Course Of Ischemic Heart Disease Research Articles

Artificial intelligence systems for predicting chronic ischemic heart disease outcomes in cardiac surgery patients based on presence of anemia: a literature review

BACKGROUND: In Russia, the number of people undergoing heart surgery exceeds 600 thousand annually. These include anemia in 30–70% of patients with a 4-fold increased risk of one-year death, a 5-fold increased risk of stent thrombosis, a 1.3-fold increased risk of recurrent acute coronary events, and a 2-fold increased risk of bleeding. However, among the prognostic systems developed using artificial intelligence (AI) technologies, few take the presence of anemia into account. Existing digital platforms are not designed to support clinical decision making. AIM: The review aimed to evaluate existing AI platforms for predicting the course of ischemic heart disease (IHD) and systems that take into account the presence of anemia. MATERIALS AND METHOD: The PubMed and Russian Science Citation Index databases from 2000 to January 2024 were analyzed. Using Keywords of “artificial intelligence”, “anemia”, “coronary heart disease”, “hemoglobin”, and “cardiac surgery”, 906 articles were found, of which 38 met the inclusion criteria for analysis. RESULTS: In some countries, AI platforms have been created to predict the course of IHD. This review analyzes published data on the development and use of AI-based digital products for the management of patients with IHD, including those that take into account key hemodynamic parameters. CONCLUSION: Analysis of existing developments revealed a focus on solving prognostic problems. However, in our opinion, the range of parameters analyzed is not wide enough. For example, anemia, which plays a key role in modifying the risk of adverse outcomes in IHD, has not been considered as a factor.

Post-COVID syndrome: status of carbohydrate metabolism in patients with hypertension and stable ischemic heart disease

Background. Post-COVID syndrome is associated with a wide range of chronic symptoms or conditions. Coronavirus di­sease 2019 (COVID-19) causes metabolic disorders such as hyperglycemia, insulin resistance. Insulin-like growth factor 1 (IGF-1) is associated with an impaired glucose tolerance and a higher risk of developing type 2 diabetes. Currently, the study of molecules regulating carbohydrate metabolism as potential biomarkers of post-COVID syndrome and targets for therapeutic influence is relevant. The purpose of the study was to assess the level of IGF-1 and its relationship with regulation of carbohydrate metabolism, as well as the dynamics of the evaluated indicators under the influence of drug treatment in patients with hypertension and stable coronary heart disease who suffered from COVID-19. Materials and methods. Fifty-five patients who had a mild and moderate COVID-19 were included in the study; their average age was 55.87 [40; 75] years. The results of routine laboratory tests were registered and analyzed. The content of insulin and IGF-1 was assessed by enzyme immunoassay. The HOMA-IR was calculated. Results. In patients with a mode­rate COVID-19 compared to those with a mild one, a significant decrease in the level of IGF-1 (р = 0.008) was found against the background of increased reference values of glucose, insulin, and HOMA-IR (р < 0.01). The influence of the degree of hypertension on the IGF-1 level was revealed (р = 0.004). An inverse relationship between IGF-1 and glucose level was noted (r = –0.28, p = 0.034). The use of meldonium contributed to a significant decrease in glucose and insulin content (p < 0.001), and an increase in IGF-1. Against the background of taking meldonium, the dynamics of the shift towards a decrease in the HOMA-IR was more significant. Conclusions. An inverse relationship was found between IGF-1 and blood glucose, regardless of the level of insulin and HOMA-IR, in patients with hypertension and stable ischemic heart disease in the post-COVID period. Meldonium has been shown to improve carbohydrate metabolism by normalizing insulin levels and redu­cing the phenomena of insulin resistance as a potential drug target. Meldonium improved the clinical course of ischemic heart disease and demonstrated good tolerability and safety.

ГЕНЕТИЧЕСКИЕ ПОЛИМОРФИЗМЫ РЕНИН-АНГИОТЕНЗИН-АЛЬДОСТЕРОНОВОЙ СИСТЕМЫ У БОЛЬНЫХ СТАБИЛЬНОЙ ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА В ПОСТКОВИДНОМ ПЕРИОДЕ

Introduction. The course of ischemic heart disease (IHD) is a multifaceted and multiparametric process influenced by both exogenous factors and genetic predispositions. The renin-angiotensin-aldosterone system (RАAS) plays a key role in regulating blood pressure and maintaining homeostasis within the cardiovascular system. Genetic polymorphisms related to the functioning of the RAS can significantly affect individual susceptibility in patients with IHD. The study of these genetic factors becomes particularly relevant in the context of the post-COVID period, where the impact of the coronavirus on the mechanisms regulating vascular tone and metabolism has not yet been fully investigated. Aim. To evaluate the clinical and laboratory picture and compare the frequency of polymorphisms of the renin-angiotensin-aldosterone system (RAAS) genes in patients with ischemic heart disease (IHD) in the post-COVID period depending on the severity in the acute phase. Material and methods. The study included 416 patients with stable ischemic heart disease who suffered documented COVID-19 3-18 months ago. The patients in the groups did not differ significantly in age, gender, cardiovascular risk factors, structure of comorbidities, antihypertensive and other drug therapy or clinical characteristics. Depending on the severity of COVID-19 in the acute period, the patients were divided into two groups. Group 1 included 203 people with mild COVID-19, group 2 included 213 people with moderate course of the disease in the acute period. The research methods included, in addition to clinical, laboratory tests, and instrumental examinations, an assessment of genotypes using the markers AGT (521 C/T), AGTR1 (1166 A/C), ACE (Del287 INS/DEL), AGT (704 T/C), GNB3 (825 C/T), AGTR2 (1675 G/A), CYP11B2 (-344 C/T). Results. It has been established that patients with IHD who had moderate COVID-19, in the post-COVID period are characterized by altered parameters of lipid, carbohydrate metabolism, and endothelial dysfunction, leading to a worsening of the disease and an increased risk of complications. It has been stated that the candidate genes for the development of moderate COVID-19 in patients with stable IHD are the G/A genotype of the 1675 G/A polymorphism of the AGTR2 gene, the C/C genotype of the (825 C/T) polymorphism of the GNB 3 gene, and the C/C genotype of the (704 T/C) polymorphism of the AGT gene. Conclusion. The data obtained indicate that patients with stable IHD who have had moderate COVID-19 in the acute stage of the infectious process constitute a special risk group for a subsequent more severe course of the underlying disease.

SILENT MYOCARDIAL ISCHEMIA IN PATIENTS WITH ACUTE CORONARY SYNDROME AND DIABETES MELLITUS

ST-segment elevation myocardial infarction, stenting of the infarct-related coronary artery, silent (painless) myocardial ischemia, diabetes mellitus, 24-hour electrocardiographic monitoring.
 Introduction. Currently, approximately 422 million people in the world have diabetes mellitus, and over 1.3 million individuals in Ukraine are diagnosed with diabetes mellitus. Diabetic neuropathy is known to contribute to the development of atypical and painless variants of ischemic heart disease in individuals with diabetes. This poses a challenge for timely diagnosis and obscures the course of ischemic heart disease, as the prevalence of silent myocardial ischemia is significantly high in these patients. Therefore, the aim of this study is to investigate the occurrence of myocardial ischemia episodes in patients with ST-elevation myocardial infarction within the first day following stenting of the infarct-related coronary artery. Furthermore, we aimed to demonstrate the painless nature of these episodes in the presence of type 2 diabetes mellitus through a clinical case presentation.
 Materials and methods. 30 patients with ST-segment elevation myocardial infarction were examined, and 24-hour electrocardiographic monitoring was performed during the first day after the infarct-related coronary artery stenting. Results. Episodes of transient myocardial ischemia were registered in 50% of people. We found that the majority of episodes (80%) were painless. In the presence of diabetes mellitus, only episodes of painless myocardial ischemia were noted that is supported by the example of a clinical case. The study highlighted the informativeness of 24-hour electrocardiographic monitoring in identifying episodes of myocardial ischemia, particularly in its painless variant. The results demonstrate that patients with ST-elevation myocardial infarction (STEMI) experience episodes of transient myocardial ischemia within the first day after coronary artery stenting, with a majority of these episodes being painless. Furthermore, in the presence of diabetes mellitus, ischemic episodes tend to be painless. Therefore, 24-hour electrocardiographic monitoring serves as a valuable method for the detection of myocardial ischemia.

Personalized approach to cytoprotective treatment in ischemic heart disease

Objectives. To assess the efficacy and harmlessness of the cytoprotective treatment with meldonium of ischemic heart disease by developing personalized approaches. Materials and methods. Our study included 160 patients with IHD (117 men and 43 women) aged 37 to 81 years. Of them, 142 patients had angina pectoris of stable effort from different functional classes, and 21 – unstable angina pectoris. The average age of patients was 59.26±0.74 years. All patients were divided into 2 groups: 1 group (n=80) only with background treatment and 2 group included (n=80) with background treatment and meldonium. The observation period was 12 months (one year). Results. Significant differences were found in the pathogenesis of the underlying pathology and in the effectiveness of meldonium treatment in men and women. In this way, for men on the background of exertion angina is characteristic of more frequent occurrence of myocardial infarction, and for women – heart failure and diabetes mellitus, but meldonium remain the same effectiveness for both groups. Men smoke 16 times more, and women suffer from abdominal obesity 2 times more, which could be the cause of the more atherogenic lipid profile in them. According to the survey, the hereditary predisposition to cardiovascular diseases is higher in women, although most likely women are simply better informed about the pathologies of relatives and they were more disciplined in treatment with meldonium. Discussions. The effectiveness of treatment in women is significantly better according to the indicators of subjective and objective improvement compared to men, which is confirmed by many existing studies. Sex factor determines the presence of a number of pathogenetic peculiarities of the course of ischemic heart disease, and therefore can be considered as one of the criteria for personalizing pharmacotherapy, however, for the individual choice of metabolic corrector, this factor is not significant. The age factor determines some pathogenetic peculiarities of the course of ischemic heart disease and the effectiveness of pharmacotherapy, however, it is not decisive for the choice of metabolic corrector. Conclusions. The standard criteria for the personalization of pharmacotherapy in cardiology - sex, age, environmental risk factors, the presence of an underlying disease and concomitant pathology, pharmacogenetic and psychological profile - affect the pathogenesis of the development of coronary artery disease, to some extent determining the sensitivity of patients to meldonium, but they are not decisive for a personalized choice of metabolic corrector.

Reduction of Cardiovascular Events and Related Healthcare Expenditures through Achieving Population-Level Targets of Dietary Salt Intake in Japan: A Simulation Model Based on the National Health and Nutrition Survey.

Reducing population dietary salt intake is expected to help prevent cardiovascular disease and thus constrain increasing national healthcare expenditures in Japan’s super-aged society. We aimed to estimate the impact of achieving global and national salt-reduction targets (8, <6, and <5 grams/day) on cardiovascular events and national healthcare spending in Japan. Using published data including mean salt intake and systolic blood pressure from the 2019 National Health and Nutrition Survey, we developed a Markov model of a closed cohort of adults aged 40–79 years in 2019 (n = 66,955,000) transitioning among six health states based on the disease course of ischemic heart disease (IHD) and stroke. If mean salt intake were to remain at 2019 levels over 10 years, cumulative incident cases in the cohort would be approximately 2.0 million for IHD and 2.6 million for stroke, costing USD 61.6 billion for IHD and USD 104.6 billion for stroke. Compared with the status quo, reducing mean salt intake towards the targets over 10 years would avert 1–3% of IHD and stroke events and save up to 2% of related national healthcare costs. Attaining dietary salt-reduction goals among adults would yield moderate health economic benefits in Japan.

Correlation between ST-elevation myocardial infarction, non-ST-elevation myocardial infarction and the local Earth’s magnetic field changes

Stronger oscillations in the local Earth magnetic field may have an impact on the course of ischemic heart disease. This effect is individual for every person and depends on the sex, age, living territory, season, capability to adjust to magnetic field fluctuations and health status. Individuals who already have cardiovascular disease are more sensitive to magnetic field fluctuations, therefore further research is needed to make conclusions. Aim: To identify correlations between changes in local Earth magnetic field frequencies and patients with ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI) cases per week, cases by sex per week and patients’ blood laboratory parameters (low-density lipoprotein cholesterol and Troponin I level). Methods: A retrospective study of 1667 patients, who were admitted to the Hospital of Lithuanian University of Health Sciences Kaunas Clinics between 1st January and 31st December 2019 due to acute coronary syndrome (STEMI and NSTEMI), were included in the study. Local Earth's time varying magnetic field (TVMF) was measured by a magnetometer located in Baisogala, Lithuania. Data from the magnetometer was collected daily, and weekly averaged. We assessed the correlations between average weekly geomagnetic field strength in six different frequency ranges (Hz) and average number of STEMI and NSTEMI cases per week, cases by sex per week and patients’ blood laboratory parameters (low-density lipoprotein cholesterol and Troponin I level). Results: The presence of a stronger magnetic field in the frequency range of 32-65 Hz was significantly related to the number of cases in the STEMI group during the winter season (r= 0.583, p= 0.036). Tendency towards a positive correlation was found during the winter in the men's group with STEMI in the high frequency range of 32-65 Hz. Low-density lipoprotein cholesterol level correlated positively in the winter STEMI group with the magnetic field in the 32-65 Hz range, and in the autumn STEMI group with the magnetic field in the frequency range of 0-7 Hz. Conclusion: Increased geomagnetic field strength in the high frequency range of 32-65 Hz is associated with a higher number of cases in the STEMI group.

Особливості перебігу та лікування ішемічної хвороби серця у хворих з порушеннями метаболізму глюкози та цукровим діабетом

Поєднання ішемічної хвороби серця та цукрового діабету характеризується особливостями клініки та недостатньою ефективністю лікування ішемічної хвороби серця. Із метою вивчення патогенетичних механізмів та особливостей клінічного перебігу ішемічної хвороби серця за умов порушення гомеостазу глюкози проведене обстеження 116 хворих (медіана віку 63 роки) (нормальна регуляція глюкози (24), порушення глікемії натще (23), порушення толерантності до глюкози (21), комбіноване порушення (24), цукровий діабет (24)) та їх проспективне спостереження впродовж 40 місяців із кінцевими точками — госпіталізація з приводу серцево-судинних ускладнень або смерть від них та виникнення цукрового діабету. Встановлено, що ішемічна хвороба серця за умов предіабетичних порушень та цукрового діабету має особливості: більш рання клінічна маніфестація в жінок, частіша та тяжча серцева недостатність, нижча толерантність до навантаження, атипові прояви ангінозного болю (довший, атиповий або відсутній), супутні порушення ритму та провідності, ураження декількох коронарних артерій, ускладнений перебіг інфаркту, ексцентричний тип ремоделювання лівого шлуночка, кальциноз клапанів серця. Принципи лікування ішемічної хвороби: зниження маси тіла, корекція порушень метаболізму глюкози медикаментами навіть на етапі предіабету, при хронічних формах ішемічної хвороби серця метформін суттєво покращує обмін глюкози, зменшує інсулінорезистентність, не спричиняє зростання частоти серцево-судинних ускладнень та декомпенсацію серцевої недостатності. Вибір препаратів базового лікування ішемічної хвороби серця повинен проводитись з урахуванням їх впливу на метаболізм глюкози, слід уникати засобів, що його погіршують. Повинні використовуватися препарати з чіткими показаннями, оскільки їх взаємодія непередбачувана.

Cardioprotective effects of alendronate bisphosphonate in patients with ischemic heart disease associated with type 2 diabetes mellitus and osteoporosis

Introduction. Diabetes mellitus, cardiovascular diseases and osteoporosis are linked by common pathophysiological mechanisms.Objective. To evaluate the effect of alendronate bisphosphonate on cardiovascular outcomes in comorbid patients with ischemic heart disease (CHD) associated with type 2 diabetes mellitus (type 2 diabetes) and osteoporosis during a two-year follow-up.Materials and methods. A total of 112 women with comorbid pathology including osteoporosis, coronary artery disease, and type 2 diabetes were examined. The patients' condition was assessed at baseline and prospectively for 24 months with a combined endpoint assessment, including: mortality, readmission for cardiovascular diseases, the development of myocardial infarction (MI), stroke, atrial fibrillation. Women were divided into groups: group 1 (n = 59) included patients who received basic therapy for IHD and type 2 diabetes, group 2 (n = 53) included patients who, in addition to basic therapy for coronary artery disease and diabetes Type 2 was prescribed alendronic acid preparation.Results and discussion. According to the results of two-year follow-up, the patients were divided into two subgroups: patients with a favorable (n = 61) and unfavorable course of coronary artery disease (n = 51). At the same time, during prospective observation, the following was assessed: the frequency of hospitalizations for cardiovascular diseases, the dynamics of the functional class (FC) of exertional angina, the development of MI, stroke, atrial fibrillation, and mortality. A significant association of alendronate therapy with a favorable course of ischemic heart disease (OR = 0.26; 95% CI = 0.18-0.57; p = 0.008), a decrease in the risk of MI (OR = 0.32; 95% CI = 0.11-0.87; p = 0.018) and worsening of FC of exertional angina (OR = 0.4; 95% CI = 0.17-0.91; p = 0.014).Conclusion. Long-term (24 months) use of alendronate is an effective and safe method for the treatment of associated cardiovascular pathology, represented by coronary artery disease, type 2 diabetes and osteoporosis in postmenopausal women, reducing the risk of MI, worsening of FC of exertional angina. These results suggest a more aggressive prescription of alendronate for osteoporotic patients at very high cardiovascular risk.

Relationship between the level of blood plasma amino acids with daily amount of group ventricular extrasystoles and the duration of pain or painless myocardial ischemia in patients with stable and unstable angina

It is now known that the human body suffering from coronary heart disease is trying to adapt to new working conditions through biochemical rearrangements, one of which is to increase the involvement of amino acids in car diomyocyte metabolism. Amino acids are metabolized in the myocardium under normal conditions, myocardial ischemia leads to a major restructuring of biochemical reactions, which increases the use of amino acids as metabolites. It is proved that myocardial ischemia, painless myocardial ischemia, and group ventricular extrasystoles are prognostic indicators of the adverse course of ischemic heart disease. According to the results of the study, in patients with stable (SA) or unstable angina (UA), the reliable correlations between the frequency of group ventricular extrasystoles and painless or painful myocardial ischemia with the levels of arginine, the amount of sulfur-containing amino acids and amino acids with branched lateral chain are formed. This indicates the pathogenetic role of the imbalance of the amino acid spectrum of blood plasma in the development of atherosclerosis, destabilization of coronary circulation, and the emergence of cardiac arrhythmia.

The Hypothalamo-Pituitary-Gonadal System in Men with Ischemic Heart Disease

Purpose: This Research was to study the functional state of the hypothalamic-pituitary gland-gonadal system in males with Ischemic Heart Disease (IHD), as well as the effect of hormonal correction of the revealed disorders on factors of pathogenesis and the course of IHD.&#x0D; Materials and Methods: We examined 120 males with IHD of different severity of disease, aged 20-50 years and 34 healthy males of the same age with normal body weight and with uncompromised history for diseases of the endocrine system. Among those surveyed were not included alcoholou anabolizant steroids abusers with severe somatic and inflammatory diseases of the genital organs (prostatitis, urethritis, orchitis). The body weight of patients fluctuated within ± 10% of the ideal. At the time of the examination, all the patients were married, 2 were divorced, and all had children.&#x0D; Depending on the age, the examinees were divided into 2 groups: the first - 44 patients in the age of 20-35 years, the second - 76 patients 36-50 years old.&#x0D; The patient was examined in Ashgabat city, Hospital with the Scientific- clinical Center of Cardiology (Turkmenistan).&#x0D; Results: In the I age group, 8 patients had post infarction cardiosclerosis, in which there was a slight decrease in sexual activity, in others - angina pectoris of different functional classes (there was no violation of sexual activity).&#x0D; The average content of Т in the fasting serum of males with IHD of I group was significantly lowered, were noted a statistically unreliable tendency to increase of FSH and a statistically significant increase in the LH/T ratio. The mean levels of LH, PRL and E2 did not differ from the corresponding indices in healthy individuals.&#x0D; Conclusion: Patients with IHD have decreased testosterone secretion, especially at a young age.

Malondialdehyde and its role in pathogenesis of unstable forms of ischemic heart disease

Lipid peroxidation plays a major role in cellular biology and, consequently, in all physiological and pathophysiological processes. Malondialdehyde (MDA) is a well-studied product of lipid peroxidation. MDA is a toxic substance, which is synthesized during arachidonic acid peroxidation. This substance can react with nucleic acids, phospholipids, cholesterol and proteins, having proatherogenic and cancerogenic effects. Oxidative stress, including some biochemical reactions of MDA, plays a major role in pathogenesis of ischemic heart disease (IHD). Nevertheless, determination of oxidative stress activity is not widely used in clinical practice, because it is expensive, controversial and non-specific. Increase of MDA above 100 pmol/ml is considered a prognostic biomarker of IHD course and carotid atherosclerosis, but practical usage of this marker needs further analysis of oxidation processes with other pathogenetic mechanisms of IHD. The purpose of this study is to estimate MDA concentration and its pathogenetic role according to correlation analysis in patients with acute forms of IHD. We analyzed data of 20 inpatients with IHD, unstable angina pectoris, which were assessed and treated according to actual guidelines and other documents. Results were statistically processed with the help of Spearman’s correlation analysis. In patients with IHD, unstable angina pectoris the mean MDA value was slightly increased (122.52 pmol/ml) and characterized by the significant range (in 1.7 times). In patients with MDA level higher than mediana we noticed higher levels of segmented neutrophils and proinflammatory neutrophil / limphocyte ratio, lower relative levels of lymphocytes and monocytes and 3.75 higher odds ratio for having bilirubin lower than 10 pmol/ml, which is also a criterion of oxidative stress. When MDA level was normal, it was significantly associated with monocytes number (r=0.92) and high density lipoproteins concentration (r=-0.79). In case of increased MDA level it correlated with band neutrophils (r=0.77), thickness of left ventricle posterior wall and interventricular septum (r=-0.79 and r=-0.79). Malondialdehyde is not only a marker of oxidative stress, but also a marker of inflammation activation, dyslipidemia, carbohydrate intolerance, thrombosis, arterial hypertension and tachycardia. Keywords: malondialdehyde, ischemic heart disease, oxidative stress, inflammation, structural heart parameters.

Ischemic heart disease and chronic obstructive pulmonary disease: the topical problem of comorbidity in internal medicine

The aim. To review the current literature to study the prevalence and early diagnosis of the combined course of ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD).Results. The combination of IHD and COPD is one of the common comorbid conditions, especially in older age. With this mixed pathology, the course of both coronary heart disease and COPD worsens and the risk of adverse events increases. Diagnostic-treatment and rehabilitation programs in combination with coronary heart disease and COPD complication. This requires a comprehensive approach and consideration of the pathogenesis features of each disease. In coronary heart disease, especially in older age, diagnostic measures should include targeted detection of COPD and vice versa.Conclusions. Despite numerous studies of the IHD-COPD tandem, the issues of prevalence, course, and life expectancy in older patients with this comorbid pathology have not been adequately addressed. Causes of comorbidity are common features of pathogenesis, clinical symptoms and risk factors. At the same time, the combination of coronary heart disease and COPD raises debating questions about diagnosis, treatment and rehabilitation, especially in the elderly and aging. It is in this direction that the focus of future research on the combination of IHD and COPD should be directed. Purposeful study will help to develop directions for correction, prognosis and prevention of this comorbid pathology, especially in elderly patients

Prognostic value of epicardial fat thickness in coronary heart disease patients after myocardial revascularization

Objective To study the role of epicardial adipose tissue (EAT) in determination of risk for adverse course of ischemic heart disease (IHD) in patients after myocardial revascularization.Materials and Methods This study included 217 subjects, 182 IHD patients and 35 evaluated individuals without IHD. Percutaneous coronary intervention (PCI) was performed for 104 patients and coronary bypass (CB) was performed for 78 patients. Also echocardiography (EchoCG) and cardiac computed tomography were performed.Results In IHD patients, EAT volume and thickness were greater than in evaluated subjects without IHD. The composite endpoint (CEP) was observed after PCI more frequently than after CB. In IHD patients with an EAT thickness of 8.5 to 10.2 mm measured with EchoCG in the atrioventricular groove, the risk of CEP was 4.3 times higher after myocardial revascularization than with thicker or thinner EAT regardless of the revascularization method.Conclusion An EAT thickness of 8.5 to 10.2 mm in the atrioventricular groove as measured with EchoCG was associated with a risk of adverse IHD course in patients who have underwent myocardial revascularization.

Pathophysiologic Peculiarities of Different Factors’ Influence on Development and Course of IHD Complicated with Atrial Fibrillation

Over the last years, mortality because of cardiovascular diseases (CVD) increased significantly in Ukraine. If we speak about atrial fibrillation (AF) itself, the number of recurrent arrhythmias cases as the main cause of hospitalization of patients with AF increased at 66% over the last 20 years.&#x0D; Independent development factors of AF are heart failure, aortic and mitral valve diseases, arterial hypertension, left atrial enlargement, and also obesity and obstructive sleep apnea, etc.&#x0D; In 2013 A.A. Novykov from Kherson region and several other researchers proved the influence of chaotic changes of meteofactors in cases of overt or hidden functional cardiovascular disorders (CVD) that can significantly influence its hemodynamic stability, functional ability, particularly its rhythmic activity.&#x0D; The main problem in the treatment of one or another nosological entity of CVD today is not the adjustment of a medication for its treatment, but the finding of pathogenetic links in the development of the disease itself. Especially this occurs, when the patient gets several organs or systems disabled simultaneously.&#x0D; Several scientists and practicing physicians are interested in the development of new approaches to diagnosis and treatment of AF in patients with ischemic heart disease (IHD) considering the peculiarities of clinical course and comorbidity. After all, the finding of complications’ causes in comorbid pathology in patients with IHD will contribute to treatment optimization and prevention of other complications, especially those resulting from the anticoagulant therapy, for example when a functional liver state or metabolic processes are impaired.

Dental treatment of post-myocardial infarction patients: A review of the literature.

Patients who have suffered a heart attack often require dental treatment. The inflammation of the oral cavity not only reduces the quality of life, but also negatively affects the course of ischemic heart disease. Dental treatment in patients with a history of myocardial infarction seems complicated, since these patients require special consideration with regard to the timing and form of dental treatment as well as to the precautions required. Patients at risk of cardiac complications that are greater than the benefits of dental treatment should be identified and only the most urgent conditions should be treated. The aim of this study was to present the latest guidelines for dental treatment in patients who have suffered myocardial infarction. We reviewed the available literature explaining when dental treatment can be undertaken, whether antibiotic prophylaxis is required, whether the patient can be anesthetized locally, and how to provide the maximum safety during the visit. The principles of the surgical treatment of patients receiving drugs that affect hemostasis were also reviewed.

Risk of heart rhythm disorders in patients with chronic obstructive pulmonary disease, combined with ischemic heart disease during computer spirography

The aim — to evaluate the safety of spirography with bronchodilation test in patients with a combination of stable ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD).Materials and methods. 148 patients were examined including 53 patients with a combination of stable IHD and COPD, 53 IHD patients without concomitant COPD and 42 patients with COPD. Patients underwent general clinical examination, monitoring of an electrocardiogram, echocardiography, spirography.Results and discussion. An increase in the number of extrasystoles within 1 hour after performing spirography was noted, the greatest increase in the number of supraventricular extrasystoles (SVE) was observed in patients with combined pathology — on average (12.6 ± 6.8, p = 0.23). The number of ventricular extrasystoles (VE) within 1 hour after spirography in patients with combined pathology increased by (27.8 ± 12.6, p = 0.0064), whereas in patients with IHD — by (3.4 ± 2.2, p = 0.19), in patients with COPD — by (15.7 ± 12.5, p = 0.076). An increase in the number or occurrence of polytropic VE was reported in 4 (7.5 %) persons with combined pathology, in 2 (3.8 %) patients with IHD and in 3 (7.1 %) patients with COPD. The occurrence of high‑grade VE during spirography was established in 11 (20.7 %, p = 0.008) patients with a combination of IHD and COPD, in 5 (9.4 %, p = 0.06) patients with isolated course of IHD and in 3 (7.1 %, p = 0.23) patients with COPD. The predictors of an increase in the number of VE within 1 hour after performing spirography for patients with IHD and COPD were identified.Conclusions. Spirography is associated with the occurrence of rhythm disorders in patients with a combination of IHD and COPD. Prior to spirography, patients with IHD should undergo echocardiography and daily monitoring of the electrocardiogram.

EVALUATION OF THE INTERNAL PICTURE OF HEALTH IN PATIENTS WITH ACUTE CORONARY SYNDROME IN PRESENTING WITHOUT ST-SEGMENT AFTER PERCUTANEOUS CORONARY INTERVENTIONS AND IN THE PROCESS OF REHABILITATION

Ischemic heart disease remains an actual problem of modern clinical and rehabilitation medicine. One of the forms of ischemic heart disease (IHD) is an acute coronary syndrome (ACS) in patients presenting without persistent ST-segment, the treatment of which involves the use of conservative treatment and reperfusion techniques. An integral part of the management of patients after acute coronary syndrome is rehabilitation and restoration with the search for methods of changing the attitude of the patient to his health. To improve the rehabilitation of patients it is important to assess the internal picture of health with the formation of the correct attitude of the patient to his health. Aim. To study the peculiarities of the components of the internal picture of health in patients with acute coronary syndrome in patients presenting without persistent ST-segment in the process of treatment and rehabilitation. Materials and methods. There were examined 135 patients with ACS presenting without persistent ST-segment, who were divided into the groups depending on the treatment performed; 60 patients with conservative treatment tactics and 75 patients with the performed PCI. The analysis of the internal picture of health was carried out with the help of methods: hospital scale for the detection of anxiety and depression (HADS); patient health questionnaire (PHQ-9); scale for measuring the level of reactive (situational) and personality anxiety of Spielberg-Hanin; SF-36; indicators of the Seattle Quality of Life Questionnaire for Patients with Angine Pectoris (Seattle Angina Questionnaire - SAQ). Results. The study of the internal picture of health in patients with ACS presenting without persistent ST-segment showed low levels of emotional, sensory, cognitive, value-motivational, behavioral components on the appropriate scales, which also depend on the method of treatment used. The revealed peculiarities of patients with ACS presenting without persistent ST-segment need to increase the knowledge of the patient about the disease and the importance of rehabilitation measures. Conclusions. In assessment of the internal picture of health in patients with ACS presenting without persistent ST-segment after transcutaneous coronary intervention and in the process of rehabilitation, it has been determined that the course of ischemic heart disease in patients with ACS presenting without persistent ST-segment, both during conservative treatment and in the course of PCI at the stages of rehabilitation, is accompanied by significant changes of the internal picture of health (IPH); the most significant changes in patients with ACS presenting without persistent ST-segment is the value-motivational and behavioral components of the internal picture of health. In order to increase the effectiveness of rehabilitation after ACS, it is advisable to apply programs that will significantly affect the positive changes in the rehabilitation of patients with ACS.

Holter Monitoring (24-Hour ECG) Parameter Dynamics in Patients with Ischemic Heart Disease and Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia.

IntroductionThis study examined the dynamics of 24-h electrocardiogram (ECG) monitoring parameters (Holter monitoring) in patients with ischemic heart disease (IHD) before and after conservative or surgical treatment of patients with voiding and storage lower urinary tract symptoms (LTS) due to benign prostatic hyperplasia (BPH).MethodsA total of eighty-three 57 to 81-year-old (mean age 70.4 ± 5.75 years) patients with LUTS/BPH and accompanying IHD were examined and treated at the Institute of Urology and Human Reproductive Health and Clinic of Cardiology of Sechenov University. All patients received recommended cardiac therapy at least 6 months before inclusion in the study.ResultsOur study demonstrated that there is correlation between voiding and storage LUTS/BPH and Holter-detected cardiac impairments in patients with IHD/BPH. These data make it possible to consider LUTS/BPH (voiding and storage) as a factor in the additional functional and psychological load on the activity of patients with ischemic heart disease. Improvement of voiding and storage LUTS due to BPH and objective parameters of urination (Qmax) in patients treated with alpha-1 adrenoceptor blocker tamsulosin correlated with improvement of 24-h ECG monitoring parameters (Holter monitoring) in 72% of patients. Improvement of 24-h ECG monitoring parameters (Holter monitoring) 1 month after transurethral resection of the prostate (TURP) in IHD/BPH patients and indications for surgical treatment was observed in 65.7%. Negative dynamics of the Holter-based ECG was not registered in patients who were operated on.ConclusionHolter monitoring helps to identify groups of patients in whom urinary impairments caused by prostatic hyperplasia negatively affect the course of IHD. Restored urination (either conservatively or operatively) in patients with BPH in 72% of cases decreased the number of fits of angina, thus influencing favourably the course of IHD.Trial RegistrationClinicalTrials.gov Identifier: NCT03856242.

Dynamics of Coronary Calcification and Its Association with the Clinical Course of Ischemic Heart Disease and Osteopenic Syndrome

to study the relationship between degree of calcification of coronary arteries, osteopenic syndrome, and clinical courseof ischemic heart disease (IHD) during 3-5 years of follow-up in men after coronary artery bypass grafting (CABG). Materials andmethods. We included in this prospective study 111 men admitted for CABG under cardiopulmonary bypass. All patients underwentcolor duplex scanning (CDS) of brachiocephalic arteries (BCA), coronary angiography, multislice computed tomography (MSCT)of coronary arteries (CAs) to assess the degree of calcification, densitometry of femoral neck. Cardiac calcium score of the vessels wasassessed by the Agatston method. After 3-5 (mean 4.2) years we assessed dead or alive status of 111 patients. Mortality during followupwas 11.7 % (n=13). In 59 of 98 survived patients we repeated CDS of BCA and MSCT of CAs with calculation of CA calcificationscores. Significant CA calcification prior to CABG was detected in more than half of the patients (57.6 %). Among all clinicaland anamnestic factors only one risk factor - smoking was associated with mortality (odds ratio [OR] 9.8, 95 % confidence interval[CI] 1.2-78.1, χ2=6.6, р=0.01). There were no association of mortality with index of CA calcification, Syntax score, osteopenicsyndrome and BCA involvement. In the group of patients with baseline coronary calcification index &gt;400 there were more smokers(р=0.026) and patients with lesions in &gt;3 CAs (р=0.037) compared with the group with values ≤400. At the preoperative stage werevealed associations of CAs calcification index with T-test characterizing presence of the osteopenic syndrome (r= -0.24, р=0.06),Syntax score (r=0.26, р=0.041), and number of affected CAs (r=0.25, р=0.048). At repeated examination 3-5 years after CABG a mediumpositive correlation was detected between the severity of CA calcification and the severity of BCA stenoses (r=0.28, р=0.029).Linear regression analysis with stepwise selection identified baseline (prior to CABG) higher values of T-test evaluated at femoralbone as the only significant predictor of calcium score increase during 3-5 years of follow-up. Dynamics of calcificationof CAs in men with IHD during 3-5 years of follow-up after CABG was multidirectional, but in most cases (66 %) it was progressive.There was correlation between coronary calcification and smoking status and decreased T-test assessed at femoral bone priorto CABG. In the long-term follow-up period the correlation between severity of BCA lesion and severity of coronary calcification wasfound. Negative correlation was detected between progression of coronary calcification and baseline impairment of mineral densityof femoral bone.