CONTENTS
СОДЕРЖАНИЕCLINICAL MEDICINE NEWS
Clinical medicine updates: a review of international news
Russ J Cardiol 2014, 9 (113): 5
ACTUAL TOPICS
THE SYNDROME OF LEFT VENTRICLE HYPERTROPHY
Dzemeshkevitch S. L., Zaklyasminskaya E. V., Frolova Yu. V.
Abstract
Authors, based on their own experience of the left ventricle hypertrophy treatment, and by modern literature exploration di analyze three leading diseases, in phenotype of those the left ventricle hypertrophy and its typical central hemodynamic disorders play crucial role. Arterial hypertension, involutionary calcified aortic stenoses, bicuspid aorto-valvulopathy, hypertrophic cardiomyopathy totally hold leading position in the structure of cardiovascular modbidity. Having the same phenotypical marks, these diseases absolutely different by their genetic disorders and, respectively, require completely different treatment strategies. Taking into account the social influence of the left ventricle hypertrophy syndrome due to its prevalence, a serious epidemiological studies on the national level are required.
Russ J Cardiol 2014, 9 (113): 6–10
Key words: hypertension, left ventricle hypertrophy, involution aortal defect, bicuspid valvulopathy, hypertrophic cardiomyopathy.
FSBSU Russian Scientific Centre of Surgery n. a. academic B. V. Petrovsky, Moscow, Russia.
EFFICACY AND SAFETY OF BETA-ADRENOBLOCKER TREATMENT DURING POSTOPERATIONAL PERIOD AFTER EXTRACARDIAL SURGERY — A PARADIGM SHIFT?
Shchukin Yu. V.1, Surkova E. A.1, Khokhlunov S. M.1,2, Duplyakov D. V.1,2
Abstract
For a long time beta-blockers (BB) have been sure the leading drug class to prescribe with preventive aims for myocardial infarction MI or cardiovascular morbidity in intra- and early postoperational periods of extracardial surgical interventions. However during last years the results of the most salient trials of the DECREASE family, showing positive effects of BB on decrease of intraoperational MI, were discredited. The review concerns on contemporary thought on pathogenesis of perioperational MI; the studies are analyzed which have explored various aspects of BB use in perioperational period. It is shown that their short-term action is mostly supress of stress reactions of cardiovascular system, and long-term effects are decrease of inflammatory mediators levels; this leads to atherosclerotic plaques stabilization and their volume decrease. Also we do not have good enough data on benefits or lack of perioperationsl therapy by BB, and the problem of the safety and efficacy of BB use is still open. To answer this more trials needed with perfectly formulated targets and thoroughly worked out design, choice of drug, compliant dosing regimen, dose titration, strict control of target heartrate and plodd pressure, and strict endpoints.
Russ J Cardiol 2014, 9 (113): 11–15
Key words: beta-blockers, perioperational period, myocardial infarction.
1SBEI HPE Samara State Medical University; 2SBHI Samara Region Clinical Cardiological Dispensary, Samara, Russia.
THE PROGRAM FOR PREVENTION OF CHRONIC NON-INFECTIOUS DISEASES IN JSC “SBERBANK OF RUSSIA”: SYNTHESIS OF EVIDENCE-BASED MEDICINE AND MARKETING TECHNOLOGIES
Kontsevaya A. V.
Abstract
The article describes a program for CNID prevention, made up in 2011–2013 in JSC Sberbank of Russia. The description is given for the main components of the program, including medical part, that aimed early CNID screening and decrease of complication development risk; and marketing part, aimed on promotion of healthy life style with use of modern marketing technologies. The data provided on efficacy of the program at temporary invalidity costs, and increase of emplyer reputation. At the end the article concerns on brief review of complications occuring during program performing in a gross bank.
Russ J Cardiol 2014, 9 (113): 16–21
Key words: organized staff, prevention program, chronic non-infectious diseases, risk factors, bank.
FSBI SSRC of Preventive medicine of the Ministry of Health, Moscow, Russia.
PATIENT’S PERSONALITY: AN INTERDISCIPLINARY APPROACH TO CARDIOVASCULAR PATHOLOGY
Taratukhin E. O.
Abstract
The article takes into account the opportunity of the positive health, that is possible instead of the fight against diseases. As a main part of such interdisciplinary approach the personality is evaluated. To summon up the knowledge from biochemical to cultural bodies of human existence might turn medical science from the negation of a somatic disease to the health.
Russ J Cardiol 2014; 9 (113): 22–25
Key words: biopsychocultural approach, psychosomatics, psychocardiology, evidence-based medicine, risk factors.
SBEI HPE RNRMU n. a. N. I. Pirogov, Moscow, Russia.
ECONOMIC BURDEN OF CARDIOVASCULAR DISEASES IN RYAZAN’ REGION
Yakushin S. S., Filippov E. V.
Abstract
Aim. To evaluate economical costs of CVD in Ryazan’ Region.
Material and methods. The counting of economical expenses was done according to the data of the official statistics, and to the data of the MERIDIAN-RO study (quantity of disabled, their economical and social parameters, quantity of disability certificates and their main reasons during last year before the study). All data provided with accordance to the computation methodology of economical toll from mortality, morbidity and disability of citizens, that is ratified by the Ministry of Economics and Development, the Ministry of Health and Social Development, RosStatistics from 10.04.2012 #192/323n/45n/113.
Results. After calculation of nondirect toll from CVD in Ryazan’ Region it was shown that it is 4,9% GRP. In Ryazan’ Region more than a half (54,7%) of all nondirect toll from CVD is kinked to mortality, all other toll is equally spread to disability (23%) and morbidity (22,3%).
Conclusion. Nondirect economic toll from CVD in Ryazan’ Region are very high and in 2012 reached 1805767093,09 RUR (that is equal 4,9% VRP). The main impact is from mortality (54,7%). It requires the activation of prevention and treatment strategies for the decrease of mortality in Ryazan’ Region. Also the imrovement of statistics required and of efficacy of prevention programs evaluation.
Russ J Cardiol 2014, 9 (113): 26–30
Key words: economic toll, cardiovascular diseases, morbidity, mortality, disability.
SBEI HPE Ryazan’ State Medical University n. a. Pavlov I. P. of the Ministry of Health, Ryazan’, Russia.
ORIGINAL ARTICLES
PREDICTORS OF CORONARY ARTERIES RESTENOSIS AFTER STENTING IN OBESE WOMEN
Veselovskaya N. G.1,3, Chumakova G. A.1,2, Shenina N. N.2, Osipova E. S.2,3, Gricenko O. V.1,2
Abstract
Aim. To study predictors of coronary arteries (CA) restenosis after stenting in women with coronary heart disease (CHD) and obesity.
Material and methods. Totally 57 women included (57,1±7,8 y. o.) with CHD: stable angina II–IV functional class and general obesity I–III grade (body mass index — BMI≥30 kg/m2) (33,61±2,81 kg/m2), admitted for planned percutaneous intervention (PCI) with CA stenting. Prospective follow-up performed during 1 year after PCI. As resthenosis of CA we mentioned significant (≥50%) narrowing of vessel lumen in the area of intervention. All patients underwent laboratory study with assessment of the main and additional metabolic risk factors and EchoCG with measurement of epicardial fat tissue (EFT) thickness.
Results. In 35% (n=19) patients the restenosis of CA revealed. The equation of logictic regression was formulated with the most important complex of predictors for resthenosis: the age (standardized regression coefficient SRC=0,7360), insulin (SRC=0,4821), and EFT (SRC=0,4224). The proportion of veritable prediction was 86,6%. The square under ROC-curve was 0,865.
Conclusion. The model had been developed may be useful in clinical practice to stratify the risk of complications before planned stenting of CA to improve secondary prevention of CHD.
Russ J Cardiol 2014, 9 (113): 31–36
Key words: coronary stenting, obesity, restenosis, risk factors.
1FSBI SRI for Complex Problems of Cardiovascular Diseases of SD RAMS, Kemerovo; 2Altai State Medical University, Barnaul; 3Altai Region Cardiological Dispensary, Barnaul, Russia.
IMPROVEMENT OF RETHROMBOSIS DIAGNOSTICS IN STEACS PATIENTS WITH USE OF TELEMONITORING OF ECG
Oleynikov V. E.1, Shitogarova E. A.2, Kulyutsin A. V.1,2, Evstigneev S. V.2
Abstract
Aim. To study diagnostic significance of transient ST elevation, revealing with telemetric ECG monitoring in patients with effective systemic thrombolysis (STL) in acute coronary syndrome with ST elevation (STEACS).
Material and methods. Totally 56 patients included of both genders, with STEACS, having ECG signs of successful STL during 3 hours after disease had started. All patients in acute coronary unit envirnonment underwent telemetric ECG registration with “Astrocard-Telemetry” complex (CJSC Meditek, Russia) with analysis of ST dynamics by 12-lead automatic regimen with following physician verification.
Results. At most the re-elevation of ST was unsymptomatic. By coronary arteriography most patients with registered transient re-elevation episodes had shown thrombosis of infarction-relevant artery.
Conclusion. Transient re-elevation of ST by 1 mm and more is an accurate diagnostic criteria of coronary rethrombosis development and makes it possible to identify patients group whom urgent PCI after STL is recommended. Asymptomatic re-elevation episodes of ST can be found on time only with telemetric ECGmonitoring.
Russ J Cardiol 2014, 9 (113): 37–42
Key words: acute coronary syndrome with ST segment elevation, ECG telemetry, ST segment re-elevation, asymptomatic myocardial ischemia, coronary artery rethrombosis.
1Penza State University, Medicine Institute, department for therapy; 2SBHI Penza Region Clinical Hospital n. a. N. N. Burdenko, Penza, Russia.
SLEEP DISORDERS AND THE RISK OF MYOCARDIAL INFARCTION AND STROKE IN MEN OF NOVOSIBIRSK CITY
Gafarov V. V.1,2, Gromova E. A.1,2, Gagulin I. V.1,2, Gafarova A. V.1,2, Panov D. O.1,2
Abstract
Aim. To estimate the risk of myocardial infarction (MI) and stroke in economicallyactive men (25–64 y. o.) with sleep disorders during 14-years period.
Material and methods. In the 3rd screening for WHO program “MONICApsychosocial” the random relevant selection was studied of the men 25–64 y. o. in Novosibirsk in the year 1994 (n=657, mean age 44,3±0,4, response — 82,1%). The program of screeing examination included the registration of social and demographic data, sleep disorders assessment with Jenkins C. D. score. During 14-year perion 30 MIs and 22 strokes registered. Statistical analysis was done with SPSS v. 11.5 software. We used Pirson χ2 criteria, and for Hazard Ratio (HR) — Cox-regression. Reliability in all types of analysis was with the cut-off p≤0,05.
Results. The prevalence of sleep disorders in men 25–64 y. o. was 48,3%; “satisfactory” self sleep assessment was in 39,6%; “bad” — 7,6%; “very bad” — 1,1%. As “good” their sleep marked 46,2% and as “very good” — 5,6%. In men with the MI developed “good” sleep mark was 36,8%, “satisfactory” — 44,7%, “bad” — 18,4% (χ2=2,402, ν=4, р>0,05). In those developed stroke in 47,1% the mark was “good”, in 23,5% — “satisfactory”, and 29,4% marked bad sleep (χ2=6,234, υ=2, р<0,05). In Cox Regression the MI 5-year risk in persons of 25–64 y. o. with sleep disorders was HR=2,4, during 10 years — HR=2,6, and during 14 years HR=2,3; for stroke, respectively, 3,9; 2,72; 1,5. A serious influence on the MI and stroke risk among men having sleep disorders, made family status. MI and stroke risk is much higher in single, divorced or widowed. The highest risk of MI and stroke had men with sleep disorders having low education level and on strenuous physical labour.
Conclusion. Sleep disorders is important an influencing psychosocial risk factor for MI and stroke.
Russ J Cardiol 2014, 9 (113): 43–47
Key words: sleep disorders, risk, myocardial infarction, stroke, male cohort.
1FSBI Scientific-Research Institute of Therapy and Prevention of the SD RAMS, laboratory of sociology and psychology of internal diseases; 2Interdepartmental Laboratory of Cardiovascular Epidemiology of the SD RAMS, Novosibirsk, Russia.
OPPORTUNITIES FOR THE USE OF VISCERAL OBESITY INDEX IN METABOLIC SYNDROME DIAGNOSTICS AND PROGNOSIS OF ITS COMPLICATION RISK
Libis R. A., Isaeva E. N.
Abstract
Aim. To study VAI as diagnostic marker for MS and its usefulness for prognosis of cardiovascular complications development in MS comparing to other common antropometric parameters (WR, BMI, WR/HR, WR/height, TG/HDL).
Material and methods. Totally 301 person included (148 men, 153 women). All participants undewent anthropometry, BP measurement, fasting glucose, lipid profile, adiponectine. At second stage (follow-up) the participants were divided into two groups depending on end-points: first group had cardiovascular complications (CHD, MI, cardiovascular disease), second group — DM 2 type. MS was assessed with IDF (2005).
Results. MS was found in 108 respondents (35,9%). Significant positive correlations were found between VI and BP, fasting glucose, LDL; negative — with VAI and adiponectine. Significant predictors for MS dignosis were WR/height, TG/HDL and VAI (p<0,0001). By the results of multiple regression VAI, WR/height and adiponectine were independent factors of cardiovascular risk in MS; and risk factors for DM 2 type were VAI, TG/HDL, adiponectine.
Conclusion. VAI proved its diagnostic reliability in MS diagnostics, as in cardiovascular risk prognosis of MS. Further studies required with longer follow-up period and various patient groups.
Russ J Cardiol 2014, 9 (113): 48–53
Key words: visceral obesity index, adiponectine, metabolic syndrome.
SBEI Orenburg State Medical Academy of the Ministry of Health, Orenburg, Russia.
SYSTEMIC INVOLVEMENT OF CONNECTIVE TISSUE AND THE HEART AS IMPORTANT CHARACTERISTICS OF PRIMARY MITRAL VALVE PROLAPSE
Zemtsovsky E. V.1,2, Malev E. G.1, Reeva S. V.1,2
Abstract
Aim. To evaluate systemic involvement of connective tissue (SICT) in young adults with mitral valve prolapse (MVP) without significant mitral regurgitation (MR).
Material and methods. We studied 78 asymptomatic young subjects (mean age 19,7±1,6, 72% male) with MVP in comparison with 80 sex- and age-matched healthy subjects. We performed phenotypic examination of MVP patients and control group subjects, and echocardiographic study to identify the minor heart anomalies. Longitudinal strain and strain rate (SR) were determined using spackle tracking (Vivid 7 Dimension GE, EchoPAC’08).
Results. We identified two clusters of patients with MVP. In the first cluster (17 subjects, 28% of the MVP group) a significant reduction of longitudinal systolic strain observed comparing to the control group and the second cluster (61 subjects, 72%). Global strain in the second cluster did not differ significantly from the control group. Echocardiographic study showed nonsignificant increase in the average number of SICT points in the first cluster and highly significant increase of the minor heart anomalies’ number in this group of patients.
Conclusion. Myocardial deformation assessment allowed to identify the signs of cardiomyopathy in quarter of young asymptomatic patients with MVP. Increasing number of minor heart anomalies in the group with primary MVP and cardiomyopathy allows considering other valve prolapses, dilatation of major vessels, basal and thick LV chords as features of the SICT in primary MVP. A great number of minor heart anomalies in primary MVP may indicate a change in the heart extracellular matrix that can cause the development of cardiomyopathy in primary MVP.
Russ J Cardiol 2014, 9 (113): 54–60
Key words: mitral valve prolapse, left ventricular function, minor heart anomalies, connective tissue involvement.
1FSBI Almazov Federal Medical Research Centre; 2SEI HPE Saint-Petersburg State Pediatric Medical University; Saint-Petersburg, Russia.
METABOLISM OF FATTY ACIDS IN LEFT VENTRICLE MYOCARDIUM AND THE EFFICACY PROGNOSIS OF CARDIO-RESYNCHRONIZING THERAPY IN DILATED CARDIOMYOPATHY PATIENTS
Gulya M. O.1, Lishmanov Yu. B.1,2, Zavadovsky K. V.1, Lebedev D. I.1
Abstract
Aim. To study perfusion and metabolism of LV myocardium in patients with dilated cardiomyopathy (DCMP) and to invent on this basement a gamma-specific predictors for cardio-resynchronizing therapy (RT) efficacy.
Material and methods. Totally 63 patients with DCMP included (41 male, 22 female) with mean age 55,4±8,3 y. o., having congestive heart failure (CHF) of III–IV NYHA. Before RT all patients underwent scintigraphy of myocardium with 99mТс (for perfusion assessment) and 123I (for fatty acids metabolism). Before and in 6 months after RT all patients underwent echocardiography to assess intracardiac hemodynamics.
Results. In 6 months after RT all patients were divided into two groups: 1) EDV LV decreased by ≥15% (n= 39) — “responders”, and 2) ESV LV decreased <15% (n=24) — “non-responders”. Before RT groups did not significantly differ by pumping function of the ventricle. Significant difference was found by following pre-operational scintigraphic parameters: perfusion defect (PD) (9,22±5,06% and 12,5±4,22%, p<0,01), metabolism defect on earlier pictures (MD) (9,21±5,42% and 11,27±5,39%, p<0,01). The equation of multiple regression was invented, which may prognose the dynamics of end-systolic volume after RT. By the ROC analysis data the main prognostic significance for RT has the size of metabolism defect area and calculated value of end-systolic volume dynamics. The best threshold MD=7,35% and it confirms the efficacy of RT with 77,8% sensitivity and 66,7% specificity. The best threshold value of calculated endsystolic volume dynamics — 34,02 confirms the 87,5% sensitivity and 100% specificity of RT.
Conclusion. The data collected during metabolic myocardial gamma-scintigraphy may be used in the complex of methods that allow to predict the efficacy of cardioresynchronizing therapy.
Russ J Cardiol 2014; 9 (113): 61–67
Key words: dilated cardiomyopathy, scintigraphy of myocardium, cardioresynchronizing therapy.
1FSBI SRI of cardiology of SB RAMS; 2FSBEI HPE National Research Tomsk Polytechnik Univestity, Tomsk; Russia.
QUALITY OF LIFE AND PSYCHO-COGNITIVE CONDITION IN PATIENTS AFTER CORONARY ARTERY BYPASS GRAFT SURGERY
Goruleva M. V.1, Ganenko O. S.1, Коvaltcova R. S.2, Kutuzova A.1, Petrova N. N.1,2, Demchemnko E. A.1, Nedoshivin A. O.1
Abstract
Aim. To study psychic, cognitive status and life quality of petients underwent coronary bypass grafting (CABG).
Material and methods. Totally 81 patient with CHD studied (80% men, 20% women) with the age 56,3±1 y. o., underwent planned CABG. On 7–8th day after CABG the 6-minute walk test (WT) was done and the Hospital anxiety-depression score used, Hamilton anxiety-depression score, Spielberger anxiety score and other methods to assess asthenia and cognitive status (MMSE, MoCA). Life Quality (LQ) assessed with 10-points visual-analogue scale; coping behavioural strategies studied.
Results. Values by WT were 415±130 m, LQ — 6±0,3 points. In 35% patients there was lowering of cognitive functioning. In 20% there were affective disorders and the negative correlation of WT with anxiety (r= –0,3; p<0,01), affective disorders with LQ (r= –0,53; p<0,05). Anxiety was comorbid to depression (r=0,91; p<0,05). Moderate and prominent asthenia registered in 36% and 18% of patients, asthenia was linked with affective (r=0,96; р<0,02) and cognitive (r=0,97; р<0,001) disorders. 46% patients used non-constructive and relatively constructive coping strategies.
Conclusion. On 7–8th days after CABG in 35% patients there is lowering of cognitive functioning and not less than 20% show signs of affective disorders, that impacts LQ of patients and tolerability of physical exertion. The anxiety and depression revealed were associated not only with each other but with asthenisation of patients to. Cognitive disorders and emotional dyscomfort, experiencing by patients, may affect adaptation leading to non-constructive coping strategies. The found specifics of psychic and cognitive status must be taken into account for elaboration of individualized patient-centered programs of rehabilitation after CABG.
Russ J Cardiol 2014; 9 (113): 68–71
Key words: coronary bypass grafting, affective and cognitive disorders.
1FSBI FMIC n. a. Almazov V. A.; 2Pavlov’s Saint-Petersburg Medical University, Saint-Petersburg; Russia
CLINIC AND PHARMACOTHERAPY
THE PLACE OF NEBIVOLOL IN RATIONAL THERAPY OF CONGESTIVE HEART FAILURE
Khadzegova A. B.
Abstract
The prevalence of congestive heart failure (CHF) is growing further with age, and 65% of the sufferers are in the age group from 65 to 80 y. o. Despite success in CHF treatment, mean year mortality is about 6%, and mortality of those with clinically salient CHF reaches 12%. To increase duration of life it is important to prescribe efficient drug therapy, that must include beta-adrenoblockers (BAB), especially in CHF with low ejection fraction (EF) of the left ventricle (LV). Taken into account the results of SENIORS and NEMESIDA, in the year 2013 Nebivolol was included to the National Guidelines on diagnostics and treatment of CHF (IVth review). Benefits on Nebivolol are super-selectivity, vasodilation due to NO release, ability to decrease central aortal pressure, good tolerability and low risk of side effects, especially in patients with concomitant diseases. Nebivolol is effective in coronary heart disease (CHD) and arterial hypertension (AH).
Russ J Cardiol 2014, 9 (113): 72–76
Key words: congestive heart failure, beta-adrenoblockers, nebivolol, National Guidelines.
Moscow State Medical and Stomatological University, Moscow, Russia.
THE PLACE FOR SYSTEMIC THROMBOLYSIS IN MODERN REPERFUSION METHODS FOR MYOCARDIAL INFARCTION
Averkov O. V.1,2, Pavlikova E. P.1, Tyulkina E. E.2
Abstract
The analytic article provides a brief history of thrombolytic therapy in myocardial infarction and discusses benefits and restrictions of contemporary reperfusion methods of treatment. Albeit dominating position of primary transcutaneous interventions, thrombolytic therapy remains the main part for primary stage of treatment, especially in hard acessible and remote areas. Its usage especcialy important for Russia where such territories and cities with out of date infrastructure make impossible to follow optimal standards of care during permitted time window. The attention spotted on the improvement of thrombolytic therapy by pre-hospital thrombolysis and broad usage of pharmacoinvasive approach.
Russ J Cardiol 2014; 9 (113): 77–83
Key words: myocardial infarction, reperfusion strategy, thrombolysis.
1City Clinical Hospital № 15 n. a. O. M. Filatov, Moscow; 2Russian Peoples Friendship University, Moscow, Russia.
CLINICAL CASES
A RARE CASE OF AORTITIS IN SYPHILIS
Luneva E. B.1, Ryzhkov A. V.1, Mitrophanova L. B.1, Malev E. G.1, Pakhomov A. V.1, Samokhvalova M. V.1, Zemtsovsky E. V.1,2
Russ J Cardiol 2014, 9 (113): 84–85
1FSBI Federal Medical Research Centre n.a. Almazov V.A., Saint-Petersburg; 2Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russia.
LONG-TERM DYNAMIC MONITORING OF THE PATIENT WITH CHRONIC ISOLATED OCCLUSION OF THE ANTERIOR INTERVENTRICULAR BRANCH OF THE LEFT CORONARY ARTERY
Konstantinov, I. M., Prokudina M. N.
Russ J Cardiol 2014, 9 (113): 86–87
FSBI Federal Medical Research Centre n.a. Almazov V.A., Saint-Petersburg, Russia.
