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СОДЕРЖАНИЕ

RUSSIAN JOURNAL OF CARDIOLOGY, 2016, 3 (131)

Address to the readers

Russ J Cardiol 2016, 3 (131): 6

CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russ J Cardiol 2016, 3 (131): 8

CLINICAL GUIDELINES

2015 ESC GUIDELINES FOR THE MANAGEMENT OF ACUTE CORONARY SYNDROMES IN PATIENTS PRESENTING WITHOUT PERSISTENT ST-SEGMENT ELEVATION

Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC)

Russ J Cardiol 2016, 3 (131): 9–63

http://dx.doi.org/10.15829/1560-4071-2016-3-9-63

Key words: acute cardiac care, acute coronary syndromes, angioplasty, anticoagulation, apixaban, aspirin, atherothrombosis, beta-blockers, bivalirudin, bypass surgery, cangrelor, chest pain unit, clopidogrel, dabigatran, diabetes, early invasive strategy, enoxaparin, European Society of Cardiology, fondaparinux, glycoprotein IIb/IIIa inhibitors, guidelines, heparin, high-sensitivity troponin, myocardial ischaemia, nitrates, non-ST-elevation myocardial infarction, platelet inhibition, prasugrel, recommendations, revascularization, rhythm monitoring, rivaroxaban, statin, stent, ticagrelor, unstable angina, vorapaxar.

ORIGINAL ARTICLES

REGIONAL ALGORITHM OF CARE IN ST ELEVATION MYOCARDIAL INFARCTION

Vafin A. Yu., Galyavich A. S.

Abstract The aim of the study — to present the developed and applied algorithms of ST elevation myocardial infarction (STEMI) patients. The data analyzed on the medical care provision for STEMI in Tatarstan Republic in 2009-2015 y. Application of algorithms with considered regional specifics and resources makes to significantly decrease the values of in-hospital mortality in STEMI.

Russ J Cardiol 2016, 3 (131): 64–65

http://dx.doi.org/10.15829/1560-4071-2016-3-64-65

Key words: myocardial infarction, percutaneous coronary intervention.

Kazan State Medical University, Kazan, Russia.

PROGNOSTIC FACTORS AND LONGTERM SURVIVAL OF MYOCARDIAL INFARCTION PATIENTS, COMPLICATED BY EARLY RECURENT ANGINA AND RENAL FUNCTION DECREASE

Khasanov N. R.1, Belkorey O. S.2, Dyakova E. N.2

Abstract

Aim. To study prognosis factors for early postinfarction angina (EPA) in myocardial infarction (MI) and decreased functioning of kidneys, and long-term survival in this group of patients.

Material and methods. Into the retrospective study, 179 patients included, of hospitalized to Moscow clinics, with verified diagnosis MI. Decreased kidney function was defined as GFR <59 mL/min/1,73 m2. The endpoint was death and complications during hospitalization and all follow up. Time mediana was 18 months.

Results. Totally, 29 cases registered (17,4%) of EPA in MI and known GFR (n=167). Patients with EPA were significantly older (72±11 y. and 62±12 y., respectively, р=0,0001) and among those males predominated (p=0,001). Atrial fibrillation (AF) and diabetes (DM) among EPA patients were significantly more prevalent. In decreased renal function group, EPA was found in 45,5 (n=25), in normal GFR — in 3,5% (n=4, p=0,0001), and the risk of EPA in decreased GFR below 59 mL/ min/1,73 m2 increased 14 times (RR=13,9; 95% CI=4,23-45,65; p=0,001). Long term mortality in EPA group was 30,8% (p=0,001).

Conclusion. PCI improved survival rate in EPA and decreased renal function patients.

Russ J Cardiol 2016, 3 (131): 66–69

http://dx.doi.org/10.15829/1560-4071-2016-3-66-69

Key words: acute myocardial infarction, chronic kidney disease, glomerular filtration rate, early postinfarction angina.

1Kazan State Medical University, Kazan; 2City Polyclinics №218 of Healthcare Department, Moscow, Russia.

RESULTS OF ENDOVASCULAR REVASCULARIZATION IN ELDERLY PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION IN MULTIVESSEL DISEASE

Kochergina A. M.1,2, Tarasov R. S.1, Ganyukov V. I.1, Kashtalap V. V.1,2, Kochergin N. A.1, Barbarash O. L.1,2

Abstract

Aim. To study the results of endovascular revascularization in older patients with ST elevation myocardial infarction (STEMI) in multivessel disease (MV).

Material and methods. Totally, 327 patients included. Inclusion criteria were: STEMI with duration <12 hours and primary PCI; hemodynamically significant (≥70%) lesion of 2 and more coronary arteries; technically possible percutaneous intervention (PCI). Criteria of exclusion: acute heart failure Killip III-IV (pulmonary edema and cardiogenic shock); left main stem lesion ≥50%. Patients were selected to 2 groups according to their age. To the 1st group we included elderly persons (age ≥65 y., n=103), to the second — patients younger than 64 y. o., n=224. Endpoints of the study were death, myocardial infarction (MI) (fatal and non-fatal), recurred non-scheduled target vessel revascularization, and the prevalence of combination endpoint. Evaluation of long-term results was done with clinical data collection during office visit or phone survey.

Results. The group of elderly patients was characterized by expectedly more severe comorbidities, usually having cardiovascular risks as associated diseases, had higher SYNTAX score, significantly higher 30-day and year mortality rates. Prevalence of three-vessel disease, as the usage of drug-coated stents and multivessel strategy (MS) under the primary PCI tactics, were comparable.

Conclusion. Sedentary patients were characterized by higher levels of mortality in acute myocardial infarction in hospital period, which makes significant to do more investigations for the development of optimal revascularization strategies in elderly patients having MV.

Russ J Cardiol 2016, 3 (131): 70–74

http://dx.doi.org/10.15829/1560-4071-2016-3-70-74

Key words: myocardial infarction, primary PCI, multivessel disease, revascularization outcomes in elderly.

1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo; 2Kemerovo State Medical Academy of the Ministry of Health, Kemerovo, Russia.

BLOOD LEVEL OF COLLAGEN BIOMARKERS AND SULFATED GLYCOSAMINOGLYCANS IN ACUTE TRANSMURAL MYOCARDIAL INFARCTION

Govorin A. V., Ratsina E. V., Fetisova N. V., Sokolova N. A.

Abstract

Aim. To study dynamics of blood levels of carboxyterminal propeptide of I type procollagen (PICP), carboxyterminal telopeptide of type I collagen (CITP) and sulfated glycosaminoglycans (sGAG) in the dynamics, in patients with transmural transmural myocardial infarction (MI) complicated with aneurysm.

Material and methods. Totally, 46 patients included with acute transmural anterior MI, who underwent the assessment of PICP, CITP and sGAG in dynamics.

Results. On the 1st to 3rd days of MI without aneurysm there was increase of PICP up to 61,4 ng/mL, on 10-12th and 18-22nd days its level did not change significantly, remaining high. In aneurysm MI the level of PICP increased just from the 10-12th days and in lower grade — comparing to patients without aneurysm. Level of CITP in patients without aneurysm was comparable to controls during the entire study. Level of sGAG in non-aneurysm patients increased from 10-12th days, and in MI with aneurysm — did not differ from healthy persons during the entire study.

Conclusion. Increase of CITP and lower PICP and sGAG in MI patients with aneurysm witnesses' probable predominance of degradation processes of connective tissue over its synthesis.

Russ J Cardiol 2016, 3 (131): 75–79

http://dx.doi.org/10.15829/1560-4071-2016-3-75-79

Key words: transmural anterior MI, aneurysm, extracellular matrix, PICP, CITP, sGAG.

Chita State Medical Academy of the Ministry of Health, Chita, Russia.

LONG TERM CLINICAL RESULTS OF AUTOLOGOUS CD133+ BONE MARROW CELLS TRANSPLANTATION IN ST ELEVATION MYOCARDIAL INFARCTION PATIENTS

Kirgizova М. А.1, Ryabov V. V.1,2,3, Suslova Т. Е.1,3, Shtatolkina М. А.1, Markov V. А.1,2, Karpov R. S.1,2

Abstract

Aim. To study the long-term effectiveness and safety of CD133+ bone marrow cells transplantation in ST elevation myocardial infarction (STEMI) patients.

Material and methods. To the open-label, randomized study we included 26 patients, admitted with primary MI during years 2006-2007 to SRI of Cardiology. Patients were randomized to two groups: 1st — stenting of infarction-related coronary artery (IRA) and transplantation of CD133+ bone marrow cells (n=10), 2nd — only stenting of IRA (n=16). Baseline clinical and anamnestic parameters were similar. In 7,70±0,42 years after MI we performed control investigation, that included physical examination, 6-minute walking test (6WT), echocardiography.

Results. It is found, that in the 1st group comparing to the 2nd, total and cardiovascular mortality was lower (20% (2) vs 44% (7), p=0,11; 22% (2) vs 25% (4), p=0,58, resp.). In the 2nd there were 7 cases of recurrent MI (44% of patients), 4 of those were fatal, but in the 1st group there were no any recurrent MI (p=0,01). During the whole followup, unstable angina was more common in the 2nd group (11 (69%) vs 2 (20%) in 1st, р=0,04). CHF of II FC and higher was more common in 2nd group: 8 (50%) vs 2 (20%) in 1st, р=0,07. Also, there were significant differences in analysis of volumetrics of the left ventricle (EDV — 100,7±50,2 mL vs 144,4±42,7 mL, р=0,049; ESV — 56,3±37,8 mL vs 89,7±38,7 mL, р=0,049, resp.). These values were lower in the 1st group.

Conclusion. The results demonstrated that transplantation of autologous CD133+ bone marrow cells positively influences long-term survival of patients, CHD course and volumetric LV parameters.

Russ J Cardiol 2016, 3 (131): 80–86

http://dx.doi.org/10.15829/1560-4071-2016-3-80-86

Key words: CD133+ bone marrow cells, myocardial infarction.

1Scientific-Research Institute of Cardiology, Tomsk; 2Siberian State Medical University of the Ministry of Health, Tomsk; 3National Research Tomsk State University, Tomsk, Russia.

CLINIC AND PHARMACOTHERAPY

ASSESSMENT OF DIASTOLIC FUNCTION OF THE LEFT VENTRICLE, INTIMA-MEDIA THICKNESS AND EXERCISE TOLERANCE IN CHD PATIENTS TAKING BISOPROLOL AND IVABRADINE

Khairutdinova G. I.1, Babushkina G. V.1,2,3

Abstract

Aim. To assess the parameters of the left ventricle diastolic function, intima-media thickness, exercise tolerance in stable angina and CHF I-III FC (NYHA) with sinus rhythm and HR >70 bpm; with the signs of diastolic dysfunction of I type and EF >50% taking bisoprolol and ivabradine (Coraxan®, Les Laboratories Servier, France).

Material and methods. Totally, 73 patients studied with stable angina of II and III FC with CHF I-III FC (NYHA) at the age 40-65 y. o., HR >70 bpm and I type diastolic dysfunction of the left ventricle (LV), during 12 weeks. Patients were randomized to 3 groups: group A consisted of 27 patients who received bisoprolol with dose titration up to 10 mg per day; group B — 24 patients taking combination therapy with bisoprolol and Coraxan®, group В — 22 patients taking Coraxan® up to 15 mg per day. Patients of all groups received basic therapy by angiotensin converting enzyme inhibitors (ACEi), antiplatelet drugs, statins, short acting nitrates for angina attacks. To assess the results of the study, 6-minute walking test was performed, with echocardiography and Doppler, electrocardiography (ECG), ultrasound duplex scan of arteries of the head (UDSAH).

Results. By the results of our study, in all three groups there was target HR achievement, that was followed by statistically significant increase of exercise tolerance by the results of 6-minute walking test, most prominent in the group of patients taking bisoprolol with Coraxan®. Echo in three groups at baseline and in 12 week showed significant deceleration of diastolic flow through mitral valve only in the group receiving Coraxan® (р<0,05), and increase of the velocity of early diastolic filling in this group (р<0,01). By the results of UDSAH, there was tendency to decrease of intima-media thickness in all groups.

Conclusion. In stable angina patients with CHF I-III FC taking complex therapy with β-blocker bisoprolol and/or Coraxan®, was the target level of HR reached, that retained for 12 weeks and was followed by increase of exercise tolerance (p<0,05 to <0,01). In the group of patients who received ivabradine, there was improvement of the values of diastolic function of the left ventricle that helped to increase effective duration of diastolic filling of the left ventricle.

Russ J Cardiol 2016, 3 (131): 87–91

http://dx.doi.org/10.15829/1560-4071-2016-3-87-91

Key words: chronic heart failure, diastolic dysfunction, angina pectoris, heart rate, 6-minute walking test, intima-media complex.

1Bashkirsky State Medical University of the Ministry of Health, Ufa; 2LLC Cardioneurological Dispensary, Ufa; 3Healthcare Institution CCH №13, Ufa, Russia.

STUDY OF CARDIOPROTECTIVE AND ANTI-ISCHEMIC EFFECTIVENESS OF STANDARD TREATMENT FOR ISCHEMIC HEART DISEASE WITH ADDITION OF PERINDOPRIL ARGININE, IN OLDER PATIENTS

Maksyutova L. F., Maksyutova A. F., Bikkinina G. M.

Abstract

Aim. To evaluate the cardioprotective, anti-ischemic and vasoprotective effectiveness of perindopril arginine (Prestarium А®, Les Laboratories Servier,France) in stable angina patients of older age, after myocardial infarction (MI).

Material and methods. Totally, 68 patients of older age (72±12 y.) included, with stable angina, who had MI. All patients underwent echocardiography with dopplerographic analysis of transmitral blood flow, Holter monitoring of ECG, ultrasound dopplerography of carotid arteries. Patients from the 1 group (33 persons) were taking standard therapy of stable angina. Patients from the 2 group (n=35) as addition were taking PA 10 mg daily.

Results. By the data of Holter ECG, in patients of both groups there was decrease of mean frequency of angina attacks (by 76,4% in 1 group, by 86,3% in 2), need for nitroglycerin use (by 68,7% and 71,3%, resp.), frequency of ischemia episodes (by 35,5% and 55,6%, resp.), total daily duration of ischemia (50,3% and 49,7%), depth of ischemic ST segment depression (44,6% and 58,6%, resp.). There was more prominent significant decrease of the parameters mentioned, in patients taking Prestarium А®. Also, in the 2 group patients the decrease of intima-media thickness of the right and left common carotid arteries was more significant than in the 1 group. In 2 group there was increase of relation of the peak velocities of the left ventricle (LV) filling in early phase of diastole and in atrium systole phase, by 14,6% and decrease of end-diastolic size of the LV by 10,9%.

Conclusion. Usage of Prestarium А® in stable angina patients of older age, after MI, was effective, which presented with the decrease of the frequency and intensity of angina attacks, slowing of desadaptive LV remodeling processes, improvement of clinical condition, decrease of supraventricular rhythm disorders, positive influence on the heart and vessels, hence having vasoprotective and cardioprotective effect.

Russ J Cardiol 2016, 3 (131): 92–96

http://dx.doi.org/10.15829/1560-4071-2016-3-92-96

Key words: stable angina, postinfarction cardiosclerosis, perindopril arginin.

Bashkirsky State Medical University of the Ministry of Health, Ufa, Russia.

CLOPIDOGREL FOR SELECTIVE MYOCARDIAL REVASCULARIZATION

Teplova N. V.

Abstract The article focuses on the practical issues of selective revascularization of myocardium, including the specifics of procedure and patients characteristics, whom this intervention is at most indicated. The emphasis is done on antiplatelet therapy, its timing related to the procedure itself, and on the recommended drugs. The data is provided from the point of evidence based medicine — recent European Guidelines.

Russ J Cardiol 2016, 3 (131): 97–100

http://dx.doi.org/10.15829/1560-4071-2016-3-97-100

Key words: percutaneous coronary intervention, aspirin, acetylsalicylic acid, clopidogrel, clapitax, stable coronary heart disease, angina.

N. I. Pirogov Russian National Research Medical University, Moscow, Russia.

IN-PATIENT OUTCOMES OF PHARMACOINVASIVE REPERFUSION STRATEGY FOR ST ELEVATION MYOCARDIAL INFARCTION

Khripun A. V.1, Malevanny M. V.1, Kulikovskikh Ya. V.1, Kastanyan А. А.2

Abstract

Aim. To evaluate efficacy of pharmacoinvasive strategy (PCS) of treatment in ST elevation myocardial infarction (STEMI) in Rostovskaya Region, during the nearest (in-patient) period.

Material and methods. The analysis performed, of 587 STEMI patients, who were referred to Regional Vascular Center "ROKB" of Rostov-na-Donu city from hospitals of the city and neighborhoods since January 2010 till June 2015, with the aim to undergo percutaneous coronary intervention (PCI) after thrombolytic therapy (TT) as PCS reperfusion strategy. Timeline mediana from pain onset to the start of TT was 140 minutes (interquartile range: 80,5-205 min). In 36,5% cases, TT was done at prehospital stage. Timeline mediana between TT and PCI was 34 hours. The results were evaluated in the nearest (in-hospital) period by the parameters as success of TT by ST dynamics on ECG, the level of blood flow restore in infarction-related artery (IRA) by TIMI score on coronary arteriography after TT in finishing of PCI, the rate of bleedings by TIMI and combinatory parameter of major adverse cardiovasular events (death, recurrent MI, stroke, need for another revascularization of target vessel).

Results. ТТ regarded as successful in 52,5% of patients. By the results of coronary arteriography, blood flow TIMI-2/3 after TT was reached in 378 from 586 (64,5%) of patients. Stenting of coronary arteries was done in 548 among 586 (93,5%) of patients; in 25 (4,3%) of patients after TT there were no hemodynamically significant stenoses, in 13 (2,2%) patients stenting of IRA was technically impossible. Application of PCS in STEMI treatment made it to achieve TIMI-2/3 blood flow in IRA in 98,5% (577 among 586) patients. Rate of major bleedings was 1,9%. Stent thrombosis and recurrent infarctions did not happen, in-hospital mortality was 3,6%, rate of major adverse cardiovascular events — 3,7%.

Conclusion. PCS makes it to increase time parameters of reperfusion and to increase its efficacy comparing to thrombolysis in those hospitals where it is impossible to perform primary PCI to improve long-term results of PCS it is important to reduce the time "pain-needle", and to perform coronary angiography in maximum short time after thrombolysis. Regardless that the PCS matches with the region specifics, it is important to optimize healthcare with the aim to perform primary PCI for the highest possible number of patients.

Russ J Cardiol 2016, 3 (131): 101–106

http://dx.doi.org/10.15829/1560-4071-2016-3-101-106

Key words: acute myocardial infarction, thrombolysis, stenting, pharmacoinvasion strategy.

1Regional Vascular Center of the Rostov Regional Clinical Hospital, Rostov-na-Donu; 2Rostov State Medical University of the Ministry of Health, Rostov-na-Donu, Russia.

OPINION ON A PROBLEM

CLINICAL TYPES OF POSTINFARCTION STATE

Galyavich A. S.

Abstract A definition of the clinical type makes it to prescribe differentiated treatment and to individualize recommendations for the patients folow-up after myocardial infarction.

Russ J Cardiol 2016, 3 (131): 107 –110

http://dx.doi.org/10.15829/1560-4071-2016-3-107-110

Key words: myocardial infarction, postinfarction state, heart failure.

Kazan State Medical University, Kazan, Russia.

LITERATURE REVIEW

CONSERVATIVE THERAPY IN MYOCARDIAL INFARCTION: THE IMPACT OF GENETIC FACTORS

Solodun M. V.

Abstract Recently, myocardial infarction is a significant medical and social problem. Mortality in one year after infarction remains high, regardless the therapy with all recommended for the prognosis improvement medications. As one of probable reasons for adverse prognosis could be considered drug tolerance, related to genes polymorphism, responsible for pharmacokinetics and pharmacodynamics of the drugs. Current review summarizes some available at the moment literature data in the genes SLCO1B1, LIPC, CYP2C19, АСЕ, ADRB1 polymorphism influence on the effectiveness of myocardial infarction therapy, that might be useful for further scientific investigation or improvement of long term treatment of this disease by personalization of drug therapy.

Russ J Cardiol 2016, 3 (131): 111–116

http://dx.doi.org/10.15829/1560-4071-2016-3-111–116

Key words: genes polymorphism, pharmacokinetics, personalized medicine, prognosis after myocardial infarction.

I. P. Pavlov Ryazan State Medical University, Ryazan, Russia.

CLINICAL CASE

MYOCARDIAL INFARCTION AND HEMOPHILIA

Galyavich A. S.1, Stekolshchikova N. Yu.2, Kasimova R. A.2, Mukhamednazarova F. I.2

Abstract The rare case of myocardial infarction and hemophilia A is presented. Brief review is provided of this issue by literature data. Accent is done upon the opportunities of myocardial infarction treatment in hemophilia patients.

Russ J Cardiol 2016, 3 (131): 117-119

http://dx.doi.org/10.15829/1560-4071-2016-3-117-119

Key words: myocardial infarction, hemophilia, factor VIII.

1Kazan State Medical University, Kazan; 2Interregional Clinical-diagnostical Center, Kazan, Russia.

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