CARDIOVASCULAR MORTALITY IN 12 RUSSIAN FEDERATION REGIONS – PARTICIPANTS OF THE “CARDIOVASCULAR DISEASE EPIDEMIOLOGY IN RUSSIAN REGIONS” STUDY
Shalnova S. A.1, Konradi A. O.2, Karpov Yu. A.3, Kontsevaya A. V.1, Deev A. D.1, Kapustina A. V.1, Khudyakov M. B.1, Shlyakhto E. V.2, Boytsov S. A.1
1 State Research Centre for Preventive Medicine, Moscow; 2 V. A. Almazov Heart, Blood, and Endocrinology Federal Centre, St. Petersburg; 3 Russian Cardiology Scientific and Clinical Complex, Moscow, Russia.Abstract
Similar to most developed countries, cardiovascular disease (CVD) is a leading cause of mortality in Russia. The levels of CVD mortality in working-age Russian men and women are the highest in Europe and characterised by marked fluctuations. Up to 60% of fatal CVD cases could be explained by the population levels of cardiovascular risk factors. Presently, however, no data are available to demonstrate the varied prevalence of these risk factors in Russia. The information on the actual health status and cardiovascular risk factor levels in the Russian population could be obtained only in epidemiological studies. Therefore, the Russian Ministry of Health and Social Development initiated the study “Cardiovascular Disease Epidemiology in Russian Regions”. This study involves 12 Russian regions which differ by their climatic, geographic, economic, and demographic characteristics. This analysis presents the official levels of CVD mortality in respective Russian regions and the associations between mortality and regional per capita income. A marked inter-regional heterogeneity in fatal CVD levels, as well as a significant regional gradient in CVD mortality by income, demonstrates the urgent need for the wide implementation of risk factor monitoring across the Russian regions.
Key words: epidemiology, cardiovascular disease, Russian regions, mortality, per capita income.
TREATMENT SPECIFICS AND CLINICAL OUTCOMES IN PATIENTS WITH ACUTE CORONARY SYNDROME AND ANAEMIA: RECORD REGISTRY RESULTS
Erlikh A. D., Gratsianskyi N. A., on behalf of the RECORD Registry participants
Clinical Cardiology Department, Research Institute of Physico-Chemical Medicine, Russian Federal Medic-Biological Agency, Moscow, Russia.Abstract
Aim. To analyse the treatment characteristics and specifics in patients with acute coronary syndrome (ACS) and anaemia, based on the data from the Russian ACS registry (RECORD).
Material and methods. The recruitment of the patients (November 2007 – February 2008) was performed, using the independent Russian ACS register RECORD.
Results. The study included 796 patients (mean age 64,7±12,1 years; 57,2% men). ACS with ST segment elevation (ST ACS) was registered in 246 patients (30,1%), while ACS without ST segment elevation (non-ST ACS) was observed in 550 patients (69,9%). Anaemia at admission was registered in 228 participants (29,0%). The anaemia group had a higher proportion of elderly patients – those with diabetes mellitus, heart failure in anamnesis and at admission, and high risk by the GRACE scale. These patients were less often hospitalised in “invasive” hospitals. In hospital, anaemic patients less often received clopidogrel and underwent reperfusion in ST ACS or invasive procedures in non-ST ACS. Low baseline levels of haemoglobin (<110 g/l) independently predicted the risk of in-hospital death (odds ratio 4,6; 95% confidence interval 1,9–11,2; p=0,001). Anaemic patients had significantly higher risk of in-hospital death, compared to their non-anaemic peers (10% vs. 5,2%; p=0,012). In the group of anaemic patients with non-ST ACS, the risk of adverse outcomes (death or new myocardial infarction during hospitalisation) was significantly lower in those who underwent percutaneous coronary intervention (PCI) (4,1% vs. 18,2%; p=0,04) or PCI and coronary artery bypass graft surgery (3,6% vs. 17,6%; p=0,013). However, in non-anaemic patients, no such difference was observed: 5,8% vs. 4,2% (p=0,6) and 5,6% vs. 4,1% (p=0,6), respectively.
Conclusion. First, in RECORD Registry participants, haemoglobin levels <110 g/l independently predicted the risk of in-hospital death. Second, anaemic patients were characterised by a higher number of risk factors, lower rates of invasive procedures, and a significantly higher risk of in-hospital death. Third, in patients with non-ST ACS and anaemia, the absence of coronary interventions was linked to a significantly higher risk of death or new MI during hospitalisation.Key words: acute coronary syndrome, registry, anaemia.
PROGNOSIS IN PATIENTS WITH ST SEGMENT ELEVATION MYOCARDIAL INFARCTION, IN REGARD TO THE PRESENCE OF TYPE 2 DIABETES MELLITUS AND SELECTED TREATMENT STRATEGY IN THE ACUTE PERIOD
Belen’kova Yu. A.1,2, Tavlueva E. V.1, Karetnikova V. N.2,1, Zykov M. V.2,1, Kashtalap V. V.1,2, Ganyukov V. N.1, Barbarash O. L.1,2
1 Research Institute of Complex Cardiovascular Problems, Siberian Branch, Russian Academy of Medical Sciences, Kemerovo; 2 Kemerovo State Medical Academy, Kemerovo, Russia.Abstract
Aim. To assess the results of endovascular revascularisation in patients with acute myocardial infarction (AMI) and ST segment elevation (STEMI), in regard to the presence of Type 2 diabetes mellitus (DM-2), in the real-world clinical settings.
Material and methods. The study included 423 STEMI patients, with or without concomitant DM-2. In the DM-2 group (n=77, 18,20%), percutaneous coronary intervention (PCI) was performed in 35 individuals (45,5%); in participants without DM-2, the respective figure was 54,91% (n=190). The follow-up period lasted for one year. The adverse long-term prognosis included repeated non-fatal MI and/or stroke, cardiac death, unstable angina, and decompensated heart failure (combined end-point).
Results. In patients who underwent PCI, the presence of DM-2 did not affect substantially (p>0,05) the incidence of adverse clinical outcomes: it reached 28,57% (n=10) in participants with STEMI and DM-2 and 30,53% (n=58) in STEMI patients without DM-2. However, among individuals who did not undergo PCI, DM-2 was associated with increased incidence of the combined end-point: 52,38% (n=22) among those with STEMI and DM-2 vs. 42,95% (n=67) among those with STEMI only. Repeated interventions due to stent thrombosis (n=2; 5,71%) or stent restenosis (n=4; 11,43%) were non-significantly more frequent among patients with DM-2, compared to the non-diabetic patients (1,05% (n=2) and 3,68% (n=7), respectively). Therefore, PCI in STEMI patients with DM-2 substantially improved the long-term prognosis, halving the incidence of the combined end-point. By contrast, this incidence was reduced only by 1,5 among patients who did not undergo PCI. To summarise, the presence of DM-2 is associated with adverse long-term prognosis only in STEMI patients who do not undergo PCI.
Conclusion. The presence of DM-2 significantly aggravates long-term prognosis in AMI patients who do not undergo PCI.Key words: myocardial infarction, diabetes mellitus, percutaneous coronary intervention.
EFFECTS OF ENDOVASCULAR INTERVENTION VS. THROMBOLYSIS ON INTRACARDIAC HEMODYNAMICS AND LEFT VENTRICULAR REMODELLING IN ACUTE MYOCARDIAL INFARCTION
Makoeva M.Kh., Semitko S. P., Avtandilov A. G.
Russian Medical Academy of Post-diploma Education; City Clinical Hospital No. 81, Moscow, Russia.Abstract
Aim. To assess the dynamics of myocardial contractility, geometry, and diastolic function in patients with acute myocardial infarction (AMI) after endovascular intervention vs. thrombolysis.
Material and methods. In total, 60 patients (mean age 48,9±2 years) with AMI and ST segment elevation (STEMI) were examined within the first 6 hours from the AMI onset. All participants were divided into three groups: Group I – 22 patients with primary stenting; Group II – 22 patients with the stenting within 24 hours after successful thrombolysis; and Group III – 16 patients with effective thrombolysis and no endovascular intervention. At Day 1 and 7, all participants underwent Doppler echocardiography with the assessment of left ventricular (LV) diastolic function, LV size and volume parameters, total and segmental myocardial contractility (biplane Simpson’s method).
Results. According to the comparative analysis results, LV volume parameters did not deteriorate substantially only in Group I. By Day 7, Group III demonstrated a restrictive type of LV diastolic dysfunction, persistent reduction of ejection fraction, and more pronounced disturbances of local LV contractility, compared to Groups I and II.
Conclusion. In STEMI patients, primary stenting of the infarct-related artery more effectively prevents early pathological LV remodelling, compared to successful thrombolysis or post-thrombolysis endovascular intervention.Key words: acute myocardial infarction, endovascular intervention, remodelling.
COMPARATIVE ANALYSIS OF LEFT VENTRICULAR VOLUME PARAMETERS BY VISUALISATION METHOD IN PATIENTS WITH MYOCARDIAL INFARCTION
Yaroshchuk N. A.1, Kochmasheva V. V.2, Dityatev V. P.3
1 City Clinical Hospital No. 3, Kamensk-Uralsky; 2 Sverdlovsk Region Clinical Hospital № 1, Yekaterinburg; 3 Ural State Medical Academy, Yekaterinburg, Russia.Abstract
Aim. To investigate the parameters of systolic function in patients with acute Q-wave myocardial infarction (AMI), comparing the results of two-dimensional echocardiography (2D EchoCG), three-dimensional real-time EchoCG (3D EchoCG), and computed tomography (CT) as a verification method. To study the parameters of dyssynchrony, which develops due to mechanic myocardial heterogeneity in AMI patients.
Material and methods. In total, 82 patients (61 men and 21 women; mean age 52±21 years) were examined within the first 6 days of AMI. The comparison group, comparable by age and sex, included 65 individuals without clinically manifested cardiovascular pathology. All participants underwent standard examinations, electrocardiography (ECG), 24-hour ECG monitoring, EchoCG, angiography, and CT. Mechanic dyssynchrony was assessed by dispersion of the time to the minimal volume of 16 segments (strain dyssynchrony index, SDI).
Results. The difference for end-diastolic volume (EDV; 2D vs. 3D EchoCG and 2D EchoCG vs. CT) was statistically significant (respective p-values 0,014 and <0,005). Ejection fraction (EF) and local contractility index (LCI) were significantly different for 2D vs. 3D EchoCG (p=0,0002 and <0,005, respectively). EF values were similar for 3D EchoCG and CT (p=0,3). SDI values in AMI patients were significantly higher than in the comparison group participants (6,8±2,7% vs. 2,9±1,6%; p<0,001). In patients with anterior AMI, the SDI differences were observed for one vs. two-vessel (p<0,05) and one vs. three-vessel pathology (p<0,005), but not for two vs. three-vessel pathology. Patients with inferior AMI did not demonstrate any marked differences in SDI values. Among patients with SDI >5,1, the incidence of clinical complications (pulmonary oedema, ventricular fibrillation, high-grade atrioventricular block) was higher by 55% (p<0,05; r=0,35). SDI was also associated with high-grade ventricular arrhythmias (p<0,005; r=0,48).
Conclusion. Three-dimensional visualization provides an opportunity to assess systolic function parameters more accurately. SDI values were linked to the number of affected coronary vessels. The significance of the observed differences was related to AMI localization. SDI could be regarded as a determinant of both mechanical myocardial heterogeneity and the risk of clinical and arrhythmic complications in AMI.Key words: myocardial infarction, systolic function, echocardiography, index of systolic dyssynchrony.
GASTRO-DUODENAL ULCERS AND EROSIONS ASSOCIATED WITH UNSTABLE ANGINA: CLINICAL AND MORPHOLOGICAL FEATURES AND THE ROLE OF PATHOPHYSIOLOGICAL FACTORS IN THEIR DEVELOPMENT
Osadchyi V. A., Sergeev A. N., Rasskazova Yu. V., Bukanova T. Yu.
Tver State Medical Academy, Tver, Russia.Abstract
Aim. To investigate clinical and morphological features of gastro-duodenal ulcers and erosions associated with unstable angina (UA) and to study the role of the disturbances of gastric secretion, microcirculation, and haemostasis in their development
Material and methods. The study included 82 UA patients with gastro-duodenal ulcers or erosions confirmed by the clinical findings and endoscopy results. Parameters of gastric secretion, gastro-duodenal tissue blood flow, systemic microcirculation, and haemostasis were assessed with the methods adapted to the pathology of interest.
Results. Acute erosions were found in 73,2% of UA patients, acute ulcers in 11,0%, and recurrent ulcers in 15,8%. Clinical manifestations of acute erosions typically included various dyspeptic symptoms, or, less often, diffuse epigastric pain during the first treatment days. For acute ulcers, moderate abdominal pain syndrome was often less intense than the gradually receding and disappearing symptoms of gastric dyspepsia. Recurrent ulcers were characterised by the combination of moderate abdominal pain, often without a typical circadian rhythm, and dyspeptic symptoms, typically persisting throughout the first two weeks of treatment. The symptoms of minor gastro-duodenal haemorrhage were registered in 33,3% of UA patients with acute ulcers, 11,8% of the participants with acute erosions, and 7,7% of the individuals with recurrent ulcers. The development of gastro-duodenal erosions and ulcers in UA patients was associated with increased acidic and peptic gastric secretion, reduced production of protective mucus, and disturbed blood flow in gastro-duodenal tissues, which could be regarded as a manifestation of Stage 1–2 haemorrhagic syndrome.
Conclusion. Gastro-duodenal erosions and ulcers in UA patients have some morphological, clinical, and pathogenetic features which should be taken into account in order to facilitate the early diagnostics and adequate choice of pharmacological therapy.Key words: unstable angina, gastro-duodenal ulcers and erosions, clinical features, disorders of gastric secretion, microcirculation, and haemostasis.
LONG-TERM TRENDS AND PREDICTORS OF THE CLINICAL COURSE AND OUTCOME IN ACUTE CORONARY SYNDROME
Provotorov V. M.1, Shevchenko I. I.2
1 N. N. Burdenko Voronezh State Medical Academy, Voronezh; 2 Voronezh City Clinical Hospital of Emergency Medical Care No. 10, Voronezh, Russia.Abstract
Aim. To analyse the long-term trends in the acute coronary syndrome (ACS) outcomes; to identify the predictors of ACS clinical course and outcomes using a discrimination model.
Material and methods. From 1993 to 2011, over 31000 patients with suspected ACS, including 8686 patients with acute myocardial infarction (AMI), were hospitalised to the Acute Cardiac Care Unit of the Voronezh City Clinical Hospital of Emergency Medical Care No. 10. The present analysis includes 565 patients (311 men, 55%).
Results. Over 18 years of the follow-up, no significant increasing or decreasing trend in in-hospital mortality was observed. In all hospitalised patients, the mean level of in-hospital mortality was 3,91% per year; in ACS patients, it was 13,65%. The outcome predictors included age, degree of myocardial damage, Killip class, the degree of ST segment deviation, ST segment depression, and corrected QT interval dispersion. A discrimination model was created, which identified the groups with poor, ambiguous, and good prognosis. Overall, the classification matrix was accurate in 96,4% of the patients.
Conclusion. The long-term trend in the levels of in-hospital mortality among ACS patients failed to demonstrate any marked reduction. The proposed discrimination model accurately predicted the clinical course and outcomes of ACS.Key words: acute coronary syndrome, Killip class, discrimination model, trends and predictors of ACS clinical course and outcomes.
ANTIHYPERTENSIVE THERAPY EFFECTS ON REGULATORY AND ADAPTIVE STATUS OF PATIENTS WITH FUNCTIONAL CLASS I–II CHRONIC HEART FAILURE
Kanorskyi S. G.1, Tregubov V. G.2*, Pokrovskyi V. M.1
1 Kuban State Medical University, Krasnodar; 2 City Clinical Hospital No. 2, Krasnodar, Russia.Abstract
Aim. To identify the optimal therapeutic strategy in Functional Class (FC) I–II chronic heart failure (CHF), in accordance with the effects of different drug classes on the regulatory and adaptive status (RAS).
Material and methods. The study included 200 patients with FC I–II CHF, who were randomised into two groups. The first group included 104 patients (mean age 52,8±1,9 years) who received metoprolol succinate extended-release in the mean daily dose of 87,7±7,6 mg. The second group included 96 patients (mean age 55,0±1,4 years) receiving quinapril in the mean daily dose of 21,0±5,5 mg. At baseline and 6 months later, 24-hour blood pressure monitoring, the cardio-respiratory synchronism test, treadmill test with the VO2max assessment, echocardiography, and the measurement of the plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) were performed.
Results. Both medications improved the parameters of left ventricular (LV) diastolic function. However, only quinapril effectively improved LV structure, geometry, and systolic function. Only in the quinapril group, exercise capacity and stress test VO2max increased, while the reduction in NT-proBNP levels, together with the improvement in RAS parameters, was more pronounced.
Conclusion. Compared to metoprolol succinate, quinapril demonstrated more pronounced positive effects on cardiac structure and function, as well as on RAS parameters, in patients with FC I–II CHF.Key words: chronic heart failure, metoprolol succinate, quinapril, cardio-respiratory synchronism, regulatory and adaptive status.
MARKERS OF INCREASED RISK OF SUDDEN CARDIAC DEATH IN PATIENTS WITH STABLE ANGINA AND ARTERIAL HYPERTENSION: ASSOCIATION WITH THE PROGRESSION OF LEFT VENTRICULAR HYPERTROPHY
Surovtseva M. V.1, Koziolova N. A.1, Chernyavina A. I.1, Shatunova I. M.2
1 Academician E. A. Vagner Perm State Medical Academy, Perm; 2 Gazprom Polyclinic, Moscow, Russia.Abstract
Aim. To analyse the markers of sudden cardiac death (SCD) in patients with stable angina and arterial hypertension (AH), in regard to the progression of left ventricular hypertrophy (LVH).
Material and methods. In total, 90 patients with Functional Class II–III stable angina, AH, and LVH were examined. The following parameters were assessed: left ventricular myocardial mass index (LVMMI), left ventricular ejection fraction (LVEF), heart rate variability (HRV) parameters (SDNN, HRVi, CBBP); mean 24-hour HR levels, QT and QTc intervals, QT dispersion (QTds), ectopic ventricular activity; mean 24-hour blood pressure (BP) levels; levels of serum markers of myocardial collagenolysis and N-terminal pro-brain natriuretic peptide (NT-proBNP).
Results. In all participants, LVEF was preserved, without significant difference between the tertiles. The increase in LVMMI was linked to a significant increase in the total number of ventricular extrasystoles (VE) over 24 hours (p<0,001) and the mean number of paired (p<0,008) and polytopic (p<0,011) VE per patient; reduced HRV, based on the SDNN dynamics (p=0,004); increased mean 24-hour pulse BP (p=0,003); elevated levels of tissue inhibitors of matrix metalloproteinase-1 (p=0,017) and NT-proBNP; and decreased levels of procollagen type I C-terminal telopeptide (p=0,011).
Conclusion. In patients with stable angina, AH, and preserved LVEF, the LVH progression is associated with an increased number of SCD markers: increased ventricular ectopic activity, reduced HRV, increased mean 24-hour BP, and elevated levels of NT-proBNP and serum markers of myocardial fibrosis, which confirms the increase in the risk of SCD in parallel to the increase in the LVMMI.Key words: stable angina, arterial hypertension, left ventricular hypertrophy, sudden death markers.
EFFECTIVENESS OF THE SEATTLE HEART FAILURE MODEL IN PREDICTING THE LONG-TERM PROGNOSIS AMONG MEN WITH CORONARY HEART DISEASE
Krasnova O. A., Sitnikova M. Yu., Ivanov S. G., Fedotov P. A.
V. A. Almazov Federal Centre of Heart, Blood, and Endocrinology, St. Petersburg, Russia.Abstract
Aim. To assess the life prognosis in patients with chronic heart failure (CHF) – male residents of St. Petersburg – according to the Seattle Heart Failure Model (SHFM) and compare it to the observed survival.
Material and methods. A retrospective survival analysis was performed in 135 patients with Functional Class (FC) II–IV CHF of ischemic aetiology. At baseline, anamnestic, clinical, functional, and instrumental data were collected. Observed five-year all-cause mortality was compared to that predicted by SHFM. Statistical analyses were performed in SPSS 15.0.
Results. Over the five years of the follow-up (60 months), 67% of the participants (n=88) survived. Observed one-, two-, and five-year survival in FC II CHF patients was 95%, 92%, and 74%, respectively. In FC III CHF patients, the respective figures were 92%, 85%, and 61%. Predicted one-, two-, and five-year survival, according to the mean risk estimates by SHFM, was 98%, 95%, and 89% for FC II CHF individuals, and 96%, 92%, and 80%, respectively, for the FC III CHF participants. Therefore, for the first five years of the follow-up, the SHFM predictions exceeded the observed survival by 3–15% and 4–19% in CHF patients with FC II and FC III, respectively (p1,2<0,05). There was a statistically significant association between the observed survival and smoking, concomitant chronic obstructive pulmonary disease, and hypertension duration before the CHF manifestation.
Conclusion. The SHFM markedly overestimated the observed survival in male patients with systolic CHF – St. Petersburg residents. Therefore, in this population, this instrument cannot be recommended for the CHF prognosis assessment. There is a need to develop a survival model for Russian patients with CHF, which would incorporate additional determinants of adverse prognosis.Key words: long-term prognosis, systolic heart failure, Seattle Heart Failure Model.
“WAITING LIST” PROBLEMS: REASONS FOR PATIENTS’ REFUSAL OF PLANNED CORONARY ARTERY BYPASS GRAFT SURGERY
Sumin A. N., Osokina A. V., Kochergina A. M.
Research Institute of Complex Cardiovascular Problems, Siberian Branch, Russian Academy of Medical Sciences, Kemerovo, Russia.Abstract
Aim. To identify the reasons for the patients’ refusal to undergo a planned coronary artery bypass graft (CABG) surgery, after being put on the “waiting list” for the intervention.
Material and methods. From January 2010 to March 2011, 1,057 patients (100%) were put on the CABG “waiting list” of the Research Institute of Complex Cardiovascular Problems, Kemerovo. Due to various reasons, 74 individuals refused to undergo the surgery (7%). The reasons for refusal were identified during a telephone interview of 65 patients; for 51 (4,8%), the refusal was confirmed. The final analysis included 51 patients – the main group, who refused the intervention due to various reasons. Clinical and anamnestic parameters of these patients were compared to those of the control group (51 consecutive patients hospitalised for the planned CABG). For both groups, the primary medical documentation was used to determine the waiting period between establishing the need for CABG and the planned hospitalisation, as well as to record the results of coronary artery angiography (CAG). In addition, we analysed the results of echocardiography (EchoCG; left ventricular ejection fraction, LVEF) and the levels of creatinine, urea, potassium, sodium, glucose, haemoglobin, white and red blood cells, and erythrocyte sedimentation rate, measured before CAG.
Results. The most prevalent refusal reasons were fear of the intervention (35,3%) and good self-perceived health (33,3%). The third most common reason was no explanation of the intervention importance to the patient by the doctor (9,8%). In the control group, the hospitalisation for planned CABG significantly more often took place within one month after CAG, compared to the main group (n=17 and 6, respectively; p<0,01). By contrast, in the main group, hospitalisation for CABG was significantly more often planned for the sixth month after CAG, compared to the control group (n=12 and 4, respectively; p=0,02). According to the multivariate analysis results, waiting for the intervention for longer than one month was associated with an increased likelihood of refusal.
Conclusion. The prevalence of CABG refusal among “waiting list” patients was 4,8%. The main reasons for refusal included no symptoms of coronary heart disease progression, fear of intervention, and no explanation of the intervention necessity. The key additional factor associated with refusal was the waiting time over one month.Key words: coronary heart disease, coronary artery bypass graft surgery, waiting list order.
SLEEP APNOEA SYNDROME EFFECTS ON CLINICAL COURSE AND QUALITY OF LIFE IN PATIENTS WITH CORONARY HEART DISEASE
Shaidyuk O. Yu.
N. I. Pirogov Russian Research Medical University, Moscow, Russia.Abstract
Aim. The sleep apnoea syndrome (SAS) is a widely prevalent but under-studied condition which might aggravate the clinical course of various diseases. This study aimed to assess the influence of SAS on the clinical course of coronary heart disease (CHD) and quality of life (QoL) of CHD patients.
Material and methods. The study included 186 patients with various CHD forms and 24 controls with angiographically confirmed absence of CHD. The patients were divided into groups of effort angina, post-infarction cardiosclerosis without chronic heart failure (CHF), and with Functional Class (FC) II–III CHF (NYHA classification). All participants underwent cardiorespiratory monitoring and QoL assessment (WHOQOL-BREF and SAQL questionnaires). Based on the SAS severity, two subgroups with low (0–10 per hour) and high (11–30 per hour) index of apnoeahypopnoea (AHI) were defined.
Results. SAS affected the clinical course and QoL to the greatest extent in patients with CHF. Among effort angina patients, this effect was weaker, while no negative impact of SAS was registered in patients with post-infarction cardiosclerosis without CHF.
Conclusion. The management of CHD patients should incorporate the screening for possible SAS and target SAS, if present, as one of the factors aggravating the clinical course of the main pathology.Key words: sleep apnoea, coronary heart disease, quality of life.
CARDIOMETABOLIC RISK AND MODERN METHODS OF ITS CORRECTION IN PREGNANT WOMEN WITH CHRONIC ARTERIAL HYPERTENSION
Padyganova A. V., Chicherina E. N.
Kirov State Medical Academy, Kirov, Russia.Abstract
Aim. To assess the effects of antihypertensive therapy on the dynamics of cardiometabolic risk factors among pregnant women with chronic arterial hypertension (AH) in the second trimester.
Material and methods. In total, 37 pregnant women with chronic AH were examined. The clinical and anamnestic data were analysed, and the levels of office blood pressure, body mass index, blood lipids, systemic inflammation markers (C-reactive protein, fibrinogen), and glucose were measured. Subclinical pathology of target organs was assessed via the measurement of left ventricular myocardial mass index (echocardiography), glomerular filtration rate, and microalbuminuria.
Results. Slow-release nifedipine therapy improved the parameters of lipid metabolism and target organ status. Metoprolol therapy was linked to an improvement in cardiovascular and renal structure and function. However, metildopa treatment was associated with some increase in glucose levels and a significant elevation in total cholesterol levels.
Conclusion. The complex assessment of cardiometabolic risk factors and target organ status is particularly important for a differential choice of antihypertensive therapy in pregnant women.Key words: cardiometabolic risk, pregnancy, chronic arterial hypertension.
HORMONAL HOMEOSTASIS IN FEMALE CORONARY HEART DISEASE PATIENTS FROM DIFFERENT AGE GROUPS
Kasumova F. N.
A. A. Aliev Azerbaijani State Institute of Post-diploma Medical Education, Therapy Department, Baku, Azerbaijan.Abstract
Aim. To perform a clinical and epidemiological survey of women with coronary heart disease (CHD) from different age groups, in comparison with healthy people without CHD.
Material and methods. We examined 122 women of childbearing or menopausal age (20–69 years), including 102 patients with clinical and epidemiological evidence of CHD. The control group included 20 healthy women. In all participants, the levels of the following hormones were measured: estradiol (E), progesterone (P), testosterone (T), cortisol (C), and estradiol: testosterone ratio (E: T).
Results. Hormonal homeostasis disturbances, typical for each age group, were identified. The levels of sex hormones could be regarded as additional risk factors of CHD in women of childbearing age and menopausal women.
Conclusion. In the age of 30–39 years, decreased E and P levels are combined with elevated T. Among 40–49-year-old women, E decreases and T increases, without any marked P dynamics. In age groups of 50–59 and 60–69 years, P levels are substantially decreased, without significant changes in E and T levels.Key words: coronary heart disease, female sex hormones, hormonal homeostasis.
CENTRAL HEMODYNAMICS IN ELDERLY PATIENTS WITH CHRONIC HEART FAILURE: THE EFFECTS OF COMPLEX TREATMENT INCLUDING PERINDOPRIL/INDAPAMIDE AND LOW-INTENSITY LASER THERAPY
Filippova T. V., Mel’nikova Yu. A., Efremushkin G. G.
Altay State Medical University, Barnaul, Russia.Abstract
Aim. To assess and compare the effects of perindopril/indapamide (Noliprel) and low-intensity laser therapy (LILT) on central hemodynamic parameters in elderly patients with chronic heart failure (CHF).
Material and methods. In total, 160 CHF patients, aged 60–96 years, were randomised into four groups. Group 1, “Noliprel” (n=26), received Noliprel and other medications; Group 2, “LILT” (n=54), received LILT and other medications (not Noliprel); Group 3, “Noliprel + LILT” (n=27), was administered complex treatment with LILT and Noliprel; and Group 4, a comparison group (n=53), received pharmacological therapy only. At baseline and 20 days after the start of the treatment, central hemodynamic parameters were assessed, using Doppler echocardiography method.
Results. At baseline, our participants typically had normal systolic function, in combination with diastolic dysfunction and increased heart chamber size. By the end of the treatment phase, reverse cardiac remodelling was observed in Noliprelreceiving patients. In the “LILT” group, myocardial function improvement was not accompanied by marked morphological changes. The combination of Noliprel and LILT had a complementary beneficial effect on intracardiac hemodynamics, particularly in Functional Class III CHF.
Conclusion. In elderly CHF patients, including Noliprel and LILT into the complex CHF treatment demonstrated a larger positive effect on central hemodynamics, compared to the standard treatment.Key words: chronic heart failure, elderly age, central hemodynamics, Noliprel, lowintensity laser therapy.
ORAL TREATMENT WITH NICORANDIL AT DISCHARGE IS ASSOCIATED WITH REDUCED MORTALITY AFTER ACUTE MYOCARDIAL INFARCTION
Sakata Y.1, Nakatani D.1, Shimizu M.1, Suna Sh.1, Usami M.1, Matsumoto S.1, Hara M.1, Sumitsuji S.1,2, Kawano Sh.3, Iwakura K.4, Hamasaki T.5, Sato H.6, Nanto Sh.1,2, Hori M.7, Komuro I.1, on Behalf of the Osaka Acute Coronary Insufficiency Study (OACIS) Investigators.
1 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; 2 Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; 3 Cardiovascular Division, Kawachi General Hospital, Higashi-osaka, Osaka, Japan; 4 Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Osaka, Japan; 5 Department of Biomedical Statistics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; 6 School of Human Welfare Studies Health Care Center and Clinic, Kwansei Gakuin University, Nishinomiya, Osaka, Japan; 7 Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Osaka, Japan.Abstract
Background. Previous studies showed that nicorandil can reduce coronary events in patients with coronary artery disease. However, it is unclear whether oral nicorandil treatment may reduce mortality following acute myocardial infarction (AMI).
Methods and Results. We examined the impact of oral nicorandil treatment on cardiovascular events in 1846 AMI patients who were hospitalized within 24 h after AMI onset, treated with emergency percutaneous coronary intervention (PCI), and discharged alive. Patients were divided into those with (Group N, n = 535) and without (Group C, n = 1311) oral nicorandil treatment at discharge. No significant differences in age, gender, body mass index, prevalence of coronary risk factors, or history of myocardial infarction existed between the two groups; however, higher incidences of multi-vessel disease, and a lower rate of successful PCI were observed in Group N. During the median follow-up of 709 (340–1088) days, allcause mortality rate was 43% lower in Group N compared with Group C (2.4% vs. 4.2%, stratified log-rank test: p = 0.0358). Multivariate Cox regression analysis revealed that nicorandil treatment was associated with all-cause death after discharge (Hazard ratio 0.495, 95% CI: 0.254–0.966, p = 0.0393), but not for other cardiovascular events such as re-infarction, admission for heart failure, stroke and arrhythmia.
Conclusions. The results suggest that oral administration of nicorandil is associated with reduced incidence of death in the setting of secondary prevention after AMI.Keywords: nicorandil, acute myocardial, infarction, mortality, secondary prevention.
Adopted translation from Journal of Cardiology (2012) 59, 14–21.
BLOOD PRESSURE VARIABILITY AS A NEW TARGET FOR ANTIHYPERTENSIVE THERAPY: FOCUS ON THE FIXED COMBINATION OF AMLODIPINE AND PERINDOPRIL ARGININ
Gorbunov V. M.
State Research Centre for Preventive Medicine, Moscow, Russia.Abstract
The assessment of blood pressure variability (BPV) based on the office BP measurements (“visit-to-visit” BPV) has recently gained more attention. A retrospective meta-analysis demonstrated that in the cohorts of patients after stroke or transient ischemic attack (n≥2450), this parameter strongly and independently from mean BP levels predicted the risk of stroke. In the ASCOT-BPLA study, the “visit-to-visit” variability of systolic BP was a strong predictor of stroke and coronary events, as confirmed by the results of the multivariate regression analyses adjusting for conventional risk factors. Throughout the follow-up period, BPV values were significantly lower in the amlodipine/perindopril group, compared to the atenolol/diuretic group, which was associated with a reduced risk of cardiovascular complications. BPV appears a promising new target for antihypertensive therapy. Statistically significant BPV reduction denotes the stability of the treatment effects and other beneficial pharmacodynamic effects. The most extensive evidence base exists for the combination of amlodipine and perindopril.
Key words: arterial hypertension, blood pressure variability, amlodipine, perindopril.
RENAISSANCE OF ARTERIAL HYPERTENSION MONOTHERAPY – THE POSITION OF THIAZIDE DIURETICS
Adasheva T. V., Zadionchenko V. S., Grineva Z. O., Shchikota A. M.
Moscow State Medico-Stomatological University, Department of Therapy and Family Medicine, Moscow, Russia.Abstract
The importance of the optimal choice of antihypertensive treatment strategy is currently widely recognised. The evidence obtained over the last five years justifies the revision of the traditional approach towards the tactics of mono- and combination antihypertensive therapy. It is essential to ensure that the patient-centred tactics of mono- and combination therapy choice is based on the detailed analysis of the clinical status.
Key words: arterial hypertension, therapy. ++++++++++++++++++
SLEEP APNOEA SYNDROME AND CARDIOVASCULAR DISEASE: A MODERN VIEW
Gordeev I. G., Shaydyuk O. Yu., Taratukhin E. O.
N. I. Pirogov Russian Research Medical University, Therapy Faculty, Hospital Therapy Department No. 1, Moscow, Russia.Abstract
This review presents the modern evidence on the association between sleep apnoea syndrome and cardiovascular disease. Among other aspects, the recently discovered mechanisms linking sleep apnoea and the development of atherosclerosis, coronary heart disease, and cardiac arrhythmias, are discussed. The authors focus on the sleep apnoea syndrome impact on quality of life.
Key words: apnoea, hypopnoea, atherosclerosis, cardiac arrhythmias, heart failure, quality of life.
PREDICTIVE ROLE OF CHROMOSOME 9P21.3 POLYMORPHISMS AND THEIR ASSOCIATION WITH FAMILY HISTORY OF CORONARY HEART DISEASE IN PATIENTS WITH MYOCARDIAL INFARCTION
Shesternya P. A.1, Shulman V. A.1, Nikulina S.Yu.1, Martynova E. A.1, Demkina A.I.1, Orlov P. S.2, Maksimov V. N.2, Voevoda M. I.2
1Prof. V. F. Voyno-Yasenetskyi Krasnoyarsk State Medical University, Krasnoyarsk; 2Institute of Internal Medicine, Siberian Branch, Russian Academy of Medical Sciences, Novosibirsk, Russia.Abstract
Aim. To investigate the association between single-nucleotide polymorphisms (SNPs) rs10757278 and rs1333049 of the 9p21.3 locus and family history of coronary heart disease (CHD) in myocardial infarction (MI) patients.
Material and methods. The MI group (n=243) and the control group (n=280) were comparable by such parameters as age, gender, arterial hypertension, diabetes mellitus, hypercholesterolemia, overweight and obesity, abdominal obesity, and smoking history. However, the groups were significantly different in terms of family history of CHD (p=0,004). Genome DNA was extracted from venous blood using the phenol-chloroform extraction method. The SNPs rs10757278 (9p21.3) and rs1333049 (9Sр21.3) were tested using real-time polymerase chain reaction (PCR) and the AB 7900HT device, according to the producer’s protocol (TaqMan probes, Applied Biosystems, USA).
Results. A statistically significant association between MI and the CC rs1333049 genotype or the GG rs10757278 genotype was observed in the whole study sample and separately in men and women. The MI odds ratio (OR) for carriers of the CC rs1333049 genotype was 2,02 (95% confidence interval, CI, 1,32–3,08) in the whole sample, 1,91 (1,11–2,95) in men, and 2,91 (1,22–6,91) in women. For carriers of the GG rs10757278 genotype, respective OR values were 1,98 (1,30– 3,02), 1,77 (1,08–2,87), and 2,94 (1,26–6,87). Among participants without CHD in family history, OR for the CC rs1333049 genotype (1,92, 95% CI 1,16–3,16) and the GG rs10757278 genotype (1,82, 95% CI 1,10–3,00) were comparable for those among MI patients with CHD in family history (respective OR 2,19 (1,28–3,75) and 2,23 (1,31–3,81)).
Conclusion. For the first time in Russia, the association between MI-related polymorphisms of the 9p21.3 chromosome and family history of CHD was analysed. Two SNPs (rs1333049 and rs10757278) of the 9p21.3 locus predicted MI risk independently from either conventional risk factors or CHD in family history.Key words: myocardial infarction, polymorphisms, rs10757278, rs1333049, 9Sр21.3 locus, family history.
APOLIPOPROTEIN A1 GENE AND ITS ROLE IN DYSLIPIDEMIA DEVELOPMENT ACROSS ETHNIC GROUPS OF PATIENTS WITH ESSENTIAL ARTERIAL HYPERTENSION
Bairova T. A., Dolgikh V. V., Kolesnikova L. I., Munkoeva D. M.
Research Centre of Family Health and Human Reproduction, Siberian Branch, Russian Academy of Medical Sciences, Irkutsk, Russia.Abstract
Aim. To assess the impact of insertion-deletion polymorphism of apolipoprotein A gene on the development of dyslipidemia among adolescents with essential arterial hypertension (EAH), in regard to the ethnic group: non-indigenous Slavic vs. indigenous Buryat.
Material and methods. In total, 399 adolescents were examined: 226 patients with the verified EAH diagnosis and 173 controls. Among EAH patients, 144 adolescents (63,7%) were from the non-indigenous ethnic group, while 82 (36,3%) were from the indigenous one; among controls, the respective figures were 94 (53,4%) and 79 (45,7%). Dyslipidemia was diagnosed using the unified criteria. For genetic analyses, total DNA was extracted from venous blood samples, using a non-enzymatic method. DNA fragments were amplified in the polymerase chain reaction (PCR), using the reagent kit “SNP express” according to the producer’s protocol (Litech, Moscow).
Results. The deletion allele prevalence in adolescents from the indigenous ethnic group was 8,2% among controls and 8,0% among EAH patients (p=1,000). In the non-indigenous ethnic group, the respective figures were 7,9% and 9,8% (p=0,493).
According to the multivariate analysis results, lipid levels in non-indigenous carriers of various insertion-deletion ApoA1 genotypes could be predicted as follows: triglyceride (TG) levels = 1,552 + (-0,653 ApoA1 (II); model F=7,174, p=0,009; R 2=9,4%; very low-density lipoprotein cholesterol (VLD-CH) levels = 0,613 + (-0,189 ApoA1 (II)); model F=4,738, p=0,033; R 2=6,3%.
Among indigenous patients – carriers of various insertion/deletion ApoA1 genotypes, this polymorphism did not appear to have a significant impact on lipid metabolism parameters.
Conclusion. The genome impact on clinical and biochemical phenotype is variable and differs across ethnic groups. Multivariate analyses have demonstrated that TG and VLD-CH levels are associated with the insertion/deletion ApoA1 gene polymorphism. Therefore, this genetic marker could be regarded as a “modifier” gene which determines biochemical polymorphism in non-indigenous patients. In adolescents from the indigenous ethnic group, this molecular and genetic marker appeared irrelevant.Key words: gene, dyslipidemia, apolipoprotein, ethnos, adolescents.
ENDOTHELIAL FUNCTION CHANGES IN PRE- AND POST-MENOPAUSAL WOMEN WITH ARTERIAL HYPERTENSION
Prokofyeva E. B., Avtandilov A. G.
Russian Medical Academy of Post-diploma Education, Moscow, Russia.Abstract
Aim. To assess the impact of climacteric disturbances in menopause on the dynamics of endothelial function among women with arterial hypertension (AH).
Material and methods. The study included 129 women: 101 with elevated blood pressure (BP) levels and 28 without AH. All participants underwent echocardiography, 24 hour BP monitoring (BPM), brachial artery (BA) Doppler ultrasound, and reactive hyperemia test with nitroglycerine. The parameters of 24 hour BPM, left ventricular myocardial mass index, diastolic function, and endothelial function were analysed by age and the time of the climacteric disturbance development.
Results. According to the 24 hour BPM results, examined women had Stage I–II AH. AH duration increased with age and reached 4,67±0,45 years for pre-menopausal women, 6,47±0,57 years for women in early menopause, and 12,48±0,94 years for women in late menopause. Left ventricular diastolic dysfunction was registered in all three groups; among women in late menopause, it was significantly more pronounced than among pre-menopausal women (p<0,05).
Mean values of BA diameter were 3,88±0,07, 4,11±0,08, and 4,08±0,08 mm among women in pre-menopause, early menopause, and late menopause, respectively (p<0,05). The reactive hyperemia test demonstrated inadequate BA dilatation in 36,1%, 46,9%, and 60,6%, respectively.
Conclusion. Endothelial dysfunction was more pronounced among women in late menopause, which supports the presence of the association between more severe vascular disturbances and menopause among hypertensive women, as well as suggests a post-menopausal increase in cardiovascular risk levels.Key words: arterial hypertension, women, menopause, endothelial dysfunction.
AGE AND ARTERIAL STRUCTURE AND FUNCTION IN MEN WITH ARTERIAL HYPERTENSION AND LIPID METABOLISM DISTURBANCES
Petrosov S. L.
Moscow City Polyclinic No. 190, Moscow, Russia.Abstract
Aim. To assess arterial structure and function in men with arterial hypertension (AH) combined with dyslipidemia and obesity, in comparison to men with AH and normal body weight.
Material and methods. The study included 205 men with the combination of AH, dyslipidemia, and obesity, as well as 42 men with AH and normal body weight. All participants (age 20–71 years) underwent ultrasound examination and oscillometry.
Results. Men with disturbed lipid metabolism demonstrated a tendency towards the increase in intima-media thickness (IMT) of common carotid artery (CCA), starting from the age of 45 years. Endothelial dysfunction, manifested as reduced endothelium-dependent vasodilatation, manifested from the age of 35–38 years. These changes occurred, on average, 15 years earlier than in AH patients without dyslipidemia and obesity. Among men with AH and disturbed lipid metabolism, CCA IMT values strongly correlated with age, body mass index, waist circumference, peak systolic blood flow velocity, cholesterol levels, and pulse wave velocity.
Conclusion. Obesity and dyslipidemia are not only strong predictors of cardiovascular risk, but also aetiological factors of vascular pathology.Key words: arterial hypertension, obesity, dyslipidemia, endothelium, age-related changes.
MODIFIABLE AND NON-MODIFIABLE RISK FACTORS IN PREDICTING THE RECURRENCE OF ATRIAL FIBRILLATION IN PATIENTS WITH ARTERIAL HYPERTENSION
Arakelyan M. S.1, Poteshkina N. G.2, Mogutova P. A.2
1L. A. Vorokhobov City Clinical Hospital No. 67, Moscow; 2N. I. Pirogov Russian Research Medical University, Moscow, Russia.Abstract
Aim. To identify the most important risk factors of recurrent atrial fibrillation (AF) and their prognostic value in patients with arterial hypertension (AH).
Material and methods. In total, the study included 60 patients with Stage 1–3 AH (Grade I–III, cardiovascular risk 2–4): 20 with the first episode of AF (33%) and 40 with recurrent AF (67%). In all patients, sinus rhythm was restored with pharmacological or electric impulse therapy. At baseline and 6 months after restoring sinus rhythm, the assessment of medical history, antihypertensive and antiarrhythmic therapy, echocardiography, and Doppler ultrasound were performed. To identify silent cardiac arrhythmias and conductivity disorders, Holter electrocardiography monitoring was performed; coronary heart disease was verified with the bicycle stress test. Statistical analyses were performed using the Statistica 6.0 software.
Results. The early recurrence of AF was associated with Stage 3 AH, AF in anamnesis, and left atrium dilatation.
Conclusion. The combination of Stage 3 AH, AF in anamnesis, and left atrium dilatation was associated with a higher risk of recurrent AF, compared to each of these factors in isolation.Key words: Atrial fibrillation, arterial hypertension, left atrium dilatation, modifiable and non-modifiable risk factors, risk prediction.
FUNCTIONAL STATUS OF HEART AND KIDNEYS AND CARDIO-RENAL INTERACTIONS IN PATIENTS AFTER CORONARY REVASCULARISATION INTERVENTION
Statsenko M. E., Bolotov D. V.
Volgograd State Medical University, Volgograd, Russia.Abstract
Aim. To assess cardio-renal interactions and the functional status of heart and kidneys in patients with acute myocardial infarction (AMI) who underwent the post-AMI coronary revascularisation.
Material and methods. In total, 100 men, aged 45–60 years, were examined, including 50 AMI patients who underwent the revascularisation surgery. Cardiac structure and function, as well as excretory, glomerular, and tubular renal functions, were assessed.
Results. Patients who underwent revascularisation demonstrated lower creatinine levels. In this group, the prevalence of the serum creatinine concentration >115 μmol/l and glomerular filtration rate (GFR) <60 ml/min was significantly lower than in the patients treated conservatively. Urine levels of β2 microglobulin, reflecting the tubular renal function, were significantly lower in AMI patients after revascularisation. In addition, the revascularisation group demonstrated an improvement in cardio-renal interactions, compared to the conservative treatment group.
Conclusion. Among AMI patients who underwent coronary revascularisation, in comparison to the patients treated conservatively, there was an improvement in cardio-renal interactions and a positive dynamics in both cardiac structure and function and renal functional status. In the revascularisation group, renal function parameters were significantly associated with the parameters of cardiac structure and function, which confirmed the existence of cardio-renal interactions.Key words: coronary revascularisation, renal function, cardio-renal interactions.
RENAL AND CORONARY PREDICTORS OF POST-MYOCARDIAL REVASCULARISATION PROGNOSIS IN PATIENTS WITH CORONARY HEART DISEASE
Batyushin M. M.1, Levitskaya E. S.1, Terentyev V. P.1, Savis’ko A. A.1, Dyuzhikov A. A.2, Kulikovskikh Ya. V.3
Rostov State Medical University1, Rostov Region Clinical Hospital of Cardiology and Cardiovascular Surgery2; Regional Vascular Centre3, Rostov-on-Don, Russia.Abstract
Aim. To assess the impact of renal and local coronary risk factors (RFs) on cardiovascular survival in patients with coronary heart disease (CHD) before and after myocardial revascularisation.
Material and methods. The study included 90 CHD patients with indications for myocardial revascularisation. In all participants, the presence of renal RFs (microalbuminuria (MAU) and increased levels of β2 microglobulin (β2 MG)) was assessed at different intervention stages. In addition, the number of coronary arteries (CA) affected by atherosclerosis, as well as CA atherosclerosis severity, was assessed.
Results. Among the majority of CHD patients with myocardial revascularisation indications, MAU was observed at all intervention stages. The end-point incidence was associated with MAU, β2 MG levels, the number of CA affected by atherosclerosis and CA with hemodynamically non-significant stenosis. The levels of β2 MG significantly correlated with atherosclerotic plaque growth rate.
Conclusion. The increased risk of coronary events was associated with elevated levels of MAU and β2 MG and the increased number of CA affected by atherosclerosis and CA with hemodynamically non-significant stenosis. Elevated CV risk was linked to β2 MG levels of ≥0,1 ng/ml. The levels of β2 MG increased in parallel with the CHD progression.Key words: myocardial revascularisation, atherosclerosis, microalbuminuria, β2 microglobulin, survival.
NEURAL NETWORK MODEL FOR DIAGNOSING MYOCARDIAL INFARCTION
Zagidullin B. I.1, Nagaev I. A.2, Zagidullin N.Sh.3, Zagidullin Sh. Z.3
1Tatar Republic Hospital of Emergency Medical Care, Naberezhnye Chelny; 2Bashkir Republic Cardiology Dispanser, Ufa; 3Bashkir State Medical University, Ufa, Russia.Abstract
Body surface potential mapping (BSPM) is a non-invasive and effective method for diagnosing coronary heart disease (CHD) and acute myocardial infarction (AMI). However, most existing systems of BSPM are unable to create standard diagnostic criteria.
Aim. To develop the neural network model (NNM) for diagnosing Q wave AMI and to assess the model effectiveness.
Material and methods. The BSPM method in 90 leads was used in 96 controls, 35 patients with anterior Q wave AMI, 43 with posterior Q wave AMI, 14 with inferior Q wave AMI, and 21 with lateral Q wave AMI. The input NNM layer was decomposed into five subsets corresponding to horizontal levels of registered signals, using amplitudes of Q, R, S, and T waves and the ST segment. The output layer produced the probability of the norm (controls) and different AMI locations.
Results. Exploring the NNM performance in controls and AMI patients, sensitivity of 100% and specificity of 97,4% was observed. Sensitivity reached 100% for anterior Q wave AMI, 94,4% for posterior Q wave AMI, 85,7% for inferior Q wave AMI, and 83,3% for lateral Q wave AMI.
Conclusion. Our data have demonstrated the effectiveness of NNM in AMI diagnostics.Key words: body surface potential mapping, neural network modelling, acute myocardial infarction.
LIPID PROFILE AND CALCIUM AND PHOSPHATE METABOLISM IN PATIENTS WITH CORONARY HEART DISEASE AND AORTIC STENOSIS
Rodicheva O. A., Levashov S.Yu., Volkova E. G.
Chelyabinsk State Medical Academy, Chelyabinsk, Russia.Abstract
Aim. To compare the parameters of lipid profile and calcium and phosphate metabolism in patients with coronary heart disease (CHD) or CHD combined with aortic stenosis (AS).
Material and methods. The study included 147 CHD patients, aged over 60, with stable angina pectoris, (functional Class (FC) I–IV) and degenerative calcific AS. The comparison group included 41 CHD patients without calcification or stenosis of aortal valve. In all participants, the parameters of lipid profile and calcium and phosphate metabolism were assessed.
Results. Dyslipidemia was more prevalent in CHD patients without AS (85,4% vs. 68%). AS was linked to lower levels of total cholesterol and triglycerides. However, the combination of AS and mitral calcification was characterised by higher levels of low-density and non-high-density lipoprotein cholesterol (LDL–CH and non- HDL–CH). More severe AS was associated with decreased levels of non-HDL–CH and elevated levels of parathyroid hormone, ionized calcium, and alkaline phosphatase. There was a direct correlation between the levels of parathyroid hormone and the presence of calcific AS (r=0,532; p=0,013).
Conclusion. The results obtained confirm the disturbance of lipid and calcium metabolism among patients with calcific AS, which suggests that this cardiac valve pathology could be regarded as a manifestation of ectopic calcinosis.Key words: coronary heart disease, aortic stenosis, dyslipidemia, phosphorus and calcium metabolism, calcification.
DYNAMICS OF HEART RATE VARIABILITY AND VENTRICULAR ECTOPIC ACTIVITY IN IVABRADINE-TREATED PATIENTS WITH CHRONIC HEART FAILURE
Surovtseva M. V., Koziolova N. A., Chernyavina A. I.
Academician E. A. Vagner Perm State Medical Academy, Perm, Russia.Abstract
Aim. In patients with chronic heart failure (CHF) of ischemic aetiology, to assess the dynamics of heart rate variability (HRV) and ventricular ectopic activity during the complex, ivabradine-including therapy.
Material and methods. In total, 90 patients with CHF and stable angina pectoris were examined. All participants were randomised into three equally sized groups: Group 1, receiving perindopril and ivabradine, as a part of the complex treatment; Group 2, receiving perindopril, bisoprolol, and ivabradine; and Group 3, receiving perindopril and bisoprolol. The therapy duration was 6 months. At baseline and in the end of the treatment phase, the following parameters were assessed: HRV measures (mean 24 hour hear rate (HR), SDNN, triangular index (HRVti), and mean weighted variation of rhythmogram (MWVR)); mean 24 hour QT, QTc, QTc dispersion (QTcd), and ventricular extrasystolia (VE).
Results. The treatment was associated with a significantly greater reduction of mean 24 hour HR in Groups 1 and 2 vs. Group 3 (p<0,001). In Group 3, the SDNN increase was significantly lower than in Groups 1 and 2 (p<0,001), where SDNN values were similar (p=0,091). Group 3 also demonstrated a significantly lower increase in MWVR, compared to Groups 1 and 2 (p<0,001). This parameter was similar in Groups 1 and 2 (p=0,065). The increase in HRVti was more pronounced in Group 2 than in Groups 1 and 3 (p<0,001). The reduction in the total 24 hour VE number was significantly more pronounced in Group 2 than in Groups 1 and 3 (p<0,001). The dynamics of 24 hour QTc and QTcd was similar across three groups.
Conclusion. Including ivabradine in the complex therapy of patients with CHF and stable angina pectoris was associated with improved HRV, no marked QTc or QTcd changes, and a moderate preventive effect on VE.Key words: heart failure, heart rate variability, ventricular ectopic activity, complex treatment, ivabradine.
COMBINATION THERAPY WITH ATENOLOL AND AMLODIPINE AND CORRECTION OF CARDIOVASCULAR AUTONOMIC DYSFUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSION
Kiselev A. R.1, Gridnev V. I.1, Karavaev A. S.2, Posnenkova O. M.1, Shvartz V. A.1, Ponomarenko V. I.3, Prokhorov M. D.3, Bezruchko B. P.2
1Saratov Research Institute of Cardiology; 2N. G. Chernyshevskyi Saratov State University, Faculty of Nano- and Biomedical Technology; 3Saratov Branch, Institute of Radio Engineering and Electronics, Russian Academy of Sciences, Saratov, Russia.Abstract
Aim. To assess the effects of the combination therapy with atenolol and amlodipine on the synchronisation of 0,1 Hz rhythms of heart rate variability (HRV) and distal vessel filling (DVF).
Material and methods. The study included 25 patients with Stage 1–2 arterial hypertension (AH), aged 58±8 years. The registration of 0,1 Hz oscillations in HRV and DVF was performed during the passive tilt test with spontaneous breathing; each test stage lasted for 10 minutes. Synchronisation was assessed by the phase difference between 0.1 Hz-rhythms in HRV and DVF. Frequency values of the HRV spectrum in LF and HF-ranges were also assessed. The duration of combination therapy was 8 weeks.
Results. In patients with AH and a markedly manifested autonomic dysfunction, the therapy with atenolol and amlodipine was associated with some improvement in the functional interaction between HRV and DVF 0,1 Hz rhythms. In the rest of AH patients, the treatment was linked to stable levels of cardiac 0,1 Hz regulation and slightly decreased synchronisation levels. All participants demonstrated an increase in the influence of respiratory parasympathetic effects.
Conclusion. The combination therapy with atenolol and amlodipine effectively corrected autonomic cardiovascular dysfunction in patients with Stage 1–2 AH.Key words: autonomic regulation, synchronisation, 0,1 Hz rhythm, therapy, atenolol, amlodipine.
METABOLIC EFFECTS OF VARIOUS ANTIHYPERTENSIVE DRUG COMBINATIONS
Alimova E. E., Leonova M. V., Belousov Yu. B.
N. I. Pirogov Russian Research Medical University, Moscow, Russia.Abstract
Aim. To investigate the effects of various antihypertensive combinations on metabolic parameters in patients with arterial hypertension (AH).
Material and methods. The study included 144 AH patients and 7 groups of combination therapy: Group 1 (n=30) – trandolapril/verapamil SR; Group 2 (n=19) – perindopril/indapamide; Group 3 (n=15) – felodipine/metoprolol; Group 4 (n=20) – amlodipine/atenolol; Group 5 (n=20) – ACE inhibitor/hydrochlorothiazide (HCT); Group 6 (n=22) – telmisartan/lacidipine; and Group 7 (n=18) – metoprolol/HCT. In all participants, the parameters of lipid, carbohydrate, and purine metabolism were assessed. The effects of antihypertensive combinations on the risk of metabolic disturbances were studied using the factor regression analysis of quantitative and qualitative parameters (factors) as weighted ordered functions.
Results. The negative effects on the levels of cholesterol (CH), triglycerides (TG), and glucose were most pronounced for the combination of metoprolol and HCT, while the combination of amlodipine and atenolol demonstrated the weakest negative effects on CH and glucose levels. The levels of CH, TG, and uric acid were affected to the least extent by the combination therapy with ACE inhibitor and HCT, which was also associated with a reduction in glucose levels. The combination of trandolapril and verapamil SR had the largest positive effect on the levels of CH, TG, and uric acid, together with a beneficial effect on glucose levels. The combination therapy with perindopril and indapamide was the most beneficial for the levels of CH and TG, while the felodipine/metoprolol combination had the most pronounced positive effects on TC and glucose levels. The combination of lacidipine and telmisartan was the most beneficial for glucose levels, but negatively affected the levels of uric acid. The perindopril/indapamide combination demonstrated negative effects on glucose levels.
The full doses of diuretics and β-blockers negatively affected the levels of TC and glucose, while the full doses of ACE inhibitors benefited these metabolic parameters.
Conclusion. The combination of a β-blocker and HCT was the least desirable, in terms of metabolic safety, for the treatment of AH patients. Including ACE inhibitors in the combination therapy demonstrated beneficial metabolic effects. To minimise the pre-existing metabolic disturbances and prevent the negative metabolic effects of diuretics, full doses of ACE inhibitors are required.Key words: Arterial hypertension, combination therapy, metabolic effects.
COMPARATIVE ANALYSIS OF TOTAL DISEASE COSTS IN PATIENTS WITH ARTERIAL HYPERTENSION: THE RESULTS OF THE OPEN, MULTI-CENTRE OBSERVATIONAL PROGRAMME «PRORYV»
Tarlovskaya E. I., Mal’chikova S. V.
Kirov State Medical Academy, Kirov, Russia.Abstract
Aim. To compare total disease costs by the treatment regimen and blood pressure (BP) control levels among patients with arterial hypertension (AH).
Material and methods. Pharmacoeconomic analyses of total disease costs were performed for two treatment regimens and 4115 patients participating in the open, multi-centre observational programme “PRORYV”: a retrospective cost analysis for the 12 pre-inclusion weeks and a prospective cost analysis for the 12 weeks of the programme participation.
Results. The treatment with a fixed-dose combination of perindopril and amlodipine (Prestance) was more expensive for the patients than the pre-inclusion treatment (955,15±849,96 vs. 566,78±432,70 RUB per person per month). However, total direct costs for the Prestance-treated patients were 2,6 times lower (3164,07 vs. 8245,33 RUB per person for 12 weeks). Total treatment costs were also lower: 3463,47 vs. 14226,03 RUB per person for 12 weeks, respectively. Switching to a more effective treatment regimen (Prestance) modifies the distribution of the therapy costs, due to decreased incidence and duration of hospitalisation episodes and reduced number of medical visits and ambulance calls.
Conclusion. The reduction in the AH treatment costs and modification of their distribution provides an opportunity for a wider use of more effective medications. Switching one patient from ineffective treatment to Prestance covers the costs of additional treatment of 310% patients (n=12757) for 12 weeks.Key words: total disease costs, arterial hypertension.
SALT CONSUMPTION. CARDIOVASCULAR SYSTEM AS A TARGET ORGAN. PART III
Poteshkina N. G.
N. I. Pirogov Russian Research Medical University, Post-diploma Medical Education Faculty, Therapy Department, Moscow, Russia.Abstract
The review discusses the clinical impact of salt consumption on the cardiovascular system status. The therapeutic potential of reduced salt intake, in order to facilitate regression of cardiovascular disturbances, is also discussed. Daily consumption of standard or increased amounts of salt results in the complex multilevel changes of cardiac chambers, arterial and venous vessels, and microcirculation in individuals with normal and elevated blood pressure (BP). The underlying mechanisms, both hemodynamic and non-hemodynamic, are present even in normotensive people. Reduced salt consumption is associated with the regression of structural cardiovascular disturbances.
Key words: arterial hypertension, salt consumption, cardiovascular system, target organ.
RESTENOSIS AND IN-STENT STENOSIS: PATHOGENETIC MECHANISMS AND PROGNOSTIC MARKERS
Berezovskaya G. A.1, Ganyukov V. I.2, Karpenko M. A.1
1V. A. Almazov Federal Centre of Heart, Blood, and Endocrinology, St. Petersburg; 2Research Institute of Complex Cardiovascular Problems, Siberian Branch, Russian Academy of Medical Sciences, Kemerovo, Russia.Abstract
The paper focuses on various aspects of restenosis and in-stent thrombosis, as complications of percutaneous coronary intervention. The complex assessment of this problem is warranted, as it remains far from being resolved, despite the recent technical and therapeutic advances.
Key words: restenosis and in-stent thrombosis, platelets, apoptosis, fibronectin, leptin, antiaggregants.