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Issue. Articles

1(49) // 2015

 

 

1.

 

Features of left ventricular walls longitudinal displacement in patients with dilated cardiomyopathy

. M. Trembovetska, G. V. Knyshov, V. P. Zakharova, K. V. Rudenko

Purpose — to analyze the features of the left ventricular (LV) walls longitudinal displacement in patients with different kinds of dilated cardiomyopathy (DC).

Materials and methods. 70 patients with DC and 35 patients without cardiac pathology have been involved into study.

Results and discussion. Elevation of end-diastolic and end-systolic indices, as well as lowering of heart beat index and ejection fraction, intensification of hypertension in the pulmonary artery and occurrence of moderate mitral and tricuspid regurgitation have been noted in patients with dilated cardiomyopathy. These changes worsen significantly in case of total left bundle-branch block. During the normal heartbeat and in dilated cardiomyopathy, the peak values of longitudinal displacement were demonstrated by the basal segments of the left ventricle. At the same time the apex of the heart remains almost static. In group I, the longitudinal displacement of the basal segments of septal and lateral walls equaled 8.3 ± 2.7 mm and 8.1 ± 3.2 mm, respectively (as compared to 18.4 ± 1.8 mm and 19.0 ± 3.2 mm in normal condition). In the occurrence of the total left bundle-branch block, the lowering of the indices in the basal segment worsened, particularly near the lateral wall (4.0 ± 2.0 mm);

Conclusions. In dilated cardiomyopathy, the indices of longitudinal myocardial displacement of the left ventricle were strongly decreasing with the augmenting of heart failure signs. The appearance of the total left bundle-branch block, manifested by the total decrease of amplitude of longitudinal displacement of exactly the lateral and posterior walls of the left ventricle, led to the augmenting of mitral regurgitation (up to 2+) and increase of pulmonary hypertension to 60.1 ± 7.5 mmHg. Consequently, it can lead to aggravation of circulatory deficiency signs.

Keywords: dilated cardiomyopathy, echocardiography, longitudinal displacement, heart failure.

2.

 

The predictive role of various phenotypes of circulating endothelial-derived microparticles in patients with chronic heart failure: results of prospective study

. E. Berezin, . . Kremzer, T. . Samura

Purpose — to evaluate whether circulating microparticles with apoptotic or none-apoptotic phenotypes are useful for risk assessment of three-year cumulative fatal and non-fatal cardiovascular events in CHF patients.

Materials and methods. It was studied prospectively the incidence of fatal and non-fatal cardiovascular events, as well as the frequency of occurrence of death from any cause in a cohort of 388 patients with CHF during 3 years of observation. Circulating levels of NT-pro brain natriuretic peptide (NT-pro-BNP), high-sensitivity C-reactive protein (hs-CRP), endothelial apoptotic microparticles (EMPs) were measured at baseline.

Results and discussion. Median follow-up was of 2.32 years (IQR = 1.8 — 3.1). During follow-up, 110 cardiovascular events (including 43 fatal cases) were determined. Additionally, 74 subjects were hospitalized repetitively due to worsening CHF and also 16 subjects were readmitted in the hospital due to other cardiovascular reasons. In the univariate logistic regression analysis, the main factors independently related with cumulative end-points were creatinine, fasting glucose, HbA1c, total cholesterol, uric acid various types of EPMs, NT-pro-BNP, hs-CRP, NYHA class, decreased left ventricular ejection fraction (LVEF) less 45 %, and type 2 diabetes mellitus. In multivariate model NYHA class, decreased LVEF (less 45 %), NT-pro-BNP, hs-CRP, CD144+/CD31+/ annexin V+ EMPs, and CD31+/annexin V+ EMPs remained statistically significant for cumulative end-point. Adding of CD144+/ CD31+/annexin V+ EMCs and CD31+/annexin V+ EMCs to the standard ABC model may improve the relative IDI for cumulative end-point by 11.4 % and 10.5 % respectively.

Conclusions. Apoptotic phenotype of circulating microparticles may relate three-year combined clinical outcomes in CHF patients.

 

Keywords: chronic heart failure, microparticles, predictive value, cardiovascular outcomes.

3.

 

Features of coronary artery bypass in ischemic heart disease and atherosclerosis of ascending aorta

I. O. Aksonova

Purpose — to improve the immediate results of myocardial revascularization, reduce complications and deaths during operations on atherosclerotic ascending aorta.

Materials and methods. For the period from 01.01.2010 to 30.12.2013, 422 patients with coronary heart disease (CHD) and atherosclerosis of the ascending aorta were operated on at Heart Institute of Ministry of Health of Ukraine. Patients were divided into two groups: 208 patients operated on by the standard method and 214 patients operated on using an algorithm developed by us to perform surgery.

Results and discussion. Application of the optimization algorithm gave the following results: number of neurological complications decreased from 6 (2.9 %) to 2 (0.9 %) cases; number of rethoracotomias — from 6 (2.9 %) to 2 (0.9 %) cases; mortality — from 6 (2.9 %) to 1 (0.5 %) case.

Conclusions. Optimization tactics of coronary artery bypass grafting using the proposed algorithm shows significant advantages in the surgical treatment of patients with coronary artery disease complicated by aortic atherosclerosis of the ascending aorta. It allows reducing the number of complications (rethoracotomias and brain damages) and the number of deaths.

Keywords: coronary heart disease, coronary artery bypass grafting, atherosclerosis.

4.

 

Plasma amino acids in patients with acute Q-myocardial infarction and left ventricular ejection fraction > 40 % complicated by resistant/late left ventricular failure

O. B. Iaremenko, P. F. Dudka, N. K. Iordanova, T. M. Kuchmerovska

Purpose — to investigate plasma amino acids (PAA) in patients with acute Q-myocardial infarction (Q-MI) and left ventricle ejection fraction (LVEF) > 40 % and to identify the independent amino acid predictors of development of resistant / late left ventricular failure (LVF).

Materials and methods. The study was based on prospective examination of 90 patients with Q-MI and LVEF > 40 % (63.3 % — males, mean age — 58.46 ± 9.15 years) who were not treated by revascularization methods. All the patients were divided into two clinical groups depending on the presence of resistant/late LVF (on the third day of hospitalization period and later). The concentrations of free amino acids in plasma of patients were analyzed by cation-exchanged liquid-column chromatography on the day of admission.

Results and discussion. The significant increase in the baseline concentrations of all PAA (except homocysteine and cysteine) were registered in patients with resistant/late LVF compared with patients without resistant/late LVF. Multivariate logistic regression and ROC analyses found that baseline hyperglycinemia was a risk factor of resistant/late LVF (odds ratio 2.49; 95 % confidence interval (95 % CI) 1.51 — 4.11; p < 0.0001; area under ROC-curve 0.839; 95 % CI 0.731 — 0.916; p < 0.0001), which was independent of other risk factors: demographic (female sex), anamnestic (obesity, diabetes mellitus, chronic heart failure history), clinical (sinus tachycardia, paroxysm of atrial fibrillation, acute LVF on the day of admission), instrumental (extent of ischemic damage by electrocardiography and diastolic dysfunction of left ventricle by echocardiography) and laboratory (glomerular filtration rate, erythrocyte sedimentation rate, prothrombin index) ones. Sensitivity and specificity of baseline plasma level of glycine > 2.582 mg/100 ml (95 % CI 2.158 — 3.335) as a predictor of resistant/late LVF were 86.67 % and 77.78 % respectively.

Conclusions. The development of resistant/late LVF in the patients with Q-MI and preserved LVEF is associated with higher baseline concentrations of PAA (except homocysteine and cysteine) compared with the patients without this complication. In patients with Q-MI and preserved systolic function of left ventricle, the development of resistant/late LVF can be predicted by the baseline plasma concentration of glycine > 2.58 mg/100 ml (sensitivity — 86.67 %, specificity — 77.78 %).

 

Keywords: acute Q-myocardial infarction, preserved systolic function of left ventricle, left ventricular failure, plasma amino acids.

5.

 

Clinical characteristics of patients with acute decompensated heart failure, effectiveness of inpatient treatment, early and late results in clinical practice: a retrospective single-center study

. M. Amosova, A. B. Bezrodnyi, I. I. Gorda, A. V. Sablin, N. V. Melnychenko, I. V. Gubar, I. V. Prudky, O. M. Herula, P. O. Lazarev, Yu.O. Schenko, I.Yu. Katsytadze, . V. Khodakivska, S. Z. Bogdan, A. V. Soloshchenko

Purpose — to carry out a retrospective analysis of the clinical characteristics of patients with acute decompensated heart failure (ADHF), hospitalized in cardiology departments of practical public health institutions of Ukraine in real clinical practice conditions, to estimate the effectiveness and immediate and long-term results of treatment.

Materials and methods. Continuous method of retrospective analysis was used to select 216 records of patients admitted to the cardiology department of Oleksandrivska Clinical Hospital in Kyiv from January 1 to December 31, 2009 for ADHF due to chronic ischemic heart disease, arterial hypertension (AH) or dilated cardiomyopathy, regardless of ejection fraction (EF). The criterion for inclusion in the study, other than that of the etiology of heart failure (HF), was the administration of diuretics and the criteria for non-inclusion — age > 85 years, cardiogenic shock, acute coronary syndrome having occurred 3 month before or earlier, clinically significant heart defects (primarily degenerative aortic stenosis), pulmonary embolism, post-thromboembolic pulmonary hypertension and pulmonary heart, myocarditis, pericarditis, clinically significant arrhythmias and conduction failure with hemodynamic changes, severe chronic kidney disease with glomerular filtration rate (GFR) < 15 ml/min and other severe comorbidities that could significantly worsen heart failure. Mandatory examination of patients included ECG in the dynamics, Doppler echocardiography, radiography of the chest and standard general clinical and biochemical laboratory tests if prescribed. GFR was estimated by MDRD formula, which took into account the age, gender, race, and serum creatinine levels. Long-term results in 131 (65.4 %) patients were established in 2.5 — 4.5 3.40 ± 0.27 years after discharge when communicating on the phone with a patient or relatives.

Results and discussion. The average age of the patients was 66.3 ± 1.08 years. 83 (38.4 %) persons were older than 70. 169 (78.2 %) patients had AH, 103 (47.7 %) — constant and persistent atrial fibrillation/atrial flutter. Among the most frequent comorbidities were diabetes mellitus (DM) — 56 (25.9 %), chronic obstructive pulmonary disease (COPD) — 44 (20.3 %), chronic pyelonephritis — 27 (12.3 %), urolithiasis — 26 (12 %) patients. Dyspnea at rest was present in 161 (74.5 %) patients, paroxysmal nocturnal dyspnea — in 42 (19.4 %), orthopnea — in 28 (13.8 %). The pronounced symptoms and signs of right ventricular failure were observed less frequently than those of dyspnea at rest: peripheral edema — in 149 (68.9 %), hepatomegaly more than 5 cm from the costal margin in the midclavicular line — 84 (38.9 %), hydrothorax — in 49 (22.7 %), ascites — in 33 (15.3 %) patients. Stage of chronic HF was evaluated as IIA in 98 (45.4 %) patients, IIB — in 99 (45.8 %) and III — in 19 (8.8 %). Restriction of physical activity of III and IV FC by NYHA, respectively, was in the ratio of 1 : 1 (54.6 and 45.4 %). In this case, according to the record in the history of the disease, stable angina was fixed in 96 (44.5 %) patients, including that of I — II FC — in 58 (26.9 %) and III FC — in 38 (18.6 %) patients. According to Doppler echocardiography, decreased EF < 45 % was recorded in 122 (56 %) patients. Mean systolic pulmonary artery pressure was 48.7 ± 1.3 mmHg, its increase ≥ 30 mmHg was observed in 191 (88.5 %) patients. The mean diameter of the right ventricle (DRV) was 2.8 ± 0.1 mm, DRV ≥ 26 mm was identified in 107 (49.5 %) patients. The average GFR at admission was 56.9 ± 1.8 ml/min. When analyzing individual values, GFR (over 60 ml/min) was preserved in 90 (41.3 %) patients, GFR 30 — 60 ml/min — in 114 (52.3 %), expressed reduction in renal function (GFR 15 — 30 ml/min) — in 12 (5.5 %) patients. Among the prevailing complications of hospital period were: cardiogenic pulmonary edema (in 17 (7.8 %)) patients, persistent ventricular tachycardia (in 8 (3.7 %)) patients, ventricular fibrillation (in 3 (1.4 %)) and true cardiogenic shock (in 6 (2.8 %)). During treatment in hospital, one NYHA FC decrease occurred in 61.7 % of patients, two NYHA FC decrease — in 6.8 % patients. According to a survey of adherence to outpatient treatment, for 3 years, 62 % of the patients took all prescribed medications regularly, 26 % — occasionally and 12 % — almost did not take the drugs.

Conclusions. According to the continuous retrospective single-center study, the majority of ADHF patients without cardiogenic shock hospitalized in cardiology departments in real clinical practice conditions were males (62 %), the predominant etiologic and favorable factors were myocardial infarction (50.9 %) and constant/persistent atrial fibrillation (47.7 %), the prevailing comorbidities — chronic kidney disease with GFR < 60 mL/min (58.7 %), DM (25.9 %), COPD (20.3 %) and anemia (11.6 %). In real clinical practice conditions, at the time of admission, the hospital mortality of ADHF patients without cardiogenic shock with preserved EF (> 45 %) was 6.4 %; 35 % patients were discharged from the hospital without an improvement in NYHA FC. Within 3 years, 34.5 % of patients die and 71.6 % are rehospitalized due to cardiac causes.

 

Keywords: acute heart failure, decompensated chronic heart failure, consequences of heart failure.

6.

 

Integral indices of previous and repeated surgery in adults with congenital heart defects

I. G. Lebid

Purpose — to compare the quantitative characteristics of primary and recurrent cardiac surgery procedures in adults with congenital heart defects (CHD) and develop integral indexes of previous and repeated surgical procedures for the prediction of risk of cardiac surgery in these patients.

Materials and methods. A retrospective review included an analysis of medical records of all patients aged 16 years and older within the period from 01.01.1999 to 31.12.2013. Analysis of materials of M. M. Amosov Institute of Cardiac Surgery for the period of 1999 — 2006 and those of the Scientific and Practical Medical Center of Pediatric Cardiology and Cardiac Surgery of Ministry of Health of Ukraine for the period of 2006 — 2013 was performed.

Results and discussion. During 15 years of follow up of 451 patients who underwent surgery, primary interventions were performed in 326 (77.89 %) and recurrent operations — in 125 (22.11 %) cases. During the annual analysis, a steady increase was noted in the number of operated patients (from 9 in 1999 to 78 in 2013) against the relative decrease in the number of patients initially operated in the current year (from 77 % in 1999, 100 % in 2001, to 60.26 % in 2013). The number of patients with reintervention reached 38.89 % in 2012 and 39.71 % in 2013. Over the observation period, an increase was marked in the number of patients who underwent prior surgery before the operation made in the current year (1 patient in 1999, 23 — in 2012 and 21 — in 2013). Two integral indices were developed — integral index of previous procedures (IIPP) and the integral index procedure / patient (IIP/P). Since 2005, a steady growth in IIPP from 1.00 to 1.78 in 2012 and 1.67 in 2013 has been marked. Such dynamics shows a more severe course of CHD in adults who have been undergoing surgical correction for the recent few years. From 2007 to 2009, a progressive increase in IIP/P was marked, which in 2013 reached a maximum value of 1.61.

Conclusions. Improvement of cardiac care for adult patients with CHD leads to the increase in the number of repeated operationsand interventional procedures against the decrease in the number of primary interventions. Two indexes were developed: the IIPP, as the ratio of the total number of primary cardiac surgery procedures to the total number of patients with these surgical procedures, and the IIP/P, as the ratio of total number of performed surgical operations to the number of re-operated patients in the current year.

Keywords: adults, heart defects, surgery, repeated surgery.

7.

 

Gender differences in monitoring office and home blood pressure in patients with uncomplicated hypertension in ambulatory practice

Yu. V. Rudenko

Purpose — to determine the effectiveness of a simplified stepped algorithm of antihypertensive therapy for achievement of target office and «normal» home (< 135/85 mmHg) blood pressure (BP) in patients with arterial hypertension (AH) and improvement of their adherence to treatment in general outpatient practice of a cardiologist depending on gender.

Materials and methods. An open prospective study of 54 outpatient cardiology hospitals in Kiev included 430 patients aged 35 to 70 years (mean age 57.3 ± 0.5 years) with uncomplicated essential hypertension with blood pressure > 160/100 mmHg. in. those treated previously or ≥ 140/90 mmHg in those who had not been treated before. Six major and two additional visits as needed were conducted within 6 months. During the first visit, the doctor determined the blood pressure using standardized automatic device Microlife BPW200 with universal cuff. The patient was provided with oscillometric automatic device Microlife BP3AG1, trained to use it, instructed on lifestyle modifications and prescribed a fixed combination of perindopril and amlodipine («Bi-Prestarium», «Servier», France) at a dose of 5/5, 5/10, 10 / 5 or 10/10 mg at the option of the doctor (Step 1). Before each follow-up visit, twice a day for 7 days, the patient independently measured the blood pressure and recorded the results in the diary. In case of failure to reach the target office blood pressure (< 140/90 mmHg), during follow-up visits the dose of «Bi-Prestarium» was increased to the maximum tolerated (Step 2) and subsequently indapamide retard («Arifon retard», «Servier», France) 1.5 mg once a day (Step 3), spironolactone 25 mg 2 times a day (Step 4), moxonidine from 0.2 to 0.6 mg per day, or doxazosin 4 — 8 mg per day (Step 5) were prescribed. Adherence to treatment through a questionnaire (X. Girerd et al, 2001) was evaluated during the first visit in patients who had received antihypertensive therapy prior to inclusion into the study and during the final visit — in all patients. The effectiveness of treatment was assessed by the primary endpoints (the number of patients who reached the target level of office blood pressure after 6 months of follow up, and the number of patients with «normal» home blood pressure (< 135/85 mmHg)) and by the secondary endpoint (change in the commitment to treatment).

Results and discussion. The study included 233 (54.2 %) women (group 1) and 197 (45.8 %) men (group 2). Patients in both groups were comparable by frequency of comorbidities (coronary heart disease, type 2 diabetes and left ventricular hypertrophy), glucose and total blood cholesterol levels, heart rate (HR) at rest (all p > 0.05). Women were older (p < 0.01), had larger body mass index (p < 0.05) and higher incidence of abdominal obesity (p < 0.001), lower glomerular filtration rate (p < 0.001) than men. Among men we found more smokers (p < 0.001), persons with grade 3 AH (p < 0.05) and cardiovascular disease in family history (p < 0.01). In 6 months, the mean systolic office blood pressure in women decreased from 164.3 ± 0.9 to 129.6 ± 0.6 mmHg, in men — from 167.3 ± 1.0 to 132.0 ± 0.7 mmHg, the diastolic pressure — from 95.9 ± 0.7 to 78.4 ± 0.4 mmHg. and from 98.6 ± 0.7 to 80.3 ± 0.5 mmHg, respectively (all p < 0.001). Target office BP level was achieved in 206 (88.4 %) women and 145 (73.6 %) men, which was accompanied by a «normal» level of home BP — in 169 (72.5 %) and 104 (52.8 %) cases, respectively (all p < 0.01). Low levels of adherence to treatment during the first visit was registered in 101 (50.8 %) of 199 women and in 79 (51.6 %) of 153 men who were treated prior to enrollment, during the sixth visit the low levels of adherence were observed in 12 (5 2 %) and 19 (9.6 %) patients of the 1st and 2nd groups, respectively (all p < 0.0001); a high level during the first visit was fixed in 41 (20.6 %) and 38 (24.8 %) cases, during the sixth visit — in 113 (48.5 %) and 102 (51.8 %) patients, respectively (all p < 0.001).

Conclusions. 6 months of treatment of uncomplicated hypertension with the use of stepwise algorithm based on a fixed combination of perindopril and amlodipine together with the control of home blood pressure and the education program in ambulatory practice of cardiologists allowed to reach the target level of office blood pressure in 88.4 % of women and 73.6 % of men, which was accompanied by a decrease in home blood pressure to «normal» (< 135/85 mmHg) in 72.5 and 52.8 % cases, respectively. This approach was effective regardless of gender, and ensured a high and moderate adherence to treatment, according to the X. Girerd questionnaire, in 94.8 % of women and 90.4 % of men.

 

Keywords: essential hypertension, target blood pressure, perindopril, amlodipine, fixed low-dose combination, adherence to treatment.

8.

 

Alternative approaches to endovascular revascularization of lower limbs of patients with critical ischemia

O. I. Pityk

Purpose — to assess the efficiency of alternative approaches to endovascular revascularization in recanalization of complex occlusions of infrainguinal arteries.

Materials and methods. Over the period from 2010 to 2014, 54 patients with critical limb ischemia caused by long occlusive lesions of infrainguinal arteries underwent endovascular interventions using alternative methods. In 42 cases, retrograde accesses through distal segments of femoropopliteal or tibial arteries were used. In 12 cases, revascularization of the foot through the plantar arterial arch or the collateral of the peroneal artery was performed.

Results and discussion. Technical success of endovascular interventions in the group of the patients, where retrograde access was used, made up 83 % in the femoropopliteal and 88 % in the tibial arteries. In the group of the patients who underwent the revascularization of the foot through the plantar arterial arch or the collateral of the peroneal artery, technical success was achieved in 92 %. No complications related to the retrograde puncture of popliteal or tibial arteries were observed.

Conclusions. Alternative methods of recanalization of chronic occlusions of infrainguinal arteries in patients with critical ischemia are safe and effective methods of endovascular revascularization of lower limbs after failure of the previous attempt of antegrade intervention.

Keywords: endovascular intervention, alternative methods of revascularization.

9.

 

Influence of perioperative factors on short-term results of surgical treatment of patients with intracranial aneurism

S. O. Dudukina, Y. Y. Kobelyaczkyj, O. M. Matsuga

Purpose — to determine the influence of perioperative factors on short-term results of surgical treatment of patients with intracranial aneurismatic hemorrhages, make models of result prognosis.

Materials and methods. 328 patiens with intracranial aneurism hemorrhages were included in the research. 257 patients underwent intracranial surgery, 71 — endovascular intervention. Models of binary logistic regression were made to determine the prognosis of treatment results.

Results and discussion. While analyzing the correlation of chances it was found out that the following factors increase the risk of unfavorable treatment results: ampullar aneurism localization in the low-back cerebral artery — by 2.75 times; severity of condition according to Hunt-Hess II scale — by 2.68 times or more; presence of parenchymal and intraventricular component — by 2.52 times; intensity of subarachnoid hemorrhage > I according to Fisher — by 2.18 times; presence and extension of arterial angiospasm — by 2.15 times; intra-operative aneurism rupture — by 4.74 times; temporary clipping of arteries — by 2.59 times; progression of secondary brain ischemia with indications for decompressive craniotomy — by 2.58 times; general peri-operative complications — by 42.96 times and can be considered risk factors of negative prognosis. Models of binary logistic regression with equations for determination of prognosis have been constructed in order to determine the combined effect of the factors on the forecast. Several models have been built that include a combination of different factors determining the probability of poor outcomes.

Conclusions. Main factors influencing treatment results in patients with intracranial aneurism hemorrhages are intra-operative aneurism rupture; presence of complications in the peri-operative period, such as secondary brain ischemia, 2 or more aneurism raptures, severity of condition according unt-ess scale and level of consciousness according to GCS before the operation. The presence of secondary cerebral ischemia with indications for decompressive craniotomy and intraoperative aneurysm rupture increases the risk of poor outcomes. Therapeutic hypothermia and decompressive craniotomy in patients with intracranial hypertension do not increase the likelihood of poor outcomes, which may be indicative of the effectiveness of hypothermia as a method of treatment of intracranial hypertension.

Keywords: intracranial aneurism hemorrhages, prognosis, logistic regression.

10.

 

Galectin-3 as predictor of complications in patients with myocardial infarction of the right ventricle against the background of Q-myocardial infarction of the left ventricle posterior wall

V. Y. Tseluyko, T. A. Lozova, V. P. Zheleznyy

Purpose — to assess the significance of galectin-3 as a predictor of the development of unstable angina (UA), recurrent myocardial infarction (MI), stroke and death in the long-term follow-up of patients with MI of the right ventricle (RV) against the background of Q-myocardial infarction (Q-MI) of the left ventricle posterior wall (LVPW).

Materials and methods. The study involved 155 patients with MI of RV against the background of Q-MI of LVPW aged 64.11 ± 0.78 years. Galectin-3 levels were determined on the 2 day of MI at baseline using Human Galectin-3 Platinum ELISA kit (Austria). Follow-up was 2.6 ± 0.4 years. Study endpoints were: unstable angina (UA), recurrent MI (Re-MI), stroke and death.

Results and discussion. Study end points were reached by 62 (40 %) patients: UA — 50 (32.2 %), Re-MI — 15 (9.6 %), stroke — 9 (5.8 %) patients, death — 14 (9.0 %) persons. The concentration of galectin-3 in patients with complicated follow-up period was significantly higher than in those without complications (34.33 ± 0.58 ng/ml vs 27.16 ± 0.52 ng/ml, p < 0.0001). Multivariable analysis demonstrated that galectin-3 level is an independent risk factor for acute left ventricular failure (ALVF) (Killip III), (p = 0.029); cardiogenic shock (CS) (p = 0.05), paroxysmal atrial fibrillation (AF) (p = 0.011) in acute period of MI and predictor of Re-MI (p = 0.001) during long-term follow-up.

Conclusions. Galectin-3 level in patients with MI of RV against the background the Q-MI of LVPW is an independent predictor for paroxysmal AF, ALVF (Killip III) and cardiogenic shock. Galectin-3 level in patients with RV MI is a predictor of Re-MI during the 2.6-year follow-up.

 

Keywords: galectin-3, myocardial infarction, right ventricle, complications of postinfarction period, predictors.

11.

 

Systemic Kawasaki vasculitis: state of the problem

O. I. Boiko

The review presents recent data on the etiology, pathogenesis and clinical manifestations of Kawasaki disease (KD) — systemic vasculitis of unknown etiology, affecting medium and small arteries, especially the coronary, with the occurrence of aneurysms. KD in Japan, North America and Europe as a cause of acquired heart disease in children is more common than acute rheumatic fever. Coronaritis due to KD is considered the main cause of coronary heart disease in young age and childhood. Dilation of the arteries and aneurysms occurs in 20 — 25 % of untreated patients. KD is diagnosed by the presence of 5 of 6 major diagnostic criteria (fever, changes in the limb periphery, polymorphic exanthema, bilateral conjunctival hyperemia, lesions of the lips and mucous membranes of the buccal cavity, cervical lymphadenopathy), one of which must necessarily be fever or 4 main criteria in combination with the development of coronary artery aneurysms. Intravenous immunoglobulin reduces the likelihood of aneurysms to 5 %. Fatal cases are possible in KD within the first 2 — 12 weeks of the disease due to occlusion or rupture of coronary aneurysms or heart failure caused by arrhythmias.

Keywords: Kawasaki disease, etiology, pathogenesis, clinical features, histopathological changes.

12.

 

The diagnosis of gunshot injuries of major vessels

Yu. V. Nahalyuk, B. M. Koval, N. Yu. Litvinova, V. . Rogovskyj, Ye. V. Tsema, V. G. Mishalov

Damage to blood vessels is important and difficult issue of angiosurgery both in medical and organizational aspects. Diagnosis and treatment of gunshot injuries of major vessels is a sensitive issue not only for the military, but also for emergency vascular surgery. Not all issues of diagnosis and strategy of treatment of the wounded with this pathology have been solved. The success of treatment is largely determined by the timely qualified medical assistance. However, even after recovery operations, unsatisfactory results of treatment due to untimely damage recognition, organizational, tactical and technical errors are observed.

 

 

Keywords: damage to blood vessels, gunshot wounds.

13.

 

Methods of indirect revascularization for critical lower limb ischemia

N. Yu. Litvinova, V. A. Chernyak, O. V. Panchuk

Review of the literature is devoted to topical issues of treatment of critical lower limb ischemia. Aspects of conservative, surgical and combined treatment are discussed in detail. Isolated methods of conservative and surgical treatment used today lead to amputation at the hip within 5 years’ period in 84 % of cases and mortality — in 53 %. Patients with critical ischemia have decompensated capillary circulation and expressed endothelial dysfunction, which leads to inhibition of metabolism in tissues. Surgical treatment in these conditions is accompanied by frequent thrombotic complications due to decompensation of capillary blood flow. According to the literature, these patients require drug correction — preoperative for operable and monotherapy for inoperable patients. Therefore the restoration of the main circulation and microcirculation for achievement of the maximum positive effect is indicated.

 

Keywords: obliterating atherosclerosis, critical lower limb ischemia, indirect revascularization, combined treatment.

14.

 

Effect of cilostazol on the long-term results of endovascular and reconstructive procedures on major arteries

I. M. Gudz, O. I. Gudz

An overview of recent world literature data on the expansion of indications for use of cilostazol in patients with vascular disease is presented. It was established that long-term administration of the drug may reduce the risk of restenosis and related complications following endovascular and reconstructive interventions both on femoropopliteal segment and carotid artery.

Keywords: cilostazol, results, intervention, main arteries.

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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