Angina Functional Class Research Articles

Are there any benefits from prescribing a cardiac cytoprotector to enhance the quality of life in patients with coronary heart disease and chronic heart failure?

Introduction. Type 2 diabetes (T2D) increases the risk of developing cardiovascular diseases, which leads to a high mortality in this category of patients. Issues regarding the prevention of the onset and progression of coronary heart disease (CHD) and chronic heart failure (CHF) in patients with T2D and/or metabolic syndrome (MS) are still not fully understood. The use of metabolic drugs with cardioprotective effects, in particular Mildronate®, is one of the possibilities to improve the effectiveness of combination treatment of CHD and CHF.Aim. To study the effect of Mildronate® on the quality of life (QoL) of patients with CHD and CHF, suffering from T2D and/or MS.Materials and methods. A total of 2.084 patients with co-occurring two (or more) disorders: obesity, type 2 diabetes, angina pectoris, CHT, and CHF were included in the INDICOR observational study conducted in real-life clinical practice settings. Group 1 received therapy with disease-modifying agents prescribed due to CHD and T2D; Group 2 received Mildronate® at a dose of 1000 mg per day in addition to the same therapy. The studied lab test results were assessed at baseline and 42 days of therapy.Results. A 42-day course of therapy in patients receiving Mildronate® at a dose of 1000 mg per day in addition to disease-modifying therapy (DMT) contributed to a percentage increase in the number of patients with CHD, FC (functional class) I angina pectoris (Δ,% + 63%, p < 0.001 ) as compared to the control group with no significant changes (Δ,% + 7%, p > 0.5). A significant increase in the number of patients with FC I CHF was recorded in Group 2 (from 23.5 to 42.1%, Δ,% + 79%) as compared to Group 1, where no significant changes were detected (22.7 to 23.7%, Δ,% + 4%). The QoL in patients with CHF based on data collected using the Minnesota Questionnaire and QoL in patients with CHD based on data collected using the Seattle Questionnaire significantly improved in the groups that received Mildronate® in addition to DMT, as compared with the group of patients who were only on DMT.Conclusion. Results from the Seattle and Minnesota questionnaires showed that the use of Mildronate® as part of combination therapy in patients with CHD and CHF, suffering from T2D and/or MS, contributed to a significant reduction in the frequency of angina attacks and lowering angina FC, CHF FC, and also enhanced the quality of life in this category of patients.

Характеристика пацієнтів з ішемічною хворобою серця та стабільною стенокардією в Україні, оцінка підходів до їх лікування за даними багатоцентрового дослідження GO-OD

Treatment of coronary artery disease (CAD) and stable angina, includes lifestyle modification, pharmacological therapy and invasive interventions to achieve stabilization or regression of the disease. Knowledge of the current situation regarding the use of pharmacological therapy and evaluation of its effectiveness is necessary for further management optimization. Trimetazidine (TMZ) has previously been shown to reduce angina symptoms and increase exercise tolerance in patients with CAD and stable angina and may be among an option for optimizing antianginal treatment. However, the effectiveness of long-term treatment depends on patient adherence, so the use of TMZ once daily (OD) at a dose of 80 mg may improve satisfaction and adherence in patients with CAD and stable angina.Methods. The GO-OD study is a 3-month, non-interventional, observational, multicenter prospective study conducted in Ukraine in a real-world outpatient cardiology practice during February – August 2021. Physicians were instructed to continue monitoring and treating patients in accordance with usual practice and international guidelines. No additional diagnostic or monitoring procedures were performed. Clinical, instrumental and laboratory data, frequency of angina attacks, consumption of short-acting nitrates (SAN), adherence to antianginal drugs, as well as the overall efficacy, tolerability of TMZ OD 80 mg in real-world clinical practice were analyzed. The observation includes regular assessment of patients` clinical status, treatment optimization and its effectiveness at follow up visits.Results. The study included 1529 patients (mean age 62.5 years, 56 % men). In the absence of adequate control of risk factors, pharmacological control of symptoms, and limited use of interventional and surgical treatments, the frequency of angina episodes was high, most patients had a pronounced angina functional class according to the Canadian Society of Cardiology classification (10.5 % – CCS I, 60.1 % – CCS II, 29.5 % – CCS III). Thus, the average number of angina attacks per week in CCS I was 3.7, in CCS II – 5.2, and in CCS III – 7, 97 attacks. In addition to the severity of symptoms, the following pattern was observed: the higher the angina class, the more risk factors and comorbidities patients had. After 3 months of follow-up due to optimization of therapy, there was a significant (p<0.001) decrease in the frequency of angina attacks – from (5.8±4.7 to 1.6±2.0)/week, and the use of SAN – from (4.2±4.3 to 0.8±1.6)/week). At the same time, in 3 month the % of patients with CCS II and III significantly decreased, while the % of patients with CCS I increased (48.4 % – CCS I, 45.7 % – CCS II, 6 % – CCS III). Adherence to medication was improved: 49 % of patients reported high adherence (vs. 18 % at baseline) and 12 % – low adherence (vs. 52 % at baseline). After 3 months of follow-up most of doctors rated the overall tolerability and effectiveness of the therapy as «very satisfied». Patients’ satisfaction with TMZ OD 80 mg therapy after 3 months of follow-up was 9.5 points [on a scale of 1 to 10 (very satisfied)]. Patients’ assessment of daily physical activity increased significantly: 2.42 versus 5.89 points at baseline (on a scale of 1 to 10 (severe limitation)).Conclusions. In general, the management of outpatients with CAD and stable angina in the current cardiologists’ practice, which was complicated by the COVID-19 pandemic, was not effective enough, resulting in a high frequency of angina attacks – almost 6 per week, and a significant limitation of daily activity due to angina symptoms.Significant deficiency in the management of studied population was insufficient correction of such important risk factors as hypertension, heart rate, dyslipidemia, and lifestyle-related risk factors (overweight and obesity, low level of physical activity). The baseline therapy of patients in the study was in line with current guidelines, but with an insufficient frequency of statin prescription (78 %) and ACE inhibitors (54.5 %); antianginal treatment with an average of 2 or more antianginal drugs was not optimal for controlling angina symptoms, and the frequency of coronary revascularization procedures was also insufficient, mostly during acute MI (58.0 %).Optimization of drug therapy as the first step in correcting the condition of patients with CAD and stable angina in accordance with all current recommendations with the inclusion of the original trimetazidine OD 80 mg once daily among antianginal drugs, as well as active monitoring of patients for 3 months allowed to reduce the frequency of angina attacks regardless of its initial FC, increase patient adherence to treatment and their functional activity.

Abstract 17136: Prospective Cohort Study for Evaluating the Safety and Efficacy of Mobile, Motorized Enhanced Extracorporeal Counterpulsation in Refractory Angina Patients

Introduction: Enhanced external counterpulsation (EECP) therapy is a potential treatment for refractory angina, which refers to persistent symptoms despite optimal treatment. However, the immobility, cost, and lack of individualized pressure control limit the accessibility and clinical implications of EECP. To address these limitations, a new Mobile, Motorized Enhanced Counterpulsation (MECP) device has been developed. Hypothesis: To investigate efficacy of MECP in improving in angina functional class and exercise tolerance in patients with refractory angina and to validate the consistency in outcomes observed with conventional EECP treatment. Methods: This prospective study enrolled patients with symptomatic refractory angina between September 2020 and December 2022 at two tertiary centers in Korea. Baseline and post-treatment assessments included measurements of angina scale, 6-minute walking test, cardiopulmonary exercise test, and central arterial pressure. Results: The study included 71 patients (70.4% male, median age 66 years). After the 10-hour MECP treatment session, 57.7% of patients showed improvement in angina scale based on Canadian Cardiovascular Society classification, with a significant distribution change from 76.8% to 49.3% in class II and from 21.7% to 5.7% in class III (p<0.001). Furthermore, patients demonstrated an increase of 20 meters in the 6-minute walk distance after MECP treatment (464 meters vs. 484 meters, p<0.001). However, there were no statistically significant differences in the baseline characteristics of patients based on their response to MECP. Conclusion : Our study highlights the substantial benefits of MECP in relieving symptoms for patients with refractory angina and suggests its potential for broader clinical applications which merits further investigation.

Mid-Term Clinical Outcomes and Hemodynamic Performances of Trifecta and Perimount Bioprostheses following Aortic Valve Replacement.

Aims of the Study: We evaluated the clinical outcome and the hemodynamic and freedom from structural valve degeneration of two standard aortic bioprostheses. Methods: Clinical results, echocardiographic findings and follow-up data of patients operated for isolated or combined aortic valve replacement with the Perimount or the Trifecta bioprosthesis were prospectively collected, retrospectively analysed and compared. We weighted all the analyses by the inverse of the propensity of choosing either valves. Results: Between April 2015 and December 2019, 168 consecutive patients (all comers) underwent aortic valve replacement with Trifecta (n = 86) or Perimount (n = 82) bioprostheses. Mean age was 70.8 ± 8.6 and 68.8 ± 8.6 years for the Trifecta and Perimount groups, respectively (p = 0.120). Perimount patients presented a greater body mass index (27.6 ± 4.5 vs. 26.0 ± 4.2; p = 0.022), and 23% of them suffered from angina functional class 2-3 (23.2% vs. 5.8%; p = 0.002). Mean ejection fraction was 53.7 ± 11.9% (Trifecta) and 54.5 ± 10.4% (Perimount) (p = 0.994), with mean gradients of 40.4 ± 15.9 mmHg (Trifecta) and 42.3 ± 20.6 mmHg (Perimount) (p = 0.710). Mean EuroSCORE-II was 7 ± 11% and 6 ± 9% for the Trifecta and Perimount group, respectively (p = 0.553). Trifecta patients more often underwent isolated aortic valve replacement (45.3% vs. 26.8%; p = 0.016) and annulus enlargement (10.5% vs. 2.4%; p = 0.058). All-cause mortality at 30 days was 3.5% (Trifecta) and 8.5% (Perimount), (p = 0.203) while new pacemaker implantation (1.2% vs. 2.5%; p = 0.609) and stroke rate (1.2% vs. 2.5%; p = 0.609) were similar. Acute MACCE were observed in 5% (Trifecta) and 9% (Perimount) of patients with an unweighted OR of 2.22 (95%CI 0.64-7.66; p = 0.196) and a weighted OR of 1.10 (95%CI: 0.44-2.76, p = 0.836). Cumulative survival at 24 months was 98% (95%CI: 0.91-0.99) and 96% (95%CI: 0.85-0.99) for Trifecta and Perimount groups, respectively (log-rank test; p = 0.555). The 2-year freedom from MACCE was 94% (95%CI: 0.65-0.99) for Trifecta and 96% (95%CI: 0.86-0.99) for Perimount (log-rank test; p = 0.759, HR 1.46 (95%CI: 0.13-16.48)) in the unweighted analysis (not estimable in the weighted analysis). During the follow-up (median time: 384 vs. 593 days; p = 0.0001) there were no re-operations for structural valve degeneration. Mean valve gradient at discharge was lower for Trifecta across all valve sizes (7.9 ± 3.2 vs. 12.1 ± 4.7 mmHg; p < 0.001), but the difference did not persist during follow-up (8.2 ± 3.7 mmHg for Trifecta, 8.9 ± 3.6 mmHg for Perimount; p = 0.224); Conclusions: Postoperative outcome and mid-term follow-up were similar. An early better hemodynamic performance was detected for the Trifecta valve but did not persist over time. No difference in the reoperation rate for structural valve degeneration was found.

The Effect of Enhanced External Counterpulsation on the Vascular State, Indicators of Glycemic Control and Quality of Life in Patients with Coronary Artery Disease and Type 2 Diabetes Mellitus

Aim. To study the effect of enhanced external counterpulsation (EECP) on the functional status, quality of life, structural and functional state of the vascular bed, and markers of glycemic control in patients with coronary artery disease (CAD) and type 2 diabetes mellitus (DM).Material and methods. A pilot prospective randomized study included 30 patients with CAD and DM. Using a random number generator, patients were randomized into 2 groups: EECP (n=15) and a comparison group (n=15). All patients (n=30) received optimal medical therapy (OMT) during 3 months of follow-up. Patients in the EECP group underwent a course of EECP (35 hours, cuff pressure: 220-280 mmHg) during the first 7 weeks of the study. At baseline and after 3 months of follow-up, patients in both groups underwent an assessment of clinical status, quality of life (based on the SF-36 questionnaire), as well as a 6-minute walk test to assess exercise tolerance. The dynamics of fasting glucose, postprandial glucose, insulin resistance index (HOMA-IR) and glycated hemoglobin were assessed. Photoplethysmography and applanation tonometry were performed to assess the state of the vascular bed.Results. In the EECP group, after 3 months, there was a decrease in the frequency of angina attacks and an improvement in the functional class of angina according to the Canadian Cardiovascular Society (CCS) classification. A significant improvement in exercise tolerance was revealed [an increase in the 6-minute walking distance by 51 (35; 65) m, p&lt;0.05], as well as an improvement in the physical and mental components of health according to the SF-36 questionnaire. A positive dynamics was shown in relation to the indicators of the state of both large vessels and the microvasculature (p&gt;0.05), with the exception of the reflection index and the stiffness index (p&lt;0.05). There was also a significant decrease in the HOMA-IR [-9.9% (-26.5; -4.0) vs 7.7% (-7.9; 13.8), p=0.004], as well as in the levels of fasting glucose [-10.5% (-15.8; -4.0) vs -2.7 (-8.3; 5.9), p=0.012] in the EECP group, compared with the OMT group.Conclusion. EECP course therapy in addition to OMT has a positive effect on the functional status and quality of life of patients with CAD and DM. After 3 months of observation, there was noted a positive dynamics of the vascular state, as well as markers of glycemic control, and these changes were more pronounced in the EECP group. The results obtained may indicate the effectiveness of EECP as an add-on treatment for this group of patients.

Особливості зміни показників кумулятивного виживання пацієнтів з гострим коронарним синдромом без стійкої елевації сегмента ST, яким перкутанні коронарні втручання проводили в різні терміни від початку захворювання

Мета роботи – оцінити вплив реваскуляризації міокарда, яка була виконана хворим з гострим коронарним синдромом без стійкої елевації сегмента ST у різні терміни від початку симптомів, на ультразвукові показники скорочувальної функції лівого шлуночка та на функціональний клас стенокардії через 12 місяців спостереження. Матеріали і методи. Пацієнти з гострим інфарктом міокарда без стійкої елевації сегмента ST (NSTEMI), які увійшли в дослідження (n=128), були поділені на групи за часом проведення реваскуляризації (ургентна або планова реваскуляризація), а також за способом реваскуляризації (коронарне стентування або шунтування) на 5 груп, у тому числі групу хворих з NSTEMI, яким стентування не проводили. 1-шу групу (n=28) становили пацієнти, яким були виконані ургентні коронарографія та стентування ad hoc у перші 72 год від початку симптомів. У 2-гу групу (n=61) увійшли пацієнти, яким коронарографію і стентування проводили планово через 72 год і більше до кількох місяців від початку розвитку симптоматики. У 3-тю групу (n=12) увійшли пацієнти, яким у плановому порядку виконували коронарне шунтування. 4-та група (n=27) складалася з пацієнтів, яким після коронарографії реваскуляризацію не проводили («контрольна група»). 5-ту групу (n=101) склали пацієнти вищеозначених груп, яким була проведена будь-яка реваскуляризація. Результати та обговорення. Ефективність лікування і частота виникнення серйозних кардіоваскулярних подій у пацієнтів з NSTEMI статистично значуще залежить від наявності в стратегії лікування перкутанних і хірургічних методик реваскуляризації. Доповнення процедури реваскуляризації статистично значуще поліпшує прогноз, статистично значуще знижує комбінований показник МАСЕ (major adverse cardiac events, серйозні кардіоваскулярні події) у період спостереження за пацієнтами (до 48 міс) порівняно з групою контролю (p=0,000001). При прямому порівнянні групи ургентного коронарного стентування (протягом 72 год від початку симптомів) пацієнтів з NSTEMI з GRACE Score &gt;140 балів виявлено статистично значущу розбіжність за кількістю серйозних кардіоваскулярних подій за 48 міс спостереження (p&lt;0,05) порівняно з групою контролю GRACE Score &gt; 140.Висновки. Віддалені результати стентування пацієнтів з NSTEMI з високим ризиком ускладнень (група ургентного стентування) не мали переваг перед результатами лікування стабільних пацієнтів з NSTEMI (група планового стентування) після їх ефективної стабілізації на тлі оптимальної медикаментозної терапії. При порівнянні частоти МАСЕ у цих двох групах перевагу зі слабким ступенем статистичної значущості (p&lt;0,05) було виявлено в групі стабілізованих пацієнтів, що повністю підтверджує стратегію стратифікації хворих з нестабільним коронарним кровоплином на групи ризику ускладнень. Однак ургентні втручання абсолютно показані пацієнтам з високим ризиком ускладнень у перші дні від початку симптомів дестабілізації.

Short Terms Safety of Chinese Origin Covid-19 Vaccine in Cardiac Patients

Objective: To find out short terms safety of Chinese origin Covid-19 vaccines in cardiac patients. To identify frequency of major and minor cardiovascular events in Covid-19 vaccinated cardiac patients. Methodology: It was a cross sectional study conducted in Qazi Hussain Ahmad Medical Complex Nowshera and Kuwait Teaching Hospital Peshawar, Pakistan from February 2021 to April 2021 on a sample of 325 cardiac patients irrespective of their gender. Cardiac patients who received 2 doses of sinopharm vaccine were included in our study. The clinical characteristics of patients included age, gender, comorbids like diabetes and hypertension and those patient s who have undergone any cardiac procedures i-e post CABG and post PCI. The data was analyzed with SPSS version Results: Total 325 known cardiac patients who received 2 doses of sinopharm vaccine were enrolled in the study, among them 198 were male and 127 were female. Participants age range was 56.48±5.9 years and among them mean age of male was 56.59±6.55 years and of female was 57.64±4.27 years. Among the participants 76(23.3%) were hypertensive out of which 44(22.2%) were male. Total number of diabetics were 98(30.15%) among which 59(29.79%) were male. Post CABG patients were 56(17.23%) in number, and among these 34(17.17%) were male. Among them 176(54.15%) were post PCI and among these 102(51.51%) were male. Out of total 325 participants the frequency of major adverse cardiovascular events was 4(1.2%) which include major cardiovascular events , death of any cause, urgent repeat revascularization, MI (not revascularized) an ischemic stroke were 1.2%, 0.91%, 0.31%, 0.92%, 0% respectively. Frequency of minor adverse cardiovascular events in cardiac patients after sinopharm vaccination was 4(1.2%) out of total 325 participants. which include minor cardiovascular events(9.85%), atrial fibrillations(0.92%), complete heart block(0%), increase in angina functional class(2.46%), increase in NYHA functional class(2.53%), and palpitations(3.69%). Conclusion: Chinese origin covid-19 vaccine (sinophorm) is safe in cardiac patients and has minor side effects and rare major side effects in cardiac patients. Keywords: Sinopharm vaccine, Cardiac patients, Corona virus

Determination of the influence of risk factors for coronary artery disease on the effectiveness of cardiac surgery by the method of myocardial scintigraphy

Background. Myocardial revascularization is a life-saving technology that not only increases life expectancy, reduces recurrences of myocardial infarction and repeated surgery, but also improves its quality in patients with coronary artery disease. Risk assessment, the complexity of coronary artery disease, the presence of comorbidities, the area of hibernating myocardium, the patient’s consent are the basis for choosing a method of treatment. Positive structural and functional changes of the myocardium (increase in the area of viable myocardium), restoration or improvement of left ventricular systolic function (increase in ejection fraction and decrease in end-diastolic volume), reduction of angina are the expected result of the surgical treatment. Purpose – determining the influence of risk factors for coronary heart disease on the outcome of surgical treatment by aorto-coronary artery bypass grafting with the help of diagnostic evaluation of myocardial scintigraphy. Materials and Methods. To achieve the clinical tasks, 62 patients with coronary artery disease were examined. The mean age of the subjects was (59.6 ± 8.2) years. Myocardial scintigraphy was performed in SPECT with ECG synchronization (Gated SPECT). 99mTc-MIBI with an activity of 555–740 MBq was used. Myocardial scintigraphy was performed over time of treatment (before and after coronary artery bypass grafting) according to the protocol – One Day Rest. Results. The influence of risk factors was assessed using dynamic and static integrated indicators. The dynamic integral indicator did not show statistically significant risk factors: smoking (p = 0.54), left ventricular contractility (p = 0.43), the presence of myocardial infarction in past (p = 0.4), heart failure stage (p = 0.53) and functional class of angina (p = 0.08). The static integrated indicator also did not show statistically significant effects from smoking (p = 0.13), left ventricular contractility (p = 0.58), the presence of myocardial infarction in past (p = 0.1), heart failure stage (p = 0.11) and functional class of angina (p = 0.6). Conclusions. The risk factors for coronary artery disease, such as: myocardial infarction in past, left ventricular contractility, heart failure stage, functional class of angina and smoking, in the study group of patients, had no reported effect on revascularization by the method of aorto-coronary artery bypass grafting (static and dynamic integrated indicators p &gt; 0.05).

Role and place of radiotherapy in neoadjuvant treatment of pancreatic cancer

Background. Myocardial revascularization is a life-saving technology, which contributes to increase in lifespan, reduction in myocardial infarction recurrences and repeated surgeries along with improved life quality of the patients with coronary artery disease (CAD). Estimation of the risks, severity of coronary bed lesion, presence of concomitant diseases, and area of hibernating myocardium, as well as patient’s agreement are the basis of treatment method selection. Positive structural and functional changes in myocardium (increase in area of viable myocardium), restoration or improvement of systolic function of left ventricle (increase in ejection fraction and decrease in end-diastolic volume), reduction of angina symptoms are the expected results from the surgical treatment.&#x0D; Purpose – to determine the influence of risk factors for coronary artery disease on the outcome of surgical treatment by the method of aorto-coronary artery bypass grafting with the help of diagnostic evaluation of myocardial scintigraphy parameters.&#x0D; Materials and methods. For the implementation of the clinical objectives, 62 patients with coronary artery disease were examined. The average age of the patients was 59.6 ± 8.2 years. Myocardial scintigraphy was performed in the SPECT mode with ECG synchronization (Gated SPECT). 99mTc-MIBI with an activity of 555-740 MBq was used. Myocardial scintigraphy was conducted over time of treatment (before and after coronary artery bypass grafting) according to One Day Rest protocol.&#x0D; Results. The influence of risk factors was assessed using dynamic and static integral indices. The dynamic integral index didn’t reveal statistically significant risk factors: smoking (p = 0.54), left ventricular contractility impairment (p = 0.43), history of myocardial infarction (p = 0.4), stage of heart failure (p = 0.53), and functional class of angina (p = 0.08). The static integral index didn’t reveal statistically significant influence as well: smoking (p = 0.13), left ventricular contractility impairment (p = 0.58), history of myocardial infarction (p = 0.1), stage of heart failure (p = 0.11), and functional class of angina (p = 0.6).&#x0D; Conclusions. The studied risk factors for coronary artery disease, namely: history of myocardial infarction, left ventricular contractility impairment, stage of heart failure, functional class of angina, and smoking in the study group of patients had no registered influence on the revascularization effect by coronary artery bypass grafting method (integrated static and dynamic indices p &gt; 0.05).

Pretest probability of coronary artery disease as a factor for optimizing invasive diagnostics in routine clinical practice

According to the European Society of Cardiology guidelines, patients with chest pain requires the calculation of pretest probability (PTP) of coronary artery disease (CAD), followed by the identification of diagnostic tactics.Aim. To analyze the registry of patients with stable CAD in order to assess the frequency of PTP calculation, as well as the validity of diagnostic tactics choice depending on its level.Material and methods. The data of the registry of patients with stable CAD for the periods from 2012 to 2014 and from 2017 to 2019 were analyzed. We assessed the number of CAD patients, proportion of men, and distribution of patients depending on angina functional class. In addition, data on PTP calculation, as well as distribution of patients and diagnostic strategy selected depending on its value was analyzed. To assess differences (p) in pairwise comparisons, Student’s t-test was used. Differences were considered significant at p&lt;0,05. Statistical analysis was performed using Microsoft Office Excel 2010 (Microsoft, USA) and STATISTICA 6.0 (StatSoft Inc., USA).Results. In 2017-2019, the number of detected CAD cases and proportion of men increased. In both time periods, an insufficient level of calculating PTP of CAD remains. In patients with intermediate PTP, 15-85% of priority tactics are invasive interventions, and with high PTP, the percentage of invasive methods does not reach the proper level, which does not correspond to modern guidelines for the management of CAD patients and leads to misappropriation of funds and healthcare resources.Conclusion. According to medical records, PTP can be determined in less than half of patients. In CAD patients with intermediate PTP, non-invasive studies are not carried out in full, since coronary angiography is preferred. In patients with a high PTP, invasive diagnostics is insufficient.

Analysis of differential expression of lipid metabolism genes in atherosclerotic plaques in patients with coronary atherosclerosis

Aim. The goal of the study was to analyze the differential expression of lipid metabolism-related genes in the atherosclerotic plaques of different types in patients with coronary atherosclerosis.Material and Methods. The study was performed on the specimens of atherosclerotic plaques in 45–65-year-old patients with coronary atherosclerosis with stable exertional angina functional class II-IV without acute coronary syndrome. Coronary atherosclerosis was verified by coronary angiography. Atherosclerotic plaque tissue was sampled intraoperatively when indicated. Whole-genome sequencing of ribonucleic acid (RNA) was performed using the TruSeq RNA Sample Preparation Kit (Illumina, USA).Results. We analyzed the differences in the expression of 12 genes including LDLR, APOB, PCSK9, LDLRAP1, LIPA, STAP1, ABCA1, APOA1, APOE, LPL, SCARB1, and SREBF2 depending on the type of atherosclerotic plaques. The expression level of APOE gene was eight times higher in unstable atherosclerotic plaques of dystrophic-necrotic type (p &lt; 0.0001). The expression levels of LDLR and APOB genes were eight times higher in stable atherosclerotic plaques (p &lt; 0.0001). We did not find differences in the expression levels of the ABCG5, ABCG8, APOC3, CETP, CLPS, CYP7A1, and PNPLA5 genes.Conclusion. The study showed the differences in the activity of individual metabolism-related genes in the atherosclerotic plaques of different types in patients with coronary atherosclerosis. Obtained data may become the basis for the development of test systems aimed at predicting the development of atherosclerotic process and its complications.

КЛИНИКО-ГЕМОДИНАМИЧЕСКАЯ ОЦЕНКА ПАЦИЕНТОВ С НЕРЕВМАТИЧЕСКОЙ НЕДОСТАТОЧНОСТЬЮ ТРЕХСТВОРЧАТОГО КЛАПАНА СЕРДЦА (ФУНКЦИОНАЛЬНОЙ) ПРИ ХРОНИЧЕСКИХ ФОРМАХ ИШЕМИЧЕСКОЙ БОЛЕЗНИ СЕРДЦА ИЛИ ДИЛАТАЦИОННОЙ КАРДИОМИОПАТИИ

Objectives: to study and compare the clinical and echocardiographic characteristics of patients with functional (secondary) tricuspid insufficiency, depending on its etiology and depending on the surgical methods used in surgical practice for its correction. Materials and methods: clinical and hemodynamic assessment of a population of patients with non-rheumatic tricuspid valve insufficiency (functional) in chronic forms of coronary heart disease (CHD) or dilated cardiomyopathy (DCMP) was performed. The study included 792 patients who underwent correction of non-rheumatic tricuspid valve insufficiency (functional) during a period 2011–2020: 642 participants with coronary artery disease, 150 participants with DCMP. Clinical and echocardiographic parameters were assessed. Results: In the analyzed patient population, in-hospital mortality after surgery in patients with CAD was significantly higher than in patients with DCMP, which can be explained by a number of factors, including the more severe nature of the pathology in patients with CAD (in the study, patients with multiple coronary arteries lesions and a high functional class of angina prevailed in the group of coronary artery disease), and a larger scale of surgical intervention. In patients with DCMP, a more significant dilatation of the right ventricular cavity and a significantly higher increase of right ventricle volumes were noted. At the same time, despite more significant remodeling of the left (LV) and right ventricles (RV), the level of systolic and mean pulmonary artery pressure did not differ significantly between patients with CAD and DCMP. There was no significant difference in the levels of dilatation and volume of the right atrium between patients with CHD and DCMP. Patients with DCMP showed more severe dilatation of the tricuspid valve annulus and the area of its orifice. However, when assessing the magnitude of the degree of severity of the functional tricuspid valve insufficiency, no significant differences were noted in almost all parameters, depending on the etiology. Despite a comparable volume of regurgitation and the degree of tricuspid valve insufficiency, patients with DCMP had a significantly more severe changed geometry of the tricuspid valve annulus. Ring plasty techniques were used in patients with more pronounced LV remodeling and severe LV systolic dysfunction. This, most likely, caused a more significant overload of the pulmonary circulation, causing a higher level of pulmonary hypertension and volume overload of the right heart. In patients with CHD, suture repair methods were more often used, and in patients with DCMP, ring methods of annuloplasty of the tricuspid valve were used more often. At the same time, regardless of the etiology, ring annuloplasty techniques were used with more severe functional insufficiency of the TV in patients with a significantly more significant decrease in right ventricular contractility. Conclusion: in the study population, hospital mortality was higher in the CHD group than in the DCMP group. In DCMP, a more pronounced dilatation of the tricuspid valve annulus and the area of its opening were observed, however, the degree of severity of the functional insufficiency of the tricuspid valve in all respects does not depend on the etiology. In patients with DCMP, there is a significantly more pronounced violation of the geometry of the tricuspid valve annulus. In patients with coronary heart disease, suture repair methods are more often used, and in patients with DCMP, ring methods of annuloplasty of the tricuspid valve are used. Both in CHD and DCMP, ring plasty of tricuspid valve were used in cases of more severe functional insufficiency in patients with a significantly more decreased contractility of the left and right ventricles.

Percutaneous coronary intervention and carotidal endarterectomy: hospital and long-term outcomes of hybrid interventions and predictors of complications

Goal. Analysis of hospital and long-term results with the identification of predictors of complications after combined interventions on the coronary and carotid arteries in the volume of percutaneous coronary intervention + carotid endarterectomy (PCI + CEE). Materials and methods. From 2010 to 2016, 64 patients underwent hybrid revascularization of the brain and myocardium in the volume of PCI + CEE. Initially, PCI was performed, then the patient was transported to the vascular operating room, where he underwent CEE was performed according to the classical technique with modeling the reconstruction zone with a patch made of diepoxy-treated xenopericardium. Brain protection was achieved by invasive measurement of retrograde pressure. After CEE, the patient received a loading dose of clopidogrel 600 mg. The average follow-up period in the long-term period was 53.04 ± 17.1 months. Results. In the hospital period, only hemorrhagic complications were noted (n = 3; 4.68 %) while taking double antiplatelet therapy (acetylsalicylic acid + clopidogrel) and intraoperative heparin. In the long-term period, the leading position was occupied by a lethal outcome (n = 9; 16.6 %). Despite taking double antiplatelet therapy, in 6 (11.1 %) cases, stroke development was noted, in 1 (1.8 %) — MI. In 3 (5.5 %) patients, repeated unplanned revascularization was performed — CABG as a result of restenosis in the stent. The combined endpoint (death + stroke + myocardial infarction) was 29.6 % (n = 16). Significant risk factors for the development of complications in the hospital postoperative period were chronic renal failure (OR 3.7165; 95 % CI 1.2032–11.4800), III–IV functional class of angina (OR 21.9; 95 % CI 2.29–208, 8), a history of stroke (OR 6.82; 95 % CI 1.04–44.7). In the long term, the predictors of adverse events were bleeding (OR 2.02; 95 % CI 1.15–3.55), ejection fraction less than 50 % (OR 2.9; 95 % CI 1.47–5.7) and lesion trunk of the left coronary artery and more than three additional coronary arteries (OR 2.67; 95 % CI 1.27–5.59), and two or less affected coronary arteries (OR 0.34; 95 % CI 0.19–0.62). Conclusion. The efficiency and safety of hybrid revascularization in the volume of PCI + CEE has been proven in view of the minimum number of complications at different stages of follow-up.

Функціональний стан лівого шлуночка серця в пацієнтів із гострим інфарктом міокарда без елевації сегмента ST після реваскуляризації міокарда, яка проводилася в різні терміни від початку розвитку симптомів захворювання

Мета роботи – оцінити вплив реваскуляризації міокарда, проведеної хворим із гострим інфарктом міокарда без стійкої елевації сегмента ST (non-ST-segment elevation myocardial infarction, NSTEMI) у різні терміни від початку симптомів, на стан систолічної функції лівого шлуночка (ЛШ), а також на функціональний клас стенокардії через 12 міс спостереження.Матеріали і методи. Пацієнти з NSTEMI, які увійшли в дослідження (n=128), були розподілені за часом проведення реваскуляризації (ургентна або планова реваскуляризація), а також за способом реваскуляризації (коронарне стентування або шунтування) на 5 груп, включаючи групу хворих з NSTEMI, яким стентування не проводили. Групу 1 (n=28) становили пацієнти, яким були виконані ургентні коронаровентрикулографія (КВГ) та стентування ad hoc у перші 72 год від початку симптомів. До групи 2 (n=61) увійшли пацієнти, яким КВГ і стентування проводили планово через 72 год і більше (до кількох місяців від початку розвитку симптоматики). До групи 3 (n=12) увійшли пацієнти, яким у плановому порядку виконували коронарне шунтування. Група 4 (n=27) складалася з пацієнтів, яким після КВГ реваскуляризацію не проводили (контрольна група). До групи 5 (n=101) увійшли пацієнти вищеозначених груп, яким була виконана будь-яка реваскуляризація. Хворим усіх груп була проведена вихідна КВГ, визначено вихідний рівень серцевих тропонінів, проведено ангіографічне та ехокардіографічне дослідження стану ЛШ за стандартними методиками з оцінюванням вихідних показників регіонарної та загальної скоротливості міокарда. За відсутністю протипоказань хворим груп 2 і 3 виконували тести з дозованим фізичним навантаженням для встановлення функціонального класу (ФК) стенокардії. Під час короткострокового (перед виписуванням зі стаціонару, через 1 міс та через 3 міс після виписування) і довгострокового (через 6 місяців та через 1 рік) спостережень хворим повторно визначали фракцію викиду (ФВ) ЛШ, оцінювали регіонарну скоротливість ЛШ та ФК стенокардії.Результати та обговорення. Дані тесту з дозованим фізичним навантаженням показали: якщо до реканалізації стенокардію 0–I ФК не фіксували в жодному випадку, то через 6 міс цей показник становив 70,6 %, а через рік – 73,8 % Кількість випадків тяжкої стенокардії зменшилася з 43,8 % під час першого обстеження до 7,7 % через 12 міс спостереження. Аналіз показників регіонарної та загальної скоротливості ЛШ виявив статистично значуще поліпшення цих показників у пацієнтів з NSTEMI через 12 міс, як у групі ургентного, так і у групі планового стентування. Кількість нормокінетичних сегментів підвищилася на 10 % (з 84,2 до 94,2 %), а гіпокінетичних – зменшилася більш ніж удвічі (з 16,5 до 6,8 %). ФВ ЛШ за 12 міс спостереження, як у групі ургентного, так і у групі планового стентування, статистично значуще поліпшилася. У контрольній групі, як і в групі шунтування, статистично значущих позитивних змін ФВ ЛШ через 12 міс після NSTEMI не спостерігали.Висновки. Коронарне стентування, як ургентне, так і планове, у пацієнтів з NSTEMI, за даними річного спостереження, статистично значуще поліпшує функціональні й об’ємні показники ЛШ. Поліпшення цих показників зумовило статистично значуще зменшення ФК стенокардії в пацієнтів з NSTEMI, що своєю чергою покращило якість життя цих хворих.

The effectiveness of the method of external counterpulsation in patients with chronic stable angina

Aim. To assess the effectiveness of the complex treatment of patients with stable angina pectoris using the method of external counterpulsation (ECP).&#x0D; Methods. 92 patients with chronic stable angina were included in the comparative analysis, which divided into 2 groups: 57 patients received one course of treatment using the ECP method (main group), 35 patients received only drug treatment (control group). Before and after the therapy, a general clinical examination (including determining the functional class of angina pectoris and the need to use nitroglycerin preparations), coronary angiography, echocardiography, exercise stress test (stress ECG), and quality assessment using the Seattle Angina Questionnaire (SAQ) was performed.&#x0D; Results. The decrease in the average functional class of angina was more significant in the main group compare to the control group from 2.280.73 to 0.930.80 (p 0.05) versus from 2.340.73 to 1.830.71 (p 0.05). A decrease of at least 1 functional class more often occurred in the main group 78.9% of patients versus 57.1% (p=0.0258). The use of nitroglycerin sharply decreased after treatment in the group, that use the ECP method (by 51.6%; p=0.002), whereas in the control group, despite a slight decrease (by 22.7%), the changes did not reach statistical significance (p=0.0736). Both groups showed similar dynamics of changes in echocardiography. The differences were obtained only for the dynamics of the ejection fraction of the left ventricle (LVEF), which was greater in the main group an increase of 4.695.56% versus 1.755.15% (p=0.0448). The dynamics of all indicators of exercise stress test significantly differ between groups, and if for the main group it is positive, in the control group it is negative. Some indicators of quality of life change insignificant and similar for both groups (for example, on the scale for limiting physical exertion), and on some scales (stability scales for attacks and the frequency of angina attacks), the improvement in the main group is much more significant in comparing with the control group: 3037 points versus 1213 points, respectively (p 0.0001). The overall quality of life assessment score improved more in the group, that use the ECP method: +96.1040.73 versus +45.3135.06 the control group (p 0.0001).&#x0D; Conclusion. The method of external counterpulsation (ECP) can be used in clinical practice as part of a comprehensive treatment of patients with stable angina pectoris; it can significantly reduce the class of angina pectoris and the need to use nitroglycerin preparations, improve a number of indicators of echocardiography, electrocardiography with exercise and quality of life indicators.

Transition of care of stable ischaemic heart disease patients from tertiary to primary care with telemedicine support: Randomized noninferiority clinical trial

Introduction Evidence of telehealth for chronic disease management is scarce and contradictory. Objectives We aimed to evaluate the safety and efficacy of teleconsultations as support in the care transition of patients with stable coronary artery disease (CAD) from tertiary to primary care. Methods A randomized noninferiority clinical trial was undertaken in patients with CAD from a tertiary hospital in a middle-income country. Patients with functional angina class 1 or 2 and meeting discharge criteria were randomized to remain in the cardiology outpatient clinic for 12 months (control group, CG) or continue follow-up in a primary care unit with clinical support via telemedicine (intervention group, IG). The primary outcome was the maintenance of the functional angina class after 12 months. Secondary outcomes included control of risk factors and clinical outcomes. Results In total 271 patients (mean age, 66 years) were included; 81.1% and 91% of the IG and CG, respectively, maintained stable angina symptoms, thus noninferiority could not be shown between the groups. Regarding emergency room visits at 1 year, the IG (7.6%) was noninferior to the CG (6.0%) (absolute difference, 1.6%; noninferiority margin (NIM), –4.8% to 8.2%). For control of risk factors, 30.7% and 29.6% of the IG and CG, respectively, had blood pressure <130/80 mmHg (absolute difference, 1.1%; NIM, –10.5% to 12.8%), and 48.9% and 33.3% of diabetic patients in the IG and CG, respectively, had glycated haemoglobin <7% (absolute difference, 15.6%; NIM, –6.8% to 36%). Conclusions In our study, the difference in the patients’ angina functional class did not result in greater seeking of emergency care, supporting that discharge from the outpatient clinic with telemedicine is safe for patients with stable CAD treated at the tertiary level. The control of risk factors in these patients was noninferior to patients followed up in primary care. ClinicalTrials.gov (NCT02489565).

ROLE OF IMMUNO-INFLAMMATORY REACTIONS IN THE PATHOGENESIS OF CLINICAL VARIANTS OF CORONARY HEART DISEASE

The role of inflammation in the pathogenesis of atherosclerotic lesion in CHD is widely discussed. In the study the relationship between the production of cytokines IL1, IL4, IL10, TNFα and clinical variations of ischemic heart disease has been studied. Patients with ischemic heart disease with stable and unstable angina were examined. The level of production of cytokines in blood serum was determined by immunoenzyme analysis. Studies show strong evidence for the participation of cytokines in immune inflammation mechanisms in coronary heart disease. The high functional class of angina accompanied by hyperproduction of pro-inflammatory cytokines dictates the need to develop new therapeutic approaches to reduce the production of proinflammatory cytokines in order to reduce the progressive inflammatory process and prevent the transition to an unstable form of the disease.

Long-term results of isolated transmyocardial laser revascularization in combination with the intramyocardial autologous bone marrow stem cells injection.

To evaluate the long-term results of TMLR using a CO2 laser in combination with intramyocardial injection of ABMSC as an isolated procedure in patients with the end-stage coronary artery disease, the study included 20 patients (90% male), with a mean age of 58.4 ± 8.7 years. To assess the long-term results, patients were examined in a hospital. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the Seattle Angina Questionnaire (SAQ) were used. The evolution of laboratory and instrumental indices, as well as medical therapy, was assessed. The end points of the study were death, acute myocardial infarction (AMI), repeated myocardial revascularization, recurrent hospitalizations due to coronary artery disease, and stroke. The changes in angina functional class were also evaluated. The median of follow-up period was 54 (36; 83) months, that is, 4.5 years. The analysis of the evolution of echocardiographic data showed the absence of statistically significant changes in the following parameters: left ventricular end-diastolic diameter (EDD) (p = 0.967), end-systolic diameter (ESD) (p = 0.204), end-diastolic volume (EDV) (p = 0.852), end-systolic volume (ESV) (p = 0.125), and left ventricular ejection fraction (LVEF) (p = 0.120). The patients continued to regularly take the main groups of medications. Nitrate consumption was significantly reduced (p < 0.001). Significant positive dynamics were observed in the changes in angina functional class. At the baseline, all patients had angina III FC, in the long term, 3 patients had II FC, 11 patients had I FC, and 6 patients had no angina. Clinical outcomes (mortality, recurrent myocardial infarction, stroke) were absent during the follow-up period. There were two cases of repeated myocardial revascularization. Regression analysis revealed that SYNTAX score was associated with the clinical outcome "repeated revascularization." TMLR in combination with intramyocardial injection of ABMSC is a safe method to achieve a statistically significant antianginal effect and reduce the need for "nitrates," which in turn improves the quality of life and reduces the frequency of hospitalizations due to coronary artery disease. These results can be achieved with strict adherence to the certain indications for the intervention.

Long-term outcomes after bioresorbable scaffold implantation in patients with coronary artery stenosis

Aim. The present study aimed to demonstrate the long-term outcomes after Absorb (Abbott Vascular, USA) everolimus-eluting bioresorbable vascular scaffold (BVS) implantation in real-world patients with coronary artery disease.Methods. This trial involved the largest registry of Absorb BVS implantation in patients with coronary artery disease from Russia, and it was conducted between 2014 and 2018 (n = 500). Safety and efficacy parameters (target vessel failure, defined as a composite of cardiac death, target vessel myocardial infarction and clinically driven target vessel revascularisation; major adverse cardiac and cardiovascular events, defined as a composite of cardiac death, myocardial infarction, target vessel revascularisation and stroke, stent thrombosis according to the Academic Research Consortium definition) were assessed over a period of 2 years after the index procedure. Results. Lesion treatment success was achieved in 98.51% (n = 594) of patients. In the 2 years after Absorb BVS implantation, long-term outcomes were assessed via phone calls. Only 9.8% (n = 49) of patients were lost to follow-up. The rates of target vessel failure and major adverse cardiac and cerebrovascular events were 11.6% (n = 58) and 12.6% (n = 63), respectively. Definite/probable stent thrombosis was observed in 3.2% (n = 16) of patients. Conclusion. Using an optimal implantation technique during Absorb BVS implantation in routine clinical practice leads to a high level of lesion treatment success. However, despite this, Absorb BVS use is associated with an increased risk of device-related adverse events, particularly stent thrombosis. Absorb BVS use in long and bifurcated lesions and BVS implantation in the distal segment of the coronary artery are independent predictors of stent thrombosis. In addition, Absorb BVS use in patients with a high functional class of angina and heart failure, multivessel coronary artery disease as well as BVS implantation in the distal segment of the coronary artery are independent predictors of device-related adverse events.Received 22 July 2019. Revised 1 October 2019. Accepted 14 October 2019.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.

The effectiveness of the method of external counterpulsation in patients with chronic stable angina

Purpose: to evaluate the effectiveness of multipurpose treatment of patients with chronic stable angina pectoris using the method of external counterpulsation (ECP). Materials and methods: a total of 92 patients with chronic stable angina included in the comparative analysis, which divided into 2 groups: the main group and the control group. The main group consisted of 57 patients who received one course of treatment using the ECP method, the control group consisted of 35 patients. Before and after the treatment, all patients underwent the following: general clinical examination, including the determination of the functional class of angina pectoris and the need to use nitroglycerin preparations; echocardiographic examination; stress-ECG test; quality of life assessment (based on the Seattle Quality of Life Questionnaire (Seattle Angina Questionnaire)). Results: a decrease in the average functional class of angina pectoris noted more in the ECP group than in the control group (from 2.280.73 to 0.930.80, p0.05 vs. from 2.340.73 to 1.830.71, p0.05). A decrease in the functional class of angina at least in one functional class was significantly higher in the main group (78.9% vs. 57.1%, p=0.0258). The use of nitroglycerin sharply decreased after treatment in the ECP group (by 51.6%, p=0.002), and in the control group, despite a slight decrease (by 22.7%), the changes did not reach the level of statistical significance (p=0.0736). When comparing the dynamics of changes in echocardiographic parameters, the dynamics turned out to be approximately the same in both groups. Differences obtained only for the dynamics of the left ventricular ejection fraction, which was greater in the ECP group (an increase of 4.695.56% vs. an increase of 1.755.15%, p=0.0448). The dynamics of all indicators of the stress-ECG test is significantly different in the main and control groups, and the dynamics in the ECP group are positive, but in the control group are negative. When comparing the data of quality of life, the dynamics of changes on some scales are insignificant and the same for both groups, for example, on the physical limitation scale, but on some scales (scales of angina stability and angina frequency), the dynamics of improvement in the ECP group are much higher than in the control group (30-37 points vs. 12-13 points respectively, p0.0001). The overall quality of life assessment score improved significantly more in the ECP group than in the control group (+96.1040.73 vs. +45.3135.06, p0.0001). Conclusion: the study showed that the method of external counterpulsation can be used in clinical practice as part of the multipurpose treatment of patients with chronic stable angina. The use of this technique has significantly reduced the class of angina, reduced the need for using nitroglycerin preparations, and improved some number of echocardiographic, stress-ECG test and quality of life indicators.