Purpose of the study. To compare the effect of loading doses of atorvastatin and rosuvastatin on the value of the acute kidney injury and acute inflammatory response to elective percutaneous coronary interventions. Materials and methods. An open prospective comparative study included 68 patients referred for elective percutaneous coronary intervention (PCI). At baseline, all patients had been taking statins for a long time as a standard lipid-lowering therapy. The first group included 33 patients who received a loading dose of 80 mg of atorvastatin (As) 12 hours before the intervention with saving this dose for 2-6 days. The second group included 35 patients treated with rosuvastatin (Rs) 40 mg/day in the same manner. The levels of creatinine and cystatin C in the blood were determined at baseline and 12, 24, 48 and 72 hours after the intervention. HsCRP level was determined at baseline and 72 hours after PCI. Results. AKI was diagnosed in 5 patients (7.94%): 4 patients (12.1%) in group As and 1 patient (3.3%) in group Rs (p = 0.36). The increase of serum creatinine level in the group As patients was 43.4% higher than one in the Rs group patients (p = 0.024). The decrease of glomerular filtration rate (GFR) in group As was 15.5% higher than one in group Rs (p = 0.09). Initially, the level of cystatin C in the groups did not differ (698.9 (560.2-869.6) ng/ml in group As vs 759.5 (673.8-899.9) ng/ml in group Rs, p = 0.75). Significant intergroup differences were found in the level of serum cystatin C 12 hours after PCI (718.3 (555.6-839.6) ng/ml in group As vs 470.6 (378.2-689.4) ng/ml in the Rs group, p = 0.007) that persisted 24 hours after the intervention (732.1 (632.3-887) ng/ml vs 526.4 (357.4-802.7) ng/ml, respectively, p = 0.02). From the second day after PCI, intergroup differences in serum cystatin C disappeared. The level of hsCRP significantly increased 72 hours after the intervention in group As (1.65 (0.9-4) mg/l at baseline vs 4.55 (1.6-8.7) mg/l 72 hours after PCI, p = 0.01). The level of hsCRP did not change significantly at the same time in the Rs group (2.8 (0.8-6.8) mg/l at baseline vs 2.75 (1.5-6.5) mg/l 72 hours after PCI, p = 0.16). Conclusion. The loading dose of rosuvastatin better prevents periprocedural kidney injury in PCI and more significantly reduces the overall inflammatory response to intervention compared to the loading dose of atorvastatin.

Background. A method for predicting one-year survival of patients with heart failure and reduced ejection fraction (HFrEF) is required to choose a management tactics and determine indications for high-tech care at the outpatient stage. Aim. To develop a method for proper prediction of survival of patients with HFrEF in outpatient clinics. Materials and methods. This was a prospective study of 212 patients with functional class II-IV CHF of non-valvular origin and LV EF (Simpson) ≤35 % aged 18-70, including 176 (83 %) men and 36 (17 %) women who had given an informed consent to participate in the study. Study design: hospitalization to a specialized department for treatment of heart failure; best titration of tolerated doses and stabilization of the patient’s condition; evaluation of status; laboratory and instrumental tests; outpatient follow-up by an HF specialist (visits, telephone contacts, therapy adjustment, and admission to a specialized HF department in case of decompensation); 200-item database population; recording the composite endpoint (cardiovascular death, or implantation of a mechanical circulatory assist (MCA) device, or heart transplantation (HT) within 12 months). Results. For 12 months, 135 (64 %) patients survived; a MCA device was implanted to 5 (2 %) patients; HT was performed for 21 (10 %) patients; and a fatal outcome was observed in 51 (24 %) patients. Therefore, 77 patients had the composite endpoint. A method for predicting survival was developed using a multiple logistic regression analysis. The developed proper method for survival prediction included the following parameters: age of HFrEF onset; frequency of respiratory movements; systolic blood pressure measured at 3-5 min of orthostasis; lymphocyte count, and red cell distribution width. An identified patient with a predicted survival less than one year should be as soon as possible forwarded to a selection panel for considering HT or MCA implantation as a «bridge» to HT. A predicted survival longer than one year is an indication for further outpatient management and considering cardioverter defibrillator implantation. Conclusion. The method for proper outpatient evaluation of survival prognosis for patients with HFrEF allows to predict the one-year survival using routine indexes, such as results of objective examination, case history, and blood count, without additional expenses

Due to current options of cardiac surgery, operations on the heart of elderly patients have become routine in specialized cardiosurgical centers. Ee issue of pre- and postoperative anemia of different nature is essential in surgical correction of heart valves and coronary bypass. Aim. To study indexes of red blood in elderly patients with ischemic heart disease (IHD) and pathology of heart valves before and after surgical correction, including the relationship with position and type of the prosthesis. Materials and methods. 79 patients aged 61 [53,67] were evaluated. The patients had acquired heart valve disease of rheumatic origin, manifestations of heart connective tissue dysplasia, and IHD and were admitted to a cardiosurgical hospital. Blood tests were performed using a hematological analyzer, Cell-Dyn 3700 (USA), before the surgery and on days 5 and 10 following the surgical correction. Reticulocytes were counted using a unified manual method in a blood smear stained with brilliant cresyl blue and expressed per 1000 red cells. Reticulocyte indexes (corrected reticulocyte count, CRC, and reticulocyte production index, RPI) were computed. Results. Elderly patients with a combination of acquired heart disease and mitral valve disease were characterized by preoperative morphological heterogenicity of red blood cells as evidenced by RDW. Postoperative anemia associated with significant decreases in mean hemoglobin concentration, red cell count, and hematocrit, and increased morphological heterogenicity of red cell pool were observed in patients with IHD and heart valve pathology on days 5 and 10 of the postoperative period. During the early postoperative period, more pronounced changes in red cell heterogenicity were observed in patients with implanted disk mechanical prosthesis, particularly in mitral position. In the early postoperative period following the surgical correction, elderly patients with IHD and valve disease were characterized with a low reticulocyte production index, which indicated reduced proliferative activity of bone marrow. The fastest stabilization of red blood indexes occurred in patients after coronary bypass.

Objective. The aim of our study was to analyze long-term outcomes, to identify their predictors and to develop a model for determining the risk of long-term adverse сardiovascular events after elective percutaneous coronary interventions (PCI). Materials and Methods. A retrospective study included 151 patients 6 years after the elective PCI. Outcomes were assessed by analyzing medical records and telephone interviews. The primary composite end point of the study was a major adverse cardiovascular event (MACCE), including death from cardiovascular causes, acute coronary syndrome, acute cerebrovascular accident. Results. Death from cardiovascular events was reported in 10.6% of patients, acute coronary syndrome occurred in 34.4%, stroke - in 6.6%. Thus MAСCE occurred in 40.4% of patients. MACCE predictors in the long-term period were chronic kidney disease, contrast-induced acute kidney injury, baseline C-reactive protein more than 5.5 mg/l. Restenosis of previously installed stents increases the risk of MACCE at 8.09 times, chronic obstructive pulmonary disease - 3.4 times PT - 2.84 times, family history for cardiovascular disease (CVD) - in 2.94 times, a very high risk of contrast-induced nephropathy (CIN) (≥11 points on the R. Mehran scale) - 2.15 times. The most significant MACCE’s predictors identified using stepwise logistic regression and included in the developed model are: family history for CVD, statins reception during the procedure of PCI, the initial level of postprandial blood glucose, high risk of CIN (11-15 points on a scale of R. Mehran). AUC values for the found model was 0.852 [95% CI 0.749-0.956]. Conclusion. The use of our model of risk stratification in patients after elective PCI allows, on the basis of simple clinical characteristics, to distinguish groups of patients with a high residual risk of adverse cardiovascular events that require the timely application of more active follow-up strategies.

The aim of this work was a retrospective assessment of the quality of treatment, depending on the severity of polymorbidity (PM) in patients with atrial fibrillation (AF) before admission to acute coronary syndrome (ACS). Materials and methods. Retrospectively, 105 patients were included in the analysis (54 men (51,4%), mean age 65,94±9,34 years) who had AF before hospitalization for ACS. The index of polymorbidity (IPM) was assessed by ME Charlson et al. (1987) in the modification of H. Quan et al. (2005). The M±cr, the Student’s coefficient, χ² were calculated. Results. Patients were ranked according to the IPM: the moderate degree of PM was revealed in 40%, the severe degree of PM - in 60% of patients. The group with a moderate degree of PM included patients aged 58,91±6,95 years, in the group with a severe degree of PM age was 70,63±7,65 years (p <0,001). Men predominated (71 vs 29%, p=0,0001) in the group with a moderate degree of PM, and women predominated (62 vs 38%, p=0,0075) in the group with a severe degree of PM. In the group of patients with a severe degree of PM, the average number of all diseases was 7,97±2,66. When analyzing the quality of antithrombotic therapy (ATT ), lipid-lowering and antihypertensive therapy, it was found that it was of lower quality in patients with a severe degree of PM than in patients with moderate PM. Only 20 (33,33%) patients ≥65 years and 8 (40%) patients ≥75 years received ATT drugs of class B of the FORTA (Fit fOR The Aged) list - oral aticoagulants. All other patients of these age categories did not receive any ATT. Conclusion. Patients with AF are characterized by high PM, which is more pronounced in the older age group and in women. Multiple drug therapy is associated with high PM in patients with AF. A retrospective assessment of the quality of treatment, depending on the severity of PM in patients with AF before admission to the ACS, showed the deterioration in the quality of ATT, lipid-lowering and antihypertensive therapy with an increase in IPM.

The article presents a review of pharmacokinetics and pharmacodynamics of different acetylsalicylic acid (ASA) dosage forms. The review showed that efficacy and safety of ASA are determined by its systemic effects and do not depend on the dosage form. Issues of ASA resistance are discussed.

In recent years there has been a marked decrease in cardiac glycosides use in patients with heart failure in sinus rhythm and atrial fibrillation. The results of published studies contradict each other. Some of them doubt the favorable effect of digoxin in patients with heart failure; others refute the increase in the lethality and frequency of hospitalizations associated with the use of digoxin. In this regard, we found it important to analyze these reports impartially and reflect modern views on the mechanisms of cardiac glycosides, the pharmacokinetics and the possibility of optimizing digitalis therapy in cardiac practice.

Le article discusses management of a female patient with chronic heart failure with reduced left ventricular ejection fraction after an episode of acute decompensation. Replacing an angiotensin-converting enzyme inhibitor with a representative of a new angiotensin receptor-neprilysin inhibitor class, sacubitril/valsartan, in the combination therapy allowed fast achievement and maintenance of the compensation state. RAe treatment was well tolerated and was not associated with clinically significant adverse effects.