Vol 10, No 1 (2019)

Articles
The study of vascular wall stiffness in patients with arterial hypertension depending on some factors of risk and associated clinical conditions
Khaisheva L.A., Shlyk S.V., Samakaev A.S., Glova S.E., Pirozhenko A.A., Samokhina L.Y.
Abstract
Aim. To study the effect of gender, age, duration of disease and different forms of ischemic heart disease on the stiffness of the vascular wall in patients with arterial hypertension by determining the propagation velocity of the pulse wave. Materials and methods. In order to study the propagation velocity of the pulse wave it was examined 369 patients with the method of volumetric sphygmography. In all patients was diagnosed arterial hypertension I-III stage, 1-3 degree, besides 47 patients were diagnosed with stable angina I-III functional class, 50 patients had a history of prior myocardial infarction. The investigation was held with the help of hardware complex "Poli-Spektr" made by Neirosoft firm (city Ivanovo) by the classical method of determining the propagation velocity of the pulse wave using synchronous registration sphygmograms of the carotid, radial and femoral arteries. Results. Patients with arterial hypertension had statistically higher velocity of pulse wave propagation for elastic-type vessels in comparison with healthy volunteers (9.48±0.18 и 7.28±0.64 cm/sec; р<0.05), and 80 people had velocity of pulse wave propagation more than 12 m/cek. In women with arterial hypertension in age till 60 years old in 81% were recorded normal values of pulse wave propagation velocity for elastic-type vessels compared to men at the same age among whom such values were registered in 35.9% cases (р<0.05). We revealed that velocity of pulse wave propagation for elastic-type vessels directly depends on age and pulse blood pressure level. With age velocity of pulse wave propagation for elastic-type vessels increases, besides grows the strength of the relationship between these indicators, however associated clinical conditions and disease duration does not affect on the strength of the relationship. Influence of the pulse blood pressure level manifests itself in patients that have arterial hypertension more than 10 years and has gender differences originating in women over 60 years. Conclusion. Vascular wall changes by increasing its rigidity in conditions of arterial hypertension significantly ahead of clinical manifestations and defines serious difficulties for early diagnosis and prognosis and requires a detailed approach to the patient taking into consideration all possible risk factors for the particular situation.
CardioSomatics. 2019;10(1):6-11
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Cardiopulmonary relationships in patients with concomitant chronic obstructive pulmonary disease who were hospitalized for acute coronary syndrome
Iskenderov B.H., Berenshtein N.V., Lokhina T.V., Ivanchukova M.G.
Abstract
Aim. To study cardiopulmonary relationships in patients hospitalized for acute coronary syndrome with concomitant chronic obstructive pulmonary disease (COPD). Materials and methods. Based on having/not having of COPD exacerbation on admission. 52 patients (29 men and 23 women) were divided into 2 groups: group 1 (n=33) with COPD exacerbation and group 2 (n=19) without COPD exacerbation. Patients examination inclused spirometry with bronchodilator test and identification of serum troponin T (TnT) levels. Results. In 30 patients TnT levels confirmed a development of acute myocardial infarction (AMI) and in 22 patients TnT levels were below the diagnostic threshold. In patients with AMI mild-to-moderate COPD was prevalent (70.0% out of all cases) and exacerbation of COPD was diagnosed in 76.7% of patients on admission. TnT levels in patients with both AMI and an exacerbation of COPD were significantly higher compared to those in patients without COPD exacerbation: 0.78±0.17 and 0.59±0.14 ng/ml, respectively (p=0.014). Patients without AMI and with COPD exacerbation had higher TnT levels compared to patients without COPD exacerbation: 0.19±0.08 and 0.11±0.04 ng/ml respectively (p=0.002). Conclusion. Thus concomitant COPD, especially with acute exacerbation, is associated with an increased risk of AMI in patients hospitalized with acute coronary syndrome.
CardioSomatics. 2019;10(1):12-18
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Modern approaches to the assessment of comorbidity in patients
Sarsenbayeva G.I., Tursynbekova A.E.
Abstract
Aim. To provide modern data on advantages and disadvantages of available international comorbidity scales and indices. Materials and methods. Data of 29 scientific sources published in Russian and foreign literature press within 1973-2018 are considered. Results. The presence of comorbidity in a patient is an issue of modern medicine. In most cases some comorbid diseases if timely diagnosed and managed in accordance with algorithms for medical care can be corrected and treated. In order to control risks of development of complications and to prescribe an effective therapy for comorbidity the international and national clinical guidelines have been created. They include algorithms for clinical and instrumental assessment of complications and provide scales and indices, such as Cumulative lllness Rating Scale (CIRS), Charlson comorbidity index, Kaplan-Feinstein index, Index of Co-Existent Disease (ICED), Geriatric Index of Comorbidity (GIC), Functional Comorbidity Index (FCI) et al. Data of Canadian comparative study of 5 international scales of comorbidity in patients with head and neck cancers showed a significant impact of comorbidity on survival of patients with different stages of neoplasms. It was emphasized that the index of comorbidity is necessary to control an impact of comorbid diseases on the patients' status in the long-term period. The Kaplan-Feinstein scale was the best index for assessing a survival of patients with head and neck cancer. According to V.de Groot, the most widely studied comorbidity index for predicting mortality is the Charlson index. Each index has its advantages and disadvantages and is used in different clinical situations. Conclusion. General comorbidity index is a comprehensive summary score of a disease combination or severity, which combines all conditions, problems and illnesses of patients, weights them by severity, and it significantly affects treatment tactics and outcome in a future.
CardioSomatics. 2019;10(1):19-23
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Comparative efficiency of continuous intensity trainings and interval loads in patients aftering myocardial infarct with a subsequent corrective coronary intervention
Chistyakova Y.V., Mishina I.E., Arkhipova S.L., Dovgalyuk Y.V., Fokicheva S.O., Zolotareva A.A.
Abstract
Aim. The purpose of the study is to conduct a comparative analysis of the effectiveness of physical aerobic training in the mode of interval and constant loads in patients who have had a myocardial infarction with subsequent percutaneous coronary intervention. Materials and methods. 35 patients aged from 46 to 67 years old were examined in the process of passing a 3-week course of physical rehabilitation in a day hospital. Of these, 18 people (group 1) performed daily training on cardiovascular machines in the mode of interval loads, 17 people (group 2) - in the mode of moderate loads with constant intensity. Results. When conducting physical training in different training regimens, both groups of patients showed an improvement in exercise tolerance. At the same time, the interval training as compared to the constant intensity training provided a more pronounced training effect on the cardiorespiratory system due to high-intensity loading phases and at the same time a low level of hemodynamic load due to the presence of relatively low-intensity phases. Conclusion. Interval training is preferred in patients who have had a myocardial infarction followed by percutaneous coronary intervention, due to their high efficacy and safety.
CardioSomatics. 2019;10(1):24-28
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Magnetic resonance imaging can diagnostic early morphofunctional changes in the myocardium in young people with type 1 diabetes
Popov K.A., Bondarenko I.Z., Biryukova E.V., Averkieva E.V., Vorontsov A.V.
Abstract
Aim. To study the morphofunctional state of the myocardium in young people with diabetes mellitus 1 using magnetic resonance imaging (MRI) technology. Materials and methods. 38 patients (14 men, 24 women), aged 18 to 36 years old, with an experience of type 1 diabetes from 5 to 16 years old were underwent contrastive MRI of the heart. The exclusion criteria were: pronounced electrolyte disorders in the blood, dysproteinemia, chronic liver and kidney failure - glomerular filtration rate (EPI)≤60 ml/min/1.73 m2, thyroid dysfunction, obesity (body mass index ≥30 kg/m2), diagnosed cardiovascular diseases, contraindications for MRI. The indicators of functional changes in the left ventricle (circular strain, strain relaxation index - SRI), peak early diastolic strain (PSRDS) were obtained and the accumulation of the contrast agent in the delayed period were assessed. Results. The obtained results of strain, SRI, PSRDS do not allow to exclude the presence of functional changes in the myocardium of the left ventricle. In 42.11%, zones of accumulation of the contrast agent were visualized in the delayed period (insignificant - 28.95% and moderate accumulation - 13.16%), mainly by the endocardium of the cardiac apparatus (mitral and tricuspid), and in one observation (2.9%) - in combination with unexpressed diffuse heterogeneity of the myocardium of the left ventricle. Conclusion. MRI of the heart is a promising direction in the assessment of early morphofunctional changes in the structure of the myocardium, which will probably make it possible to predict life-threatening changes in the heart muscle in young patients with type 1 diabetes.
CardioSomatics. 2019;10(1):29-35
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Priorities of self-monitoring of blood glucose in a treatment of diabetes mellitus
Biryukova E.V., Shinkin M.V., Ganekova C.S.
Abstract
Aim. To describe a role of self-monitoring of glycemia in a treatment of diabetes mellitus (DM) and in a prevention of vascular complications of DM. Materials and methods. Data of 57 scientific sources from Russian and foreign literature published within 2005-2017 are considered. Results and conclusions. DM is a chronic disease associated with a development of micro- and macrovascular complications and to prevent them is an important task of modern medicine. In patients with DM an incidence of cardiovascular diseases is 2-3 times higher compared with the general population. Hyperglycemia is among the major damaging factors for the cardiovascular system. Clinical studies have clearly demonstrated that programs of therapeutic management of diabetic patients which include regular self-monitoring of glycemia lead to a better reduction of glycated hemoglobin levels compared to programs without self-monitoring as well as they help many patients to avoid late complications. СКГ rate is correlated with glycated hemoglobin levels. Regular self-monitoring allows you to avoid sudden and dangerous fluctuations in glycemia, including hypoglycemia, which contribute to high cardiovascular risk. The use of self-monitoring of glycemia in combination with structured patient education is associated with improving the quality of life of patients with DM. Current view on self-monitoring implies a certain frequency of blood glucose systematic measurement (varies depending on the type of glucose-lowering therapy and the degree of diabetes compensation) and is an important reference point used by both the doctor and the patient to assess a treatment outcome and to correct it if necessary. An availability of modern glucometers and skills of their correct and regular use turn a patient into an active and valuable participant in a management of DM. Achieving and maintaining the target glycemia levels depends largely on an accuracy of the glucometer since measurement results provide the basis for changing a glucose-lowering therapy if necessary. From the physician's point of view, the most important criterion for selecting a glucometer is compliance with the accuracy standards, and from the patient’s point of view this is convenience and ease of use. Thanks to improving technologies that increases an accuracy of blood glucose measurements, the procedure for self-monitoring of glycemia is simplified, which contributes to glucose-lowering therapy effectiveness and treatment compliance.
CardioSomatics. 2019;10(1):36-41
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Analysis of modern practice of remote forms of medical consultations and dispensary observation of patients with ischemic heart disease (literature review)
Mishina I.E., Gudukhin A.A., Sarana A.M., Urazov S.P.
Abstract
Aim. To describe modern opinions about the role of remote technologies in the dispensary observation of patients with cardiovascular diseases. Materials and methods. The data of 57 scientific sources published in the russian and foreign press in 1984-2018 are considered. Results and conclusion. It is generally recognized that patients with myocardial infarction need cardiac rehabilitation, but the frequency of their participation in its programs remains low due to transport problems, unwillingness to leave home due to anxiety and depression, and to change the mode of the day due to the need for ambulant visits, etc. Modern achievements of telemedicine solve these problems and allow doctors to monitor the status of patients remotely. All types of telemetry devices have some advantages: external cardiomonitoring systems in real time quickly collect and transmit the most complete information without the participation of the patient, standard non-loop and loop recorders are inexpensive and widely available, and adhesive patch recorders are very easy to use and increase compliance. The use of mobile applications and SMS in the framework of remote cardiorehabilitation has not been sufficiently studied, but data on their effectiveness in correcting the behavior of patients have already been collected. Experts have not yet come to a consensus on the effectiveness of complex tele-cardiorehabilitation, including telemetry, telecoaching and teleconsulting, but many studies have shown that it is a worthy alternative to traditional rehabilitation programs, as it has higher rates of attendance.
CardioSomatics. 2019;10(1):42-50
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Adverse effects of statin therapy: real evidence
Bubnova M.G.
Abstract
Aim. To provide a current view on the tolerability and safety of statin therapy. Materials and methods. The data of 73 scientific sources from Russian and foreign literature published within 1996-2018 are considered. Results. It is generally accepted that statins are first-line therapeutic agents for hypercholesterolemia and combined hyperlipidemia. Today there in growing evidence that lowering of low-density lipoprotein cholesterol levels prevents atherosclerotic diseases and reduces a risk of cardiovascular and overall mortality. Main issues of current statin therapy include a use of inadequate dosage for atherosclerotic diseases prevention, low treatment compliance and drug intolerance. In recent years the issue of statin intolerance has become of great importance. Criteria were proposed for determining an inability to tolerate statins, some experts suggest replacing definition of “statin intolerance” with the term “statin-associated side-effects”. Most discussed adverse effects due to statins include muscle-related symptoms (myalgia/myopathy), hepatotoxicity (hepatic hyperenzymemia) new-onset diabetes, dementia and cognitive impairment. Mechanisms of development of these adverse effects are still unclear. Certain factors and conditions capable of triggering some adverse effects as well as absolute contraindications to statin therapy were established. Some factors and conditions capable of triggering some adverse effects as well as absolute contraindications to statin therapy were identified. Occurrence of statin-associated side-effects depends on statin dose, a patient's age, gender, comorbidity and concomitant therapy. Many adverse effects of statins are drug class effect. At the same time each of statins has specific features of its structure, metabolism, drug interactions and pharmacokinetics. Pitavastatin belongs to the last generation of statins and it has distinct pharmacological features and neutral diabetogenic effects, etc. Risk of adverse effects due to statins is often exaggerated while benefit from the use of statins for preventing atherosclerotic diseases outweighs potential risks. Real occurrence of some adverse effects due to statin therapy requires additional evidence. Conclusion. Overall, statins have a good tolerability profile and are approved for use in the vast majority of patients who required lipid-lowering therapy.
CardioSomatics. 2019;10(1):51-61
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