Abstract

Coronary artery bypass grafting (CABG) remains the main method of surgical treatment of coronary artery disease (CAD) which provides the improvement of quality of life of patients and in severe coronary bed lesion – improvement of prognosis. However, in the long-term period after CABG a poor compliance to the background and antianginal CAD therapy can limit the positive effects of surgical myocardial revascularization.

The purpose of the present research is the estimation of the long-term follow-up stage in patients with CAD during 3-5 years after coronary artery bypass grafting from the position of clinical status, actually taken drug therapy and achievement of treatment targets.

Material and methods. Among 680 patients of the initial sample of CABG registry, 111 men were selected for follow-up and assessment of the taken therapy at the long-term stage. The selected patients were hospitalized in 2011 with the clinical signs of stable CAD to perform a complete myocardial revascularization by the method of coronary artery bypass grafting (CABG) with cardiopulmonary bypass. The mean age was 61 (55;65) years. Statistical processing of the research results was made using SPSSStatistics version 22.0.0.0 software of IBM Corporation (USA).

Results. After 3-5 years, the prognosis (alive/dead status) was estimated in 111 patients according to Civil Registry Office database. The mean value of the follow-up period was 4.2 years. The mortality rate was 11.7 % (n=13): in 11 cases – cardiovascular mortality and in 2 cases – mortality from the undetermined causes. The endpoints, defined as repeated hospitalizations and CAD progression, were revealed in 18 out of 98 examined patients (18.4%). Only a quarter of the patients didn’t have clinical signs of angina pectoris within 3-5 years after CABG. In 5 (5.1%) patients a new onset type 2 diabetes mellitus was registered. Enteric coated acetylsalicylic acid was taken by 80 (81.6%) patients, angiotensin-converting enzyme inhibitor – 60 (61.2%), beta-blockers – 80 (81.6%) and statins were taken by 81 (82.6%) patients. However, high-intensity statins (rosuvastatin 20-40 mg, atorvastatin 40 mg) were taken only by 20 (20.4%) out of 98 re-examined patients. Target values of low-density lipoproteins (LDL) less than 1.8 mmol/l were registered only in 7 patients (7.1%). In more than 80% of cases, the patients were taken bisoprolol in low and medium dosage (2.5-10 mg) as a beta-blocker. None of the patients had prescribe dbeta-blockers in maximum therapeutic dosage. Target heart rate in stable angina (55-60 beats/min) was achieved only in 12 (12.2%) patients. Target values of arterial blood pressure (SBP<140 mmHg) were achieved in 64 (65.3%) and (DBP<90 mmHg) 69 (70.4%) patients.

Conclusion. Real clinical practice data shows the insufficient quality of the background and antianginal therapy in patients with CAD after CABG. The indicators of control of anginal attacks, heart rate and achievement of lipid profile target values remain unsatisfactory.

Purpose. Assessment of prevalence of arterial hypertension (AH), need for prescription of antihypertensive therapy (AHT), and efficacy of AHT in Russian population in accordance with novel guideline of the American College of Cardiology/American Heart Association (“American recommendations”) on diagnosis and treatment of AH (2017).

Materials and methods. Epidemiological study ESSE-RF (ЭССЕ-РФ) was carried out in 12 regions of Russian Federation (RF) with different climatic-geographic characteristics. Number of examined residents of RF aged 25–65 years was 20 652. The sample was stratified by  gender and age. Examination included anthropometry, laboratory tests, blood pressure (BP) measurement with the OMRON tonometer. The SCORE scale was used for evaluation of risk of development of cardiovascular diseases (CVD). In  American recommendations AH was defined as  follows: 1-st degree  – systolic BP (SBP) 130–139  and/or diastolic BP (DBP) 80–89 mm Hg, 2-nd degree – BP ≥140/90 mm Hg and/or presence of AHT. In recommendations of the European Society of Cardiology (2013, 2018) (“European recommendations”) AH was defined as BP ≥140/90 mm Hg and/or presence of AHT.

Results. We analyzed data of examination of  20 607  participants – 7806 men (37.9%) and 12 801  women (62.1%). According to  European recommendations AH was diagnosed in 10 347  persons (50.2%)  – 3987 men (51.1%) men and 6 360 women (49.7%). According to American recommendations AH was registered in 14 853 persons (72.1%) – 6 059 men (77.6%) and 8 794 women (68.7%). AHT received 6324 persons (61.1% of those with AH); according to American recommendations, the onset of AHT was indicated to additional 620 persons with 1-st degree AH because of high CVD risk. Among all participants with AH (on and without AHT) strengthening of AHT for achievement of target BP level was required in 77.8 and 92.6% of patients according to European and American recommendations, respectively.

Conclusion. Application of novel criteria of AH diagnosis from 2017 ACC/AHA guideline to Russian population would increase prevalence of AH up to 72.1%. Onset of AHT would be indicated in 13.8% of patients with 1-st degree AH, while in 93% of patients receiving AHT its strengthening would be required.

Purpose: to assess drug therapy and achievement of target parameters of treatment in patients with ischemic heart disease (IHD) during 3–5 years of follow-up aſter coronary bypass surgery.

Materials and methods. From the initial sample of the coronary bypass surgery registry (n=680) we selected for this study 111 men (mean age 61 [55; 65] years) hospitalized in 2011 with clinical picture of IHD for coronary artery bypass graſting (CABG).

Results. Mean duration of follow-up was 4.2 years. Mortality was 11.7 % (n=13), 11 deaths were cardiovascular, 2 – from unknown causes. End points defined as repeat hospitalizations and IHD progression were registered in 18 of 98 patients (18.4 %). Only in 25 % of patients during 3–5 years of observation aſter CABG there were no clinical signs of angina. Five patients (5.1 %) developed new type 2 diabetes. Drug therapy: 80 patients (81.6 %) received acetylsalicylic acid, 60 (61.2 %) – angiotensin converting enzyme inhibitors, 80 (81.6 %) – β-adrenoblockers. Eighty-one men (82.6 %) received statins, but only 20 of 98 re-examined patients (20.4 %) took high doses. Target levels of low density lipoprotein cholesterol

Conclusion. Data of clinical practice illustrate insufficient quality of basic and antianginal therapy in patients with IHD aſter CABG. Indicators of control of angina, heart rate, achievement of target levels of parameters of lipid metabolism remain unsatisfactory.

Background. Dual antiplatelet therapy (DAPT) with aspirin and one of inhibitors of P2Y12 receptors (clopidogrel, ticagrelor, prasugrel) is an international standard of receptors (clopidogrel, ticagrelor, prasugrel) is an international standard of is an international standard of treatment strategy in patients with acute coronary syndrome (ACS).

Purpose: to analyze experience of prasugrel use in the National Medical Cardiology Research Center in comparison to similar groups of patients treated with other P2Y12 inhibitors for determination of optimal place of DAPT with prasugrel in ACS patients. 

Materials and methods. We included in this retrospective study 40 patients who received therapy with prasugrel, ticagrelor, or clopidogrel in connection with urgent percutaneous coronary intervention (PCI) performed in the Department of Urgent Cardiology from May to December 2018. We analyzed specific characteristics of prasugrel treated patients including disease history, features of clinical presentation and coronary anatomy, use of strategies of escalation and de-escalation, as well as inhospital mortality, development of complications and side effects. 

Results. New P2Y12 inhibitors were more effective in patients with higher risk of atherothrombosis compared with risk of bleeding. Median of implanted stents in ticagrelor and clopidogrel groups was equal to 1, in the prasugrel group – 2 stents per PCI. When multivascular stenting was performed the choice usually was made in favor of prasugrel or ticagrelor, excluding cases with presence of limiting factors – use of oral anticoagulants (OAC) (n=4) and prehospital thrombolytic therapy (n=5). Of note was close to statistical significance high number of side effects related to ticagrelor use (n=3, 23.08%, p=0.057). There were no significant differences between groups in rates of unfavorable outcomes and complications. 

Conclusion. Administration of prasugrel can be considered in patients with high risk of atherothrombosis: with diabetes, with large number of implantable stents. The choice between ticagrelor and prasugrel can be made with consideration of the potential for side effects that significantly impair the quality of life of patients. Main limitations for application of both prasugrel and ticagrelor are the need to permanent use of OAC, prehospital thrombolytic therapy, and higher cost compared to clopidogrel.

Systematic analysis of 3 728 publications on the relationship between microelement status and chronic heart failure (CHF) was carried out. Three main areas of research have been identified: 1) magnesium, electrolytes and CHF; 2) the transcriptional and antioxidant effects of zinc, selenium, copper; 3) iron-deficiency anemia and CHF. In this paper, we consider a complex of relationships between the magnesium insufficiency and CHF, the effect of magnesium on vascular tone, mitochondria, heart rhythm and the susceptibility of cardiomyocytes to adrenergic stimulation. Using magnesium orotate for the treatment of CHF is a feasible approach to compensate magnesium insufficiency in patients with CHF.

The aim of the study was to ascertain whether the use of plastomitin, the mitochondrial antioxidant, can affect the development of systolic dysfunction that occurs in rats after 4 weeks of doxorubicin treatment (2 mg/kg weekly). 

Materials and methods. Male Wistar rats weighing 320–380 g were used in this work. Echocardiographic study was carried out using Vevo 1100 with linear probe 13–24 MHz frequency. 

Results. Echocardiographic study of rats through 8 weeks from the beginning of doxorubicin treatment showed the presence of systolic dysfunction with decrease of ejection fraction of the left ventricle (LV) by 32%. Hearts of rats, to which plastomitin (0.32 mg/kg daily) was administered simultaneously with doxorubicin, showed significantly increased ejection fraction and shortening fraction as compared with doxorubicin group, and these values were close to the control. In experiments with simultaneous registration of LV pressure and volume, it was found that the hearts of all rats treated with doxorubicin showed reduced contractility index and stroke work, while maintaining normal cardiac output. Such compensation in experiments with treatment with doxorubicin alone was achieved through significant reduction in the peripheral resistance, slowing of myocardial relaxation, and facilitation of LV diastolic filling during prolonged diastolic pause (the heart rate was slowed by 23%). In experiments with simultaneous application of doxorubicin and plastomitin, the compensation was achieved through preservation of myocardial contractility and relaxability, the heart rate and peripheral resistance. This method of compensation is more beneficial for the body, because it does not restrict the supply of organs and tissues with oxygen, and has significant advantage over doxorubicin group at equal heart rate. 

Conclusion. The results allow to conclude that the use of plastomitin together with doxorubicin prevents the development of doxorubicin-induced systolic dysfunction.

Purpose: to analyze causes of sudden death (SD) of workers of locomotive crews. 

Materials and methods. We performed the retrospective analysis of SDs of employees of Joint Stock Company ( JSC) “Russian Railways” for the period 2009–2017 (total 119 cases). 

Results. As a rule, the combination of risk factors of development of cardiovascular diseases was present, but the SCORE scale risk of cardiac death was average. However, in 60 % of cases at life risks were not correctly assessed. Differences were found between the deceased depending on what type of locomotive they steered. Also, a part of SD victims overworked during the last month (year). 

Conclusion. Further improvement of work of medical service of JSC “Russian Railways” is necessary.

Chronic obstructive pulmonary disease (COPD) is the fourth largest cause of worldwide mortality.  Presence of comorbidities is registered in 96% of COPD patients. The most important of these are cardiovascular diseases (coronary artery disease, arterial hypertension, chronic heart failure), which contribute to COPD patients’ mortality in every third case. COPD and cardiovascular diseases have common risk factors and pathogenesis mechanisms. Cardioselective beta-blockers reduce morbidity risk and frequency of COPD exacerbation, are effective and safe in treatment of COPD patients.

Chronic kidney disease (CKD) is a powerful cardiovascular risk factor, its presence is accompanied by an increased risk of hospitalization for exacerbation of chronic heart failure (CHF), adverse outcomes in myocardial infarction, and cardiovascular mortality. Among the adverse events, an increased risk of atrial fibrillation (AF) should be noted. This article contains discussion of current approaches to the treatment of AF in patients with different stages of CKD, data on benefits of certain direct oral anticoagulants, as well as comparative characteristics of therapy with direct oral anticoagulants and warfarin. Pharmacokinetics and pharmacodynamics of direct oral anticoagulants, which determine the features of therapy in CKD, are also considered.

Modern strategies of primary prevention of cardiovascular complications of atherosclerotic etiology are presented in this article: traditional approach based on assessment of risk of development of complication and coming to replace it concept of prevention based on direct application of results of prospective clinical studies. The article contains detailed presentation of new opportunities of computer tomography of the heart allowing to substantially elevate precision of assessment of risk of cardiovascular complications of atherosclerotic etiology. Main attention is paid to the coronary artery calcification index, which determination substantially simpli- fies decision making relative to strategy of primary prevention in clinical practice

This article presents a clinical case of a 40-year-old woman with fulminant myocarditis which progressed rapidly to the development of cardiogenic shock resistant to standard intensive care, but with a positive response to extracorporeal membrane oxygenation.

Arrhythmogenic dysplasia of the right ventricle is a rare pathology of the myocardium, the diagnosis of which is difficult. Isolated myocardial infarction of the right ventricle occurs and is diagnosed extremely rarely. In this article we describe a case of arrhythmogenic right ventricular dysplasia, complicated by transmural infarction of the anterolateral wall of the right ventricle, myocardial rupture, and cardiac tamponade.

Thrombolytic therapy (TLT), as a method of treatment, began to develop in the second half of the 50s of the last century. At that time, there was an accumulation of data on its effectiveness, side effects and contraindications, as well as the development of fibrinolytic drugs, such as fibrinolysin, streptokinase, urokinase, and the conditions for their administration. Official recognition of TLT in regulatory documents began only in the 80s after the development of more effective and safe tissue plasminogen activators. However, on the threshold of an era of development in this area in the treatment of patients with thrombosis of the coronary, carotid, and other peripheral vascular regions, the researchers obtained conflicting data on the results of the use of thrombolytics. There was no concept of a therapeutic window for the use of TLT, there was no data on possible combinations of thrombolytic drugs with anticoagulants, the high probability of bleeding prevented widespread introduction of the method into clinical practice. At that time, vascular imaging and laboratory diagnostics were not sufficiently developed, there was no consensus of the world’s leading experts on the benefits of thrombolysis. The use of TLT in acute arterial thrombosis required not only clinical experience, but also courage and ability to make non-standard decisions. The authors of the article analyze in detail the case of rescuing a patient with progressive thrombotic occlusion of the arteries of the brain stem. Then the pioneer in the field of thrombolytic therapy E. I. Chazov and his colleagues took responsibility for the application in this situation of an insufficiently studied treatment method with uncertain consequences. This decision was not due to the identity of the patient or the threat of an internal investigation. Marshal or soldier – it did not matter for E. I. Chazov and his colleagues. If doctors in this clinical situation relied on recommendations, orders and standards, then such a patient would have to wait thrombolysis for another 30 years.