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RUSSIAN JOURNAL OF CARDIOLOGY, 2016, 2 (130)

Address to the readers

Russ J Cardiol 2016, 2 (130): 5

CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russ J Cardiol 2016, 2 (130): 6

ORIGINAL ARTICLES

LONG TERM RESULTS OF PERCUTANEOUS CORONARY INTERVENTIONS COMPARING WITH CONSERVATIVE MANAGEMENT IN TREATMENT OF STABLE ISCHEMIC HEART DISEASE PATIENTS UNDER REAL CIRCUMSTANCES

Kuznetsov V.A., Samoylova E.P., Bessonov I.S., Gultyaeva E.P., Zyryanov I P., Berdinskikh S.G., Gorbatenko E.A., Kolunin G.V.

Abstract

Aim. To evaluate long term results of percutaneous coronary interventions (PCI) in stable ischemic heart disease patients (IHD) under real clinical circumstances.

Material and methods. The PCI group consisted of 150 patients with stable IHD after PCI, randomly selected from the Registry of Coronary Angiography. Comparison group consisted of randomly selected from the Registry 150 patients with stable IHD receiving only drug therapy (DT).

Results. In long term perion it was found that total mortality (4,0% vs. 11,3%, p=0,017) and cardiovascular mortality (3,3% vs. 10,7%, p=0,013) were lower in PCI group. After PCI there was rarer coronary bypass operation need (2,0% vs. 10,0%, p=0,004). By the prevalence of myocardial infarction in compared groups there were no statistically significant differences (6,7% vs. 5,3%, p=0,627). Kaplan-Meier curve analysis showed that positive effect of PCI was fulfilled in 15 months and progressively increased until the end of follow-up. In stepped regression of Cox proportional risks it was revealed that in long term period PCI performing associated with the increase of survival rate 2,8 times (RR=2,81, 95% CI 1,03-7,69, p=0,044). Long term survival showed independent relation with the grade of coronary lesion. In PCI group, as in DT group, there were no positive dynamics of angina functional classes. In MT group during the follow-up functional class of heart failure became harder than in PCI group, and in PCI group there were no significant dynamics of heart failure functional class.

Conclusion. Real clinical practice proved the effectiveness of PCI with DT in treatment of stable IHD. In long term results evaluation, PCI for stable IHD associated with the increase of survival 2,8 times comparing with the group with only DT. Positive PCI effect realized after 15 months and progressively increased to the end of follow-up.

Russ J Cardiol 2016, 2 (130): 7–11

http://dx.doi.org/10.15829/1560-4071-2016-2-7-11

Key words: ischemic heart disease, percutaneous coronary interventions, medication therapy.

Branch of SRI Cardiology Tyumen Center of Cardiology, Tyumen, Russia.

PREDICTORS OF PERSISTANT POST-OPERATION COGNITIVE DYSFUNCTION IN 2 TYPE DIABETES PATIENTS AFTER CORONARY BYPASS GRAFTING

Trubnikova O.A.1, Mamontova A.S .1, Maleva O.V.1, Tarasova I.V.1, Kukhareva I.N.1, Kuzmina А.А.1, Kagan Е.S.2, Barbarash O.L.1

Abstract

Aim. To study predictors of long-term post-operation cognitive dysfunction (POCD) in patients with diabetes mellitus 2 type (DM), underwent coronary bypass grafting (CBG) under on-pump conditions.

Material and methods. Totally, 54 men included, with DM 2 type, underwent scheduled on-pump CBG, at the age 45-69 y. o. All patients, together with standard clinical assessment, were neurophysiologically tested on the 3-5th day after operation, on 7-14th day and in 1 year after CBG. As factors, suggestively significant for persistent POCD development, were selected: integral parameter of patents adherence to treatment, moderate cognition disorders (MCD) before operation, anxiety level (AL) and progression of carotid arteries (CA) stenoses, measured in 1 year before the operation.

Results. In DM2 patients after on-pump CBG, the following most significant factors were identified as predictors for POCD: CA stenoses progression, high AL, low integral parameter of adherence; this allows for high probability level of prediction of POCD in 1 year after CBG.

Conclusion. The obtained data demonstrated significance of the factors as CA stenoses progression, high LA and low adherence to treatment for development of persistent POCD in DM2 patients after on-pump CBG.

Russ J Cardiol 2016, 2 (130): 12–18

http://dx.doi.org/10.15829/1560-4071-2016-2-12-18

Key words: diabetes mellitus 2 type, coronary bypass graft, on-pump, persistant post-operation cognitive dysfunction, treatment adherence, personal anxiety, carotid arteries stenoses.

Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo; Kemerovo State University, Kemerovo, Russia.

CARDIOVASCULAR COMPLICATIONS AND CARBOHYDRATE METABOLISM IN CORONARY SHUNTING "OFF-PUMP" ACCORDING TO THE REGIMEN OF GLUCOSE LOWERING TREATMENT IN ISCHEMIC HEART DISEASE AND DIABETES

Borodashkina S. Yu.1, Podkamenny V. A.2, Protasov K. V.2

Abstract

Aim. To study the shortest term results of coronary bypass (CBG) under "off-pump" circumstances and the condition of carbohydrate metabolism in ischemic disease patients (IHD) with comorbid diabetes 2 type (DM2) under various regimens of perioperation glucose lowering therapy.

Material and methods. In the study, the IHD and DM2 patients included, receiving oral glucose lowering drugs (OGLD), with the mean age 57,5 (53-62) y. o., men 99 (78,6%). Before operation the patients were selected to the groups of OGLD (n=61) and insulin (IN) (n=65). In OGLD group the intake of the drugs was continued during perioperation period. In the IN group there was switch to short insulin. The dynamics of carbohydrate metabolism markers in different timeline intervals of postoperation period was studied, and its relation with the glucose lowering regimen. The early postoperation cardiovascular complications (CVC) rate was measured: myocardial infarction, stroke, atrial fibrillation. The carbohydrate metabolism parameters in subgroups of patients was measured, with CVC and without.

Results. At baseline there were no differences in carbohydrate metabolism parameters in groups. Loading IN, mean daily glucose levels, its variability and glycemia below the recommended perioperation range (6,1-10,0 mM/L) were lower than in OGLD group. Total number of CVC also predominated in IN group (20,0% vs. 8,2%, p=0,049). Complication subgroups and non-complicated, significantly differed by the baseline glycosilated hemoglobin, mean level of glucose and its daily variability in all timeline intervals studied, as by the prevalence of glucose <6,1 mM/L 0ne day before operation, just before and just after.

Conclusion. Patients underwent CBG as off-pump, after switch on short IN, comparing to OGLD patients, have higher mean glycemia level, its variability and number of shifts from recommended range, as higher rate of post-operation CVC.

Russ J Cardiol 2016, 2 (130): 19–24

http://dx.doi.org/10.15829/1560-4071-2016-2-19-24

Key words: coronary bypass, diabetes mellitus, oral glucose lowering drugs, insulin.

1Irkutsk "Honor Award" Regional Clinical Hospital, Irkutsk; 2Irkutsk State Medical Academy of Postgraduate Education of the Ministry of Health, Irkutsk, Russia.

KIDNEY FUNCTION AFTER CORONARY BYPASS IN PREDIABETES PATIENTS

Kremneva L.V.1, Suplotov S.N.2, Arutyunyan L.A.2

Abstract

Aim. To reveal the predictors of renal dysfunction due to surgical revascularization of myocardium in stable angina patients with prediabetes.

Material and methods. Totally, 48 patients with prediabetes studied, having indications for coronary bypass grafting (CBG) at the age 60±7,4 y. o. with CHD anamnesis 6±5,4 y. Multivessel disease of coronary vessels had 68,8% of patients, LCA stem stenosis >50% had 10,9% of patients. On-pump CBG was done in 87,5% of patients, off-pump — 12,5%. Duration of on-pump period was 95±23 min., number of distal anastomoses for one patient — 2,8±0,8. Baseline, on the first and second days post-CBG, and if needed later, the creatinin concentration was measured in the blood, as glomerular filtration rate (GFR) by CKD-EPI equation. Of the development of renal dysfunction in CBG we decided if GFR decreased below 60 mL/min/1,73 m2. In statistics we took continuous variables as М±SD and as Me (25-75%) depending on the type of distribution. Kidney dysfunction predictors were defined with the method of staged regression.

Results. In patients with stable angina and prediabetes we found moderate transient decrease of GFR after CBG comparing to the baseline level with Me 89,4 (78-105) to Ме 77,8 (59-96) mL/min/1,73 m2 (р<0,01). Significant decrease of GFR after CBG had the patients with in-hospital complications (introperational myocardial infarction, acute heart failure, atrial fibrillation paroxysm) — Ме 92 (82-107) and Ме 72,4 (56-89) mL/min/1,73 m2, р=0,000 differ from the patients groups not having complications, р=0,797. The part of persons developing CBG related renal dysfunction was 21,7%. Decrease of GFR <60 mL/min/1,73 m2 after CBG is associated with older age, higher baseline GFR and longer on-pump period.

Conclusion. Among patients with stable angina and prediabetes the part of those developing CBG related renal dysfunction was 21,7%. The increase of on-pump time more than Me 105 (86-136) minutes significantly increased the relative risk of renal dysfunction development after CBG.

Russ J Cardiol 2016, 2 (130): 25–29

http://dx.doi.org/10.15829/1560-4071-2016-2-25-29

Key words: prediabetes, renal dysfunction, coronary bypass graft.

1Scientific-Practical Medical Center, Tyumen; 2Tyumen State Medical Academy of the Ministry of Health, Tyumen, Russia.

THE INFLUENCE OF THREE-WEEK AEROBIC EXERCISE PROGRAM ON NEURODYNAMIC PARAMETERS OF PATIENTS UNDERWENT CORONARY BYPASS GRAFTING

Argunova Y. A., Trubnikova O. A., Mamontova A. S., Syrova I. D ., Kuhareva I. N., Maleva O. V., Barbarash O. L.

Abstract

Aim. To assess the influence of three-week aerobic exercise program on the parameters of cognition status of patients underwent coronary bypass grafting (CBG).

Material and methods. Totally, 92 men studied with ischemic heart disease (CHD), underwent CBG under on-pump. Patients were selected to 2 groups: first group — 39 patients (mean age — 55,5±5,3 y.) had a 3-week program of bicycle training, the second — 53 persons (57,2±6,21 y.) did not participate in bicycle trainings. The following neurodynamics parameters were evaluated — velocity of complex visualmotor reaction (VCVMR), level of functional mobility of neural processes (LFM) and endurance of the brain (EB) on 5-7 day before CBG, in 7-10 days and in 1 month after operation.

Results. In assessment of the neurodynamics parameters in post-operation period, as on 7-10 day, there were no significant differences in the groups. On 7-10th day and in 1 month after CBG there was acceleration of sensomotoric reactions at neurodynamic tests comparing to preoperation values. In 1 month in patients without trainings there was reaction speed in neurodynamics tests comparing to those after bicycle trainings. Dynamics analysis of the mistakes done showed their increase in bicycle group on 7-10 day after CBG with further return to pre-operation levels by 1 month — in EB and LFM tests, but in the group without trainings there was increase by 7-10 day, as by 1 month after CBG. While comparing the quantity of skipped signals in non-training patients it was significantly higher than in bicycle group during the LFM and EB test.

Conclusion. At the background of three-week bicycle training in patients underwent CBG, there is improvement of neurodynamics parameters, that does set the trainings as the method of prevention and rehabilitation of delayed cognitive dysfunction.

Russ J Cardiol 2016, 2 (130): 30–36

http://dx.doi.org/10.15829/1560-4071-2016-2-30-36

Key words: coronary bypass graft, post-operation cognition dysfunction, physical trainings, rehabilitation.

Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia.

GLOBAL LONGITUDINAL STRAIN OF THE LEFT VENTRICLE AFTER CORONARY STENTING IN STA BLE ISCHEMIC HEART DISEASE

Pavlyukova E. N., Gladkikh N. N., Baev A. E., Karpov R. S .

Abstract

Aim. To evaluate the global longitudinal strain of the left ventricle (LV) after coronary stenting (CS) in patients with stable ischemic heart disease (IHD).

Material and methods. Totally, 50 IHD patients included (35 men, 15 women, age 59,3±6,89 y.). All had indications for CS. Syntax Score was not higher than 22 units (11,78±6,77 units). Before and during the first week after CS all patients underwent standard echocardiography (EchoCG), where the Global Longitudinal Strain-GLSLV was assessed with "AFI" option. All patients also got quantitative measurement of troponin I and MB-creatinkinase (CK-MB) before intervention, in 6 hours and in 24 hours after stenting.

Results. Before CS, in 21 patient there was normal GLSLV (-18,0% and less), in 29 GLSLV decreased (more than -18%). After stenting the patients with improvement of GLSLV were marked (n=28) and with worsening of GLSLV (n=22). During early postoperation period there were no any clinically significant complications, electrocardiographic changes, worsenings of local contractility. In worsening of GLSLV group there was increase of troponin I and CK MB in 6 hours and in 24 hours after stenting, not more than threshold value of acute coronary syndrome (ACS).

Conclusion. Worsening of global longitudinal strain of the LV after CA stenting was found in 44% of stable IHD patients. Negative dynamics of GLSLV was associated with an increase of troponin I, CK-MB levels in 6 and 24 hours after CS not higher significant for ACS level. Worsening of global strain of the LV and increase of troponin, probably, can be explained by embolism of microcirculatory pool during CA stenting. Damage of myocardium during stenting further determines the decrease of the strain in patients with such increase at the baseline.

Russ J Cardiol 2016, 2 (130): 37–42

http://dx.doi.org/10.15829/1560-4071-2016-2-37-42

Key words: ischemic heart disease, global longitudinal strain of the left ventricle, coronary stenting, troponin I.

RI Cardiology, Tomsk, Russia.

COMPLEX ASSESSMENT OF RISK FACTORS FOR PRECISE CHOICE OF REVASCULARIZATION STRATEGY IN ST ELEVATION MYOCARDIAL INFARCTION AND MULTIVESSEL CORONARY DISEASE

Tarasov R. S .1, Ganyukov V. I.1, Kagan E. S .2, Barbarash O. L.1, Barbarash L. S .1

Abstract

Aim. Invention of the model of differentiated strategy selection of revascularization in acute myocardial infarction with ST elevation (STEMI) and multivessel disease (MVD).

Material and methods. Totally, 327 patients with STEMI and MVD included, undergoing primary transcutaneous coronary intervention (PCI). Patients were selected into 2 groups: (1) Multivessel stenting (MVS) during primary PCI (n=91); (2) Staged revascularization (SR) (n=236). The endpoints for 12 months follow-up were significant adverse cardiovascular events. Inside every group the relative level of an adverse outcome was calculated and prognostic coefficient invented that makes possible to estimate significance of every including clinical and demographic and angiographic parameter in the development of adverse outcome.

Results. The most negative prognostic significance for adverse outcome in patients undergoing MVS for primary PCI had the following factors: (1) post infarction cardiosclerosis, (2) severe coronary atherosclerosis (SYNTAX ≥23 points), (3) older age (≥65 y. o.), (4) female gender. Concerning SR: (1) anamnesis of stroke, (2) post infarction cardiosclerosis, (3) multifocal atherosclerosis, (4) three-vessel coronary disease (5) non-drug eluting stents.

Conclusion. Taking into account the complex of clinical and demographic, anatomic and angiographic factors facilitates the improvement of treatment results in STEMI by defining of optimal revascularization strategy.

Russ J Cardiol 2016, 2 (130): 43–51

http://dx.doi.org/10.15829/1560-4071-2016-2-43-51

Key words: myocardial infarction, primary PCI, multivessel disease, outcomes of revascularization.

1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo; 2Kemerovo State University, Kemerovo, Russia.

THE PREVALENCE OF INTACT CORONARY ARTERIES IN RELATION WITH INDICATIONS FOR SCHEDULED CORONARY ARTERIOGRAPHY

Korok E. V., Sumin A. N., Sinkov M. A., Nagirnyak O. A., Chichkova T. Yu., Barbarash L. S .

Abstract

Aim. To evaluate the prevalence and possible reasons for intact coronary arteries (CA) diagnostics in patients with different indications for scheduled coronary arteriography (CAG).

Material and methods. The selection studied, consisted of 711 case histories of patients, underwent scheduled CAG at SRI CICVP during 1 April — 31 may 2014. Taken the indications for CAG, 5 groups were selected: 1 — patients with coronary heart disease (CHD) suspicious (n=288), 2 — patients with myocardial infarction (MI) in anamnesis (n=277), 3 — atherosclerosis of peripheral arterial pools (PAP) (n=18), 4 — patients with acquired valve defects (AVD) (n=43), 5 — patients with cardiac rhythm disorders (CRD) (n=85).

Results. In intergroup comparison it is marked that men were predominant among patients with MI in anamnesis and having PAP atherosclerosis, but women predominated among AVD patients (p<0,01). The age of groups was comparable (p=0,266). Typical angina clinical picture was more common significantly in suspected CHD group and previous MI (p<0,001). Also, the atypical angina and cardialgia were less common in MI anamnesis group (p=0,003) and p<0,001). Cardialgia was more common in AVD (p<0,001). Mean value of pretest probability of CHD was higher in groups with MI anamnesis and PAP lesion, and lesser — in AVD (p=0,015). Rhythm disorders were more common in AVD patients and those who actually was being investigated for CRD (p<0,001). also, ischemic strokes dominated among PAP and AVD (p=0,019). Analysis of CAG data showed that the absence of coronary lesion with higher prevalence is in groups with AVD and CRD (p<0,001). No significant stenoses of CA were less common in MI anamnesis group and AVD (p=0,004). However, hemodynamically significant stenoses of CA were significantly more common in those after MI and in PAP lesion (p<0,001).

Conclusion. Among studied patients, in 32,9% there were no stenoses of CA in planned CAG. Highest number of intact CA was found in preoperation investigation of AVD patients (76,7%) and CRD (67,1%), least — in MI anamnesis (11,6%) and PAP lesion (16,7%). In investigation of suspected CHD, intact CA were found in 37,9% cases.

Russ J Cardiol 2016, 2 (130): 52–59

http://dx.doi.org/10.15829/1560-4071-2016-2-52-59

Key words: coronary arteriography, ischemic heart disease, intact coronary arteries.

Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia.

THE ASSESSMENT OF BIOMARKER COMPLEX IN MEN WITH CORONARY ATHEROSCLEROSIS

Kashtanova E. V.1, Chernjavsky А. М.2, Polonskaya Ya. V.1, Stakhneva Е. М.1, Kurguzov А. V.2, Murashov I. S .2, Kamenskaya О. V.2, Ragino Yu. I.1

Abstract

Aim. To study relation of antioxidant status, lipid and carbohydrate metabolism and to evaluate the influence of these factors on coronary atherosclerotic lesions vulnerability.

Material and methods. Totally, 104 men included — mean age 60,74±8,1 y., selected to control (non-CHD) and main group with angiographically verified coronary atherosclerosis and CHD. Main group was divided to 2 subgroups. The first included 38 men, who had unstable plaques, the second — 34 men who had been diagnosed only stable plaques in coronary arteries. In all serum specimens we measured: malonic dialdehyde concentration (MD); oxidation resistance of low density lipoproteides (LDL), general level of oxidation stress; level of retinol, β-carotene in LDL; total cholesterol; high density cholesterol (HDL); cholesterol of low density lipoproteides (CLDL); triglycerides (TG); glucose; C-peptide and insulin. Statistics was done on the SPSS software (13.0).

Results. In men with coronary atherosclerosis, comparing to the control group, among the studied complex of lipid-lipoproteide, carbohydrate and oxidation-antioxidant biomarkers in blood there were elevated CLDL, TG, ApoB, relation ApoB/ApoA, LP(a), C-peptide, grade of oxidation stress and CHDL level decreased, as retinol, β-carotene and LDL resistance to oxidation. Existence of unstable atherosclerotic lesions in vessel wall determined interrelation of CHDL with TG (p<0,01) and resistance of LDL to oxidation (p<0,05). Also, as in the second subgroup the level of CHDL correlated with CLDL (p<0,01), β-carotene and retinol (p<0,05). While studying the relation of lipid and carbohydrate metabolisms there was relation of glucose level with those parameters as CHDL, CLDL, TG (p<0,01), apo B, LP(a), ApoB/ApoA (p<0,05).

Conclusion. The data obtained in the study points on the relation of parameters of lipid, carbohydrate and oxidation-antioxidant status with coronary atherosclerosis development and possibility of atherosclerotic lesion instability.

Russ J Cardiol 2016, 2 (130): 60–64

http://dx.doi.org/10.15829/1560-4071-2016-2-60-64

Key words: atherosclerosis, biomarkers, lipids, antioxidants, oxidation.

1SRI of Therapy and Prevention Medicine of Siberian Division of RAS, Novosibirsk; 2E.N. Meshalkin Novosibirsk Scientific-Research Institute of Circulation Pathology, Novosibirsk, Russia.

PERSONALITY TYPE D AND THE LEVEL OF SUBCLINICAL INFLAMMATION MARKERS IN CHD PATIENTS

Sumin A. N., Osokina A. V., Fedorova N. V., Raikh O. I., Khryachkova O. N., Barbarash O. L.

Abstract

Aim. To study the level of biomarkers of subclinical inflammation in CHD patients with existence of absence of personality type D.

Material and methods. In 62 patients with stable CHD before planned CBG operation we assessed concentrations: of matrix metalloproteases -2, -3, -9, tissue inhibitor of matrix proteases -1, -2, C-reactive protein, soluble CD40 ligand, tumor necrosis factor alpha. For further study we selected two groups: 1 group (n=27) — patients with type D and 2 group (n=35) — with non-D type. Personality type was defined with DS-14 questionnaire. Patients were asked 14 questions with 5 variants of responses to each. Counting of points was done by two scales: negative irritability and social suppression. Type D was set if 10 points and more by each of the scales. All patients underwent: general and biochemical blood tests, echocardiography, color duplex scanning of brachiocephalic arteries and coronary angiography.

Results. In intergroup comparison both groups were comparable by the most anamnestic and clinical parameters. There were no any differences in the instrumental assessments data. In type D patients there was higher level of MMP-9 (resp. 53,2 pg/mL and 66,5 pg/mL; р=0,051) and sCD40L (resp. 2,8 ng/mL and 5,7 ng/mL; р=0,013) comparing with those non-D-type. The level of other biomarkers in groups did not differ, concentration of MMP-2 and TNF-α were slightly higher among type-D, of the others — among non-D-typers. There were also statistically significant negative correlations of type-D and MMP-9 and sCD40L.

Conclusion. In CHD patients, examined before coronary bypass operation, presence of type D personality was not followed by the increase of subclinical inflammation markers level comparing to patients without such type. In type-D patients there was increase of platelet activation markers activation, that associates with adverse outcomes in CHD.

Russ J Cardiol 2016, 2 (130): 65–70

http://dx.doi.org/10.15829/1560-4071-2016-2-65-70

Key words: type D personality, subclinical non-specific inflammation, ischemic heart disease.

Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia.

EVALUATION OF CARDIOVASCULAR RISK FACTORS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Starodubtseva I. A., Vasilieva L. V.

Abstract

Aim. To find out the relation between the pro-inflammatory cytokines level in serum, and cardiovascular markers in rheumatoid arthritis (RA) patients, as the comorbidities are prevalent in this group of patients.

Material and methods. Totally, 620 RA patients studied with RA (diagnosis according to ACR/EULAR 2010 criteria), hospitalized to rheumatologic department at the age 43,4±10 y.; 95,4% of patients were positive for CCPA, activity by DAS 28 was II, III; of those 85,4% women with disease duration 3-15 y. Level of cytokines (IL-1 и TNF-α) was measured by ЕLISA assay and TNF-α assay ("Picon", Russia). Also, VLDL, TG and hsCRP were measured in the serum.

Results. Data analysis showed statistically significant increase of IL-1 and TNF-α in RA patients serum (p<0,001). As a result of correlation analysis the moderate and strong significant relation was found between the values of systolic blood pressure and cytokines level — 0,742 (p<0,02) and 0,521 (p<0,05), VLDL 0,621 (p<0,01) and 0,578 (p<0,05), TG 0,512 (p<0,01) and 0,364 (p<0,05), hsCRP 0,821 (p<0,05) and 0,632 (p<0,05) respectively for IL-1 and TNF-α.

Conclusion. The level of pro-inflammatory cytokines (IL-1, TNF-α) might be a nondirect risk factor of development and progression of arterial hypertension and atherosclerosis in RA patients, that is necessary to take into account in such patients management.

Russ J Cardiol 2016, 2 (130): 71–74

http://dx.doi.org/10.15829/1560-4071-2016-2-71-74

Key words: rheumatoid arthritis, cytokines, inflammation, cardiovascular system, C-reactive protein.

N. N. Burdenko Voronezh State Medical University, Voronezh, Russia.

CLINIC AND PHARMACOTHERAPY

TIMELINE FOR THE DOUBLE ANTIPLATELET THERAPY. FACTS AND SUGGESTIONS

Barbarash O. L.1,2, Kashtalap V. V.1,2

Abstract The review article provides with recent data on the crucial cardiology problems — duration of double antiplatelet therapy (DAPT) in patients with different types of ischemic heart disease. The analysis is provided of actual clinical guidelines on this issue, the results of recent clinical trials are highlighted, as of metaanalyses. Based on the results of international trials, the necessity postulated of thorough assessment of risk and safety for either prolongation or shortening of DAPT, and some possible indications provided for these changes in 12-month DAPT.

Russ J Cardiol 2016, 2 (130): 75–83

http://dx.doi.org/10.15829/1560-4071-2016-2-75-83

Key words: double antiplatelet therapy, duration, ischemic events, bleedings, aspirin, tienopyridines.

1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo; 2Kemerovo State Medical Academy of the Ministry of Health, Kemerovo, Russia.

DIFFERENTIATED APPROACH TO TREATMENT OF OSTEOARTHROSIS IN CARDIOVASCULAR PATHOLOGY

Vasilieva L. V., Evstratova E. F., Nikitin A. V., Burdina N. S ., Lednyova V. S .

Abstract

Aim. Assessment of clinical efficacy of cutaneous and supravenal cutaneous lowintensive radiation (CLIR) together with parenteral chondroitin sulfate (Chondrogard®) in osteoarthrosis patients with cardiovascular comorbidities.

Material and methods. Totally, 65 women and 15 men studied, at the age 50,62±8,9 y. o., with knee and hip osteoarthrosis stage I-III by X-ray staging. Patients from treatment group underwent intramuscular Chondrogard® once in 2 days for 2 months, with CLIR, cutaneous and supravenal, and low doses of NSAIDs. Controls received Chondrogard® with common therapy (CT) or only CT.

Results. The significantly better dynamics is shown of the pain syndrome in joint is shown by the results of VAS in points and mm, and BP and HR, comparing to those receiving Chondrogard® and CT, that made to decrease the dosages of NSAIDs and to minimize side effects.

Russ J Cardiol 2016, 2 (130): 84–89

http://dx.doi.org/10.15829/1560-4071-2016-2-84-89

Key words: osteoarthrosis, blood pressure, Chondrogard, laser radiation.

N. N. Burdenko Voronezh State Medical University, Voronezh, Russia.

OPINION ON A PROBLEM

SURGICAL AND ENDOVASCULAR REVASCULARIZATION OF MYOCARDIUM IN MULTIVESSEL DISEASE

Gordeev I. G., Lebedeva A. Yu., Volov N. A., Grishina I. S ., Semiokhina A. S .

Abstract The article focuses on the comparative analysis of tactics of the rational complete and incomplete revascularizations in patients with ST elevation myocardial infarction and angina, underwent multivessel stenting and coronary bypass grafting. Patients with diffuse atherosclerotic lesion of coronary arteries are one of the most strenuous kinds of patients. The demand for revascularization of high in this group and, by the data of several authors, is up to 70% among all surgeries. This origins from the changes in demographics (population ageing) as the manifest of ischemic disease in younger age that further presents with the worse morphological substrate. The problem of optimal tactics choice (coronary bypass, endovascular revascularization, conservative strategy) of diffuse coronary atherosclerosis is still of the main topics in discussion and controversy in science.

Russ J Cardiol 2016, 2 (130): 90–94

http://dx.doi.org/10.15829/1560-4071-2016-2-90-94

Key words: CHD, angina pectoris, myocardial infarction, multivessel disease, incomplete myocardial revascularization, multivessel stenting, CBG.

N. I. Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia.

CLINICAL CASE

A CASE OF FULMINANT DEVELOPMENT AND PROGRESSION OF HEART FAILURE IN HEART AMYLOIDOSIS

Bobrov A. L., Kulikov A. N., Gorokhova E. V., Rud' S. D., Bobrov L. L.

Russ J Cardiol 2016, 2 (130): 95–96

http://dx.doi.org/10.15829/1560-4071-2016-2-95-96

Key words: heart amyloidosis, heart failure.

Kirov Military-Medical Academy MD RF, Saint-Petersburg, Russia.

PRESS RELEASE

Russ J Cardiol 2016, 2 (130): 97–98

AD MEMORIAM

Russ J Cardiol 2016, 2 (130): 99-100

INFORMATION

XV Congress of cardiologists of Southern Russia, Rostov-on-Don, 27-29 May 2016

Russ J Cardiol 2016, 2 (130): 101

The rules for authors 2016

Russ J Cardiol 2016, 2 (130): 102-108

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