CONTENTS
СОДЕРЖАНИЕ

RUSSIAN JOURNAL OF CARDIOLOGY, 2015, 9 (125)

Address to the readers

Russ J Cardiol 2015, 9 (125): 5

CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russ J Cardiol 2015, 9 (125): 6

ORIGINAL ARTICLES

INTRACARDIAC ECHINOCOCCOSIS

Malikova M. S .¹, Frolova Yu. V.¹, Raskin V. V.¹, Dzemeshkevich A. S .¹, Dombrovskaya A. V.¹, Mershina E. A.², Sinitsin V. E.², Dzemeshkevich S . L.¹

Abstract

Aim. To present the unique observations and success of the surgical treatment of intracardiac echinococcosis localization.

Material and methods. During the 2011-2015 period, we successfully operated 3 patients with intracardiac echinococcosis localization. Before the operation, all patients underwent EchoCG, MRT/CT. Operations were performed under the artificial circulation conditions and pharmaco-cold cardioplegy. It was obligatory to use TEEchoCG during the operation.

Results. In all patients the removal of echinococcosis cysts from the heart was successful. In one case, we also removed the cyst from the right lung.

Conclusion. In echinococcosis of any localization, it is necessary to perform transthoracal EchoCG to rule out extracardiac cysts. In intracardiac echinococcosis it is recommended to operate off-pump with the aim of proper localization of the operation. We recommend to perform CT/MRI before the operation which make it possible to evaluate the anatomy of the heart and to explicate full and detailed operation plan, and during the operation to use transesophageal EchoCG with the same aim.

Russ J Cardiol 2015, 9 (125): 7–11

http://dx.doi.org/10.15829/1560-4071-2015-09-7-11

Key words: intracardiac echinococcosis, surgical treatment, diagnostics.

¹FSBSI Russian Scientific Center of Surgery n. a. Petrovsky, Moscow; ²FSBI Treatment-Rehabilitation Canter of the Healthcare Ministry, Moscow, Russia.

DIELECTRIC SPECIFICS OF THE BLOOD IN UNSTABLE ANGINA: NEW ADDITIONAL TEST FOR ACUTE MYOCARDIAL ISCHEMIA DIAGNOSTICS

Grinshtein Yu. I.¹, Sukhovolsky V. G.², Andina L. A.¹, Grinshtein I. Yu.¹, Kovalev A. V.²

Abstract

Aim. To study blood dielectric properties of patients with unstable angina (UA) for the development of novel additional diagnostic criteria for acute myocardial ischemia.

Material and methods. Totally, 61 patient studied with non-ST-elevation acute coronary syndrome (NSTEACS), of those 40 patients having on ECG the changes of ischemic type, 21 patient with ACS without ECG changes. In all patients troponin T was negative in single measurement. Comparison group consisted of the stable angina patients II FC (n=13). Controls consisted of 30 healthy donors of blood transfusion center; to 59% patients with preliminary diagnosis NSTEACS (n=61) diagnostic coronary angiography was don (CAG). To all patients we performed study of dielectric properties of the blood by the Fourier-spectroscopy method.

Results. Dielectric properties of the blood in NSTEACE/UA, during the first hours of pain onset significantly differ from those in stable angina and controls. In 26% of patients dielectric properties of the blood get back later than positive changes of ECG occur (ST return to isoline).

Conclusion. Diagnostic test for acute myocardial ischemia, together with ECGdiagnostics and clinical picture makes it possible, in short time, to perform expressdiagnostics of myocardial ischemia when NSTEACS/UA is suspected, especially in comorbidity patients having the same ST depression on ECG, caused by LV hypertrophy.

Russ J Cardiol 2015, 9 (125): 12–18

http://dx.doi.org/10.15829/1560-4071-2015-09-12-18

Key words: NSTEACS, unstable angina, myocardial ischemia, dielectric Fourierspectroscopy of the blood.

¹SBEI HPE Krasnoyarsk State Medical University n. a. Voyno-Yasenetskiy V.F. of the HM, Krasnoyarsk; ²International Science Center for the Research of Extreme States of the Body at the Head of Krasnoyarsk Scientific Center of Siberian Department of

RAS, Krasnoyarsk, Russia.

PROSPECTIVE STUDY OF TABLE SALT TASTE SENSITIVITY THRESHOLD INFLUENCE ON CARDIOVASCULAR COMPLICATIONS

Batyushin М. М.

Abstract

Aim. To evaluate prognostic significance of TSTST in cardiovascular complications development.

Material and methods. Totally 162 persons studied, of those 67 with arterial hypertension (AH) and 95 their close relatives of the 1 grade of relativity, healthy at the moment of the first examination in 1998. Second study of the group has been done in 16 years, in 2014. Totally 28 families studied. In 16 years, 101 person had arterial hypertension, and in 34 it had been developed during the observation period. Ischemic heart disease (IHD) was diagnosed in 38 patients, diabetes (DM) — in 21 (all had 2nd type). For 16 years, the brain stroke (BS) developed in 15 participants, in 6 cases it was fatal, and myocardial infarction (MI) — in 13 participants, in 10 cases fatal. Totally 15 patients died (9,3%), one — from melanoma. The participants at the baseline were studied for the TSTST by Henkin R. J. method under Konstantinov E. N. modification. For the second study in 16 years a protocol was created included the results of anthropometric and hemodynamic data, and the cases of AH, IHD, MI and BS, and the death.

Results. In the group of those died comparing to the others, were higher levels of TSTST at the baseline (2,52±0,39 vs 1,38±0,16, р<0,05). During 16 years among 54 participants with high TSTST (more than 0,64) died 14 — 25,9%, and from 47 participants with normal TSTST died 1 — 2,13%. In analysis of the influence of TSTST on cardiovascular outcomes, it was shown that the risk of fatal and nonfatal cases of BS increased with TSTST, but the risk of MI did not differ significantly. In addition, the survival of the patients was significantly lower in the case of higher TSTST in BS, as in MI. In survival analysis for the influence of TSTST on nonfatal cases of MI and BS there were no such influence.

Conclusion. High TSTST in AH patients increases the risk of fatal and nonfatal cases of BS, fatal MI during 16 years of study. High TSTST is followed by the increase of the risk of new onset of AH, and higher mean values of BP in AH. The decrease of general survival and 16-year survival of AH patients due to fatal cases of BS and MI is caused by higher TSTST.

Russ J Cardiol 2015, 9 (125): 19–24

http://dx.doi.org/10.15829/1560-4071-2015-09-19-24

Key words: table salt taste sensitivity threshold, brain stroke, myocardial infarction.

SBEI HPE Rostov State Medical University of the HM RF, Rostov-na-Donu, Russia.

MULTIFACTOR PREDICTION OF LONG-TERM OUTCOMES OF ACUTE CORONARY SYNDROME WITH SUSTAINED ST SEGMENT ELEVATION

Lozhkina N. G.¹, Maksimov V. N.^1,2, Ragino Yu. I.², Kuimov A. D.¹, Voevoda M. I.²

Abstract

Aim. Prediction of long-term (annual) adverse and benefit outcomes of acute coronary syndrome with sustained ST elevation (STEMI) for the improvement of rehabilitation, secondary prevention and personified approach to treatment.

Material and methods. Totally 145 patients included with STEMI (106 men, 39 women), hospitalized to the CCH №1 of Novosibirsk during the year 2010. Mean age of the patients was 59,1±6,1 y. Diagnosis of ACS was set by a collection of criteria developed by European Society of Cardiology and American Heart Association (2000). All patients underwent clinical and instrumental investigation as following: clinical examination, electrocardiography, echocardiography, Holter monitoring, measurement of the inflammatory cytokines and molecular-genetic test. By the methods of factor and correlation analysis, the study made it to define the influence of the each of the factors studied on probability of adverse annual prognosis.

Results. As the result of the study, we invented a brand new method of multifactor prediction of long-term (annual) adverse and positive outcomes of the acute coronary syndrome with sustained ST elevation. The model includes the check for the absence or existence in the patient of diabetes mellitus (DM), ejection fraction of the left ventricle (EF LV), ultrasensitive C-reactive protein concentration (hsCRP), and genotype for polymorphism rs1376251 of the gene TAS2R50. Sensitivity of the proposed method of prediction for adverse outcomes was 82%, positive outcomes — 80%.

Conclusion. The model proposed was created on the basis of the parameters measured in Russian patients and includes the activity of atherosclerotic inflammation and the patient’s genotype. An equation for the probability calculation of an adverse outcome shows, what is the weight multiplier of one or another factor to influence the probability of adverse outcome. The model is simple in use and makes it possible to individualize secondary prevention for this type of patients.

Russ J Cardiol 2015, 9 (125): 25–31

http://dx.doi.org/10.15829/1560-4071-2015-09-25-31

Key words: acute coronary syndrome, hi-sensitive C-reactive protein, genetic markers, multifactorial prediction.

¹SBEI HPE Novosibirsk State Medical University of the Healthcare Ministry, Novosibirsk, Russia; ²FSBI SRI of Therapy and Prevention Medicine of SD RAMS, Novosibirsk, Russia.

PRACTICAL CONCERNS OF ANTICOAGULATION IN NONVALVULAR ATRIAL FIBRILLATION: A UNIVERSITY CLINICS REGISTRY

Sokolova A. A., Zhilenko A. V., Tsarev I. L., Napalkov D. A., Sulimov V. A.

Abstract

Aim. To evaluate the possibility to increase the effectiveness and safety of anticoagulation therapy in nonvalvular atrial fibrillation (AF) under the circumstances of an office for anticoagulation control located at the University Clinics.

Material and methods. Observational prospective study (registry), included 325 patients with nonvalvular AF, taking various anticoagulation drugs for the prevention of thromboembolic complications (TEC). Mean duration of follow-up is 24±12 months.

Results. At the current moment about 95% of patients continue taking anticoagulants and follow-up in the office of anticoagulation control. Totally there were 37 bleedings marked, of those 19 minor and 18 major. By the general quantity of bleeding cases there is no significance in the difference between warfarin and “novel” anticoagulants (NOAC) (p>0,05). Major bleedings significantly more common in warfarin group than in NOAC (p<0,05), and absolute number of minor is lower in warfarin group (p<0,05). By the total number of bleedings anticoagulants ranged as following: dabigatran (in 5,13% of patients), warfarin with time in target INR more than 40% (10,34%), rivaroxaban (14,3%), apixaban (26,9%). Higher rate in apixaban can be explained by older mean age of the patients taking it (p<0,05), that is itself a risk factor for hemorrhagic complications. It should be marked that by the rate of major bleedings warfarin was significantly worse, than any NOAC. During follow-up time thromboembolic complications were found just in 3% (0,9% of all taking anticoagulants).

Conclusion. Anticoagulation control under the conditions of specialized office is effective and safe for the patients with nonvalvular AF. On vitamin K antagonists (even in good INR control) there are significantly more common major (potentially life-threatening) bleedings, though in NOAC treatment there are more minor bleedings that require only short interruption of drug intake.

Russ J Cardiol 2015, 9 (125): 32–37

http://dx.doi.org/10.15829/1560-4071-2015-09-32-37

Key words: atrial fibrillation, anticoagulation control office, novel oral anticoagulants, vitamin K antagonists, registry.

SBEI HPE First MSMU n. a. I. M. S echenov, Moscow, Russia.

ASSOCIATION OF THE METABOLIC SYNDROME CONSTITUENTS WITH MARKERS OF SUBCLINICAL

TARGET ORGAN DAMAGE DURING FOLLOW-UP OF INTELLECTUAL LABORERS

Rotar O. P., Boyarinova М. А., Moguchaya Е. V., Kolesova Е. P., Erina А. М., Solntsev V. N., Konradi А. О.

Abstract

Aim. To evaluate the relation of metabolic syndrome (MS) and its constituents with markers of subclinical damage of target organs (TOD) in follow-up of almost healthy intellectual laborers.

Material and methods. From the selection of 1600 employees of a bank we randomly selected 383 with at least one component of MS without cardiovascular disorders, of those by the end of 2 years period 331 came to final visit (response 86%). Mean age 46,6±9,0 y., mostly women (214 (64,6%)). All patients underwent anthropometry, blood pressure measurement (BP), lipids investigation, creatinine and fasting glucose, echocardiography with the assessment of the left ventricle hypertrophy (LVH), ultrasound study of carotid arteries (intima-media complex thickness — CIM, and atherosclerotic plaques), vascular rigidity assessment, anklebrachial index, albumin concentration in single portion of urine at both stages of observation.

Results. While performing multiple logistic regression, presence of arterial hypertension (AH) associated with increased probability of LVH, thickening of CIM and higher vessel rigidity in standardization by gender and age. Relation of MS with the markers of TOD has not been found. In 2 years of follow-up there was a significant increase of patients with thickening of CIM (from 81 (24,5%) to 146 (44,1%), p<0,001) and decrease of LVH prevalence (from 154 (46,7%) to 109 (32,9%), p=0,003) together with significant decrease of BP and total cholesterol.

Conclusion. Presence of AH is associated with higher probability of LVH and increased vessel rigidity, as atherosclerotic changes in carotid arteries. MS was not related with an increased prevalence of TOD, and the main predetermining factors for structural heart abnormalities, the vessels and kidneys, were gender and age. In 2 years of observation there was markedly decreased number of patients with LVH and kidney dysfunction at the background of BP pattern improvement, and increase of the number of patients with thicker CIM, regardless of a decrease of the hypercholesterolemia patients. In MS patients there was more common to use antihypertension treatments, that led to more prominent LVH regression.

Russ J Cardiol 2015, 9 (125): 38–43

http://dx.doi.org/10.15829/1560-4071-2015-09-38-43

Key words: subclinical target organ damage, metabolic syndrome, left ventricle hypertrophy, obesity, arterial hypertension.

FSBI North-Western Federal Medical Research Center of the Healthcare Ministry, Saint-Petersburg, Russia.

METABOLIC SYNDROME AND THE RISK OF ACUTE KIDNEY DAMAGE DEVELOPMENT AFTER CORONARY ARTERY BYPASS PROCEDURE

Iskenderov B. G., Sisina O. N.

Abstract

Aim. To find out the causal relationship of metabolic syndrome (MS) with acute kidney damage (AKD) in coronary bypass grafting patients (CABG).

Material and methods. To the clinical comparative study totally 742 patients included (489 men и 253 women) at the age 53 to 67 y. o. (mean 62,1±4,7), who underwent CABG on-pump. Of those 477 (64,3%) did not have the metabolic criteria for MS (1st group), and 265 pts. (35,7%) had MS (2nd group). Depending on the maximum increase of serum creatinine (sCr) during early post-operation period ARF was diagnosed in the 1^st group on 119 patients (24,9%) in the 2^nd — 92 patients (34,7%). AKD was diagnosed by AKIN.

Results. It was shown that early post operational cardiovascular complications significantly more frequently developed in AKD in both groups, and in the 2^nd group comparing to the 1^st . Also the procedures of hemodialysis in acute renal failure (3 stage of AKD) in the 1^st group performed in 5,9% cases and in the 2^nd — in 17,4% cases (p=0,015). In-hospital mortality was 2,0% to 16,3% depending on the development of AKD and MS. However in the 2^nd group, in the development AKD as without this, intra-hospital mortality was significantly higher (p<0,05), than in the 1^st group. It was revealed that in the case of AKD the parameters of MS were significantly higher than in its absence, especially in the 1^st group. Also in the 2^nd group, not related to the development of AKD metabolic parameters were higher in the 2^nd group than in the 1^st . Also, 1^st stage and transient AKD were more prevalent in the 1^st group, and III stage and non-reversible AKD with the onset of CKD — in the 2nd group. The time of hospitalization in the 2^nd group was significantly longer than in the 1^st (p=0,008).

Conclusion. It is shown that in MS patients after CABG, comparing to those without MS, the prevalence of AKD is higher 1,5 times, in-hospital mortality — 2,5 times.

Russ J Cardiol 2015, 9 (125): 44–50

http://dx.doi.org/10.15829/1560-4071-2015-09-44-50

Key words: metabolic syndrome, coronary artery bypass grafting, acute kidney damage.
SBEI APE Penza Institute of Physicians Improvement of the Healthcare Ministry, Penza, Russia.

DIABETES MELLITUS 2ND TYPE WITH CARDIOVASCULAR AUTONOMIC NEUROPATHY

Serhiyenko V. A., Serhiyenko А. А.

Abstract

Aim. To perform the analysis of some parameters of insulin resistance, concentration of N-terminal natriuretic pro-brain peptide (NT-prоBNP), hi-sensitive С-reactive proteine (hsCRP) and some pro- and anti-inflammatory cytokines in diabetes mellitus patients with diabetes mellitus 2nd type (DM2) with cardiovascular autonomic neuropathy (CAN).

Material and methods. Totally 48 patients studied with DM2, of those 12 without verified cardiovascular diseases (CVD), 36 patients with functional stage of CAN, age 50-59 y., DM2 1-6 y. duration, HbA1c 7,1±0,6%. Controls: 15 same age almost healthy persons (р>0,05). The screening for CAN was performed that included 5 cardiovascular tests, the data from ambulatory blood pressure monitor was analyzed, ECG; and echocardiography, HbA1c, insulin (IRI), NT-proBNP, hsСRP, tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-8 и IL-10. The Index of insulin resistance was calculated (НОМА-IR), coefficient TNF-α/IL-10.

Results. In DM2 patients with CAN there was an increase of insulin resistance values, e. g. IRI concentration (26,6±1,73 mcIU/ml, р<0,001 — comparing to controls; р1<0,001 — patients with DM2 not CVD), НОМА-IR (8,56±0,72, р<0,001, р1<0,01); levels of proinflammatory cytokines TNF-α (5,75±0,24 pg/ml, р<0,001, р1<0,001), IL-6 (5,88±0,38 pg/ml, р<0,001, р1<0,001), IL-8 (6,65±0,3 pg/ml, р<0,001, р1>0,05); and hsCRP (2,77±0,24 pg/L, р<0,001, р1<0,001) and coefficient TNF-α/IL-10 (44,2±3,57%, р<0,01, р1<0,05). Addition of CAN is associated with the increase of NTproBNP (407,0±23,0 fmol/ml, р<0,001, р1<0,001), that correlates with the growth of the left ventricle myocardial mass (LVMM) (r=0,52, p<0,05).

Conclusion. In DM2 patients with the functional stage of CAN there is an increase of IRI, НОМА-IR; concentrations of NT-prоBNP, hsСRP, TNF-α, IL-6, IL-8 и IL-10. There is also an increase of TNF-α/IL-10, that witnesses for the compensatory type of cytokine balance. The level of NT-prоBNP in DM2 patients correlates with LVMM that is associated with CAN development.

Russ J Cardiol 2015, 9 (125): 51–54

http://dx.doi.org/10.15829/1560-4071-2015-09-51-54

Key words: second type diabetes, cardiovascular autonomic neuropathy, insulin resistance, N-terminal brain-type pro-natriuretic peptide, myocardial mass of the left ventricle, inflammation markers.

Lviv National Medical University n. a. Danila Galitsky, Lviv, Ukraine.

THE CLINICAL COURSE OF PRESYNCOPE IN THE DIFFERENTIAL DIAGNOSIS OF SYNCOPE

Piotr J. Stryjewski¹, Agnieszka Kuczaj², Ryszard Braczkowski³, Jadwiga Nessler⁴, Ewa Nowalany-Kozielska²

Abstract

Aim. To evaluate the clinical signs and symptoms in the differential diagnosis of syncope.

Material and methods. We investigated 160 patients (64 men and 96 women), aged 18-77 years with reflex or cardiac syncope over the last 3 years. The following were investigated: age, sex, age at first syncope, number of presyncopal episodes, number of syncopal episodes, number of sudden syncope without prodromal signs and the circumstances of syncope. Moreover, we assessed the frequencies of prodromal signs in the differential diagnosis of syncope.

Results. Patients with reflex syncope were younger compared to patients with cardiac syncope (41,3±16,5 vs. 61,8±12,8; P<0,001) and had lower weight and body mass index (BMI). Reflex syncope patients more often presented with presyncope (10 (2, 20) vs. 2 (1, 3); p=0,01)) and syncope (8,1±7,8 vs. 5,4±1,6; P<0,001). Dyspnea, heart palpitations, feeling of cold or heat, visual disturbances and tinnitus were associated with reflex syncope (P<0,01).

Conclusion. The course of syncope may facilitate a diagnostic process of reflex and cardiac syncope.

Russ J Cardiol 2015, 9 (125): 55–58

http://dx.doi.org/10.15829/1560-4071-2015-09-55-58

Key words: cardiac syncope, prodromal symptoms, reflex syncope, syncope.

¹Cardiology Department, Chrzanow City Hospital; ²2^nd Department of Cardiology, Zabrze, Medical University of Silesia, Katowice; ³Department of Public Health, Medical University of Silesia, Katowice; ⁴Coronary Disease Department, Institute of

Cardiology, Medical School of Jagiellonian University, John Paul II Hospital, Cracow, Poland.

CLINIC AND PHARMACOTHERAPY

THE FIRST INDEPENDENT STUDY: FIXED COMBINATION OF PERINDOPRIL AND AMLODIPINE IN 2^ND STAGE ARTERIAL HYPERTENSION

Andreicheva E. N.

Abstract

Aim. To evaluate efficacy and safety of combination antihypertension compound Dalneva® — combination of perindopril and amlodipine by KRKA company in treatment of patients with second stage arterial hypertension (AH).

Material and methods. Totally 36 patients included with AH of II stage (20 women, 16 men). Mean age was 56,4±2,6 y; duration of hypertension anamnesis — 8,2±1,9 y. All patients had noncontrolled AH on the previous treatment. Compliance to previously prescribed medications was low — 55,5% of patients did not take the drugs on regular basis. At the moment of study inclusion the mean systolic BP (SBP) was 166,6±28,1 mmHg, mean diastolic BP (DBP) — 90,6±11,4 mmHg. All patients were assigned the Dalneva® in various dosages: from 4/5 mg to 8/10 once per day, relating baseline condition. Efficacy of treatment was evaluated by BP level in office visits and by selfcontrol. Respectively, the correction of dosages was done. For life quality assessment, we used EQ5D and VAS before the beginning of drug intake and in 3 months of treatment. Drug tolerability was assessed with the clinical condition questionnaire CGI-I.

Results. In 3 months of therapy the mean SBP was 138,5±13,4 mmHg (p=0,001), mean DBP — 80,4±6,1 mmHg (p=0,001). Side effects, such as dry cough and peripheral edema, specific for the drug components, were not registered. The dynamics of values: by VAS — 61,2±3,8; in 3 months 72,6±3,3 (p<0,05); by EQ5D the activity, self-help at the baseline were high and did not change in Dalneva® group. CGI-I showed: 31 patients marked “significant improvement”, 2 — “very significant improvement”, 3 — minimal improvement”. The treatment by Dalneva® continued 91,6% of patients.

Conclusion. Hypotension drug Dalneva® — the fixed combination of perindopril and amlodipine — is safe and effective against AH of II stage. Once per day intake makes it comfortable and improves compliance.

Russ J Cardiol 2015, 9 (125): 59–64

http://dx.doi.org/10.15829/1560-4071-2015-09-59-64

Key words: systemic hypertension, combination treatment, Dalneva®.

SBEI HPE Kazan State Medical University, Kazan, Russia.

LONG-TERM EFFECTS OF ORLISTAT ON EATING BEHAVIOR OF OBESity PATIENTS

Korneeva E. V.

Abstract

Aim. The assessment of the influence of long-term orlistat use on the eating behavior of obesity patients.

Material and methods. Totally 189 young patients studied with various grade of obesity, of those 107 women and 82 men at the age 18-44 y. o. Comparison group consisted of 34 healthy women and 31 healthy men (mean age — 39,21±0,46 y.). The anthropometric study performed, evaluation of food taking behavior, measurement of ghrelin level in the blood serum via ELISA method. Non-medication treatment (hypocaloric diet, physical exertion) was provided during 3 months. If no effect, then orlistat was prescribed 120 mg per os t. i.d. for 6-24 months.

Results. Among the studied patients, there were various types of eating behavior disorders found, mostly of emotiogenic and external types, nonbalanced of the food being taken. The decrease of body mass and mean value of WC was more prominent in patients with the III grade of obesity. Ghrelin level in the blood correlated with DMI and WC. The decrease of ghrelin in blood serum by from 10,4% in 6 months treatment to 46,3% in 24 months treatment witnessed sufficient saturation by the food if rational pattern of eating had been kept. After the end of treatment stability of following the rational pattern of food intake and healthy life style in the orlistat group less than 6 months was 59,5%, in 24 months — 97,8%.

Conclusion. Medication type of treatment, especially orlistat usage, is recommended to obesity patients as supportive to life style modification. Serious decrease of bodyweight is possible for the patients with obesity if long-term following healthy lifestyle.

Russ J Cardiol 2015, 9 (125): 65–70

http://dx.doi.org/10.15829/1560-4071-2015-09-65-70

Key words: obesity, eating behavior, ghrelin, orlistat.

BI HE of Khanty-Mansiysky Autonomic Region — Yugra, The Surgut State University, Surgut; BI K-MAD-Yugra Surgut City Clinical Polyclinics №1, Surgut, Russia.

COMPARATIVE EFFICACY OF ENZYME MEDICATION WITH THROMBOLYTIC EFFECT IN ATRIUM THROMBOSIS AND SPONTANEOUS ECHO-CONTRAST PHENOMENON IN PATIENTS WITH ATRIAL FIBRILLATION

Vyshlov E. V.^1,2, Batalov R. E.¹, Markov V. A.^1,2, Popov S . V.¹

Abstract

Aim. To assess efficacy of Thrombovazim® in combination antithrombotic therapy in atrial fibrillation (AF) with intra-atrial clots of spontaneous echo-contrasting found by echocardiography.

Material and methods. Totally 28 patients included with persisting atrial fibrillation: 20 with thrombosis of the left atrium appendage and 8 with the phenomenon of spontaneous echo-contrasting of II-III grate in atrium by transesophageal ultrasound contrast study (TEECS). Among patients with left appendage thrombosis there were 15 men and 5 women, mean age 60,3±1,6. Among those with spontaneous echocontrasting — 4 men and 4 women, mean age 58,2±1,2. After detecting the thrombus or spontaneous echo-contrasting phenomenon all patients were prescribed Thrombovazim® in dosage 800U t. i.d. for 7 days with standard warfarin therapy.

Results. On the control TEECS at the 8th day of therapy among 20 patients with previously diagnosed left appendage thrombosis in 19 were found the absence of clots. Level of total fibrinogen and soluble fibrin-monomers complexes in Thrombovazim® intake did not change. In all patients with spontaneous echocontrasting phenomenon after Thrombovazim® course this phenomenon still existed, so Thrombovazim® was not effective in this phenomenon elimination. There were no side effects of Thrombovazim®.

Conclusion. In atrial fibrillation patients and thrombus in left atrium appendage the use of Thrombovazim® 800U t. i.d. per os at the background of standard therapy by warfarin during 7 days in 95% leads to the lysis of clots without side effects. In spontaneous echo-contrasting phenomenon in atrial fibrillation Thrombovazim® 800U t. i.d. per os with standard therapy for 7 days does not lead to this phenomenon elimination. The lack of effect of Thrombovazim® in the phenomenon of spontaneous echo-contrasting indirectly suggests that there are not fibrin strands in this phenomenon.

Russ J Cardiol 2015, 9 (125): 71–75

http://dx.doi.org/10.15829/1560-4071-2015-09-71-75

Key words: Thrombovazim®, thrombosis, atrial fibrillation, spontaneous echocontrasting phenomenon.

¹FSBI SRI of Cardiology of SD RAMS, Tomsk; ²SBEI HPE Siberian State Medical University, Tomsk, Russia.

OPINION ON A PROBLEM

SPECIFICS OF THE EARLY PHASES OF CLINICAL TRIALS: FROM SCIENCE TO PERSON

Gordeev I. G., Taratukhin E. O.

Abstract

The article focuses on the form of ethical controversy of the new drugs studies on humans. The issue is at its most importance in early phases of clinical trials that resemble an experiment, therefore requiring specific regulation. Has the difficulties been resolved, that are related to ethical aspects of human participants in new drugs investigation? Are not there any aspects that require thorough interdisciplinary workout, but being covered by strict regulation? Authors try to answer these questions taking into account a biosocial nature of the object of investigations.

Russ J Cardiol 2015, 9 (125): 76–79

http://dx.doi.org/10.15829/1560-4071-2015-09-76-79

Key words: evidence based medicine, ethics, informed consent, first phase, second phase.

SBEI HPE RNRMU n. a. N. I. Pirogov, Moscow, Russia.

BIOPSYCHOSOCIAL APPROACH: A MODERN DEMAND FOR INTERDISCIPLINARITY

Taratukhin E. O.

Abstract

The article takes into consideration a novel integrated approach that combines cultural and psychological parts of human being with biological signs of the disease and health. The historical roots from GL Engel are sketched, and some thoughts provided on evaluation and scientific significance of the approach in research and clinical practice.

Russ J Cardiol 2015, 9 (125): 80–83

http://dx.doi.org/10.15829/1560-4071-2015-09-80-83

Key words: integrated science, personality, personhood, interdiscourse, psychosocial, biomedical, psychosomatics.

SBEI HPE RNRMU n. a. N. I. Pirogov, Moscow, Russia.

RESTING ELECTROCARDIOGRAPHY IN 12 COMMON LEADS: THE PRESENT AND THE FUTURE

Zemtsovsky E. V.^1,4, Abdalieva S . A.², Balluzek M. F.³, Kim A. V.², Morozova N. N.³

Abstract

The method of electrocardiography registration in resting state (in the following: ECG resting) in 12 common leads is considered as a routine method, that is used by a broadest range of indications for screening, in outpatient practice and standard clinical assessment of patients with various nosologies in inpatient practice. The method poor sides are discussed, i. e. a necessity for the use of heavy device, usage of the paper line, special archiving for storage and dynamics analysis. The benefits of internet-electrocardiography are shown that make it useful to record ECG by low-weight device (300 g), possibilities for ECG storage in personal space of the user, comfortable software of ECG comparison, that were recorded in dynamics.

Russ J Cardiol 2015, 9 (125): 84–87

http://dx.doi.org/10.15829/1560-4071-2015-09-84-87

Key words: data archiving, 12 main leads, Internet-electrocardiography, computed analysis, “cloud” cardioserver, electrocardiography resting, ECG in-home, ECG in dynamics.

¹Saint-Petersburg State Pediatrician Medical University; ²SBHI Polyclinics №37, Saint-Petersburg; ³FSBHI Saint-Petersburg Clinical Hospital of RAS; ⁴ FSBI NWFMIC, Saint-Petersburg, Russia.

LITERATURE REVIEWS

FONDAPARINUX USAGE IN NON-ST-ELEVATION ACUTE CORONARY SYNDROME

Mardaryan G. V.¹, Abugov S. A.^1,2

Abstract

Anticoagulation treatment is a vital component of acute coronary syndrome treatment. Selection of the most efficient and safe drug for the acute coronary syndrome patients without ST elevation (NSTEACS) depends on the strategy of treatment and is in fact a difficult task. Fondaparinux (Arixtra) is a synthetic Xa factor clotting inhibitor, has showed its benefits in clinical studies, according to which it is included into clinical guidelines. Current review focuses on the main results and conclusions of the studies, and the place for fondaparinux in clinical practice is described.

Russ J Cardiol 2015, 9 (125): 88–91

http://dx.doi.org/10.15829/1560-4071-2015-09-88-91

Key words: acute coronary syndrome, NSTEACS, anticoagulation, PCI, fondaparinux, enoxaparin, myocardial infarction, bleeding.

¹FSBSI Russian Scientific Center of Surgery n. a. B. V. Petrovsky, Moscow; ²SBEI APE Russian Medical Academy of Postgraduate Education, Moscow, Russia.

PLEIOTROPIC EFFECT OF NEBIVOLOL: RECENT DATA

Shaydyuk O. Yu., Taratukhin E. O.

Abstract

The article focuses on the review of recent data on Nebivolol as hypotensive and cardioprotecting medication. The accent is set upon the specific properties of nebivolol, partly, its influence on nitric oxide metabolism. The new information is provided on the study of pleiotropic effects of the drug.

Russ J Cardiol 2015, 9 (125): 92–95

http://dx.doi.org/10.15829/1560-4071-2015-09-92-95

Key words: arterial hypertension, heart failure, nitric oxide, erectile dysfunction, pharmacoeconomic effect.

SBEI HPE RNRMU n. a. N. I. Pirogov, Moscow, Russia.

GALECTIN-3 — BIOMARKER OF FIBROSIS IN PATIENTS WITH METABOLIC SYNDROME

Drapkina O. M., Deeva T.A.

Abstract

Recent decades there was a growing amount of people with obesity, hence the amount of the associated pathologies such as arterial hypertension, heart failure, non-alcoholic fatty liver disease. In obesity the most common for all diseases is a chronic “smoldering” inflammation. Inflammatory reaction can be a cause of apoptosis and/or necrosis of the cells (cardiomyocytes, hepatocytes, pancreocytes, endoteliocytes). Terminal pathway of chronic inflammation and tissues damage is usually related to fibrosis — the most common and widespread outcome of many diseases. An important issue is diagnostics of fibrosis at early stages. The main interest for the study is focused on noninvasive assessment of fibrosis at early stages, e. g. the levels of galectin-3. This marker is regarded as possible profibrotic molecule, potential marker of liver and heart fibrosis. Perhaps the investigation on galectin-3 might help in evaluation of the risk of fibrosis development and progression assessment.

Russ J Cardiol 2015, 9 (125): 96–102

http://dx.doi.org/10.15829/1560-4071-2015-09-96-102

Key words: galectin-3, fibrosis, metabolic syndrome, chronic heart failure, nonalcoholic fatty liver disease.

SEI HPE First Moscow Medical University n. a. I. M. Sechenov. Clinics of Internal Diseases Propedeutics of FMSMU n. a. I. M. Sechenov, Moscow, Russia.

ADRENORECEPTORS BLOCKING: RECENT DATA ON URAPIDIL USAGE

Shaydyuk O. Yu., Taratukhin E. O.

Abstract

The article is focused on recent (last two years) data from the trials of alphaadrenoblocker urapidil as a drug of choice for severe refractory hypertension, for controlled hypotension, and for outpatient care as part of combination therapy.

Russ J Cardiol 2015, 9 (125): 103–106

http://dx.doi.org/10.15829/1560-4071-2015-09-103-106

Key words: sympathetic block, combination therapy, controlled hypotension, Ebrantil®.

SBEI HPE RNRMU n. a. N. I. Pirogov, Moscow, Russia.