Address to the readers
Russ J Cardiol 2015, 5 (121): 5
CLINICAL MEDICINE NEWS
Clinical medicine updates: a review of international news
Russ J Cardiol 2015, 5 (121): 6
2014 ESC GUIDELINES ON DIAGNOSIS AND MANAGEMENT OF HYPERTROPHIC CARDIOMYOPATHY
The Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology
Russ J Cardiol 2015, 5 (121): 7–57
Key words: Key words: Guideline, Diagnosis, Cardiac imaging, Genetics, Symptoms, Heart failure, Arrhythmia, Left ventricular outflow tract obstruction, Sudden cardiac death, Implantable cardioverter defibrillators, Pregnancy, Athletes, Hypertension, Valve disease.
ANATOMIC AND MORPHOLOGICAL SIGNS OF A DIFFUSE-GENERALIZED HYPERTROPHIC CARDIOMYOPATHY
Dzemeshkevich S. L., Frolova Yu. V., Kim S. Yu., Fedorov D. N., Zaklyazminskaya E. V., Fedulova S. V., Shapiyeva A. N., Malikova M. S., Lugovoy A. N.
Aim. Based on the instrumental, histological and genetic studies to show the role and significance of intracardial anomalies and morphological specifics of the special form of hypertrophic cardiomyopathy (HCM), that the authors name as diffuse-generalized.
Material and methods. A clinical, instrumental, histological and molecular-genetic study was conducted with 16 enrolled patients with diffuse-generalized form of HCM, who underwent complex surgical interventions: by transaortal approach the extended myoectomy of interventricular sept, and by intraatrial approach — parietal resection of papillary muscles, and universal chordal-sparing mitral valve replacement.
Results. There was no in-hospital mortality. The long-term results for up to 5 years show that all patients moved from the IV-III NYHA to I-II NYHA functional classes. Morphological study showed that in the base of myocardial mass increase in HCM there is neither hypertrophy, but hyperplasia of cardiomyocytes. All 16 patients showed significant signs of myxomatous mitral valve degeneration.
Conclusion. Diffuse-generalized type of HCM is due to spread hyperplasia process in myocardium. The invented radical remodeling operation abolishes intraventricular severe changes of pressure and increases diastolic volume of the left ventricle, preventing diastolic dysfunction development.
Russ J Cardiol 2015, 5 (121): 58–63
Key words: hypertrophic cardiomyopathy, diffuse-generalized hypertrophy/ hyperplasia, surgical remodeling
FSBSI National Research Center of Surgery n. a. Petrovsky B. P. Moscow, Russia.
ATRIAL FIBRILLATION AND FLUTTER IN HYPERTROPHIC CARDIOMYOPATHY
Krylova N. S.1,2, Demkina A. E.1, Khashieva F. M.1, Kovalevskaya E. A.1,2, Poteshkina N. G.1
Aim. To find out the factors associated with atrial fibrillation/flutter (AF) in patients with hypertrophic cardiomyopathy.
Material and methods. Totally 182 HCMP patients included, of those 103 — men (mean age 59,6±14,6 y.). Diagnosis of AF was set using ECG or Holter monitoring of ECG using medical charts with the mentioned anamnesis of AF.
Results. Paroxysmal or permanent form of AF were found in 60 (33%) patients. AF patients were older (64,2±11,2 vs 57,3±15,6 y., p=0,005), with more significant symptomatics (CHF FC by NYHA 2,4±0,8 vs 2,1±0,8, p=0,02). In AF patients the size of left atrium (LA) was larger than in sinus patients (4,5±0,6 vs 4,1±0,7 cm, p=0,00003). Prevalence of outgoing tract of the left ventricle (OTLV) was nearly same in both groups (50% vs 52,2%, p=0,2), and maximum pressure gradient (PGmax) in OTLV was higher in AF patients (46,0±48,0 vs 21,8±26,6 mmHg, p=0,02). There is and increase of AF with the age (r=0,21, р=0,005), severity of symptoms (r=0,2, р=0,001), LA enlargement (r=0,44, р=0,04), severity of pulmonary hypertension (r=0,47, р=0,004), value of PGmax in OTLV (r=0,23, р=0,02). With the method of binary logistic regression 3 main variables were selected as the most of predictable value for AF: age, LA size, PGmax in OTLV. The model defined that makes to estimate the risk of AF with high diagnostic probability — χ2 22,0, df=3 (p=0,00006): AF = 0,05307 * age + 0,98065 * LA + 0,01516 * PGмакс in OTLV — 8,66. With the result >0 there is a high risk of AF, and if <0 — the risk of AF is minimum.
Conclusion. The model invented for risk prediction in AF in HCMP patients using three predictors: patient age, left atrium diameter and maximum gradient of pressure in OTLV.
Russ J Cardiol 2015, 5 (121): 64–70
Key words: hypertrophic cardiomyopathy, atrial fibrillation, left ventricle outgoing tract obstruction.
1SBEI HPE Russian National Research Medical University n. a. N. I. P irogov of HM; 2SBHI City Clinical Hospital №52 of Healthcare Department of Moscow, Moscow, Russia.
MYOCARDIAL REMODELLING TYPES IN HYPERTROPHIC NON-OBSTRUCTIVE CARDIOMYOPATHY
Aim. To evaluate the prevalence of the left ventricle remodeling types in hypertrophic non-obstructive cardiomyopathy, and their relation to clinical and instrumental data.
Material and methods. Totally 97 patients studied, with hypertrophic nonobstructive cardiomyopathy. Instrumental methods — EchoCG by standard method with assessment of the left ventricle using the myocardial mass index and values of relative wall thickness, and relative thickness index of the walls.
Results. In 59% cases hypertrophy of myocardium was localized in the area of interventricular septum, in 18% cases it also involved the apex of the left ventricle, in 22% — spread myocardial hypertrophy. In hypertrophic non-obstructive cardiomyopathy there was the predominance of less benign concentric hypertrophy (in 75-80% of patients) with significant asymmetry of hypertrophy. With the aim to assess the type of remodeling it is recommended not only to measure the relative thickness index, but also more traditional parameter of relative walls thickness.
Russ J Cardiol 2015, 5 (121): 71–75
Key words: hypertrophic non-obstructive cardiomyopathy, remodeling, left ventricle.
SBEI HPE South-Ural State Medical University of the Healthcare Ministry, Chelyabinsk, Russia.
CARDIOVASCULAR HEMODYNAMICS AND SPECIFICS OF 24-HOUR BP PROFILE IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY AND INADEQUATE BP REACTION ON PHYSICAL EXERTION
Khashieva F. M.1,2, Demkina A. E.1, Krylova N. S.1,2, Kovalevskaya E. A.2, Poteshkina N. G.1
Inadequate reaction of blood pressure (IRBP) in physical exertion in patients with hypertrophic cardiomyopathy (HCMP) is one of the risk factors of sudden cardiac death.
Aim. To study structural and functional parameters of the heart, vessels and 24-hour blood pressure parameters in patients with HCMP and IRBP in physical exertion.
Material and methods. 17 patients with HCMP (13 women, mean age 54,0±11,4 y.) underwent echocardiography (EchoCG), ambulatory blood pressure monitoring (ABPM) with assessment of vessels rigidity, exercise test on treadmill. By the results of treadmill test the patients were selected into 2 groups: I group (n=10, of those 7 women, mean age 51,4±13,9 y.) with IRBP, II group (n=7, of those 6 women, mean age 56,0±9,3 y.) with normal BP reaction in physical exertion.
Results. Presence of IRBP in physical exertion was associated: with more significant diastolic dysfunction of the left ventricle (LV): the correlation is found with the peak delayed diastolic filling on mitral valve (peak A mv) (r=-0,76, p=0,002), relation of the velocities of early and delayed diastolic filling on the mitral valve (E/A mv) (r=0,53, p=0,03); decreased volume of LV: correlation with end-diastolic volume (EDV); end systolic volume (ESV) (r=-0,55, p=0,03); increased stiffness of arterial wall: correlation with the velocity of pulse wave (PWVao) (r=0,7, p=0,005), ambulatory index of vessel rigidity (AASI) (r=0,49, p=0,05), augmentation index (Axi) (r=-0,51, p=0,04). In discriminate analysis the EDV, E/A and AASI were the most significant predictors of IRBP. The functions were invented that make, by the highest value, an separation of a patients into one of 2 groups: I group (n=10, of those 7 women, mean age 51,4±13,9 y.) with IRBP, II group (n=7, of those 6 women, mean age 56,0±9,3 y.) with normal reaction of BP to physical exertion.
Results. IRBP in exertion has been associated with: more significant diastolic dysfunction of the left ventricle (LV): the correlation found with the peak late diastolic filling on mitral valve (peak A) (r=-0,76, p=0,002), relation of the velocities of early and late diastolic filling on mitral valve (E\A mv) (r=0,53, p=0,03); decrease of the LV volume: end systolic volume (ESV) (r=-0,55; p=0,03); increased stiffness of arterial wall: correlation with the pulse wave velocity (PWVao) (r=0,7; p=0,005), ambulatory index of vessel rigidity (AASI) (r=0,49, p=0,05), augmentation index (Axi) (r=-0,51; p=0,04). During discrimination analysis the EDV, E/A and AASI were the most significant predictors of IRBP. The functions are formulated that make distinction of the patients for one of two groups: group 1 (F1) with IRBP in exertion, group 2 (F2) with adequate BP reaction: F1=0,995xEDV-6,854xE/Amv+1,937xAASI-33,833; F2=0,531xEDV- 3,651xE/Amv+21,685xAASI-23,029.
Conclusion. Patients with HCMP and IRBP to exertion have more prominent diastolic LV dysfunction with its decreased volume, increased arterial wall stiffness. The model invented that makes by the three cardiohemodynamical parameters to prognosis the development of IRBP to exertion in HCMP patients.
Russ J Cardiol 2015, 5 (121): 76–81
Key words: hypertrophic cardiomyopathy, inadequate blood pressure reaction to physical exertion.
1SBEI HPE RNRMU n. a. N. I. P irogov of the Healthcare Ministry, Moscow; 2SBHI City Clinical Hospital №52 of the Healthcare Department of Moscow, Moscow, Russia.
MYOCARDIAL BIOPSY IN GENERAL CARE CLINIC: PATIENTS SELECTION, THE RESULTS, SIGNIFICANCE FOR TREATMENT STRATEGY
Blagova O. V., Sulimov V. A., Nedostup A. V., Kogan E. A.
Aim. To analyze the results of first 50 endomyocardial biopsies (EMB) in general care clinic, to clarify the selection criteria and procedure role in management decision in patients with various noncoronarogenic diseases of myocardium.
Material and methods. Totally 50 patients included, who had been underwent EMB during 2007-2014 (31 men, mean age 44,3±13,5). Investigation included the level of anticardiac antibodies (n=49), DNA of herpes group viruses and parvovirus B19 by PCR in blood (n=40) and myocardium (n=49), scintigraphy of myocardium (n=20), MDCT (n=21), MRI (n=17), coronary arteriography (n=22), genetician consultation (n=15). EMB of the right ventricle was done using biopsy forceps STANDARD 5.5 F 104 FEMORAL (Cordis). The materials were coloured with hematoxyline-eosine, picrofucsine by Van Hison, Schiff reactives, Pearls, red congo. The study was approved by the Ethics Comittee of FMSMU.
Results. Indications for EMB were set for 3 groups of patients: 1. With dilated cardiomyopathy (DCMP) as a syndrome, including the probability of acute/ subacute myocarditis (n=7), allergic myocarditis (n=1), myocarditis with myocardial infarction (n=1), vasculitis (n=3), possible myocarditis in long-lasting course of DCMP (n=9), in patients with non-compact myocardium, myodystrophy of Emeri-Dreyfus and possible arrhythmogenic dysplasia of the right ventricle (n=7). 2. With “idiopathic” rhythm and conduction disorders (n=18), including high probability of myocarditis (n=13), vasculitis (n=2), necessity for differentiation of myocarditis and genetic cardiomyopathies (n=3). 3. With the syndrome of primary myocardial hypertrophy (n=3). EMB was informative in all patients, myocarditis found in 82,6%.
Conclusion. The criteria for high diagnostic value of EMB is nosological way of selection. In addition to current scenarios it is aimfull to perform EMB if clinically significant ischemia with non-changed coronary arteries, with suspected myocarditis in patients with genetic cardiomyopathies, inborn defects, CHD and other established heart diseases. The EMB results define the tactics of medication and surgical treatment.
Russ J Cardiol 2015, 5 (121): 82–92
Key words: endomyocardial biopsy, myocarditis, dilated cardiomyopathy, “idiopathic” arrhythmias, hypertrophic cardiomyopathy, immunosuppression therapy.
SBEI HPE I Moscow State Medical University n. a. I.M. Sechenov, Moscow, Russia.
SUBCLINICAL CARDIOVASCULAR SYSTEM INVOLVEMENT IN RHEUMATIC DISEASES
Maslyansky A.L.1, Zvartau N.E.1, Kolesova E.P.1, Kozlyonok A.V.1, Vasilyeva E.Yu.1, Mazurov V. I.1, Konradi A.O.1, Shlyakhto E. V.1
Aim. Assessment of patients with different rheumatic diseases and studying of markers of subclinical course of involvement of target organs (the heart, vessels, kidneys), with consequent analysis of their relation to the level of ADMA.
Material and methods. Totally 162 patients included in the study, with RD (RA, SSD, AS), 63 without rheumatic pathology with more than 2 factors of cardiovascular risk, and 10 healthy volunteers. All patients were examined by rheumatologist and cardiologist, the anamnesis was collected and physical examination with anthropometry. Of laboratory tests we performed creatinine measurement, glucose, total cholesterol, C-reactive protein (C-RP), ADMA. Estimated glomerular filtration rate was calculated by MDRD equation. Functional assessment included Ech0CG, ultrasound visualization of carotid arteries and vessel stiffness evaluation. Data processing was done using the software Statistica 8.0 (StatSoft Inc., USA), and Prism 5 for Windows, version 5,03, GraphPad Software, Inc., USA).
Results. Analyzing subclinical involvement of target organs in it found that, as in RD, in the comparison group patients the parameters of the pulse wave velocity, glomerular filtration rate, left ventricle hypertrophy were not out of normal range. The main changes affected intima-media complex thickness, that was the highest in rheumatoid arthritis, and the beginning renal disease was characteristic for systemic sclerodermia patients. These same subgroups of ADMA were the highest and correlated with the studied parameters the same way as in the group of patients with more prominent atherosclerotic disease.
Conclusion. The earliest sign of subclinical involvement of target organs in rheumatic diseases is remodeling of vessel wall. ADMA can be a mediator of atherosclerosis progression in rheumatic diseases as in patients with the combination of traditional risk factors of cardiovascular diseases.
Russ J Cardiol 2015, 5 (121): 93–100
Key words: rheumatic diseases, pulse wave velocity, glomerular filtration rate, left ventricle hypertrophy, intima-media complex,
ADMA FSBI Federal Medical Research Center n. a. V.A. Almazov, Saint-Petersburg, Russia.
UNIVERSAL CHORD-SAVING MITRAL VALVE REPLACEMENT AS A FACTOR OF LONG-TERM FUNCTIONAL IMPROVEMENT
Lugovoy A.N., Dzemeshkevich A.S., Malikova M.S., Kuznetsova L.M., Buravikhina T.A., Karshieva A.R., Frolova Yu.V.
Aim. To assess short — and 5-year long-term results of the universal chord-saving mitral valve replacement.
Material and methods. Totally 103 patients included, who during 2009-2014 y. at the department of myocardium dysfunction and heart failure of FSBSI “Russian Scientific Center for Surgery n. a. Petrovsky B. P.” underwent a surgical cord-saving mitral valve replacement. The age of the patients varied from 21 to 75 y and the mean was 55,2±0,9 y. Among the operated 51 (49,5%) were male and 52 (50,5%) female.
Results. Of 103 patients 101 were discharged. Long-term results were collected from 98 patients that is 97% of all discharged. Follow-up period lasted for 3 month — 5 years. Functional results are more than satisfying: I functional class have 66 patients (67,3%) of the discharged, II — 26 (26,5%), III — 3 (3,06%), died 3 patients (3,06%). In 89 patients (90,8%) there is an increase of the functional class by 2 or even 3 steps. During long-term follow-up in 25,5% cases (25 patients) had atrial fibrillation paroxysms. In 19 patients sinus rhythm was reversed with drugs and only in 6 (6,1%) atrial fibrillation became permanent. Sinus rhythm returned in 15 patients having atrial fibrillation before the operation. Bleedings of different localization developed in 10 (10,2%) cases and were related to miscompliance for anticoagulant drugs. After INR correction bleeding did not repeat. Complications, more or less related to indirect anticoagulants (prosthesis thrombosis, left atrium thrombosis, myocardial infarction, transient ischemic attack of the brain) were registered in 11 patients that is 11,2% of all cases in long-term period.
Conclusion. The universal chord-saving valve replacement fulfills the main criteria for the method of mitral valve replacement: simplicity of performing, save of left ventricle contraction physiology, safety for the patient and stability of good results in long-term period. This method can be recommended for implementation in mitral regurgitation and stenosis as well. Saving of normal intracardiac anatomy of the left ventricle makes it to improve its contractility and to increase functional class of the patient in long-term period after operation.
Russ J Cardiol 2015, 5 (121): 101–105
Key words: mitral valve replacement, annulopapollary contact, rheumatic fever, dysplasia.
FSBSI National Research Center of Surgery n. a. Petrovsky B. P., Moscow, Russia.
A GIANT CAVERNOUS HEMANGIOMA OF THE HEART
Nechaenko M.A., Fedorov D.N., Frolova Yu.V., Dzemeshkevich A.S., Fokina O.A., Dombrovakaya A.V., Dzemeshkevich S.L.
Aim. To demonstrate a clinical case of giant cavernous hemangioma of the heart.
Material and methods. The operation was done: resection of cavernous hemangioma of the right chambers of the heart and right atrium plastics with xenopericardial patch, modeling of the right atrium-ventricular sulcus, sewing of the right ventricle, autovenous aortocoronary shunting of the right coronary artery in conditions of artificial circulation and cold pharmacological cardioplegia.
Results. The cavernous hemangioma of the heart was removed.
Conclusion. The possibility of radical hemangioma removal was demonstrated, with good outcomes.
Russ J Cardiol 2015, 5 (121): 106–110
Key words: cavernous hemangioma of the heart, right atrium, right atrio-ventricular sulcus, right ventricle, right coronary artery.
FSBSI National Research Center of Surgery n. a. Petrovsky B.P., Moscow, Russia.
SHERESHEVSKY-TURNER SYNDROME IN AORTIC SURGERY: AN EXAMPLE OF HYBRID ANEURISM TREATMENT AND DISSECTION OF THORACOABDOMINAL AORTA
Tchartchan E.R.1, Abugov S.A.1,2, Polyakov R.S.1,2, Zaklyazminskaya E.V.1, Rumyantseva V.A.1, Khovrin V.V.1, Skvortsov А.А.1, Kabanova М.N.1, Khatchatryan Z.R.1, Oparina N.V.1
Shereshevsky-Turner syndrome — is chromosome anomaly, the monosomia by X-chromosome (cariotype 45, X0) that has prevalence 1:2000-1:2500 newborn girls. It is well known that these patients very often have cardiovascular pathology. Aortic aneurysm is 100 times more common than in general population. Another significant specifics is the high risk of aortic dissection even with relatively small diameter of aorta, than in average for the dissections. Currently it is common to concern a variety of aortic pathology treatment ways in patients with the syndrome: traditional open-chest interventions, endovascular treatment, hybrid operations. The article provides an example of successful usage of the hybrid method in women 58 years old with Shereshevsky-Turner syndrome, thoracoabdominal aortic aneurysm and dissection of descending thoracal and abdominal aorta parts. The clinical example shows that hybrid method makes it to perform radical intervention on aorta, decreasing traumaticity of operation, mortality and complications rate in postoperation period.
Russ J Cardiol 2015, 5 (121): 111–117
Key words: Shereshevsky-Turner syndrome, hybrid operations, visceral debranching.
1FSBSI Russian Scientific Center for Surgery n. a. Petrovsky B.P., Moscow; 2SBEI Additional Professional Education of Russian Medical Academy of Postdiploma Education, Moscow, Russia.
CLINIC AND PHARMACOTHERAPY
IMPROVEMENT OF AMLODIPINE CONTROL EFFICACY OVER HYPERTENSION USING FIXED COMBINATION OF PERINDOPRIL ARGININE AND AMLODIPINE
Kryuchkova O.N., Itskova E.A., Lutay U.A., Turna E.U., Kucherenko T.V.
Aim. To evaluate possibilities of hypertension control improvement using fixed combination of perindopril arginine and amlodipine.
Material and methods. Totally 46 patients studied (25 men, 21 women of the age 53,6±4,3 y.) with arterial hypertension 2-3 grade. All patients underwent ABPM with analysis of the following: mean 24-hour BP, velocity of morning SBP and DBP rise, BP variability of Ps BP (VPsBPd, VPsBPn). The criteria of inclusion were insufficient control over hypertension while using free combinations of ACE inhibitor or angiotensin II receptor blockers and diuretic or calcium channel blocker. To control arterial hypertension all patients were prescribed the fixed combination of perindopril arginine/amlodipine it standard dosage 10/5 mg (Prestans, “Les Laboratories Servier”, France) with further possible increase of dosage up to 10/10 mg.
Results. While receiving the therapy 84,7% patients reached “target” BP. Mean 24-hour SBP decreased from 139,24±1,8 to 121,13±1,22 mmHg (р<0,05), DBP decreased from 84,51±2,08 to 73,14±1,4 (р<0,05), mean BP decreased from 103,07±1,56 to 87,66±1,13 (р<0,05). 24-hour variability of SBP significantly decreased from 15,28±0,72 to 10,21±0,42 (р<0,05), DBP from 13,46±0,72 to 10,72±0,31 (р<0,001). Values of VMR after the treatment also decreased. Before treatment VMR of SBP was 27±3,26 mmHg/hour, on therapy — 15,3±5,04 mmHg/hour., (р<0,01); the same for DBP — VMR decreased from 23,6±2,37 mmHg/hour to 11±1,62 mmHg, (р<0,01).
Conclusion. The usage of combined perindopril arginine/amlodipine in patients with former uncontrolled arterial hypertension at the background of free chosen antihypertensive drugs combinations succeeded in the target BP values achievement in 84,7% cases. The reached control over BP was successful daily and during the night, as over variability of BP and velocity of morning BP rise. Usage of fixed combination of perindopril arginine/amlodipine was marked with good tolerability and high patients’ compliance.
Russ J Cardiol 2015, 5 (121): 118–122
Key words: arterial hypertension, fixed antihypertension combination, perindopril arginine, amlodipine, Prestans.
Medical Academy n. a. C.I. Georgievsky of FSAOIHE Crimea Federal University n. a. V.I. Vernadsky, Simferopol, Russia.
CYTOPROTECTION WITH TRIMETAZIDINE MB: RECENT DATA
Gordeev I.G., Luchinkina Е.Е., Taratukhin E.O.
The article focuses on new data on trimetazidine MB cytoprotection studies. The data provided on novel mechanisms of its effect including systemic action not related to myocardium. The results of epidemiological studies and meta-analysis are provided that confirm safety and efficacy of the medication in ischemic heart disease and chronic heart failure.
Russ J Cardiol 2015, 5 (121): 123–126
Key words: chronic heart failure, stable ischemic heart disease, metabolism, fatty acids, trimetazidine MB, Preductal MB.
SBEI HPE RNRMU n. a. N.I. Pirogov, Moscow, Russia.
FIXED ANTIHYPERTENSIVE DRUGS COMBINATION SELECTION WITH THE AIM OF ORGANS PROTECTION
Ostroumova O.D.1,2, Kopchenov I.I.1, Bondarets O.V.1, Guseva T.F.1
The article focuses on the problems of choice among the antihypertension drugs combinations according to organs protection properties. It is underlined that target organs damage (microalbuminuria, pulse wave rate velocity increase, myocardial hypertrophy of the left ventricle, atherosclerotic plaques in carotid arteries) are independent predictors of cardiovascular mortality.
Optimal combinations of antihypertension drugs are reviewed taking kidney damage, vessel wall damage, the heart and the brain. The data provided on organs protective properties of lercanidipine, enalapril and fixed combination of them.
Russ J Cardiol 2015, 5 (121): 127–133
Key words: arterial hypertension, antihypertension drugs fixed combinations, left ventricle myocardium hypertrophy, microalbuminuria, cognitive functions, enalapril, lercanidipine.
1MSMSU n. a. E.A. Evdokimov, Moscow; 2First MSMU n. a. I.M. Sechenov, Moscow, Russia.
A TYPICAL PATIENT WITH ATRIAL FIBRILLATION AND RENAL DYSFUNCTION — HOW TO PREVENT STROKE?
Lozhkina N.G., Abuzdina А.А., Kuimov А.D.
Aim. To evaluate efficacy and safety of rivaroxaban for stroke and systemic embolism prevention in patients with AF of non-valvular cause and concomitant CKD.
Material and methods. Totally 16 patients with AF included, having chronic kidney disease of II-III stages, who during a year were being assessed an efficacy — cases of death, stroke and systemic embolism, and drug safety (clinically significant and non-significant bleedings).
Results. As a result for efficacy — stroke, systemic embolism, death cases were not registered. In assessment of safety, mild nasal bleedings (not needed medical help) were marked in 3 patients during one month of treatment, and in 2 patients there were non-persistent petechias. Clinically significant bleedings were not registered.
Conclusion. The usage of the oral anticoagulant rivaroxaban in dose 20 mg and 15 mg per day in patients with AF of non-valvular cause with comorbid CKD II-III stage is effective and safe for the prevention of stroke and systemic embolism.
Russ J Cardiol 2015, 5 (121): 134–138
Key words: stroke, atrial fibrillation, chronic kidney disease, rivaroxaban.
SBEI HPE Novosibirsk State Medical University of the Healthcare Ministry, Novosibirsk, Russia.