Vol 12, No 4 (2021)

От главного редактора

Rene Favaloro, a real doctor and a real man

Aronov D.M.
CardioSomatics. 2021;12(4):188-189
pages 188-189 views

Original articles

Comparative analysis of aerobic cardiorespiratory training of high and moderate intensity in cardiac surgery profile patients

Kakuchaya T.T., Dzhitava T.G., Pachuashvili N.V., Kuular A.M., Domracheva I.I., Zakaraya N.E.

Abstract

Aim. The aim of our study was to conduct a comparative analysis of aerobic high-intensity interval training and constant moderate intensity training in cardiac rehabilitation of adult patients after open-heart surgery, namely after coronary artery bypass grafting (CABG).

Material and methods. 137 patients after CABG were included in the study. 90.4% of patients were consider as class I of chronic heart failure after surgery. Cardiorespiratory trainings were initiate in 4 weeks after surgery, using cycling by veloergometers. Two groups were compare according to rehabilitation programs: one carried out constant aerobic trainings of moderate and medium intensity, and the other, aerobic high-intensity interval trainings. Supervised trainings were carry out for 150 minutes per week. Total length of trainings was 4–7 weeks. Long-term trainings were distantly monitore.

Results. Ergospirometric results as well as results of echocardiography were significantly improve after training course. These results were more significant in high-intensity interval training group, compared to moderate intensity-training group. VO2, heart rate and training power significantly improved. Body mass index significantly diminished in high-intensity interval training group, compared to moderate intensity-training group. In 7 weeks after training ominously decreased blood triglycerides and increased high-density lipoproteins.

Conclusion. Cardiorespiratory trainings ameliorate mitochondrial biogenesis, carbohydrate and lipid metabolism, promote to reduce abdominal obesity and other crucial risk factors of coronary patients. Aerobic high-intensity interval cardiac trainings are as safe as moderate intensity cardiac trainings, and in some issues, they outperform moderate intensity cardiac trainings.

CardioSomatics. 2021;12(4):190-199
pages 190-199 views

Possibilities of neurocognitive rehabilitation using the dual tasks method in patients in the early postoperative period of coronary bypass surgery

Syrova I.D., Tarasova I.V., Trubnikova O.A., Sosnina A.S., Lozhkina O.A., Belik E.V., Dyleva Y.A., Temnikova T.B., Frolov A.V., Gruzdeva O.V., Barbarash O.L.

Abstract

Background. Previously, it has been demonstrated that the use of the dual-task method (performance cognitive and motor tasks simultaneously) in cognitive rehabilitation provides sustainable improvements in cognitive and motor functions. However, the effectiveness of the dual-task method in cardiac surgery patients has not been studied enough yet.

Aim. To evaluate the effectiveness of the training for recovering cognitive function using a computer program of dual tasks in the early postoperative period of on-pump coronary artery bypass surgery (CABG).

Material and methods. Sixty-two patients aged 64 [60; 69] years were examined before surgery and divided into two groups: with postoperative cognitive training (n=29) and without cognitive rehabilitation (n=33). The extended neuropsychological testing was performed 2–3 days before and 8–9 days after CABG to assess the psychomotor and executive functions (neurodynamic), attention and short-term memory, as well as the serum concentrations of markers of brain damage: neuron-specific enolase and S100β protein were measured.

Results. The data of preoperative extended neuropsychological testing did not demonstrate between-group differences. At 8–10 days after CABG, ≥20% decrease of the cognitive indicators was detected in patients of both groups. In the group with cognitive training, the number of patients with impaired memory, attention and neurodynamics was significantly lower than in the group without training. Also, in patients who underwent cognitive rehabilitation, there was no increase in the concentrations of neuron-specific enolase and calcium-binding protein S100β compared to preoperative values, in contrast to patients without rehabilitation.

Conclusion. The use of dual tasks computer program demonstrated a decrease in the severity of cognitive impairment after surgery.

CardioSomatics. 2021;12(4):200-205
pages 200-205 views

Genotypic stratification of risk of acute cerebral circulation disorder

Nikulin D.A., Chernova A.A., Nikulina S.Y., Prokopenko S.V., Mar'ina N.M.

Abstract

Aim. To study the association of rs662799 gene APOA5 with the development of Acute Cerebrovascular Event in patients with cardiovascular diseases (CVD) and their risk factors.

Material and methods. 260 Acute Cerebrovascular Event patients (main group) and 272 control group patients were examined. The age range of patients of the main group is defined from 32 to 69 years [57.0; 51.0–62.0], individuals in the control group were 37 to 68 years old [55.0; 51.0–62.0]. The distribution by sex of the main group was as follows: 157 men (age [56.5; 51.0–62.0]) and 103 women (age [57.0; 51.0–62.0]). The sex and age composition of the control group is comparable to those of the main group: 170 men (age [55.0; 51.0–62.0]) and 102 women (age [55.0; 51.0–62.0]). The main group's research methods were as follows: clinical examination, computed brain tomography, electrocardiography, echocardioscopy, ultrasound duplex scanning extracranial brachiocephalic arteries, daily monitoring of blood pressure and heart rate, blood coagulation system analysis. The control group of our study is a population sample of residents of Novosibirsk, who were examined according to the standard of the international HAPIEE project. Examination of individuals in the control group included: questionnaire (socio-economic living conditions, chronic diseases, level of physical activity, mental health), anthropometry (height, weight, waist volume, hips), survey on smoking, alcohol consumption (frequency and typical dose), blood pressure measurement, lipid profile assessment, stress angina detection (Rose) survey, resting electrocardiogram in 12 leads. All patients of the main and control groups underwent molecular genetic analysis of venous blood. Statistical processing of the material was carried out using the set of applications Statistica for Windows 7.0, Excel and SPSS 22.

Results. 199 patients (123 men and 76 women) of the main group had ischemic stroke, 51 patients (28 men and 23 women) were diagnosed with hemorrhagic stroke, 10 patients (6 men and 4 women) showed a mixed type of Acute Cerebrovascular Event. Of the 260 patients, 19 (13 men and 6 women) had repeated Acute Cerebrovascular Event. None of the patients examined had clinical, anamnestic and instrumental evidence suggesting the presence of CVD. The most common CVD preceding Acute Cerebrovascular Event was arterial hypertension – AH (249 people, 153 of them men and 96 women). Heart rhythm disorders by type of paroxysmal supraventricular tachycardia, including atrial fibrillation, were detected in 31 patients (20 men and 11 women). Among the risk factors for Acute Cerebrovascular Event in the patient group surveyed, dyslipidemia was observed (159 patients, 95 men and 64 women), atherosclerosis of brachiocephalic artery (160 patients, 94 men and 66 women), disorders of the hemostasis system towards hypercoagulation (90 patients, 53 of them men and 37 women), 28 patients (19 men and 9 women) had an aggravated hereditary history according to Acute Cerebrovascular Event. In the control group, AH was diagnosed in 177 patients, of which 98 were men and 79 were women. Other CVD and their risk factors were absent in the control group at the time of the survey. The statistically significant prevalence of rare GG genotype and G allele wearability among Acute Cerebrovascular Event patients compared to healthy patients was verified (4.7% of patients in the main group versus 0.4% in the control group; p=0.001). In addition, a statistically significant decrease in the number of carriers of the advanced AA genotype and allele A compared to the control group (61.8% in the main group versus 61.5% in the control group, p=0.000) was determined in patients with Acute Cerebrovascular Event. In the subgroup of men with Acute Cerebrovascular Event, the common AA genotype was statistically significantly less common (59.9%) than among men in the control groups (82.9%; p=0.000; odds ratio – OR 3.26, 95% confidence interval – CI 1.95–5.46). The AG genotype was significantly predominant in the subgroup of men with Acute Cerebrovascular Event (33.6%), than in the control group of men (17.1%; p=0.001). A rare GG genotype was detected in 6.6% of men with Acute Cerebrovascular Event, and among men in the control group, this genotype was absent (p=0.001). In the subgroup of women with Acute Cerebrovascular Event, the AG genotype was statistically more common (33.3%) than among women in the control group (14.7%; p=0.002). The AA genotype, in contrast, significantly predominated in the control subgroup of women (84.3%) compared to women with Acute Cerebrovascular Event (64.7%; p=0.001; OR 2.93, 95% CI 1.49–5.75). No statistically significant differences were obtained with respect to the GG genotype. Thus, in the subgroup of women with Acute Cerebrovascular Event, the GG genotype of ONV rs662799 (A>G) occurred in 2.0% of patients, in the control subgroup of women – in 1.0% (p=0.56). We analyzed the frequencies of the genotypes and alleles rs662799 (A>G) of the APOA5 gene among patients with AH undergoing Acute Cerebrovascular Event and individuals in the control group without AH and Acute Cerebrovascular Event. The frequency of the AA genotype in the subgroup of AH patients undergoing Acute Cerebrovascular Event was 62.1%, in the control group – 78.9% (p=0.003; OR 2.28, 95% CI 2.13–5.98). The AG genotype was detected in 33.7% of patients with AH and Acute Cerebrovascular Event and in 21.1% of individuals in the control group (p=0.022). The GG genotype in the subgroup of patients with AH and Acute Cerebrovascular Event occurred at a frequency of 4.1%, was absent in the control group (p=0.045). In the subgroup of patients with dyslipidemia and Acute Cerebrovascular Event, a statistically significant predominance of the number of AG genotype carriers (p=0.008) and a decrease in the number of AA genotype carriers (p=0.002; OR 2.11, 95% CI 1.32–3.38) compared to control. With respect to the GG genotype, no statistically significant differences were obtained as in the subgroup of patients with brachiocephalic artery atherosclerosis (p=0.05). The rare G allele was statistically significantly more common among patients with dyslipidemia and Acute Cerebrovascular Event than among the control group (p=0.001; OR 2.01, 95% CI 1.35–3.16). In a subset of patients with impairment in the hemostasis system who underwent Acute Cerebrovascular Event, similar results were obtained. So, among patients with hypercoagulation, the frequency of carrying the AA genotype was 63.8%, the frequency of the AG genotype was 33.0%, and the frequency of the GG genotype was 2.3%. In a subgroup of patients with impaired hemostasis and Acute Cerebrovascular Event, a statistically significant predominance of the number of AH genotype carriers (p=0.001) and a decrease in the number of AA genotype carriers (p=0.000; OR 2.74, 95% CI 1.59–4.72) compared to control. No statistically significant differences were obtained with respect to the GG genotype (p=0.09). The wearing of the rare G allele was statistically significantly more common among patients with hypercoagulation and Acute Cerebrovascular Event than among the control group (p=0.000; OR 2.50, 95% CI 1.54–4.05).

Conclusion. The results of our study suggest the need for further investigation of this polymorphic variant in order to study the possible mechanisms of its influence on the development of CVD and cerebrovascular pathology. We may suggest that the wearing of the AG genotype and the G allele rs662799 (A>G) increase the risk of Acute Cerebrovascular Event in patients regardless of previous CVD and risk factors, including those with AH, supra-ventricular tachyarrhythmias, brachiocephalic artery atherosclerosis, impaired lipid metabolism and hemostasis systems.

CardioSomatics. 2021;12(4):206-213
pages 206-213 views

Early and long-term outcomes of ischemic stroke in patients with stroke-associated pneumonia

Santikova L.V., Zhemukhov A.C., Chipova D.T., Tlapshokova L.B.

Abstract

Aim. Assessment of the influence of infectious complications of acute carotid ischemic stroke (IS) on long-term outcomes of the disease.

Material and methods. 98 patients with IS, 46 developed infectious complications (group 1), 52 did not have them (group 2). In dynamics, the severity of neurological deficit (NIHSS scale, Bartel index) and the state of cognitive functions (MMSE, MoCA scales) were assessed.

Results. Patients of the 1st group turned out to be significantly older, they initially had a more pronounced neurological deficit, and swallowing disorders were more often observed. Within 6 months after IS, patients of the 1st group had more severe focal neurological and cognitive impairments. After 12 months, the differences between the groups leveled off. There were no differences in the course of IS in patients with infectious lesions of the lower respiratory or urinary tract.

Conclusion. Infectious complications of acute IS are associated with more severe cognitive and neurological impairments for 6 months. 12 months after undergoing carotid IS, the severity of focal neurological deficit, the level of independence from outside help in everyday life, and the state of cognitive functions do not differ significantly in patients with and without infectious complications.

CardioSomatics. 2021;12(4):214-218
pages 214-218 views

Consumption of cardiovascular and antithrombotic drugs during the spread of coronavirus infection in retail sector of the Samara region pharmaceutical market

Petrukhina I.K., Lebedev P.A., Ryazanova T.K., Blinkova P.R., Paranina E.V.

Abstract

Aim. Study of multi-year sales statistics in pharmacy market segment to assess the volume and structure of consumed cardiovascular and antithrombotic drugs under COVID-19 pandemic conditions.

Material and methods. Data on nomenclature and sales volumes of drugs in pharmacy segment of Samara region in 2015–2020.

Results. It is shown that the share of basic cardiovascular drugs in physical terms is insignificant (5.2-3%). The largest volume of sales are drugs of angiotensin-converting enzyme inhibitor group (28%) and b-adrenoblockers (23.5%). Fixed combinations of hypotensive drugs account for only 13% of the volume of sold basic cardiovascular drugs, and the share of statins is 7.6%, which does not correspond to their role as the most effective drugs in primary and secondary cardiac prevention. The share of antithrombotic drugs in total sales in volume terms was 0.45% in 2015–2019. In absolute terms, sales of anticoagulants and disaggregants increased in 2018–2020, which was accompanied by an average 15% increase in the cost per daily dose. Among disaggregants, acetylsalicylic acid (66.6%), clopidogrel (21.6%), and dipyridamole (10.2%) are most frequently sold. The share of disaggregants in sales fell from 74.8 to 57.6% at the expense of acetylsalicylic acid drugs. In 2020, consumption of dipyridamole increased significantly to 16.6% due to inclusion of the drug in protocols for managing patients with COVID-19. Among anticoagulants, the proportion of new oral medications is characterized by a progressive increase from 7.8% in 2015 to 27% in 2020. During the COVID-19 pandemic, the most demanded group of Xa factor blockers is dominated by apixaban (63.8%), which can be explained by the lower cost (by 16%) of a daily equivalent dose compared to rivaroxaban.

Conclusion. Low consumption of basic cardiovascular drugs among the population of Samara region, especially statins and combined hypotensive drugs was observed. During COVID-19 pandemic there was an increase in consumption of antithrombotic drugs, due to dipyridamole and new oral anticoagulants.

CardioSomatics. 2021;12(4):219-226
pages 219-226 views

Reviews

New trends for artificial intelligence development in medicine

Ryazanova S.V., Mazaev V.P., Komkov A.A.

Abstract

The article discusses the modern aspects of the use of artificial intelligence (AI) in medicine, the use of AI technologies in Russia and abroad. The article describes the limitations of the use of AI in various fields of medicine, discusses possible solutions, and develops electronic devices for remote and independent monitoring. The problems of information security and ethical issues of AI application are presented with the arguments of experts and expert organizations in AI issues, as well as the prospects for development and possible consequences of AI implementation. The possibilities of using AI in real clinical practice are explained, indicating the prospects for the future generation of doctors and their patients. Examples of data systematization for AI processing are given, which is a key factor in the reliability of predictive models obtained using AI.

CardioSomatics. 2021;12(4):227-233
pages 227-233 views

Type 2 diabetes mellitus and chronic heart failure: new treatment strategies

Bondarenko I.Z., Bubnova M.G.

Abstract

The article is devoted to the use of sodium-glucose cotransporter type 2 inhibitors in patients with type 2 diabetes mellitus and chronic heart failure drawing the example of clinical studies with Empagliflozin. Key results of the clinical studies are considered, thanks to which it can be argued that patients with type 2 diabetes mellitus and atherosclerosis-associated diseases, including chronic heart failure, have advantages in predicting cardiovascular outcomes when using hypoglycemic drugs and adding Empagliflozin to standard cardiovascular therapy.

CardioSomatics. 2021;12(4):234-238
pages 234-238 views

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