Vol 12, No 1 (2021)

Short Survey
American physician Samuel A. Levine and his contribution into the cardiac rehabilitation
Aronov D.M.
Abstract

The greatest contribution to the formation of the modern concept of early, from the first days of acute myocardial infarction (MI), activation of patients and a decisive rejection of the conservative tactics of long-term immobilization was made in 1952 by the American cardiologist Samuel Albert Levine, who recommended the treatment of patients in a chair. In one of his articles, he called the allegedly protective myocardial effect of strict bed rest for cardiac patients a myth [1].

CardioSomatics. 2021;12(1):4-4
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Original studies
Predicting the coronary atherosclerosis severity in cardiac patients
Fedulaev Y.N., Makarova I.V., Pinchuk T.V., Arakelov S.E., Titova I.Y.
Abstract

Background. Coronary atherosclerosis is an ongoing pathological process, varying from asymptomatic forms to angina pectoris, myocardial infarction and even sudden cardiac death. Early identification of persons with an increased risk of the severe atherosclerosis will promote adequate diagnostic and therapeutic measures to prevent cardiovascular complications.

Aim. To make a prognostic model determining the probability of a severe coronary atherosclerosis in cardiac patients.

Material and methods. The actual study included 116 patients of cardiology departments with various degree of coronary atherosclerosis measured by coronary angiography: group I ≥70% coronary stenosis (≥50% in case of left main coronary artery), group II – those with less severe atherosclerotic process. All patients underwent electrocardiography (ECG) at rest and Holter monitoring. Pathological Q-waves, qualitative and quantitative characteristics of ventricular extrasystoles as well as QRS-fragmentation were assessed in all cases. In individuals having sinus rhythm, heart rate turbulence (HRT), T-wave alternans and QT, QTc dispersion on maximum and minimum heart rate were additionally calculated.

Results. The prognostic model included the following ECG-markers: HRT, pathological Q-waves, QTc dispersion on maximum heart rate and QRS-fragmentation in lateral leads (I, AVL, V6). All parameters have demonstrated a direct relationship with the likelihood of severe coronary atherosclerosis. The current model took into account 71% of the factors influencing significant atherosclerosis, AUC=0.94±0.04, the sensitivity and the specificity were 90.0 and 94.4% respectively.

Conclusion. A comprehensive assessment of the ECG data helps to identify the group with an increased risk of severe coronary atherosclerosis among cardiac patients.

CardioSomatics. 2021;12(1):11-14
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Stenotic remodeling of coronary vessels in the elderly patients with high cardiovascular risk and the presence of multifocal atherosclerosis
Khasanov A.K., Bakirov B.A., Kudlay D.A., Karamova I.M.
Abstract

Aim. Identifying persons who are distinguished by an increased frequency of stenosing atherosclerosis of the coronary arteries also affects the process of identifying the features of the analyzed disease.

Material and methods. The main research method was the method of hierarchical analysis of categorical variables. At the same time, they differentiated into 3 clusters depending on the age and duration of the disease. The age of the analyzed patients is from 61 to 75 years. For diagnostics, a general assessment of the clinical condition, coronary angiography, and echodopleroscopy of a number of carotid and lower limb arteries were performed. The research base is the Regional Vascular Center of Ufa.

Results. The work revealed that the age-related feature of 65+ is a stable lesion of the coronary vessels. At the same time, it was determined that both men and women suffer from this.

Conclusion. It has been shown that this is characterized by an increased frequency of stenosing-type remodeling.

CardioSomatics. 2021;12(1):15-22
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The role of markers of endothelial dysfunction, oxidative and cellular stress in the prediction of myocardial infarction in comorbid patients with stable coronary heart disease
Kotova Y.A., Zuikova A.A., Strahova N.V., Krasnorutskaya O.N., Esina E.Y.
Abstract

Aim. To study the role of markers of endothelial dysfunction, oxidative and cellular stress in the prediction of myocardial infarction (MI) in comorbid patients with stable coronary heart disease (CHD).

Material and methods. The study involved 336 patients with a diagnosis of CHD. The presence of CHD was confirmed by diagnostic coronary angiography with the calculation of the Gensini index. All patients were divided into 2 groups: group 1–288 patients without a history of MI, group 2–48 patients with a history of MI. All patients were assessed for the levels of oxidized modified proteins, high-sensitivity C-reactive protein (hs-CRP), homocysteine, heat shock protein (HSP70), and superoxide dismutase activity.

Results. All patients were comparable in age. For other clinical and anthropometric characteristics, we saw significant differences (according to the Mann–Whitney criterion): patients with previous MI had higher BMI, waist circumference, and blood pressure. The correlation analysis revealed positive significant average strength relationships between past MI and the Gensini index, low-density lipoprotein level, total cholesterol level, homocysteine level, hs-CRP level, and the level of oxidized modified proteins; and negative significant average strength relationships between past MI and SOD activity level (r=-0.374, p=6.4 E-07) and HSP70 level (r=-0.563, p=2.6 E-15). The ROC analysis revealed that not all markers were significant in predicting the risk of MI. It is shown that the most expected characteristics were shown by the hs-СRP. However, further analysis of the predictive significance of the markers demonstrated that the addition of HSP70 to hs-CRP increases the predictive significance of hs-CRP in relation to the risk of developing MI.

Conclusion. We have demonstrated that a strategy using a cumulative risk assessment consisting of 2 biomarkers (individually involved in inflammation and stress-induced cellular responses) can identify patients with an established diagnosis of CHD who have an increased risk of acute MI.

CardioSomatics. 2021;12(1):23-27
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Association of ADRB2 gene polymorphism with dilated cardiomyopathy
Nikulina S.Y., Kuznetsova О.O., Chernova A.A., Matyushin G.V., Gurazheva A.A., Maksimov V.N.
Abstract

Aim. To study the association of the rs1042713 polymorphism of the ADRB2 gene with cardiomyopathies of various origins.

Material and methods. The study included patients with dilated cardiomyopathy (DCMP) and myocardial dilatation of ischemic genesis (DM IG).The total number of people surveyed is 221. The average age of the subjects was 55.30±9.69 years. Patients were divided into 2 groups: one of them – patients with a diagnosis of dilated cardiomyopathy idiopathic (predictors of expansion of the heart cavities are excluded) and the other-patients with dilated myocardium of ischemic origin (a history of IHD). The number of patients in the first group was 111, including 99 (89.2%) men and 12 (10.8%) women. The average age of patients in this group is 51.73±9.74 years. The second group included patients with myocardial dilatation of ischemic origin. Their number is 110 people, including 100 (91.5%) men and 10 (8.5%) women. The average age of the respondents is 58.68±8.38 years. The control group consists of individuals who did not have any manifestations of cardiovascular diseases. Their number is 221 people (average age 53.6±4.8 years). Laboratory and instrumental studies, coronary angiography, and molecular genetic studies of the rs1042713 polymorphism of the ADRB2 gene were performed for all participants in the study. Those patients who were excluded predictors of the occurrence of dilation of the heart cavities were assigned to the first group. The second group included patients with a history of CHD.

Results. In the group with DCMP, 10.8% of patients were carriers of the common homozygous AA genotype, the heterozygous AG genotype – 48.6%, and the rare homozygous GG genotype – 40.5%. In the group of patients with DM IG, 16.4% of patients were carriers of the common homozygous AA genotype, the heterozygous AG genotype – 51.8%, and the rare homozygous GG genotype – 31.8%. In the control group, 11.8% of patients were identified as carriers of the homozygous genotype for the common allele, 47.5% – carriers of the heterozygous genotype, and 40.7% – carriers of the homozygous genotype for the rare allele. No statistically significant results were obtained in the group of patients with DCMP and DM IG compared to the control group of the rs1042713 polymorphism of the ADRB2 gene.

Conclusion. No association of ADRB2 gene rs1042713 polymorphism with DCMI and DM IG was revealed.

CardioSomatics. 2021;12(1):28-33
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The necessity and timing of smoking cessation before scheduled cardiovascular interventions – doctors' survey
Bazdyrev E.D., Galimova N.A., Barbarash O.L.
Abstract

Background. No specific time frames are specified in the guidelines for smoking cessation for patients preparing for cardiovascular intervention. Current smoking is an adverse prognostic factor according to the Russian and foreign legal documents, but the recommendations do not specify the timing of smoking cessation, even though it could help minimize postoperative complications and improve the prognosis.

Aim. To analyze doctors' opinions on the necessity and timing of smoking cessation for patients before scheduled cardiovascular surgery.

Material and methods. 320 specialists – 250 (78.1%) general practitioners and 70 (21.9%) surgeons, were surveyed, each participant had at least 10 years of experience performing preoperative program before coronary artery bypass graft surgeries or other interventions and providing postoperative rehabilitation. The questionnaire included seven questions reflecting the doctors' opinion on the feasibility, timing and limiting factors of smoking cessation in patients referred for planned coronary artery bypass graft surgery.

Results. Most of the respondents – 218 (68.1%) people would recommend patients to stop smoking during preoperative period; fewer specialists – 102 (31.9%), would advise them to quit smoking after surgery. The majority of respondents, 166 (76.2%) doctors, believe that patients should quit smoking 2 months before the operation. A third of respondents said it would be appropriate to stop smoking after surgical treatment: 31 (30.4%) specialists recommended it immediately after the operation; 43 (42.1%) – within the first month. The majority of respondents noted an increased risk of patient’s health deterioration, such as: increased cough – according to 200 (62.5%) specialists; sputum secretion – 85 (26.6%); shortness of breath – 25 (7.8%); and 10 (3.1%) doctors mentioned the risk of developing withdrawal syndrome and anxiety. All of those are the reasons why experts consider not recommending patient to stop smoking during preoperative period.

Conclusion. Doctors, involved in the caring for and management of cardiac surgery patients, do not have unanimous opinion on the time frames of smoking cessation.

CardioSomatics. 2021;12(1):34-40
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The influence of plant saponins on the elasticity parameters of the great arteries in patients with multifocal atherosclerosis
Bogdanov A.R., Pyko M.E., Romanova T.A., Fedulaev Y.N.
Abstract

Background. Among the goals of pathogenetic therapy in patients with multifocal atherosclerosis, not only control of the intensity of atherogenesis, but also the elastic properties of the arterial system is becoming increasingly important, which opens up additional ways to reduce overall and cardiovascular mortality in this category of patients.

Aim. To evaluate effectiveness of medication Vazosponin (ZAO “Vifitekh”, Russia), which is a source of plant saponins in a dosage 400 mg per day, on the indicators of the elasticity of the great arteries.

Materials and methods. The study included 100 patients with multifocal atherosclerosis: those who had had myocardial infarction or percutaneous coronary intervention during the previous 2– 1 2 months and who had stenosing atherosclerosis of peripheral arteries – brachiocephalic arteries and/or arteries of the lower extremities. The main group – MG (n=50) consisted of patients who received combined hypolipidemic treatment: atorvastatin in dosage 40 mg/day + Vazosponin 400 mg/day along with baseline treatment. The control group (CG) included 50 patients who received only atorvastatin in dosage 40 mg/day along with baseline treatment. The observation period for each patient was 90 days with 3 control points (on the 1st, 10th and 90th days of therapy), in which were evaluated the elasticity indicators of the main arteries – pulse wave velocity, linear blood flow velocity, total peripheral vascular resistance, actual specific vascular resistance.

Results. There was a decrease in pulse wave velocity in both groups by the 90th day of the study, with a significant advantage in the group of patients who received Vazosponin: in the CG the indicator decreased by 7.3% (p<0.05), in the MG – by 19.3% (p<0.05). The decrease in linear blood flow velocity was 14.3% (p<0.05), in the CG the indicator decreased by 5.7% (p<0.05). The dynamics of peripheral vascular resistance indicators showed an obvious advantage in the group of patients who received plant saponins: in the MG of patients, a decrease in total peripheral vascular resistance was detected by an average of 11.0% (p=0.006) and actual specific vascular resistance – by 39.3% (p=0.0008), while in the CG – by 4.5% and 5.0%, respectively.

Conclusion. The addition of Vazosponin to the basic therapy of patients with multifocal atherosclerosis made it possible to achieve an additional increase in the elasticity of the arterial system, a significant decrease in peripheral vascular resistance, and the elimination of the “escape effect” of basic therapy. The data presented make it possible to consider the possibility of using preparations of plant saponins in combination therapy of patients with multifocal atherosclerosis who have instrumentally verified violations of the elastic properties of the arterial system.

CardioSomatics. 2021;12(1):41-47
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Reviews
Features of speckle tracking echocardiography for diagnosis of myocardial dysfunction
Gritsenko O.V., Chumakova G.A., Trubina E.V.
Abstract

Despite the undoubted success in the diagnosis of heart failure using echocardiography, the issue of detecting diastolic dysfunction of the left ventricle of the heart in the early stages remains insufficiently studied. The article describes a non-invasive ultrasound method for evaluating myocardial function, which allows early detection of left ventricle diastolic dysfunction due to myocardial fibrosis.

CardioSomatics. 2021;12(1):5-10
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Pitavastatin: focus on safety and drug interactions
Minushkina L.O., Zateyshchikov D.A.
Abstract

Pitavastatin is a drug from the group of HMG-CoA reductase inhibitors, which has good lipid-lowering efficacy and has no significant effect on the risk of diabetes mellitus. This drug is non significantly metabolized by the P450 cytochrome system, which minimizes the risk of possible drug-drug interactions. Peptide organic anionic transporter inhibitors also may affect the efficacy and safety of the drug. This review summarizes the data on the problems of drug interactions of pitavastatin.

CardioSomatics. 2021;12(1):48-53
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Case reports
Brugada syndrome in the practice of a cardiologist. Case report
Evdokimova A.G., Zhukolenko L.V., Shuiskaia O.A., Kiiakbaeva E.V.
Abstract

Cardiovascular mortality occupies a leading position in the structure of total mortality. Brugada syndrome is one of the syndromes associated with the risk of sudden non-coronary death at a young age. However, the prevalence of this syndrome and its clinical manifestations are underestimated due to low detectability. This article presents a clinical case of the diagnosis of Brugada syndrome with the installation of a cardioverter-defibrillator in the practice of a cardiologist and a brief literature review of this syndrome.

CardioSomatics. 2021;12(1):54-58
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