CONTENTS
СОДЕРЖАНИЕRUSSIAN JOURNAL OF CARDIOLOGY, 2016, 1 (129)
Address to the readers
Russ J Cardiol 2016, 1 (129): 5
CLINICAL MEDICINE NEWS
Clinical medicine updates: a review of international news
Russ J Cardiol 2016, 1 (129): 6
ORIGINAL ARTICLES
DCMP AS A CLINICAL SYNDROME: RESULTS OF NOSOLOGICAL DIAGNOSTICS WITH MYOCARDIAL BIOPSY AND DIFFERENTIATED TREATMENT IN VIRUS-POSITIVE AND VIRUS-NEGATIVE PATIENTS
Blagova O.V.1, Nedostup A.V.1, Kogan E.A.1, Sedov V.P.1, Donnikov A.E.2, Kadochnikova V.V.2, Zaydenov V.A.3, Kupriyanova A.G.4, Sulimov V. A.1
Abstract
Aim. The nosological diagnostics in patients with the baseline syndromic diagnosis "dilated cardiomyopathy" (DCMP) with the use of myocardial biopsy and evaluation of complex treatment (cardiotropic, antiviral, immune suppressing, surgical), including virus-positive and virus-negative patients with myocarditis.
Material and methods. Totally, 220 patients included with DCMP syndrome, 69 women and 151 men (31,4% and 68,6%), from 16 to 77 y. o. (mean age — 47,5±12,5,) with dilation and systolic dysfunction of the left ventricle (LV); end diastolic size (EDS) more than 5,5 cm; ejection fraction (EF) less than 50%, and absence of exclusion criteria. Mean EDS was 6,5 [6,0; 7,1] cm, EF — 30,3±10,1%, dp/dt 659 [535; 774,25] mmHg, VTI — 10,8±3,9 cm. The assessments were done of the anticardial antibodies via immune enzyme assay (IEA) and PCR-diagnostics of viral genome in blood of 95,5% patients, tread-mill test (5,9%), coronary arteriography (41,8%), MSCT (67,7%), MRI (22,3%), scintigraphy with 99mТс-MIBI (31,4%), genetic consultation and DNA-diagnostics via sequencing by Senger (21,8% and 16,8%). Morphological study of myocardium was done in 84 (38,2%) patients, incl. 52 endomyocardial biopsies (EMB) with PCR for parvovirus B19 genome and herpes viruses.
Results. By the data of clinical-morphological assessment, viral genome in blood was revealed in 21% patients, in myocardium — 52%, definite myocarditis was set in 48%, possible — 8%, genetical DCMP.— in 12%, myocarditis with genetic cardiomyopathy — 23% (incl. those with pathogenic mutations in genes MYBPC3, DSP, DSG2, LMNA, EMD, DES, TTR, DTNA), idiopathic DCMP.— in 9%. In 59% patients myocarditis was primarily chronic, in more than one third of patients there was combination of several causes for DCMP (incl. alcohol). Short-term and long-term results of treatment were evaluated in 127 patients with myocarditis: 52 virus-positive by blood and/or myocardium (myocarditis morphologically proved in 73,1%) and 75 virus-negative (biopsy in 30,7%), that differed by a little lower EDS LV and lower EF. Significant differences by immunity activation (titres of anticardial antibodies) were not found; in 7% there was isolated viral myocarditis, in 34% — viral-immune; in 59% — immune. If viruses were found, therapy ordered with acyclovir, gancyclovir, entecavir, i. v. immunoglobulines; elimination of virus from the blood reached in 81% of patients. If there was tolerance to cardiotropic therapy and high immune activity, immune suppression therapy (IST) was ordered: in 51% of virus-positive and 62,7% virus-negative patients: steroids 30 [22; 40] and 24 [16; 32] mg/day, azathioprin 1-2 mg/kg, hydroxychloroquine 200 mg/day. In 12,0 [6,0; 20,0] months it was found that only in IST group there was remarkable decrease of CHF FC, LV sizes, MPPA and increase of EF LV from 30,3±10,6% to 39,2±11,9% independently from presence or absence of viral genome. In absence of IST such dynamics was not found. The best results were found in virus-negative patients receiving IST (mortality 9,8%, need for surgical treatment 21,3%), the worst — in virus-positive patients without IST (66,7% and 61,1%, respectively).
Conclusion. Nosological nature of DCMP syndrome can be defined in most cases; usually there is myocaditis in its origin. IST in high immune activity of myocarditis (high titers of anticardial antibodies) leads to significant increase of EF, decrease of the left ventricle size, MPPA, mortality and necessity of surgery in virus-negative, as in virus-positive patients.
Russ J Cardiol 2016, 1 (129): 7–19
http://dx.doi.org/10.15829/1560-4071-2016-1-7-19
Key words: dilation cardiomyopathy, myocarditis, endomyocardial biopsy, anticardial antibodies, herpes viruses, antiviral therapy, immunity suppression therapy.
1I.M. Sechenov First Moscow State Medical University of the Ministry of Health, Moscow, Russia; 2SPF "DNA-technology", Moscow; 3V. I. Shumakov Federal Research Center of Transplantology and Artificial Organs of the Ministry of Health, Moscow; 4Research clinical institute of pediatrics N. I. Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia.
THE SPECIFICS OF HYPERTROPHIC CARDIOMYOPATHY CLINICAL PRESENTATION IN PATIENTS WITH VARIOUS MUTATIONS OF SARCOMERE GENES
Komissarova S. M .1, Chakova N. N.2, Niyazova S. S.2, Kazakov S. V.3, Zhukova E. A.4, Aleksandrov A. V.3, Glotov O. S.4,5, Glotov A. S.4,5
Abstract
Aim. The assessment of clinical presentation of HCMP in patients having mutations of the sarcomere protein genes.
Material and methods. In 11 patients with hypertrophic cardiomyopathy (HCMP) we performed analysis of clinical and instrumental data and search for mutations of coding sequences of the genes ACTC1, MYBPC3, MYH7, MYL2, MYL3, TNNI3, TNNT2 и TPM1 via the sequencing method (next-generation sequencing (NGS).
Results. The clinical presentation is described, of HCMP, and the analysis provided of the complications development during the period of follow-up of the patients with genes coding sarcomere proteins: Arg403Trp, Lys847del and Arg1712Trp (gene MYH7); Gln1233Term, Trp1214Arg, Arg502Gln, Arg326Gln and Ser236Gly (gene MYBPC3); Arg58Gln in gene MYL2.
Conclusion. The revealed mutations in sarcomere genes in patients with HCMP are associated with early clinical onset of the disease, with worse family anamnesis and development of complications during follow-up.
Russ J Cardiol 2016, 1 (129): 20–25
http://dx.doi.org/10.15829/1560-4071-2016-1-20-25
Key words: hypertrophic cardiomyopathy, sequencing of the next generation, sarcomere genes, mutations, clinical presentation.
1Republic Scientific-Practical Center "Cardiology", Minsk, Belorussia; 2Institute of Genetics and Cytology of NSA of Belorussia, Minsk, Belorussia; 3Saint-Petersburg National Research University of Information Technologies, Mechanics and Optics, Saint-Petersburg, Russia; 4FSBSI The Research Institute of Obstetrics, Gynecology and Reproductology n.a. D.O. Ott, Saint-Petersburg, Russia; 5Saint-Petersburg State University, Saint-Petersburg, Russia.
THE SPECIFICS AND WAY OF ATRIOVENTRICULAR BLOCK COURSE IN INFANTS MYOCARDITIS
Vasichkina E. S.1, Lyuskina N. M .1, Pervunina T. M .1,2, Lebedev D. S.1
Abstract
Aim. To study the specifics of clinical course and outcomes of higher degree AVB, developed due to inflammatory changes of myocardium in infants, during three years follow-up.
Material and methods. For the assessment of AVB specifics in current myocarditis we have summarized the investigation data of 6 patients younger than 1,5 y. o.; mean age 10,0±4,5 months (3 to 16 months). In all clinical cases we performed the analysis of medical source documents with outcopying of pregnancy data, analysis of cardiotocography (CTG) data and ultrasound examination (USE) of the fetus (to rule out inborn cause for AVB), stages of the growth and development of a child, diseases anamnesis. The complex laboratory and instrumental investigation was done, including evaluation of biochemical markers of inflammation and serum markers of myocardial damage, electrocardiographic (ECG) and echocardiographic (EchoCG) studies.
Results. Mean follow-up was 23,3±10,4 months (from 9 to 35 months). On treatment, all patients had tendency for the decrease of cardiac specific enzymes, the decrease of heart failure functional class and positive EchoCG dynamics by the end of the first year. However, AV-conduction disorders of the heart in all patients had irreversible course. Permanent pacemaker (PPM) was set up in two cases, in 6 and 14 months after diagnosis.
Conclusion. In infants the AV conduction disorders that develop in myocarditis, show irreversible pattern of clinical course.
Russ J Cardiol 2016, 1 (129): 26–31
http://dx.doi.org/10.15829/1560-4071-2016-1-26-31
Key words: atrioventricular block, antrioventricular conduction, myocarditis, infants, permanent pacemaker.
1Federal Almazov North-West Medical Research Centre of the Ministry of Health, Saint-Petersburg; 2Saint-Petersburg State University, Saint-Petersburg, Russia.
IMMUNOPATHOGENESIS OF HEART FAILURE IN PATIENTS WITH INFECTIVE-IMMUNE MYOCARDITIS
Paleev F. N.1, Sanina N. P.1, Makarkov A. I.2, Khishova N. N.1, Moskaletz O. V.1, Paleev N. R.1
Abstract
Aim. To study quantitative parameters, specifics of functional state of the main subpopulations of peripheral blood lymphocytes of the infective-immune myocarditis patients (IIM) and postmyocarditis cardiosclerosis (PMC), and specifics of cytokine profile.
Material and methods. Totally, 35 IIM patients included, and 39 with PMC. In 17 patients with IIM there was significant heart failure (HF) — III functional class (FC) by New-York Heart Association (NYHA), in 18 patients with IIM there were no signs of HF, or mild signs (0-II FC by NYHA). In 18 patients with PMC there were no signs of HF, and in 21 — there was I FC by NYHA. The controls were 10 formally healthy persons. Study of population and subpopulation contents, and lymphocytes activation markers of peripheral blood, was done with four-color laser flow cytometry using FACSCalibur equipment and relevant monoclonal antibodies (Beckton Dickinson, USA). We studied the mean cytokines concentrations characterizing Th1-, Th2- and Th17- subpopulations of the helper lymphocytes. Measurement of serum cytokines was done with the method solid-phase immune-enzyme assay with LLC "Vectro-Best" (Russia) media. Statistics was done with software PASW Statistics 18.
Results. Inflammatory diseases of myocardium show the deviations of native, as acquired immunity. In IIM and PMC there was significant decrease of NKT-lymphocytes, not related to the severity of HF signs and durations of the disease. Immunity activation signs in IIM group showed the increase of the early activator marker CD25 expression activation, that was marked during the first 2 weeks from the disease onset. Following, by the end of the 1st month and on the 2nd month from the disease onset, the increase of T- and non-T-lymphocytes was found with the signs of delayed activation, revealed by HLA-DR antigen expression. The activator marker patterns were differ in patients with different grade of HF severity. Concentration of interferon-γ (IFN-γ) and interleukine (IL)-4 was more than 3 times higher in IIM patients comparing to controls. There was more than 7-times higher increase of IL-17A, and concentrations of effectory cytokines of Th17-subpopulation — IL-8 and granulocyte-macrophagal colony-stimulating factor (GM CSF). The level of IFN-γ reached maximal levels during the first 2 weeks from the disease onset. Later, IFN-γ concentration declined. Opposite, serum level of IL-4 was significantly increased by the end of the 1st and on the 2nd month from disease onset. Concentrations of IL-17A, IL-8 and GM CSF in blood serum were increased during the whole 2nd week, by the end of the 1st month and on the 2nd month. Th17-cytokines concentrations were significantly increased in PMC patients. Level of IL-17A was higher than in controls almost two times, IL8 — by 51%, GM CSF — by 50%. Serum levels of IL-4, and IL-17A, IL-8 and GM CSF were higher in subgroup of PMC patients with the disease duration less than 6 months.
Conclusion. Disorders of anti-infection immunity and mechanisms of selfrestriction of immune reactions do play important role in development of myocardium damage of inflammatory origin.
Russ J Cardiol 2016, 1 (129): 32–40
http://dx.doi.org/10.15829/1560-4071-2016-1-32-40
Key words: infective-immune myocarditis, postmyocarditis cardiosclerosis, lymphocytes, immune activation.
1Moscow Regional Research and Clinical Institute (MONIKI), Moscow; 2Center for Family Care and Reproduction of the Healthcare Department of Moscow, Moscow, Russia.
CHANGE OF THE LEFT VENTRICLE FUNCTIONING IN LYMPHOMA TREATED WITH ANTHRACYCLINE ANTIBIOTICS
Shuykova K. V., Emelina E. I., Gendlin G. E., Storojakov G. I.
Abstract
Aim. Study of toxic effect of anthracycline anibiotics on the heart in various periods of application.
Material and methods. We studied 94 patients with lymphomas before, at the moment and in long-term follow-up of chemotherapy. All patients underwent AHM with HRV and QTc duration. In EchoCG we studied systolic and diastolic LV function; the latter — with values of V1/3, IF and RF in the first third of diastole.
Results. In some patients at the moment of anthracycline application we found the prolonged QTc with statistically lower HRV and diastolic parameters (IF and RF of LV). In 11 from 24 patients, assessed in dynamics, we found the signs of CHF, followed with consequent decrease of EDV, iEDV amd RF of LV.
Conclusion. In some patients at the moment of anthracycline antibiotics load there is covert diastolic dysfunction of the LV and predominance of SNS on the heart that might lead later to remodeling of myocardium with the development of anthracyclineinduced cardiomyopathy.
Russ J Cardiol 2016, 1 (129): 41–46
http://dx.doi.org/10.15829/1560-4071-2016-1-41-46
Key words: chemotherapy, anthracycline cardiotoxicity, heart rate variability, corrected interval, diastolic dysfunction, left ventricle volume in first third of diastole, injection fraction, relaxation fraction.
N. I. Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia.
STRUCTURE OF MORPHOLOGICAL CHANGES OF MYOCARDIUM IN NON-CORONARY ORIGIN SYSTOLIC DYSFUNCTION OF THE LEFT VENTRICLE
Bakhchoyan M . R .1, Kosmacheva E. D.1, Slavinsky A. A.1, Terman E. A.2, Porkhanov V. A.2
Abstract
Aim. To assess morphological changes of myocardium in patients with noncoronarogenic systolic dysfunction of the left ventricle (LV).
Material and methods. Totally, 96 patients studied. Among the 80 males, 16 females at the age 14-66 y. o. Follow-up duration: April, 2010 — August, 2014. In 81 patient coronary arteriography was done to rule out atherosclerotic lesion of arteries. Nine patients were excluded due to hemodynamically significant stenoses. Others underwent endomyocardial biopsy of the right ventricle.
Results. All patients suffered from various degree CHF (by NYHA): FC I — 2,83%, FC II — 16,9%, FC III — 56,33%, FC IV — 23,94%. By EchoCG the ejection fraction of LV was 20,67±8,10%, by left ventriculography — 21,75±8,94%. The intervention group underwent biopsy of the right ventricle with further qualitative and quantitative study of myocardial infiltrate and its histomorphological assessment. We got following results: definite myocarditis — 1,39%, possible myocarditis — 9,71%, myocarditis cardiosclerosis — 6,94%, non-inflammatory cardiomyopathy — 38,9%, amyloidosis — 1,39%. In 37,5% cases myocardial specimens were of common histological structure, without signs of current inflammation and myocyte necrosis; 4,17% of specimens were non-informative due to lack of amount for assessment.
Conclusion. The data obtained in the study makes it possible to define nosological structure of severe systolic dysfunction of the LV of non-coronary origin in Krasnodarsky Region. Taken the absence in Russian Federation of any large scale epidemiological studies of the problem, it is necessary to elaborate database and to implement it into routine practice of cardiologists. Such data might improve diagnostics, etiotropic and pathogenetic therapy, and improve outcomes of the diseases group.
Russ J Cardiol 2016, 1 (129): 47–50
http://dx.doi.org/10.15829/1560-4071-2016-1-47-50
Key words: cardiomyopathy, myocarditis, endomyocardial biopsy, heart failure.
1Kuban State Medical University of the Ministry of Health, Krasnodar; 2Research Institute, S. V. Ochapovskiy Regional clinical hospital №1, Krasnodar, Russia.
CLINIC AND PHARMACOTHERAPY
THE INFLUENCE OF LIFESTYLE ON THE EFFICACY AND SAFETY OF MEDICATIONS IN CARDIOLOGICAL PRACTICE: WHAT SHALL PHYSICIAN BE AWARE OF?
Tarlovskaya E. I.1, Koziolova N. A.2, Chesnikova A. I.3
Abstract The article provides an overview of the data on the influence of food, herbs, alcohol and smoking on the efficacy and safety of drug treatments. It is shown, that strictly implausible is to take drug treatments and fitomedicines at the same time, those influencing metabolism in opposite ways. Alcohol consumption, depending on duration and intensity, also influences the effectiveness of drugs. The compounds of tobacco smoke significantly decrease the effectiveness of many medications, activating cytochrome systems. While choosing the medications, it is important to prefer those drugs having minimum interactions with food as with drugs.
Russ J Cardiol 2016, 1 (129): 51–59
http://dx.doi.org/10.15829/1560-4071-2016-1-51-59
Key words: food interaction, herbs, alcohol, tobacco smoking, valsartan, rosuvastatin, clopidogrel.
1Nizhny Novgorod State Medical Academy of the Ministry of Health, Nizhny Novgorod; 2Wagner E. A. Perm State Medical University of the Ministry of Health, Perm; 3Rostov State Medical University of the Ministry of Health, Rostov-na-Donu, Russia.
ASSESSMENT OF THE PERIOPERATION RISK WITH VerifyNow ARU® TOOL IN PATIENTS AFTER CORONARY BYPASS ON PROLONGED ASPIRIN TREATMENT
Krivoshapova K. E.1,2, Altarev S. S.1, Gruzdeva O. V.1, Plotnikov G. P.1, Barbarash O. L.1,2
Abstract
Aim. During perioperation time of coronary bypass grafting (CBG) to evaluate diagnostical significance of platelet functional activity by the system VerifyNow ARUR in assessment of high hemorrhagic and ischemia risk patients on prolonged aspirin treatment.
Material and methods. Totally, 32 patients included, that were preparing for planned primary operation of CBG. In perioperation time all patients were taking acetylsalicylic acid 75-100 mg/day. Platelet function was assessed in 3 days before surgical intervention with VerifyNow ARUR (Accumetrics, USA).
Results. Depending on the ARU level, all patients were selected into two groups. First group (1), consisted of 11 patients, included those with the highest antiplatelet effect of aspirin, the second (2) included all the rest. Mean value of VerifyNow among all selection, in groups 1 and 2 was, respectively, 505,9±87,3, 425,2±21,7 and 548,2±78,2 ARU. Comparison groups were comparable in clinical and anamnestic properties. By the values of intraoperation blood loss (509,1±30,2 mL in the 1st group versus 515,8±50,1 mL in the second, p=0,30) and postoperation blood loss (drainage flow during 6 hours was 115,9±42,2 mL in the 1st group vs. 111,8±38,5 mL in the 2nd, p=0,87; during 12 hours 188,6±83,9 mL in 1st vs. 187,4±93,0 mL, resp., p=0,89; during 24 hours — 218,2±110,2 mL vs. 253,6±142,6 mL, resp., p=0,70) comparison groups did not differ. In correlation assessment there was tendency found of the platelets reactivity level with 6-hour blood loss (p=0,09). This data was confirmed by the results of linear regression analysis, that showed negative correlation of blood loss volume and VerifyNow results. In five patients (15,6%) postoperation period complicated with coronary flow instability and development of myocardial infarction, confirmed by dynamics of myocardial damage markers. All five patients were in the second and third terciles of VerifyNow, in lower tercile of VerifyNow there were no any perioperational coronary events (p=0,14).
Conclusion. Results of the analysis demonstrate that the assessment of functional activity of platelets by VerifyNow assay can be applied as laboratory criteria for prediction of postoperation blood loss and perioperation ischemia events in CBG operations at the background of prolonged aspirin therapy.
Russ J Cardiol 2016, 1 (129): 60–67
http://dx.doi.org/10.15829/1560-4071-2016-1-60-67
Key words: prolonged aspirin therapy, perioperation complications, aorticcoronary bypass grafting, system VerifyNow ARUR.
1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo; 2Kemerovo State Medical Academy of the Ministry of Health, Kemerovo, Russia.
APPLICATION OF RIVAROXABAN IN ACUTE CORONARY SYNDROME: EVIDENCE AND CURRENT GUIDELINES
Averkov O. V.1,2
Abstract The analytical article focuses on the data concerning duration of anticoagulation treatment in acute coronary syndrome patients. The information provided on the evidence for impossibility of widespread usage of vitamin K antagonists in acute coronary syndrome — the novel selective oral anticoagulants that differ from rivaroxaban. The main evidence is showed for efficacy and safety of rivaroxaban in acute coronary syndrome, conditions of its application and fundamentals for dosage selection as 2,5 mg two times per day. European and Russian Guidelines are presented that permit usage of rivaroxaban in acute coronary syndrome.
Russ J Cardiol 2016, 1 (129): 68–72
http://dx.doi.org/10.15829/1560-4071-2016-1-68-72
Key words: acute coronary syndrome, myocardial infarction, anticoagulants, Xa factor inhibitor, rivaroxaban.
1O. M . Filatov City Clinical Hospital №15, Moscow; 2Peoples Friendship University of Russia, Moscow, Russia.
LITERATURE REVIEWS
THE ROLE OF ENDOMYOCARDIAL BIOPSY IN DIAGNOSTICS OF INFLAMMATORY MYOCARDIUM DISEASES
Mitrofanova L. B.
Abstract Literary review focuses on the role of endomyocardial biopsy in diagnostics of inflammatory diseases of myocardium. The article discusses indications for biopsy, its informativity, and diagnostical value; the list of possible complications is provided, the clear algorithm defined for histological, histochemical, immunehistochemical investigation of the specimens with differential diagnosis of the pathological findings. The review provides with the analysis of molecular-biological methods, that are in use for verification of myocarditis etiology, recent morphological criteria provided for different types of the disease.
Russ J Cardiol 2016, 1 (129): 73–79
http://dx.doi.org/10.15829/1560-4071-2016-1-73-79
Key words: endomyocardial biopsy, morphological diagnosis, myocarditis.
Federal Almazov North-West Medical Research Centre of the Ministry of Health, Saint-Petersburg, Russia.
INFECTIVE ENDOCARDITIS IN ELDERLY: FROM ETIOLOGY TO TREATMENT AND PREVENTION
Vatutin N. T.1,2, Taradin G. G.1, Tchaus E. A.1, Smirnova A. S.1
Abstract The review reflects the changes of epidemiological profile of infective endocarditis (IE) with an increase of prevalence in elderly. The risk factors are discussed, including anamnesis of various endocardium diseases, artificial valves implantation, different treatments or diagnostic procedures and especially cardiosurgical interventions. Among risk factors, predisposing to the infectious involvement of endocardium in elderly, are calcification of leaflets, age-related changes, diabetes, inflammatory diseases of gastrointestinal and urogenital tracts. The specifics of etiological spectrum of IE microbes is presented, with increased prevalence of S. bovis endocarditis, enterococcus, coagulase-negative staphylococci, in comparison with younger patients. The review focuses on microbiological diagnostics as one of the main criteria of IE. Approaches to treatment of the disease are shown with general principles, selection of empirical therapy and prescription of relevant antibacterial drugs after obtaining of bacteriological results of hemoculture. The principles of treatment of the elderly are based upon expert Guidelines of European Society of Cardiology and American Heart Association, published in 2015. The importance underlined of prevention in higher risk groups and procedures of high risk, as of following general hygienic and sanitation norms.
Russ J Cardiol 2016, 1 (129): 80–89
http://dx.doi.org/10.15829/1560-4071-2016-1-80-89
Key words: infective endocarditis, elderly, etiology, antibiotics, treatment, prevention.
1M. Gorky Donetsk National Medical University, Donetsk; 2V. K. Gusak Institute of Urgent and Reconstruction Surgery, Donetsk, DFR.
LECTURE
PERICARDIUM DISEASES
Dyomin A. A., Drobysheva V. P.
Abstract The lecture summarizes published and our own data on etiology, diagnostics, management, prevention and prediction of pericarditis (PC), that is currently the most common type of pericardium diseases (PD) and quite common cause of chest pain. Causes of PD differ and usually are related to infections (viral and bacterial), neoplasms (primary and secondary), autoimmune disorders (connective tissue diseases and vasculitides), drugs and the syndrome of pericardial damage. Idiopathic/viral PC is the most common type of PD and shows recurrence in one third of patients. the diagnosis is based upon clinical and instrumental criteria (ECG, EchoCG, cardiac MR I, pericardium biopsy). In acute PC the most common treatments are NSAIDs, antiviral drugs and, additionally, colchicine (first line treatment). New treatment for recurrent PC is intravenous immunoglobulins or anakinra (second line treatment). In our own last series of patients the evolution of PD causes has been marked: tendency to increase of specific types of PC (tuberculosis, autoimmune) and appearance of novel iatrogenic types after cardiovascular interventions. Therapy with non-steroidal antinflammatory drugs and colchicine do decrease the rate of recurrents.
Russ J Cardiol 2016, 1 (129): 90–98
http://dx.doi.org/10.15829/1560-4071-2016-1-90-98
Key words: pericardium diseases, etiology changes, clinical signs, diagnostics, treatment.
Novosibirsk State Medical University, Novosibirsk, Russia.
CLINICAL CASE
ISOLATED SARCOIDOSIS OF THE HEART: CLINICAL CASE AND LITERARY REVIEW
Moiseeva O. M ., Mikhailov E. N., Mitrofanova L. B., Khashchevskaya D. A., Ignatieva E. S., Malikov K. N., Ryzhkova D. V.
Abstract The case is presented of the isolated sarcoidosis of the heart, presented with permanently recurrent ventricular tachicardia. The diagnosis was set based on the histological and immune-histochemical analysis of myocardium specimens. The algorithm of diagnostics of the heart involvement in sarcoidosis is discussed based on echocardiographical, magnetic resonance and positrone-emission with 18F-fluorodesoxyglucose data. The analysis of literary data on prevalence of sarcoidosis of the heart is provided, as its clinical presentation, diagnostics and main approaches to treatment.
Russ J Cardiol 2016, 1 (129): 99–104
http://dx.doi.org/10.15829/1560-4071-2016-1-99-104
Key words: heart sarcoidosis, diagnostics, treatment.
Federal Almazov North-West Medical Research Centre of the Ministry of Health, Saint-Petersburg, Russia.
