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№2(50) // 2015

 

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1.

 

Morphological thrombus examination after aspiration from infarct-related coronary artery in patients with acute myocardial infarction

Yu. M. Sokolov, M. Yu. Sokolov, D. D. Zerbino, Yu. V. Bisyarin, D. І. Besh

Purpose — to identify the features of occurrence and «age» of aspirated from the infarct-related artery of intracoronary thrombus in patients with acute coronary syndrome and stable ST-segment elevation (STEACS).

Materials and methods. The study included patients (n = 45) with STEACS, who were admitted to hospital in the first 12 hours of onset of symptoms with signs of acute myocardial ischemia (clinical manifestations, ECG data, elevation of specific cardiac enzymes). All patients underwent coronary angiography. If a patient was admitted to hospital after 12 hours from the onset of STEACS symptoms, urgent catheterization was performed in case of recurrent acute myocardial ischemia confirmed by ECG changes. In the event of thrombotic occlusion or floating thrombus in the lumen of coronary artery we performed its preliminary aspiration using the aspiration catheter and primary stenting. After photomacrography, clot was recorded in 10 % solution of neutral formalin and embedded in paraffin. Slices of no more than 10 — 15 microns thick were stained by two methods: hematoxylin-eosin and orange-red-blue using D. D. Zerbino methodology. Preparations were studied using light microscope and photographed with an increase from 100 to 400.

Results and discussion. The study involved 8 men (age 35 to 50 years) and 2 women (37 and 47 years old), of which 5 (50 %) suffered from obesity (body mass index — from 33.1 to 40.8 kg/m2), 5 (50 %) smoked, 8 (80 %) had professional contact with gasoline, welding, nitropaint, household chemicals, alkaline electrolyte. From time of occurrence of the first symptoms to reperfusion in 9 patients was 5.5; 6; 8; 4; 12; 2.5; 2.2; 4.5 and 6.5 h, and morphological «age» of the clot was 7; 8; > 24; 5; > 24; > 24; > 12; > 24 and 8 h, respectively. In one case, the ‘age’ of thrombus could not be determined.

Conclusions. The results of the study of morphology in vivo of intracoronary thrombi aspirated in patients with STEACS give reason to suggest the disparity between clinical and morphological «age» of thrombus.

 

Keywords: acute myocardial infarction, intracoronary thrombus, reperfusion therapy, primary percutaneous coronary intervention.

2.

 

Possibilities of use of deformation mapping method in determination of myocardial mass and type of left ventricular remodeling

A. S. Matyaschuk, M. V. Kostylev

The aim — to study the possibilities of deformation mapping (DM) in the definition of volumes, ejection fraction (EF), myocardial mass, average thickness of left ventricle (LV) wall and remodeling type compared with conventional echographic techniques.

Materials and methods. 122 individuals (93 men, 29 women) aged 20 to 84 years (mean age (52.76 ± 12.91) years) were examined with the use of ultrasound scanner Toshiba Aplio 500. End-diastolic (EDV) and end-systolic (ESV) volumes were determined as mean value of the relevant parameters obtained in DM in the apical projections and EF was derived from EDV and ESV. Myocardial mass of LV was obtained as the difference between EDV together with the walls and EDV multiplied by density. The wall thickness was calculated as the average of the minimum distances from the inner to the outer contour of the left ventricle, the average end-diastolic diameter (AEDD) — as LV diameter along the short axis at the level of papillary muscles, the index of relative wall thickness — as 2T/AEDD and type of remodeling — from LV myocardial mass and index of relative wall thickness.

Results and discussion. EF determined in DM did not differ significantly from that calculated according to Simpson algorithm (r = 0.999). We revealed the closest correlation of LV wall thickness and the mean value of thickness of interventricular septum and posterior wall (r = 0.938). The difference between the AEDD and end-diastolic diameter of LV was also insignificant (0.22 ± 0.4 cm; r = 0.82). The correlation between the mass of the left ventricular myocardium, determined by the proposed method and the traditional methods, was less close (r = 0.636 — 0.751) because of the inaccuracy of assumptions regarding LV geometric shapes. LV sensitivity and specificity of the new technique and the classical method of determining the type of remodeling coincided (100 and 66 %, respectively).

Conclusions. EDV, EF, LV myocardial mass, LV wall thickness and end-diastolic volume obtained by DM have greater accuracy and reproducibility than the corresponding figures calculated by classical methods. Obtaining the proposed indicators eliminates the need for calculating their classical counterparts, namely EDV and EF by Simpson method, LV myocardial mass by spheroid method, thickness of posterior wall and interventricular septum and left ventricular end-diastolic volume.

Keywords: echocardiography, deformation mapping, left ventricular myocardial mass, wall thickness of the left ventricle, left ventricular remodeling.

3.

 

Effective control of arterial blood pressure of patients with arterial hypertension and obesity by algorithmization of therapy and adherence to treatment on outpatient basis

Yu. V. Rudenko

Purpose — to determine the efficiency of a unified simplified stepped algorithm of antihypertensive therapy for achieving target office and «normal» home (< 135/85 mmHg) arterial blood pressure (ABP) in patients with arterial hypertension (AH) and obesity compared to patients with excessive and normal body weight and improving their adherence to treatment in general outpatient practice of cardiologist.

Materials and methods. An open prospective study involved 54 dispensary cardiologists from medical institutions in Kyiv which included into the study 195 (45.3 %) obese patients (I group), 190 (44.2 %) patients with excessive body weight (II group), 33 (7.7 %) patients with normal body weight (III group) with uncontrolled uncomplicated essential AH hypertension. During the first visit, the doctor determined ABP using standardized automatic device Microlife BPW200 with universal cuff. The patient was provided with an automatic oscillometric device Microlife BP3AG1. They were trained to use it, informed about the 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 doctor’s choice (Step 1). There were 6 visits within 6 months. During 7 days, the patient measured blood pressure by himself and recorded the results in the diary twice a day before each subsequent visit. In case of failure to reach the target office blood pressure, during the following visit the doctor increased the dose of Bi-Prestarium to the maximum tolerated (Step 2) and subsequently prescribed indapamide retard (Arifon retard, Servier, France) 1.5 mg 1 time per day (Step 3), spironolactone 50 mg per day (Step 4), moxonidine 0.2 — 0.6 mg per day, or doxazosin 4 — 8 mg per day (Step 5). Adherence to treatment was e.valuated in patients who received antihypertensive treatment before the study, during the first and the final visits. Treatment efficacy was assessed by the number of patients who achieved the level of office blood pressure < 140/90 mmHg, the number of patients with home BP < 135/85 mmHg after 6 months of follow up and by change the adherence to treatment.

Results and discussion. Patients of all groups were comparable by age, frequency of stable angina of I — II FC, left ventricular hypertrophy, heart rate at rest and baseline serum creatinine (all p > 0.05). Patients with obesity often suffered from diabetes type 2 and had complications in relation to cardiovascular disease heredity (all p < 0.01). After 6 months of treatment, mean systolic office blood pressure in the three groups decreased from (166.7 ± 1.0) to (132.5 ± 0.6) mmHg, from (165 ± 1.0) to (129.2 ± 0.7) mmHg and from (165.4 ± 2.8) to (128.7 ± 2.2) mmHg, diastolic pressure — from (96.4 ± 1.1) to (79.8 ± 0.5) mmHg, from (96.8 ± 0.7) to (78.5 ± 0.5) mmHg and from (97.9 ± 1.9) to (79.6 ± 1.6) mmHg, respectively, (all p < 0.0001). Office blood pressure of 140/90 mmHg was achieved in 80.5, 83.7 and 75.8 % patients, respectively, which was accompanied by normalization of home blood pressure — in 56.4, 64.7 and 63.6 % cases, respectively (all p < 0.05). The proportion of patients with low adherence to treatment during the study was reduced from 48.2 to 8.2 % (p < 0.001), from 55 to 7.4 % (p < 0.001) and from 53.5 to 3 % (p < 0.01), respectively. The proportion of patients with high levels of adherence to treatment increased from 25.6 to 51.3 % (p < 0.01) in I group, from 20.8 to 47.4 % (p < 0.01) in II group and from 17.9 to 51.5 % (p < 0.05) in III group.

Conclusions. After 6 months of use of stepped treatment algorithm based on a fixed combination of perindopril and amlodipine together with the control of home blood pressure and the education program for patients with uncomplicated hypertension in the dispensary cardiologist’s practice, the proportion of cases with a target level of office blood pressure was 80.5 % among obese patients, 83.7 % among overweight ones, 75.8 % among persons with normal weight, which was accompanied by a decline in home blood pressure to < 135/85 mmHg in 56.4, 64.7 and 63.6 % cases, respectively. According to X. Girerd questionnaire, this approach proved to be effective regardless of the value of body mass index and ensured a high and moderate adherence to treatment at 91.8 % of obese patients, 92.7 % of patients with excessive body mass and 97 % of cases with normal weight.

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

4.

 

Effective control of arterial blood pressure of patients with arterial hypertension and obesity by algorithmization of therapy and adherence to treatment on outpatient basis

Yu. V. Rudenko

Purpose — to determine the efficiency of a unified simplified stepped algorithm of antihypertensive therapy for achieving target office and «normal» home (< 135/85 mmHg) arterial blood pressure (ABP) in patients with arterial hypertension (AH) and obesity compared to patients with excessive and normal body weight and improving their adherence to treatment in general outpatient practice of cardiologist.

Materials and methods. An open prospective study involved 54 dispensary cardiologists from medical institutions in Kyiv which included into the study 195 (45.3 %) obese patients (I group), 190 (44.2 %) patients with excessive body weight (II group), 33 (7.7 %) patients with normal body weight (III group) with uncontrolled uncomplicated essential AH hypertension. During the first visit, the doctor determined ABP using standardized automatic device Microlife BPW200 with universal cuff. The patient was provided with an automatic oscillometric device Microlife BP3AG1. They were trained to use it, informed about the 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 doctor’s choice (Step 1). There were 6 visits within 6 months. During 7 days, the patient measured blood pressure by himself and recorded the results in the diary twice a day before each subsequent visit. In case of failure to reach the target office blood pressure, during the following visit the doctor increased the dose of Bi-Prestarium to the maximum tolerated (Step 2) and subsequently prescribed indapamide retard (Arifon retard, Servier, France) 1.5 mg 1 time per day (Step 3), spironolactone 50 mg per day (Step 4), moxonidine 0.2 — 0.6 mg per day, or doxazosin 4 — 8 mg per day (Step 5). Adherence to treatment was e.valuated in patients who received antihypertensive treatment before the study, during the first and the final visits. Treatment efficacy was assessed by the number of patients who achieved the level of office blood pressure < 140/90 mmHg, the number of patients with home BP < 135/85 mmHg after 6 months of follow up and by change the adherence to treatment.

Results and discussion. Patients of all groups were comparable by age, frequency of stable angina of I — II FC, left ventricular hypertrophy, heart rate at rest and baseline serum creatinine (all p > 0.05). Patients with obesity often suffered from diabetes type 2 and had complications in relation to cardiovascular disease heredity (all p < 0.01). After 6 months of treatment, mean systolic office blood pressure in the three groups decreased from (166.7 ± 1.0) to (132.5 ± 0.6) mmHg, from (165 ± 1.0) to (129.2 ± 0.7) mmHg and from (165.4 ± 2.8) to (128.7 ± 2.2) mmHg, diastolic pressure — from (96.4 ± 1.1) to (79.8 ± 0.5) mmHg, from (96.8 ± 0.7) to (78.5 ± 0.5) mmHg and from (97.9 ± 1.9) to (79.6 ± 1.6) mmHg, respectively, (all p < 0.0001). Office blood pressure of 140/90 mmHg was achieved in 80.5, 83.7 and 75.8 % patients, respectively, which was accompanied by normalization of home blood pressure — in 56.4, 64.7 and 63.6 % cases, respectively (all p < 0.05). The proportion of patients with low adherence to treatment during the study was reduced from 48.2 to 8.2 % (p < 0.001), from 55 to 7.4 % (p < 0.001) and from 53.5 to 3 % (p < 0.01), respectively. The proportion of patients with high levels of adherence to treatment increased from 25.6 to 51.3 % (p < 0.01) in I group, from 20.8 to 47.4 % (p < 0.01) in II group and from 17.9 to 51.5 % (p < 0.05) in III group.

Conclusions. After 6 months of use of stepped treatment algorithm based on a fixed combination of perindopril and amlodipine together with the control of home blood pressure and the education program for patients with uncomplicated hypertension in the dispensary cardiologist’s practice, the proportion of cases with a target level of office blood pressure was 80.5 % among obese patients, 83.7 % among overweight ones, 75.8 % among persons with normal weight, which was accompanied by a decline in home blood pressure to < 135/85 mmHg in 56.4, 64.7 and 63.6 % cases, respectively. According to X. Girerd questionnaire, this approach proved to be effective regardless of the value of body mass index and ensured a high and moderate adherence to treatment at 91.8 % of obese patients, 92.7 % of patients with excessive body mass and 97 % of cases with normal weight.

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

5.

 

Effective control of arterial blood pressure of patients with arterial hypertension and obesity by algorithmization of therapy and adherence to treatment on outpatient basis

Yu. V. Rudenko

Purpose — to determine the efficiency of a unified simplified stepped algorithm of antihypertensive therapy for achieving target office and «normal» home (< 135/85 mmHg) arterial blood pressure (ABP) in patients with arterial hypertension (AH) and obesity compared to patients with excessive and normal body weight and improving their adherence to treatment in general outpatient practice of cardiologist.

Materials and methods. An open prospective study involved 54 dispensary cardiologists from medical institutions in Kyiv which included into the study 195 (45.3 %) obese patients (I group), 190 (44.2 %) patients with excessive body weight (II group), 33 (7.7 %) patients with normal body weight (III group) with uncontrolled uncomplicated essential AH hypertension. During the first visit, the doctor determined ABP using standardized automatic device Microlife BPW200 with universal cuff. The patient was provided with an automatic oscillometric device Microlife BP3AG1. They were trained to use it, informed about the 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 doctor’s choice (Step 1). There were 6 visits within 6 months. During 7 days, the patient measured blood pressure by himself and recorded the results in the diary twice a day before each subsequent visit. In case of failure to reach the target office blood pressure, during the following visit the doctor increased the dose of Bi-Prestarium to the maximum tolerated (Step 2) and subsequently prescribed indapamide retard (Arifon retard, Servier, France) 1.5 mg 1 time per day (Step 3), spironolactone 50 mg per day (Step 4), moxonidine 0.2 — 0.6 mg per day, or doxazosin 4 — 8 mg per day (Step 5). Adherence to treatment was e.valuated in patients who received antihypertensive treatment before the study, during the first and the final visits. Treatment efficacy was assessed by the number of patients who achieved the level of office blood pressure < 140/90 mmHg, the number of patients with home BP < 135/85 mmHg after 6 months of follow up and by change the adherence to treatment.

Results and discussion. Patients of all groups were comparable by age, frequency of stable angina of I — II FC, left ventricular hypertrophy, heart rate at rest and baseline serum creatinine (all p > 0.05). Patients with obesity often suffered from diabetes type 2 and had complications in relation to cardiovascular disease heredity (all p < 0.01). After 6 months of treatment, mean systolic office blood pressure in the three groups decreased from (166.7 ± 1.0) to (132.5 ± 0.6) mmHg, from (165 ± 1.0) to (129.2 ± 0.7) mmHg and from (165.4 ± 2.8) to (128.7 ± 2.2) mmHg, diastolic pressure — from (96.4 ± 1.1) to (79.8 ± 0.5) mmHg, from (96.8 ± 0.7) to (78.5 ± 0.5) mmHg and from (97.9 ± 1.9) to (79.6 ± 1.6) mmHg, respectively, (all p < 0.0001). Office blood pressure of 140/90 mmHg was achieved in 80.5, 83.7 and 75.8 % patients, respectively, which was accompanied by normalization of home blood pressure — in 56.4, 64.7 and 63.6 % cases, respectively (all p < 0.05). The proportion of patients with low adherence to treatment during the study was reduced from 48.2 to 8.2 % (p < 0.001), from 55 to 7.4 % (p < 0.001) and from 53.5 to 3 % (p < 0.01), respectively. The proportion of patients with high levels of adherence to treatment increased from 25.6 to 51.3 % (p < 0.01) in I group, from 20.8 to 47.4 % (p < 0.01) in II group and from 17.9 to 51.5 % (p < 0.05) in III group.

Conclusions. After 6 months of use of stepped treatment algorithm based on a fixed combination of perindopril and amlodipine together with the control of home blood pressure and the education program for patients with uncomplicated hypertension in the dispensary cardiologist’s practice, the proportion of cases with a target level of office blood pressure was 80.5 % among obese patients, 83.7 % among overweight ones, 75.8 % among persons with normal weight, which was accompanied by a decline in home blood pressure to < 135/85 mmHg in 56.4, 64.7 and 63.6 % cases, respectively. According to X. Girerd questionnaire, this approach proved to be effective regardless of the value of body mass index and ensured a high and moderate adherence to treatment at 91.8 % of obese patients, 92.7 % of patients with excessive body mass and 97 % of cases with normal weight.

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

6.

 

Effective control of arterial blood pressure of patients with arterial hypertension and obesity by algorithmization of therapy and adherence to treatment on outpatient basis

Yu. V. Rudenko

Purpose — to determine the efficiency of a unified simplified stepped algorithm of antihypertensive therapy for achieving target office and «normal» home (< 135/85 mmHg) arterial blood pressure (ABP) in patients with arterial hypertension (AH) and obesity compared to patients with excessive and normal body weight and improving their adherence to treatment in general outpatient practice of cardiologist.

Materials and methods. An open prospective study involved 54 dispensary cardiologists from medical institutions in Kyiv which included into the study 195 (45.3 %) obese patients (I group), 190 (44.2 %) patients with excessive body weight (II group), 33 (7.7 %) patients with normal body weight (III group) with uncontrolled uncomplicated essential AH hypertension. During the first visit, the doctor determined ABP using standardized automatic device Microlife BPW200 with universal cuff. The patient was provided with an automatic oscillometric device Microlife BP3AG1. They were trained to use it, informed about the 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 doctor’s choice (Step 1). There were 6 visits within 6 months. During 7 days, the patient measured blood pressure by himself and recorded the results in the diary twice a day before each subsequent visit. In case of failure to reach the target office blood pressure, during the following visit the doctor increased the dose of Bi-Prestarium to the maximum tolerated (Step 2) and subsequently prescribed indapamide retard (Arifon retard, Servier, France) 1.5 mg 1 time per day (Step 3), spironolactone 50 mg per day (Step 4), moxonidine 0.2 — 0.6 mg per day, or doxazosin 4 — 8 mg per day (Step 5). Adherence to treatment was e.valuated in patients who received antihypertensive treatment before the study, during the first and the final visits. Treatment efficacy was assessed by the number of patients who achieved the level of office blood pressure < 140/90 mmHg, the number of patients with home BP < 135/85 mmHg after 6 months of follow up and by change the adherence to treatment.

Results and discussion. Patients of all groups were comparable by age, frequency of stable angina of I — II FC, left ventricular hypertrophy, heart rate at rest and baseline serum creatinine (all p > 0.05). Patients with obesity often suffered from diabetes type 2 and had complications in relation to cardiovascular disease heredity (all p < 0.01). After 6 months of treatment, mean systolic office blood pressure in the three groups decreased from (166.7 ± 1.0) to (132.5 ± 0.6) mmHg, from (165 ± 1.0) to (129.2 ± 0.7) mmHg and from (165.4 ± 2.8) to (128.7 ± 2.2) mmHg, diastolic pressure — from (96.4 ± 1.1) to (79.8 ± 0.5) mmHg, from (96.8 ± 0.7) to (78.5 ± 0.5) mmHg and from (97.9 ± 1.9) to (79.6 ± 1.6) mmHg, respectively, (all p < 0.0001). Office blood pressure of 140/90 mmHg was achieved in 80.5, 83.7 and 75.8 % patients, respectively, which was accompanied by normalization of home blood pressure — in 56.4, 64.7 and 63.6 % cases, respectively (all p < 0.05). The proportion of patients with low adherence to treatment during the study was reduced from 48.2 to 8.2 % (p < 0.001), from 55 to 7.4 % (p < 0.001) and from 53.5 to 3 % (p < 0.01), respectively. The proportion of patients with high levels of adherence to treatment increased from 25.6 to 51.3 % (p < 0.01) in I group, from 20.8 to 47.4 % (p < 0.01) in II group and from 17.9 to 51.5 % (p < 0.05) in III group.

Conclusions. After 6 months of use of stepped treatment algorithm based on a fixed combination of perindopril and amlodipine together with the control of home blood pressure and the education program for patients with uncomplicated hypertension in the dispensary cardiologist’s practice, the proportion of cases with a target level of office blood pressure was 80.5 % among obese patients, 83.7 % among overweight ones, 75.8 % among persons with normal weight, which was accompanied by a decline in home blood pressure to < 135/85 mmHg in 56.4, 64.7 and 63.6 % cases, respectively. According to X. Girerd questionnaire, this approach proved to be effective regardless of the value of body mass index and ensured a high and moderate adherence to treatment at 91.8 % of obese patients, 92.7 % of patients with excessive body mass and 97 % of cases with normal weight.

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

7.

 

Atrial fibrillation after coronary artery bypass grafting: predictors of recurrence for six-month postoperative period

B. M. Todurov, O. I. Zharinov, O. A. Epanchintseva, O. P. Nadorak

Purpose — to determine the predictors of atrial fibrillation (AF) after coronary artery bypass grafting (CABG), its recurrence and other complications during the prospective 6-month follow-up.

Materials and methods. In a prospective single-center study, data were analyzed obtained in clinical and instrumental examination of 53 patients with coronary heart disease (CHD) who underwent CABG without concomitant valvular cardiac surgery. There was no information about the presence of AF before surgery. In 29 patients (basic group) diagnosed postoperative AF, in 24 patients AF paroxysm did not register. Estimated the factors associated with the origin of AF and complications at a 6-monthly prospective study.

Results and discussion. The occurrence of postoperative AF was associated with higher levels of C-reactive protein, a large enddiastolic volume and low left ventricular ejection fraction, more frequent identification of mitral regurgitation and multivessel coronary disease. Altogether 26 complications were registered in 19 patients. Four of them were diagnosed in the early postoperative period, 22 — during the 6-month follow-up. Recurrence of AF was fixed in 9 cases including 6 ones in the early postoperative period.

Conclusions. Groups of patients with and without polyorientational phase transitions did not differ significantly in the number of large cardiovascular complications and hospitalizations in the 6-month follow-up. However, recurrence of AF is more often seen in patients with polyorientational phase transitions. These features should be taken into account during post-operative risk stratification, e.valuation of the feasibility and duration of prophylactic use of amiodarone.

Keywords: coronary artery bypass grafting, postoperative atrial fibrillation, complications, predictors.

8.

 

Atrial fibrillation after coronary artery bypass grafting: predictors of recurrence for six-month postoperative period

B. M. Todurov, O. I. Zharinov, O. A. Epanchintseva, O. P. Nadorak

Purpose — to determine the predictors of atrial fibrillation (AF) after coronary artery bypass grafting (CABG), its recurrence and other complications during the prospective 6-month follow-up.

Materials and methods. In a prospective single-center study, data were analyzed obtained in clinical and instrumental examination of 53 patients with coronary heart disease (CHD) who underwent CABG without concomitant valvular cardiac surgery. There was no information about the presence of AF before surgery. In 29 patients (basic group) diagnosed postoperative AF, in 24 patients AF paroxysm did not register. Estimated the factors associated with the origin of AF and complications at a 6-monthly prospective study.

Results and discussion. The occurrence of postoperative AF was associated with higher levels of C-reactive protein, a large enddiastolic volume and low left ventricular ejection fraction, more frequent identification of mitral regurgitation and multivessel coronary disease. Altogether 26 complications were registered in 19 patients. Four of them were diagnosed in the early postoperative period, 22 — during the 6-month follow-up. Recurrence of AF was fixed in 9 cases including 6 ones in the early postoperative period.

Conclusions. Groups of patients with and without polyorientational phase transitions did not differ significantly in the number of large cardiovascular complications and hospitalizations in the 6-month follow-up. However, recurrence of AF is more often seen in patients with polyorientational phase transitions. These features should be taken into account during post-operative risk stratification, e.valuation of the feasibility and duration of prophylactic use of amiodarone.

Keywords: coronary artery bypass grafting, postoperative atrial fibrillation, complications, predictors.

9.

 

Effective control of arterial blood pressure of patients with arterial hypertension and obesity by algorithmization of therapy and adherence to treatment on outpatient basis

Yu. V. Rudenko

Purpose — to determine the efficiency of a unified simplified stepped algorithm of antihypertensive therapy for achieving target office and «normal» home (< 135/85 mmHg) arterial blood pressure (ABP) in patients with arterial hypertension (AH) and obesity compared to patients with excessive and normal body weight and improving their adherence to treatment in general outpatient practice of cardiologist.

Materials and methods. An open prospective study involved 54 dispensary cardiologists from medical institutions in Kyiv which included into the study 195 (45.3 %) obese patients (I group), 190 (44.2 %) patients with excessive body weight (II group), 33 (7.7 %) patients with normal body weight (III group) with uncontrolled uncomplicated essential AH hypertension. During the first visit, the doctor determined ABP using standardized automatic device Microlife BPW200 with universal cuff. The patient was provided with an automatic oscillometric device Microlife BP3AG1. They were trained to use it, informed about the 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 doctor’s choice (Step 1). There were 6 visits within 6 months. During 7 days, the patient measured blood pressure by himself and recorded the results in the diary twice a day before each subsequent visit. In case of failure to reach the target office blood pressure, during the following visit the doctor increased the dose of Bi-Prestarium to the maximum tolerated (Step 2) and subsequently prescribed indapamide retard (Arifon retard, Servier, France) 1.5 mg 1 time per day (Step 3), spironolactone 50 mg per day (Step 4), moxonidine 0.2 — 0.6 mg per day, or doxazosin 4 — 8 mg per day (Step 5). Adherence to treatment was e.valuated in patients who received antihypertensive treatment before the study, during the first and the final visits. Treatment efficacy was assessed by the number of patients who achieved the level of office blood pressure < 140/90 mmHg, the number of patients with home BP < 135/85 mmHg after 6 months of follow up and by change the adherence to treatment.

Results and discussion. Patients of all groups were comparable by age, frequency of stable angina of I — II FC, left ventricular hypertrophy, heart rate at rest and baseline serum creatinine (all p > 0.05). Patients with obesity often suffered from diabetes type 2 and had complications in relation to cardiovascular disease heredity (all p < 0.01). After 6 months of treatment, mean systolic office blood pressure in the three groups decreased from (166.7 ± 1.0) to (132.5 ± 0.6) mmHg, from (165 ± 1.0) to (129.2 ± 0.7) mmHg and from (165.4 ± 2.8) to (128.7 ± 2.2) mmHg, diastolic pressure — from (96.4 ± 1.1) to (79.8 ± 0.5) mmHg, from (96.8 ± 0.7) to (78.5 ± 0.5) mmHg and from (97.9 ± 1.9) to (79.6 ± 1.6) mmHg, respectively, (all p < 0.0001). Office blood pressure of 140/90 mmHg was achieved in 80.5, 83.7 and 75.8 % patients, respectively, which was accompanied by normalization of home blood pressure — in 56.4, 64.7 and 63.6 % cases, respectively (all p < 0.05). The proportion of patients with low adherence to treatment during the study was reduced from 48.2 to 8.2 % (p < 0.001), from 55 to 7.4 % (p < 0.001) and from 53.5 to 3 % (p < 0.01), respectively. The proportion of patients with high levels of adherence to treatment increased from 25.6 to 51.3 % (p < 0.01) in I group, from 20.8 to 47.4 % (p < 0.01) in II group and from 17.9 to 51.5 % (p < 0.05) in III group.

Conclusions. After 6 months of use of stepped treatment algorithm based on a fixed combination of perindopril and amlodipine together with the control of home blood pressure and the education program for patients with uncomplicated hypertension in the dispensary cardiologist’s practice, the proportion of cases with a target level of office blood pressure was 80.5 % among obese patients, 83.7 % among overweight ones, 75.8 % among persons with normal weight, which was accompanied by a decline in home blood pressure to < 135/85 mmHg in 56.4, 64.7 and 63.6 % cases, respectively. According to X. Girerd questionnaire, this approach proved to be effective regardless of the value of body mass index and ensured a high and moderate adherence to treatment at 91.8 % of obese patients, 92.7 % of patients with excessive body mass and 97 % of cases with normal weight.

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

10.

 

Effective control of arterial blood pressure of patients with arterial hypertension and obesity by algorithmization of therapy and adherence to treatment on outpatient basis

Yu. V. Rudenko

Purpose — to determine the efficiency of a unified simplified stepped algorithm of antihypertensive therapy for achieving target office and «normal» home (< 135/85 mmHg) arterial blood pressure (ABP) in patients with arterial hypertension (AH) and obesity compared to patients with excessive and normal body weight and improving their adherence to treatment in general outpatient practice of cardiologist.

Materials and methods. An open prospective study involved 54 dispensary cardiologists from medical institutions in Kyiv which included into the study 195 (45.3 %) obese patients (I group), 190 (44.2 %) patients with excessive body weight (II group), 33 (7.7 %) patients with normal body weight (III group) with uncontrolled uncomplicated essential AH hypertension. During the first visit, the doctor determined ABP using standardized automatic device Microlife BPW200 with universal cuff. The patient was provided with an automatic oscillometric device Microlife BP3AG1. They were trained to use it, informed about the 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 doctor’s choice (Step 1). There were 6 visits within 6 months. During 7 days, the patient measured blood pressure by himself and recorded the results in the diary twice a day before each subsequent visit. In case of failure to reach the target office blood pressure, during the following visit the doctor increased the dose of Bi-Prestarium to the maximum tolerated (Step 2) and subsequently prescribed indapamide retard (Arifon retard, Servier, France) 1.5 mg 1 time per day (Step 3), spironolactone 50 mg per day (Step 4), moxonidine 0.2 — 0.6 mg per day, or doxazosin 4 — 8 mg per day (Step 5). Adherence to treatment was e.valuated in patients who received antihypertensive treatment before the study, during the first and the final visits. Treatment efficacy was assessed by the number of patients who achieved the level of office blood pressure < 140/90 mmHg, the number of patients with home BP < 135/85 mmHg after 6 months of follow up and by change the adherence to treatment.

Results and discussion. Patients of all groups were comparable by age, frequency of stable angina of I — II FC, left ventricular hypertrophy, heart rate at rest and baseline serum creatinine (all p > 0.05). Patients with obesity often suffered from diabetes type 2 and had complications in relation to cardiovascular disease heredity (all p < 0.01). After 6 months of treatment, mean systolic office blood pressure in the three groups decreased from (166.7 ± 1.0) to (132.5 ± 0.6) mmHg, from (165 ± 1.0) to (129.2 ± 0.7) mmHg and from (165.4 ± 2.8) to (128.7 ± 2.2) mmHg, diastolic pressure — from (96.4 ± 1.1) to (79.8 ± 0.5) mmHg, from (96.8 ± 0.7) to (78.5 ± 0.5) mmHg and from (97.9 ± 1.9) to (79.6 ± 1.6) mmHg, respectively, (all p < 0.0001). Office blood pressure of 140/90 mmHg was achieved in 80.5, 83.7 and 75.8 % patients, respectively, which was accompanied by normalization of home blood pressure — in 56.4, 64.7 and 63.6 % cases, respectively (all p < 0.05). The proportion of patients with low adherence to treatment during the study was reduced from 48.2 to 8.2 % (p < 0.001), from 55 to 7.4 % (p < 0.001) and from 53.5 to 3 % (p < 0.01), respectively. The proportion of patients with high levels of adherence to treatment increased from 25.6 to 51.3 % (p < 0.01) in I group, from 20.8 to 47.4 % (p < 0.01) in II group and from 17.9 to 51.5 % (p < 0.05) in III group.

Conclusions. After 6 months of use of stepped treatment algorithm based on a fixed combination of perindopril and amlodipine together with the control of home blood pressure and the education program for patients with uncomplicated hypertension in the dispensary cardiologist’s practice, the proportion of cases with a target level of office blood pressure was 80.5 % among obese patients, 83.7 % among overweight ones, 75.8 % among persons with normal weight, which was accompanied by a decline in home blood pressure to < 135/85 mmHg in 56.4, 64.7 and 63.6 % cases, respectively. According to X. Girerd questionnaire, this approach proved to be effective regardless of the value of body mass index and ensured a high and moderate adherence to treatment at 91.8 % of obese patients, 92.7 % of patients with excessive body mass and 97 % of cases with normal weight.

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

11.

 

Effective control of arterial blood pressure of patients with arterial hypertension and obesity by algorithmization of therapy and adherence to treatment on outpatient basis

Yu. V. Rudenko

Purpose — to determine the efficiency of a unified simplified stepped algorithm of antihypertensive therapy for achieving target office and «normal» home (< 135/85 mmHg) arterial blood pressure (ABP) in patients with arterial hypertension (AH) and obesity compared to patients with excessive and normal body weight and improving their adherence to treatment in general outpatient practice of cardiologist.

Materials and methods. An open prospective study involved 54 dispensary cardiologists from medical institutions in Kyiv which included into the study 195 (45.3 %) obese patients (I group), 190 (44.2 %) patients with excessive body weight (II group), 33 (7.7 %) patients with normal body weight (III group) with uncontrolled uncomplicated essential AH hypertension. During the first visit, the doctor determined ABP using standardized automatic device Microlife BPW200 with universal cuff. The patient was provided with an automatic oscillometric device Microlife BP3AG1. They were trained to use it, informed about the 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 doctor’s choice (Step 1). There were 6 visits within 6 months. During 7 days, the patient measured blood pressure by himself and recorded the results in the diary twice a day before each subsequent visit. In case of failure to reach the target office blood pressure, during the following visit the doctor increased the dose of Bi-Prestarium to the maximum tolerated (Step 2) and subsequently prescribed indapamide retard (Arifon retard, Servier, France) 1.5 mg 1 time per day (Step 3), spironolactone 50 mg per day (Step 4), moxonidine 0.2 — 0.6 mg per day, or doxazosin 4 — 8 mg per day (Step 5). Adherence to treatment was e.valuated in patients who received antihypertensive treatment before the study, during the first and the final visits. Treatment efficacy was assessed by the number of patients who achieved the level of office blood pressure < 140/90 mmHg, the number of patients with home BP < 135/85 mmHg after 6 months of follow up and by change the adherence to treatment.

Results and discussion. Patients of all groups were comparable by age, frequency of stable angina of I — II FC, left ventricular hypertrophy, heart rate at rest and baseline serum creatinine (all p > 0.05). Patients with obesity often suffered from diabetes type 2 and had complications in relation to cardiovascular disease heredity (all p < 0.01). After 6 months of treatment, mean systolic office blood pressure in the three groups decreased from (166.7 ± 1.0) to (132.5 ± 0.6) mmHg, from (165 ± 1.0) to (129.2 ± 0.7) mmHg and from (165.4 ± 2.8) to (128.7 ± 2.2) mmHg, diastolic pressure — from (96.4 ± 1.1) to (79.8 ± 0.5) mmHg, from (96.8 ± 0.7) to (78.5 ± 0.5) mmHg and from (97.9 ± 1.9) to (79.6 ± 1.6) mmHg, respectively, (all p < 0.0001). Office blood pressure of 140/90 mmHg was achieved in 80.5, 83.7 and 75.8 % patients, respectively, which was accompanied by normalization of home blood pressure — in 56.4, 64.7 and 63.6 % cases, respectively (all p < 0.05). The proportion of patients with low adherence to treatment during the study was reduced from 48.2 to 8.2 % (p < 0.001), from 55 to 7.4 % (p < 0.001) and from 53.5 to 3 % (p < 0.01), respectively. The proportion of patients with high levels of adherence to treatment increased from 25.6 to 51.3 % (p < 0.01) in I group, from 20.8 to 47.4 % (p < 0.01) in II group and from 17.9 to 51.5 % (p < 0.05) in III group.

Conclusions. After 6 months of use of stepped treatment algorithm based on a fixed combination of perindopril and amlodipine together with the control of home blood pressure and the education program for patients with uncomplicated hypertension in the dispensary cardiologist’s practice, the proportion of cases with a target level of office blood pressure was 80.5 % among obese patients, 83.7 % among overweight ones, 75.8 % among persons with normal weight, which was accompanied by a decline in home blood pressure to < 135/85 mmHg in 56.4, 64.7 and 63.6 % cases, respectively. According to X. Girerd questionnaire, this approach proved to be effective regardless of the value of body mass index and ensured a high and moderate adherence to treatment at 91.8 % of obese patients, 92.7 % of patients with excessive body mass and 97 % of cases with normal weight.

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

12.

 

Effective control of arterial blood pressure of patients with arterial hypertension and obesity by algorithmization of therapy and adherence to treatment on outpatient basis

Yu. V. Rudenko

Purpose — to determine the efficiency of a unified simplified stepped algorithm of antihypertensive therapy for achieving target office and «normal» home (< 135/85 mmHg) arterial blood pressure (ABP) in patients with arterial hypertension (AH) and obesity compared to patients with excessive and normal body weight and improving their adherence to treatment in general outpatient practice of cardiologist.

Materials and methods. An open prospective study involved 54 dispensary cardiologists from medical institutions in Kyiv which included into the study 195 (45.3 %) obese patients (I group), 190 (44.2 %) patients with excessive body weight (II group), 33 (7.7 %) patients with normal body weight (III group) with uncontrolled uncomplicated essential AH hypertension. During the first visit, the doctor determined ABP using standardized automatic device Microlife BPW200 with universal cuff. The patient was provided with an automatic oscillometric device Microlife BP3AG1. They were trained to use it, informed about the 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 doctor’s choice (Step 1). There were 6 visits within 6 months. During 7 days, the patient measured blood pressure by himself and recorded the results in the diary twice a day before each subsequent visit. In case of failure to reach the target office blood pressure, during the following visit the doctor increased the dose of Bi-Prestarium to the maximum tolerated (Step 2) and subsequently prescribed indapamide retard (Arifon retard, Servier, France) 1.5 mg 1 time per day (Step 3), spironolactone 50 mg per day (Step 4), moxonidine 0.2 — 0.6 mg per day, or doxazosin 4 — 8 mg per day (Step 5). Adherence to treatment was e.valuated in patients who received antihypertensive treatment before the study, during the first and the final visits. Treatment efficacy was assessed by the number of patients who achieved the level of office blood pressure < 140/90 mmHg, the number of patients with home BP < 135/85 mmHg after 6 months of follow up and by change the adherence to treatment.

Results and discussion. Patients of all groups were comparable by age, frequency of stable angina of I — II FC, left ventricular hypertrophy, heart rate at rest and baseline serum creatinine (all p > 0.05). Patients with obesity often suffered from diabetes type 2 and had complications in relation to cardiovascular disease heredity (all p < 0.01). After 6 months of treatment, mean systolic office blood pressure in the three groups decreased from (166.7 ± 1.0) to (132.5 ± 0.6) mmHg, from (165 ± 1.0) to (129.2 ± 0.7) mmHg and from (165.4 ± 2.8) to (128.7 ± 2.2) mmHg, diastolic pressure — from (96.4 ± 1.1) to (79.8 ± 0.5) mmHg, from (96.8 ± 0.7) to (78.5 ± 0.5) mmHg and from (97.9 ± 1.9) to (79.6 ± 1.6) mmHg, respectively, (all p < 0.0001). Office blood pressure of 140/90 mmHg was achieved in 80.5, 83.7 and 75.8 % patients, respectively, which was accompanied by normalization of home blood pressure — in 56.4, 64.7 and 63.6 % cases, respectively (all p < 0.05). The proportion of patients with low adherence to treatment during the study was reduced from 48.2 to 8.2 % (p < 0.001), from 55 to 7.4 % (p < 0.001) and from 53.5 to 3 % (p < 0.01), respectively. The proportion of patients with high levels of adherence to treatment increased from 25.6 to 51.3 % (p < 0.01) in I group, from 20.8 to 47.4 % (p < 0.01) in II group and from 17.9 to 51.5 % (p < 0.05) in III group.

Conclusions. After 6 months of use of stepped treatment algorithm based on a fixed combination of perindopril and amlodipine together with the control of home blood pressure and the education program for patients with uncomplicated hypertension in the dispensary cardiologist’s practice, the proportion of cases with a target level of office blood pressure was 80.5 % among obese patients, 83.7 % among overweight ones, 75.8 % among persons with normal weight, which was accompanied by a decline in home blood pressure to < 135/85 mmHg in 56.4, 64.7 and 63.6 % cases, respectively. According to X. Girerd questionnaire, this approach proved to be effective regardless of the value of body mass index and ensured a high and moderate adherence to treatment at 91.8 % of obese patients, 92.7 % of patients with excessive body mass and 97 % of cases with normal weight.

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

13.

 

Effective control of arterial blood pressure of patients with arterial hypertension and obesity by algorithmization of therapy and adherence to treatment on outpatient basis

Yu. V. Rudenko

Purpose — to determine the efficiency of a unified simplified stepped algorithm of antihypertensive therapy for achieving target office and «normal» home (< 135/85 mmHg) arterial blood pressure (ABP) in patients with arterial hypertension (AH) and obesity compared to patients with excessive and normal body weight and improving their adherence to treatment in general outpatient practice of cardiologist.

Materials and methods. An open prospective study involved 54 dispensary cardiologists from medical institutions in Kyiv which included into the study 195 (45.3 %) obese patients (I group), 190 (44.2 %) patients with excessive body weight (II group), 33 (7.7 %) patients with normal body weight (III group) with uncontrolled uncomplicated essential AH hypertension. During the first visit, the doctor determined ABP using standardized automatic device Microlife BPW200 with universal cuff. The patient was provided with an automatic oscillometric device Microlife BP3AG1. They were trained to use it, informed about the 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 doctor’s choice (Step 1). There were 6 visits within 6 months. During 7 days, the patient measured blood pressure by himself and recorded the results in the diary twice a day before each subsequent visit. In case of failure to reach the target office blood pressure, during the following visit the doctor increased the dose of Bi-Prestarium to the maximum tolerated (Step 2) and subsequently prescribed indapamide retard (Arifon retard, Servier, France) 1.5 mg 1 time per day (Step 3), spironolactone 50 mg per day (Step 4), moxonidine 0.2 — 0.6 mg per day, or doxazosin 4 — 8 mg per day (Step 5). Adherence to treatment was e.valuated in patients who received antihypertensive treatment before the study, during the first and the final visits. Treatment efficacy was assessed by the number of patients who achieved the level of office blood pressure < 140/90 mmHg, the number of patients with home BP < 135/85 mmHg after 6 months of follow up and by change the adherence to treatment.

Results and discussion. Patients of all groups were comparable by age, frequency of stable angina of I — II FC, left ventricular hypertrophy, heart rate at rest and baseline serum creatinine (all p > 0.05). Patients with obesity often suffered from diabetes type 2 and had complications in relation to cardiovascular disease heredity (all p < 0.01). After 6 months of treatment, mean systolic office blood pressure in the three groups decreased from (166.7 ± 1.0) to (132.5 ± 0.6) mmHg, from (165 ± 1.0) to (129.2 ± 0.7) mmHg and from (165.4 ± 2.8) to (128.7 ± 2.2) mmHg, diastolic pressure — from (96.4 ± 1.1) to (79.8 ± 0.5) mmHg, from (96.8 ± 0.7) to (78.5 ± 0.5) mmHg and from (97.9 ± 1.9) to (79.6 ± 1.6) mmHg, respectively, (all p < 0.0001). Office blood pressure of 140/90 mmHg was achieved in 80.5, 83.7 and 75.8 % patients, respectively, which was accompanied by normalization of home blood pressure — in 56.4, 64.7 and 63.6 % cases, respectively (all p < 0.05). The proportion of patients with low adherence to treatment during the study was reduced from 48.2 to 8.2 % (p < 0.001), from 55 to 7.4 % (p < 0.001) and from 53.5 to 3 % (p < 0.01), respectively. The proportion of patients with high levels of adherence to treatment increased from 25.6 to 51.3 % (p < 0.01) in I group, from 20.8 to 47.4 % (p < 0.01) in II group and from 17.9 to 51.5 % (p < 0.05) in III group.

Conclusions. After 6 months of use of stepped treatment algorithm based on a fixed combination of perindopril and amlodipine together with the control of home blood pressure and the education program for patients with uncomplicated hypertension in the dispensary cardiologist’s practice, the proportion of cases with a target level of office blood pressure was 80.5 % among obese patients, 83.7 % among overweight ones, 75.8 % among persons with normal weight, which was accompanied by a decline in home blood pressure to < 135/85 mmHg in 56.4, 64.7 and 63.6 % cases, respectively. According to X. Girerd questionnaire, this approach proved to be effective regardless of the value of body mass index and ensured a high and moderate adherence to treatment at 91.8 % of obese patients, 92.7 % of patients with excessive body mass and 97 % of cases with normal weight.

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

14.

 

Effective control of arterial blood pressure of patients with arterial hypertension and obesity by algorithmization of therapy and adherence to treatment on outpatient basis

Yu. V. Rudenko

Purpose — to determine the efficiency of a unified simplified stepped algorithm of antihypertensive therapy for achieving target office and «normal» home (< 135/85 mmHg) arterial blood pressure (ABP) in patients with arterial hypertension (AH) and obesity compared to patients with excessive and normal body weight and improving their adherence to treatment in general outpatient practice of cardiologist.

Materials and methods. An open prospective study involved 54 dispensary cardiologists from medical institutions in Kyiv which included into the study 195 (45.3 %) obese patients (I group), 190 (44.2 %) patients with excessive body weight (II group), 33 (7.7 %) patients with normal body weight (III group) with uncontrolled uncomplicated essential AH hypertension. During the first visit, the doctor determined ABP using standardized automatic device Microlife BPW200 with universal cuff. The patient was provided with an automatic oscillometric device Microlife BP3AG1. They were trained to use it, informed about the 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 doctor’s choice (Step 1). There were 6 visits within 6 months. During 7 days, the patient measured blood pressure by himself and recorded the results in the diary twice a day before each subsequent visit. In case of failure to reach the target office blood pressure, during the following visit the doctor increased the dose of Bi-Prestarium to the maximum tolerated (Step 2) and subsequently prescribed indapamide retard (Arifon retard, Servier, France) 1.5 mg 1 time per day (Step 3), spironolactone 50 mg per day (Step 4), moxonidine 0.2 — 0.6 mg per day, or doxazosin 4 — 8 mg per day (Step 5). Adherence to treatment was e.valuated in patients who received antihypertensive treatment before the study, during the first and the final visits. Treatment efficacy was assessed by the number of patients who achieved the level of office blood pressure < 140/90 mmHg, the number of patients with home BP < 135/85 mmHg after 6 months of follow up and by change the adherence to treatment.

Results and discussion. Patients of all groups were comparable by age, frequency of stable angina of I — II FC, left ventricular hypertrophy, heart rate at rest and baseline serum creatinine (all p > 0.05). Patients with obesity often suffered from diabetes type 2 and had complications in relation to cardiovascular disease heredity (all p < 0.01). After 6 months of treatment, mean systolic office blood pressure in the three groups decreased from (166.7 ± 1.0) to (132.5 ± 0.6) mmHg, from (165 ± 1.0) to (129.2 ± 0.7) mmHg and from (165.4 ± 2.8) to (128.7 ± 2.2) mmHg, diastolic pressure — from (96.4 ± 1.1) to (79.8 ± 0.5) mmHg, from (96.8 ± 0.7) to (78.5 ± 0.5) mmHg and from (97.9 ± 1.9) to (79.6 ± 1.6) mmHg, respectively, (all p < 0.0001). Office blood pressure of 140/90 mmHg was achieved in 80.5, 83.7 and 75.8 % patients, respectively, which was accompanied by normalization of home blood pressure — in 56.4, 64.7 and 63.6 % cases, respectively (all p < 0.05). The proportion of patients with low adherence to treatment during the study was reduced from 48.2 to 8.2 % (p < 0.001), from 55 to 7.4 % (p < 0.001) and from 53.5 to 3 % (p < 0.01), respectively. The proportion of patients with high levels of adherence to treatment increased from 25.6 to 51.3 % (p < 0.01) in I group, from 20.8 to 47.4 % (p < 0.01) in II group and from 17.9 to 51.5 % (p < 0.05) in III group.

Conclusions. After 6 months of use of stepped treatment algorithm based on a fixed combination of perindopril and amlodipine together with the control of home blood pressure and the education program for patients with uncomplicated hypertension in the dispensary cardiologist’s practice, the proportion of cases with a target level of office blood pressure was 80.5 % among obese patients, 83.7 % among overweight ones, 75.8 % among persons with normal weight, which was accompanied by a decline in home blood pressure to < 135/85 mmHg in 56.4, 64.7 and 63.6 % cases, respectively. According to X. Girerd questionnaire, this approach proved to be effective regardless of the value of body mass index and ensured a high and moderate adherence to treatment at 91.8 % of obese patients, 92.7 % of patients with excessive body mass and 97 % of cases with normal weight.

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

15.

 

Effective control of arterial blood pressure of patients with arterial hypertension and obesity by algorithmization of therapy and adherence to treatment on outpatient basis

Yu. V. Rudenko

Purpose — to determine the efficiency of a unified simplified stepped algorithm of antihypertensive therapy for achieving target office and «normal» home (< 135/85 mmHg) arterial blood pressure (ABP) in patients with arterial hypertension (AH) and obesity compared to patients with excessive and normal body weight and improving their adherence to treatment in general outpatient practice of cardiologist.

Materials and methods. An open prospective study involved 54 dispensary cardiologists from medical institutions in Kyiv which included into the study 195 (45.3 %) obese patients (I group), 190 (44.2 %) patients with excessive body weight (II group), 33 (7.7 %) patients with normal body weight (III group) with uncontrolled uncomplicated essential AH hypertension. During the first visit, the doctor determined ABP using standardized automatic device Microlife BPW200 with universal cuff. The patient was provided with an automatic oscillometric device Microlife BP3AG1. They were trained to use it, informed about the 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 doctor’s choice (Step 1). There were 6 visits within 6 months. During 7 days, the patient measured blood pressure by himself and recorded the results in the diary twice a day before each subsequent visit. In case of failure to reach the target office blood pressure, during the following visit the doctor increased the dose of Bi-Prestarium to the maximum tolerated (Step 2) and subsequently prescribed indapamide retard (Arifon retard, Servier, France) 1.5 mg 1 time per day (Step 3), spironolactone 50 mg per day (Step 4), moxonidine 0.2 — 0.6 mg per day, or doxazosin 4 — 8 mg per day (Step 5). Adherence to treatment was e.valuated in patients who received antihypertensive treatment before the study, during the first and the final visits. Treatment efficacy was assessed by the number of patients who achieved the level of office blood pressure < 140/90 mmHg, the number of patients with home BP < 135/85 mmHg after 6 months of follow up and by change the adherence to treatment.

Results and discussion. Patients of all groups were comparable by age, frequency of stable angina of I — II FC, left ventricular hypertrophy, heart rate at rest and baseline serum creatinine (all p > 0.05). Patients with obesity often suffered from diabetes type 2 and had complications in relation to cardiovascular disease heredity (all p < 0.01). After 6 months of treatment, mean systolic office blood pressure in the three groups decreased from (166.7 ± 1.0) to (132.5 ± 0.6) mmHg, from (165 ± 1.0) to (129.2 ± 0.7) mmHg and from (165.4 ± 2.8) to (128.7 ± 2.2) mmHg, diastolic pressure — from (96.4 ± 1.1) to (79.8 ± 0.5) mmHg, from (96.8 ± 0.7) to (78.5 ± 0.5) mmHg and from (97.9 ± 1.9) to (79.6 ± 1.6) mmHg, respectively, (all p < 0.0001). Office blood pressure of 140/90 mmHg was achieved in 80.5, 83.7 and 75.8 % patients, respectively, which was accompanied by normalization of home blood pressure — in 56.4, 64.7 and 63.6 % cases, respectively (all p < 0.05). The proportion of patients with low adherence to treatment during the study was reduced from 48.2 to 8.2 % (p < 0.001), from 55 to 7.4 % (p < 0.001) and from 53.5 to 3 % (p < 0.01), respectively. The proportion of patients with high levels of adherence to treatment increased from 25.6 to 51.3 % (p < 0.01) in I group, from 20.8 to 47.4 % (p < 0.01) in II group and from 17.9 to 51.5 % (p < 0.05) in III group.

Conclusions. After 6 months of use of stepped treatment algorithm based on a fixed combination of perindopril and amlodipine together with the control of home blood pressure and the education program for patients with uncomplicated hypertension in the dispensary cardiologist’s practice, the proportion of cases with a target level of office blood pressure was 80.5 % among obese patients, 83.7 % among overweight ones, 75.8 % among persons with normal weight, which was accompanied by a decline in home blood pressure to < 135/85 mmHg in 56.4, 64.7 and 63.6 % cases, respectively. According to X. Girerd questionnaire, this approach proved to be effective regardless of the value of body mass index and ensured a high and moderate adherence to treatment at 91.8 % of obese patients, 92.7 % of patients with excessive body mass and 97 % of cases with normal weight.

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

16.

 

Effective control of arterial blood pressure of patients with arterial hypertension and obesity by algorithmization of therapy and adherence to treatment on outpatient basis

Yu. V. Rudenko

Purpose — to determine the efficiency of a unified simplified stepped algorithm of antihypertensive therapy for achieving target office and «normal» home (< 135/85 mmHg) arterial blood pressure (ABP) in patients with arterial hypertension (AH) and obesity compared to patients with excessive and normal body weight and improving their adherence to treatment in general outpatient practice of cardiologist.

Materials and methods. An open prospective study involved 54 dispensary cardiologists from medical institutions in Kyiv which included into the study 195 (45.3 %) obese patients (I group), 190 (44.2 %) patients with excessive body weight (II group), 33 (7.7 %) patients with normal body weight (III group) with uncontrolled uncomplicated essential AH hypertension. During the first visit, the doctor determined ABP using standardized automatic device Microlife BPW200 with universal cuff. The patient was provided with an automatic oscillometric device Microlife BP3AG1. They were trained to use it, informed about the 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 doctor’s choice (Step 1). There were 6 visits within 6 months. During 7 days, the patient measured blood pressure by himself and recorded the results in the diary twice a day before each subsequent visit. In case of failure to reach the target office blood pressure, during the following visit the doctor increased the dose of Bi-Prestarium to the maximum tolerated (Step 2) and subsequently prescribed indapamide retard (Arifon retard, Servier, France) 1.5 mg 1 time per day (Step 3), spironolactone 50 mg per day (Step 4), moxonidine 0.2 — 0.6 mg per day, or doxazosin 4 — 8 mg per day (Step 5). Adherence to treatment was e.valuated in patients who received antihypertensive treatment before the study, during the first and the final visits. Treatment efficacy was assessed by the number of patients who achieved the level of office blood pressure < 140/90 mmHg, the number of patients with home BP < 135/85 mmHg after 6 months of follow up and by change the adherence to treatment.

Results and discussion. Patients of all groups were comparable by age, frequency of stable angina of I — II FC, left ventricular hypertrophy, heart rate at rest and baseline serum creatinine (all p > 0.05). Patients with obesity often suffered from diabetes type 2 and had complications in relation to cardiovascular disease heredity (all p < 0.01). After 6 months of treatment, mean systolic office blood pressure in the three groups decreased from (166.7 ± 1.0) to (132.5 ± 0.6) mmHg, from (165 ± 1.0) to (129.2 ± 0.7) mmHg and from (165.4 ± 2.8) to (128.7 ± 2.2) mmHg, diastolic pressure — from (96.4 ± 1.1) to (79.8 ± 0.5) mmHg, from (96.8 ± 0.7) to (78.5 ± 0.5) mmHg and from (97.9 ± 1.9) to (79.6 ± 1.6) mmHg, respectively, (all p < 0.0001). Office blood pressure of 140/90 mmHg was achieved in 80.5, 83.7 and 75.8 % patients, respectively, which was accompanied by normalization of home blood pressure — in 56.4, 64.7 and 63.6 % cases, respectively (all p < 0.05). The proportion of patients with low adherence to treatment during the study was reduced from 48.2 to 8.2 % (p < 0.001), from 55 to 7.4 % (p < 0.001) and from 53.5 to 3 % (p < 0.01), respectively. The proportion of patients with high levels of adherence to treatment increased from 25.6 to 51.3 % (p < 0.01) in I group, from 20.8 to 47.4 % (p < 0.01) in II group and from 17.9 to 51.5 % (p < 0.05) in III group.

Conclusions. After 6 months of use of stepped treatment algorithm based on a fixed combination of perindopril and amlodipine together with the control of home blood pressure and the education program for patients with uncomplicated hypertension in the dispensary cardiologist’s practice, the proportion of cases with a target level of office blood pressure was 80.5 % among obese patients, 83.7 % among overweight ones, 75.8 % among persons with normal weight, which was accompanied by a decline in home blood pressure to < 135/85 mmHg in 56.4, 64.7 and 63.6 % cases, respectively. According to X. Girerd questionnaire, this approach proved to be effective regardless of the value of body mass index and ensured a high and moderate adherence to treatment at 91.8 % of obese patients, 92.7 % of patients with excessive body mass and 97 % of cases with normal weight.

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

17.

 

Эффективный контроль артериального давления у пациентов с артериальной гипертензией и ожирением путем алгоритмизации терапии и повышения приверженности к лечению в амбулаторной практике

Ю. В. Руденко

Цель работы — определить эффективность унифицированного пошагового упрощенного алгоритма антигипертензивной терапии для достижения целевого офисного и «нормального» домашнего (< 135/85 мм рт. ст.) артериального давления (АД) у больных с артериальной гипертензией (АГ) и ожирением по сравнению с пациентами с избыточной и нормальной массой тела и повышения их приверженности к лечению в общей амбулаторной практике врача-кардиолога.

Материалы и методы. В открытом проспективном исследовании приняли участие 54 амбулаторных кардиолога лечебных учреждений г. Киева, которые включили в исследование 195 (45,3 %) пациентов с ожирением (1-я группа), 190 (44,2 %) — с избыточной (2-я группа), 33 (7,7 %) — с нормальной массой тела (3-я группа) с неконтролированной неосложненной эссенциальной АГ. Во время первого визита врач определял АД с помощью стандартизированного автоматического прибора Microlife BPW200 с универсальной манжетой. Больного обеспечивали осциллометрическим автоматическим прибором Microlife BP3AG1, обучали им пользоваться, проводили беседу по модификации образа жизни и назначали фиксированную комбинацию периндоприла и амлодипина («Би-Престариум», «Сервье», Франция) в дозе 5/5, 5/10, 10/5 или 10/10 мг по выбору врача (1-й шаг). В течение 6 месяцев проводили 6 визитов. Перед каждым последующим визитом больной 7 дней дважды в сутки самостоятельно измерял АД и фиксировал результаты в дневнике. В случае недостижения целевого офисного АД на последующих визитах повышали дозу «Би-Престариума» до максимально переносимой (2-й шаг) и последовательно назначали индапамид-ретард («Арифон-ретард», «Сервье», Франция) 1,5 мг 1 раз в сутки (3-й шаг), спиронолактон 50 мг в сутки (4-й шаг), моксонидин в дозе от 0,2 до 0,6 мг в сутки или доксазозин 4 — 8 мг в сутки (5-й шаг). У больных, которые получали антигипертензивную терапию до включения в исследование, во время первого визита и у всех больных во время заключительного визита оценивали приверженность к лечению. Эффективность лечения оценивали по количеству больных, достигнувших уровня офисного АД < 140/90 мм рт. ст., по количеству больных с домашним АД < 135/85 мм рт. ст. через 6 мес наблюдения и по изменению приверженности к лечению.

Результаты и обсуждение. Пациенты всех групп были сопоставимы по возрасту, частоте стабильной стенокардии напряжения І — ІІ ФК, гипертрофии левого желудочка, ЧСС покоя и исходным уровнем креатинина плазмы крови (все р > 0,05). Пациенты с ожирением чаще страдали сахарным диабетом 2 типа и имели осложненную в отношении сердечно-сосудистых заболеваний наследственность (все р < 0,01). Через 6 мес лечения в трех группах больных среднее систолическое офисное АД снизилось со (166,7 ± 1,0) до (132,5 ± 0,6) мм рт. ст., со (165 ± 1,0) до (129,2 ± 0,7) мм рт. ст. и со (165,4 ± 2,8) до (128,7 ± 2,2) мм рт. ст., диастолическое — с (96,4 ± 1,1) до (79,8 ± 0,5) мм рт. ст., с (96,8 ± 0,7) до (78,5 ± 0,5) мм рт. ст. и с (97,9 ± 1,9) до (79,6 ± 1,6) мм рт. ст. соответственно (все р < 0,0001). Офисное АД 140/90 мм рт. ст. было достигнуто у 80,5; 83,7 и 75,8 % больных соответственно, что сопровождалось нормализацией домашнего АД — в 56,4; 64,7 и 63,6 % случаев соответственно (все р < 0,05). Доля пациентов с низким уровнем приверженности к лечению за время исследования уменьшилась с 48,2 до 8,2 % (р < 0,001), с 55 до 7,4 % (р < 0,001) и с 53,5 до 3 % (р < 0,01) соответственно. Доля пациентов с высоким уровнем приверженности к лечению возросла с 25,6 до 51,3 % (р < 0,01) в 1-й, с 20,8 до 47,4 % (р < 0,01) во 2-й и с 17,9 до 51,5 % (р < 0,05) в 3-й группе.

Выводы. Доля пациентов с целевым уровнем офисного АД через 6 мес применения у пациентов с неосложненной АГ пошагового алгоритма лечения на основе фиксированной комбинации периндоприла и амлодипина вместе с контролем домашнего АД и образовательной программой в амбулаторной практике врачей-кардиологов составила среди пациентов с ожирением 80,5 %, с избыточной массой тела — 83,7 %, с нормальной массой тела — 75,8 %, что сопровождалось снижением домашнего АД до < 135/ 85 мм рт. ст. в 56,4; 64,7 и 63,6 % случаев соответственно. Такой подход оказался эффективным независимо от величины индекса массы тела и позволил обеспечить высокую и умеренную приверженность к лечению, по данным анкеты X. Girerd, у 91,8 % пациентов с ожирением, у 92,7 % — с избыточной и у 97 % — с нормальной массой тела.

 

Keywords: эссенциальная артериальная гипертензия, ожирение, избыточная масса тела, целевое артериальное давление, периндоприл, амлодипин, фиксированная низкодозовая комбинация, приверженность к лечению.

18.

 

Atrial fibrillation after coronary artery bypass grafting: predictors of recurrence for six-month postoperative period

B. M. Todurov, O. I. Zharinov, O. A. Epanchintseva, O. P. Nadorak

Purpose — to determine the predictors of atrial fibrillation (AF) after coronary artery bypass grafting (CABG), its recurrence and other complications during the prospective 6-month follow-up.

Materials and methods. In a prospective single-center study, data were analyzed obtained in clinical and instrumental examination of 53 patients with coronary heart disease (CHD) who underwent CABG without concomitant valvular cardiac surgery. There was no information about the presence of AF before surgery. In 29 patients (basic group) diagnosed postoperative AF, in 24 patients AF paroxysm did not register. Estimated the factors associated with the origin of AF and complications at a 6-monthly prospective study.

Results and discussion. The occurrence of postoperative AF was associated with higher levels of C-reactive protein, a large enddiastolic volume and low left ventricular ejection fraction, more frequent identification of mitral regurgitation and multivessel coronary disease. Altogether 26 complications were registered in 19 patients. Four of them were diagnosed in the early postoperative period, 22 — during the 6-month follow-up. Recurrence of AF was fixed in 9 cases including 6 ones in the early postoperative period.

Conclusions. Groups of patients with and without polyorientational phase transitions did not differ significantly in the number of large cardiovascular complications and hospitalizations in the 6-month follow-up. However, recurrence of AF is more often seen in patients with polyorientational phase transitions. These features should be taken into account during post-operative risk stratification, e.valuation of the feasibility and duration of prophylactic use of amiodarone.

Keywords: coronary artery bypass grafting, postoperative atrial fibrillation, complications, predictors.

19.

 

Right atrial appendage — underestimated cavity of heart in atrial fibrillation

G. V. Dzyak, L. I. Vasilyeva, L. V. Sapozhnychenko, O. S. Kalashnykova, V. G. Dzyak

Purpose — to study the incidence of thrombus formation in right atrial appendage of patients with persistent atrial fibrillation (AF) according to transesophageal echocardiography (TEEchoCG) after four weeks of anticoagulation therapy and related factors of cardiovascular risk.

Materials and methods. The study included 133 patients with persistent non-valvular AF who underwent TEEchoCG after four weeks of oral anticoagulant preparation for the planned electrical cardioversion (ECV).

Results and discussion. Thrombi in both atrial appendages were detected in 63 (47.4 %) patients. In 40 (30.1 %) cases thrombi were localized in the left atrial appendage, in 10 (7.5 %) — in the right atrial appendage. It was found that chances of thrombus formation in atrial appendages grow in the presence of obesity — by 3.4 times (odds ratio (OR) 3.39; 95 % confidence interval (CI) 1.25 — 9.18; p < 0.05), with a decrease in glomerular filtration rate (GFR) of less than 59 ml/(min · 1.73 m2) — by 3.9 times (OR 3.89; 95 % CI 1.08 — 14.04, p < 0.05), at risk of 1 score on HAS-BLED scale — by 4.1 times (OR 4.06; 95 % CI 1.38 — 11.95, p < 0.05).

Conclusions. Patients with non-valvular persistent AF according to TEEchoCG in four weeks of oral anticoagulant therapy before rate recovery by a planned ECV displayed frequency of isolated thrombosis of right atrial appendage in 7.5 % cases, thrombosis of both atrial appendages — in 47.4 % cases. Chances of thrombus formation in atrial appendages of patients with non-valvular persistent AF increase with body mass index of ≥ 30 kg/m2 — by 3.4 times, with reduction of GFR to less than 59 ml/(min · 1.73 m2) — by 3.9 times, with risk of 1 score on HAS-BLED scale — by 4.1 times.

Keywords: atrial fibrillation, right atrial appendage, transesophageal echocardiography.

20.

 

Features of drug correction of endothelial dysfunction in patients with chronic ischemic heart disease

O. M. Korzh, S. V. Krasnokutskiy, N. М. Vaskiv

Purpose — to study the comparative clinical effectiveness of meldonium digidratum and different doses of drug combinations of γ-butyrobetaine digidratum with meldonium digidratum for exercise tolerance and functional state of the endothelium in the complex therapy of patients with coronary heart disease (CHD) with stable exertional angina of II — III functional class (FC).

Materials and methods. The study involved 80 patients with stable exertional angina of II — III functional class, mean age (57.2 ± 1.3) years. Patients of group 1 (n = 20) were prescribed a standard therapy for treatment of coronary heart disease. Patients of group 2 (n = 20) took meldonium digidratum along with standard therapy (Mildronat, Grindeks, Latvia) 500 mg twice a day, patients of group 3 (n = 20) — the combination of γ-butyrobetaine digidratum (60 mg) with meldonium digidratum (180 mg) (Kapikor, Olainfarm, Latvia) one capsule twice a day, patients of group 4 (n = 20) — γ-butyrobetaine digidratum (60 mg) with meldonium digidratum (180 mg) 2 capsules twice a day. Before treatment and after 6 weeks we assessed the levels of asymmetric dimethyl-arginine (ADMA) in serum by enzyme immunoassay, endothelium dependent and endothelium independent vasodilation according cuff and nitroglycerine tests and subsequent calculation of the diameter of the brachial artery and the coefficient of sensitivity to shear stress, and exercise tolerance according treadmill test.

Results and discussion. Patients of all groups were comparable by age, gender, FC of angina and coronary heart disease duration, history of myocardial infarction and hypertension. Duration of exercise in patients of 1st, 2nd, 3rd and 4th groups increased from (228.0 ± 60.9) to (240.5 ± 55.4) with (p > 0.05), from (210.0 ± 73.0) to (253.1 ± 115.0) with (p < 0.05), from (209.4 ± 70.1) to (240.8 ± 98.3) with (p > 0.05), from (204.2 ± 66.4) to (249.3 ± 101.1) with (p < 0.05), respectively. The coefficient of sensitivity to endothelial shear stress increased from (0.10 ± 0.02) to (0.11 ± 0.031) mind. units. (p > 0.05), from (0.09 ± 0.13) to (0.14 ± 0.02) mind. units. (p < 0.05), from (0.08 ± 0.01) to (0.17 ± 0.02) mind. units (p < 0.05), from (0.09 ± 0.02) to (0.21 ± 0.01) mind. units (p < 0.05), respectively. ADMA level decreased from (0.632 ± 0.059) to (0.542 ± 0.062), from (0.645 ± 0.068) to (0.519 ± 0.032), from (0.618 ± 0.061) to (0.521 ± 0.045), from (0.654 ± 0.073) to (0.490 ± 0.51) mmol/l, respectively.

Conclusions. Addition of meldonium digidratum and combination of γ-butyrobetaine digidratum with meldonium digidratum to the combined therapy of patients with stable exertional angina of II — III FC was associated with an increase in execution time of physical activity by 20.5 and 22.1 %, respectively. A combination of γ-butyrobetaine digidratum with meldonium digidratum at a dose of 2 capsules twice daily improved parameters of endothelial function according to results of cuff tests after 2 weeks of therapy, while meldonium digidratum and combination of γ-butyrobetaine digidratum with meldonium digidratum at a dose of 1 capsule twice daily had an effect on endothelial function only after 6 weeks of treatment and that effect was less certain.

Keywords: meldonium digidratum, γ-butyrobetaine digidratum.

21.

 

Comparative e.valuation of the effect of control of heart rate with a combination of bisoprolol with ivabradine and monotherapy with bisoprolol on chronotropic reserve and 24-hour myocardial ectopic activity in patients with chronic ischemic heart diseas

I. Yu. Katsytadze

Purpose — to compare the effects of equivalent heart rate (HR) control with a combination of bisoprolol with ivabradine and monotherapy with bisoprolol on chronotropic reserve, indicators of heart rate and myocardial ectopic activity during the 24-hour ECG monitoring in patients with chronic ischemic heart disease (IHD) with moderately reduced ejection fraction.

Materials and methods. The open prospective study with the endpoints involved 85 patients aged < 60 years (average age (53.0 ± 2.7) years) with sinus rhythm > 70 per 1 minute with IHD (stable angina CCS I — II class), documented myocardial infarction > 3 months, mild hypertension and an average ejection fraction of 38 — 45 % who received angiotensin converting enzyme inhibitor and bisoprolol 2.5 mg/day. All patients were randomized into two groups. In the main group (n = 40) bisoprolol was uptitrated to 5 mg pd and ivabradine was added (5 mg bid uptitrated to 7.5 mg bid (12.4 ± 0.49 mg pd); in the control group (n = 45) bisoprolol was uptitrated to 10 mg od (9.1 ± 0.35 mg pd). At baseline (M0) and 6 months (M6), symptom-limited treadmill test — TT (Bruce protocol) was performed, 24-hour ECG monitoring was provided to each patient.

Results and discussion. Resting HR and systolic BP were similar in both groups at M0 and at M6 (p > 0.05). Decrease of minimal and night HR was more serious in group of BB uptitration (p < 0.01 and p < 0.001). Total number of ventricular ectopic complexes in the main group was by 35 % lower than in group of ivabradine-bisoprolol (p < 0.01). Chronotropic reserve and exercise peak HR significantly increased in the main group (p < 0.001) and did not change in the control group after 6 months’ treatment.

Conclusions. In patients with IHD and moderately reduced ejection fraction, equivalent control of heart rate at rest after 6 months of treatment with a combination of ivabradine and bisoprolol, in contrast to monotherapy with bisoprolol, improves exercise tolerance, which is associated with a significant (32 %) increase of chronotropic reserve with insignificant (by 6 %) growth of left ventricular ejection fraction at rest. Combination therapy, unlike monotherapy with β-adrenergic blockers, does not reduce the midnight heart rate and the total number of ventricular ectopic complexes per day.

Keywords: heart rate, heart failure, exercise tolerance, bisoprolol, ivabradine.

22.

 

Сlinical features of the state of hemostasis system at arteriovenous forms of congenital vascular malformations

L. M. Chernukha, O. V. Kashyrova, E. V. Lugovskoy, S. V. Komisarenko, I. N. Kolesnikova, Ye.M. Makohonenko, T. M. Platonova, L. V. Pirogova, O. V. Gornicka

Purpose — to investigate the characteristics of plasma hemostasis and fibrinolytic system of patients with diffuse arteriovenous forms of congenital vascular malformations (AVF CVM) based on the assessment of immunodiagnostic tests informativeness for determination of plasma coagulative and fibrinolytic systems activation degree aimed to forecast hemostasiological disturbances in perioperative period.

Materials and methods. The article presents the outcomes of the investigation of clinical characteristic of plasma hemostasis (D-dimer, soluble fibrin, fibrinogen) and fibrinolytic system (protein C) with the use of immunodiagnostic test system in preoperative and early postoperative periods (up to 3 days) in patients of the main group (with AVF CVM, n = 23) and in patients of the control group with varicose vein disease (n = 16, clinical class С3—С5, by CEAP).

Results and discussion. A significant imbalance was discovered of hemostasis system in the preoperative period in 9 (43 %) patients with AVF CVM, manifesting with significant activation of coagulation capacity with normal activity of fibrinolytic system. Moderate activity of coagulation capacity activation of hemostasis system in 10 (62.5 %) patients of the control group was discovered. The correlation between characteristics of coagulative and fibrinolytic systems was observed in postoperative period in the main group; hypocoagulation was observed at 4 (57 %) patients with AVF CVM; imbalance between characteristics of coagulation and fibrinolytic systems (hypercoagulability) was observed in 5 (45.5 %) patients of the control group.

Conclusions. Diagnostic tests defining the status of coagulative and fibrinolytic systems are necessary for timely correction of hemostasiological disturbances and prevention of fatal hemorragic complications in the perioperative period in patients with diffuse AVF CVM.

Keywords: congenital vascular malformations, arteriovenous forms, immunodiagnostic test-system, D-dimer, soluble fibrin, fibrinogen, protein C, balance, imbalance.

23.

 

Structural and morphologic changes of right heart chambers in essential hypertension

O. S. Barabash, Yu. A. Ivaniv

Purpose — to study the structural and functional changes of right heart chambers and to e.valuate the longitudinal kinetics of the right ventricle (RV) myocardium in patients with essential hypertension (EH) and normal contractility of the left ventricle (LV).

Materials and methods. The study included 71 patients with EH (study group), mean age (54.1 ± 7.4 years), 68 % of them — men. The control group included 30 healthy persons aged 44 to 59 years with normal blood pressure (BP). Ultrasound examination of the heart was performed on Toshiba Xario diagnostic machine. The sizes of RV and right atrium (RA) were obtained from apex fourchamber view according to existent recommendations. Correlation analysis of the left and right atrial sizes was performed in the study group. LV mass myocardial index and type of the LV remodeling were determined and compared to the RV wall thickness. Diastolic function of both ventricles was estimated by pulse wave Doppler; longitudinal kinetic of LV and RV was assessed by tissue pulse wave Doppler imaging. The systolic (peak velocity Sm, contraction time СТm) and diastolic (early velocity Em, atrial velocity Am, ratio Em/Am, deceleration time DTEm and isovolumic relaxation time IVRTm) indexes of myocardial longitudinal motion of both ventricles were determined. The correlation analysis of the indexes of myocardial longitudinal kinetic between right and left ventricles in patients with EH was conducted.

Results and discussion. The mean level of blood pressure was 161/102 mmHg in patients with EH, 117/73 mmHg (p < 0.05) — in patients of the control group. The LV myocardial index mass was markedly higher in the study group than in the control group (102.2 ± 21.9 g/m2 versus 75.7 ± 11.8 g/m2; р < 0.001). There were the following types of LV remodeling in the study group: concentric remodeling — in 34 patients (47.9 %), concentric hypertrophy — in 25 patients (35.2 %), eccentric hypertrophy — in 3 patients (4.2 %). In the study group, the RV wall was significantly thicker in patients with concentric LV hypertrophy than in those with its normal geometry. The direct correlation between the left atrium and right atrium transverse (r = 0.3, p = 0.011) and longitudinal (r = 0.5, р < 0.001) dimensions was found. RV diastolic dysfunction of type I (72 % of patients) and type II (6 %) was detected in patients with EH. Significant difference was found between indices of the longitudinal RV myocardial kinetics: in the study group, there were significanty lower velocity of myocardial Em (0.09 ± 0.020 m/s vesus 0.14 ± 0.025 m/s); lower ratio of Em/Am (0.67 ± 0.15 versus 0.98 ± 0.24); longer isovolumic relaxation time IVRTm (28 ± 23 ms versus 7 ± 11 ms), higher ratio of E/Em (4 ± 1.1 ms versus 3 ± 1 ms) and myocardial tissue index (0.31 ± 0.11 versus 0.23 ± 0.07) than in the control group. Also a direct correlation was found between indices of the longitudinal diastolic function of both ventricles, particularly early diastolic wave Em (r = 0.25, p = 0.034), deceleration time DTEm (r = 0.37, p = 0.002) and ratio Em/Am (r = 0.27, p = 0.021).

Conclusions. Hypertensive patients with normal left ventricular contractility revealed an increase in the size of RA compared to individuals with normal blood pressure. 35.2 % hypertensive patients with concentric hypertrophy of the left ventricle showed a significant increase in the RV wall thickness compared with normal LV geometry. LV myocardial mass increase in EH patients compared to patients with normal myocardial mass is associated with changes in the longitudinal RV myocardial kinetics, namely the reduction of the longitudinal early diastolic velocity, ratio of Em/Am, increase in time of internal relaxation IVRTm, increase in myocardial tissue index and ratio of E/Еm.

Keywords: essential hypertension, right ventricle, tissue Doppler imaging, longitudinal myocardial kinetic.

24.

 

Correction of complicated coarctation of aorta with partial extracorporal bypass

S. O. Dykukha, S. O. Yakubiyk, V. I. Kravchenko, Yu. M. Таrasenko

Purpose — to show the possibilities of correction method for complex forms of coarctation of aorta with partial extracorporal bypass (PECB).

Materials and methods. A simple method of partial extracorporeal bypass in the surgical treatment of coarctation of aorta complex forms has been used since 2002 in 49 patients (aged 5 — 53 years). Left atrium and descending thoracic aorta below the coarctation were cannulated by access via left thoracotomy with blood heparinization (300 units/kg) and joined to heart-lung machine. Extracorporeal bypass was switched on, the aorta was cross-clamped and the lesion was corrected. Then, PECB was stopped (26 — 150 min). There was one death of patient with concomitant idiopathic pulmonary hypertension.

Results and discussion. 48 (98 %) of 49 patients, operated on by this method, tolerated the intervention well and were discharged.

Conclusions. Partial extracorporal bypass makes the correction of complicated coarctation defects easier and safer.

 

Keywords: coarctation of aorta, partial extracorporal bypass, surgical correction.

25.

 

Role of dyslipidemia and biochemical markers in the formation of vertebral pain syndrome in postmenopausal women depending on bone mineral density

V. V. Povoroznyuk, T. V. Orlуk, O. I. Nishkumay

Purpose — to explore the relationship between the characteristics of vertebral pain syndrome and biochemical parameters in postmenopausal women depending on the state of bone mineral density (BMD).

Materials and methods. 212 postmenopausal women aged 45 — 89 years without vertebral fractures were examined. All respondents were divided into groups depending on BMD parameters: osteoporosis (n = 45), osteopenia (n = 80), normal BMD (n = 87). All women were standardized according to age, duration of postmenopausal period, body mass index, severity of pain syndrome. Features of vertebral pain syndrome were assessed using a visual analog scale (VAS). Lipid profile and macronutrients in the blood serum were examined on the unit Rayto RT-1904C. Markers of bone metabolism were examined by Eleсsys 2010 machine. BMD was measured using dual-energy X-ray densitometer Prodigy (GE Medical systems, Lunar, model 8743, 2005).

Results and discussion. Total cholesterol levels, LDL cholesterol serum levels were higher in comparison with the normal target values for the healthy population (up to 5.0 mmol/l and 3.0 mmol/l, respectively) in all groups, but there was no significant difference between the groups. In patients with osteoporosis, correlation was established between the level of 􀁅-СТх and the presence (r = 0.36; p < 0.05) and severity (r = 0.33; p = 0.04) of pain in the thoracic region, between the level of total calcium and severity of pain in the lumbar spine (r = –0.32; p = 0.04). In patients with osteopenia, the presence of pain in the thoracic region significantly correlated with triglycerides and VLDL, and the expressiveness — with the level of β-СТх (p < 0.05). The presence of pain in the lumbar region significantly correlated with indicators of P1NP, Ca, phosphorus, triglycerides and VLDL cholesterol, and the expressiveness — with all the remodeling markers (osteocalcin, 􀁅-СТх, P1NP) and an indicator of HDL cholesterol. Patients with normal BMD showed significant correlation between the presence of lumbar pain and markers of bone formation (osteocalcin: r = – 0.57; p < 0.05; P1NP: r = –0.44; p < 0.05), the level of pain and atherogenicity coefficient (r = 0.27; p = 0.02).

Conclusions. In women with osteopenia, in distinction from women with normal bone mineral density and osteoporosis, triglycerides and very low density lipoproteins negatively correlated with the presence of pain in the thoracic region and positively — with the presence of pain in the lumbar region. Also this category of patients revealed an inverse relationship between HDL cholesterol and intensity of pain according to VAS.

Keywords: back pain, lipids, markers of bone metabolis, bone mineral density, osteoporosis.

26.

 

Pulmonary hypertension associated with left heart diseases

К. М. Amosova, L. F. Konopleva, N. V. Bereza, N. V. Shyshkina

The lecture is devoted to such problem of modern cardiology as pulmonary hypertension (PH) which occurs with diseases of the left heart. PH is hemodynamic and pathophysiological condition, characterized by the increase of the average pressure in the pulmonary artery (PA) over 25 mm Hg. according to the right heart catheterization accompanying no less than 100 diseases. Depending on the location of the increased pulmonary vascular resistance, precapillary and postcapillary forms of PH are distinguished. Postcapillary PH occurs against a background of diseases associated with systolic and diastolic dysfunction of the left ventricle (LV), mitral and aortic valve lesion, congenital and acquired obstruction of LV remote tract. Reactive postcapillary PH occurs in violation of hemodynamic correspondence between the degree of increased pressure in the left atrium and pulmonary capillaries and is accompanied by a significant increase in pulmonary vascular resistance (PVR), which causes sharp disproportionate increase in LA pressure. The lecture presents a detailed description of a clinical case of PH which developed against the backdrop of left heart lesion. Different forms of PH in the left heart disease should be treated according to the mechanism of their development. In case of passive forms of PH, success is provided by treatment of the underlying disease. Differential diagnosis of various forms of PH requires catheterization of heart cavities for measuring wedge pressure, conducting relevant pharmacological tests (with nitric oxide, iloprost, adenosine) and determining the possibility of PVR reduction. Treatment with pulmonary vasodilators is indicated for patients with a disproportionate form of postcapillary PH whose PVR exceeds 2.5 — 3 Wood units.

Keywords: pulmonary hypertension, postcapillary pulmonary hypertension, heart failure, pulmonary vascular resistance.

27.

 

Willis – Ecbome disease (restless legs syndrome)

N. Yu. Litvinova

A case of restless legs syndrome occurring in practice of surgical surgeons is described. Typical complaints and assessment scales of treatment efficacy are presented.

Keywords: restless legs syndrome, Willis – Ecbome disease.

28.

 

Surgical management of aneurismal disease of main arteries of lower extremities

A. M. Bytsay

The estimation was performed of metabolic criteria that allow predicting the risk of stratification, aneurysm wall rupture in patients suffering from the aneurismal disease of lower limb arteries. Tenets of surgical treatment algorithm of multiple arterial lesions of the arterial bed were based on a clinical case. The use of the above mentioned predictors of the aneurysm wall failure will help improve the results of surgical treatment in everyday clinical practice of a vascular surgeon.

 

Keywords: aneurysm, bypass, occlusion, matrix metaloproteinase.

29.

 

Fibromuscular dysplasia of the coronary arteries: a new version of the phenomenon

J. I. Kuzyk, O. I. Boiko

This article presents the clinical and pathological analysis of a boy’s death on the second day of life. Newborn suffered fibromuscular dysplasia of the coronary arteries and congenital heart defect. Features of this case: a) fibromuscular dysplasia of the newborn baby (innate disease); b) the formation of aneurysms of the coronary arteries without evidence of stratification; c) abnormal changes combine four topics of fibroplasia — intimal, medial, adventitial and periarterial; d) affection of the coronary arteries of a different caliber from the main trunk to intramural branches; e) casuistically rare form of combination of fibromuscular dysplasia of the coronary arteries and congenital heart defect — pulmonary artery atresia.

 

Keywords: fibromuscular dysplasia, pulmonary artery atresia, coronary artery, aneurysm, postmortem changes.

30.

 

Легочная гипертензия, ассоциированная с поражением левых отделов сердца

Е. Н. Амосова, Л. Ф. Коноплёва, Н. В. Береза, Н. В. Шишкина

Лекция посвящена актуальной проблеме современной кардиологии — легочной гипертензии (ЛГ), развивающейся при заболеваниях левых отделов сердца. ЛГ — гемодинамическое и патофизиологическое состояние, характеризующееся повышением среднего давления в легочной артерии (ЛА) более 25 мм рт. ст. по данным катетеризации правых отделов сердца, развивающееся не менее чем при 100 заболеваниях. В зависимости от локализации повышенного сопротивления в сосудах легких выделяют прекапиллярную и посткапиллярную формы ЛГ. Посткапиллярная ЛГ развивается при заболеваниях, сопровождающихся систолической и диастолической дисфункцией левого желудочка (ЛЖ), поражении митрального и аортального клапанов сердца, врожденной и приобретенной обструкции выносного тракта ЛЖ и др. Реактивная посткапиллярная ЛГ возникает при нарушении гемодинамического соответствия между степенью повышения давления в левом предсердии и в легочных капиллярах, сопровождающемся значительным ростом легочного сосудистого сопротивления (ЛСС), что приводит к резкому непропорциональному повышению давления в ЛА. В лекции приводится подробное описание клинического случая пациентки с ЛГ, связанной с патологией левых отделов сердца. Лечение различных форм ЛГ при заболеваниях левых отделов сердца должно проводиться в соответствии с механизмом их развития. При пассивной форме ЛГ к успеху приводит лечение основного заболевания. Дифференциальная диагностика разных форм ЛГ требует проведения катетеризации полостей сердца для определения давления заклинивания, проведения соответствующих фармакологических проб (с оксидом азота, илопростом, аденозином) и выяснения возможности снижения ЛСС. Лечение легочными вазодилататорами показано больным с непропорциональной формой посткапиллярной ЛГ, при которой ЛСС превышает 2,5 — 3 ед. Вуда.

Keywords: легочная гипертензия, посткапиллярная легочная гипертензия, сердечная недостаточность, легочное-сосудистое сопротивление.

31.

 

Фибрилляция предсердий после аортокоронарного шунтирования: предикторы возникновения и рецидива на протяжении шестимесячного послеоперационного периода

Б. М. Тодуров, О. И. Жаринов, О. А. Епанчинцева, О. П. Надорак

Цель работы — определить предикторы возникновения фибрилляции предсердий (ФП) после аортокоронарного шунтирования (АКШ), ее рецидивов и других осложнений при проспективном 6-месячном наблюдении.

Материалы и методы. В проспективном одноцентровом исследовании проанализировали данные, полученные при клинико-инструментальном обследовании 53 пациентов с ишемической болезнью сердца, которым была проведена операция АКШ без сопутствующих клапанных кардиохирургических вмешательств и не было данных о наличии ФП до операции. У 29 пациентов (основная группа) диагностировали послеоперационную ФП, у 24 пароксизмов ФП не зарегистрировали. Оценивали факторы, ассоциированные с возникновением ФП и осложнений при 6-месячном проспективном наблюдении.

Результаты и обсуждение. Возникновение послеоперационной ФП ассоциировалось с более высоким уровнем С-реактивного протеина, большим конечнодиастолическим размером и низкой фракцией выброса левого желудочка, более частым выявлением митральной регургитации и многососудистого поражения коронарных артерий. В целом, у 19 пациентов было зарегистрировано 26 осложнений. Четыре из них диагностировали в ранний послеоперационный период, 22 — в период 6-месячного наблюдения. В 9 случаях возникли рецидивы ФП, в том числе у 6 пациентов с ранней послеоперационной ФП.

Выводы. Группы пациентов с послеоперационной ФП и без нее значимо не отличались по количеству больших сердечнососудистых осложнений и госпитализаций при 6-месячном наблюдении. В то же время, установленные предикторы возникновения послеоперационной ФП и ее рецидивов нужно учитывать при проведении стратификации риска, оценке целесообразности и длительности профилактического применения амиодарона.

Keywords: аортокоронарное шунтирование, послеоперационная фибрилляция предсердий, осложнения, предикторы.

Current Issue Highlights

№4(60) // 2017

Cover preview

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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