confirmed by multiple large clinical trials. However, there is a plenty of antiaggregants with various mechanisms of effect, only two of them: acetylsalicylic acid and clopidogrel currently are recommended for continuous use for patients with stable IHD. Acetylsalicylic acid is in priority, and clopidogrel as an alternative in its intolerance. At the same time, lower prevalence of side effects, common for clopidogrel, makes the use of the drug more attractive. Many generics of the both drugs, invented recently, actualizes the comparative studies of these forms with the originals.

Russ J Cardiol 2015, 7 (123): 120–126

http://dx.doi.org/10.15829/1560-4071-2015-07-120-126

Key words: IHD, angina, aspirin, clopidogrel, generics.

Yaroslavl State Medical University, Yaroslavl, Russia.

JUBILEE

Boris Ya. Bart

Russ J Cardiol 2015, 7 (123): 127