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Issue. Articles

№3(39) // 2012

 

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1.

 

The effectiveness of comprehensive educational and therapeutic program for achieving lipid goals in patients with chronic ischemic heart disease by statin use without dose titration: short-term results

K.M. Amosova, Ye.V. Andreyev, Yu.V. Rudenko

The purpose – to evaluate the short-term (2 months) results of a comprehensive educational and therapeutic program for achieving lipid goals without dose titration of statins in patients with chronic ischemic heart disease (IHD) in clinical practice of Ukraine.

Materials and methods. It was a prospective observational open multicenter study conducted by 70 cardiologists and therapeutists from 9 regions of Ukraine. 1125 patients were included with chronic IHD and heart failure of II or lower functional class by NYHA. When choosing a drug and the dose of statin, doctors had to use the data about dose-dependent effect of different statin drugs (Jones, 2003; Grundy, 2004) which were provided to them.

Results and discussion. Baseline levels of low density lipoprotein cholesterol (LDL CS) and total cholesterol (TC) in patients taking statins at the time of inclusion into the study were significantly (p < 0.001 and p < 0.0001) lower than those in patients that had not been using statins but the relative difference was only 6.6 and 8.6 %, the frequency of achieving a «minimal» and «optimal» lipid goals – 13.4 and 4.5 %, respectively. At the end of the observation period, a «minimal» lipid goal was achieved on the whole in 59.4 % of patients and in greater numbers of those who had previously taken statins than in those who had not (64.8 and 54.8 %, respectively; p < 0.05). «Optimal» goal was achieved in 34.4, 41.4 and 29.0 %, respectively, (p < 0.01 among groups). The average TC levels were, respectively, (4.52 ± 0.05) mmol/l (p < 0.0001 compared with baseline), (4.43 ± 0.05) and (4.58 ± 0.04) mmol/l (p < 0.05 among groups).

Conclusions. Conducting a structured training for cardiologists and therapeutists, and «single-stage» administration of statins with consideration of data on dose-dependent effect of different drugs allows reaching the «minimal» lipid goal in 4–6 weeks (LDL CS < 2.5 mmol/l or TC < 4.5 mmol/l) in 59.4 % of patients with chronic IHD and the «optimal» goal (LDL CS < 2.0 mmol/l or TC < 4.0 mmol/l) – in 34.4 %.

Keywords: ischemic heart disease, low density lipoprotein cholesterol, treatment, statins, effectiveness.

2.

 

Risk factors of cardial complications in patients that underwent surgery on account of aneurism of abdominal region of aorta against the background of ischemic heart disease

V.G. Mishalov, Ye.N. Amosova, V.A. Chernіak, T.M. Cherenko, G.А. Kostromin, L.Yu. Markulan

The purpose – to assess the risk factors of occurrence of cardial complications in the early postoperative period in patients that underwent surgery on account of aneurism of abdominal region of aorta (AAA) against the background of ischemic heart disease.

Materials and methods. The prospective study included 98 patients (81 (82.7 %) males and 17 (17.3 %) females) aged from 61 to 80 years (mean age 69.4 ± 0.3 years) with AAA and concomitant ischemic heart disease (IHD) that were treated within the period from 1999 to 2007 in the surgical department of Oleksandrivska clinical hospital in Kiev. The criteria of inclusion into the study were: infrarenal localization of AAA of atherosclerotic genesis, AAA diameter exceeding 5.5 cm in males and 5 cm in females or an increase in diameter of AAA by more than 0.5 cm in 6 months. The criteria of non-inclusion into the study were: acute myocardial infarction (MI) less than 1 month; acute cerebral stroke less than 1 month; severe heart failure (ejection fraction < 30 %; exertional angina of functional class IV; oncological diseases, the rapture of AAA). Physical examination of patients with AAA was aimed at obtaining information about the nature of aortic aneurism (size, shape, type), the condition of cardiovascular system and other comorbidities. Statistical methods: descriptive statistics, comparison of mean values (parametric and non-parametric criteria), correlation analysis, uni-factor and multi-factor regression analysis (step by step logistic regression).

Results and discussion. Cardiac complications occurred in 37.0 % of patients, MI – in 21.7 %. The largest increase of cumulative frequency of MI was observed in the first 5 days after surgery and constituted 12.2 % of those who underwent surgery and 57.1 % of all patients with MI in the first 30 days of perioperative period. Out of 74 parameters that have been studied (age, gender, data of clinical and instrumental investigations, the features of the aneurysm, course of surgical intervention and the effects of treatment) 12 were significantly associated with the development of MI in the postoperative period. However, only 5 had a correlation coefficient of mean intensity: class of coronary reserve according to transesophageal pacing data, the duration of aortic relies, concentration of cholesterol of low density lipoproteins (CL LDL), C-reactive protein (C-RP), age of patients; the rest of the parameters were of moderate intensity.

Conclusions. 37.0 % of patients that had been operated on account of AAA and have concomitant IHD develop cardiac complications. MI develops in 21.7 % patients, rhythm disturbances – in 10.2 %, acute heart failure – in 5.1 %. The largest increase of cumulative frequency of MI is observed in the first 5 days after surgery (12.2 % of the total number of patients after surgery and 57.1 % of patients with MI in the first 30 days of perioperative period). Independent prognostic risk factors of MI in the early postoperative period are coronary reserve (r = 0.617), duration of aortic relies (r = 0.59), age (r = 0.51). The risk of MI is also significantly related to the concentration of CL LDL (r = 0.549) and C-RP in the peripheral blood (r = 0.53).

Keywords: aneurism of abdominal region of aorta, postoperative period, myocardial infarction, risk factors.

3.

 

Results and quality of treatment of acute coronary syndrome with ST segment elevation in Ukraine, according to the STIMUL register

S.V. Valuуeva

The purpose – to evaluate the results and the quality of treatment for patients with acute coronary syndrome (ACS) with ST segment elevation in Vinnytsia and Khmelnytsky, according to the ukrainian register STIMUL, compared with those of the III European register of acute coronary syndromes (2004).

Matherials and methods. STIMUL, a Ukrainian register of ACS with ST segment elevation, covered 1103 patients hospitalized in cardiological departments of Vinnytsa and Khmelnytsky (three centers) from January 2008 to June 2011 during 24 hours after the onset of the disease. The results were compared with those of a European registry, the third Euro Heart Survey on ACS, 2004 (n = 1917). We estimated the incidence of myocardial infarction (MI) and chronic heart failure (HF) in anamnesis, the time from onset of symptoms to hospitalization, the number of patients with index GRACE i 150 points, frequency of using reperfusion therapy, major complications and hospital mortality.

Results and discussion. Among the patients included in the STIMUL register, 24.2 % had had one or more MI (compared to 13.7 % in the European register, p < 0.001), 22.8 and 4.4 % of individuals, respectively, (p < 0.001) had symptoms of chronic HF. The time from the onset of symptoms to hospitalization of patients in the Ukrainian register was (5.1 ± 0.3) h, and was almost twice as long as that of patients in the European register – (2.83 ± 0.14) h (p < 0.001). The number of patients with high risk and index GRACE i 150 points at admission was also significantly bigger in Ukraine – 34.5 compared with 19.4 % in Europe (p < 0.001). Reperfusion was performed in 29.9 % of patients in Ukraine and 75.7 % in Western Europe (p < 0.001). Percutaneous coronary interventions were twice (21.5 vs. 47.9 %) and thrombolysis -4.5 times (37.7 vs. 8.4 %) more rare in patients included in the STIMUL register than in those recorded in the European Register (p < 0.001). Signs of acute HF in hospital were noted in 60.5 % patients in the Ukrainian register and in 25.8 % patients in Western Europe (p < 0.001). However, the incidence of major bleedings was significantly lower in the STIMUL register (2.1 vs. 4.3 %, p < 0.05), due to significantly lower incidence of reperfusion therapy in Ukraine. The incidence of stroke was low and had no significant differences in both registers – 0.6 and 1.0 %, respectively. Hospital mortality in the STIMUL register was 11.4 %, which was significantly higher than that in the European register – 7.5 % (p < 0.01).

Conclusions. According to a prospective register, in the three centers of Vinnytsa and Khmelnytsky, hospital mortality was 11.4 %, which was 3.9 % higher than that in the European Registry, and the frequency of acute HF in the hospital period was two times higher in the STIMUL register. This is largely due to the low frequency of reperfusion therapy (29.9 %, which is 2.5 times less frequent than in Western European countries) with a larger number of patients at high risk on GRACE scale at admission (34.5 vs. 19.4 %).

Keywords: acute coronary syndrome with ST segment elevation, register, quality of health care delivery, clinical outcomes, Ukraine.

4.

 

Результаты и качество лечения больных с острым коронарным синдромом с элевацией сегмента ST в Украине, по данным регистра STIMUL

С.В. Валуева

Цель работы — оценить результаты и качество лечения пациентов с острым коронарным синдромом (ОКС) с элевацией сегмента ST в Виннице и Хмельницком, по данным украинского регистра STIMUL, по сравнению с таковыми в ІІІ Европейском регистре острых коронарных синдромов (2004).

Материалы и методы. STIMUL — украинский регистр ОКС с элевацией сегмента ST — охватил 1103 больных, госпитализированных в кардиологические стационары Винницы и Хмельницкого (три центра) с января 2008 г. по июнь 2011 г. в течение 24 ч от начала заболевания. Результаты сравнивали с данными европейского регистра Euro Нeart Survey ACS ІІІ 2004 г. (n = 1917). Оценивали частоту инфаркта миокарда (ИМ) и хронической сердечной недостаточности (СН) в анамнезе, время от возникновения симптомов до госпитализации, количество пациентов с индексом GRACE ≥ 150 балов, частоту применения реперфузионной терапии, основных осложнений и госпитальную летальность.

Результаты и обсуждение. Среди больных, вошедших в регистр STIMUL, 24,2 % перенесли один и больше ИМ (по сравнению с 13,7 % в европейском регистре; р < 0,001), признаки хронической СН имели 22,8 и 4,4 % лиц соответственно (р < 0,001). Время от начала симптомов до госпитализации у пациентов, которые вошли в украинский регистр, составило (5,1 ± 0,3) ч и было почти вдвое большим по сравнению с данными европейского регистра — (2,83 ± 0,14) ч (р < 0,001). Количество пациентов с высоким риском с индексом GRACE ≥ 150 балов при поступлении также было значительно выше в Украине — 34,5 по сравнению с 19,4 % в Европе (р < 0,001). Реперфузия проведена у 29,9 % пациентов в Украине и у 75,7 % в странах Западной Европы (р < 0,001). У включеных в регистр STIMUL пациентов перкутанные коронарные вмешательства проводили вдвое реже (21,5 по сравнению с 47,9 %), тромболизис — в 4,5 раза (37,7 по сравнению с 8,4 %), чем в европейском регистре (р < 0,001). Признаки острой СН в стационаре отмечены у 60,5 % пациентов в украинском регистре и у 25,8 % в странах Западной Европы (р < 0,001). Однако частота тяжелых кровотечений была существенно ниже в регистре STIMUL (2,1 по сравнению с 4,3 %; р < 0,05), что объясняется значительно меньшей частотой реперфузионной терапии в Украине. Частота возникновения инсультов была низкой и существенно не отличалась в обоих регистрах — 0,6 и 1,0 % соответственно. Госпитальная летальность в регистре STIMUL составила 11,4 % и значительно превышала таковую в европейском регистре — 7,5 % (р < 0,01).

Выводы. По данным проспективного регистра, в трех центрах Винницы и Хмельницкого госпитальная летальность составила 11,4 %, что на 3,9 % выше таковой по данным европейского регистра, а частота острой СН в госпитальный период превышает таковую вдвое. Это в большей мере связано с низкой частотой реперфузионной терапии (29,9 %, что в 2,5 раза меньше, чем в странах Западной Европы) при большем количестве пациентов с высоким риском по шкале GRACE при поступлении (34,5 по сравнению с 19,4 %).

Keywords: острый коронарный синдром с элевацией сегмента ST, регистр, качество предоставления медицинской помощи, клинические исходы, Украина.

5.

 

Condition of endothelial vasoregulative function in patients with systemic lupus erythematosus depending on the signs of atherosclerotic lesion and factors that affect it

К.М. Amosova, O.B. Yaremenko, I.G. Matiуashchuk, V.I. Zakharova, P.P. Мinchenko, N.М. Маkomela

The purpose – to evaluate and compare the endothelial vasoregulative function in patients with systemic lupus erythematosus (SLE) depending on the presence or absence of atherosclerotic lesions of different vascular pools, and to define independent SLE-specific and nonspecific factors that affect it.

Materials and methods. 100 patients with SLE were examined, the mean age – (40.9 ± 1.4) years, including 90 women, with I (79.0 %) or II degree of SLE activity and glucocorticoid therapy that had lasted 1 year or longer. The criteria for non-inclusion were III degree of SLE activity, glomerular filtration rate < 60 ml/min, and hypothyroidism. The control group consisted of 32 age and gender matched apparently healthy patients. Endothelial dependent vasodilatation (EDVD) was determined. Ultrasound duplex scanning of extracranial and lower extremity arteries, as well as multidetector computed tomography of coronary arteries were used to diagnose atherosclerosis. EDVD in a test with reactive hyperaemia, blood lipids, and C-reactive protein were determined in all the patients. Independent EDVD determinants were measured among 17 traditional factors of cardiovascular risk and 30 SLE-specific clinical and laboratory parameters using multiple linear regression analysis.

Results and discussion. 89 % of SLE patients generally have reduced EDVD which on the average makes up (8.00 ± 0.49) % compared to (11.60 ± 0.30) % in healthy patients (p < 0.001). According to the data of visualization methods, atherosclerosis signs of at least one vascular pool were found in 66.0 % of patients with SLE, whose mean EDVD was (6.60 ± 0.41) %, which was significantly lower than in the healthy persons (p < 0.001) and SLE patients without these signs (10.50 ± 1.08 %, p < 0.001). In the latter, the average EDVD level did not differ from that of the healthy subjects (p > 0.05). A reliable reverse correlation was revealed between EDVD values and the number of affected vascular pools (r = –0.52, p < 0.001). Independent EDVD determinants in SLE patients are the patient’s age (p < 0.001), presence of nephritis (p = 0.001), polyarthritis (p = 0.019) and Raynaud’s syndrome (p = 0.045).

Conclusions. 89 % of patients with I–II degree of SLE activity and relatively preserved renal function have reduction of EDVD which on the average comprises 32 % and correlates with the number of vascular pools affected by atherosclerosis (according to duplex scanning of extracranial arteries and arteries of the lower extremities, evaluation of coronary artery calcification by multidetector computed tomography). The independent EDVD determinants in SLE patients are age, presence of nephritis, polyarthritis and Raynaud’s syndrome.

Keywords: systemic lupus erythematosus, endothelial vasoregulative function, atherosclerosis.

6.

 

Comparative evaluation of affecting venous wall by different concentrations of sclerosing agent and optimization of sclerosing therapy for varicose disease

V.I. Palamarchuk, V.A. Khodos, I.V. Irkin

The purpose – to compare and evaluate the influence of different concentrations of sclerosing agent on the vein wall based on the morphological, sonographic and clinical studies as well as to optimize the methods of sclerosing therapy for the varicose disease on the ground of obtained data.

Materials and methods. The histological study was performed of biopsy specimens at the wellhead of the large and small saphenous veins taken from 92 patients during surgeries. Polidokanol made by Kreussler (Germany) was used as a sclerosing agent. All patients were divided into 3 groups: I group – 30 patients who were given sclerosing microfoam made of polidokanol in concentration of 2 % for the phlebitis scleroobliteration, II group – 32 patients taking polidokanol in 3 % concentration and III group – 30 patients treated by 5 % polidokanol.

Results and discussion. Changes in stem saphenous vein caused by 2 % polidokanol may be insufficient for the stable occlusion, which in some cases leads to recanalization and thrombophlebitis. Stable occlusion and fibrosis in the long-term postoperative period can only be achieved by using 3 % or 5 % concentrations. However, using 5 % concentration of polidokanol in many cases causes prolonged hyperpigmentation. The most favourable conditions for qualitative fibrous transformation of stem saphenous veins in combination with minimization of possible complications are achieved by the use of polidokanol in concentration of 3 %.

Conclusions. Сoncentration of polidokanol 3 % is optimal in terms of creating favourable conditions for the development of fibrosis process in the stem veins with minimal complications.

Keywords: varicose disease, sclerosis surgery, morphology of veins, sonography.

7.

 

Vectorcardiographic manifestations of acute myocardial infarction with Q wave of posterior-inferior localization in the first 24 hours of the disease

I.Ye. Belaya

The purpose – to identify vectorcardiographic features of acute myocardial infarction (MI) with Q wave of posterior-inferior wall of the left ventricle (LV).

Materials and methods. The study included 17 patients aged 69 ± 3 years (10 men) with Q wave MI of posterior-inferior wall of LV, hospitalized and examined in the first 24 h of the disease. In addition to general clinical and biochemical studies we carried out: 12-lead ECG, and ECG in leads V7–V9, V3R, V4R, as well as Akulinichev vectorcardiogram (VCG) in five projections on a polygraph МТМСКМ.

Results and discussion. 76.5 % of patients revealed serum levels of troponin I which were elevated in 100 % to 4.194 ± 0.287 ng/ml. The ECG recorded ST segment elevation greater than 1 mm in leads III (II) and aVF in 82.4 % of patients with reciprocal changes in the anterior wall of LV; a pathological Q wave in leads II, III and aVF was found in all patients. Vectorcardiography (VCG) in the area of necrosis (in the second and third projections) revealed displacement of QRS loops in the opposite direction from the area of affected myocardium, reduction of their size: in the BA2 – 2.99 ± 0.59 vs. 30.19 ± 5.48 mm2 in the control group, in BA3 – 2.99 ± 0.59 vs. 30.25 ± 5.47 mm2 in the control group (p < 0.001); deceleration of excitation in the myocardium in BA2 – in the initial part of QRS loop – 22.65 ± 1.62 vs. 28.92 ± 3.24 mV/s in the control group (p < 0.01), in BA3 – in the area of vector of the initial deflection of QRS loop – 6.95 ± 0.47 vs. 17.82 ± 2.38 mV/s in the control group (p < 0.001); nonclosure of QRS loops: in BA1 – 0.97 ± 0.17 mm, in BA2 – 1.16 ± 0.17 mm, in BA3 – 1.26 ± 0.17 mm, in BA4 – 1.67 ± 0.31 mm and in BA5 – 1.37 ± 0.24 mm, without breaking of the loop in the control group. In projections BA4 and BA5 we revealed an increase in the velocity of excitation distribution in the apex and basal parts of the ventricles: in the vector of final deviation of QRS loops in BA4 – 24.99 ± 2.09 vs. 14.48 ± 1.80 mV/s in the control group and in BA5 – 20.07 ± 2.10 vs. 12.58 ± 1.37 mV/s in the control group (p < 0.001); increase in the area P loops by 2.6–3.8 times: in BA2 – 0.49 ± 0.07 vs. 0.13 ± 0.05 mm2 in the control group (p < 0.001); acceleration of the pulse propagation in the initial part of P loop in BA5 – 3.44 ± 0.41 vs. 3.14 ± 0.43 mV/s in the control group (p < 0.001) and deceleration of pulse propagation in the final part of P loop in BA4 – 2.38 ± 0.14 vs. 3.26 ± 0.51 mV/s in the control group (p < 0.001) and in the first three projections – the angular divergence of QRS-P loops (an increase in BA1 – 53 ± 9 vs. 45 ± 5 in the control group (p < 0.001) and a decrease in BA2 – 63 ± 11 vs. 90 ± 20 in the control group and in BA3 – 48 ± 13 vs. 140 ± 10 in the control group (p < 0.001).

Conclusions. Acute myocardial infarction of posterior-inferior localization in the area of necrosis is revealed in the second and third VCG projections by QRS loops shift in the opposite direction from the affected area of the myocardium, a decrease in their area by 10 times with deceleration of excitation in the myocardium and impaired repolarization. Repolarization processes in the area of necrotic changes are characterized by: unclosed QRS loops with the advent of vector of ST damage, directed downward, left, back in the second and third projections, location of T loop outside QRS loop in the first three projections, differently directed changes in the angular divergence of QRS-T loops and the speed of pulse propagation in T loops with a decrease in the maximum vector of T loops in the first projection. Outside the zone of necrosis in acute MI of posterior-inferior localization in the fourth and fifth VCG projections we defined the prolongation of QRS loops along with the increase in their size and velocity of distribution of excitation in the apex and basal parts of the ventricles with a disorder of repolarization in this area expressed by a larger area and reduced maximum vector of T loops, increased angular divergence of QRS-T loops with violation of the pulse in T loops, as well as an increase in the area of P loops by 2.6–3.8 times and differently directed changes of high-speed performance in all projections with the increase of angular divergence of QRS-P loops in the first projection and its decrease in the second and third ones.

Keywords: acute myocardial infarction, vectorcardiography.

8.

 

Comparative evaluation of influence of long-term treatment with sildenafil on exercise tolerance of patients with idiopathic pulmonary arterial hypertension and Eisenmenger’s syndrome

К.М. Amosova, L.F. Konoplіova, I.V. Krуchуnska

The purpose – to evaluate and compare the changes in exercise tolerance, oxygen saturation of capillary blood, indices of endothelial function and status of NO-system in patients with idiopathic pulmonary arterial hypertension (IPAH) and Eisenmenger’s syndrome (ES) under the influence of long-term (6 months) treatment with sildenafil.

Materials and methods. We examined 18 patients with IPAH (14 women and 4 men at the age of 28.7 ± 3.2 years), 14 patients with ES (9 women and 5 men at the age of (34.3 ± 3.8) years) and 20 clinically healthy subjects age and gender matched (control group). The survey implied the definition 6-minute distance walk, the capillary blood oxygen saturation (SaO2) by transcutaneous method, the determination of endothelin-1 level and von Willebrand factor activity in plasma by ELISA, the evaluation of calciumdependent and calcium-independent NO-synthase activity, levels of nitrite- and nitrate-anions in erythrocytes spectrophotometrically before and 6 months after treatment by sildenafil at a dose of 50 mg/day.

Results and discussion. At the beginning of the study 6-minute walk distance of patients with pulmonary arterial hypertension (PAH) was in general by 42.3 % lower than that of healthy persons – 350.3 ± 40.7 vs. 607.7 ± 43.5 m, respectively (p < 0.01). As a result of 6 months’ treatment by sildenafil it increased to 462.4 ± 23.5 m, i.e. by 32 % (p < 0.05). In patients with ES, (SaO2) was lower than in healthy subjects both at rest and after a 6-minute walk. After treatment, this index increased, respectively, by 5.7 and 9.5 % (all p < 0.05). Patients with PAH had 9.6 times higher endothelin-1 plasma level than the healthy persons – 1.92 ± 0.14 vs. 0.20 ± 0.02 fmol/ml, respectively (p < 0.001). After treatment, it decreased by 32.8 % (p < 0.05) but remained significantly more elevated than in the healthy (p < 0.001). The level of von Willebrand factor activity in plasma of patients with PAH was 10.7 times higher than in the controls – 2.06 ± 0.27 vs. 0.20 ± 0.01 IU/ml, respectively, (p < 0.001). After treatment, the index decreased by 29.6 % (p < 0.05). In early studies, in general PAH patients’ level of calcium-dependent NO-synthase activity in erythrocytes was significantly lower than that of the healthy persons – 0.75 ± 0.12 vs. 2.16 ± 0.19 pmol / (mg of protein · min), respectively, (p < 0.001) and after 6 months of treatment with sildenafil it increased by 3.5 times compared with baseline (p < 0.001). Pool of nitrite-anion in these patients at baseline was significantly lower than in the healthy (16.24 ± 2.54 vs. 25.14 ± 2.29 pmol / mg of protein, respectively, p < 0.01) and during treatment was accompanied by a significant increase – by 3.7 times (p < 0.001).

Conclusions. 6 months’ sildenafil therapy of patients with pulmonary arterial hypertension (idiopathic pulmonary arterial hypertension and Eisenmenger’s syndrome) improves exercise tolerance, as measured by a 6-minute walk, and is accompanied by a reduction of initially elevated levels of endothelin-1 and von Willebrand factor, an increase in activity of calcium-dependent NO-synthase of nitric oxide, and nitrite anion pool. In patients with congenital heart disease in a phase of Eisenmenger’s syndrome, 6 months’ sildenafil therapy leads to an increase in (SaO2) at rest and after a 6-minute walk, according to pulse oximetry.

Keywords: idiopathic pulmonary arterial hypertension, Eisenmenger’s syndrome, endothelial dysfunction, sildenafil.

9.

 

Location of right ventricular electrode during pacing. Opportunities of echocardiographic verification

D.Ye. Volkov

The purpose – to develop a comparative approach to the assessment of implantation of the right ventricular electrode during pacing, based on the use of conventional echocardiography.

Materials and methods. During 2011, 76 inpatients were examined with bradyarrhythmias who had undergone pacemaker implantations under fluoroscopic control with standard ECG recordings which were the criteria for implantation of electrodes in defined areas of the right ventricle (RV). Then, during a month the position of the electrode was ascertained using echocardiography with standard and synthetic projections.

Results and discussion. Intraoperatively, basing on fluoroscopic and echocardiography markers, the assumptions about the implantation of electrodes into the interventricular septum were done in 46 (60.5 %) patients. At echocardiography such localization of the electrode was confirmed only in 32 (42.1 %) patients. This difference is explained by the fact that the locations of the electrode in the anterior (10.5 vs. 19.7 %; p < 0.05) and free (2.6 vs. 10.5 %; p < 0.05) walls were much less correctly interpreted during surgery. Apical localization of the electrode was equally well revealed by all methods (26.3 vs. 27.6 %; p = 0.34). In 28.9 % cases, the location of RV-electrode could be found only from non-standard echocardiography positions.

Conclusions. Echocardiography that uses standard and synthesized projections allows establishing the place of RV-electrode implantation with greater accuracy than fluoroscopic and ECG markers.

Keywords: pacing, alternative pacing sites, echocardiographic visualization.

10.

 

Clopidogrel in treatment of patients with chronic lower limb ischemia

V.G. Mishalov, N.Yu. Litvinova

This article provides an overview of data from randomized studies on the assignment schemes of antiplatelet therapy for patients with peripheral artery diseases. The efficacy and safety of antiaggregants in terms of evidence-based medicine are described.

Keywords: atherosclerosis, peripheral artery disease, treatment, antiaggregants, clopidogrel.

11.

 

Hemodynamically insignificant coronary artery atherosclerosis: definition, pathogenesis, clinical significance, diagnosis, options of treatment and prevention

O.T. Stremenіuk

The most common cause which determines the development of coronary heart disease is atherosclerosis of coronary arteries (CA) of the heart. Atherosclerosis that causes CA stenosis less than 50 % of its lumen is considered as hemodynamically insignificant according to coronary angiography. However, this term to a greater degree describes the anatomic insignificance of stenosis than the functional ability of CA to provide coronary blood flow. The introduction of coronary angiography has contributed to the progress in understanding the pathophysiology of coronary blood flow disorders and the development of new methods of diagnosis and treatment of coronary heart disease. However, coronary angiography cannot assess the functional changes of CA that explain the variability of ischemic threshold in patients with the same degree of CA stenosis. Considering these limitations, the current researches are directed at studying the functional state of the arterial wall, mainly endothelial function. Evaluation of the flow of clinical patterns, characteristics of endothelial function violations, systemic inflammation, and exercise tolerance in patients with hemodynamically insignificant atherosclerosis of CA are important to optimize treatment of these patients, which opens up new possibilities for the prevention of serious cardiovascular events.

Keywords: coronary artery atherosclerosis, endothelial function, intimа—media thickness, coronary artery calcification.

12.

 

Aortic aneurysm dissection: definition, etiology, pathomorphology, classification, clinical features, diagnosis and treatment

R.K. Zhuraуev

The article presents current views on the definition, etiology, morphology, classification, diagnosis and treatment of aortic aneurysm dissection. Modern classifications, methods of diagnosis and treatment are present.

Keywords: aortic aneurysm dissection, etiology, pathomorphology, clinical picture, diagnosis, treatment.

13.

 

Markers of acute kidney damage

I.I. Gorda, A.B. Bezrodnyі, O.V. Vasіlenko, I.V. Dankevіch

Early successful diagnosis and timely initiation of treatment of acute kidney damage (AKD) are the most important tasks which in recent years served as the impetus for a whole wave of researches aimed at finding new more advanced biomarkers. Biomarker is a substance found in the blood, biological fluids or tissues which enables to estimate the flow (normal or abnormal) of biological processes or a reaction to the administration of pharmacological agents or narcotics. There is a wide range of biomarkers, including mRNA, proteins, polypeptides and lipid molecules. In case of AKD, pathophysiological processes like inflammation, apoptosis, necrosis and cell death as well as tubular regeneration may be reflected in the blood or urine, which permits conducting their quantitative evaluation by means of laboratory methods. The most important among the new extensively explored markers are NGAL, KIM-1, cystatin C, L-FABP and IL-18. The urgency of this problem is caused by the fact that creatinine, the most widely used marker of renal dysfunction in clinical practice, has a number of significant drawbacks, due to which its level may vary depending on age, sex, level of metabolism, taken medications, water-base metabolism. The article briefly reviews recent data of large studies in this area.

Keywords: acute kidney damage, diagnosis, biomarkers.

Current Issue Highlights

№4(60) // 2017

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K. M. Amosova 1, I. I. Gorda 1, A. B. Bezrodnyi 1, G. V. Mostbauer 1, Yu. V. Rudenko 1, A. V. Sablin 2, N. V. Melnychenko 2, Yu. O. Sychenko 1, I. V. Prudkiy 1&a

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