CONTENTS
СОДЕРЖАНИЕRUSSIAN JOURNAL OF CARDIOLOGY, 2015, 11 (127)
Address to the readers
Russ J Cardiol 2015, 11 (127): 7
CLINICAL MEDICINE NEWS
Clinical medicine updates: a review of international news
Russ J Cardiol 2015, 11 (127): 8
ORIGINAL ARTICLES
FROM ANATOMY AND ELECTROPHYSIOLOGY TO THE DIAGNOSIS
ECHOCARDIOGRAPHIC PARAMETERS OF THE LEFT ATRIUM IN DIASTOLIC DYSFUNCTION OF THE LEFT VENTRICLE AND EPISODES OF ATRIAL FIBRILLATION
Adamyan K. G., Tunyan L. G., Chilingaryan A. L.
Abstract
Aim. To study the parameters of left atrium (LA) deformation for evaluation of left atrium deformation in diastolic dysfunction of the left ventricular (LV) and at least one known episode of paroxysmal AF or persisting AF with normal volumes of atriums.
Material and methods. The controlled study is performed in 45 patients with diastolic dysfunction of the LV and at least one known episode of paroxysmal (PXAF) of persisting (PSAF) atrial fibrillation with normal chambers volumes, by studying of EchoCG parameters of maximum deformation and other parameters of the LA for definition of atrial functioning in the conditions of LV dysfunction.
Results. By the data obtained in the study, in sinus rhythm patients and episodes of PXAF and PSAF, volumes of the LA and parameters of maximum deformity do differ from those in healthy individuals. Within these conditions LA works with more overload. Patients with PXAF and PSAF have, by 96 h EXG monitoring, more supraventricular extrasystoles.
Conclusion. In AF patients the parameters of LA differ among the groups of patients with PSAF and PXAF and are more benign in PXAF.
Russ J Cardiol 2015, 11 (127): 9–12
http://dx.doi.org/10.15829/1560-4071-2015-11-9-12
Key words atrial fibrillation, deformity, diastolic dysfunction.
SRI of Cardiology, Erevan, Armenia.
ATRIAL FIBRILLATION IN CARDIOVASCULAR INTERVENTIONS IN ON-PUMP AND OFF-PUMP REGIMENS
Rubanenko O. A.1, Fatenkov O. V. 1, Khokhlunov S . M.1,2
Abstract
Aim. To evaluate the prevalence of post-operation atrial fibrillation (POAF) in coronary artery bypass (CBG) on-pump or off-pump regimens.
Material and methods. Totally, 469 patients studied with ischemic heart disease admitted for CBG (389 patients, 77% — males, mean age — 61,1±8,0 y.) had on-pump CBG, and 2nd group — off-pump (80 patients, 80% — males, mean age — 58,4±8,0 y.).
Results. In early post-operation period AF developed in 17,7% of patients in the 1st group, in 7,5% in the 2nd. Multifactor analysis showed the odds ratio for the aorta clumping time more than 36 mins as 1,8 (95% CI, 1,0-3,3, р=0,04), for ischemia time more than 19 mins — 2,0 (95% CI, 1,1-3,8, р=0,02), for the age more than 59 y. — 2,7 (95% CI, 1,5-5,0, р=0,001), for the front-back size of the left atrium more than 39 mm — 3,7 (95% CI, 2,1-6,4, р <0,0001), for the LVEF less than 55% — 1,8 (95% CI, 1,1-3,2, р=0,03). However the odds ratio for cardiopulmonary bypass more than 56 mins was 1,4 (95% CI, 0, 6-3,1, р=0,4) and "p" value got nonsignificant.
Conclusion. In our study we showed higher prevalence of POAF in CBG as on-pump comparing to off-pump regimen. The most valuable parameter predetermining arrhythmia development were age, front-back size of the left atrium, LVEF, duration of aorta clumping and duration of ischemia.
Russ J Cardiol 2015, 11 (127): 13–17
http://dx.doi.org/10.15829/1560-4071-2015-11-13-17
Key words atrial fibrillation, coronary bypass grafting, cardiopulmonary bypass, on-pump and off-pump coronary bypass.
1SBEI HPE Samara State Medical University of the Healthcare Ministry, Samara; 2SBHI Samara Region Clinical Cardiological Dispensary, Samara, Russia.
THE MORPHOLOGY OF ELECTROPHYSIOLOGICAL DISORDERS OF MYOCARDIUM IN POSTINFARCTION ANEURYSM AND VENTRICULAR TACHICARDIA
Babokin V. E.1, Rogovskaya Yu. V.2,3, Shipulin V. M.2, Batalov R. E.2,3, Popov S . V.2
Abstract
Aim. To study morphology of the left ventricle (LV) myocardium in zones with disordered conduction of electrical potential in patients with post infarction aneurysm of the heart and ventricular tachycardia.
Material and methods. The microscopic and morphometric investigations performed of 78 fragments of LV myocardium, obtained during surgical reconstruction of LV from zones with different electrical conductivity, from 19 patients with post infarction LV remodeling and chronic heart failure. For electrical conductivity all patients underwent electrophysiological study of the heart. In the zones with normal conduction (1 group) the value of electrical potential was more than 1,5 mV, in transition zone (2 group) — 0,5-1,5 mV, in "electrical scar" zone — less than 0,5 mV (3 group). The zone with zero value of electrical potential got to the 4th group.
Results. In transition zone of myocardium pieces and "electrical scar" zone, comparing to those from normal electrical potential, there were more significant sclerosis of endocardium and myocardium, atrophy and degeneration of cardiomyocytes. In "electrical scar" zone there was more significant value of these changes than in transitory zone. Areas of myocardium with zero value of the potential differed from the zones with normal and low values of electrical potential by more significant replacement of myocardium by fat tissue.
Conclusion. Transition from normal electrical potential to electrical scar do determine the severity of endocardial fibrosis, and myocardial lipomathosis, degeneration of cardiomyocytes.
Russ J Cardiol 2015, 11 (127): 18–22
http://dx.doi.org/10.15829/1560-4071-2015-11-18-22
Key words electrophysiological study, post infarction remodeling of myocardium, arrhythmia.
1SBHI MR MRSRCI n. a. M. F. Vladimirsky, Moscow; 2FSBSI SRI of Cardiology, Tomsk; 3National Research Tomsk State University, Tomsk, Russia.
RHYTHM DISORDERS IN MORPHOLOGICALLY CONFIRMED MYOCARDITIS
Khashchevskaya D. A., Mitrofanova L. B., Ignatieva E. S ., Zverev D. A., Lebedev D. S ., Moiseeva O. M.
Abstract
Aim. To reveal the factors determining prognosis in patients with morphologically documented myocarditis presented with rhythm disorders.
Material and methods. Totally, 75 patients studied with lymphocyte infiltration myocarditis, 22 patients with dilated cardiomyopathy (DCMP). All patients underwent standard echocardiographic investigation, enhanced magnetic-resonance tomography, endomyocardial biopsy, viral genome molecular test, standard laboratory panel and autoantibodies profile in blood serum. Control group included 30 almost healthy individuals.
Results. There were no established differences between the groups with or without rhythm disorders by the activity of inflammatory process and prevalence of viral genome finding in myocarditis patients. The similarity was found for autoantibodies profile in DCMP and myocarditis with rhythm disorders that probably related to fibrous changes in myocardium.
Conclusion. The course of arrhythmia development in inflammatory myocardium diseases has complicated multifactorial nature related to a direct harm by infection, to development of autoimmune reactions and structural remodeling of myocardium. Not the arrhythmias influence prognosis, but structural changes in myocardium associated with the decrease of its global contractility.
Russ J Cardiol 2015, 11 (127): 23–28
http://dx.doi.org/10.15829/1560-4071-2015-11-23-28
Key words myocarditis, arrhythmia.
Federal Almazov North-West Medical Research Centre of the Ministry of Health, Saint-Petersburg, Russia.
NOVEL METHODS OF PATIENTS SELECTION FOR THE CARDIAC RESYNCHRONIZING THERAPY IN NON-ISCHEMIC CARDIOMYOPATHY
Lebedev D. I ., Zlobina M. V., Gulya M. O., Savenkova G. M., Krivolapov S . N., Popov S . V.
Abstract
Aim. To study a range of selection methods for cardiac resynchroizing therapy (CRT) and to evaluate the possibility of their application in clinical practice for treatment improvement.
Material and methods. Totally 88 patients studied with the diagnosis dilation cardiomyopathy (DCMP) at the age 32-75 y. o. (55±12), HF III NYHA, ejection fraction (EF) of the LV (LV) was 30,1±3,8%, distance in 6-minute walking test — 290,5±64,3 m, end-diastolic volume (EDV) — 220,7±50,9 ml, intra- and interventricular dyssynchrony was more than 120 ms. At the stage of selection the patients were separated to 3 groups: first — 28 patients — the defect of myocardium metabolism (DMM) was assessed using radionuclide methods; second — 24 patients — systolic velocity assessed of fibrous annulus of tricuspid valve of the right ventricle (Srv); third — 36 patients — controls.
Results. Control assessments were done in 1 year. Clinical responders for CRT were 69 patients (78,5%), not responded to CRT — 19 patients (21,5%). In assessment by the each method of selection it was revealed that in the 1st group there were 3 (10,7%) nonresponders, 6 (25%) in 2nd group, 10 (27,7%) in the 3rd. In the 1st group the responders were 25 (89,3%) of patients, whose LV DMM before CRT was 15%. If it was more than 15%, patients were nonresponders. In the second group the responders were 18 (75%) of patients, whose Srv before CRT was more than 10 m/s, in average — 12,5±2,1, (р=0,0001).
Conclusion. 1. Maintaining of myocardium metabolism (DMM LV less than 15%) is a predictor of CRT efficacy in DCMP patients. 2. Srv is an independent predictor of the CRT response and makes it with the sensitivity 85% and specificity 83% to reveal the responders to CRT at the stage of selection. 3. While selecting patients to CRT it is aimful to use all described methods together to improve quality of treatment.
Russ J Cardiol 2015, 11 (127): 29–34
http://dx.doi.org/10.15829/1560-4071-2015-11-29-34
Key words nonischemic cardiomyopathy, cardiac resynchronizing therapy, severe heart failure.
FSBSI SRI of Cardiology, Tomsk, Russia.
COMPARISON OF INOTROPIC AND ANTIARRHYTHMIC ACTIVITY OF FLAVONOIDS — QUERCETIN, RUTIN AND (+)-CATECHIN
Khushmatov Sh. S., Makhmudov R. R., Mavlyanov S . M.
Abstract
Aim. Studying of inotropic and antiarrhythmic action of flavonoids — quercetin, rutin and (+)-catechin on functional activity of rodent myocardium.
Material and methods. Mechanical parameters of papillary muscle in isometric regimen were registered via the sensor F30, in simulation with the impulses 5-10 ms duration and amplitude, higher than threshold for ~20%. For defining of flavonoids action mechanism we used the inhibitory method of the being studied compounds with ion-transporting system and receptors of cardiomyocytes sarcolemma. To study antiarrhythmic action of flavonoids we used the method of experimental acotinin-induced arrhythmia.
Results. It is found that quercetin and rutin have biphasic inotropic effect on contractility of rodent papillary muscle, and rutin leads to significantly lower positive inotropic effect than quercetin. In diapason of higher concentrations quercetin (100-200 mcM) and rutin (200-300) lead just to negative inotropic effect. In such conditions the value of ЕС50 for quercetin and rutin was 229 mcM or pD2 (–log EC50)=3,64 and 245,4 mcM or pD2 (–log EC50)=3,61 resp. It was found that (+)-catechin shows only negative inotropic effect (ЕС50=45,7 mcM and pD2 (–log EC50)=4,34). In incubation of the muscle with (±)-propranolol (10 mcM), blocker of β-adrenoreceptor, there is a decrease of positive inotropic effect of quercetin and rutin. In experiments we found that in presence of Са2+ L-channel antagonist — nifedipine (ЕС50), querctin (229 mcM), rutin (245,4 mcM) and (+)-catechin (45,7 mcM) additionally decreased the amplitude of myocardium contractile response by 41,3±5,4%, 43,6±6,5% and 37,2±4,8%, resp, relatively to nifedipine effect. Revealed, that the studied flavonoids, in 20-25 min after addition to the incubation medium, suppress the rate of arrhythmia, caused by aconitin (1 mcM). Also the most effective was quercetin, and in concentration 100 mcM it decreases the rate of tachycardia, caused by aconitine from от 264±14 bpm to 32±12 bpm.
Conclusion. Analyzing the data obtained, it is possible to presume that positive inotropic effect of quercetin and rutin might be related to their activtion of β-andrenoreceptors, which causes the increase of [cAMP]in and, hence leads to increase of intracellular [Ca2+]in in cardiomyocytes. Negative action of the studied flavonoids might be relevant to their interaction with Са2+-channels of cardiomyocytes sarcolemma. Also the action of the flavonoids might be related to the production of functional activity modulation of Na+ and Са2+-channels in cardiomyocytes.
Russ J Cardiol 2015, 11 (127): 35–41
http://dx.doi.org/10.15829/1560-4071-2015-11-35-41
Key words papillary muscle, quercetin, rutin, (+)-katechin, arrhythmia, inotropia.
Institute of Bioorganic Chemistry n. a. acad. A. S . S adycov SA UR, Tashkent, Uzbekistan.
POST-TRANSPLANTATION CARDIOMYOPATHY: ENERGY-PRODUCING PARTICLE OF CARDIOMYOCYTES AT THE TERMS UP TO 25 YEARS OF ORTHOTOPIC HEART TRANSPLANTATION
Dzemeshkevich S . L.1,3, Tsyplenkova V. G.2, Frolova Yu. V.1, Voronina T. S .1, Ettinger A. P.2
Abstract Russian Scientific Center of Surgery named after B. V. Petrovsky has an experience of 30 orthotopic heart transplantations with the maximum follow-up 25 years. Nine patients survived 11-year period after operation, of those in 6 during long-term period of 11-25 years we studied ultrastructural assessment of cardiomyocytes of the donor heart. This article provides the results of mitochondrial particles: the data witnesses on the increase of destruction in mitochondria with time that finally leads to energy deficit of cardiomyocytes and progression of post-transplant cardiomyopathy.
Russ J Cardiol 2015, 11 (127): 42–45
http://dx.doi.org/10.15829/1560-4071-2015-11-42-45
Key words heart transplantation, long-term results, mitochondria, post transplant cardiomyopathy.
1FSBSI Russian Scientific Center of Surgery n. a. B. V. Petrovsky, Moscow; 2Pirogov Russian National Research Medical University (RNRMU), Moscow; 3I.M. Sechenov First Moscow State Medical University of the Ministry of Health, Moscow, Russia.
EXCESSIVE MORTALITY IN WINTER AND ITS ECONOMIC VALUE DURING THE YEARS 2007-2014
Balanova Yu. A., Kontsevaya A. V., Lukianov M. M., Klyashtorny V. G., Kuznetsov A. S ., Kalinina A. M., Boytsov S . A.
Abstract
Aim. To study the excessive mortality during the winter (EMW) from all causes and CVD, monthly values of mortality; to evaluate social and economic harm due to EMW in Moscow.
Material and methods. The calculation of EMW (%) was done for Moscow by the mortality from all causes and from CVD by a special equation. For monthly values of mortality we estimated the average range per month by absolute number of the deaths — absolute parameters of mortality by every analyzed year were ranged from 1 to 12, and mean value of the range was calculated.
Results. Mean EMW per 8 years was 5,1%, for CVD higher — 8,8%. In Moscow there is an influence of the anomaly heat of 2010 — EMW was 4,5% from all causes, from CVD — 6,0%. Maximum number of deaths was registered in January and march. Gross EH by 2007-2013 from EMW was 7,9 billion rubles in Moscow.
Conclusion. A significant part of EMW are the deaths from CVD. The amount of EH from EMW has confirmed the shown previously relation from two factors — number of deaths and size of GRP in region. For Moscow — the capital of Russia, having the highest values of economic development, the harm, that is quite significant, grounds the necessity of investments into excessive mortality and search for effective by decrease of mortality in winter time.
Russ J Cardiol 2015, 11 (127): 46–51
http://dx.doi.org/10.15829/1560-4071-2015-11-46-51
Key words economic harm, excessive mortality, winter period, climate, Moscow.
FSBI State Scientific-Research Center of the Preventive Medicine of the Healthcare Ministry, Moscow, Russia.
CLINIC AND TREATMENT
EPICARDIAL MONO- AND BIVENTRICULAR ELECTROCARDIOSTIMULATION IN TREATMENT OF CONDUCTION DISORDERS IN NORMAL SYSTOLIC FUNCTION
Osadchiy An. M.2, Kamenev A. V.1, Karuzin S . V.2, Shcherbak S . G.2, Lebedev D. S .1
Abstract
Aim. To reveal the specifics, and to evaluate the efficacy of implantation of epicardial (myocardial) electrodes under the conditions of artificial circulation and to define their influence on electromechanical parameters of the heart including pumping function.
Material and methods. The results were analyzed of intraoperation and short-term (up to 24 months) results of implantation of epicardial electrodes under the conditions of AC in 32 patients, operated in 2007-2014 yy. For 32 patients the electrode was implanted (fixated) epicardially under the conditions of AC for conduction disorder correction after the main stage of cardiosurgical intervention. Including the fixation of epicardial electrode to both ventricles (group A, n=23) was done as biventricular ECS, and to one ventricle (group B, n=9) — monoventricular ECS. The following investigations were done: clinical examination, ECG, 6-minute walking test (6-WT), Echocardiography with dyssynchrony evaluation in M-, B-, doppler and tissue regimens, programming of ECS.
Results. Mean follow-up period in both groups was 17±1,9 months. In 23 patients fixation of "-"-pole of epicardial electrode was done on the lateral surface of the left ventricle, and "+"-pole on posterior surface of the right ventricle, and in 8 patients epicardial electrode "+" and "-" was fixated in the area of lateral surface of the left ventricle and in one — area of the right ventricle if possible to the basal part. In 7 patients the atrial epicardial electrode was fixed to the base of the right atrium. So, we reached in 11 cases the 3-chamber ECS (CPT-ECS), in 12 — "biventricular" ECS (patients with permanent AF) and in 9 — monoventricular cardiostimulation.
Conclusion. Epicardial (myocardial) biventricular stimulation of the heart is efficient method of rhythm disorder correction and the method of choice in those who need the replacement of endocardial ECS system, in heart defects patients, and if with CHF. While implanting epicardial systems there is a possibility to visually define the points and place of electrodes fixation. In biventricular ECS in dynamics there are significantly better results in the heart synchronicity parameters, that also was confirmed by the improvement of the LV systolic function and its remodeling in 12 months.
Russ J Cardiol 2015, 11 (127): 52–56
http://dx.doi.org/10.15829/1560-4071-2015-11-52-56
Key words epicardial stimulation, implantation of electrodes, biventricular and monoventricular cardiostimulation on-pump.
1Federal Almazov North-West Medical Research Centre of the Ministry of Health, Saint-Petersburg; 2SPb SBHI CH №40 of Resort District, Saint-Petersburg, Russia.
URGENT CATHETER ABLATION OF THE ELECTRICAL STORM IN PATIENTS WITH IMPLANTED CARDIOVERTER-DEFIBRILLATOR
Tatarsky R. B., Mikhailov E. N., Lebedeva V. K., Lebedev D. S .
Abstract
Aim. The main goal of this study was to assess the early and delayed efficacies of urgent catheter ablation (CA) in patients with coronarogenic ventricular tachyarrhythmia (VTA) and electrical storms (ES).
Material and methods. Procedures EFI and CA with the use of navigation charting system were done for 12 patients with ES. Mean time from implantation of ICD to ES was 3,4±3,2 y., quantity of adequate shocks of ICD per day in ES was 12,2±14,1. In most patients (67%) underwent CA, CHF of higher grade was diagnosed, LV EF was 32±12%.
Results. Within primary approach of RFA the acute effect of clinical VTs was 58% (7 patients). During the first year of observation four patients developed VT returns (33%). During the whole observation time ES returns were not registered. Total mortality reached 25%
Conclusion. Application of CA is able to suppress ES by 100% not only in acute period but in long-term too. Nevertheless, the additional CA application is necessary due to paroxysms of VT and interventions of ICD in 33% cases.
Russ J Cardiol 2015, 11 (127): 57–62
http://dx.doi.org/10.15829/1560-4071-2015-11-57-62
Key words electrical storm, ventricular tachycardia, ventricular fibrillation, sudden cardiac death, catheter ablation, cardioverter-defibrillator, ischemic heart disease.
Federal Almazov North-Western Medical Research Center of the Healthcare Ministry, Saint-Petersburg, Russia.
BODY MASS INDEX IN ISCHEMIC HEART DISEASE AND SHORT-TERM OUTCOMES OF CORONARY BYPASS GRAFTING
Sumin A. N., Bezdenezhnykh A. V., Ivanov S . V., Barbarash O. L.
Abstract
Aim. To study relation of body mass index and short term results of coronary bypass grafting (CBG).
Material and methods. 1490 CBG patients, were selected to groups according to body mass index (BMI): normal body mass (BMI 18,5-24,9 kg/m2, n=351), overweight (BMI 25-29,9 kg/m2, n=658), first grade obesity (BMI 30-34,9 kg/m2, n=409), second grade obesity (BMI 35-39,9 kg/m2, n=72). The groups were equal by clinical data and anamnesis, laboratory and instrumental data. Also we evaluated the prevalence of post operation complications and perioperational mortality. The relation of possible factors with the chance of complications to be found assessed via logistic regression model.
Results. The groups were comparable in age, prevalence and anamnesis of vascular catastrophes, severity of CHD and CHF. Part of men decreased with the increase of BMI (p<0,001). Diabetes of 2nd type and AH were more prevalent among patients with higher BMI (in all cases p<0,001). With BMI increase there was significant increase of triglycerides level and HDL cholesterol decrease (p<0,001 and p=0,004, resp.). Glomerular filtration rate, by MDRD, was lower in obesity groups. On-pump operation was done in 1287 (86,4%) cases. More often in groups with higher BMI the radiofrequency ablation was performed (p=0,006), and in these groups also the post operation period complicated with atrial fibrillation (p=0,001). In monofactorial logistic regression analysis the chance of complications increased with the decrease of GFR (p=0,021), age increase (p<0,001), in on-pump operation (p=0,004) and its duration (p<0,001). Age and duration of on-pump also were significant in multifactorial analysis (p<0,001 and p=0,015, resp.). Chance of fatal outcome increased with the duration of on-pump (p<0,001) and decrease of LVEF (p=0,001). These factors also showed significant contribution on the chance of fatal outcome, and in multifactor analysis — the duration.
Conclusion. Increase of BMI is associated with the prevalence of arterial hypertension and diabetes mellitus, triglycerides increase, enlargement of the left atrium, HDL decrease and GFR. Among patients with obesity there was only increase of atrial fibrillation prevalence growth during post-operational period.
Russ J Cardiol 2015, 11 (127): 63–69
http://dx.doi.org/10.15829/1560-4071-2015-11-63-69
Key words coronary bypass graft, obesity, body mass index.
FSBI Scientific-Research Institute of Complex Problems of Cardiovascular Diseases SD RAMS, Kemerovo, Russia.
CLINICAL AND PREDICTIVE VALUE OF SERUM INTERLEUKINE-18 IN ST ELEVATION MYOCARDIAL INFARCTION
Zykov M.V.1, Kashtalap V.V.1,2, Bykova I.S.1, Khryachkova O.N.1, Kalaeva V.V.1, Shafranskaya K.S.1, Karetnikova V.N.1,2, Barbarash O.L.1,2
Abstract
Aim. To assess clinical and predictive value of serum IL-18 in ST elevation myocardial infarction.
Material and methods. Totally, 132 patients included, hospitalized to Kemerovo cardiovascular dispensary due to STEMI with <24 hours pain onset. Assessment of IL-18 concentration (pg/ml) was done on 12th day of care.
Results. Mean concentration of IL-18 in all patients was 244,02 (172,13-315,91) pg/ml, that was 3,5 times higher than reference range. Correlation analysis showed relation of IL-18 levels with total cholesterol, with low density lipoproteides, left ventricle ejection fraction, glomerular filtration rate (GFR) by CKD-EPI: r=0,18 (р=0,040), r=0,24 (р=0,008), r=-0,19 (р=0,029), r=-0,18 (р=0,039), resp. Median concentration of IL-18 in multifocal atherosclerosis (MFA) patients was 214,75 (129,20-362,35) pg/ml vs. 140,40 (97,80-292,80) pg/ml in non-MFA patients (р=0,010). In those patients without any significant progression of BCA lesion, baseline concentration of IL-18 was 271,0 (128,3-358,4) mg/ml, but in patients with the increase of stenosis grade more than 30% and/or appearance of novel plaques the level of IL-18 was 119,35 (94,61-188,95) pg/ml.
Conclusion. In prediction of early (in-hospital) and long-term (3-year) stages of myocardial infarction there was no any clinical and predictive value of IL-18. Concentration of serum IL-18 did not relate to kidney diseases in STEMI patients, but correlates negatively with GFR defined by CKD-EPI. There was significant role of IL-18 in forming of multifocal atherosclerosis. High concentrations of IL-18 at 12th day of hospitalization were related to the increase of total cholesterol and LDL, and with the decrease of contractility of the left ventricle myocardium. In STEMI with MFA there is increase of IL-18 1,5 times. At the same time significant progression of atherosclerotic lesion during one year was found in patients with lower baseline IL-18 level, which requires further studies of the IL-18 role in atherogenesis.
Russ J Cardiol 2015, 11 (127): 70–74
http://dx.doi.org/10.15829/1560-4071-2015-11-70-74
Key words myocardial infarction, interleukine-18, multifocal atherosclerosis, prognosis.
1FSBSI Scientific-Research Institute of Complex Problems of Cardiology, Kemerovo; 2SBEI HPE Kemerovo State Medical Academy of the Healthcare Ministry, Kemerovo, Russia.
A POSSIBILITY TO USE ANTIARRHYTHMIC MEDICATIONS FROM II CLASS AND MODULATED KINESITHERAPY AS PRIMARY PREVENTION OF ATRIAL FIBRILLATION IN METABOLIC SYNDROME PATIENTS
Olesin A. I .1, Litvinenko V. A.2, Konstantinova I .V.1, Shlapakova A. V.2
Abstract
Aim. To evaluate the usage of II class antiarrhythmic drugs and modulated kinesitherapy (MK) as primary prevention of atrial fibrillation (AF) in patients with metabolic syndrome (MS) with revelation of short-term risk for this arrhythmia development.
Material and methods. We observed 153 patients with MS at the age 58-75 y. o. without AF in anamnesis, but with short-term risk of its development (2 years after examination), defined via comparative analysis of AF course, induced by transesophageal electrocardiostimulation, in dynamic patients observation. All patients, as primary prevention of AF, used antiarrhythmics of the 2nd class, and in side effects development or in contraindications they underwent MK; polyunsaturated fatty acids also used (PUFA).
Results. After inclusion to the study 77 (50,33%) of MS patients used II class drugs additionally to therapy, 42 (27,45%) patients underwent MK, and the rest used PUFA. The best clinical effect was found in II class drugs and MK >63,75% and 74,41%, resp. Efficacy of the therapy in this type of patients highly correlated with the improvement of the left ventricle dysfunction, signal-average electrocardiogram, P-wave dispersion and the decrease of the left atrium volume.
Conclusion. If the short-term risk of AF found in MS patients, as primary prevention the method of choice is antiarrhythmic therapy II class drugs and MK.
Russ J Cardiol 2015, 11 (127): 75–80
http://dx.doi.org/10.15829/1560-4071-2015-11-75-80
Key words atrial fibrillation, primary prevention of arrhythmia.
1I.I. Mechnikov North-West State Medical University, Saint-Petersburg; 2Elisabeth Hospital, Saint-Petersburg, Russia.
MANAGEMENT OF ANGINA ATTACKS IN HEART FAILURE DUE TO NONCORONARY HEART DISEASE: TRIMETAZIDINE USAGE
Sitnikova M. Yu., Lelyavina T. A., Galenko V. L.
Abstract
Aim. To study trimetazidine (TZ) impact on the frequency of hospitalizations, structural and functional myocardium parameters, exercise tolerance (ET) in congestive heart failure patients (CHF) of nonischemic etiology (after myocarditis or DCMP), having complaints on chest pains.
Material and methods. Totally 35 patients included (27 males) with CHF II-III FC, under observation in screening groups at SRD HF NWFMRC n. a. Almazov V. A. of the Healthcare Ministry. Mean age was 48±2,5 y., mean BMI.— 26±2,5 kg/m2. Patients were randomized to two groups: main group (MG) of 20 persons — receiving TZ (Preductal МВ, "Les Laboratories Servier", France) 70 mg per day for 12 months additionally to basic therapy of CHF; controls (CG) of 15 persons — those receiving only basic CHF therapy.
Results. All patients completed the study. There were no cases of TZ discontinuation. In both groups LV EF increased from 35±4,8 to 38,2±4,3, with р <0,05 in MG, and no significantly — in CG (from 34±5,5 to 36,1±5,1, р>0,05). By the end of TZ therapy the results by MLHFQ improved in both groups and reached 49±2,7 and 55,6±2,8 points, in MG and CG, resp., р <0,05. Baseline CPT were comparable in both groups: VО2peak were 12,9±0,9 ml/min/kg (gap 10,1-15,0 ml/ min/kg) and 13,0±1,2 (10,0-15,2 ml/min/kg), resp., (pVО2peak>0,05). In 12 months values of VО2peak increased and became significantly better than in MG than in CG: 16,4±1,3 ml/min/kg (11,8-18,3 ml/min/kg) and 14,5±1,1 ml/min/kg (11,2-16,7 ml/min/kg), resp., (pVО2peak<0,01). In MG there were strong positive correlations between duration of CHF and improvement of oxygen volume consumed at the peak of exercise (r=0,6, p<0,05); and between CHF duration and LV EF increase (r=0,74, p<0,05).
Conclusion. Hence the results of the study demonstrate that prescription of TZ to the patients with HF-LEF of non-ischemic ethiology with dose 70 mg per day additionally to basic therapy helps to decrease angina syndrome severity, to improve life quality and increase oxygen consumption during exercise.
Russ J Cardiol 2015, 11 (127): 81–85
http://dx.doi.org/10.15829/1560-4071-2015-11-81-85
Key words CHF of nonischemic etiology, chest pain, trimetazidine, Preductal MB.
Federal Almazov North-Western Medical Research Center of the Healthcare Ministry, Saint-Petersburg, Russia.
NATIONAL REGISTERS
CRYOBALLOON ABLATION IN RUSSIAN SITES OF INTERVENTIONAL ATRIAL FIBRILLATION MANAGEMENT TREATMENT: RESULTS OF THE FIRST NATIONWIDE SURVEY
Mikhailov E. N.1, Lebedev D. S .1, Pokushalov E. A.2, Davtyan K. V.3, Ivanitsky E. A.4, Nechepurenko A. A.5, Kosonogov A. Ya.6, Kolunin G.V.7, Morozov I.A.8, Termosesov S.A.9, Maykov E.B.10, Khomutinin D.N.11, Eremin S.A.12, Mayorov I.M.13, Romanov A. V.2, Shabanov V. V.2, Shatachtsyan V. S .3, Tsivkovsky V. Yu.4, Patsyuk A. V.1, Revishvili A. S h.14, Shlyakhto E. V.1
Abstract
Aim. The results of cryoballoon ablation (CBA) are known from the studies performed in the experienced centers of catheter treatment of atrial fibrillation (AF). The current study presents the results of CBA in real practice in centers with various experience
Material and methods. Among 62 Russian sites performing catheter treatment of AF, in 15 the CBA methods were in use to isolate pulmonary veins, in the years 2012-2014. Centers staff were surveyed for the detailed description of all performed CBA till 10.2014. The questionnaire included 74 lines about the centers experience, patients properties and ablation procedures, management of patients and complications. At the second step the questionnaire was used about complications.
Results. Thirteen centers provided full data on all patients with CBA (457 procedures; 94% for paroxysmal AF; >95% CBAs in Russia). Six centers were marked as highly experienced for CBA for AF (mean 414,2±339,4 ablations for AF per year), and 7 – with lesser experience (33,2±34,3 ablations for AF per year). Ten centers provided the results of 6/12 month observation, and 11 centers – detalization of the complications data. there were no statistically significant differences in arrhythmia absence in patients from both types of centers (61,9±10,0 versus 61,3±30,4%). Serious complications developed in 1,5% of patients (4 tamponades, 2 strokes and 1 diaphragmal nerve palsy) and were similarly spread among more and less experienced centers (1,4% vs. 2%, p>0,05). Minor adverse events (vascular, transient diaphragm nerve palsy, transient hemoptysis) were found in 37 (8%) patients and were more common in more experienced (teaching) centers. Overall frequency of adverse events and of vascular events was higher in females than males (12% and 4,9% vs. 6% and 0%, resp.; p<0,05).
Conclusion. In the real clinical practice CBA is performed with acceptable efficacy and moderate frequency of adverse events development. In less experienced centers of catheter treatment of AF the prevalence of serious adverse events does not differ from less experienced. Women develop vascular complications more often.
Russ J Cardiol 2015, 11 (127): 86–91
http://dx.doi.org/10.15829/1560-4071-2015-11-86-91
Key words: atrial fibrillation, catheter ablation, cryoablation, cryoballoon, results, complications.
1Federal Almazov North-West Medical Research Centre of the Ministry of Health, Saint-Petersburg; 2E.N. Meshalkin Novosibirsk Scientific-Research Institute of Circulation Pathology, Novosibirsk; 3National Research Center for Preventive Medicine of the Ministry of Health, Moscow; 4Federal Center of Cardiovascular Surgery, Krasnoyarsk; 5Federal Center of Cardiovascular Surgery, Astrakhan; 6SBHI NR City Clinical Hospital №5, Nizhniy Novgorod; 7Filial of SRI of Cardiology Tyumen Cardiological Center, Tyumen; 8V. I. Razumovskiy Research Institute of Cardiology of S aratov Medical University, Saratov; 9V.M. Buyanov City Clinical Hospital of Healthcare Department of Moscow, Moscow; 10Russian Cardiological Research and Production Complex of the Ministry of Health, Moscow; 11SBHI TR Regional Clinical Hospital №1, Tyumen; 12Republic Clinical Hospital of the MH of Tatarstan Republic, Kazan; 13S.P. Botkin City Clinical Hospital, Moscow; 14A.N. Bakulev SCCVS of the Ministry of Health, Moscow, Russia.
LITERATURE REVIEWS
ACCELERATED IDIOVENTRICULAR RHYTHM: HISTORY OF RESEARCH
Treshkur T. V., Chmelevsky M. P., Tsurinova E. A.
Abstract Accelerated idioventricular rhythm is a ventricular rhythm consisting of three or more consequent mono- or polymorphic complexes. It might be registered in patients with structural heart diseases, rarer in completely normal heart, might be found in sportsmen and children. Idioventricular rhythm might be seen in myocardial infarction, in reperfusion and under medications influence. The article focuses on the literature data that led to identification of this important ventricular arrhythmia.
Russ J Cardiol 2015, 11 (127): 92–97
http://dx.doi.org/10.15829/1560-4071-2015-11-92-97
Key words accelerated idioventricular rhythm, ventricular ectopic rhythm, ventricular ectopic centers/beats.
Federal Almazov North-Western Medical Research Center of the Healthcare Ministry, Saint-Petersburg, Russia.
ATORVASTATIN IN ACUTE AND CHRONIC KINDS OF ISCHEMIC HEART DISEASE
Oleynikov V. E., Khromova A. A., Gusakovskaya L. I ., Sergatskaya N. V., Romanovskaya E. M.
Abstract The review focuses on clinical trials data demonstrating a possibility of effective statin therapy of acute and chronic ischemic heart disease courses. The analysis of maximal dosages of atorvastatin application provided, its early prescription in first 24-96 hours after acute cardiovascular event and in preparing for revascularization with the aim to minimize the risk of adverse effects, death and to improve prognosis. The positive effect of atorvastatin is taken into consideration, mediated by not only its hypolipidemic effect, but a range of pleiotropic effects. The analysis is provided of the data on prevalence and severity of side effects in patients receiving statins.
Russ J Cardiol 2015, 11 (127): 98–103
http://dx.doi.org/10.15829/1560-4071-2015-11-98-103
Key words CHD, atorvastatin, statins, pleiotropic effect, side effects.
FSBEI HPE Penza State University, Medical Institute, Penza, Russia.
LECTURE
VENTRICULAR ARRHYTHMIA IN CHILDREN
Kruchina T. K.1,2, Vasichkina E. S .1,2, Novik G. A.2
Abstract The presented lecture focuses on epidemiology, classification, pathophysiology and clinical course of ventricular arrhythmia in children. Special attention is to the issues of risk evaluation for the development of arrhythmic dysfunction of myocardium at the background of exact rhythm disorder. The term "idiopathic" ventricular arrhythmia is considered, and the main extracardiac causes of ventricular arrhythmia are described, those relieve is crucial for treatment success. Also it is underlined that organic heart lesion in a child with ventricular arrhythmia is of a great importance for the disease outcomes and scoring of risk. Based upon national and international guidelines the recommendations are provided for follow-up of the children with ventricular arrhythmia, selection of antiarrhythmic therapy and radiofrequency ablation of arrhythmia source.
Russ J Cardiol 2015, 11 (127): 104–110
http://dx.doi.org/10.15829/1560-4071-2015-11-104-110
Key words ventricular arrhythmia, children, arrhythmogenic myocardium dysfunction, ventricular tachycardia, radiofrequency ablation.
1Federal Almazov North-Western Medical Research Center of the Healthcare Ministry, Saint-Petersburg; 2SBEI HPE Saint-Petersburg State Pediatrics Medical University of the Healthcare Ministry, Saint-Petersburg, Russia.
CLINICAL CASES
A CASE OF FOCAL ATRIAL TACHYCARDIA FROM THE LEFT ATRIAL APPENDAGE
Lebedev D. S .1, Termosesov S. A.2, Lebedeva V. K.1, Lyubimtseva T. A.1
Russ J Cardiol 2015, 11 (127): 111–113
http://dx.doi.org/10.15829/1560-4071-2015-11-111-113
Key words sinus tachycardia, atrial tachycardia, left atrial appendage, catheter ablation, navigation and mapping.
1Federal Almazov North-West Medical Research Centre of the Ministry of Health, Saint-Petersburg; 2Research clinical Institute of Pediatrics n. a. Acad. J. E. Veltishev Russian national research medical University n. a. N. I . Pirogov, Moscow, Russia.
MULTIDISCIPLINARY APPROACH TO IMPLANTATION OF RESYNCHRONIZING DEVICES
Osadchiy An.M.1, Kamenev A.V.2, Agarkov M.V.1, Pavlova N.E.1, Vlasenko S.V.1, Lebedeva S.V.1, Shcherbak S.G.1, Lebedev D.S.2
Russ J Cardiol 2015, 11 (127): 114–115
http://dx.doi.org/10.15829/1560-4071-2015-11-114-115
Key words resynchronizing therapy, chronic heart failure, coronary sinus, LV electrode implantation, stenting.
1SBHI SH №40, Saint-Petersburg; 2Federal Almazov North-West Medical Research Centre of the Ministry of Health, Saint-Petersburg, Russia.
UNEXPECTED DIFFICULTIES IN LONG PERSISTING ATRIAL FIBRILLATION TREATMENT
Mironov N. Yu., Gorieva Sh. B., Golitsyn S . P.
Russ J Cardiol 2015, 11 (127): 116–117
http://dx.doi.org/10.15829/1560-4071-2015-11-116-117
Key words atrial fibrillation, orthostatic hypotension, syncope.
FSBI Russian Cardiological Scientific-Production Complex of the Healthcare Ministry, Moscow, Russia.
THE INFLUENCE OF THYROID DISORDERS ON CARDIOVASCULAR SYSTEM: CLINICAL CASE
Chervyakova G. A.1, Sharipov R. A.2
Abstract Changes in the cardiovascular system are frequently put in the first place in the clinical picture of thyrotoxicosis while subclinical disease course is often neglected. Patients develop thyrotoxic cardiopathy which regresses in case of early detection and adequate treatment. It develops slowly in case of failure to recognize the syndrome of the disease. The article is a case study which illustrates a clinical course of an uncommon complication of thyrotoxicosis — conductivity disturbance which leads to atrioventricular obstruction.
Russ J Cardiol 2015, 11 (127): 118–122
http://dx.doi.org/10.15829/1560-4071-2015-11-118-122
Key words hyperthyroidism, thyreotoxic cardiomyopathy, post operation hypothyroidism, conduction disorder, complete atrioventricular block.
1SBEI HPE RNRMU n. a. N. I . Pirogov, Moscow; 2CCH №15 n. a. O. M. Filatov, Moscow, Russia.
