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.

 

Objective To study the prognostic role of current serum biomarkers in patients with myocardial infarction (MI) by constructing a multifactorial model for prediction of cardiovascular complications (CVC) in remote MI. Acute coronary syndrome is a major cause of death and disability in the Russian Federation. Introduction of current biomarkers, such as N-terminal pro-brain natriuretic peptide, stimulating growth factor (ST2), and centraxin-2 (Pentraxin, Ptx-3), provides more possibilities for diagnostics and calculation of risk for CVC.

Materials and Methods Concentrations of biomarkers were measured in 180 patients with MI (mean age, 61.4±1.7) upon admission. At one year, specific and composite endpoints were determined (MI, acute cerebrovascular disease, admission for CVD, and cardiovascular death). Based on this information, a prognostic model for subsequent events was developed.

Results A mathematical model was created for computing the development of a composite endpoint. In this model, the biomarkers NT-proBNP, Ptx-3 and, to a lesser extent, ST2 demonstrated their prognostic significance in diagnosis of CVC with a sensitivity of 78.79 % and specificity of 86.67 % (area under the curve, AUC 0.73).

Conclusion In patients with remote MI, the biomarkers NT-proBNP, ST2, and Ptx-3 improve prediction of CVC.

Objective To analyze a profile of hypotensive drug therapy in patients with arterial hypertension (АH) aged 55–84 in a sample of urban population at a current period of time (2015–2017).

Materials and Methods AH is a leader among risk factors of cardiovascular diseases (CVD) due to its high prevalence and serious prognosis. Despite the availability of effective hypotensive drugs and guidelines on AH treatment, 50% of patients do not achieve blood pressure (BP) goals. Knowledge about drug correction of AH in the Russian population is limited to clinical studies. Taking into account changing approaches in management of patients with AH, the population-based evaluation of hypotensive treatment if relevant. A random population sample of males and females aged 55-84 (n=3.898) was evaluated in Novosibirsk in 2015-2017 (international project, Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE)). AH was diagnosed in presence of systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg and/or treatment with hypotensive drugs within the recent two weeks. Regular intake of medication for 12 months was evaluated with coding according to the Anatomic Therapeutic Chemical Classification System (АТХ / АТС).

Results In the population sample aged 55–84, AH prevalence was 80.9 %, and 21.1 % of persons with AH did not receive drug therapy. Hypotensive medicines included (total/as a part of combination therapy) angiotensin-converting enzyme (ACE) inhibitors (42.3 % / 25.3 %), angiotensin II receptor blockers (ARBs) (30.3 % / 18.9 %), diuretics (22.6 % / 20.4 %), calcium channel blockers (20.2 % / 16.1 %), and beta-blockers (34.7 % / 27.6 %). 45.7 % of people with AH received a combination therapy. Effective BP control was achieved in 23.4 % of AH patients and in 29.6 % of patients receiving a hypotensive therapy. In the group of ineffective BP control, the proportion of females was lower, AH duration was longer, and blood glucose was higher than in the group of effective control.

Conclusion In the sample of urban population aged 55–84 in 2015–2017, each fourth participant with AH and each third participant using hypotensive drugs achieved effective BP control. The therapy profile in AH patients included recommended drug classes. However, combination therapy was used insufficiently (50% of AH patients). By frequency of use, ACE inhibitors were on the first place, beta-blockers were on the second place, ARBs were on the third place, diuretics were on the fourth place, and calcium channel blockers were on the fifth place, which differed from the guidelines (the difference from the recommended priority ranking is that the drugs taking the first places in the guidelines were in fact on the 3rd and 4th places in their actual frequency of use). 20% of persons with AH did not receive hypotensive therapy, which significantly contributed to the insufficient BP control in the population.

Objective To evaluate myocardial injury and tissue hemodynamics in elderly patients with permanent atrial fibrillation (AF) based on the achieved range of ventricular contraction rate (VCR).

Materials and Methods This prospective, randomized, blind study included 75 patients aged ≥60 with permanent AF. All patients were prescribed bisoprolol as a VCR-reducing therapy. Patients were randomized to two groups according to the permuted-block design based on the range of resting VCR goal: group 1, 60–79 bpm (n=38) and group 2, 80–100 bpm (n=37). All patients also received perindopril and apixaban. Troponin I concentration was measured using the high-sensitivity assay (hsTn); parameters of tissue hemodynamics, including the mean blood flow velocity (Vm) and pulsatility index (PI), were measured using high-frequency ultrasound doppler flowmetry; echocardiographic indexes of left heart remodeling were recorded at baseline and after 6 month of VCR monitoring.

Results Mean age of patients was 74±7 years. Medians [25th percentile; 75th percentile] of baseline hsTn concentrations were 10.2 [5.25; 21.2] ng / l in group 1 and 10.3 [5.4; 20.4] ng / ml in group 2 (p=0.91). 89.5 % of patients in group 1 and 100 % of patients in group 2 achieved the VCR range goal. At 6 month, resting VCRs were 70±4 bpm in group 1 (n=34) and 88±5 bpm in group 2 (n=37) (p1, p2<0.001). According to echocardiographic data significant progression of myocardial remodeling was not observed. Concentrations of hsTn significantly decreased in both groups but the decrease was more pronounced in group 1, to 8.0 [4.13; 17.23; p1<0.001] ng / l vs. 9.2 [4.8, 17.5] ng / l in group 2 (р1, p2<0.001). A weak direct correlation was found between the VCR decrease and hsTn concentration (rs=0.44; p=0.009 in group 1, and rs=0.41; p=0.01 in group 2); regression coefficient was 0.78 at 95 % confidence interval (CI), from 0.21 to 1.3 (p=0.009) in group 1, and 0.14 at 95 % CI, from 0.04 to 0.24 (p=0.007) in group 2. Vm values were increased to 2.93±0.10 (p<0.001) and 3.21±0.09 cm / sec (p<0.001) and PIs were decreased to 1.42±0.03 conv. units (p<0.01) and to 1.34±0.02 conv. units (p<0.001) in groups 1 and 2, respectively.

Conclusion The treatment aimed at VCR control in patients older than 60 with permanent AF was associated with a positive dynamics of myocardial injury (hsTn) and tissue hemodynamics indexes (Vm и РI). This indicates a possibility for using these indexes for further improvement of managing such patients.

Objective. To identify biomarkers, which are most specific for patients with metabolic syndrome (MS) using metabolomic profiling.

Materials and Methods. Metabolomic profiling of patients with MS and comparison of their profile with the profile of volunteers was performed using high-performance liquid chromatography-mass-spectrometry.

Results. The metabolomic profile of MS patients differed in several amino acids, including choline, cysteine, and serine and in the acylcarnitine group (р<0.05 for all comparisons).

Conclusion. The metabolites most specific for MS patients were identified. Increased concentrations of a combination of amino acids and carnitines can be considered as possible additional risk factors for cardiovascular diseases.

Objective To evaluate prospects for clinical use of circulating biomarkers for characterizing fibrotic changes in the myocardium of patients with hypertrophic cardiomyopathy (HCMP) with left ventricular (LV) outflow tract obstruction.

Materials and Methods This was a prospective study with a 12-month follow-up period. The study included 47 patients (29 females and 18 males) with obstructive HCMP who were selected for septal reduction. Echocardiography (EchoCG), cardiac magnetic resonance imaging (MRI) and measurements of serum C-reactive protein, N-terminal pro-brain natriuretic peptide, and relevant circulating markers of fibrosis (TGF-β1, MMP-2,-9, TIMP-1, galectin-3, sST2, CITP, PICP, and PIIINP) were performed for all patients. All patients were evaluated at baseline and at 7 days, 6 and 12 months following surgical treatment. Morphometrical analysis of intraoperative biopsy samples was performed for evaluation of the degree of fibrotic changes. Patients received beta-blockers (95.7%), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (34%), loop diuretics (68.1%), aldosterone antagonists (34%), and statins (66%).

Results Women with HCMP were older and more frequently had additional risk factors (arterial hypertension). Men had a higher risk of sudden cardiac death. Histological study of intraoperative myocardial biopsy samples showed that the area of fibrotic changes was 13.9±6.9%. According to cardiac MRI mean area of delayed contrast enhancement was 8.7±3.3% of LV myocardial mass. No association was established between traditional cardiovascular risk factors and severity of myocardial fibrotic changes or levels of circulating fibrosis markers. Perhaps that was due to the modifying effect of the drug therapy received by HCMP patients. According to EchoCG maximum pressure gradient in the LV outflow tract before the surgical treatment was 88 (55; 192) mm Hg, and interventricular septal thickness was 22 (16; 32) mm. A considerable decrease (p=0.0002) in the LV outflow tract gradient was observed after myectomy in all patients. At the same time, the left ventricular dimension, which tended to decrease in the early postoperative period, returned to baseline values by the 6th month of follow-up.

Conclusion The study confirmed the increase in relevant circulating markers of fibrosis in patients with obstructive HCMP. At the same time, no correlation was observed between levels of circulating biomarkers and severity of fibrosis according to data of histology and cardiac MRI, which was probably due to the modifying effect of drug therapy and limited sampling.

Objective Comparative analysis of structural and functional specific features of the heart in patients with toxic cardiomyopathy (TCMP) with a low left ventricular ejection fraction (LVEF) and severe, chronic heart failure (CHF) and in patients with idiopathic dilated cardiomyopathy (DCMP) and similar LVEF and CHF severity.

Materials and Methods This observational, single-site study included 15 patients with TCMP (12 of them received treatment including anthracycline antibiotics and 3 patients received targeted therapies) and 26 patients with idiopathic DCMP. Data of echocardiography were compared for patients with TCMP and DCMP with comparably low LVEF of <40 %.

Results In patients with severe heart damage associated with antitumor therapy with low LVEF, volumetric and linear indexes of left and right ventricles and the left atrium (left atrial volume index (LAVI), 33.7 (21.5–36.9) ml / m2; right ventricular end-diastolic dimension (RVDd), 2.49 (1.77–3.53) cm; and end-diastolic volume index (EDVI), 78.0 (58.7–90.0) ml / m2) were considerably less than in the DCMP group (LAVI, 67.1 (51.1–85.0) ml / m2; RVDd, 4.05 (3.6–4.4) cm; and EDVI, 117.85 (100.6–138.5) ml / m2, p<0.0001). Furthermore, LV wall thickness and pulmonary artery systolic pressure did not differ in these groups. Both in men and women with TCMP, LAVI and EDVI were significantly less than in men and women with DCMP.

Conclusion The study showed significant differences in parameters of cardiac remodeling. In TCMP patients as distinct from DCMP patients, despite a pronounced decrease in LVEF, LV dilatation was absent or LV volumetric parameters were moderately increased with a more severe somatic status.

Relevance The number of patients with functional class III-IV chronic heart failure (CHF) characterized by frequent rehospitalization for acute decompensated HF (ADHF) has increased. Rehospitalizations significantly increase the cost of patient management and the burden on health care system.
Objective To determine the effect of long-term follow-up at a specialized center for treatment of HF (Center for Treatment of Chronic Heart Failure, CTCHF) on the risk of rehospitalization for patients after ADHF.

Materials and Methods The study successively included 942 patients with CHF after ADHF. Group 1 consisted of 510 patients who continued the outpatient follows-up at the CTCHF, and group 2 included 432 patients who refused of the follow-up at the CTCHF and were managed at outpatient clinics at their place of residence. CHF patient compliance with recommendations and frequency of rehospitalization for ADHF were determined by outpatient medical records and structured telephone calls. A rehospitalization for ADHF was recorded if the patient stayed for more than one day in the hospital and required intravenous loop diuretics. The follow-up period was two years. Statistical analyses were performed using a Statistica 7.0 software for Windows, SPSS, and a R statistical package.

Results Patients of group 2 were significantly older, more frequently had FC III CHF and less frequently had FC I CHF than patients of group 1. Both groups contained more women and HF patients with preserved ejection fraction. Using the method of binary multifactorial logit-regression a mathematical model was created, which showed that risk of rehospitalization during the entire follow-up period did not depend on age and sex but was significantly increased 2.4 times for patients with FC III-IV CHF and 3.4 times for patients of group 2. Multinomial multifactorial logit-regression showed that the risk of one, two, three or more rehospitalizations within two years was significantly higher in group 2 than in group 1 (2.9–4.5 times depending on the number of rehospitalizations) and for patients with FC III-IV CHF compared to patients with FC I-II CHF (2–3.2 times depending on the number of rehospitalizations). Proportion of readmitted patients during the first year of follow-up was significantly greater in group 2 than in group 1 (55.3 % vs. 39.8 % of patients [odd ratio (OR) =1.9; 95% confidence interval (CI), 1.4–2.4; р<0.001]; during the second year, the proportion was 67.4 % vs. 28.2 % (OR=5.3; 95 % CI, 3.9–7.1; р<0.001). Patients of group 1 were readmitted more frequently during the first year than during the second year (р<0,001) whereas patients of group 2 were readmitted more frequently during the second than the first year of follow-up (р<0.001). Total proportion of readmitted patients for two years of follow-up was significantly greater in group 2 (78.0 % vs. 50.6 %) (OR=3.5; 95 % CI, 2.6–4.6; р<0.001). Reasons for rehospitalizations were identified in 88.7 % and 45.9 % of the total number of readmitted patients in groups 1 and 2, respectively. The main cause for ADHF was non-compliance with recommendations in 47.4 % and 66.7 % of patients of groups 1 and 2, respectively (р<0.001).

Conclusion Follow-up in the system of specialized health care significantly decreases the risk of rehospitalization during the first and second years of follow-up and during two years in total for both patients with FC I-II CHF and FC III-IV CHF. Despite education of patients, personal contacts with medical personnel, and telephone support, main reasons for rehospitalization were avoidable.

 

Oncological patients are a high-risk group for venous thromboembolic complications. These complications significantly impair the outcome of antitumor treatment and take a leading place in the structure of mortality. Treatment of venous thromboembolic complications in oncological patients is a serious challenge. When selecting an anticoagulant, the physician should consider its efficacy and safety and possible drug interactions. Based on results of multiple studies presented in this article, physicians will be able to choose an optimum therapeutic tactics and secondary prevention of thromboembolic complications for this group of patients.

This review focuses on a new method for noninvasive, complex evaluation of left ventricular (LV) systolic function using an echocardiography-based technology of computing indexes of myocardial performance by construction of pressure-deformation curves. Since this new method accounts for the effect of afterload on myocardial contractility, the article presents data demonstrating advantages of the evaluation of LV myocardial performance over the speckle-tracking echocardiography and other methods in diagnostics of several diseases. The review provides a description of this method and its advantages and limitations. The authors analyzed results of major studies on evaluation of LV performance. Prospects of implementation and practical use of the method are discussed in the aspects of diagnostics of cardiovascular diseases and risk stratification for different groups of patients.

The review focused on a relatively new issue, myocardial infarction with non-obstructive coronary arteries (MINOCA). According to current ideas, almost 6% of all myocardial infarction (MI) cases may be MINOCA. This term can be used both as a “working diagnosis” at the time of further evaluation and a final diagnosis after establishing a cause for each specific case. Since some variants of cardiac, including non-coronary, pathology may be similar to MI in a number of signs, each individual case of MINOCA requires specification. Among major causes for this condition are vasospasm, CA embolism, spontaneous CA dissection, rupture of an eccentric atherosclerotic plaque in a CA, etc. Diagnostics of MINOCA includes both a set of diagnostic tests for verification of the MI diagnosis according to the Fourth Universal Definition of MI and specific studies for elaboration of the disease etiology. A special role in differential diagnostics belongs to gadolinium-enhanced magnetic-resonance imaging (MRI) of the myocardium, which allows to distinguish between MI and non-ischemic myocardial injury of different genesis. Methods of intravascular visualization, such as optical coherence tomography (OCT) and intravascular ultrasound are also important. Commonly accepted guidelines on the treatment of this pathology consistent with current ideas are not available. However, it is obvious that therapeutic possibilities and prognosis for MINOCA depend on the identified cause in each individual case.

Chronic noninfectious diseases (cardiovascular, bronchopulmonary, oncological diseases and diabetes mellitus) are presently the most common cause of death worldwide, with cardiovascular diseases (CVD) being predominant. For this reason, the key goal of a physician is not only to treat but also to prevent diseases. Acetylsalicylic acid (ASA) is considered one of the most effective drugs for secondary prevention of CVD. However, the use of ASA for primary prevention is still debated. Results of many studies of ASA are inconsistent. Some studies have suggested that using ASA in patients aged 40-70 with a high 10-year risk of CVD and a low risk of bleeding may reduce the incidence of CVD. Administration of ASA to patients with a high or medium risk of CVD is also considered.

The review presents current data on atrial fibrillation, therapeutic approaches, and possibilities of interventional treatment and addresses inflammatory heart damage and its interrelation with arrhythmia.

The review presents current data on atrial fibrillation, therapeutic approaches, and possibilities of interventional treatment and addresses inflammatory heart damage and its interrelation with arrhythmia.

Modern cardiac rehabilitation represents a structured, multicomponent program, which includes physical activity, education of the patient, modification of the health behavior, and psychological and social support. In EU countries, only 44.8% of patients with ischemic heart disease receive a recommendation to participate in any form of rehabilitation, and only 36.5% of all patients presently have an access to any rehabilitation program. Systematic analysis of programs for prevention of cardiovascular diseases and for rehabilitation in patients with myocardial infarction (MI) and percutaneous coronary intervention showed that complex programs can still reduce all-cause and cardiovascular mortality and frequency of recurrent MI and stroke. These programs include key components of cardiac rehabilitation, reduction of six or more risk factors, and effective control by drug therapy.

Catheter ablation is presently the main method for interventional treatment of atrial fibrillation (AF). Despite improvements of the method and accumulation of personnel’s experience, incidence of recurrent AF following catheter interventions remains high. This review addresses a possibility of using contrast-enhanced cardiac magnetic resonance imaging to increase the effectiveness of interventional treatment of arrhythmia.

Deprescribing is a scheduled withdrawal, dose reduction, or replacement of a medicine with a safer one. Several groups of medicinal products (MPs) are used simultaneously in the treatment of chronic heart failure. This increases the risk of adverse drug reactions, particularly in elderly and senile patients. A systematic search for literature allowed evaluating possibilities of deprescribing for the following pharmaceutic groups: 1) MPs influencing the renin-angiotensin-aldosterone system; 2) beta-blockers; 3) digoxin; and 4) diuretics. Three systematic reviews and several studies were analyzed to determine the most feasible and potentially optimal regimens of deprescribing in CHF. It was established that in CHF, deprescribing has a very limited potential for use due to the documented, obvious effect of some MP groups on prediction and severity of clinical symptoms in CHF patients.

LEOPARD syndrome with multiple lentigines (cardiomyopathic lentiginosis) is a rare, genetically predetermined disease with autosomal dominant inheritance. Prevalence of this syndrome is unknown. One of pathognomonic clinical manifestations of this syndrome is the presence of multiple lentiginous pigment spots all over the body. The most common cardiac manifestation (approximately 80%) is myocardial hypertrophy. We presented a rare clinical case of detecting LEOPARD syndrome with multiple lentigines in a 32-year old female patient with major manifestations evident as pronounces morpho-functional alterations, myocardial hypertrophy, and heart rhythm disorders.

The article presents a clinical case of cardiovascular syphilis in a 30-year old man. The authors provided a detailed clinical picture and results of laboratory and instrumental examinations. Tactics of managing patients with cardiovascular syphilis are addressed.

The article presents a clinical case of diagnosis and treatment of a rare disease, multiple papillary fibroelastoma associated with a relapse and a complication in the form of cardioembolic stroke. The authors stressed difficulties in diagnostics of this disease and a special role of the physician-patient interaction.

The ECG stress test allows to determine possible presence of obstructive coronary atherosclerosis. The more severe the atherosclerotic lesion of coronary arteries the more likely a ST segment depression during the stress test. The article provides a description of a negative result of a stress test in a patient with multivessel coronary disease.

Transthyretin amyloidosis (ATTR) is a threatening and severe genetic disease characterized by damages to organs and systems caused by a pathological protein transthyretin produced in the liver. Clinical manifestations of this disease vary from injuries of the nervous system to injuries of the cardiovascular system. Prognosis for ATTR-amyloidosis remains unfavorable. The absence of pathognomonic symptoms complicates diagnostics of this disease, which tends to simulate other conditions. At present, medicines exist, which are pathogenetic in the treatment of ATTR-amyloidosis. The article describes a clinical case of ATTR-amyloidosis with primary heart injury complicated with functional class III chronic heart failure during the tafamidis treatment.