Vol 11, No 2 (2020)

Original article
Hemodynamic and endotheliym-protective effects of beta-blockers in patients with chronic heart failure and atrial fibrillation ischemic origin
Zakirova A.N., Abdiukova E.R., Viktorov V.V., Zakirova N.E., Nizamova D.F.
Abstract

Aim. To evaluate the effect of b-blockers (BB) on myocardial remodeling and endothelial adhesive function in patients with chronic heart failure (CHF) and atrial fibrillation (AF) of ischemic origin.

Material and methods. The study included 77 patients with functional class II–III CHF and AF who had previously suffered a large-focal Q-myocardial infarction. Patients were randomized into 2 groups, comparable in clinical and instrumental characteristics and homogeneous in basic therapy of CHF and AF. Group 1 included 40 patients who took carvedilol for 24 weeks as part of the basic therapy of CHF and AF, and group 2 included 37 patients who received metoprolol tartrate. We used clinical and instrumental (echocardiography, 6-minute walking test, clinical assessment scale) and enzyme immunoassay (analysis of the level of soluble molecules of intercellular adhesion sVCAM-1 and sE-selectin) research methods.

Results. The use of carvedilol – a non-cardioselective BB that performs a1, b1 and b2-adrenoblockade, and b1-selective, short- acting BB – metoprolol tartrate as part of basic therapy improved the clinical condition and physical performance of patients with CHF and AF. It was found that carvedilol more significantly than metoprolol affects the state of intracardiac hemodynamics, slows down the processes of remodeling of the left atrium and left ventricle, increases the contractile function of the myocardium. Carvedilol as part of basic therapy reduces endothelial adhesion and inhibits the overexpression of intercellular adhesion molecules sVCAM-1 and sE-selectin, and when using metoprolol tartrate, there is only a tendency to decrease these indicators.

Conclusion. Carvedilol as part of the basic therapy of CHF and AF has significant endothelial-protective and clinical-hemodynamic effects, positively affects the adhesive function of the endothelium and the processes of left atrium and left ventricle remodeling.

CardioSomatics. 2020;11(2):6-15
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Telemetric electrocardiography in diagnostics of cardiotoxic heart rhythm disorders and conductivity in oncologic patients
Lyamina N.P., Pogonchenkova I.V., Lyamina S.V.
Abstract

Aim. Assessment of the possibility to use ECG-telemetry in order to increase the efficiency of cardiotoxic effect diagnosis in cancer patients with chemotherapy.

Material and methods. Remote dynamic monitoring for 6 months was carried out in 31 cardio-oncological patients (in 17 – prostate cancer (PC), in 14 – breast cancer (BC), mean age was 53.6 (50.1; 56.8) years and 48.3 (38.8; 57.1) years, respectively; FC NYHA I–III; left ventricular ejection fraction 47.4% (40.2; 57.3) and 43.2% (39.7; 58.9), respectively; Mini-Mental State Examination from 30 to 24 points – 27.6 (25.4; 29,1) and 28.2 (25.1; 28.8), respectively. ECG-telemetry was performed according to the principle of auto-translation using individual ECG recorders, mobile devices and the ECG Dongle Internet application (Nordavind-Dubna, Russia). Storage, analysis of information and telemedicine consultation was perfomed with the CardioСloud asynchronous tele-cardiological platform. ECG was registered with a frequency of at least 5 times/day and additionally repeatedly in the presence of symptoms and patient desires, duration 10–20 minutes.

Results. Previously undocumented ECG changes were remotely recorded in patients for 6 months of follow-up: in 87.0% of patients – sinus tachycardia, against which ventricular extrasystole of various gradations (32.3%), supraventricular extrasystole (22.6%), transient tachy-dependent blockade of the bundle of His legs were recorded (9.7%). In 64.7% of PC patients and in 42.8% of BC patients rhythm disturbances were detected in combination with depression of the ST segment. Paroxysms of atrial fibrillation were reported in 17.6% of PC patients and in 14.3% BC patients. In 35.5% of patients the detected ECG changes were asymptomatic.

Conclusion. Remote dynamic monitoring in cancer patients receiving chemotherapy involving ECG recording scheme (≥5 times/day, 10–20 min) with ECG telemetry is an effective and unexpensive method for detecting ECG changes in the phenomenon of cardiotoxicity.

CardioSomatics. 2020;11(2):16-22
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Assessment of the effect of -blockers on the functional state in patients with ventricular arrhythmias: results of a comparative study
Shubitidze I.Z., Tregubov V.G.
Abstract

Aim. Compare the effects of bisoprolol, nebivolol and sotalol on the functional state of patients with ventricular arrhythmias (VA).

Material and methods. 120 patients with VA against the background of essential hypertension or its combination with coronary heart disease took part in the research, they were randomized into three groups for treatment with bisoprolol, nebivolol and sotalol. As part of combination therapy, patients were administered lisinopril, and if indicated, acetylsalicylic acid, atorvastatin. Initially and after 24 weeks of therapy the following was done: echocardiography, treadmill test, six-minute walk test, subjective assessment of quality of life, all-day monitoring of blood pressure and electrocardiogram.

Results. With comparable hypotensive and antiarrhythmic effects, therapy with nebivolol increased exercise tolerance to a greater extent, in comparison with bisoprolol and sotalol. Nebivolol and sotalol improved the quality of life, in comparison with bisoprolol.

Conclusion. In patients with VA against the background of essential hypertension or its combination with coronary heart disease as part of combination therapy the use of nebivolol may be preferable to bisoprolol or sotalol due to a more pronounced positive effect on the functional state.

CardioSomatics. 2020;11(2):23-27
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Comparison of the results in Normal Flow High Gradient and Low Flow Low Gradient patients after correction of pronounced aortic stenosis with Ozaki procedure in the long-term observation
Bazylev V.V., Tungusov D.S., Babukov R.M., Bartosh F.L., Mikulyаk A.I., Gorshkova A.V.
Abstract

Relevance. It has been proven that patients with Low Flow Low Gradient (LFLG) after aortic valve replacement with biological or mechanical prostheses have a higher mortality rate and the number of adverse events compared with patients with Normal Flow High Gradient (NFHG). However, there are currently no comparative studies of patients with NFHG and LFLG after the Ozaki procedure. The better hemodynamic properties of autopericardial cusps compared with biological prostheses can more favorably influence the results in patients with LFLG in the short and long-term follow-up periods.

Aim. 1. Compare the hospit and long-term results of patients of the LFLG group with the results of patients of the NFHG group after the Ozaki procedure. 2. Identify predictors of hospital and long-term mortality in patients with LFLG.

Materials and methods. All patients have been divided into two groups. Group 1: 137 patients with NFHG and signs of classic aortic stenosis: AVA<1 cm2, Gmean>40, SV index ≥35 ml/m2 and normal left ventricle (LV) ejection fraction. Group 2. 71 patients with LFLG and underestimation of the average gradient indices (Gmean<40) despite a decrease in the aortic valve aperture AVA<1 cm2 amid a decrease in the index of stroke volume <35 ml/m2 and LV systolic function.

Results. Hospital mortality after surgical correction of AV stenosis was significantly higher in patients of group 2: 3 (4.2%) patients and 1 (0.7%) patients, respectively (p=0.002). Survival at the maximum follow-up period for patients with LFLG was significantly lower than in the group of patients with NFHG 88.6 (95% confidence interval – CI 44–49.6) and 97.8 (95% CI 48.9–51), respectively (p=0.009). According to the results of the Cox regression analysis, the independent predictors of mortality in the long-term follow-up of patients with LFLG are the SV odds ratio 0.8 (95% CI 0.9–1.1); p=0.008 and the global longitudinal LV deformation (GLS) odds ratio 0.56 (95% CI 0.47–1.1); p=0.01.

Conclusions. 1. After the Ozaki procedure, patients with the LFLG group have higher risks of adverse events, both at the hospital stage and in the long-term follow-up, compared to patients with NFHG. 2. The duration of ischemia and LV mass are predictors of hospital mortality in the LFLG group of patients. 3. Predictors of long-term mortality in patients with LFLG are LV stroke volume index and global longitudinal LV deformation.

CardioSomatics. 2020;11(2):28-34
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Review
Heart lesions in individuals with arterial hypertension of various risk levels: the possibility of diagnosis and treatment
Britov A.N., Platonova E.M., Eliseeva N.A.
Abstract

Based on scientific literature and own data, the article discusses the problem of hypertensive heart disease in real outpatient practice and especially in conducting preventive examinations in the working population. It is shown that the use of modern diagnostic methods, in particular electrocardiography with dopplerography, including pulse-wave tissue mode, should be an integral study included in the professional examination, as well as medical examination, which covers an increasing number of the population of our country. Echocardiography should be performed to clarify the cardiovascular risk and confirm the electrocardiographic diagnosis of left ventricular hypertrophy (LVH), left atrial dilatation, or suspected heart diseases (coronary heart disease, atrial fibrillation, other rhythm disorders). It has been shown that concentric LVH is the strongest predictor of an increased risk of heart failure, although the degree of LVH is not always directly related to the degree of hypertension and the duration of the disease.

CardioSomatics. 2020;11(2):35-38
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Statins and diabetes: focus on pitavastatin
Urazgildeeva S.A.
Abstract

In this review, the focus is to investigate the effects of long-term statin therapy on glucose metabolism. The author analyzed the evidences of randomized clinical trials, meta-analyses, and experimental studies indicating the diabetogenic effect of the most of statins. Possible mechanisms of influence of statins on carbohydrate metabolism are presented. Particular attention is paid to the place of pitavastatin, due to its low diabetogenicity and minimal risk of drug interactions, as well as the need of taking into consideration the risk factors of diabetes and the preventive measures in patients receiving statin therapy.

CardioSomatics. 2020;11(2):40-49
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Peripheral blood leukocyte telomere length as a possible prognostic marker for the development of atrial fibrillation
Nikulina S.Y., Shihkova K.Y., Shulman V.A., Chernova A.A., Maksimov V.N.
Abstract

Atrial fibrillation is one of the most common heart rhythm disorders. The most prominent risk factor for atrial fibrillation is advanced age. Population ageing contributes to an increase in both the prevalence of this pathology and socio-economic burden of the disease for society in general and the patient in particular. Adequate therapy and prevention of atrial fibrillation requires the search for novel prognostic risk markers for disease development, progression, and patients’ response to therapy. One of these markers is the length of telomeres – structures at the ends of chromosomes that protect them from degradation during cell division. The article provides an overview of world studies, both confirming and disproving the role of leukocyte telomere length in atrial fibrillation development.

CardioSomatics. 2020;11(2):50-54
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Clinical case
A clinical case of takotsubo syndrome in combination with left ventricular hypertrabeculation
Boldueva S.A., Evdokimov D.S., Evdokimova L.S., Khomulo A.D.
Abstract

The article describes the clinical case of takotsubo syndrome in female, who has also echocardiographic picture of a left ventricular noncompaction cardiomyopathy. According to the result of magnetic resonance imaging, the diagnosis of noncompaction cardiomyopathy was not confirmed, left ventricular hypertrabeculation was revealed. There are single descriptions of the combination of takotsubo syndrome and left ventricular hypertrabeculation, the pathogenetic relationship of these conditions has not yet been established.

CardioSomatics. 2020;11(2):55-58
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