Vol 10, No 3 (2019)

Articles
Safety and effectiveness of physical training in inotrop-dependent patients with compensation for chronic heart failure at the level of the III-IV functional class
Bortsova M.A., Demchenko E.A., Fedotov P.A., Ganenko O.S., Lelyavina T.A., Galenko V.L., Zamesov S.G., Babich O.A., Sitnikova M.Y.
Abstract
Aim. To assess the safety and effectiveness of physical training in inotrop-dependent patients with stabilization of the course of chronic heart failure (CHF) at the level of the III-IV functional class (FC). Materials and methods. The prospective randomized study included men of 18-65 years old who were committed to Almazov National medical research center "due to decompensated CHF III-IV FC, left ventricular ejection fraction of 30% or less due to coronary heart disease or dilated cardiomyopathy receiving dopamine or dobutamine for 2 weeks or more, stabilizing heart failure at level III-IV FC and arterial pressure 90/60 mm Hg and above against the background of ongoing inotropic therapy. Patients were randomized into 2 groups: 1st - those participating in the physical rehabilitation program (PRP), 2nd - receiving standard CHF therapy. Results. There was no increase in the number of fatal cases and the number of patients with episodes of decompensation of CHF in the 1st group compared with the 2nd group. The number of episodes of CHF decompensation before FC IV was higher in the 2nd group compared to the 1st: 13 (50%) in the 1st group and 20 (80%) in the 2nd (p=0.04). Episodes of CHF decompensation, requiring transfer to the anesthesiology and resuscitation departments, were 2 times less frequent in patients of the 1st group compared to the 2nd: 8 (31%) and 16 (64%), respectively (p=0.03). In patients with the 1st group, malignant ventricular arrhythmias were not registered during physical training and for 3 hours after their completion. There was a tendency (without achieving a statistically significant difference) to a decrease in pulmonary thromboembolism episodes in patients of the 1st group compared with the 2nd (p=0.05). In the 1st group, after 6 months, there was a decrease in the number of lower respiratory tract infections - bronchitis + pneumonia compared with the 2nd group (p=0.0006). Conclusion. Participation of inotropic-dependent patients in individually designed RPF does not increase their mortality and does not increase their number of life-threatening cardiac rhythm disturbances. In the group of inotropic-dependent patients participating in RPF, there was a significant decrease in the number of lower respiratory tract infections and a tendency to a decrease in the number of pulmonary embolism compared with patients not participating in RPF.
CardioSomatics. 2019;10(3):6-12
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Cardiac resynchronization therapy in patients with chronic heart failure: the view of a therapist, cardiologist
Reznik E.V., Soltis S.Y., Ustiuzhanin D.V., Nikitin I.G.
Abstract
The prevalence of the chronic heart failure is increasing due to the success of cardiology and the increase in life expectancy of the population. A greater number of patients live up to the clinically pronounced stages of the chronic heart failure. This issue leads to an increasing in the absolute number of the patients in whom there is a lack of efficacy of optimally prescribed drug therapy. These patients are considering initiating cardiac resynchronization therapy (CRT). CRT is recommended for the patients with chronic heart failure II-IV functional class with severe left ventricular systolic dysfunction and prolonged QRS complex. Despite careful selection of patients for CRT implantation, the device does not lead to the expected result in one third of cases. To increase the effectiveness of this intervention, the procedure should be performed in accordance with current guidelines only for compliant patients who have been at least 3 months on selected optimal drug therapy, should use the optimal strategies and modes of stimulation and the adequate drug support after the intervention. The number of patients with long-term use of CRT is constantly growing. More and more patients with installed devices come into the field of vision of general practitioners and cardiologists of ambulatory clinics and hospitals, for whom it is extremely important to understand the specifics of the methods and tactics of managing such patients. This publication is dedicated to this.
CardioSomatics. 2019;10(3):13-29
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Comparative pharmacoepidemiological assessment of antianginal, antiplatelet and lipid-lowering drugs in patients with stable angina in outpatient practice in Kursk and Chisinau
Povetkin S.V., Levashova O.V., Klyueva E.G., Ghicavii V.I., Batchinschi N.G., Pjdgurschi L.A., Turcan L.M.
Abstract
Aim. To study structure of medical purposes of anti-anginal, antiplatelet and hypolipidemic means at coronary heart disease patients in ambulatory practice of Kursk (Russian Federation) and Chisinau (Republic of Moldova). Materials and methods. During the period from October, 2017 to January, 2018 as a one-stage descriptive research, questioning of doctors of the medical organizations of Kursk and Chisinau was carried out. Questionnaires included questions on pharmacoepidemiological aspects of purpose of antianginal, antiplatelet and hypolipidemic means. Total number of respondents was 132, of them 66 (2 cardiologists and 64 therapists) - in Kursk and 66 (10 cardiologists and 56 therapists) - in Chisinau. Results. Doctors of Kursk and Chisinau have no statistically significant differences in structure of appointments of the main groups of anti-anginal means, antiplatelet and hypolipidemic drugs. The tendency to more frequent use of blockers of calcium channels and nitrovazodilatator among doctors of Chisinau while in structure of appointments of doctors of Kursk some prevalence of a trimetazidin, antiagregants and statines was noted was noted (p>0.05). Leaders in group of beta blockers were bisoprolol and metoprolol in the conditions of the pharmaceutical market of Kursk and Chisinau. Priority of the choice of blockers of calcium channels authentically differed in the considered regions only on a felodipin - in Kursk appointed it to a thicket (p<0.01). The structure of the choice of various representatives of nitrovazodilatator practically was parity in the explored regions. The leading drug from group of antiagregant the Kursk and Chisinau doctors had acetylsalicylic acid (58.1 and 76.3% respectively) while differences in use of a klopidogrel were more essential (41.9 and 23.7% respectively, p<0.05). Hypolipidemic means were provided by statines. The leading drugs from this group were rosuvastatin, atorvastatin and simvastatin. The share of purposes of two last medicines authentically differed. So in Kursk was more demanded (p<0.05), and in Chisinau - simvastatin (p<0.01). Conclusion. Priority classes in structure of assignment anti-anginal agents according to questioning of doctors of Kursk and Chisinau were b-blockers, blockers of calcic channels. Frequency of use of antiagregants and statins was comparable in the compared regions. The main share of medical assignments in the conditions of Kursk and Chisinau considered as in the relation the anti-anginal agents, and antiagregants, statins corresponds to the existing recommendations about pharmacotherapy of patients with stable angina pectoris.
CardioSomatics. 2019;10(3):30-36
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Pharmacokinetics of enalapril in patients with arterial hypertension depending on the glomerular filtration rate
Zhuravleva M.V., Prokofiev A.B., Dmitriev A.I., Belkov S.A., Melnikov E.S., Rodina T.A., Danko A.A.
Abstract
Aim. To study the pharmacokinetics of enalapril in patients with arterial hypertension, depending on the value of the prescribed dose of enalapril and the state of renal function to improve the efficiency and safety of treatment. Materials and methods. The study was performed in a group of 328 patients (107 men and 221 women aged 43 to 88 years) who received treatment for hypertension of 1-2 degrees. As the main antihypertensive drug was prescribed enalapril in doses of 2.5 to 20 mg twice a day. Patients underwent therapeutic drug monitoring to determine the concentration of enalapril and its metabolite - enalaprilat. Results. Among the examined patients in 31% of cases there was a decrease in GFR less than 60 ml/min, and in 9 (3%) patients GFR was less than 30 ml/min. This indicates a high prevalence of chronic kidney disease among patients with hypertension. During therapeutic drug monitoring enalapril in patients with hypertension and reduced GFR (less than 60 ml/min) serum concentration of the main metabolite was 1.5-2 times higher than in patients with GFR more than 60 ml/min. Conclusion. It is advisable to carry out therapeutic drug monitoring to determine the concentrations of enalapril and enalaprilat in the serum of patients receiving the drug in high doses and having impaired renal function. In the appointment of enalapril in high doses to patients with reduced GFR, the concentration of enalaprilat significantly exceeds similar indicators in patients with normal GFR and in some cases goes beyond the therapeutic range, indicating the need to consider the correction of the treatment regimen.
CardioSomatics. 2019;10(3):37-41
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Health school for patients with atrial fibrillation
Orlova N.V., Fedulaev I.N.
Abstract
Atrial fibrillation (AF) is the leading cause of disability and death from stroke. Despite efforts of the medical community to reduce the incidence of stroke, the disease prevalence remains high. Evidence-based effective tactics for preventing stroke is the use of anticoagulant therapy. At the same time, there is insufficient treatment compliance, self-withdrawal of the drug or failure to comply with a medication regimen, insufficient control of the international normalized ratio when prescribing warfarin, as well as non-compliance with doctor’s recommendations for a correction of risk factors for AF. Health school for patients with atrial fibrillation which has been elaborated by the authors, is aimed to solve issues of prevention of the disease and its consequences. Conducting health schools does not usually require significant financial costs but at the same time it is an effective prevention mechanism. The educational cycle for patients with AF consists of 6 lessons. The lesson thematic schedule includes: a concept of AF, the disease prevalence and relevance, risk factors for the disease and its exacerbations, classification of AF, its clinical manifestations, diagnosis, complications, rhythm control and anticoagulant therapy in patients with AF. Information is adapted for patients; themes for training of practical skills are proposed.
CardioSomatics. 2019;10(3):50-59
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Diagnostic value of chaperone activity of heat shock proteins 70 in coronary atherosclerosis
Kotova J.A., Zuikova A.A., Pashkov A.N.
Abstract
Aim. The aim of the research was to study the role of chaperone activity heat shock proteins (HSP) 70 in pathogenesis and diagnostic in patients with coronary atherosclerosis. Materials and methods. We examined 354 patients with coronary heart disease, who had coronary atherosclerosis of varying degrees, according to coronary angiography (was performed by the Judkins technique). The severity of coronary atherosclerosis was determined on the basis of the Gensini index. According to the Gensini index, patients were divided into 2 groups: GS0 - 152 patients without signs of coronary atherosclerosis, GS1 - 202 patients with coronary lesions. Chaperone activity was determined by thermodynamic method. Results. The study showed significant differences in the level of chaperone activity HSP70 in patients with different severity of coronary atherosclerosis. The correlation analysis revealed a significant negative relationship between chaperone activity HSP70 and the Gensini index. The cut-off value of chaperone activity of HSP70, by which can be judged on the presence or absence of coronary atherosclerosis, is establish. Conclusion. The revealed threshold of chaperone activity can be considered as a possible marker of the severity of coronary atherosclerosis.
CardioSomatics. 2019;10(3):60-64
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Hypoglycemia prevention: current opportunities
Doskina E.V., Tankhilevich B.M.
Abstract
In Russia, as well as throughout the world, there is a constant increase in the prevalence of diabetes mellitus. The Russian Federation is in the top 10 countries with the highest number of adults with diabetes. The incidence of hypoglycemic conditions remains extremely high, despite the available methods of self-control of glycemia and a wide variety of sugar-lowering drugs. So, according to studies such as URPDS, ACCJRD, VADT, ADVANCE, the frequency of hypoglycemic conditions ranged from 0.7 to 16%, depending on the type of therapy. Regardless of the severity of hypoglycemia, they lead to a decrease in the quality of life of patients, weight gain, the development of cognitive deficits and/or dementia, convulsive syndrome, cardiovascular catastrophes, increase the frequency of hospitalizations and the costs of treating diabetes, and also increase the risk of injury. The main tool in managing diabetes is self-monitoring of glycemia. Modern blood glucose meters must meet the needs of the patient - to be informative, accurate, convenient to use. For the timely detection of hypoglycemia, the accuracy of the glucometer is of great importance.
CardioSomatics. 2019;10(3):65-70
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Evaluation of quality of life in elderly patients moving surgical correction of aortal valve stenosis
Molchanov A.N., Romachkin V.V., Urvantseva I.A.
Abstract
Aim. Conduct a comparative analysis of the patient's quality of life in the long-term period after surgical correction of aortic valve stenosis after undergoing transcatheter aortic valve replacement with the results of patients undergoing aortic valve replacement with a seamless biological prosthesis under artificial blood circulation. Materials and methods. A comprehensive examination and dynamic observation in the middle and late postoperative period for 251 patients of the older age group with aortic stenosis was performed. The average age of patients at the time of treatment was 67.62±9.94 years. Group 1 included 128 patients who underwent transcatheter aortic valve replacement. In turn, Group 1 is divided into two subgroups. Subgroup A consisted of 56 patients, due to the severity of the underlying disease, concomitant pathology EuroSCORE II more than 20% and STS SCORE more than 10%. Subgroup B consisted of 72 patients with a risk of outcome of EuroSCORE II surgical intervention less than 20% and STS SCORE less than 10%. Group 2 patients (n=123) were comparable to subgroup B by the severity of the underlying disease EuroSCORE II less than 20% and STS SCORE less than 10%. All patients in group II underwent aortic valve replacement under artificial circulation.To assess the quality of life, the SF-36 questionnaire was used 12, 24, 36, 48 and 60 months after surgery. Results. The greatest increase in the total total score in the postoperative period was noted in subgroup A - 3 times (p=0.000001), and in subgroups B and group 2 was 2.66 times (p=0.0000011). By the end of the observation period, the highest total score was recorded in subgroup B, in subgroup A it was lower by 3% (p=0.95), in group 2 - by 2.4% (p=0.97). A correlation is established between the average degree between the total score, reflecting the quality of life of patients after aortic valve replacement, and the rate of ejection fraction (R=0.23, p=0.034), and the left ventricular myocardium mass (R=-0.25, p=0.028) and shock volume (R=0.29, p=0.021) according to echocardiography. Conclusions. Thus, despite a number of difficulties that were observed after surgical correction of aortic stenosis in patients of the older age group, including the presence of concomitant somatic pathology, marked cardiac changes according to echocardiography, the analysis of quality of life indicators demonstrates the positive effect of surgical treatment with a significant improvement in quality of life.
CardioSomatics. 2019;10(3):71-78
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Positive effect of if-channel’s blocker ivabradine therapy in a patient with ischemic chronic heart failure with preserved left ventricle ejection fraction and hereditary thrombophilia (clinical case)
Belenkov I.N., Privalova E.V., Ilgisonis I.S., Naymann I.I., Zhito A.V.
Abstract
Chronic heart failure is one of the leading causes of mortality among patients with cardiovascular diseases. Current therapeutic methods for treating patients with chronic heart failure do not always provide a significant improvement in main intermediate and final outcomes. According to the neurohumoral theory of chronic heart failure development, an antagonism of the sympathoadrenal system with b-blockers is pathogenetically substantiated, and the drugs of this group are one of the first-line treatment for chronic heart failure. The selection of heart rate-reducing therapy in patients with chronic heart failure caused by ischemia, can often be difficult due to development of b-blockers side effects, b-blockers intolerance and/or due to the presence of contraindications at severe comorbid pathology. This article presents a clinical case of an effective administration of ivabradine, a drug of if-channel inhibitors group, in combination with b-blockers to a patient with chronic heart failure with a preserved ejection fraction.
CardioSomatics. 2019;10(3):79-84
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Itogi XIII Rossiyskoy nauchno-prakticheskoy konferentsii s mezhdunarodnym uchastiem «Reabilitatsiya i vtorichnaya profilaktika v kardiologii» Rossiyskogo obshchestva kardiosomaticheskoy reabilitatsii i vtorichnoy profilaktiki
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Abstract
CardioSomatics. 2019;10(3):85-66
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