CONTENTS
СОДЕРЖАНИЕ
RUSSIAN JOURNAL OF CARDIOLOGY, 2015, 6 (122)
Address to the readers
Russ J Cardiol 2015, 6 (122): 5CLINICAL MEDICINE NEWS
Clinical medicine updates: a review of international news
Russ J Cardiol 2015, 6 (122): 6EPYDEMIOLOGY AND PREVENTION
IMPACT OF THE INFLAMMATORY AND ISCHEMIC HEART DISEASE MARKERS INTO THE OVERALL CARDIOVASCULAR MORTALITY IN SENILE CITIZENS OF A LARGE CITY (THE DATA FROM SAHR TRIAL)
Shalnova S.A.1, Evstifeeva S.E.1, Deev A.D.1, Metelskaya V.A.1, Kapustina A.V.1, Muromtseva G.A.1, Balanova Yu.A.1, Tuaeva E. M.1, Imajeva A.E.1, Kiseleva N.V.1, Shkolnikova M. A.2
Abstract
Aim. To study the associations of inflammation markers (hsCRP, IL-6, FG, leucocytes, ESR) with coronary heart disease (CHD) and their impact on overall cardiovascular mortality in old citizens of Moscow.
Material and methods. We used the data from prospective cohort study “Stress, Ageing and Health in Russia” (SAHR) — a representative selection from non-organized inhabitants of Moscow citizens from 55 years old. The duration of the study has been 5 years (since June 2006 to May 2011) at FSBI SSICPM of the Healthcare ministry and included 1871 persons. All participants underwent standard questioning. Into analysis we included gender, age, educational level, classic risk factors. For the assessment of current subclinical inflammation we used high-sensititvity C-reactive protein (hsCRP), interleucine 6 (IL-6), fibrinogen (FG), leucocytes, erythrocyte sedimentation rate (ESR). For CHD screening, we used standard ROse questionnaire and ECG pattern by Minnesota coding. Mortality was evaluated under the continuous death cases registry. At the beginning of 2014 totally 314 fatal cases registered, including 186 of CVD.
Results. There were significant associations more prominent in women, of the smoking in anamnesis, increased BP levels, obesity and CHD, diagnosed at a strict multifactorial analysis. Among inflammation markers, the significant correlation with CHD showed hsCRP and IL-6. In monofactor analysis, correct just for the age and gender, all studied markers significantly associated with total and cardiovascular mortality. In multidimensional model of proportional risk, that included gender, age, CHD by strict or mild criteria, all risk factors and al inflammation markers, remained statistically significant by their impact on mortality from all causes and from CVD, except gender, age and strict-criteria CHD (HR — 95% CI: 1,5-1,15;1,96, р=0,0029 and 2,0-1,41;2,88, р=0,0001, resp.), smoking, hsCRP (HR — 95% CI: 1,03-1,01;1,05, р=0,0002 and 1,03-1,01;1,05, р=0,007, resp.) and IL-6 (HR — 95% CI: 1,02-1,0;1,03, р=0,04 и 1,02-1,0;1,04, р=0,022, resp.). Conclusion. HsCRP, IL-6 and CHD by strict criteria, even after correction on gender, age and traditional risk factors, significantly correlate with total and cardiovascular mortality in men and women of 55 y.o. and older.
Russ J Cardiol 2015, 6 (122): 7–13
http://dx.doi.org/10.15829/1560-4071-2015-06-7-13Key words: SAHR, inflammation markers, risk factors, CHD, mortality from all causes, cardiovascular mortality. 1FSBI State Scientific-Research Centre for Prevention Medicine of the Healthcare Ministry; 2FSBI Moscow Scientific-Research Institute for Paediatrics and Children Surgery of the Healthcare Ministry, Moscow, Russia.
THE STUDY OF ANAMNESTIC FACTORS AND THEIR ROLE IN ESTIMATION OF SHORT-TERM (IN-HOSPITAL) PROGNOSIS IN PATIENTS UNDERWENT BRAIN STROKE OR TRANSIENT ISCHEMIC ATTACK, BY THE DATA FROM LIS-2 REGISTRY
Martsevich S.Yu.1, Kutishenko N.P.1, Suvorov A.Yu.1, Ginzburg M. L.1,2, Deev A.D.1, Boytsov S.A.1 on behalf of the workgroup of the “LIS-2” study #
Abstract
Aim. To assess the role of anamnestic factors in estimation of the shortest-term (in-hospital) prognosis in patients after stroke.
Material and methods. We included all patients during the period 01.01.2009 to 31.12.2011 (n=960), who were diagnosed the stroke ot TIA in MHI Lyubertsy District Hospital №2.
Results. Into the registry LIS-2 included 960 patients. During hospitalization 207 patients died, in-hospital mortality was 21,6%. Mortality increased with the age, and the age became an independent death risk factor in hospital (p=0,037). Hemoorhagic stroke increased the risk of death 6,95 times, and consciousness disorders — 2-5 times (depending on the level of disorder), CHF signs — by 3,14 times, and AF — 1,86 times. These values were evaluated as independent anamnestic risk factors of the in-hospital death. Conclusion. The data from LIS-2 registry demonstrates analogy with the data from other stroke registries in RF. In-hospital mortality in LIS-2 was 2-3 times higher comparing to the registries of other countries. Factors influenced in-hospital mortality were age, type of the stroke, level of consciousness at admission, CHF and cardiac rhythm disorders as AF.
Russ J Cardiol 2015, 6 (122): 14–19
http://dx.doi.org/10.15829/1560-4071-2015-06-14-19Key words: brain stroke, risk factors, primary and secondary prevention of stroke, registry. 1FSBI State Scientific-Research Centre for Prevention Medicine of the Healthcare Ministry, Moscow; 2Lyubertsy District Hospital №2, Lyubertsy, Russia.
SLEEP DISORDERS AND CHRONIC STRESS AS CARDIOVASCULAR RISK FACTORS
Novichkova N.I.1, Kallistov D.Yu.2, Romanova Е.А.3
Abstract
Aim. To conduct an assessment of the impact of chronic sleep onset/maintenance disorders and clinical-instrumental markers of occupational stress as predictors and/or risk factors for adverse course of cardiovascular disorders in intellect-related work, and to define ways of prevention management.
Material and methods. In 2008-2009yy the group was created, consisted of 167 patients, employed in intellect-related work (85 men, 82 women, mean age 51,7+7,5 y.), not having sleep disordered breathing. 49 patients had confirmed CHD diagnosis, 55 — hypertension disease of 2-3 stage. Controls were 63 persons. Baseline investigation included collection of clinical and anamnestic data, search for psychosocial markers of occupational stress, sleep disorders diagnostics, what included nocturnal polysomnographic study. Second assessment was done in 2012-2013yy and included clinical cardiovascular outcomes collection.
Results. Chronic insomnia was found in 30 (61%) patients with CHD, in 33 (60%) with hypertension disease and in 29 (46%) controls. Elevated levels of occupational stress, defined within the model “effort-reward”, were found in 26 (53%) of CHD patients, in 29 (53%) with AH, in 25 (40%) of controls. In cardiovascular patients and disordered sleep there were instrumental findings of disordered sleep (decrease of sleep effectiveness, % of slow-wave sleep) and prevalence of stimulating influences by EEG. By the data of prospective observation the presence of chronic insomnia, at baseline, associated with increased risk of new onsets of hypertension disease (OR=2,1) and CHD (OR=1,9). Conclusion. Disordered sleep onset and sleep maintenance can be treated as indicators of chronic stress in cardiovascular patients. Programs of cardiological rehabilitation shall include the actions for stress and sleep disorders screening.
Russ J Cardiol 2015, 6 (122): 20–24
http://dx.doi.org/10.15829/1560-4071-2015-06-20-24Key words: insomnia, chronic stress, arterial hypertension, CHD, risk factors. 1FSSI Federal Scientific Center of Hygiene n. a. F. F. Erisman, Mytishchi; 2FSBI Center for Rehabilitation, Moscow region; 3FSBI Hospital with Polyclinics, Moscow, Russia.
THE INFLUENCE OF PLANNED PERCUTANEOUS CORONARY INTERVENTIONS ON MORTALITY IN TYUMEN REGION
Kuznetsov V.A.1, Yaroslavskaya E.I.1, Pushkarev G.S.1, Zyryanov I.P.1, Bessonov I.S.1, Baranova Yu.S.1, Polyakov А.М.2, Nyamtsu А.М.3
Abstract Last years there is a decline of cardiovascular mortality (CV) in Russian Federation. Recently we showed that the decrease of mortality in the south of Tyumen region is related to the use of percutaneous coronary interventions (PCI) for the treatment of acute coronary syndrome (ACS).
Aim. To reveal and evaluate the relations of mortality of patients in Tymen region (non including autonomic districts) and amount of planned PCI during 2004-2012yy. period.
Material and methods. We used the data on the quantity of planned PCIs that we were provided with by the departments of interventional centers of Tyumen Cardiological Center and Tymen Region Clinical Hospital №1, and the data on mortality and morbidity, published in statistical reports of the Healthcare department of Tyumen Region.
Results. During the studied period in the south of Tyumen region there was progressive decline of mortality and significant decrease of planned PCI. We found highly relevant negative high-power correlations between the quantity of planned PCI and parameters general mortality (r=-0,98, р<0,001), general economically active mortality (r=-0,98, р<0,001) and CVD mortality (r=-0,90, р<0,001). The quantity of planned PCI showed strong significant negative correlations with the dynamics of economically active subjects mortality from CVD (r=-0,72, р=0,003) and economically active male CVD mortality (r=-0,73, р=0,020). There was a tendency for negative correlation for the quantity of planned PCI and mortality of economically active inhabitants from myocardial infarction (MI) (r=-0,67; p=0,050) and strong negative significant correlation of the quantity of planned PCI and mortality of economically active males from MI (r=-0,70, р=0,040). Conclusion. Our data points that the decrease of general and cardiovascular mortality of the south Tyumen region inhabitants is mostly relaten to a progressive increase of the amount planned PCI during 2004-2014yy.
Russ J Cardiol 2015, 6 (122): 25–29
http://dx.doi.org/10.15829/1560-4071-2015-06-25-29Key words: cardiovascular death, planned percutaneous interventions. 1Filial of FSBI Scientific-Research Institute of Cardiology SD RAS — Tyumen Cardiological Centre, Tyumen; 2SBHI of Tyumen Region Regional Clinical Hospital №1, Tyumen; 3State Autonomic Institution of Tyumen Region Medical Information analytic Centre, Tyumen, Russia.
RISK FACTORS OF MAJOR CARDIOVASCULAR EVENTS IN LONG-TERM PERIOD OF CORONARY BYPASS IN PATIENTS WITH ISCHEMIC HEART DISEASE AND 2ND TYPE DIABETES MELLITUS
Sumin A.N., Bezdenezhnykh N.A., Bezdenezhnykh A.V., Ivanov S.V., Barbarash O.L.
Abstract
Aim. To reveal the risk factors of major cardiovascular events (MCVE) in long-term period after CABG with DM2.
Material and methods. Prospective study of 324 patients with CHD after CABG. Patients were selected into 2 groups: 148 with DM2 (median age 58 y., median of long-term follow-up 1,8 y.), 176 patients without DM and another disorders of carbohydrate metabolism (median age — 58 y., median follow-up 1,7 y.). As the long-term MCVE we used MI, stroke, cardiovascular death. An estimation of the freedom from MCVE was done by the method of multiplying estimations by Kaplan-Meier. To reveal risk factors for MCVE we used logistic regression.
Results. Patients of both groups were comparable by the age (p=0,211), long-term outcome follow-up (p=0,132). Patients with DM2 had more often the MCVE (14,2% and 6,3%, respectively, p=0,028). By the Kaplan-Meier method we built the curves of the freedom from MCVE in the studied groups, with the test of Gekhan-Wilkokson we found differences (p=0,013). MCVE in long-term period after CABG was found in 4 patients with DM (2,7%) and in two — without DM (1,1%), p=0,529. By the
Results of multifactor analysis as the predictors for MCVE were DM2 (OR 3,307 95% CI 1,372-7,968, р=0,007), female gender (OR 2,752 95% CI 1,074-7,049, р=0,034), not related to age or renal function. Chance of MCVE in long-term period increased with the time of on-pump (OR 1,145 95% CI 1,024-1,280, р=0,016) and with the decrease of LV EF (OR 1,043 95% CI 1,001-1,087, р=0,041) with the presence of peripheral atherosclerosis the risk of long-term MCVE increased 5,5 times (OR 5,539 95% CI 1,564-19,620, р=0,007) not related to gender, age, LV EF, GFR or statin intake. The level of fasting glucose at the moment of admittance after CABG was an independent predictor for MCVE (OR 1,144, р=0,037). Conclusion. The independent predictors of MCVE in long-term post-CABG period are DM2, female gender, peripheral atherosclerosis, duration of on-pump period, EF LV and glycemia before operation.
Russ J Cardiol 2015, 6 (122): 30–37
http://dx.doi.org/10.15829/1560-4071-2015-06-30-37Key words: diabetes mellitus, coronary bypass, peripheral atherosclerosis, longterm outcomes of coronary bypass. FCBI Scientific-Research Institute of Complex Cardiovascular Problems SV RAS, Kemerovo, Russia.
OCCUPATIONAL ROLE AND LONG-TERM SURVIVAL AFTER MYOCARDIAL INFARCTION
Kryuchkov D.V., Maksimov S.A., Kushch O.V., Artamonova G.V.
Abstract
Aim. To analyze the influence of occupational role on long-term survival after myocardial infarction (MI).
Material and methods. The volume of selection was 471 patient; of those 342 men, 129 women. Among them at the moment of MI 118 had a job, and 353 had not. Comparison of survival was done by Kaplan-Meier method, criteria by Gekhan-Wilkokson. To eliminate the influence of gender and age on the statistics, before the risk assessment we directly standardized mortality by both these factors. For the risk of premature death in non-workers in comparison to current workers we measured an additional risk (EF) and odds ratio (OR) with 95% confidence interval (CI).
Results. Survival rate after MI in current workers group was higher than in non-workers (p=0,00006). By the 8th year the level of survived among workers is 70%, and in non-workers — just 42%. The risks of premature death before 5 years after infarction in non-workers comparing to workers reach statistical significance: EF is 13,4% with 95% CI from 3,2% to 23,6%, OR is 1,78 with 95% CI from 1,14 to 2,78. Conclusion. The
Results of the study witness higher survival rate in long-term period in currently working inhabitants than non-working, that presents even in first months after MI development. With the increase of time period from the onset of MI the differences in survival depending on occupation role getting more significant.
Russ J Cardiol 2015, 6 (122): 38–41
http://dx.doi.org/10.15829/1560-4071-2015-06-38-41Key words: myocardial infarction, survival rate, the healthy worker effect. FSBSI Scientific-Research Institute of Complex Cardiovascular Problems, Kemerovo, Russia.
EPIDEMIOLOGY OF ISCHEMIC HEART DISEASE AND ATHEROSCLEROSIS RISK FACTORS IN IMPRISONED MEN
Elgarov A.A., Tatarova Z.I., Elgarov M.A., Kalmykova М.А.
Abstract
Aim. To reveal prevalence of coronary heart disease (CHD), arterial hypertension (AH) and risk factors for atherosclerosis (RFA) in men sentenced to imprisonment and to evaluate efficacy of secondary prevention for those with CHD and AH.
Material and methods. An epidemiological study conducted with 986 imprisoned men at the age 21-69 y. o., included 24-hour blood pressure monitoring (APBM) and ECG monitoring (Holter) within random selection; evaluation of efficacy of complex medical-psychological monitoring (pharmacotherapy + medical enlightenment) in 46 persons with CHD and AH.
Results. A high prevalence of CHD was established (15,6%), myocardial infarction (7,6%), AH (49,8%), cardiac rhythm disorders (CRD, 35,3%), borderline psychic disorders (89,2%), smoking (96,0%), alcohol consumption (AC, 96,9%), low physical activity (89,2%), left ventricle hypertrophy (52,3%), anxiety (49,7%), depression (39,5%) and their concomitance (85,0-92,0%); very low level of an existence of AH acknowledgement (10,3%), of CHD (1,6%) and CRD (4,7%). In ABPM and Holter first time were found disorders of 24-hour profile in all persons with AH and also hypertension reactions (66,6%) in normal BP, as deviations of coronary flow — episodes of transient myocardial ischemia (66,6%) and CRD (33,3%). Thanks to the treatment-educational complex, efficacy was marked in 80,0% prisoners of the 1st group, 87,5% — of the 2nd group and 93,3% — of the 3rd. Conclusion. First time a significant prevalence revealed of CHD and AH, of CRD and RFA, significant deviations of peripheral and coronary flow in isolated persons, therapeutical efficacy of secondary prevention (80,0%-93,3%) among prisoners with CHD and AH.
Russ J Cardiol 2015, 6 (122): 42–47
http://dx.doi.org/10.15829/1560-4071-2015-06-42-47Key words: sentenced (imprisoned) men, cardiovascular disorders, risk factors, secondary prevention. Cabardine-Balkarian State University n. a. Ch. M. Berbekov, Nalchik, Russia.
THE EXPERIENCE OF A UNIFIED QUESTIONNAIRE USE FOR THE SREENING OF VARIOUS TYPES OF CERBROVASCULAR DISEASES IN PATIENTS WITH ARTERIAL HYPERTENSION AT THE GENERAL PRACTITIONER OFFICE
Kim I.V.1, Bochkareva E.V.1, Varakin Yu.Ya.2, Aleksandrova E.B.3
Abstract
Aim. To assess the effectiveness of the use of a unified questionnaire for various cerebrovascular diseases types screening (CVD) in patients with arterial hypertension (AH) of middle age that are under general physician observation.
Material and methods. Totally 257 pts. screened with AH 1-3 grade, admitted general physician “by any complaint”. The survey performed with a unified questionnaire that includes questions for the chance of acute CVD types onset in anamnesis and chronic types at the moment of screening, questions on the chest pain assessment with exertion, and intermittent claudication, ECG registered with Minnesota coding. Diagnosis verification was done by independent physicians — neurologist and cardiologist, who ordered additional investigation methods.
Results. Various CVD types were diagnosed in 148 (57,6%) patients with AH, including acute types in anamnesis — in 21 (8,2%), chronic at the moment of study — in 53 (20,6%), acute and chronic — in 74 (28,8%). Previously nondiagnosed types found in 20,2% of patients. Hypertensive cerebral crisis (HCC) before the beginning of study was mentioned in the patient’s chart in 4 (1,6%) patients, in 72 (28,0%) cases this diagnosis was set first time with the unified questionnaire. Conclusion. The usage of unified questionnaire in AH patients increases the rate of finding of chronic cerebrovascular pathology and HCC, that are interesting for the prevention of stroke. The questionnaire can be used in polyclinics conditions, including screening of adult population.
Russ J Cardiol 2015, 6 (122): 48–52
http://dx.doi.org/10.15829/1560-4071-2015-06-48-52Key words: unified questionnaire, arterial hypertension, cerebrovascular diseases. 1FSBI State Scientific-Research Centre for Prevention Medicine of the Healthcare Ministry, Moscow; 2FSBSI Scientific Centre for Neurology, Moscow; 3FSBI Polyclinics №5 of PPG RF, Moscow, Russia.
ORIGINAL ARTICLES
PROGNOSTIC BLOCK-SCHEME OF CLINICAL OUTCOME OF ACUTE CORONARY SYNDROME INTO NON-Q-INFARCTION. PART II
Alieva M.G.1, Saidov M.Z.2, Abdullaev А.А.2, Khasaev A.Sh.2, Adueva S.M.1
Abstract
Aim. An invention of block-scheme of short-term personified prognosis of clinical outcome of acute coronary syndrome (ACS) into non-Q-myocardial infarction at hospital stage.
Material and methods. Totally 68 patients included, with CHD diagnosis. As prognostic factors were taken the most informative intervals of concentrations of the parameters of subclinical nonspecific inflammation, endothelial dysfunction, cardiospecific changes in immune system and serum cardiomarkers. To test the parameters listed we used the method of hard-phase immune-enzyme analysis. The value of relative risk (RR) with confidence intervals (CI), value of absolute risk (AR), diagnostic efficacy (DE) of the applied methods were calculated in accordance to the clinical outcome of ACS into non-Q-MI together with the risk factor studied (concentration intervals). Statistical data processing was done with Statistica (v. 6.0) and “Biostat 4.03”.
Results. Based on the complex analysis of the obtained
Results we invented a blockscheme for short-term personified prognosis of clinical outcome of ACS into non-Q-MI. It included the most significant intervals of concentrations of the parameters studied. Personified short-term prognosis of ACS into non-Q-MI during in-hospital stage is related to the concentration intervals: TP-I from 2,2 to 2,5 ng/ml; C-RP – from 15 to 20 mg/L; IL-1β — from 0 to 1 pg/ml; TNF-α — from 0,6 to 1 pg/ml; NO – from 12 to 20 mcM/L; ММР-9 — from 400 to 600 ng/ml; TIMP-1 — from 120 to 150 ng/ml; HC – from 15 to 17 mcM/L; NP – from 17 to 26 nM/L; AB to CL.– from 7 to 10 U/ml and in 68% cases there are AB against cardiomyocytes. Patients having the parameters listed, at the moment of admittance, are in the high risk group for clinical outcome of ACS into non-Q-MI. Conclusion. In the cases when during admittance the parameters of inflammation, endothelial dysfunction, serum cardiomarkers and immune markers get in the concentration intervals included into the block-scheme, these patients do not relate to a high risk group of clinicl outcome of ACS to non-Q-MI. This makes even at the early stage of hospitalization to perform treatment procedures in accordance to the standarts of management of occluded coronary vessels that lead to large-area non-Q-MI.
Russ J Cardiol 2015, 6 (122): 53–60
http://dx.doi.org/10.15829/1560-4071-2015-06-53-60Key words: acute coronary syndrome, non-Q-infarction, inflammation, endothelial dysfunction, cardiomarkers, immune markers, clinical outcome. 1Republic Hospital №2, Center for Specialized Urgent Medical Care (CSUMC), Makhachkala; 2SBEI HEP Dagestan State Medical Academy, Makhachkala, Russia.
ROLE OF THE SERUM NGAL FOR ASSESSMENT OF HOSPITAL PROGNOSIS IN MEN WITH ST ELEVATION MYOCARDIAL INFARCTION
Karetnikova V.N.1,2, Osokina A.V.1,2, Evseeva M.V.2, Gruzdeva O.V.1, Zykov M.V.1,2, Kalaeva V.V.1, Kashtalap V.V.1,2, Shafranskaya K.S.1, Khryachkova O.N.1, Barbarash O.L.1,2
Abstract
Aim. To evaluate clinical significance of serum NGAL in ST elevation myocardial infarction (STEMI) patients in relation with the occurrence of in-hospital period complications.
Material and methods. Totally 260 men included with STEMI, hospitalized in 24 hours after the onset of clinical symptoms of the disease. The measurement of serum NGAL concentration (ng/ml, sNGAL) at 1st and 2nd day of hospitalization was done with the hard-phase immune-enzyme analysis by HycultR biotech assay (USA), registration was done on the plain reader “UNIPLAN” (SPF “PIKON”, Russia). At the stage of in-hospital treatment we registrated endpoints — signs of coronary failure (early post infarction angina, recurrent MI), grade of acute coronary failure (Killip I-IV class), grade of chronic heart failure (by NYHA), hospital mortality.
Results. Patients were selected into 2 groups depending on the endpoints occurrence at hospital stage. Adverse hospital outcome (at least one endpoint) was found in 83 (32%) patients. The level of renal damage sNGAL, measured on the 1st day did not reveal any difference between groups with adverse or benign course of MI in hospital, and on 12th day the sNGAL concentration was significantly higher in group with adverse course — 2,1 ng/ml (1,44; 2,8) vs 1,55 ng/ml (1,11; 2,3), p=0,033. Monofactor analysis showed significance for adverse outcome, the factors as 2nd type diabetes, age >60 y., the fact of glomerular filtration rate decline during hospitalization, increase of sNGAL by 12th day. By the result of multifactor analysis — increase of the age by 1 year increases the chance of adverse outcome by 14%, increase of sNGAL by 12th day of MI increases adverse outcome chance by 3,2 times. The level of sNGAL ≥1,046 ng/ml associated with complicated course of in-hospital MI period. Conclusion. The level of sNGAL, measured on 1st day of MI did not have prognostic value for the inhospital complications, however concentration of sNGAL on 12th day was associated with already occured adverse outcomes, being a marker of MI severity.
Russ J Cardiol 2015, 6 (122): 61–67
http://dx.doi.org/10.15829/1560-4071-2015-06-61-67Key words: NGAL, myocardial infarction, hospital outcomes. 1FSBI Scientific-Research Institute of Complex Cardiovascular Problems SD RAS, Kemerovo; 2SBEI HPE Kemerovo State Medical Academy HM RF, Kemerovo, Russia.
CENTRAL AORTIC PRESSURE AND CARDIOVASCULAR RISK FACTORS ASSESSMENT IN STUDENTS AS A PART OF THE YOUTH SCREENING IMPROVEMENT
Evsevyeva M.E.1, Eryomin M.V.2, Rostovtseva M.V.1, Sergeeva O.V.1
Abstract
Aim. To study the main risk factors on representative group of first-year students of StSMU during their screening, and on pilot group of students to study possible ways of influencing on these factors on CBP and its augmentation index.
Material and methods. Totally 1351 first-year students screened for risk factors as inheritance of early onset of CVD, overweight, PH (prehypertension)/AH, smoking, chronic infectious- and immunity-related inflammations, wrong diet, hypodynamia, low stress resistibility, and for some of them — dyslipidemia and hyperglycemia (capillar test). In 80 patients, taken their risk factors, we assessed CBP and its augmentation index with diagnostical complex BPLab Vasotens Office (LLC “Piotr Telegin”, Nizhniy Novgorod).
Results. Among first-year students with PH/AH overweight were each tenth, inheritance or focal infections — almost in each fifth. Wrong diet, hypodynamia and low stress resistibility are found in each fourth-fifth of enrolled in university. Absence of risk factors was found only in one fifth of first-graders. Most of them have two and more risk factors. Having these factors students usually had an increase of systolic, mean and pulse pressure in aorta, and augmentation index of central pulse pressure. Significantly more common in them is to find systemic and isolated central PH/AH. Conclusion. Regardless of young age and short anamnesis of adverse factors, students have preclinical, however quite clear damage of target organs such as vessel remodeling, including large vessels. It is necessary to implement broader into the centers of student healthcare and outpatient institutions the methods of CBP assessment as an office procedure with the
Aim of earlier vessel remodeling relevance during screening events with the
Aim for risk groups formation and control of efficacy of prevention procedures in such risk groups.
Russ J Cardiol 2015, 6 (122): 68–74
http://dx.doi.org/10.15829/1560-4071-2015-06-68-74Key words: central aortic pressure, augmentation index, students, risk factors.
1SBEI HPE Stavropol State Medical University of HM; 2SBHI SR Stavropol Regional Clinical Hospital, Stavropol, Russia.
POLYMORPHIC VARIANTS OF GENES CODING SYMPATHOADRENAL SYSTEM INFLUENCE ON PHENOTYPE OF PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY
Komissarova S.M.1, Nyazova S.S.2, Chakova N.N.2, Krasko O.V.3
Abstract
Aim. To reveal the associations of polymorphic genes variants coding the proteins of sympathoadrenal system (ADRB1 and ADRB2) with clinical phenotype of the disease including age and gender of patients with HCMP.
Material and methods. The analysis of clinical-demographic and instrumental data of 275 patients with the diagnosis of HCMP (97 women and 178 men, age 17 to 70 y. o., median age 51 y. and 44 y., resp.) was done. All parameters were assessed at the moment of the patients inclusion. Amplification of polymorphic area of the gene was done by PCR method with consequent restriction analysis.
Results. Monofactor analysis revealed that atrial fibrillation (AF) is associated with polymorphism of Arg389Gly gene АDRB1 (p=0,028). Heart failure of the higher FC II-III showed tendency to association with polymorphism Arg389Gly gene АDRB1 (p=0,060). Multifactorial analysis showed that the presence of nonsustained ventricular tachycardia episodes (NVT) more often associated with the patients — carriers of heterozygous GC gene АDRB2 (polymorphism Gln27Glu) (OR 1,76; 1,02-3,06; 95% CI). AF was more rare in the carriers of heterozygous genotype of GC gene АDRB1 (polymorphism Arg389Gly) (OR 0,39 (0,17-0,82; 95% CI) comparing to the normal genotypes. Heart failure of higher FC II-III more often was found in patients — carriers of GC gene АDRB1 (polymorphism Gln27Glu) (OR 4,31; 1,08-29,03; 95% CI). Conclusion. Genotype GC of polymorphism gene АDRB2 (polymorphism Gln27Glu) is the most adverse factor that influence such clinical presentations of HCMP as the higher functional class of heart failure and development of life threatening arrhythmias. Russ J Cardiol 2015, 6 (122): 75–80
http://dx.doi.org/10.15829/1560-4071-2015-05-75-80Key words: hypertrophic cardiomyopathy, sympathetic system, gene polymorphism. 1SI Republic Scinetific-Practice Center “Cardiology”, Minsk; 2SSI Institute of Genetics and Cytology of NSA Belarus, Minsk; 3SSI United Institute of Informatics Problems of NSA Belarus, Minsk, Belarus.
IN-HOSPITAL AND LONG TERM RESULTS OF PERCUTANEOUS CORONARY INTERVENTION WITH BIVENTRICULAR SUPPORT AND EXTRACORPOREAL MEMBRANE OXYGENATION
Ganyukov V.I., Shukevich D.L., Khaes B.L., Kochergin N.A., Popov V.A., Barbarash L.S.
Abstract Patients, due to various reasons not indicated for coronary bypass (CABG), usually have extremely high risk of complications in percutaneous intervention (PCI) as well. Recently it was shown that extracorporeal membrane oxygenation (ECMO) might provide a necessary support in the case of high risk PCI. ECMO can be effective in PCI in patients with refractory cardiogenic shock too, however evidence base for the technological approach in high risk PCI remains underdeveloped.
Aim. To evaluate in-hospital and long-term results of high risk PCI with biventricular bypass and ECMO in patients not fitted for CABG.
Material and methods. We conducted a retrospective analysis of the treatment of 12 patients having extremely high risk of complications in CABG. In all cases PCI was done in conditions of biventricular bypass and ECMO. Stable angina and non-STelevation acute coronary syndrome occurred in 42 and 58% cases, respectively. Clinical picture of cardiogenic shock was the criteria of exclusion. All patients had severe comorbidity with high score by “EuroScore” — 6,3±4,9%. In all cases there was multivessel disease with high level of coronary lesion involvement by “Syntax Score” (30,1±10,1). Mean level of left ventricle ejection fraction was satisfactory — 51±12,6%. Ten patients (83%) had significant (≥50 %) lesion of unprotected stem of the left coronary artery (SLCA).
Results. All procedures were successful. As a success of PCI we meant the opened artery with the flow rate not worse than TIMI 3 and absent of significant cardiovascular complications. Mean quantity of the implanted drug-eluting stents was 2,4±1. Full revascularization was reached in 42% cases. Residual value of “Syntax Score” was at the level about 6,33±6,88. Significant adverse cardiovascular complications (death, myocardial infarction, repeated non-planned revascularization) during inhospital phase were not registered. In one case there was an iliac artery dissection, that did not lead to necessity of surgery. Hemorrhagic complications were found just in one patients (8%, 2nd type by “BARC”). All patients were discharged. There were no any fatal cases or myocardial infarction (MI) in 6 months after observation. Two patients required another revascularization (17%). In long-term period there were no and signs of “definite” or “probable” stent thrombosis. Conclusion. PCI in the conditions of biventricular bypass and ECMO might be effective alternative strategy of revascularization in a cohort of patients not indicated for CABG due to high complications risk.
Russ J Cardiol 2015, 6 (122): 81–86
http://dx.doi.org/10.15829/1560-4071-2015-06-81-86Key words: ECMO, high risk PCI, biventricular support. FBSI Scientific-Research Institute of Complex Cardiovascular Problems of SD RAS, Kemerovo, Russia.
CLINIC AND PHARMACOTHERAPY
THE OPPORTUNITIES FOR RISK REDUCTION OF RECURRENT STROKE IN ATRIAL FIBRILLATION
Davydkin I.L.1, Zolotovskaya I.A.2
Abstract
Aim. To study adherence to guidelines of patients’ management in atrial fibrillation (AF) in the spotlight of recurrent stroke risk reduction.
Material and methods. Totally 350 patients (227 women, 123 men) included with AF of non-valvular etiology, with anamnesis of cardioembolic stroke (CES) in carotid pool. Patients were selected into 3 groups according to the parameters of NIHSS stroke severity. A complex clinical and instrumental study was performed at the baseline, in 3, 6 months and 1 year of follow-up, including hemostasis assessment.
Results. In 28% AF was found first time during the stroke acute phase; in 109 (31,1%) patients — paroxysmal AF. Before the inclusion anticoagulants took 23 patients (6,9%), 8 (2,4%) took NOAC. The highest part of persons with the high risk of bleeding by HAS-BLED was marked in the III group — 27 cases (34,6%). In 3 month 6 patients died (1,7%): mean age 74,3±1,34 y., NOAC received only 2 patients. In 3 months in the group of the diseased (n=51) taking apixaban, a significant (p<0,05) improvement marked, of the clotting parameters: decrease of fibrinogen level, stabilization of APTT. Conclusion. Conduction of further follow-up would define relevant markers of clotting pathology, making to forecast an adverse outcome in early rehabilitation period in AF, having CES and high comorbidity index.
Russ J Cardiol 2015, 6 (122): 87–93
http://dx.doi.org/10.15829/1560-4071-2015-06-87-93Key words: atrial fibrillation, cardioembolic stroke, anticoagulant therapy, apixaban. 1SBEI HPE Samara State Medical University, Samara; 2SBHI SD Samara City Polyclinic №9, Samara, Russia.
LITERATURE REVIEWS
URBANIZATION AND CARDIOVASCULAR DISEASES IN MODERN SOCIETY
Tabakaev M.V., Artamonova G.V.
Abstract Nowadays cardiovascular diseases are the primary cause of death of the population nearly in all over the world. According to WHO data, this kind of pathology will keep its leading positions in future, that is presupposed by ageing of population and urbanization processes. The main
Aim of current review is gathering and analysis of the data on the influence of urbanization on the prevalence of cardiovascular pathology and risk factors. It is revealed that urbanization of territories, together with active socio-economical processes is ambivalent in its influence on the health. Also in developed countries the positive aspects of living in large cities (result of complex active actions for the fight with risk factors) prevail negative (negative ecological situation), that engines a decline of the mortality rate from cardiovascular diseases. In developing countries, contrary, urbanization is linked with higher risk of adverse outcomes of cardiovascular diseases. It marked that not so many fatherland studies available, focused on the complex influences of urbanization processes on population health and prevalence of cardiovascular diseases. All this together creates the fundamentals for novel approaches to study of the problem in modern society.
Russ J Cardiol 2015, 6 (122): 94–99
http://dx.doi.org/10.15829/1560-4071-2015-06-94-99Key words: urbanization, cardiovascular diseases, cardiovascular risk factors. FSBSI Scientific-Research Institute of Complex Cardiovascular Problems, Kemerovo, Russia.
ALCOHOL IN PREVENTION OF CARDIOVASCULAR PATHOLOGY: KNOWN AND UNKNOWN
Poteshkina N.G.1,2, Krylova N.S.1,2, Adjigaitkanova S.K.1,2, Troshina А.А.1,2
Abstract The review focuses on the data of alcohol influence on cardiovascular health. The recommended and safe prevention dosages are discussed. The data summarized on the risk estimation, of development and progression of ischemic heart damage, heart rhythm disorders, stroke and other vascular complications in long-term alcohol consumption in various dosages. The article should be of interest for physicians, general practitioners, cardiologists, neurologists.
Russ J Cardiol 2015, 6 (122): 100–105
http://dx.doi.org/10.15829/1560-4071-2015-06-100-105Key words: alcohol, cardiovascular morbidity and mortality, arterial hypertension, stroke, heart rhythm disorders. 1SBEI HPE RNRMU n. a. N. I. Pirogov of Healthcare Ministry, Moscow; 2CCH №52 of Healthcare department, Moscow, Russia.
YOGA IN CARDIOVASCULAR PATHOLOGY PREVENTION
Vatutin N.T., Sheveliok A.N., Kravchenko A.V.
Abstract The review focuses on the influence of yoga on cardiovacular system in nearly healthy persons, on risk factors modification with yoga, improvement of cardiovascular profile. The data provided about the opportunities of yoga implementation for secondary prevention of cardiovascular diseases. The
Results shown of recent studies, and further research perspectives briefly sketched.
Russ J Cardiol 2015, 6 (122): 106–112
http://dx.doi.org/10.15829/1560-4071-2015-06-106-112Key words: cardiovascular prevention, yoga, cardiovascular diseases, risk factors. Donetsk National Medical University n. a. M. G orky, Donetsk.
