Myocardial Infarction In Anamnesis Research Articles

The effect of antiphospholipid antibodies on the frequency of extrasystoles in men with coronary heart disease and and myocardial infarction

Abstract Background Coronary heart disease (CHD) is one of the most socially significant diseases of the cardiovascular system. Acute myocardial infarction (MI) develops 10 years earlier in men than in women. Manifestation of MI in young men quite often happen without clinically significant stenosis of coronary vessels. And fatal arrhythmias are one of the main causes of death in patient with cardiovascular diseases. Purpose To evaluate the clinical and pathogenetic significance of antiphospholipid antibodies (aPL) in patients with MI and disorders of rythm. Methods 107 patients men (average age 51.2 ± 6.15 years) with CHD and MI were examined. The content of aPL IgG - antibodies to cardiolipin, phosphatidylserine, phosphatidylinositol, phosphatidylacetate in the blood serum were determined by enzyme-linked immunosorbent assay and electrocardiography Holter monitor 24 hours tests were done. Results aPL IgG were detected in 56 patients (52,3% of the total number of patients with MI), it concentration threshold 10 GPL U/ml in blood serum. The median age of first acute MI in men 56 years, according to the literary data. In our investigation average age of aPL positive patients is 44.8 ± 5.47 years. They had first MI on average 12 years earlier than general population. The level of aPL IgG in blood serum was higher in 1,7 times (19,3 ± 7,32 GPL U/ml and 11,4 ± 5,41 GPL U/ml (p <0.05) in patients with recurrent MI compared to one MI. Also the results of the study showed that the highest prevalence of polytopic extrasystoles is observed among aPL positive CHD patients with recurrent MI (68,3%) compared to one MI in anamnesis (26,3%). Moreover, 23.2% of people who had recurrent MI had ventricular extrasystole of high gradations. It is important to note, that іn patients with first Q-MI levels of aFL IgG were in 1.27 times higher (p<0.05) than in patients with first non-Q-MI. And the frequency of the polytopic extrasystoles was on 38% higher (p<0.01) іn patients with first Q-MI compared to patients with first non-Q-MI. Conclusion The results obtained by us indicate the possible involvement of the autoimmune factor, in particular aPL IgG, in the pathogenesis of CHD. Positive correlation of aPL IgG with the frequency of rhythm disorders indicates the severity of condition in men with CHD and MI in anamnesis and need for further research.

ENDOTHELIAL NITRIC OXIDE SYNTHASE GENE POLYMORPHISM (894G>T, 786T>C) CONTRIBUTE TO HYPERTENSION RISK AND LIPIDS PROFILE DISORDERS

Objective: Endothelial nitric oxide synthase (eNOS) gene meet the criteria for candidate genes of cardiovascular disease, including essential arterial hypertension (EAH). The aim of the study was to evaluate the association of eNOS gene polymorphism (894G>T, 786T>C) with EAH risk, lipids profile and some concomitant diseases. Design and method: 100 EAH patients with target-organ damage, moderate, high/very high cardiovascular risk were involved in the case-control study. 79.0% females and 21.0% males, mean age 59.87 ± 8.02; disease duration 6–25 years. Control included 48 practically healthy persons of relevant age. eNOS gene polymorphisms (894G>T, 786T>C) was examined by Real-Time PCR. Lipids’ profile was studied by total cholesterol (TC), high-, low density cholesterol (HDL-C, LDL-C), triglycerides (TG) and atherogenic index (AI). Results: eNOS gene mutants’ T-allele of 894G>T and C-allele of 786T>C were observed in 34.2% and 32.2% patients, that was almost 2 times less, than G-allele carriers (p = 0.006) and T-allele patients (p = 0.004) respectively. eNOS gene T-allele (894G>T) and C-allele (786T>C) were associated with increased relative risk of EAH 1.8 times [OR = 2.43; 95%CI:1.20–4.95] and 2.15 times [OR = 3.48; 95%CI:1.58–7.68], also with higher risk of concomitant Diabetes Mellitus type 2, cerebrovascular disease and acute myocardial infarction in anamnesis 1.53–1.72 times (p < 0.05). eNOS gene haplotype analysis proved the contribution of -894G/786C and -894T/786C haplotypes to EAH risk increase 2.05 times [OR95%CI:1.18–4.04] and 3.18 times [OR95%CI:1.27–7.29], elevation of TG level and atherogenic index by 10.5–18.7% (p < 0.05) and 12.65–14.19% (p < 0.05) accordingly. The HDL-C level was significantly lower in -894G/786C and -894T/786C carriers by 18.16% (p < 0.01) and 22.07% (p < 0.001). -894G/786T genotypes combination played a protective role against EAH [OR = 0.55; 95%CI:0.39–0.76; P < 0.001]. Conclusions: eNOS gene -894G/786C and -894T/786C increased the EAH risk and lipids profile metabolism disorders.

Relationship between transient symptomatic hypotensive episodes and 24-hour blood pressure variability in patients with arterial hypertension

Abstract Purpose Low blood pressure may be as harmful as high. Symptomatic hypotensive episodes should be a manifestation of circulatory disorders of hypertension – mediated organs especially among hypertensive patients. However, the association of such episodes with blood pressure variability is unknown. Aim To study the relationship between the symptomatic hypotensive episodes and the daily blood pressure variability according to the ambulatory blood pressure monitoring (ABPM) in patients with hypertension. Materials and methods 106 patients aged between 40 and 65 years with hypertension were studied. A questionnaire developed by the authors was used to identify symptomatic hypotension. During the study all the subjects had ABPM. Daily blood pressure variability was defined as standard deviation. Results Among all patients, symptomatic hypotensive episodes were observed in 60.6%. Among patients without myocardial infarction or stroke in anamnesis - 52.4%, with ones - 75% participants (p=0.05). Among patient without myocardial infarction or stroke and with symptomatic hypotensive episodes, the high variability of daily systolic BP was observed in 36% of the subjects and averaged 14.3 mm Hg, in the absence of symptomatic hypotensive episodes, the variability of daily systolic BP was 16.3 mm Hg, with a variety of blood pressure exceeding the norm, 80% of the participants (p<0.05). In case of stroke or myocardial infarction in anamnesis and the presence of symptomatic hypotensive episodes, the systolic BP variability of daytime (18.0 mm Hg) and nighttime (14.8 mm Hg) was the highest. The proportion of participants with daily systolic BP variability exceeding the norm was 78%. In the absence of symptomatic hypotensive episodes, the blood pressure variability indicators did not deviate from the norm (p<0.05). Conclusion Heart attack and/or stroke in anamnesis with symptomatic hypotensive episodes are associated with lower daily systolic BP variability (14.3 mm Hg) in comparison with patients without symptomatic hypotensive episodes (16.3 mm Hg). If there were stroke or myocardial infarction in anamnesis, patients with symptomatic hypotensive episodes have higher daily systolic BP variability (18.0 mm Hg) than without hypotensive episodes (14.5 mm Hg). Symptomatic hypotensive episodes are not unidirectionally associated with the variability of blood pressure, the character of the relationship is associated with the presence of heart attack and/or stroke diseases in anamnesis. Funding Acknowledgement Type of funding sources: None.

Predictors of atrial fibrillation recurrence after surgical ablation of long-standing persistent AF with concomitant coronary artery bypass grafting

Abstract Background A long-standing persistent form of atrial fibrillation (AF) in anamnesis, requiring surgical ablation together with coronary artery bypass surgery (CABG), significantly increases the risk of reccurence in the postoperative period. Before operation should consider the predictors of AF for long-term preservation of rhythm after surgery. Purpose To evaluate the predictors of AF recurrence on 3rd day and at discharge in patients after CABG with concomitant surgical ablation of long-standing persistent AF. Methods A prospective randomized single-center analysis was performed on patients with long-standing persistent AF, undergoing CABG with concomitant left atrial ablation (LAA) or biatrial ablation (BA) between 2016 and 2019. 116 patients were randomized into two groups: 58 in LAA+CABG, 58 in BA+CABG. The median age of the patients was 65 (IQR, 61 to 67.75) years in gr. BA and 62 (IQR, 58 to 66) in gr. LAA (Mann-Whitney U-test, p=0.050), 83% of men were in gr. BA (Fisher test, p>0.999). Predictors of AF development on day 3 were identified using multivariable logistic regression from the following baseline characteristics: myocardial infarction in anamnesis, time of artificial circulation, time of application of radiofrequency energy, the size of the left and right atrium, funcrional class of cardiac angina and heart failure, gender, age, acute cerebrovascular accident (CVA), additional intervention on the heart (operations for aortic aneurysm, mitral, aortic and tricuspid valves replacement), concomitant cardiovascular, respiratory, digestive and urogenital diseases. Results Using a multivariate model of logistic regression, the following significant predictors of arrhythmias on the 3rd day in gr. BA were included: additional intervention on the heart valves (OR 63.13, p=0.001); an increase in the functional class (FC) of chronic heart failure (CHF) NYHA by 1 (OR 40.06, p=0.018); a history of CVA (OR 9.13, p=0.026). The following significant predictors of AF reccurence on the 3rd day in gr.LAA were identified: an increase in the long axis of the right atrium by 1 cm (OR 3.05, p=0.006); an increase of the FC of cardiac angina by 1 (OR 7.11, p=0.011); in women (OR 7.14, p=0.017). In BA significant predictors of AF reccurence at discharge were: an increase in the long axis of the left atrium by 1 cm (OR4.86, p=0.015); reccurence of AF on the 3rd day (OR 17.45, p=0.005); 1 year increase in age (OR 1.24, p=0.023); the presence of diabetes (OR 47.67, p=0.002). In gr. LAA the predictors at discharge were: reccurence of AF on 3rd day (OR 38.35, p=0.001); a history of CVA increases the chances of arrhythmia (OR 210.83, p=0.032). Conclusion Number of clinical and functional characteristics of a patient may be predictors of AF. We examined the predictors of reccurence of AF after surgical ablation of long-standing persistent AF with concomitant CABG. Taking them into account when choosing the optimal strategy of treatment is important. Funding Acknowledgement Type of funding sources: None.

Type D personality in patients with coronary heart disease underwent coronary stenting: a prospective study

To evaluate the type D personality relation with clinical and instrumental parameters in patients with coronary heart disease (CHD) underwent coronary stenting (CS) and to determine the influence of the personality type D on the prognosis in these patients within one year after CS.Material and methods. Into prospective study we included 977 patients (740 men and 237 women) aged 33 to 86 years (mean age 58.7±9.4) who underwent CS. The Cox proportional hazard regression model was used to estimate the relative risk (RR) with a 95% confidence interval (CI) of the end point. The end points included death from all causes, death from cardiovas- cular disease (CVD), myocardial infarction (fatal + non-fatal) (MI), non-fatal myocardial infarction (non-fatal MI), unstable angina (UA), and stroke.Results. Type D personality was found in 31.8% patients. These did not differ from the others in terms of age, gender, main cardiovascular risk factors. Patients of D-type had tendency to the increase of diabetes diagnosed - 25.1% vs 20.3% (p=0.09). At the same time D-type patients had more prevalent ≥2 myocardial infarction in anamnesis - 9.0% vs 4.5% (p=0,006) among those with post infarction cardiosclerosis. There was no difference between the groups according to echocardiography and the short-term outcomes of CS. During the prospective study period (12±1.8 months) 24 patients (2.4%) died from all causes, 21 patients (2.1%) died from CVD. MI developed in 47 patients (4.8%) of whom, 23 patients (2.4%) underwent non-fatal MI. In 50 patients (5.1%) ischemic heart disease in a prospective period complicated UA. In 8 patients (0.8%) developed a stroke. There was no effect of personality type D on the prognosis in patients with CHD who underwent CS for 1 year after surgery.Conclusion. Among CHD patients underwent CS, type D personality was found in 31.8%. There is no link for type D personality and severity of CHD clinically as well as the short-term and long-term outcomes of CS.

Features of coronary artery bypass grafting in young patients with acute coronary syndrome

Aim: Purpose of the study was retrospective analysis of hospital and early (up to six monthes after operation) results of the surgical myocardial revascularization in patients, third and fourth decates of life, with acute coronary syndrome. Material and Methods: Since 2012 year up to November, 2018 year in CCH by the same brigade, performed 500 coronary artery bypass grafting operations in the patients with acute coronary syndrome, at the age of 30-83 years old, including 15 operations in patients ≤ 40 years old (3%). Clinical manifestation of acute coronary syndrome was presented: unstable angina in 13 (86.7%) patients, 6 (40%) of them with pass myocardial infarction in anamnesis; acute myocardial infarction, accompanied by S-T segment elevation (STEMI) in 2 (13.3%) patients. In coronarography: multivessel lesion of coronary arteries was revealed in 10 (66.7%) patients, 3 of them with lesion of trunk of the left coronary artery; bivascular lesion in 4 (26.7%) patients, single vessel lesion in 1 (6.6%). In 13 (86.7%) patients were performed coronary artery bypass grafting under the cardiopulmonary bypass (CPB). Average duration of the CPB= 127±9.66 min. Mean aortic clamp time = 68±6.91 min. Number of shunts for the whole group of 15 operated were from 1 to 5, at the average (3.28±0.31). In 6 patients (40%) performed three-branches CPB, in 5 patients (33.3%) fourth-branches, in 1 patient (6.7%) fifth-branches, in 2 patients (13.3%) double-branches and in 1 patient (6.7%) single branch CPB. Used conduits: left internal mammary artery in all 15 patients (100%), autovein in 12 (80%), radial artery in 10 (66.7%) patients. In last group with using radial artery, average amount of shunts was 1.5±0.1. Results: The structure of postoperative complications consist: low cardiac output syndrome in two patients; bleeding in 2 patients. In analyzed series, no lethal outcomes watched in duration up to 30 days after operation. All patients were watched during 6 monthes after discharge. It was not watches necessity for reinterventions and lethal outcomes. Conclusion: Hospital and immediate results of myocardial revascularization in young people with acute coronary syndrome very encouraging, while long-term results are not so optimistic and unsatisfactory. Therefor, considering the long life expectancy and higher functional and social demands of the patients at age ≤ 40 years, preference is given to hybrid interventions or isolated shunting using arterial conduits in both variants of revascularization.

Предиктори довгострокового клінічного прогнозу в пацієнтів з хронічною серцевою недостатністю та зниженою фракцією викиду лівого шлуночка

Мета роботи – визначити прогностичні фактори розвитку несприятливих серцево-судинних подій (смерті та госпіталізації) у пацієнтів із хронічною серцевою недостатністю (ХСН) та фракцією викиду лівого шлуночка (ФВЛШ) ≤ 35 % при довгостроковому спостереженні.Матеріали і методи. Обстежено 120 гемодинамічно стабільних пацієнтів з ХСН, віком 18–75 років, II–IV функціональних класів за NYHA, з ФВЛШ ≤ 35 %. За допомогою множинної логістичної регресії за методом Кокса аналізували незалежні фактори, що впливають на довгостроковий прогноз пацієнтів із ХСН. Результати та обговорення. За період спостереження із 120 обстежуваних 61 пацієнт досяг комбінованої критичної точки (ККТ). В уніваріантній регресійній моделі предикторами досягнення ККТ виявилися функціональний клас за NYHA, втрата маси тіла за останні 6 місяців ≥ 6 %, систолічний і діастолічний артеріальний тиск, наявність у пацієнта інфаркту міокарда в анамнезі та стенокардії, анемія, кількість госпіталізацій за останній рік та параметри, що відображають функціональний стан пацієнта (дистанція 6-хвилинної ходьби, кількість розгинань нижньої кінцівки). Ризик розвитку ККТ статистично значуще вищий у пацієнтів із меншими значеннями індексу маси тіла, окружності плеча напруженої та ненапруженої руки, стегна, товщини шкірно-жирової складки над біцепсом і трицепсом, розрахункової частки жирової маси тіла. Предикторами досягнення ККТ є вищі рівні сечової кислоти і С-реактивного білка. Ехокардіографічними предикторами настання ККТ виявилися ФВЛШ, розмір лівого передсердя, показник TAPSE, а також його співвідношення до систолічного тиску в легеневій артерії, індекс кінцеводіастолічного тиску в лівому шлуночку. Також ризик досягнення ККТ є більшим при менших значеннях показника потокозалежної вазодилатації плечової артерії (ПЗВД ПА). Незалежними предикторами настання ККТ виявилися окружність плеча ненапруженої руки, рівень С-реактивного білка у крові і показник ПЗВД ПА. При аналізі показників у 77 пацієнтів, яким була проведена денситометрія, виявлено, що на досягнення ККТ впливають показник Е/E´, індекс м’язової тканини кінцівок, індекс жирової маси і відношення жирової маси до зросту. При мультиваріантному аналізі з урахуванням показників денситометрії незалежними предикторами настання ККТ виявилися розмір лівого передсердя, індекс м’язової маси кінцівок, показник ПЗВД ПА і наявність інфаркту міокарда в анамнезі.Висновки. Незалежними предикторами досягнення ККТ пацієнтами з ХСН і ФВЛШ ≤ 35 % є наявність інфаркту міокарда в анамнезі, менші показники окружності плеча ненапруженої руки, індексу м’язової маси кінцівок, потокозалежної вазодилататорної відповіді, вищі рівні С-реактивного білка, розміри лівого передсердя.

The role of the superoxide dismutase for predicting long-term adverse events in patients with acute coronary syndrome.

To study the relationship between the blood concentration of superoxide dismutase in at the end of the hospital period of acute coronary syndrome without ST-segment elevation (nonST-ACS) and the development of adverse events in the long-term follow-up period. 415 patients with nonST-ACS are included in the local register study. The follow-up period was 60 months. The blood concentration of superoxide dismutase (SOD) determined in 200 patients on the 10-13th day of hospitalization in addition to clinical procedures. Within five years after discharge in 178 (47 %) patients reported the development of adverse events. Patients with poor outcome were older, had a history of myocardial infarction (PICS), stenoses of extracranial arteries more than 30% and decreased left ventricular ejection fraction (LVEF). There were significant differences in the concentration of SOD10-13 day, which was lower in the patients with development of adverse cardiovascular events (p = 0.0003). Multivariate analysis identified the factors that are most strongly associated with the development of the adverse events during a 5-year follow-up period in patients with nonST-ACS: SOD blood concentration ≤ 175,4 ng / ml (OR-3,85; р=0,0008), myocardial infarction in anamnesis (OR-3,26; р=0,006), LVEF ≤ 52% (OR-2,8; р=0,035). The incidence of adverse cardiovascular events during five years follow-up in patients with nonST-ACS was 47 % of cases. Adverse factors associated with the development of an unfavorable outcome in the long-term period follow are: SOD blood concentration ≤ 175,4 ng / ml, myocardial infarction in anamnesis, LVEF ≤ 52%.

FUNCTIONAL STATUS OF KIDNEYS AT PATIENTS WITH ARTERIAL HYPERTENSION (ACCORDING TO THE RUSSIAN FEDERAL REGISTER OF ARTERIAL HYPERTENSION)

Objective: to estimate functional status of kidneys at patients with arterial hypertension (AH), who were under the care in primary health care Design and method: The study was carried out with AH Register method (Software with remote access and specially trained doctors made data inputs from medical records into the Register). A selection of 18,656 patients (pts) with AH from 22 Russian regions in 2010–2016 was analyzed. Among them, there were 38% men (n = 7153) of average age 61.4 ± 12 and 62% women with AH, who were 3.7 years older than men; their age was 62.5 ± 12 correspondingly (p < 0.01). The average level of creatinine accounted for 86.5 ± 15.9 micromole/l. Chronic renal disease (CRD) was estimated according to SCF (by formula MDRD). The data were analyzed with using statistical software STATISTICA 10. Results: Normal kidneys function was observed at 20.1 %; slightly diminished function CRD II – at 54.9 %; CRD III at 24.5% and CRD IV – at 0.5% patients with AH. Cardiovascular diseases frequency at patients with CRD IV vs CRD II increases along with progress of state of CRD coronary heart disease 54.2% vs 34.4%, chronic heart failure 40.3% vs 14.7%, Q myocardial infarction in anamnesis 32% vs 15%, peripheral arterial disease 18% vs 6.4%. Stroke |TIA in anamnesis was more often at patients with CRD IV: 19.4% vs 5.2% at patients with AH and CRD II. Diabetes mellitus frequency increases at patients with CRD IV and accounts for 28% vs 14 % at patients with AH and CRD II. Conclusions: According the Register data, along with progress of state of CRD the cardiovascular diseases, stroke |TIA and diabetes mellitus frequency increases in progress; kidney function depression is observed at 24.5 % patients with arterial hypertension

Evaluation of Thrombin Generation in Patients with Stable Coronary Artery Disease with a Prior Myocardial Infarction

Background. Despite invasive technologies and the advancement of modern pharmacotherapy in the treatment of coronary artery disease (CAD), patients still have risks of complications. There is a special group of patients with CAD with a prior myocardial infarction (MI). As demonstrated, a prior MI increases risk of recurring cardiovascular events. Thus, there was a decrease in the frequency of such events to a greater extent than that with aspirin monotherapy in the clinical study on combined antiplatelet and anticoagulant therapy in this group. By contrast, there was an increase in the frequency of large bleeding, which is a significant limitation of the combined therapy. Therefore, it is relevant to identify subjects with CAD and high thrombotic risk for individualization of therapy. In this study, the activity of thrombin formation was assessed with help of an integral hemostasis assessment method — a thrombin generation test (TGT) in patients with CAD regarding the presence or absence of MI in anamnesis. Objective . Investigation of the thrombogenic activity with the help of TGT in patients with CAD with a prior MI. Materials and methods . A total of 59 patients with a diagnosis of stable CAD hospitalized for myocardial revascularization were examined. Of these, 28 patients who had a history of MI (group 1), and 31 patients without previous MI (group 2). The control group consisted of 31 people without clinical manifestations of atherosclerosis. In vitro thrombin generation in platelet-poor plasma was measured by means of the calibrated automated thrombogram method (Thrombinoscope BV, Maastricht, the Netherlands). Four parameters were derived from the thrombin generation curves: LT (lag time — initiation phase of coagulation, min), Peakthr (peak thrombin concentration, nmol), ttPeak (time to peak concentration, min), ETP (endogenous thrombin potential — area under the thrombin generation curve), and VI (velocity index of thrombin generation, nmol/min). Results. A significant increase in TGT parameters was revealed in Group 1 compared to Group 2 and control group: the peak height of thrombin (304.09 [279.97-353.91] nmol vs 283.38 [209.07-313, 54] and 258.86 [211.28-299.50] nmol, respectively (p &lt; 0.01)) and the VI thrombin (131.78 [111.98-158.38] nmol/min vs 100.64 [56.33-122.19] and 77.96 [62.45-122,54,] nmol/min, respectively, (p &lt; 0.001)). There was a significant positive correlation between ETP and total cholesterol level (r = 0.35, p = 0.01), LDL (r = 0.32, p = 0.02) in the general group of patients with CAD. Conclusion. In patients with CAD and prior MI, a higher quantity and rate of thrombin formation were found by TGT, determining the test perspectivity for assessment of thrombotic risk in order to isolate subjects with an indication for more strong antithrombotic therapy.

The effectiveness of treatment of patients with stable coronary heart disease and concomitant arterial hypertension: the results of a multicenter study PRESTOL

The aim – to evaluate the profile of patients with coronary heart disease (CHD) and concomitant arterial hypertension (AH) who were administered bisoprolol as part of previous therapy, but did not reach normal levels of heart rate and blood pressure; to estimate the percentage of getting to recommended levels of heart rate, blood pressure and treatment adherence in patients after 4 weeks of using the fixed-dose combination of bisoprolol/perindopril with a correction of doses.Materials and methods. The study involved 170 cardiologists from various regions of Ukraine. Each researcher selected 15 consecutive outpatients with coronary heart disease who came for a regular visit. Inclusion criteria: age over 18 years old, blood pressure above 140/90 mm Hg, heart rate above 60 bpm, bisoprolol as part of antihypertensive therapy in the last ≥ 3 months. The study included two visits. At each visit, the patient’s objective status was assessed; an individual questionnaire with office systolic and diastolic blood pressure, heart rate, ECG data, clinical manifestations of CHD, risk factors, lifestyle features, concomitant diseases, current therapy was filled out. Medication adherence was also evaluated, the therapy was corrected if necessary and the presence of side effects and adverse events was registered.Results and discussion. 2785 patient questionnaires were provided by doctors, 2394 (86 %) of them met the inclusion criteria. The mean age of the patients was 61.4 years, men – 57.1 %, women – 42.9 %. The diagnosis of coronary artery disease was based on: chest pain – 751 (31.7 %), a history of documented myocardial infarction – 1281 (53.5 %), coronary ventriculography (VHR) – 735 (30.7 %), revascularization (CABG/stenting) – 474 (19.8 %) patients. The use of a fixed combination of previously taken drugs (perindopril, bisoprolol) for 4 weeks allows to reduce heart rate and blood pressure effectively (heart rate ≤ 70 bpm reached 84.9 % of patients, blood pressure ≤ 140/90 mm Hg – 86.9 %), to reduce the number of angina attacks from 4.4 to 2.6 per week and the need for nitroglycerin from 4.8 to 2.7 tablets per week, to improve therapy adherence in 66.5 % of patients.Conclusions. The study demonstrated that the use of the fixed combination of bisoprolol and perindopril in patients with coronary artery disease and concomitant hypertension, including those who had myocardial revascularization and myocardial infarction in anamnesis, helps to improve treatment efficacy, to achieve recommended levels of blood pressure and heart rate, to increase adherence to therapy.

Predictors of renal dysfunction in patients with chronic heart failure and reduced left ventricular ejection fraction

The aim — to elucidate the predictors of renal dysfunсtion (RD) in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF).Materials and methods. 134 patients were examined with stable CHF, II — IV NYHA functional class (FC), and LVEF < 40 %. Median age was 59.5 [54; 68] years. All patients underwent general clinical examination. Glomerular filtration rate was calculated. The levels of interleukin­6, insulin, NTproBNP, uric acid, blood urea nitrogen, levels of microalbuminuria were determined. Ultrasound diagnosis of the vasodilating function of the endothelium of the brachial artery was performed using a test with reactive hyperemia. The patients were treated according to the current guidelines of the Association of Cardiologists of Ukraine on the diagnosis and treatment of chronic heart failure.Results and discussion. RD was detected in 39.5 % of the patients examined. Older patients, women, patients with coronary heart disease (CHD), arterial hypertension (AH), diabetes mellitus, anemia, and also III — IV NYHA class have a greater chance of having RD. The presence of myocardial infarction (MI), atrial fibrillation (AF), smoking in the anamnesis did not reveal significance in calculating the odds ratio. None of the major hemodynamic and echocardiographic parameters was a predictor of PD. Among the laboratory indices, independent predictors of RD were detected levels of blood urea nitrogen, uric acid, and citrulline levels.The results obtained indicate the priority role of neuro­humoral activation, inflammation and oxidative stress in the formation of RD.Conclusions. The independent laboratory predictors of RD in 39.5 % of the patients with CHF and a reduced LVEF are the levels of blood urea nitrogen, uric acid and citrulline in the plasma. Its risk increases with age, NYHA class, the duration of CHF, and in the presence of such co­morbidities as AH, CHD, diabetes mellitus, anemia. The presence of RD is not associated with MI in anamnesis or the presence of AF, parameters of central hemodynamics, parameters of LV structural­functional states, level of microalbuminuria, ratio of albumin/creatinine, level of glucose, insulin, interleukin­6 and NTproBNP in plasma.

STUDY OF ADHERENCE TO DRUG THERAPY OF PATIENTS WITH CARDIOVASCULAR DISEASES IN DISTRICT HOSPITAL OF SMALL TOWN IN SARATOV REGION AND IN CARDIOLOGY DEPARTMENT OF UNIVERSITY CLINIC IN SARATOV

Aim. To study the relation of various factors with adherence to long-term drug therapy in patients with cardiovascular diseases in district hospital of small town in Saratov Region and patients from clinical hospital of Saratov medical university.Material and methods. The hospitalized patients with cardiovascular diseases were included into the prospective study of long-term adherence to treatment. Questioning of patients with the determination of the attitude of respondents to their health, the desire to receive information about the disease, the level of awareness of the therapy, the degree of participation in the treatment process, the nature of the relationship with the attending physician was performed. A year after discharge, control calls were made to patients to learn whether the patient was continuing treatment prescribed a year ago in the hospital. The data on patient adherence in both hospitals were analyzed.Results. 108 patients in the district hospital (58% of selected patients) and 70 in the Saratov hospital (33% of selected patients) responded to all questions in the questionnaire during hospitalization. Successful reaching by phone 12 months after discharge from the hospital took place in 74 patients of the small town and 40 patients of the regional center. The continuation of treatment was found in 28 (38%) and 24 (50%) patients, respectively. Patients who continued treatment significantly differed from those, who stopped therapy, by presence of myocardial infarction in anamnesis [14 (78%) patients in the university hospital and 6 (60%) patients in the district hospital; p&lt;0.01] as well as acute cerebrovascular accident [6 (78%) patients in the university hospital and 4 (75%) patients in the district hospital; p&lt;0.05] and stable angina class I-III [22 (61%) patients in Saratov and 28 (44%) patients in the small town; p&lt;0.01]. Adherence to recommendations after 12 months was found in patients who considered that doctor or relatives were responsible for their health (6 patients in Saratov and 12 – in the small town; p&lt;0.05) and believed that attending physician determines the portion of information provided to the patient [20 (60%) patients of the district hospital and 11 (63%) patients in the university clinic; p&lt;0.05 for university clinic].Conclusion. The adherence to long-term treatment after discharge remained low and did not exceed 50% among patients in both groups. The paternalistic model continued to dominate in the doctor-patient interconnection system.

Serum matrix metalloproteinase-2,9 activity, galectin-3 and systemic inflammation in patients with postinfarction heart failure with preserved ejection fraction.

The available data suggest that heart failure (HF) after myocardial infarction (MI) is a very frequent event. Recent meta-analysis showed that restrictive mitral filling pattern, the most severe form of diastolic dysfunction, was presented in approximately 10% of the patients with preserved ejection fraction. In addition, restrictive pattern was associated with poor outcome. However, the true prevalence and relevance of diastolic dysfunction after MI remains to be elucidated. Objective: study was designed to evaluate the serum level of MMP-2,9, galactin-3 and C-reactive protein (C-RP) in postinfarction heart failure with preserved ejection fraction (HFpEF) patients. Methods: We divided all included patients into two main groups: 1st group – 20 patients with HFpEF and history of myocardial infarction. 2nd group – 18 patients with HFpEF and stable angina. Standard laboratory blood tests for erythrocyte sedimentation rate (ESR), C-RP, haematological parameters, lipid profile, glucose, renal and liver function tests were performed and calculated body mass index (BMI) for all patients. MMP activity assay and galectin-3 serum level was detected for all patients. Results: It was established significant differences between study groups in MMP-2, MMP-9 levels. Particularly, patients with HFpEF with MI in anamnesis had significantly higher MMP-2, MMP-9 levels on 21.8% and 20.7% respectively. The C-RP and leucocytes levels were significantly higher in 1st group pts. Significant differences in MMP-2, MMP-9 were established in 1st group patients in different age groups (p&lt;0.05) (tab. 3). The MMP 2 level was positively correlated with MMP 9 level (R=0.73, p&lt;0.05), the MMP 9 level – with age (R=0.68, p&lt;0.05). There were no significant differences between galectin-3 level in study group. But we estimated significant differences in galectin-3 level between 1st and 2nd subgroups (p&lt;0.05). Conclusion: Serum MMP-2, MMP-9, CRP and galactin-3 were significantly increased in pts with postinfarction heart failure with preserved ejection fraction compare to pts without myocardial infarction in anamnesis.

Endothelial function, systemic inflammation and cardiac hemodynamics in different age patients with post infarction chronic heart failure.

Heart failure (HF) is a major cause of morbidity and mortality. After myocardial infarction, physiological and anatomical ventricular changes occur, There is also an inflammatory reaction with release of cytokines, growth factors and reactive oxygen species production, which contributes to perpetuate ventricular dysfunction. The study was designed to evaluate the level of inflammatory markers (white blood cells and C-reactive protein), endothelial function and cardiac hemodynamic in different age patients with post infarction heart failure. We divided 45 patients with HF with preserved ejection fraction (HFpEF) with mean age 67,5 [65,5; 71,7] years into two main groups. 1st group: 25 patients with HFpEF and history of myocardial infarction. 2nd group: 20 patients with HFpEF and stable angina (without myocardial infarction in anamnesis). Standard laboratory blood tests for erythrocyte sedimentation rate, C-reactive protein, haematological parameters, lipid profile, glucose, renal and liver function tests, echocardiographic examination, endothelial function estimation were performed. Patients with a history of myocardial infarction had significantly higher levels of left ventricle end diastolic volume, left ventricle end systolic dimension (p&lt;0.05). There was estimated direct correlation between LVEDV, LVESD and age - R=0.68 (p&lt;0.05), R=0.52 (p&lt;0.05). Further analysis of cardiac hemodynamics depending on age revealed significant differences between LVEDV indices in patients with myocardial infarction. A significantly higher level of leukocytes was found in patients with HFpEF with a history of myocardial infarction in both groups (p&lt;0.05). A direct correlation between the leukocyte count and age in patients with HFpEF-R = 0.48 (p&lt; 0.05) was also found. Patients with HFpEF with a history of myocardial infarction had a significantly higher level of CRP, including in the age aspect (p&lt;0.05). A direct correlation between CRP level and age was established in patients with HFpEF - R=0.46 (p&lt;0.05). It was revealed that in the older age groups with myocardial infarction the signs of endothelial dysfunction were significantly more frequent (p&lt;0.05). Reverse correlations were established between the level of endothelium dependent vasodilatation (ESVD) and CRP (R=-0.48, p&lt;0.05), triglycerides (R=-0.45, p&lt;0.05), diastolic blood pressure (R=-0.54, p&lt;0.05). Conclusion: high level of inflammation markers, endothelial dysfunction and changes in cardiac hemodynamics were recorded more often in elderly patients with post infarction heart failure.

Effect of L-Arginine on the Serum Level of Advanced Glycation End Products in Patients with Post Infarction Chronic Heart Failure

Post-infarction heart failure with preserved ejection fraction (HFpEF) determines a great morbidity and mortality, and given the physiopathology implications of advanced glycation end products (AGEs) in the genesis of myocardial dysfunction. As known endothelial dysfunction is an independent predictor for cardiovascular disease. L-Arginine is the amino acid with potential to improve endothelial function which leading to prevention and treatment of cardiovascular diseases, and we think that L-Arginine may decrease the serum AGEs. We aimed to estimate the value of AGEs in post-infarction HFpEF patients, and detect the effect of L-Arginine on the serum level of AGEs in post-infarction HFpEF pts. all individuals (25) included aged 40 to 80 years, 20(80%) males and 5(20%) females were diagnosed with (HFpEF) according to ESC guidelines (2012), and their functional class according to NYHA classification for HF. 20(80%) patients of them have myocardial infarction in anamnesis. 1st group:13 patients with HFpEF and history of myocardial infarction with L-Arginine added to their standard treatment. 2nd group:7 patients with HFpEF and history of myocardial infarction with standard treatment (without L-Arginine). Comparsion group: 5 patients with HFpEF with standard treatment. We prescribed L. Arginine aspartate (Tivortin 4.2gm) intravenously once daily for 10 days for all 1st group patients. The levels of total cholesterol, triglycerides, glucose, white blood cells, erythrocyte sedimentation rate and AGEs serum level were deterimined. AGEs serum level increased markedly increased in middle-age pts with post infarction HFpEF. Inclusion of L-arginine aspartate in complex of treatment for post infarction HFpEF contributed to the significant decrease AGEs level in &gt;60 years old patients.

SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY IN DIAGNOSTICS OF OBSTRUCTIVE LESION IN CORONARY ARTERIES

Aim. To evaluate the potential of single photon emission computed tomography (SPECT) in diagnostics of obstructive lesion of coronary arteries (CA). Material and methods. The studied group consisted of 107 patients, admitted for diagnostics and treatment in the SRI CICVD during 2012-2015 with former established diagnosis of coronary heart disease (CHD) or hospitalized to rule it out. For hemodynamically significant stenoses, coronary arteriography (CAG) was applied. Data from CAG was compared with SPECT. As a result, four groups were formed: 1 group — with positive results by SPECT and CAG (SPECT“+”/CAG“+”, n=24); 2 group — with positive SPECT and negative CAG (SPECT“+”/CAG“-”, n=6); 3 group — with negative SPECT and positive CAG (SPECT“-”/CAG“+”, n=36); 4 group — negative both SPECT and CAG (SPECT“-”/CAG“-”, n=41). Results. In assessment of the patients with suspected CHD, positive result of pharmacological stress-test in SPECT was revealed in 28% cases, and hemodynamically significant CA lesion was found in 56% of patients. Myocardial infarction in anamnesis predominated in SPECT“+”/CAG“+” (79,2%), SPECT“+”/CAG“-” (83,3%), SPECT“-”/CAG“+” (55,6%) comparing to SPECT“-”/CAG“-” (39%; р=0,007). Also, in the group SPECT“-”/CAG“-” pre-test probability of CHD was the lowest (58%) comparing to other groups — 80,5%; 80,5% and 77% (р=0,002). Hence ejection fraction of the left ventricle was significantly lower in the group of SPECT“+”/CAG“+” (53%; р=0,011). In this group also subocclusion was found in circumflex (29,2%) and right CA (45,8%), respectively, р=0,033 and р=0,054. With the false negative results of SPECT there was association of male gender, former coronary bypass operation, increased cardiac volume. Sensitivity of SPECT in hemodynamically significant CA stenoses diagnostics was 40%, specificity — 87%. Conclusion. The results of current study are important for further elaboration on the approaches to obstructive CHD diagnostics.

Оценка качества обследования больных артериальной гипертонией в первичном звене здравоохранения (по данным российского Регистра артериальной гипертонии)

Objective: to assess the quality of examination of patients with arterial hypertension in primary health care. Materials and methods. The study was carried out with the Arterial Hypertension Register method (a software with remote access, medical data inputs were made from medical records of patients with AH). The study included a selection of 29 126 patients with AH under care in primary health care in 22 regions of Russia in 2010-2014. 35% were males, females were older by 3.7 years (60.9±12.5 years and 64.6±12.0 years respectively, p<0.05). Results. 1 stage AH was observed in 43% of patients; 2 stage - in 12%; 3 stage - in 3%. BP<140/90 mm Hg was registered in 38% of patients. 80% of patients were under antihypertensive therapy. 4% of patients with AH lacked BP data in their medical records. Analysis of examinations of patients with AH showed that 63% of patients had data on family medical history of cardiovascular diseases in their medical cards; 78.1% - data on smoking status; 45% - on alcohol consumption; 83.8% - on physical activity level; 26.4% - on waist circumference; 46.5% - on height and bodyweight. Total cholesterol was identified in 86.4%, HDL cholesterol - in 25.5%, triglycerids - in 38.6%, glucose - in 85.3% and creatinine in 58.7% of patients with AH. ECG examination was done on 100% of patients, echo-cardiography - on 28.9%, duplex screening of brachiocephalic arteries - on 1% of patients with AH.Chronic heart failure (44.4%), coronary artery disease (45.6%) and Q-wave myocardial infarction in anamnesis (20.5%) were statistically more frequently observed in males. In females CHF was observed in 35.2% of patients, CAD - in 26.7% and Q-wave MI in anamnesis - in 5.5% of pts. II type diabetes mellitus was observed in 12.1% of males and in 17.8% of females with AH. Conclusion. The Register method study on a selection of patients with AH under care in primary health care in 2010-2014 shows that their examination with regard to medical history taking, cardiovascular risk factors and target organ damage assessment in patients with AH is nonoptimal. Further efforts are needed to educate physician primary care physician, family doctors and cardiologists on the methods of diagnostics and treatment of patients with AH according to the Russian guidelines on AH.

QRS COMPLEX FRAGMENTATION — AN IMPORTANT MARKER OF ABNORMAL DEPOLARIZATION

Aim . To investigate on the QRS complex fragmentation (fQRS) in patients with idiopathic ventricular arrhythmias (VA) . Material and methods. Totally, 125 patients, selected into 2 groups: 1st group — 100 patients (mean age 46,4±14,1 y., 69 females) with idiopathic VRD. Patients had predominating daytime arrhythmia (63%), more oftenly — monomorphic ventricular exstrasystolic complexes (VE) (59%), in 39% patients — paroxysms of nonsustained ventricular tachicardia. Structural pathology of myocardium was ruled out based on electrocardiography data, echocardiography, in some cases — magnetic resonance. Second, control group — 25 pts. (69,0±11 y. o., 12 females) with VRD of ischemic origin (coronary heart disease, myocardial infarction in anamnesis). In this group, polymorphic (84%) daytime (68%) VE predominated, and in 25% — nonsustained ventricular tachicardia. Analysis was done with Holter ECG in 12 leads (“KTResult 2”, “Inkart” JSC). Results. In the 1st group, fQRS of sinus complexes was registered in 2 patients (2%) and was transient. Relations in 24-hour dynamics of fQRS were not found. FQRS in VE was registered in 25 patients (25%). One patient had fQRS of sinus complexes as well as fQRS in VE. In 17 patients (68%) fQRS was found in VE. In controls, fQRS of sinus complexes was found in 6 patients (24%), fQRS of VE — in 23 (92%) and was permanent. Conclusion. The phenomenon of fQRS can be found during routine instrumental investigation (standard ECG or Holter ECG), and is more common for CHD patients, being significant criteria for repolarization processes evaluation. Looking for fQRS in patients with idiopathic VRD, probably, is related to dysbalance of autonomous nervous regulation that leads to electrical instability of myocardium. It cannot be ruled out that fQRS might be an early marker of cardiomyopathies. It is necessary to investigate on this phenomenon further and to find its place in risk stratification of sudden cardiac death of patients with no structural heart pathology.

RESULTS OF THE MODIFIED LEFT VENTRICLE RECONSTRUCTION WITH EVALUATION OF GEOMETRIC PARAMETERS IN POSTINFARCTION ANEURYSM OF THE HEART

Modern times, surgeons of the entire world utilize the technics of left ventricular reconstruction (LVR) developed by professor Dor V. However, oftenly the left ventricle (LV) presents with a spheric shape in postoperation period, by echocardiography. When, normally, geometry of the LV is conceptualized as a stretched ellipse with longitudinal axis directed from apex to the base of the heart. Aim. To evaluate effectiveness of modified LVR using Z-suture to create the LV apex in patients with postinfarction heart aneurysms. Material and methods . Twelve patients with anterior-septal localization of the LV aneurysm having myocardial infarction in anamnesis more than 6 months, with LV ejection fraction less 45%, underwent the modified LVR with Z-suture. Efficacy of the correction was assessed by echocardiography data in short term period till 1 month after the operation, comparing with pre-surgery data. Results . In all patients surgery proceeded successfully. Sphericity index significantly decreased in diastolic phase at basal level from 0,83±0,17 to 0,63±0,11 (p=0,05) and at apical level from 0,56±0,12 to 0,37±0,09 (p=0,01). Conical index increased at basal level from 1,26±0,06 to 1,67±0,40 (p=0,05), at middle-apical level from 1,34±0,30 to 1,4±0,34 (p=0,05). Conclusion. The modified left ventricular reconstruction with Z-suture forms the ellipsoid heart shape and is an effective method of surgery of postinfarction LV aneurysm.