CONTENTS
СОДЕРЖАНИЕRUSSIAN JOURNAL OF CARDIOLOGY, 2016, 9 (137)
Address to the readers
Russ J Cardiol 2016, 9 (137): 5
CLINICAL MEDICINE NEWS
Clinical medicine updates: a review of international news
Russ J Cardiol 2016, 9 (137): 6
ORIGINAL ARTICLES
LIFE QUALITY OF PERSONS WITH ARTERIAL HYPERTENSION IN RUSSIA — IS THERE RELATION TO TREATMENT? (BY DATA FROM POPULATIONAL STUDY ESSE-RF)
Balanova Yu. A., Kontsevaya A. V., Shalnova S. A., Deev A. D., Kapustina A. V., Evstifeeva S. E., Muromtseva G. A., Imaeva A. E ., Boytsov S. A.
Abstract
Aim. To evaluate LQ in AH patients, to analyze the relation of LQ and treatment status, and to study associated with LQ factors, by the data of ESSE-RF study.
Material and methods. The materials for analysis were representative selections of inhabitants (n=21894) of 13 regions of RF, included to ESSE-RF study in 2012-2013 y. Response was 80%. We used standard epidemiological methods and criteria. The participants were selected to 4 groups: 1) non-AH, 2) AH not taking AHD and having normal BP, 3) AH taking drugs with non-controlled hypertension (non-effective treatment), 4) AH not taking AHD. LQ was assessed with international EUROQOL-5D and visual analogue scale EQ-VAS. Integral LQ assessment was done with LW Shaw et al. methodics. Into analysis the following were included: sex, age, education and wealth levels, systolic and diastolic pressure, AH treatment status, comorbidities, region of participation.
Results. In general, women with AH have worse LQ than men (p<0,0005). In analysis of EQ-5D components we found, that prevalence of prominent disorders was not higher than 3% for every single, but moderate disorders reached 5-41% in those with AH for different parameters. EQ-VAS were significantly lower among those having AH comparing to non-AH — 66,4% vs. 70,1%, p<0,0005. Highest values (p<0,0005) were found in those with AH not taking AHD, but AHD values in the group of those effectively managed and non-effectively managed were comparable. Total index of life quality by EQ-5D among men is higher than women (p<0,005), but it decreases with age. Among both genders — in AH and "AH not taking drugs" groups — LQ by EQ-5D was comparable and significantly higher than in groups "treated effectively" and "treated non-effectively".
Conclusion. Prevalence of AH in RF remains high. LQ in AH persons is lower than in non-AH (mostly for those taking AHD). This witnesses on the necessity for more attention to AH in real clinical practice, including dispensary observation and involvement to educational programs. The populational data obtained in the study, of LQ in AH persons can be applied for QALY calculation in modelling of economical efficacy of various diagnostic and management procedures in relation to Russian patients with AH.
Russ J Cardiol 2016, 9 (137): 7–13
http://dx.doi.org/10.15829/1560-4071-2016-9-7-13
Key words: arterial hypertension, treatment efficacy, life quality, antihypertension treatment.
National Research Center for Preventive Medicine of the Ministry of Health, Moscow, Russia.
SPECIFICS OF ARTERIAL HYPERTENSION COURSE IN PATIENTS WITH AORTIC ATHEROSCLEROSIS COMPLICATED BY ACUTE THROMBOTIC OCCLUSION
Evsikov Е. М.1,2, Teplova N. V.1, Maytesian D. А.2, Sharipov R. А.2, Zhapueva М. Kh.1, Levchuk N. N.2, Kashirin V. V.2, Chervyakova G. А.2, Kurumlidu Е . G.1, Abduragimov S. А.1
Abstract
Aim. To evaluate the main possible reasons for arterial hypertension in patients with thrombotic occlusion of the large arteires of extremities in atherosclerotic disease.
Material and methods. The course of arterial hypertension was analyzed in 129 cases of atherosclerotic aortic disease, complicated with acute thrombotic occlusion of the arteries of lower (112) and upper (17) extremities due to thrombosis (108) and embolism (21) of magistral vessels comparing to the data of 46 patients with chronic ischemia of lower extremities.
Results. Arterial hypertension (AH) in anamnesis was marked in all patients of study groups and comparison group. Systolic AH was diagnosed in 17,8% (23), and in comparsion group — 19,5% (9). Thrombectomy was followed by the decrease of mean BP in most of patients, with good effect of operation and return of adequate circulation in the extremity — in 82,2%, by mean 17,1% systolic and 21,4% — diastolic BP. In 31 patient the dynamics of systolic and diastolic BP after operation was not single-directed and did not raise for more than 5% over baseline, and in 7% cases there was increase of BP, by mean 19,4% systolic and 22,6% diastolic. GFR levels were lower than normal in more than 70% patients of AEI and more than 65% in comparison group.
Conclusion. Thrombectomy and reconstruction interventions on occluded arteries, with successful restore of main circulation in the extremity, are followed by significant decrease of systemic systolic and diastolic arterial pressure in most patients.
Russ J Cardiol 2016, 9 (137): 14–18
http://dx.doi.org/10.15829/1560-4071-2016-9-14-18
Key words: acute arterial thrombosis, chronic ischemia of lower extremities, arterial hypertension.
1N. I. Pirogov Russian National Research Medical University (RNRMU), Moscow; 2O. M. Filatov CCH № 15 of the Department of Health of Moscow, Moscow, Russia.
RESULTS OF BIODEGRADABLE VASCULAR ENDOPROSTHESES IMPLANTATION IN ISCHEMIC HEART DISEASE PATIENTS WITH TYPE 2 DIABETES
Shugushev Z. Kh.1,2, Maksimkin D. А.1,2, Vorob'eva Yu. S.1, Chepurnoj А. G.2, Veretnik G. I.1, Fajbushevich А. G.1
Abstract
Aim. To evaluate efficacy of endovascular treatment in patients with diabetes, operated with biodegradable vascular endoprostheses and everolimus eluting stents.
Material and methods. Primarily, 143 patients were selected into the study. Then 125 patients included and randomized to 2 groups. Patients of I group (n=57) underwent implantation biodegradable vascular endoprostheses, and the II group (n=68) — coronary stents eluting everolimus. For the control of biodegradable endoprostheses implantation optical coherent tomography was used, that was performed at the end of intervention and in long-term follow-up by 12 months.
Results. Totally, 63 biodegradable vascular endoprostheses implanted to the patients of I group, and 102 everolimus coated stents to II group patients. Mean diameter of implanted endoprostheses in group I was — 2,88±0,06 mm, and in group II — 2,68±0,12 mm (р>0,05). Technical success of intervention was 100% in both groups. Total number of serious cardiovascular complications during in-patient phase was 3,5% and 2,94% in groups, respectively (p>0,05). Long-term results were followed-up in 41 patient from group I and in 52 from group II. In 12 months survival rate was 100%. Prevalence of non-fatal MI among I and II group patients was 4,9% and 3,8%, resp. (p>0,05). The reason was progression of atherosclerotic process in other arteries. Restenosis prevalence that required new intervention on target lesion was 2,4% and 1,9%, resp. (p>0,05). Late thrombosis in long-term follow-up was not marked in both groups. Late loss of intrinsic lumen of the vessel, by the data of optical coherent tomography was 0,14±0,19 mm and 0,12±0,23 mm, respectively, for groups I and II (р>0,05).
Conclusion. Biodegradable vascular endoprostheses in CHD patients with diabetes and mostly involvement of middle and distal segments of coronary arteries, showed equal efficacy and safety, with everolimus coated stents, in 12 months after intervention.
Russ J Cardiol 2016, 9 (137): 19–24
http://dx.doi.org/10.15829/1560-4071-2016-9-19-24
Key words: diabetes, biodegradable vascular endoprostheses, everolimus coated stents.
1Peoples' Friendship University of Russia, Moscow; 2N. A. Semashko Central Clinical Hospital №2 of "RGD", Moscow, Russia.
SOMATIC COMORBIDITY AMONG MEN AND WOMEN WITH STABLE ANGINA
Mamedov M. N.1, Didigova R. T.2, Ugurchieva Z. O.2
Abstract
Aim. To assess somatic comorbidity in male and female cohort with stable angina (SA).
Material and methods. Into multicenter, simlutaneous cohort-clinical study, 300 men included (mean age 54±0,4 y. o.) and 230 women (mean age 55,7±0,5 y. o.) with SA of I-III functional class. Four institutions participated from Ingushetia Republic. Clinical and instrumental assessment included anthropometry, office blood pressure, heart rate, ECG in 12 leads recording. In fasting venous blood we measured total cholesterol (mM/L) and glucose (mM/L)
Results. In cohort of patients with SA the most prevalent are cholelythiasis, gastric and duodenal ulcer disease, chronic diseases of pancreas, separately or together; chronic bulbitis is found in each third person, and urinary lythiasis in 15% of cases. Gastric ulcer and duodenal ulcer diseases, chronic bronchitis and urinary lythiasis are two times more prevalent in men compare to women, but cholelythiasis and chronic diseases of pancreas show the same prevalence among men and women. Among women with SA thyroid diseases are 3 times more prevalent than in men.
Conclusion. So, in SA patients comorbidity is quite common. Management and prevention in SA patients cohort should be multifactorial taken a broad spectrum of social and demographic parameters, main risk factors and comorbidities. The key role in coordination and realization of all these activities should be granted to an internist of broad spectrum or general care physician.
Russ J Cardiol 2016, 9 (137): 25–28
http://dx.doi.org/10.15829/1560-4071-2016-9-25-28
Key words: comorbidity, ischemic heart disease, cohort study.
1National Research Center for Preventive Medicine of the Ministry of Health, Moscow; 2Ingushsky State University, Nazran, Ingushetia, Russia.
CLINIC AND PHARMACOTHERAPY
ANTIARRHYTHMIC ACTION OF CARDIOCYTOPROTECTORS IN TREATMENT OF ISCHEMIC HEART DISEASE WITH VENTRICULAR ARRHYTHMIAS
Ryngach E. A., Tatarinova A. A., Ryzhkova D. V., Budanova M. A., Treshkur T. V.
Abstract. It is known that ventricular dysrhythmias in patients with ischemic heart diasease can be of various origin. Hence selection of antiarrhythmic tactics in such patients should be individual and pathogenetically proved.
Aim. To check antiarrhythmic abilities of metabolic therapy for ischemic heart disease combined with variety of ventricular arrhythmias of III-IV grades (by Myerburg RJ).
Material and methods. For 42 patients with ventricular arrhythmias of high grade and stable ischemic heart disease with saved ejection fraction of the left ventricle, before and after treatment were done the following: Holter monitoring, treadmill test, and as indicated — coronary arteriography, radionuclide methods of perfusion assessment and metabolism of myocardium, non-invasive topical diagnostics. To individually selected antianginal and antihypertension therapy for all patients was added ethylmethylhydroxypyridine succinate (ES) in daily dosage 300 mg, for 2 months.
Results. During the study, according to relationship of ventricular arrhythmia with transient ischemia, patients were selected to 2 groups. In the 1 group, with ischemic arrhythmias, in 2 months after start of ES, there was significant antiarrhythmic effect: number of single ventricular premature beats decreased by 55%, couplets — by 90%, and episodes of non-sustained ventricular tachicardia — by 100%. At control positrone-emisson tomography in the areas of myocardial ischemia there was significant increase of 11C-buthirate sodium excretion, which witness on the increase of efficacy of energetic metabolism in zones of hypoxia. In the II group, with non-ischemic ventricular arrhythmias — antiarrhythmic effect was not achieved.
Conclusion. ES should be regarded as pathogenetic chain in complex antiarrhythmic treatment of ventricular arrhythmias in patients with stable ischemic heart disease.
Russ J Cardiol 2016, 9 (137): 29–34
http://dx.doi.org/10.15829/1560-4071-2016-9-29-34
Key words: ventricular arrhythmias, ventricular tachicardia, stable ischemic heart disease, cardiocytoprotectors.
Federal Almazov North-West Medical Research Centre of the Ministry of Health, Saint Petersburg, Russia.
FIXED COMBINATION OF RAMIPRIL AND HYDROCHLOROTHIAZIDE: TO WHOM AND WHAT FOR?
Nedogoda S. V.
Abstract. The article focuses on the "pros" and "contras" of thiazide containing combinations usage for treatment of arterial hypertension in real clinical practice. Based on evidence, clear indications are formulated for effective and safe application of the ramipril and hyndrochlorothiazide combination.
Russ J Cardiol 2016, 9 (137): 35–40
http://dx.doi.org/10.15829/1560-4071-2016-9-35-40
Key words: arterial hypertension, ramipril, hydrochlorothiazide, diuretics, fixed combination.
Volgograd State Medical University, Volgograd, Russia.
ACTUAL TOPICS
ISSUES OF MEDICAL SPECIALISTS EDUCATION. FOUNDATION OF INSTITUTE OF INDEPENDENT PROFESSIONAL EXPERTS
Sirotkina O. V., Ishchuk T. N., Parmon E. V., Shlyakhto E . V.
Abstract. Medical care improvement in Russan Federation directly depends upon implementation to broad practice of professionally-public accreditation of professional educational programs of medical profile. Important role in the evaluation of professional education and specialists preparing, including physicians, for the labour market and professional standards, play a personality of expert participating in accreditation procedure. Under the realization of Russian Society of Cardiology project "Professional-public accreditation of educational programs as an element of medical education improvement" and with involvement of the Central expert board of Russian Unity of medical association "National medical board" in FSBI "North-Western Federal Medical Research Centre n. a. V. A. Almazov" of the Ministry of Health, experts training is go for professional-public accreditation of the programs of medical profile.
Russ J Cardiol 2016, 9 (137): 41–45
http://dx.doi.org/10.15829/1560-4071-2016-9-41-45
Key words: professional-public accreditation, educational programs of medical profile, experts training.
Federal Almazov North-West Medical Research Centre of the Ministry of Health, Saint Petersburg, Russia.
"MEDICINE OF THE WHOLE PATIENT": A MODERN PERUSAL OF CLASSICAL CLINICIAN'S TEXT
Taratukhin E. O., Nozdrachev D. I.
Abstract. Medicine of 21st Century has absorbed a broadest knowledge of biochemistry, genetics, pathology, pharmacology, which make to do wonders. More and more common is definition of medicine as personalized or patient-centred. However exact meanings of such "centredness" are still vague. This article is an attempt for modern reading of a classical text by G. A. Zakharyin, one of the most prominent figures in classical medical thought. A "commented reading" is provided of his "Clinical Lectures" with emphasis on the meanings of wholeness of a patient as the one merged into social background, having psychological suffering together with somatic pathology itself. The possibility is commented on how to explicate the author's thoughts to modern evidence based practice of medicine.
Russ J Cardiol 2016, 9 (137): 46–50
http://dx.doi.org/10.15829/1560-4071-2016-9-46-50
Key words: patient-centered medicine, person-centered medicine, clinical tradition, personalized medicine, holistic approach, non-communicable diseases, Zakharyin G.A.
N. I. Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia.
LITERATURE REVIEWS
PATHOPHYSIOLOGY OF ACUTE HEART FAILURE. WHAT'S NEW?
Tereshchenko S. N., Zhirov I. V., Nasonova S. N., Nikolaeva O. A., Ledyakhova M. V.
Abstract. By the date, acute heart failure (AHF) is of the most significant problems in whole world healthcare, as it is one of the main causes for hospitalization to specialized units and intensive care units. About 80% of AHF cases are due to acute decompensation (AD) of heart failure (HF), and if formerly AHF was regarded as a condition actual only for elderly (older than 70), now these are the patients "younger" — economically active (50-65 y. o.), what makes AHF not just medical but social, economical problem, demanding special attention from policies and healthcare. It is crucial to diagnose on-time for risk stratification and correct assessment. Also, mechanisms of AHF are complicated and are not studied completely, that is why till now there is no single strategy for that sort of patients management. Understanding of pathophysiological mechanisms of HF development has been changed significantly recent decades, from simple hemodynamic model to a conception of systemic multifactorial process, with involved multiple mechanisms of various organs and systems interaction. Hemodynamic overloads, venous congestion, neuro-humoral systems activation, natri-uretic peptides, inflammation, endothelial dysfunction, oxidative stress and its influence on the heart and vessels remodeling, as mechanisms of cellular adaptation are currently the main in AHF pathogenesis reasons.
Russ J Cardiol 2016, 9 (137): 52–64
http://dx.doi.org/10.15829/1560-4071-2016-9-52-64
Key words: acute decompensation of heart failure, pathophysiology, target organ damage.
Russian Cardiological Research-and-Production Complex of the Ministry of Health, Moscow, Russia.
CARDIOVASCULAR PATIENT WITH STAGE 1-3 CHRONIC KIDNEY DISEASE: CONTEMPORARY CARDIONEPHROPROTECTION IN REAL CLINICAL PRACTICE
Tarlovskaya E. I.
Abstract. The article provides a review of data on cardiovascular patients' treatment, with 1-3 grades of chronic kidney disease (CKD). It is shown that for cardiovascular patients the function of kidneys must be assessed before beginning of treatment, which is important for on-time diagnostics of CKD. Practitioners must remember that patients with the 3rd grade of CKD require specific nephroprotection. On all stages of the disease optimal nephroprotectors are inhibitors of renin-angiotensine system (RAS) (blockers of angiotensine receptors (ARB) and angiotensine converting enzyme inhibitors (ACEi)). The evidence provided for relation of ARBs nephroprotective effect with dosage, and that these drugs must be used in highest tolerated dosages, but not in minimal effective dosage that leads to normalization of BP. It is shown that combination of ACEi and ARBs with statins enhances cardiorenal protection as a result of nephroprotective effects synergy of statins and RAS inhibitors.
Russ J Cardiol 2016, 9 (137): 65–71
http://dx.doi.org/10.15829/1560-4071-2016-9-65-71
Key words: chronic kidney disease, nephroprotection, angiotensine receptor blockers, valsartan, rosuvastatin.
Nizhny Novgorod State Medical Academy of the Ministry of Health, Nizhny Novgorod, Russia.
MECHANISMS OF CARDIOVASCULAR DISEASES DEVELOPMENT IN OBESITY AND INSULIN RESISTANCE: FOCUS ON ATHEROTHROMBOSIS
Shishkova V. N.
Abstract. Article takes into consideration pathogenetic mechanisms of cardiovascular diseases development in obesity and insulin resistance, approaches to atherothrombotic complications prevention. The issues of resistance to antiplatelet drugs are condsidered and possible ways for its overcome. The data is evidence based.
Russ J Cardiol 2016, 9 (137): 72–78
http://dx.doi.org/10.15829/1560-4071-2016-9-72-78
Key words: obesity, diabetes, atherothrombosis, insulin resistance, hyperglycemia, clopidogrel, aspirin, clapitax.
SI Center for Speech Pathology and Neurorehabilitation, Moscow, Russia.
PATIENT-CENTERED MEDICINE. A NEW REALITY
Taratukhin E. O.
Abstract. The literary analysis is presented to underline the importance and controversy of the meaning of patient-centered medicine, which attracts more and more researchers and practitioners. The origins of this concept are reviewed, its further directions as a novel generalized physician approach to a human with opportunity to launch positive dynamics on all levels from somatic to social and cultural. A range of questions is taken, and the pathways sketched towards conceptualization and evidence base for practical implementation of patient-centered paradigm.
Russ J Cardiol 2016, 9 (137): 79–83
http://dx.doi.org/10.15829/1560-4071-2016-9-79-83
Key words: person-centered medicine, patient-centered interview, psychosomatics, rehabilitation, prevention, non-communicable diseases.
N. I. Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia.
TELOMERE LENGTH AND ATHEROSCLEROSIS
Drapkina O. M., Shepel R. N.
Abstract. The development and progression of atherosclerosis in most cases takes decades, and at early stages does not present clinically. Multiple studies results witness that telomere length reflects total grade of DNA damage by the factors that are responsible for atherosclerosis and its complications. Velocity of telomeres shortening increases even before the disease onset that may play diagnostic and predictive role.
Russ J Cardiol 2016, 9 (137): 84–89
http://dx.doi.org/10.15829/1560-4071-2016-9-84-89
Key words: atherosclerosis, telomeres, cellular ageing, oxidative stress.
National Research Center for Preventive Medicine of the Ministry of Health, Moscow, Russia.
SYSTEMIC CARDIOVASCULAR OUTCOMES OF SLEEP RELATED BREATHING DISORDERS
Kallistov D. Yu.1, Romanov A. I.1, Novichkova N. I.2, Romanova Е. А.3
Abstract. Related to sleep breathing disorders are prevalent kind of disordered sleep and influence significantly and negatively on development of a range of somatic diseases, primarily — cardiovascular and metabolic. Results of evidence research witness on the relation of the sleep apnea and arterial hypertension, ischemic heart disease, heart failure, arrhythmias, cerebrovascular diseases, diabetes. Inclusion of the methods of diagnostics and treatment of sleep related disorders to the standards of management and rehabilitation of patients with these nosological units is theoretically based and clinically significant.
Russ J Cardiol 2016, 9 (137): 90–94
http://dx.doi.org/10.15829/1560-4071-2016-9-90-94
Key words: sleep disorders, apnea, arterial hypertension, CHD, arrhythmias, cerebrovascular diseases, diabetes, standards.
1Center for Rehabilitation of the President Services, settlement of Hertsen sanatorium, Moscow Region; 2Erisman F.F. Federal Scientific Center for Hygiene of Rospotrebnadzor, Moscow Region, Mytishchi; 3Hospital with Outpatient care of the President Services, Moscow, Russia.
