Vol 10, No 4 (2019)


Predictors of repeat myocardial revascularization for the long-term after percutaneous coronary interventions in patients with combination of coronary artery disease and chronic obstructive pulmonary disease

Zafiraki V.K., Skaletsky K.V., Kosmacheva E.D.


Aim. To assess the influence of concomitant chronic obstructive pulmonary disease (COPD) on the frequency of repeat myocardial revascularization in patients with coronary artery disease (CAD) after percutaneous coronary interventions (PCI), as well as to determine independent predictors of repeat revascularization in patients with concominant COPD. Materials and methods. A prospective cohort study included 646 patients with CAD, of which 254 had concominant COPD. All patients underwent PCI (46.9% for acute coronary syndrome in the main group and 44.9% in the control group. Remaining interventions were elective). The frequency of repeat myocardial revascularization and the time till re-intervention was registered during the follow-up period up to 36 months. Results. COPD increases risk of repeat myocardial revascularization (hazard ratio - HR 1.46; 95% confidence interval - CI 1.03-2.06), repeat PCI (HR 1.62; 95% CI 1.03-2.32) and is accompanied by an earlier onset of re-intervention. An independent predictors of repeat myocardial revascularization in the Cox regression model are: glomerular filtration rate (p=0.001), ankle-brachial index (p=0.004), frequent exacerbations of COPD (p=0.028), total number of coronary artery stenosis (p=0.039) and blood concentration of C-reactive protein (p=0.066). Conclusions. COPD is a significant risk factor of re-intervention after PCI in patients with acute and chronic forms of CAD and leads to its earlier performing. The patients with frequent COPD exacerbations have the highest risk of repeat myocardial revascularization during follow-up.
CardioSomatics. 2019;10(4):6-11
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Acute coronary syndrome: especially treatment and rehabilitation on a stationary stage

Zolotukhin N.N., Kon’kov A.V.


Introduction to medical practice of the term «acute coronary syndrome» (ACS) showed increased interest in the problems of not only the features of the occurrence, the course of acute myocardial infarction (AMI) and unstable angina (UA), the effectiveness of treatment methods, but also the re-evaluation of the system of medical rehabilitation. Aim. To assess the features of treatment and comprehensive medical rehabilitation in AMI and UA of the Ministry of Internal Affairs of Russia (MIA), the ratio of these diseases in the structure of ACS in the treatment and rehabilitation in the Main Clinical Hospital of the MIA. Materials and methods. Over a period of 4 years treated and conducted medical rehabilitation 551 persons in the MIA, of which 152 police officer. The criterion for inclusion in the study was the presence of AMI or UA. Examination and treatment of AMI and UA was carried out in strict accordance with the approved standards. Medical rehabilitation was carried out by the method of Russian Cardiology Research and Production Complex of the Ministry of Health of the Russian Federation with the use of the dosed physical activity. Results. Of the total number of diseases, ACS was most often diagnosed in pensioners of the MIA. In the structure of the ACS, the MIA most often identifies AMI, 28-29 cases annually. The maximum frequency of the hospitalizations and 46 cases of ACS from the employees of the MIA recorded in 2015. Among pensioners of the MIA the number of ACS was maximum - 399 in comparison with employees of the MIA - 152. It should be noted that the MIA staff is dominated by AMI, pensioners - UA. For further rehabilitation, 135 patients were transferred to a rehabilitation center, most of whom were diagnosed with AMI. Transfer to the rehabilitation center for ACS for further rehabilitation was carried out up to 38% of patients with AMI and up to 4% of UA. Conclusion. The presence of the rehabilitation center in the structure of MIA allows optimal stage-by-stage medical rehabilitation of patients with ACS.
CardioSomatics. 2019;10(4):12-16
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Left ventricle reconstruction in patients with ejection fraction less than 30% and left ventricle aneurysm of the 2 and 3 type according to L. Menicanti classification improves the quality of life

Bazylev V.V., Tungusov D.S., Mikulyak A.I., Senzhapov I.Y.


Aim. To assess the quality of life (QOL) in patients with left ventricular reconstructions with an ejection fraction of less than 30%and left ventricle (LV) aneurysm of type 2 and 3 according to L. Menicanti. Materials and methods. The retrospective one-center study included 72 patients with left and right ventricular aneurysms of the second and third types according to the classification of L. Menicanti and an extremely reduced ejection fraction (less than 30%). The observation period was up to 33 months. The study included 61 (84%) men and 11 (16%) women, whose average age at the time of surgery was 58.2±9.2 years. All patients underwent LV reconstruction under CPB. Patients independently filled in the questionnaire before surgery. Repeated questionnaires were conducted no earlier than a year after the operation, in order to exc-lude the influence of possible complications associated with surgical access on the physical and mental health components. QOL was assessed using a standard SF-36 questionnaire. Results. According to the analysis, it was found that during the observation period of up to 33 months in patients, the "physical functioning" parameter is significantly lower than the initial value ( p =0.001). Also at a fairly high level the value of the indicator "body pain" is maintained, which is higher than the initial value ( p =0.001). According to other indicators, in patients with a low ejection fraction after reconstruction of the LV, an improvement in the QOL parameters was revealed. The mental and physical health of patients after reconstruction of the LV is significantly higher than the values before surgery. Results. Reconstruction of the LV in patients with LV aneurysm of type 2 and 3 according to L. Menicanti significantly improves the QOL of patients in such parameters as role-playing activity, general health, vitality, social functioning, emotional condition and mental health. A decrease in the indexed value of stroke volume of less than 23% is a predictor of a decrease in both physical and mental components of health.
CardioSomatics. 2019;10(4):17-22
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Evaluation of the influence of the therapy with fosinopril and zofenopril on the regulatory-adaptive status of patients with diastolic chronic heart failure

Nedvetskaya S.N., Tregubov V.G., Shubitidze I.Z., Pokrovskiy V.M.


Aim. Еvaluate the influence of combination therapy with fosinopril or zofenopril on the regulatory-adaptive status (RAS) of patients with diastolic chronic heart failure (CHF). Material and methods. The study includes 80 patients with CHF I-II functional class according to the classification of the New York heart Association with left ventricle ejection fraction ≥50% because of hypertensive disease (HD) of III stage, who were randomized into two groups for treatment with fosinopril (14.7±4.2 mg/day, n=40) or zofenopril (22.5±7.5 mg/day, n=40). As part of combination pharmacotherapy, patients were included nebivolol (7.1±2.0 mg/day and 6.8±1.9 mg/day), in the presence of indications, atorvastatin and acetylsalicylic acid in the intestinal shell were prescribed. Initially and after six months, the following was done: a quantitative evaluation of the RAS (by cardio-respiratory synchronism test), echocardiography, tredmil-test, six-minute walking test, determination of the N-terminal precursor of the natriuretic brain peptide level in blood plasma and subjective evaluation of quality of life. Results. Therapy, using fosinopril, in comparison with zofenopril, more improved RAS (by 66.5%, p<0.01 and 50.6%, p<0.01). In the group of fosinopril more pronounced increased tolerance to physical activity: increased test distance with a six-minute walk (by 27.2%, p<0.05 and 24.3%, p<0.05), decreased functional class of CHF (from II to I in 57% of patients, in 17% of cases of CHF was not registered and from II to I in 29% of patients, in 11% of cases of CHF was not registered) respectively. In both groups, a comparable improvement in cardiac diastolic function was observed (decreased VE/Ve´ by 37.8%, p<0.01 and 36.3%, p<0.01), reduction of neurohumoral hyperactivity (NT-proBNP decreased by 40.9%, p<0.01 and 37.3%, p<0.01), improving the quality of life (decrease in the amount of negative points by 69.5%, p<0.01, and 64.9%, p<0.01) respectively. The data obtained were not compared with the control group. Conclusion. In patients with diastolic CHF because of HD III stage as part of the combination pharmacotherapy, the use of fosinopril, in comparison with zofenopril, may be preferable because of a more pronounced positive influence on RAS.
CardioSomatics. 2019;10(4):23-28
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Allelic variants of rs1800801 polymorphism in patients with stroke

Nikulina S.Y., Shulman V.A., Chernova A.A., Prokopenko S.V., Nikulin D.A., Platunova I.M., Tretyakova S.S., Semenchukov A.A., Marilovtseva O.V., Chernov V.N., Maksimov V.N., Gurazheva A.A.


Aim. To study the association of single nucleotide polymorphism (SNP) rs556621 (G>T) with the development of stroke in patients of the East Siberian population with cardiovascular pathology and risk factors. Material and methods. The study involved 260 patients with stroke (157 men and 103 women) and 272 patients of the control group (170 men and 102 women). The following cardiovascular pathology and risk factors were present in the patients of the main group: arterial hypertension, paroxysmal supraventricular tachycardias, dyslipidemia, atherosclerosis of the brachiocephalic arteries, disorders of the hemostatic system. All patients underwent clinical, instrumental and molecular genetic examination. Statistical processing of the material was carried out using the set of application programs Statistica for Windows 7.0, Excel and SPSS 22. Results. As a result of the study, no statistically significant associations of genotypes and alleles of the rs1800801 polymorphism (C>T) with stroke were found in any of the analyzed groups and subgroups. Conclusion. SNP rs1800801 (C>T) does not have a significant effect on the development of stroke in people of the East Siberian population, regardless of the preceding cardiovascular pathology and risk factors.
CardioSomatics. 2019;10(4):29-33
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The role of single-nucleotide polymorphism rs10824026 of the SYNPO2L gene in the development of atrial fibrillation in a study in the East-Siberian population

Shishkova K.Y., Nikulina S.Y., Shulman V.A., Chernova A.A., Maksimov V.N., Gurazheva A.A.


Background. Atrial fibrillation (AF) is the most common type of heart rhythm disturbance, leading to the development of lifethreatening conditions, such as cardio embolism, heart failure, and even sudden cardiac death. In recent years, the genetic aspects of AF have been actively discussed. The largest number of genetic predictors of AF was identified after a full genome-wide association studies (GWAS). Given that so far no studies of the association of rs10824026 polymorphism of chromosome 10q22 with the development of AF have been conducted in the Russian population, we conducted this clinical study. Aim. Checking the associations of the development of AF with the single-nucleotide polymorphism rs10824026 of the SYNPO2L gene in the East-Siberian population. Materials and methods. The study design was formed in accordance with the National Standard of the Russian Federation Good Clinical Practice, GOST P 52379-2005. The study uses design - “case-control”. The main group of patients - patients with known cardiac arrhythmias by the type of AF (n=106, average age 57.0±9 years, men 49.4%, women 50.6%), the group was formed using the criteria of the World Health Organization and the European Society of cardiologists. The control group (n=105, average age 57.0±9 years, men - 50.0%, women - 50.0%) was selected by age and gender from the DNA bank of international studies MONICA (Multinational MONItoring of trends and determinants in cardiovascular disease) under a joint agreement with the Research Institute of Therapy and preventive medicine - Novosibirsk. DNA was isolated by phenol-chloroform extraction. Among other things, among the research methods, routine laboratory methods were used; instrumental data; and invasive tactics such as CAG. Results. As a result of clinical genetic testing, it was found that the frequency of G/G polymorphism of the SYNPO2L gene in patients with AF shows a statistically significant difference.
CardioSomatics. 2019;10(4):34-38
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Influence of type A behavioral activity on the development of cardiovascular disease

Martynov A.I., Akatova E.V., Pervichko E.I., Nikolin O.P., Urlaeva I.V.


Aim. To study the influence of type of behavioral activity on the development of cardiovascular diseases, to evaluate the effect of type of behavior on the frequency of repeated hospitalizations and fatal outcomes after acute coronary syndrome. Materials and methods. The study included 100 patients with acute coronary syndrome who were subsequently divided into groups according to the main disease - acute myocardial infarction and unstable angina. The median age was 62.09±5.46 years, the therapy according to the underlying disease. All patients had anamnesis of previous and concomitant diseases, anthropometric measurements, physical examination, and observation during the next 24 months after inclusion in the study. In dynamics he carried out daily monitoring of electrocardiogramm, daily monitoring of blood pressure, echocardiography. Diagnosis of types of behavioral activity was carried out using the test method "type of behavioral activity" developed on the basis of the questionnaire Jenkins Activity Survey, published in 1974 by C. Jenkins, the Russian-language adaptation was performed in NIPNI Bekhtereva (L.I. Wasserman, N.V. Gumenyuk). Results. In patients with behavioral activity type A more frequent occurrence of diseases such as angina, hypertension, acute myocardial infarction, acute violation of cerebral circulation, type 2 diabetes than in persons with behavior type AB and B. Repeated hospitalizations for unstable blood pressure and unstable angina on the background of standard therapy in patients with type a behavior occur more often than in patients with type AB and B.
CardioSomatics. 2019;10(4):39-43
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Cardiovascular multimorbidity and temporary disability among health professionals of the multidisciplinary city hospital

Larina V.N., Glibko K.V., Kasaeva D.A.


Relevance. The article highlights the topical issues of cardiovascular mulimorbidity (CVM) and temporary disability (TD) among medical workers of a large multi-profile city clinical hospital. Aim. To assess the incidence of chronic noncommunicable diseases, CVM and TD in medical workers of the city clinical hospital. Materials and methods. 527 physicians (207 men and 320 women) aged 25 to 79 (42±9.8) years and 857 nurses (32 men and 825 women) aged 19 to 79 (41±9) years were included in a retrospective, open-label study. The medical documentations analysis was performed. Results. Hypercholesterolemia was diagnosed in 38%, overweight - in 26%, obesity - in 4.8%, smoking - in 27,2%, hypertension - in 9.1%, coronary artery disease - in 3%, diabetes mellitus - in 3.2%, CVM - in 2.3% of health care workers. Over the 3-year period, 42.3% of cases of TD were recorded. TD was associated with the female sex (OR 2.4, 95% CI 1.7-3.4; p<0.001), working in the outpatient department (OR 2.0, 95% CI 1.3-3.0; p<0.001), hypertension (OR 31.4, 95% CI 12.1-82.0; p<0.001), as well as age both in men (OR 1.03, 95% CI 1.0-1.1; p=0.045) and in women (OR 1.02, 95% CI 1.0-1.03; p=0.001). The relationship between age and CVM was confirmed (OR 1.08, 95% CI 1.05-1.12; p<0.001). Conclusion. Among medical workers of city clinical hospital there was a high incidence of smoking, overweight and hypercho-lesterolemia. Coronary heart disease, diabetes and hypertension were prevailed among the diseases. CVM was revealed among 2.3% of health workers, with an average age of 41 years. Persons with CVM were older than those without CVM and among them women were prevailed. Over the 3-year period, 42.3% of cases of TD were recorded, which associated with age, working in the outpatient department and hypertension, the most important component of multimorbidity.
CardioSomatics. 2019;10(4):44-50
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Functional status of the cardiovascular system in young children who had correction for congenital heart defect by the age of 1 year

Khabibullina A.R., Khairetdinova T.B.


Background. The topic relevance is determined by the increasing number of children with congenital heart defect (CHD) who require surgical correction at an early age. For further follow-up it is necessary to determine a functional status of the cardiovascular system (CVS), its adaptation to new conditions of hemodynamics, that is especially important in childhood during the period of morphological and functional changes in the growing organism. Aim. To assess the functional status of the CVS in children with CHD using a test with dosed exercise load (EL) to determine the need for an individual approach to physical rehabilitation.Materials and methods. The study included 80 children, who have been surgically treated for CHD by the age of 1 year. The study population included 32 (40.0%) boys and 48 (60.0%) girls; an average age of patients was 33.5 ± 4.28 months. The control group included 50 conditionally healthy children, with an average age of 35.0 ± 4.1 months; of which 23 (46%) were boys and 27 (54%) were girls. To assess the functional status of the CVS, a test with dosed EL was performed (10 squats in 20 s). Blood pressure and heart rate were measured at rest and after exercise, the double product and the quality of response index were calculated. Results. In children with CHD 2 years after surgery, resting blood pressure was lower compared with healthy children, no significant differences in heart rate between groups were found. The double product in children of the main group was close to above average value. Analysis of hemodynamic changes due to EL showed a more pronounced increase in heart rate and less pronounced increase in pulse pressure and stroke volume in children with CHD after correction, which indicates the adaptation of CVS to EL due to an increase in the rate rather than the strength of heart contractions. The quality of response index in the group of children with CHD corresponded to an irrational reaction to EL. Analysis of CVS responses to the load showed that the most prevalent type was asymptaticotonic one (when there is an increase in heart rate and almost no changes in blood pressure). In the hypertensive type (revealed in a small number of children), there is a significant increase in both heart rate and systolic and diastolic blood pressure. The time of hemodynamics backing up to the baseline parameters did not exceed 5 minutes in both groups, no child complained during the test. Conclusions. In young children who had surgical correction for septal CHD in infancy, blood pressure is characterized by low parameters, that is associated with a possible alteration in the regulation of vascular tone. The predominant type of the CVS response to EL in young children with septal CHD which was corrected in infancy is the asympathicotonic one with a normal period of restoration of hemodynamics to the baseline parameters. The test with EL allows us to individualize the program of physical rehabilitation of young children who had surgery for septal CHD in infancy, taking into account the status of CVS and the initial fitness
CardioSomatics. 2019;10(4):51-54
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National Medical Research Center for Preventive Medicine, Moscow, Russia

Evsyutina Y.V.


Arterial hypertension is the leading cause of cardiovascular morbidity and mortality. According to Russian and international studies, prevalence of hypertension is approximately 40%. In the next years an increase in the number of patients can be expected. Hypertension is the main independent risk factor for coronary heart disease for all age groups. Modern antihypertensive drugs can provide good control of blood pressure and reduce the incidence of complications and mortality. By prescribing antihypertensive therapy, it is necessary to achieve the target level of blood pressure, for most patients ≤130/80 mm Hg. When prescribing combination therapy, preference should be given to fixed combinations. Approximately 10% of patients with hypertension have resistance to therapy. Such patients often need an extended diagnostic search to exclude pseudoresistance and secondary hypertension. One of the main causes of pseudoresistance is poor adherence to therapy. Patients with resistant hypertension have a higher risk of adverse outcomes compared with patients without this type of disease.
CardioSomatics. 2019;10(4):55-58
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