Vol 11, No 4 (2020)

Editorial

Rehabilitation after new coronavirus infection (COVID-19): principles and approaches

Bubnova M.G., Persiyanova-Dubrova A.L., Lyamina N.P., Aronov D.M.

Abstract

The novel coronavirus infection (COVID-19), which quickly became a pandemic in 2020, has presented new challenges for healthcare system. COVID-19, being a contagious infectious disease predominantly affects respiratory system, causes cardiovascular, neurocognitive, renal, gastrointestinal, hepatic, metabolic and mental damages, which is in fact a multisystem disease. Patients with COVID-19, primarily with moderate and severe forms, need appropriate rehabilitation. This article establishes need of development of rehabilitation programs for COVID-19 patients, identifies their problems that leads to restrictions on everyday life, self-service, mobility, communication, interpersonal relationships, and professional activities. Goals and general principles of medical rehabilitation in context of a pandemic at all three stages are presented. Features of rehabilitation approaches are highlighted and important components of individual rehabilitation program for COVID-19 patients are highlighted.

CardioSomatics. 2020;11(4):6-14
pages 6-14 views

Original studies

Treatment of patients with acute coronary syndrome in real clinical practice in the Republic of Karelia: 10-years registry results

Skopets I.S., Vezikova N.N., Karapetian T.D., Malafeev A.V., Malygin A.N., Litvinova V.A.

Abstract

Aim. To present the treatment of Acute coronary syndrome (ACS) in clinical practice in the Republic of Karelia and the results of Cardiovascular centers working.

Material and methods. The prospective study included 9949 patients successively hospitalized from 01.01.2020 to 01.01.2020 in the Regional cardiovascular center (Petrozavodsk, Russia), 6335 were included in Federal register. Risk factors, clinical features, reperfusion strategy as well as the rate of clinical complications, drug therapy and outcomes were assessed.

Results. 9949 patients were treated in Regional cardiovascular center from 01.01.2010 to 01.01.2020 due to acute coronary syndrome, and 6335 were included to the Federal registry. 40.2% of patients had ST-elevation Myocardial Infarction and 59.8% – ACS without ST elevation. The first group was younger (the average age was 69) than the second (the average age was 74). The drug therapy of ACS in the hospital was following: 98.7% of patients took aspirin; b-blockers – 92.3%, statins – 97.4%. The outcomes of ACS during the hospital discharge were following: Q-wave myocardial infarction (MI) was diagnosed in 34.2% cases, non-Q-wave MI – in 23.4%, unstable angina – 20.5%, repeated MI – 18.7% and 2.5% MI unspecified localization.

The analysis of the clinical features of ACS shows that significant number of patients (24.8%) had severe complications. So, ventricle arrhythmias were diagnosed in 17.3% of cases, acute left ventricle insufficiency – in 7.6%, cardiogenic shock – in 3.0%, cardiac arrest– in 1.9%, myocardial rupture – in 0.4%. The hospital mortality rate reached 6.38%.

Conclusion. The article presents data about treatment of patients with acute coronary syndrome in real clinical practice in the Republic of Karelia based on 10-years register. Difficulties of management and reperfusion interventions, the volume of drug therapy, the frequency of complications, as well as outcomes and hospital mortality are discussed. The presented data show the results of modernization of the medical care program for patients with acute coronary syndrome in practical healthcare in the region.

CardioSomatics. 2020;11(4):15-19
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Analysis of predictors of sick sinus syndrome after open surgical treatment of atrial fibrillation

Karnakhin V.A., Bazylev V.V., Voevodin A.B., Slastin Y.S.

Abstract

Aim. To identify and analyze predictors of the development of sick sinus syndrome in patients with atrial fibrillation.

Material and methods. We include 847 patients with paroxysmal (121) and permanent (726) form of atrial fibrillation in our research. Patients underwent the Cox-Maze IV procedure with correction of valvular and/or coronary pathology in the conditions of artificial blood circulation. The volume of surgical intervention, clinical, laboratory and echocardiographic parameters were considered as independent predictors.

Results. Permanent pacemaker implantation at the hospital stage required 37 (4.3%) from all 847 patients. None of these patients had indications for permanent pacemaker implantation before the intervention. Indications for pacemaker implantation: sick sinus syndrome – in 30 (3.5%), bradiarrhythmia – in 6 (0.7%); Frederick’s syndrome – in 1 (0.11%) patient. Sinus node weakness syndrome is the most common reason for installing permanent pacemaker. Analysis of neural networks showed that body mass index, time of cardiopulmonary bypass, time of mechanical ventilation, and the age of the patient are independent predictors of the development of this condition.

Conclusion. Obesity, time of cardiopulmonary bypass, time of mechanical ventilation, and age of the patient are the independent and most significant predictors of the development of sick sinus syndrome.

CardioSomatics. 2020;11(4):20-24
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Assessment of the effect of nebivolol and сarvedilol on the functional state of patients with diastolic chronic heart failure

Tregubov V.G., Khil′kevich P.V., Shubitidze I.Z., Tregubova A.V.

Abstract

Aim. To determine the effect of combined therapy with nebivolol or carvedilol on the functional state of patients with diastolic chronic heart failure (CHF).

Material and methods. The study involved 68 patients with CHF and preserved left ventricular ejection fraction, who were randomized into two groups for treatment with bisoprolol or carvedilol. As part of the combination therapy was prescribed quinapril, and if indicated – atorvastatin, acetylsalicylic acid in the intestinal soluble shell. Initially and after 24 weeks of therapy were carried out: quantitative assessment of regulatory-adaptive status (RAS), echocardioscopy, treadmill test, six-minute walking test, subjective assessment of quality of life, determination of level of N-terminal fragment of the brain natriuretic peptide precursor in blood plasma.

Results. Both schemes of combined therapy comparably improved the morpho-functional parameters of the heart and quality of life. In comparison with carvedilol, nebivolol more pronouncedly increased RAS and tolerance to physical activity.

Conclusion. In patients with diastolic CHF in combination therapy, the use of nebivolol, in comparison with carvedilol, may be preferable due to the positive effect on the functional state.

CardioSomatics. 2020;11(4):25-29
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Quality of life after surgical treatment of mitral heart disease

Bazylev V.V., Nemchenko E.V., Abramova G.N., Kanaeva T.V., Karnakhin V.A.

Abstract

Aim. To evaluate long-term quality of life (QOL) of patients after surgical treatment of mitral valve disease depending on the types of surgical intervention, to identify predictors of a lower QOL after surgery.

Material and methods. A single-center retrospective study involved 107 patients after isolated correction of primary non-ischemic mitral valve (MV) pathology, who were operated on from 2009 to 2016, and analyzed their long-term QOL. The follow-up period was from 2 to 6 years. 2 groups of patients were formed: the 1st group (n=60) – patients who underwent mitral valve replacement (MVR); the 2nd group (n=47) – patients who underwent mitral valve repair (MVRep). There were no statistically significant differences between the main clinical and demographic characteristics in reference to the groups. The SF-36 questionnaire was used for studying QOL.

Results. The indicators of QOL approach the average population levels in both groups. In group MVRep Physical Functioning – PF (p=0.02 and 0.01), Bodily Pain – BP (p=0.04), Vitality – VT (p=0.01) and Social Functioning – SF (p=0.001) are higher. There are improvements in physical and mental health components after surgery. Mental and physical components are lower than in the normal population but they don’t go beyond average population’s indicators. Mental health in the MVRep group is better than in the MVR group (p=0.01). Female gender, dilatation of the left atrium (every 1 mm before surgery), older age (every year) increased the probability of lower QOL in the long term by 84, 11 and 8% respectively.

Conclusion. Long-term QOL of patients after surgical treatment of mitral valve disease improves both after valve repair and after valve replacement. After MVRep Physical Functioning, Bodily Pain, Vitality and Social Functioning indicators are higher. There are improvements in physical and mental health components. Psychological component of health is higher in patients in the MVRep-group. Female gender, dilatation of the left atrium, older age increase the probability of lower QOL in the long term after mitral valve surgery.

CardioSomatics. 2020;11(4):30-35
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In memoriam

Obituary: Academician of the Russian Academy of Sciences, Professor Rafael G. Oganov 09.12.1937–24.09.2020. Professor Anatoliy N. Britov 15.01.1934–03.12.2020

Abstract

The Russian Society of Cardiosomatic Rehabilitation and Secondary Prevention, members of the editorial board of the CardioSomatics journal express their condolences to family and friends.

CardioSomatics. 2020;11(4):36-37
pages 36-37 views

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