[Резюме номера на русском]

 

GENETIC ASPECTS OF MYOCARDIAL INFARCTION: PROBLEMS AND PERSPECTIVES

Shesternya P.A., Shulman V.A., Nikulina S.Yu.
Prof. V. F. Voyno-Yasenetskyi Krasnoyarsk State Medical University, Krasnoyarsk, Russia.

The role of hereditary factors in the development of coronary heart disease and myocardial infarction is known, but the underlying pathogenetic mechanisms remain understudied. Multiple studies of candidate genes (those coding protein synthesis, participating in atherosclerosis pathogenesis, or regulating hemostasis and inflammation) have not been particularly successful. The main problem of these studies has been a very low level of reproducibility of the results obtained. By contrast, whole-genome association studies have provided new perspectives in this research area. This review discusses the modern relevant evidence and new directions for future research.
Russ J Cardiol 2012, 1 (93): 4-9

Key words: Myocardial infarction, genetics, predictors, polymorphisms.

 

COMPARISON OF IN-HOSPITAL LETHALITY PROGNOSTIC SCALES IN MYOCARDIAL INFARCTION PATIENTS

Zykov M.V.¹, Barbarash O.L.², Zykova D.S.¹, Karetnikova V.N.², Tavlueva E.V.¹, Kashtalap V.V.¹
Research Institute of Complex Cardiovascular Problems, Siberian Branch, Russian Academy of Medical Sciences¹, Kemerovo; Kemerovo State Medical Academy², Kemerovo, Russia.

Aim. To assess the prognostic value of selected in-hospital lethality prognostic scales in patients with ST segment elevation myocardial infarction (STEMI) and to create a new, original risk scale.
Material and methods. The analysis included the data of 800 consecutive patients admitted to the Kemerovo Cardiology Dispanser with STEMI diagnosis in 2008–2009. The level of in-hospital lethality was 10,5% (84 deaths).
Results. The risk stratification at admission with TIMI (after pre-hospital thrombolysis) or GRACE scales, or after angiography with CADILLAC scale, provided an important prognostic information and relatively accurately identified the patients at high risk. However, these scales, created for different clinical groups, demonstrated heterogeneous prognostic value, required information on the levels of coronary artery damage, and were not always applicable to the everyday clinical practice settings.
Conclusion. Therefore, a new, original prognostic scale (KemScore) has been created, which is based on clinical parameters and glycaemia levels. Independently of the selected therapeutic strategy, this scale provides a reliable assessment of in-hospital lethality risk, and could be used as early as within the first hour after admission.
Russ J Cardiol 2012, 1 (93): 11-16

Key words: In-hospital prognosis in myocardial infarction.

 

ENDOVASCULAR INTERVENTION EFFECTS ON POST-INFARCTION CLINICAL COURSE IN PATIENTS UNDER 60 YEARS

Zaytsev D.G.², Volov N.A.1, Lebedeva A.Yu.², Filatov A.A.², Klykov L.L.², Lusov V.A.¹
N. I. Pirogov Russian National Medical Research University¹, Moscow; O. M. Filatov Moscow City Clinical Hospital No. 15², Moscow, Russia.

Aim. One of the major issues in modern cardiology is the treatment and prevention of complications in younger patients (under 60 years) after myocardial infarction with ST segment elevation (STEMI). According to the available evidence, in female patients, endovascular interventions are less common, and coronary artery bypass graft surgery is more common than in male patients.
Material and methods. The study included 102 male and female patients aged under 60 years and diagnosed with STEMI. In all participants, coronary angiography was performed within first 6 hours, followed by infarct-related artery revascularisation via balloon angioplasty and stenting. At Days 10–15, as well as 6 and 12 months later, clinical examination (presence of angina, heart failure, or arrhythmias), Holter ECG monitoring, and treadmill test were performed.
Results. The results of the one-year follow-up suggested that in female patients, heart failure developed earlier, ejection fraction was significantly lower, and Functional Class II angina was more prevalent than in their male peers. Moreover, female patients more often demonstrated clinically significant cardiac arrhythmias, reduced exercise capacity, and decreased heart rate variability.
Conclusion. Post-infarction clinical course in women under 60 years was characterized by earlier development of heart failure, which justifies adequate control of its clinical manifestations and more aggressive therapy. The prevalence of effort angina or supraventricular extrasystolia was higher in women, which requires the antianginal therapy correction, via increasing the doses of β-adrenoblockers or calcium channel blockers. In men, ventricular arrhythmias were more prevalent, which might require antiarrhythmic drug therapy.
Russ J Cardiol 2012, 1 (93): 17-23

Key words: Myocardial infarction, coronary heart disease, coronary angiography, chronic heart failure.

 

COMPARATIVE ASSESSMENT OF LARGE ARTERY ELASTICITY IN PATIENTS WITH STABLE ANGINA RECEIVING METABOLIC THERAPY

Ilukhin O.V.¹, Tarasov D.L.², Prom A.K.², Kalganova E.L.3, Termisultanova T.Kh.^1,2, Ilukhina M.V.⁴
Volgograd State Medical University¹, Volgograd; Volgograd Region Clinical Cardiology Centre², Volgograd; Clinical Polyclinic No.12³, Volgograd; Volgograd Region Clinical Hospital No.1⁴, Volgograd, Russia.

Aim. To assess the effects of metabolic therapy, administered together with standard antianginal treatment, on large artery elasticity and endothelium dependent vasodilatation in patients with stable angina and subsequent heart failure.
Material and methods. The study included 74 patients with coronary heart disease (CHD), stable angina of II–III Functional Class (FC), and FC II–III chronic heart failure (CHF). In the main group, standard antianginal treatment was combined with metabolic therapy (trimetazidine, trimethylhydrazinium propionate, and isosorbide dinitrate) for 4 months; the control group received standard treatment only.
Results. The four-month metabolic therapy failed to substantially improve the pulse wave velocity (PWV) in elastic arteries. In muscular arteries, PWV significantly decreased during the treatment with isosorbide dinitrate, which negatively affected endothelium-dependent vasodilatation of radial arteries. However, trimetazidine treatment was associated with a significant improvement in endothelial function, as well as with a significant reduction in anginal FC and a substantial improvement in exercise capacity.
Trimethylhydrazinium propionate therapy was linked to non-significant positive dynamics of these parameters.
Conclusion. In stable angina patients, the combination of trimetazidine and standard antianginal therapy was associated with a significant improvement in endothelium dependent vasodilatation of muscular arteries. Considering its positive impact on endothelial function and the absence of direct effects on arterial tonus in stable angina, trimetazidine therapy was more effective than isosorbide dinitrate treatment.
Russ J Cardiol 2012, 1 (93): 24-30

Key words: Pulse wave velocity, endothelium-dependent arterial reactivity, trimetazidine, endothelial function.

 

HEART-TYPE FATTY ACID BINDING PROTEIN IN ACUTE CORONARY SYNDROME

Kashtanova E.V.¹, Voevoda M.I.¹, Kuimov A.D.², Polonskaya Ya.V.¹, Lozhkina N.G.², Ragino Yu.I.¹
Institute of Internal Medicine, Siberian Branch, Russian Academy of Medical Sciences¹, Novosibirsk; Novosibirsk State Medical University², Novosibirsk, Russia.

Aim. To compare the serum levels of heart-type fatty acid binding protein (H-FABP), measured with immune-enzyme assay and immunochromatography express test system, in patients with acute coronary syndrome (ACS), such as myocardial infarction (MI) and unstable angina (UA).
Material and methods. The study included 250 ACS patients: 166 with MI and 84 with UA. At Days 1 and 10 of ACS, serum levels of troponin I (immune-enzyme assay), creatine kinase-MB (CK-MB; photometry), and H-FABP (quantitative measurement with immune-enzyme assay, H-FABP-IEA-BEST test system, Vector-Best, Russia; qualitative measurement with immunochromatography express test system, BioTest, Russia) were assessed in all participants.
Results. At Day 1, serum H-FABP levels were substantially higher in men vs. women with MI, and in men with MI vs. men with UA. This parameter significantly correlated with MI diagnosis, including Q-wave MI, with other ACS biomarkers (troponin I and CK-MB), and with selected inflammatory biomarkers.
Conclusion. H-FABP is a significant, sensitive biomarker of myocardial damage and ACS development. Immunochromatography express test system produced qualitatively “positive” results even in serum H-FABP concentrations lower than 15 ng/ml.

Key words: Heart-type fatty acid binding protein (H-FABP), acute coronary syndrome, myocardial infarction, immune-enzyme assay, immunochromatography express test system H-FABP.

 

SPECIFICS OF PRE-ADMISSION EMERGENCY CARE IN PATIENTS WITH ATRIAL FIBRILLATION

Yepifanov V.G.¹, Dolgikh V.T.²
Emergency Care Unit¹, Omsk; Omsk State Medical Academy², Pathophysiology and Clinical Pathophysiology Department, Omsk, Russia.

Aim. To perform a retrospective comparison of pre-admission emergency care tactics and outcomes in patients with uncomplicated atrial fibrillation (AF) episodes.
Material and methods. In total, 1200 cases of pre-admission emergency care in AF patients were analyzed, using the ambulance call forms, polyclinics medical cards, and hospital case histories. The emergency care outcomes were compared for the patients who were not hospitalized and those were admitted to the hospital within 1, 12, or 24 hours.
Results. The pre-admission emergency care in patients with uncomplicated AF was not effective within the first hour of the follow-up. In over 90% of the cases, AF episode was resolved within 24 hours, regardless of the emergency care tactics or the antiarrhythmic drug used. Inadequate ventricular rate reduction at the preadmission stage was associated with a longer AF episode duration and an increased chance of hospitalisation.
Conclusion. The tactics of pre-admission emergency care in uncomplicated AF episodes lasting under 24 hours should primarily address the reduction of ventricular rate. The strategy of obligatory hospitalisation of all ambulanceattended uncomplicated AF episodes which lasted less than 24 hours is not justified.

Key words: Atrial fibrillation, emergency care, pre-admission stage.

 

CLINICAL ROLE OF CARDIAC EXAMINATION IN COPD PATIENTS

Akramova E. G.
Kazan City Central Clinical Hospital No. 18, Kazan, Russia.

Aim. To assess cardiac structure and function, using echocardiography and Holter ECG monitoring, in patients with chronic obstructive pulmonary disease (COPD), or a combination of COPD and arterial hypertension (AH) or coronary heart disease (CHD).
Material and methods. In total, 72 COPD patients (21 with COPD only, 28 with COPD and AH, and 23 with COPD and CHD) underwent echocardiography (HD 11 XE, Philips, США) and Holter ECG monitoring (Schiller, Switzerland).
Results. In COPD patients without cardiac comorbidity, Stage I COPD was characterized by mild relative dilatation of right ventriculum (RV) and right atrium (RA), left ventricular (LV) diastolic dysfunction, and reduced Sm of mitral and tricuspid annulus fibrosus. Stage II COPD was additionally characterised by RV diastolic dysfunction, while in Stage III–IV COPD, RV hypertrophy was observed. Clinical manifestations of chronic heart failure (CHF) were registered in one-third of the patients with isolated COPD or COPD and AH, compared to 87% of the participants with COPD and CHD.
Conclusion. RV hypertrophy was observed at Stage I COPD in patients with COPD and CHD, at Stage II in individuals with COPD and AH, and at Stage III in participants with isolated COPD. LV abnormalities, such as concentric remodelling or diastolic dysfunction, were registered in some patients at Stage I of isolated COPD. The most severe cardiac pathology, such as LV and RV hypertrophy, reduced global contractility, frequent episodes of ventricular tachycardia, and myocardial ischemic episodes, was observed in patients with COPD and CHD.

Key words: Echocardiography, Holter monitoring, chronic obstructive pulmonary disease, arterial hypertension, coronary heart disease.

 

NEBIVOLOL ROLE IN THE CORRECTION OF INTRACARDIAC HEMODYNAMICS IN PATIENTS WITH CHRONIC HEART FAILURE

Dzhanaeva R.L., Astakhova Z.T., Makoeva V.Yu.
North Ossetia State Medical Academy, Vladikavkaz, Russia.

Aim. To assess the effectiveness and safety of a super-selective vasodilating β-adrenoblocker (β-AB) nebivolol in patients with NYHA Functional Class (FC) I–III chronic heart failure (CHF), as a complication of coronary heart disease (CHD).
Material and methods. In total, 42 patients with post-infarction cardiosclerosis and FC I–III CHF (30 men and 12 women), aged 52–73 years, were examined. Nebivolol was administered once daily, in the morning, as a part of complex CHD treatment, for 12 weeks. The clinical effectiveness of the therapy and its effects on intracardiac hemodynamics (echocardiography) were assessed.
Results. After 12 weeks of the treatment, clinical manifestations of CHF decompensation (oedema, dyspnoea, palpitation, and fatigue) were reduced, the mean CHF FC significantly decreased from 3,12±0,08 to 1,88±0,05 (p<0,05), and exercise capacity increased. A significant reduction in systolic and diastolic blood pressure levels was observed among hypertensive patients. In all participants, mean heart rate was significantly reduced, from 76,80±10,41 to 62,0±5,54 bpm (p≤0,05). Nebivolol also improved the parameters of pathological cardiac remodeling and intracardiac hemodynamics. Mean end-diastolic and end-systolic volume decreased by 19,5% and 15,7%, respectively, while mean left ventricular (LV) myocardial mass decreased by 22,4%. Improved systolic function manifested in significantly increased LV ejection fraction (by 23,8%) and fractional shortening (by 38,3%). Nebivolol also improved LV diastolic function, as demonstrated by increased Ve and F/A ratio (from 1,12±0,34 to 1,29±0,45; p<0,05).
Conclusion. Nebivolol therapy improved clinical status and extra- and intracardiac hemodynamics in patients with CHF.
Russ J Cardiol 2012, 1 (93): 48-51

Key words: Nebivolol, chronic heart failure, intracardiac hemodynamics, diastolic function.

 

ANTIHYPERTENSIVE EFFICACY AND SAFETY OF OLMESARTAN MEDOXOMIL AND RAMIPRIL IN ELDERLY PATIENTS WITH MILD TO MODERATE ESSENTIAL HYPERTENSION: THE ESPORT STUDY

Malacco E.¹, Omboni S.², Volpe M.³, Auteri A.⁴ and Zanchetti A.⁵, on behalf of the ESPORT Study Group
Keywords: ambulatory blood pressure monitoring, elderly, essential hypertension, office blood pressure, olmesartan, ramipril.

Department of Internal Medicine. Ospedale L. Sacco, University of Milan¹, Milan; Italian Institute of Telemedicine², Varese; Division of Cardiology, II Faculty of Medicine, University of Rome «La Sapienza» and IRCCS Neuromed³, Pozzilli, Isernia; Internal Medicine III, University of Siena⁴, Siena; Centro di Fisiologia Clinica e Ipertensione University of Milan and Istituto Auxologico Italiano⁵, Milan, Italy
Objective. To compare the efficacy and safety of the angiotensin II antagonist olmesartan medoxomil (O) and the ACE inhibitor ramipril (R) in elderly patients with essential arterial hypertension.
Methods. After a 2-week placebo wash-out 1102 treated or untreated elderly hypertensive patients aged 65–89 years (office sitting diastolic blood pressure, DBP, 90–109mmHg and/or office sitting systolic blood pressure, SBP, 140–179mmHg) were randomized double-blind to 12-week treatment with O 10mg or R 2.5mg oncedaily.
After the first 2 and 6 weeks doses could be doubled in non-normalized [blood pressure (BP) <140/90mmHg for nondiabetic and<130/80mmHg for diabetic) individuals, up to 40mg for O and 10mg for R. Office BPs were assessed at randomization, after 2, 6 and 12 weeks of treatment, whereas 24-h ambulatory BP was recorded at randomization and after 12 weeks.
Results. In the intention-to-treat population (542 patients O and 539 R) after 12 weeks of treatment baseline-adjusted office SBP and DBP reductions were greater (P<0.01) with O [17.8 (95% confidence interval: 16.8/18.9) and 9.2 (8.6/9.8) mmHg] than with R [15.7 (14.7/16.8) and 7.7 (7.1/8.3) mmHg]. BP normalization rate was also greater under O (52.6 vs. 46.0% R, P<0.05). In the subgroup of patients with valid ambulatory BP recording (318 O and 312 R) the reduction in 24-h average BP was larger (P<0.05) with O [SBP: 11.0 (12.2/9.9) and DBP: 6.5 (7.2/5.8) mmHg] than with R [9.0 (10.2/7.9) and 5.4 (6.1/4.7) mmHg]. The larger blood pressure reduction obtained with O was particularly evident in the last 6 h from the dosing interval; a better homogeneity of the 24-h BP control with O was confirmed by higher smoothness indices. The proportion of patients with drug-related adverse events was comparable in the two groups (3.6 O vs. 3.6% R), as well as the number of patients discontinuing study drug because of a side effect (14 O vs. 19 R).
Conclusion. In elderly patients with essential arterial hypertension O provides an effective, prolonged and well tolerated BP control, representing a useful option among first-line drug treatments of hypertension in this age group.

Adopted translation in Russian from Journal of Hypertension 2010, 28:2342—2350.

 

COMPARATIVE EFFECTIVENESS OF PERINDOPRIL AND LOSARTAN IN PATIENTS WITH ARTERIAL HYPERTENSION AND OBESITY

Nedogoda S.V., Ledyaeva A.A., Chumachek E.V., Tsoma V.V., Mazina G.G., Salasyuk A.S., Barykina I.N.
Volgograd State Medical University, Post-Diploma Medical Education Faculty, Therapy and Endocrinology Department, Volgograd, Russia.

Aim. To assess the antihypertensive effectiveness of perindopril А and losartan and their influence on the main cardiovascular risk factors among patients with arterial hypertension and obesity.
Material and methods. This single-blind, randomised, comparative parallel study included patients either untreated with antihypertensive medications or in the end of the two-week wash-out period. All patients were randomised (random envelope method) into 2 groups: Group I (n=30) received perindopril А (Prestarium A, Servier; 10 mg/d), while Group II (n=30) was administered losartan (Cozaar, Merck Sharp & Dohme; 100 mg/d) for 24 weeks. The examination included 24-hour blood pressure monitoring (SpaceLabs 90207, USA), the measurement of pulse wave velocity (PWV), augmentation index, and central aortal pressure (Sphygmocor), and standard echocardiography (EchoCG) (ALOKA prosound L7 premier).
Results. In the perindopril А group, 24-hour levels of systolic and diastolic blood pressure (SBP, DBP) decreased by 15,2% and 18,1%, respectively; in the losartan group, this reduction was 7,8% (p<0,05) and 14,9%, respectively. Perindopril А more effectively, compared to losartan, reduced left ventricular myocardial thickness and myocardial mass index – by 5,3% and 14,3%, respectively, vs. 1,2% and 5,5% (p<0,05). Perindopril А also reduced the carotid-femoral PVW (CF PWV) by 28,9% and the carotid-radial PVW (CR PWV) by 25,8%, compared to 4,1% and 15,7% (p<0,05) in the losartan group. Augmentation index and central aortal pressure decreased by 17,4% and 7,5%, respectively, in the perindopril А group. In the losartan group, the respective figures were 3,5% and 1,3% (p<0,05). An important finding for the patients with arterial hypertension and obesity was a reduction in blood leptin levels – by 29,7% vs. 6,9% in participants treated with perindopril А vs. losartan (p<0,05).
Conclusion. Perindopril А is more suitable for the arterial hypertension treatment in obese patients, since it not only more effectively, compared to losartan, reduced BP, but also demonstrated more beneficial effects on the cardiovascular risk factors in this clinical group (including normalisation of lipid and carbohydrate metabolism or improvement of anthropometric parameters).

Key words: Hyperuricemia, gout, arterial hypertension, pulse wave velocity, losartan.

 

IVABRADINE THERAPY IN PATIENTS WITH CORONARY HEART DISEASE AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Zheleznyakova N. A., Sokolov I. M., Gafanovich E.Ya.
V.I. Razumovskyi Saratov State Medical University, Saratov, Russia.

The combination of coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD) is widely prevalent in clinical practice. The problem of adequate therapy choice is important, since the majority of the medications administered in isolated CHD or COPD are contraindicated for the combination of these two disorders. In CHD patients with angina, heart rate (HR) control is one of the major methods to achieve the anti-anginal effect. In case of contraindications for beta-adrenoblockers or nondihydropyridine calcium channel blockers, the medication of choice is ivabradine.

Key words: Heart rate, ivabradine, tachycardia, COPD, CHD.

 

PREGNANCY COURSE AND OUTCOME IN A WOMAN WITH STAGE III ESSENTIAL ARTERIAL HYPERTENSION

Chicherina E.N., Padyganova A.V.
Kirov State Medical Academy, Kirov, Russia

A clinical case of pregnancy in a woman with Stage III essential arterial hypertension is presented. The authors discuss the importance of hyperhomocysteinemia problem in pregnancy, and demonstrate the need to combine standard diagnostic methods with the assessment of hereditary thrombophilia markers in this clinical group. The therapeutic strategy is justified, and respective clinical recommendations are given.

Key words: pregnancy, essential arterial hypertension, hereditary thrombophilia markers, hyperhomocysteinemia.

 

MINOR HEART ANOMALIES

Zemtsovskyi E.V.^1,2, Malev E.G.¹, Lobanov M.Yu.², Parfenova N.N.^1,2, Reeva S.V.^1,2, Khasanova S.I.^1,2, Belyaeva E.L.²
V. A. Almazov Federal Centre of Heart, Blood, and Endocrinology¹, St. Petersburg; St. Petersburg State Paediatrics Academy², St. Petersburg, Russia.

The paper attempts to revise the working classification of minor heart anomalies (MHA). It is proposed to exclude some syndromes and abnormalities which clearly have an independent clinical significance. The need for exclusion of prevalent normal variants, as well as anatomical and physiological characteristics of child’s heart, is justified. The inverse dynamics of selected MHA in older vs. younger age groups is demonstrated. The authors suggest that the current working classification should be modified.

Key words: Minor heart anomalies, classification, connective tissue dysplasia, anatomical and physiological characteristics of child’s heart.