CONTENTS
СОДЕРЖАНИЕAddress to the readers
Russ J Cardiol 2014, 12 (116): 5
CLINICAL MEDICINE NEWS
Clinical medicine updates: a review of international news
Russ J Cardiol 2014, 12 (116): 6
CARDIAC DYSRHYTHMIAS
IDIOPATHIC FORM OF ATRIAL FIBRILLATION, INFLAMMATION AND CLINICAL RESULTS OF RADIOFREQUENCY ABLATION
Batalov R.E.1,2, Rogovskaya Yu. V.1,2, Ryabov V. V.1,2, Tatarsky R. B.3, Sazonova S. I.1, Khlynin M. S.1, Popov S. V.1, Karpov R. S.1
Abstract
Aim. To evaluate the impact of inflammation on clinical results of radiofrequency ablation (RFA) for atrial fibrillation (AF).
Material and methods. Totally 274 patients studied, admitted to the hospital with the diagnosis idiopathic AF, of those just 67 (24,5%) had this diagnosis been confirmed at previous stage of clinical assessment. All patients underwent intracardiac investigation and RFA AF, endomyocardial byopsy (EMB) with histologic and immunohistochemical studies for immunophenotype cells study of the endomyocardial infiltrate and revealing of cardiotropic viruses antigenes expression: to parvovirus B19, enterovirus, virus human herpes 1 and 2 types, adenovirus, cytomegalovirus, Epstein-Barr virus. We studied efficacy of catheter treatment, development of early and late recurrent episodes of atrial tachiarrhythmias.
Results. Histologic changes in right ventricle myocardium were not found in 9 (13,4%) patients. In 26 (38,8%) we found fibrous changes of myocardium: in 11 (42,3%) — mostly perivascular fibrosis, in 8 (30,8%) — small-nodular, in 7 — (26,9%) — perimuscular. Inflammatory changes (according to Dallas criteria) were marked in 32 (47,8%) patients, of those in 9 (28,1%) lymphocyte infiltration found (less than 14 lymphocytes mm²). In one of these patients (3,1%) there was combination of herpes sumplex virus 2nd type and Epstein-Barr. In 23 patients (34,3%), myocarditis found, of those in 18 (78,3%) virus expression found. In one (5,6%) patient there was expression of 3 viruses, and in six (33,3%) patients — of two viruses, in 11 patients (61,1%) — one virus antigen. Total follow-up lasted for 19,3±3,7 months. Effectiveness of primary RFA in patients with intact myocardium was 88,9%, with fibrous changes — 46,2%, in myocarditis — 34,4%. Early recurrent episodes of arrhythmia were absent in unchanged myocardium (53,8%) and rarer — late (34,6%). Having inflammatory changes led to reverse relation, and later recurrent episodes developed more frequently (53,1%) and rarer — early (37,5%).
Conclusion. By our data, only 24,5% patients do not have diseases that predispose to arrhythmias. Histologic study showed that only 10% patients have idiopathic type of arrhythmia, and a half have subclinic inflammatory changes of myocardium, the rest have fibrous changes. Presence of inflammatory and fibrous changes in myocardium increases the quantity of early and late arrhythmia onsets and, therefore, double decreases RFA AF efficacy.
Russ J Cardiol 2014, 12 (116): 7–12
http://dx.doi.org/10.15829/1560-4071-2014-12-7-12Key words: atrial fibrillation, endomyocardial biopsy, inflammatory myocardium diseases, radiofrequency ablation.
1FSBSI Scientific-Research Institute for Cardiology, Tomsk; 2FSAOI HE National Research Tomsk State University, Tomsk; 3FSBI Federal Medical Research Centre n. a. V. A. Almazov, Saint-Petersburg, Russia.
SCINTIGRAPHIC ESTIMATION OF THE SYMPATHETIC INNERVATION OF THE HEART AND MYOCARDIAL PERFUSION IN PATIENTS WITH ATRIAL FIBRILLATION
Lishmanov Yu. B.1,2, Saushkina Yu. V.1, Minin S. M.1, Efimova I. Yu.1, Kisteneva I. V.1, Popov S. V.1
Abstract
Aim. The aim of the study was to scintigraphically evaluate the condition of sympathetic innervation of myocardium and coronary microcirculation in patients with atrial fibrillation (AF).
Material and methods. Totally 40 patients included with CHD II-III functional class and AH III stage. Of those: 15 patients — with paroxysmal AF (PAF), 15 — with long-lasting persistent AF (LPAF) and 10 patients — without any signs of AF. To evaluate the sympathetic activity of the myocardium all patients underwent scintigraphy with 123I-metaiodbenzylguanidine (123I-MIBG). With planary study of myocardium investigation with 123I-MIBG we assessed regionary sympathetic activity by the relation of “Heart/ Mediastinum” (H/M) and speed of indicator washout. Also all participants underwent myocardial scintigraphy with 99mTc-MIBG to measure coronary microcirculation.
Results. Analysis of the data showed that patients with PAF and LPAF the relation of H/M at early and delayed scintigrammes was significantly lower comparing to the same value in the patients without AF (1,57±0,15, 1,54±0,18 vs. 1,82±0,12 on early scintigrammes and 1,47±0,15, 1,46±0,16 vs. 1,83±0,13 on delayed, with p<0,05). Also in PAF and LPAF was significantly higher the velocity of indicator excretion comparing to the group of patients without AF (31,2%±11,5%, 29,4%±10,5% vs. 17,5%±10,3%, resp., p<0,05). By the evaluation of regional sympathetic activity in patients with LPAF the filling defect of 123I-MIBG on early and delayed scintigrammes was significantly higher than in groups with PAF and without AF. In evaluation of coronary microcirculation there were no any significant differences of the perfusion defect among the groups studied.
Conclusion. The study showed that in patients with AF there are the most prominent changes in functional conditions of myocardial sympathetic system comparing to the group without AF. At the same time AF does not lead to significant influence on myocardial flow, and the most significant disorders of regional sympathetic activity are visible in patients with long persistent AF.
Russ J Cardiol 2014, 12 (116): 13–18
http://dx.doi.org/10.15829/1560-4071-2014-12-13-18Key words: atrial fibrillation, monophoton emission computed tomography, 123I-MIBG, sympathetic innervation, 99mTc-MIBG.
1FSBSU Scientific-Research Institute of Cardiology, Tomsk; 2FSAIS HE National Research Tomsk Polytechnik University, Tomsk, Russia.
DYNAMICS OF STRUCTURAL AND FUNCTIONAL ELECTROPHYSIOLOGICAL PARAMETERS OF THE HEART IN PATIENTS WITH PAROXYSMAL ATRIAL FIBRILLATION AFTER AORTIC-CORONARY BYPASS GRAFTING SIMULTANEOUS WITH RADIOFREQUENCY ABLATION OF PULMONARY VEINS OSTIUM
Iskenderov B. G., Rakhmatullov A. F.
Abstract
Aim. Assessment of antiarrhythmic efficacy of surgical radiofrequency ablation (RFA) of pulmonary veins ostiums, performed during coronary bypass grafting (CABG) procedure, and its inflluence on structural and functional and electrophysiological parameters of the heart in patients with paroxysmal atrial fibrillation (AF).
Material and methods. Into open-label clinical trial totally 116 patients included (71 male and 45 female) in the age 43 to 65 y. o. (mean age 57,6±6,4 y. o.), who underwent planned CABG plus RFA. By the data of long-term Holter monitoring of ECG after 12 months after operation we divided the patients into 2 groups: 1st group — 88 patients with stable sinus rhythm and 2nd group — 28 patients with recurrent AF episodes.
Results. It was shown that in patients with paroxysmal AF in 12 months after RFA with CABG there is stable sinus rhythm in 75,9% cases (1st group). After combination treatment in both groups the values of effective refractory period of the atriums and frequency threshold of arrhythmia induction were significantly decreased, however P wave dispersion increased, and some group differences of these parameters revealed. Also, in the 1st group sinus rhythm was stabilized by a significant increase of the left ventricle diastolic function, which were significantly better than in the 2nd group.
Conclusion. It was shown that combination of RFA of pulmonary veins ostiums with CABG in patients with paroxysmal AF improves structural and functional electrophysiology of the heart and therefore saves stable sinus rhythm.
Russ J Cardiol 2014, 12 (116): 19–24
http://dx.doi.org/10.15829/1560-4071-2014-12-19-24Key words: atrial fibrillation, radiofrequency abliation, aortic-coronary bypass grafting.
SBEI APE Penza Institute for Physician Development of the Ministry of Health RF, Penza, Russia.
ATRIAL FIBRILLATION ONSET RISK IN PATIENTS WITH METABOLIC SYNDROME: PROSPECTIVE STUDY
Olesin A. I.1, Litvinenko V. A.2, Al-Barbari A. V.2, Konstantinova I. V.1, Smolin Z. Yu.2, Prosyanikova O. N.2
Abstract
Aim. To evaluate the usefulness of atrial fibrillation (AF) risk predictors for assessment for long-term and short-term risk of its development in patients with metabolic syndrome (MS) during prospective study.
Material and methods. During 1998-2008 y. we studied 1968 patients with MS at the age of 45-75 y. o. All patients underwent common clinical investigation, hemodynamics assessment, late atrial potentials (LAP), P-wave dispersions (Pd), transesophageal electrocardiostimulation with AF risk index (AFRI). After inclusion into the study the patients were followed-up during 1-5 years. The endpoint was absence or presence of AF.
Results. In 176 (8,94%) of the patients studied during 4-4,5 year prospective study we marked the onset of paroxysmal and persistent types of AF. If during single assessment of the patients with MS older than 55 y. o. and BMI ≥30 kg/sq.m there is atrial dilatation and/or LAP, pathological values of Pd, and induction of AF with electrocardiostimulation which presuppose long-term risk of AF. Short-term risk (during 1-2 years after the first year postobservational) of AF development in MS can be evaluated only in dynamics: while lowering of AFRI by 20% and more every 3-4 months of observation leads to development of AF during 1-2 years in MS, and in AFRI less than 3 Units with further decline of this parameter by 90% and more during 1-3 months — during 6 months after investigation.
Conclusion. Complex investigation of MS patients, that includes assesssment of LAP, Pd, AFRI, improves the evaluation of long- and short-term risks of AF development.
Russ J Cardiol 2014, 12 (116): 25–30
http://dx.doi.org/10.15829/1560-4071-2014-12-25-30Key words: atrial fibrillation, risk assessment.
1SBEI HPE North-Western State Medical University n. a. I. I. Mechnikov, Saint-Petersburg; 2St. Elisabeth City Hospital, Saint-Petersburg, Russia.
CLINICAL AND HEMODYNAMIC INTERRELATIONS OF ARRHYTHMIA COURSE IN CHILDREN OF 0 TO 7 YEARS OLD
Svintsova L. I.1, Kovalev I. A.1,2, Krivolapov S. N.1, Brazovskaya N. G.3, Usenkov S. Yu.1
Abstract
Aim. To study clinical and hemodynamic parallels in preschool children with arrhythmias in different age groups.
Material and methods. Totally 195 children studied with idiopathic arrhythmias at the age of 0 to 7 y. o. — 82 with WPW syndrome, 55 with atrial tachiarrhythmias, 7 with AVNRT, 13 — with ventricular tachis (VT), 38 with ventricular and supraventricular onsets (isolated, group and their combination). Age groups: 1 — children 1 y. o. (n=72; 37%); 2 — 1-3 y. o. (n=37; 19%); 3 — 3-7 y. o. (n=87; 44%). All patients underwent standart laboratory assessment, electrocardiography in 12 standard leads, Holter monitoring, echocardiography.
Results. In analysis of tachicardias course variants there was prevalence of of paroxysmal tachicardia in children of 3 to 7 y. o. (p=0,001) and permanent tachicardia in children less than 1 y. o. (p<0,001). Frequency of episodes in paroxysmal tachicardias in 1 y. o. children was higher than in those from 1 to 3 y. o. (p=0,028) and 3-7 y. o. children (p<0,001). In assessment of echocardiography of arrhythmic children depended on age there was significant prevalence of ACMP in older children comparing to the younger (p=0,002). Signs of heart failure were more common in children of 1 y. o. comparing to those of 1-3 and 3-7 y. o. (F=44,117; p=<0,001).
Conclusion. So the arrhythmogenic heart remodeling mostly common for the children of 3 to 7 y. o. In less 1 year infants with arrhythmias clinical signs of HF are followed by diastolic disorders that develop before ACMP development, that is traditionally regarded as systolic dysfunction. Into the factors that influence these hemodynamic relations we include high mean heartrate, tendency of tachicardias to recurrent and permanent course, high frequency of attacks in paroxysmal tachicardias in infants before 1 year old.
Russ J Cardiol 2014, 12 (116): 31–37
http://dx.doi.org/10.15829/1560-4071-2014-12-31-37Key words: arrhythmias, children, echocardiography, heart failure, arrhythmogenic cardiomyopathy.
1FSBSI Scientific-Research Institute for Cardiology, Tomsk; 2SRCI SBEI HPE RNRMU n.a. N.I. Pirogov of the Ministry of Health, Moscow; 3SBEI HPE SibSMU of the Ministry of Health, Tomsk, Russia.
CONTRAST MAGNETIC RESONANCE INVESTIGATION IN PATIENTS AFTER MYOCARDIAL INFARCTION AND TACHIARRHYTHMIAS
Usov V.Yu.1, Babokin V.E.1, Mochula O.V.1, Khlynin M.S.1, Lukyanenok P. I.1, Shelkovnikova T. A.1, Borodina E. E.1, Kurlov I. O.1, Petsh A. I.2, Batalov R. E.1
Abstract
We present the results of MRI study of the heart with paramagnetic contrasting for visualization of the foci of myocardial damage, that lead to atrial tachiarrhythmias in patients with severe infarction of the left ventricle. It is shown that the volume of the left atrium more than 75 cm3 and accumulation of paramagnetic contrast in atrial myocardium with the enhancement T1-adj. spin-echo regimen index more than 1,27 are prognostic factors for atrial tachiarrhythmias, and MRI of the heart with contrast is an important additional method of patients’ investigation with atrial rhythm disorders.
Russ J Cardiol 2014, 12 (116): 38–43
http://dx.doi.org/10.15829/1560-4071-2014-12-38-43Key words: MRI of the heart with contrast, atrial tachiarrhythmias.
1FSBSI Scientific-Research Institute of Cardiology, Tomsk; 2LLC «L.M.E. Biotok», Tomsk, Russia.
CARDIAC ARRHYTHMIAS AND CARDIOHEMODYNAMIC DISORDERS IN PATIENTS WITH VIRAL LIVER CIRRHOSIS
Chistyakova M. V., Govorin A. V., Radaeva E. V.
Abstract
Aim. To study the influence of viral liver cirrhosis on prevalence, typers of arrhythmias and some cardiohemodynamic parameters.
Material and methods. Totally 75 patients studied with viral cirrhosis classes A, B, C by Child-Piugh. Patients were divided into 2 groups: with ascitis and without, controls consisted of 19 healthy volunteers. Doppler echo-study, Doppler tissue-study were used, as Holter monitoring of ECG, and QT dispersion was calculated.
Results. In patients with viral cirrhosis of the liver we found the increase of mean daily heartrate, disordered segmentary diastolic dysfunction and global longitudinal systolic function of the ventricle, increase of the left atrium volume with rhythm disorders and conduction disorders formation: QT becomes longer, heart rate variability decreases, p<0,001. These disorders are more prominent in ascitis patients. In all patients with viral cirrhosis the study of interdependence of structure-functional parameters and heart rate variability was done.
Conclusion. In liver cirrhosis patients of viral ethiology we found the increase of the left atrium, rhythm and conduction disorders, QT interval prolongation, heart rate variability decrease, as global longitudinal systolic function of ventricles. These changes are more prominent in ascitis patients.
Russ J Cardiol 2014, 12 (116): 44–48
http://dx.doi.org/10.15829/1560-4071-2014-12-44-48Key words: liver cirrhosis, segmentary diastolic function.
SBEI HPE Chita State Medical Academy, Chita, Russia.
ORIGINAL ARTICLES
SEARCH FOR EFFECTIVENESS PREDICTORS OF BIVENTRICULAR STIMULATION IN PATIENTS WITH DRUG-REFRACTORY SEVERE CHRONIC HEART FAILURE
Lebedev D. I.1, Krivolapov S. N.1, Borisova E. V.1, Kisteneva I. V.1, Minin S. M.1, Gulya M. O.1,2, Lishmanov Yu. B.1,2
Abstract
Aim. To reveal factors influencing the results of cardiac resynchronizing therapy (CRT) and to analyze the possibility of radionuclide investigation methods usage for evaluation of indications for this method.
Material and methods. Totally 64 patients included with dilated cardiomyopathy (DCMP) at the age of 32 to 75 y. o., with chronic heart failure (CHF) III NYHA, with left ventricle ejection fraction (EF LV) 30,1±3,8%, 6-minute walking test at 290,5±64,3 m, end-diastolic volume (EDV) — 220,7±50,9 ml. All patients before CRT and after 1 year underwent Holter ECG monitoring. Patients were divided into 2 groups by the type of AF registration. Into the 1st group 40 patients included (62,5%) patients, who had permanent AF with 1-3 years anamnesis, mean 2±1,2 years. Second group consisted of 24 (37,5%) patients with sinus rhythm (SR). Before CRT 28 patients underwent balanced radionuclide ventriculography (BRVG) with EF LV increase estimation. To all the CRT devices were implanted with defibrillation function, and for patients with AF complete AV-block created.
Results. After 1 year all patients had positive clinical dynamics: LV EF increased to 42,8±4,8% (p≤0,001), HF class decreased from III to II, 6-minute distance increased to 377,2±45,3 m (p≤0,001). EDV LV decreased to 197,9±47,8 ml (p≤0,005). In 24 (37,5%) patients during a year sinus rhythm spontaneously returned. It was found that in patients with SR before the beginning of the study increase of EF during 1 year of CRT was 14%, and EDV decreased by 32 ml. In patients with permanent AF after 1 year CRT EF increased by 9%, and EDV decreased only by 13 ml. In patients with baseline AF and spontaneous SR EF increased by 13% and EDV decreased by 18 ml. Second stage of the study was the division of patients into two groups of responders and nonresponders by the level of EF increase after 12 months CRT and retrospective evaluation of metabolism defect of myocardium (MDM), measured by BRVG. Responders were the patients who, before CRT had MDM less than 15%, but if in increased 15%, patients were non-responders.
Conclusion. Hence the increase and maintenance of SR at the background of CRT in DCMP and AF helps to improve the parameters and clinical picture of CHF. Maintenance of fatty acid metabolism (MDM LV less than 15%) is a predictor of CRT effectiveness in DCMP.
Russ J Cardiol 2014, 12 (116): 49–53
http://dx.doi.org/10.15829/1560-4071-2014-12-49-53Key words: cardioresynchronizing therapy, severe heart failure.
1FSBSI Scientific-Research Institute for Cardiology, Tomsk; 2FSAOI HE National Research Tomsk State University, Tomsk, Russia.
SPECIFICS OF ACTIVE ORThOSTATIC TEST IN PATIENTS WITH CHRONIC HEART FAILURE
Kuznetsov V. A., Shebeko P. V., Enina T. N., Melnikov N. N., Petelina T. I., Soldatova A. M.
Abstract
Aim. To reveal clinical and morphofunctional and biochemical differences among patients with chronic heart failure (CHF) with different response type on active orthostatic test (AOT).
Material and methods. Totally 63 patients with CHF included with cardiomyopathy of ischemic and non-ischemic origin mostly of II-III functional class NYHA. All patients underwent echocardiography, heart rate variability analysis (HRV) resting and during DOT, plasma levels of NT-proBNP measured with C-reactive protein, tumor necrosis factor-α, interleukines (IL)-1β,6,10. According to the dynamics of HF% in AOT, all patients were divided into 2 groups: 1st group consisted of patients with decrease of HF% in AOT, 2nd group — with increase of HF% in AOT.
Results. In patients from 2nd group we found larger heart chambers and volumes, as lower left ventricle ejection fraction comparing to the patients of the 1st group. Also in the 2nd group there were higher levels of NT-proBNP and IL-6. Resting patients of the both groups had very low values of all parameters of HRV. During AOT in the 1st group there was significant increase of HRV parameters, characterizing sympathetic and humoral systems activity. In the 2nd group the response on orthostasis was as a decrease of HRV values that characterize adreno-humoral influences, and sympathovagal index, characterizing sympathetic influence, was unchanged.
Conclusion. Population of CHF patients is heterogenic according to neuro-humoral activation. Decrease of sympatho-adrenal reactivity and relative increase of parasympathic influences in active orthostasis in CHF patients probably witnesses the exhaustion of sympatho-adrenal regulation and is a marker of CHF severity.
Russ J Cardiol 2014, 12(116): 54–58
http://dx.doi.org/10.15829/1560-4071-2014-12-54-58Key words: heart rate variability, active orthostatic test, chronic heart failure.
Filial of FSBI Scientific-Research Institute of Cardiology of SD RAMS, Tyumen Cardiology Centre, Tyumen, Russia.
MAINTENANCE OF СА2+-ATP-ASE AMOUNT IN SARCOPLASMATIC RETICULUM CARDIOMYOCYTES IN ISCHEMIC MYOCARDIUM DURING SHORT DURATION OF DIABETES MELLITUS COURSE
Kondratyeva D. S., Afansyev S. A., Kanev A. F., Kozlov B. N.
Abstract
Aim. To study the level of Са2+-ATP-ase of sarcoplasmatic reticulum (SR) in human myocardium in ischemic heart disease (CHD) and in CHD with diabetes mellitus 2nd type (DM), and also in animals with postinfarction cardiosclerosis with DM.
Material and methods. The study performed on biopsy material of the hearts from patients and rats with chronic ishemic heart disease wih DM. A piece of left atrial appendage (biopsy material) was cut away during the period of the artificial circulation device setup. Postinfarction cardiosclerosis (PICS) had being formed during 6 weeks after coronary artery occlusion. DM developed during 6 weeks after intraperitoneal injection of streptosotocine (60 mg/kg). The level of Са2+-ATP-ase was measured by immuneblotting.
Results. It was shown that in both groups there were patients, whose myocardium contained high level of Са2+-ATP-ase and patients with low levels of this protein. At the same time myocardium of patients with CHD having high level of Са2+-ATP-ase, contained by 26,6%±0,53% (p<0,05) more of the protein studied, than myocardium of CHD patients with DM. Comparison of low Са2+-ATP-ase level patients did not show statistically significant difference between groups. Measurement of Са2+-ATP-ase in animals’ myocardium showed that ischemic and diabetic remodeling of myocardium leads to the decrease of Са2+-ATP-ase CP to 38,6±0,92% and 49±2,71%, resp. Concomitant development of these pathologies characterizes by the lowest amount of the protein studied and is 52,3±2,6% from controls.
Conclusion. Myocardium of CHD patients, and rats with PICS shows higher level of Са2+-ATP-ase with DM with short disease duration.
Russ J Cardiol 2014, 12 (116): 59–63
http://dx.doi.org/10.15829/1560-4071-2014-12-59-63Key words: ischemic heart disease, diabetes mellitus, Са2+-ATP-ase of sarcoplasmatic reticulum.
FSBSI Scientific-Research Institute for Cardiology, Tomsk, Russia.
CLINIC AND PHARMACOTHERAPY
ARTERIAL HYPERTENSION AND DIABETES MELLITUS: A QUEST FOR OPTIMAL TREATMENT — AN EXPERIENCE OF PERINDOPRIL A/AMLODIPINE USAGE
Poteshkina N. G.
Abstract
The article highlightes some data on the prevalence of arterial hypertension with diabetes mellitus. A review is provided on the modern consensus data about antihypertensive therapy selection for this combination of diseases. The main groups of drugs are mentioned that are mostly in use for this pathology. Also some new data on the net meta-analyses is highlighted, that are done by the novel Multiple Treatments Meta-analysis (MTM) technology, having Bayesian method in its bases. This method allows to use the results of non-direct comparative clinical trials for direct comparison of different drugs and regimens. It is argued that there are benefits in use a combination of ACE inhibitor and calcium channel blocker, and then fixed dose combination of Prestans (“Les Laboratories Servier”, France) prescription is recommended for arterial hypertension with diabetes treatment.
Russ J Cardiol 2014, 12 (116): 64–70
http://dx.doi.org/10.15829/1560-4071-2014-12-64-70Key words: arterial hypertension, ischemic heart disease, diabetes mellitus, metabolic syndrome, Prestans.
SBEI HPE Russian National Research Medical University n. a. N. I. Pirogov, Moscow; SBHI CCH №52 of Moscow Healthcare Department, Moscow, Russia.
EFFICACY OF NEBIVOLOL IN TREATMENT OF WOMEN WITH CORONARY HEART DISEASE
Koryagina N. A.1,2, Petrishcheva A. V.1
Abstract
Aim. Evaluation of clinical efficacy and tolerability of beta-blockers in premenopausal women with stable angina.
Material and methods. The anaysis of 43-55 years old premenopausal 50 women with stable angina was performed. Therapy included enalapril 2,5-10 mg daily, beta-adrenoblocker in 1 group (23 persons) – 5-10 mg of bisoprolol daily, and in 2 group (27 pers.) nebivolol 2,5-5 mg daily (Nebilet®, “Berlin-Chemie/A. Menarini”, Germany), acetylsalycilic acid 100 mg daily during 6 months. The studies done were veloergometry, long-lasting ECG monitoring, echocardiography and also the test with reactive hyperemia on brachial artery. Severity of anxiety-depressive syndrome was evaluated usin hospital scale of anxiety and depression, and the severity of climacteric disorders – by the M. Kuppermann index.
Results. With the therapy all patients self-reported improvement of their condition: in 80% there was a decrease of angina functional class, more significant in the second group. Also there was decrease of climacteric symptoms salience as anxiety-depressive disorders, especially in nebivolol group. By the results of ECG monitoring, i. e. frequency of rhythm dosirders (supraventricular and ventricular arrhythmias) there was lower quantity of episodes, more significant in nebivolol group. All groups showed an increase of basal brachial artery diameter, more significant in the 2nd group. Also we marked the changes in central hemodynamics parameters and sctructure-functional parameters of the left ventricle in both groups.
Conclusion. Nebilet® in saily dose as 2,5-5 mg is an effective antianginal drug in women with CHD and stable angina pectoris. Under Nebilet® action there is improvement of systolic and diastolic functions of the left ventricle myocardium. With Nebilet® women with stable angina significantly increase exercise tolerance and there is a decrease of climacteric and anxiety-depressive syndrome.
Russ J Cardiol 2014, 12 (116): 71–75
http://dx.doi.org/10.15829/1560-4071-2014-12-71-75Key words: ischemic heart disease, women, nebivolol.
1SBEI HPE PSMA n. a. acad. E. A. Wagner of the Ministry of Health, Perm’; 2LLC “Women Health Clinicl”, Perm’, Russia.
THE EVALUATION OF ANTIHYPERTENSIVE EFFICACY OF ORALLY-DISPERSING FORM OF PERINDOPRIL IN PATIENTS WITH MILD TO MODERATE ARTERIAL HYPERTENSION
Khokhlov R. A., Tsareva E. E., Taranina V. I.
Abstract
Aim. To evaluate the influence of Prestarium A (perindopril as orally dispersing pills, “Les Laboratories Servier”, France) on dynamics of systolic and diastolic arterial pressure and life quality parameters in patients with mild to moderate arterial hypertension.
Material and methods. A 12-week prospective observation was performed on 13 women and 9 men in the age of 38 to 60 (mean age 49 y. o.) with mild and moderate arterial hypertension, who received Prestarium A as antihypertensive treatment with the mean daily dose 8,4±2,3 mg. The main endpoints were: 1) changes in mean office blood pressure and of the life quality by EQ-5Q and SF-36 questionnaires at the final visit; 2) intolerability of the drug.
Results. In 12 weeks of Prestarium A therapy mean blood pressure significantly decreased from baseline 159,6±12,3 и 101,2±4,3 mmHg to 133,7±7,8 и 83,5±6,2 mmHg (р=0,0009 и р=0,0011, resp., for systolic and diastolic blood pressure; Wilkokson criteria). Target blood pressure (<140 and 90 mmHg) was achieved in 4 weeks in 13 (59%), in 8 weeks in 17 (77%), and in 12 weeks in 20 (86%) patients, and there were no any side effects. Monotherapy by Prestarium A was followed by significant improvement of life quality of the patients according to analogue scale (EQ-5D) from 60,3±6,8 to 75,4±7,3 points (р=0,0041; Wilkockson criteria) and by the scale of physical functioning SF-36 from 48,6±7,6 to 61,6±5,8 points (р=0,0001; Wilkokson criteria).
Conclusion. Therapy with Prestarium A in patients with non-complicated mild and moderate arterial hypertension during 12 weeks with average dosage 8,4±2,3 mg made it to achieve target blood pressure levels in 86% patients. Relevant decrease of arterial pressure, achieved by the last visit, was followed by an improvement of lfe quality of the patients, and the therapy itself was perfectly tolerated.
Russ J Cardiol 2014, 12 (116): 76–79
http://dx.doi.org/10.15829/1560-4071-2014-12-76-79Key words: arterial hypertension, life quality, dispersing form of perindopril.
BHI MD «MDCH №1», Voronezh, Russia.
MEMBRANE-SАVING ACTION OF TRIMETAZIDINE IN SUBJECTS WITH ACUTE MYOCARDIAL INFARCTION
Vasilyev S. V.1, Maychuk E. Yu.2, Vasilyev V. Yu.2
Abstract
The article concerns the assessment of functional condition of cell membranes in a variety of pathological conditions, influence of various physical and chemical factors and pharmacological drugs.
Aim. To reveal cytoprotection action of trimetazidine in short- and longterm periods of acute myocardial infarction.
Material and methods. As controls we used the condition of cell membranes under the age aspects in healthy volunteers (n=106). Into main group we included patients with acute myocardial infarction (n=46), of those to 25 we added trimetazidine to the standard treatment. We studied the level of membrane damage and cytoprotective action of trimetazidine at different stages of treatment by exposure cell membranes to electricity.
Results. Inclusion of trimetazidine to MI treatment allows to reduce by 2 days the period of functional membrane condition restoration, that had kept for up to 3 months of observation.
Conclusion. Improvement of erythrocyte membranes condition and general condition of patients after acute MI is significantly proved by addition of cytoprotector trimetazidine to the treatment complex.
Russ J Cardiol 2014, 12 (116): 80–84
http://dx.doi.org/10.15829/1560-4071-2014-12-80-84Key words: acute myocardial infarction, trimetazidine, cell membrane, impulse electrical field, Preductal MR.
1Medical Centre “Nebolit”, Mytishchi; 2CCH №5, MSMSU n. a. E. A. Evdokimov, Moscow, Russia.
LITERATURE REVIEW
POSSIBILITY OF NOVEL ORAL ANTICOAGULANTS USAGE DURING ABLATION IN ATRIAL FIBRILLATION
Tatarsky B. A.1, Batalov R. E.2, Popov S. V.2
Abstract
The review provides the data on contemporary approaches to anticoagulant therapy during catheter radiofrequency ablation of atrial fibrillation. The opportunities are discussed for various types of periprocedural use of warfarin, and the results mentioned for the efficacy and safety of novel oral anticoagulants in catheter ablation.
Russ J Cardiol 2014, 12 (116): 85–95
http://dx.doi.org/10.15829/1560-4071-2014-12-85-95Key words: catheter ablation, atrial fibrillation, warfarin, novel oral anticoagulants.
1FSBI Federal Medical Research Centre n. a. V. A. Almazov, Saint-Petersburg; 2FSBSI Scientific-Research Institute of Cardiology, Tomsk, Russia.
INFORMATION
Russian Journal of Cardiology: contents for 2014
Russ J Cardiol 2014, 12 (116): 96-103
