Vol 12, No 1 (2021)

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].

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.

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.

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.

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.

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.