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Issue. Articles

4(56) // 2016

 

 

1. Original researches

 

Resolution of ST-segment after thrombolytic therapy in patients with acute coronary syndrome in real clinical practice: frequency, influence on prognosis and predictors (retrospective concentric research) (UKR)

K. M. Amosova1, Yu. O. Sychenko2, Yu. V. Rudenko1, I. V. Prudkyi1, A. B. Bezrodnyi1

1 . . Bogomolets National Medical University, Kyiv
2 Oleksandrivska Clinical Hospital, Kyiv

The aim — to define the achievement of frequency of ST segment resolution after thrombolytic therapy (TT) in patients with acute coronary syndrome (ACS) in the real clinical practice, its influence on immediate prognosis and possible predictors (retrospective research).
Materials and methods. A retrospective analysis was conducted of case histories of 295 patients with ACS with ST-segment elevation without cardiogenic shock, who were subsequently hospitalized, received thrombolytic therapy in Oleksandrivska Clinical Hospital in 2009 and 2011 — 2013. Patients were divided according to ST segment resolution ≥ 50 % in 90 min after thrombolysis (for anterior MI — evaluation according to one lead electrocardiogram starting with the largest ST segment elevation, for non-anterior MI — evaluation according to the arithmetic sum of the largest elevation and depression of ST) after thrombolysis (with streptokinase — in 89 %, with alteplase — in 11 % cases). We analyzed the factors that affect the achievement of ST segment resolution ≥ 50 % in 90 minutes, and the effect of the resolution/non-resolution of ST segment ≥ 50 % on hospital mortality and complications of myocardial infarction.
Results and discussion. ST segment resolution ≥ 50 % in 60 min was achieved in 67 (22.7 %) pts, in 90 min — in 129 (43.7 %) pts, in 180 min — in 182 (61.7 %) patients of mean age of 64.5 ± 0.7 years with the average time of ischemia of 5.6 ± 0.6 hr. Comparison of results of treatment in two groups revealed the association of ST segment resolution ≥ 50 % in 90min with lower hospital mortality — 4 (3.1 %) cases versus 18 (10.8 %) in the group of ST < 50 %, with less occurrence of ventricular tachycardia (VT)/ventricular fibrillation (VF) in hospital period (7 (5.4 %) cases versus 16 (9.6 %) cases, as well as with combined end-points (death + nonfatal reinfarction + postinfarction angina + VF/VT — 5 (3.9 %) versus 22 (13.3 %) and death + reinfarction + VF/VT — 27 (20.9 %) versus 66 (39.8 %)) (p <0.01). Multivariate regression analysis revealed the correlation of ST segment resolution ≥ 50 % with the time of ischemia ≤ 3 hr (OR [95 % CI] = 0.63 [0.47 — 0.95]; p = 0.012). Also association was found between failure to achieve ST-segment resolution ≥ 50 % in 90 minutes and age (over 70) (OR [95 % CI] = 2.26 [1.14 — 4.11]; p = 0.02), TIMI risk score ≥ 5 (OR [95 % CI] = 2.14 [1.13 — 3.85]; p = 0.015), the presence of acute left ventricular failure (ALVF) of II — III class at admission (OR [95 % CI] = 2.38 [1.58 — 3.58]; p = 0.01).
Conclusions. In real life, ACS patients with ST segment elevation, who were admitted on average in 4.9 hours and received streptokinase in 89 % cases, demonstrated ST segment resolution ≥ 50 % in 90 minutes in 43.7 % cases, in 180 minutes — in 61.7 % cases. Such resolution was associated with a reduction in hospital mortality, frequency of potentially fatal ventricular arrhythmias (by 2.4 times) and all fatal and nonfatal cardiovascular events (by 1.9 times). The independent predictors of ST segment resolution ≥ 50 % are: age under 70 years, ischemia time ≤ 3 hours, TIMI risk score < 5, absence of ALVF.

Keywords: acute coronary syndrome, thrombolysis, ST segment resolution, ischemia time, TIMI risk score.

List of references:
1.​ Parhomenko AN, Lutay YaM, Danshan N. Ukrainian Registry of acute myocardial infarction as a fragment of Europe: characteristics of patients, the organization of medical care and hospital treatment (Rus). Ukr. Med. Chasopis [Ukrainian Medical Journal] (Ukr). 2011;1:20-24.
2.​ Sokolov MYu. Percutaneous Coronary Interventions Registry: comparative analysis of 2014-2015 years. The dynamics of regional reperfusion networks in Ukraine (Rus). Serce i sudyny [Heart and vessels] (Ukr). 2016;3:14-34.
3.    Bhatia L., Clesham G. J., Turner D. R. Clinical implications of ST-segment non-resolution after thrombolysis for myocardial infarction // J. R. Soc. Med. — 2004. — Vol. 97. — P. 566 — 570.
4.    Brener S. J., Dizon J. M., Mehran R. et al. Complementary prognostic utility of myocardial blush grade and ST-segment resolution after primary percutaneous coronary intervention: analysis from the HORIZONS-AMI trial // Am. Heart J. — 2013. — Vol. 166. — P. 676 — 683.
5.    Cenko ., Ricci B., Kedev S. et al. Reperfusion Therapy for ST-Elevation Acute Myocardial Infarction in Eastern Europe: the ISACS-TC Registry // Eur. Heart J. — 2014. — Vol. 2. — P. 45 — 51.
6.    Costantini C. O., Stone G. W., Mehran R. et al. Frequency, correlates, and clinical implications of myocardial perfusion after primary angioplasty and stenting, with and without glycoprotein IIb/IIIa inhibition, in acute myocardial infarction // J. Am. Coll. Cardiol. — 2004. — Vol. 44. — P. 305 — 312.
7.    De Lemos J. A. ST-Segment resolution as a marker of epicardial and myocardial reperfusion after thrombolysis: insights from the TIMI 14 and in TIME-II trials // J. Electrocardiol. — 2000. — Vol. 33. — P. 67 — 72.
8.    De Lemos J. A., Braunwald E. ST segment resolution as a tool for assessing the efficacy of reperfusion therapy // J. Am. Coll. ­Cardiol. — 2001. — Vol. 38. — P. 1283 — 1294.
9.    Doevendans P. A., Gorgels A. P., van der Zee R. et al. Electrocardiographic diagnosis of reperfusion during thrombolytic therapy in acute myocardial // Am. J. Cardiol. — 1995. — Vol. 75. — P. 1206 — 1210.
10.    Hof A. W. J., Liem A., Suryapranata H. et al. Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction myocardial blush grade // Circulation. — 1998. — Vol. 97. — P. 2302 — 2306.
11.    Kristensen S. D., Laut K. G., Fajadet J. et al. Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011: current status in 37 ESC countries // Eur. Heart J. — 2014. — Vol. 35. — P. 1957 — 1970.
12.    Morrow D. A. et al. Application of the TIMI Risk Score for ST-Elevation MI in the National Registry of Myocardial Infarction 3 // JAMA. — 2000. — Vol. 286. — P. 1356 — 1359.
13.    Morrow D. A. et al. TIMI Risk Score for ST-Elevation Myocardial Infarction: A Conveniet, Bedside, Clinical Score for Risk Assessment at Presentation: An Intravenous nPA for Treatment of Infarcting Myocardium Early II Trial Substudy // Circullation. — 2000. — Vol. 102. — P. 2031 — 2037.
14.    Ndrepepa G., Alger P., Kufner S. et al. ST-segment resolution after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction // Cardiol. J. — 2012. — Vol. 19. — P. 61 — 69.
15.    Park S. R., Kang Y. R., Seo M. K. et al. Clinical predictors of incomplete ST-segment resolution in the patients with acute ST segment elevation myocardial infarction // Korean Circ. J. — 2009. — Vol. 39. — P. 310 — 316.
16.    Ratcliffe A. T., Pepper C. Thrombolysis or primary angioplasty? Reperfuion therapy for myocardial infarction in the UK // Postgrad. Med. J. — 2008. — Vol. 84. — P. 73 — 77.
17.    Schroder K., Wegscheider K., Zeymer U. et al. Extent of ST-segment deviation in a single electrocardiogram lead 90 min after thrombolysis as a predictor of medium-term mortality in acute myocardial infarction // Lancet. — 2001. — Vol. 358. — P. 1479 — 1486.
18.    Sejersten M., Valeur N., Grande P. et al. DANAMI-2 Investigators. Long-term prognostic value of ST-segment resolution in patients treated with fibrinolysis or primary percutaneous coronary intervention results from the DANAMI-2 (DANish trial in acute myocardial infarction-2) // J. Am. Coll. Cardiol. — 2009. — Vol. 54. — P. 1763 — 1769.
19.    Steg P. G., James S. K., Atar D. et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation // Eur. Heart J. — 2012. — Vol. 33. — P. 2569 — 2619.
20.    Tarantini G. Acceptable reperfusion delay to prefer primary angioplasty over fibrin-specific thrombolytic therapy is affected (mainly) by the patient’s mortality risk: 1 h does not fit all // Eur. Heart J. — 2010. — Vol. 31. — . 676 — 683.
21.    Van de Werf F., Chairperson J. B., Betriu A. et al. ESC Guidelines Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation // Eur. Heart J. — 2008. — Vol. 29. — P. 2909 — 2945.
22.    Widimsky P., Groch L., Zelizko M. et al. Multicentre randomized trial comparing transport to primary angioplasty vs immediate thrombolysis vs combined strategy for patients with acute myocardial infarction presenting to a community hospital without a catheterization laboratory. The PRAGUE study // Eur. Heart J. — 2000. — Vol. 21. — P. 823 — 831.
23.    Widimsky P., Wijns W., Fajadet J. et al. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries // Eur. Heart J. — 2010. — Vol. 31. — P. 943 — 957.
24.    Zijlstra F., Patel A., Jones M. et al. Clinical characteristics and outcome of patients with early (< 2 h), intermediate (2 — 4 h) and late (> 4 h) presentation treated by primary coronary angioplasty or thrombolytic therapy for acute myocardial infarction // Eur. Heart J. — 2002. — Vol. 23. — P. 550 — 557.

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Original language: Ukrainian

2. Original researches

 

Experience of right heart and pulmonary artery catheterization in patients with pulmonary hypertension (UKR)

Yu. M. Sirenko1, G. D. Radchenko1, I. O. Zhyvylo1, N. A. Krushynska1, O. Yu. Sirenko2, O. O. Danylenko1

1 SI «National Scientific Centre «M. D. Strazhesko Institute of Cardiology» of NAMS of Ukraine», Kyiv
2 SI «M. M. Amosov National Institute of Cardiovascular Surgery of NAMS of Ukraine», Kyiv

The aim — of the research was the evaluation of pulmonary and systemic hemodynamics in patients with pulmonary arterial hypertension (PAH) in Ukraine.
Materials and methods. Right heart and pulmonary artery (PA) catheterization was performed on 50 patients with probable or highly probable (PAH) based on the echocardiography data. All patients underwent echocardiography before the procedure of catheterization. Using the standard method we calculated the end-diastolic and end-systolic volumes of the left ventricle. We calculated the sizes of stroke volume and minute volume of blood flow with the use of echocardiography. Evaluation of systolic pulmonary artery pressure by echocardiography method was performed by determining the maximum speed of tricuspid regurgitation on the basis of pressure in the right atrium. The pressure in the right atrium was determined by echocardiography, based on the diameter and respiratory fluctuations of diameter of inferior vena cava. During the right heart and PA catheterization we measured central and pulmonary hemodynamics as well as arterial and mixed venous blood gas consistency data.
Results and discussion. The diagnosis of pulmonary hypertension was confirmed in 48 patients. According to the results of catheterization, the diagnosis of pulmonary arterial hypertension was cancelled in two patients: systolic pressure volume in PA was less than 25 mm Hg. The value of cardiac index according to echocardiography was 2.42 ± 0.12 l/min/m2, according to direct measurements by thermodilution method — 2.22 ± 0.12 l/min/m2. The percentage of the error (difference between the values exceeding 0.25 l/min/m2) was 80 % (40 out of 50 patients). The value of systolic pulmonary artery pressure according to echocardiography data was 94.1 ± 3.6 mm Hg, while according to the catheterization method it was 88.8 ± 4.1 mm Hg. The percentage of the individual errors (difference between the values exceeding 10 mm Hg) was high and comprised 80 % (40 out of 50 patients).
Conclusions. Right heart and PA catheterization is the only reliable method for diagnosing and assessing the illness severity in patients with pulmonary arterial hypertension. It is possible to use echocardiography data only for screening purposes.

Keywords: pulmonary hypertension, right heart and pulmonary artery catheterization, average pressure in pulmonary artery, thermodilution, SwanGanz catheter.

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Original language: Ukrainian

3. Original researches

 

Efficiency estimation of algorithmic antihypertensive therapy in patients with uncomplicated hypertension depending on initial indicators of central hemodynamics and diastolic left ventricular function (UKR)

Yu. V. Rudenko

O. O. Bogomolets National Medical University, Kyiv

The aim —  to determine clinical and demographic factors, indicators of structural and functional state of left ventricle (LV), in particular, its diastolic function according to the tissue Doppler and central hemodynamic parameters which are associated with the achievement of the target office blood pressure (BP) in patients with uncomplicated hypertension after 6 months of algorithmic antihypertensive therapy on the basis of a fixed combination of perindopril and amlodipine.
Materials and methods. The study included 91 patients with uncomplicated essential hypertension, not previously treated, with blood pressure ≥ 160/100 mm Hg or ≥ 140/90 mm Hg. Office and home blood pressure was measured using standardized oscillometric devices with a universal or individually fitted cuff. Treatment algorithm presupposed the prescription of a fixed combination of perindopril and amlodipine, followed by titration and the sequential addition of indapamide, spironolactone, moxonidine or doxazosin during the following visits in 7 days, 1, 2, 3 and 6 months in case of failure to reach the target office BP. The parameters of central hemodynamics were determined prior to treatment with the use of applanation tonometry. At baseline and at 6 months, Doppler with Tissue Doppler was performed to identify key structural and functional parameters of left ventricle and its diastolic function. Adherence to treatment was measured at baseline and after 6 months using X. Girerd questionnaire.
Results and discussion. After 6 months, control of office BP was achieved in 60 (65.9 %) patients (group 1) and was not achieved in 31 (34.1 %) patients (group 2). In group 1, original office systolic (SBP) and diastolic (DBP) blood pressure (p < 0.001, p < 0.01), central SBP (p < 0.03), left atrial volume (p < 0.05), interventricular septum thickness, posterior wall, relative wall thickness (all p < 0.03), myocardial mass (MM), LV MM index (p < 0.05, p < 0.01) before and after treatment were significantly smaller than in group 2. Throughout the study the groups did not differ in the volume of transmitral flow, speed characteristics of motion of the mitral valve ring, in particular, E/e′, the detection rate of LV diastolic dysfunction (before and after treatment — 13 (21.7 %) vs. 8 (25.8 %) and 12 (20 %) vs. 7 (22.6 %) patients, respectively). After 6 months, in group 1 the percentage of people with high adherence to treatment significantly increased (p < 0.01), the percentage of people with low adherence — decreased (p < 0.001). In the group 2 this percentage did not changed significantly. According to multivariate linear regression analysis with the achievement of the target office blood pressure at 6 months, only lower initial office SBP and the increase of adherence to treatment (β (95 % CI): –0.492 (–0.025... –0.019); p = 0.005 and –0.363 (–0.265... –0.019); p = 0.025, respectively) independently associated with each other.
Conclusions. Independent factors associated with the achievement of the target office blood pressure at 6 months of algorithmic antihypertensive treatment of patients with uncomplicated hypertension are high adherence to treatment and lower baseline office SBP. Structural and functional state of the left ventricle and the initial values of the central hemodynamics parameters according to applanation tonometry do not affect the achievement of optimal office blood pressure control in 6 months of algorithmic antihypertensive therapy of patients with uncomplicated hypertension. 6 months′ algorithmic antihypertensive therapy on the basis of a fixed combination of perindopril and amlodipine in patients with uncomplicated hypertension did not cause any changes in LV diastolic function, in particular, E/e′, despite the significant decrease in blood pressure

Keywords: arterial hypertension, antihypertensive therapy, perindopril, amlodipine, diastolic left ventricular function.

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Original language: Ukrainian

4. Original researches

 

Morphological changes in pig iliac artery walls after implantation of β-zirconium alloy spiral device for closing arterial duct (preliminary report) (RUS)

Yu. V. Panichkin1, I. O. Skiba2, V. P. Zakharova1, M. L. Zhuravleva1,
V. M. Besleaga1, E. V. Besleaga1, Yu. O. Ruzhin1

1 SI «M. M. Amosov National Institute of Cardiovascular Surgery of NAMS of Ukraine», Kyiv
2 G. V. urdyumov Institute of Metal Physics of NAS of Ukraine, Kyiv

The aim — to study the response of the artery walls to implant of an alien body into it — an occluder made of low modulus β-zirconium alloy.
Materials and methods. Biocompatibility and histotoxicity of products from low modulus β-zirconium alloy were studied in five clinically healthy animals — pigs weighing 30 — 35 kg. The occluders were implanted in vascular bed of pigs by X-linked Immune Defect method under echocardiography control. The animals were taken out of the experiment in 2.5 months. Samples of blood vessel sections, surrounding tissue and the occluder were taken. Macro- and microscopic examination provided for determination of the degree of endothelisation, thrombosis, inflammation, necrosis, calcification, the presence of foreign bodies and their replacement by connective tissue.
Results and discussion. Macroscopic research of tissue areas in the zone of implantation of the occluder showed that the animals used in experiment had no signs of infection. The position of each of the implanted devices corresponds to the original place of installation. Thrombuses, vegetation, abnormal structures or destruction were not found. The interior surfaces of the introduced spirals are covered with pale, smooth, shiny fabric. Microscopic examination showed that a capsule of fibrosis neointima is formed around β-zirconium alloy based occluder in 2.5 months after its implantation in the lumen of the artery. Severity of manifestations depends on mechanical action of the the occluder on the surrounding tissue and is largely determined by the design of the product. Proliferation of elements of neointima spread in the distal direction from the occluder.
Conclusions. Transcatheter implantation of β-zirconium alloy occluder is safe and effective technique in animal models. Proliferation of neointima is a normal physiological response to intervention of a foreign body in the body of the animal. The study results suggest the need for further testing of the device on animals. If they are positive and reliable, we can proceed to clinical trials.

Keywords: patent ductus arteriosus, heart occluder, biological model, β-zirconium alloy.

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Original language: Russian

5. Original researches

 

Level of galectin-3 in patients with hypertrophic cardiomyopathy (RUS)

V. Y. Tseluyko, S. Daghar

Kharkiv Medical Academy of Postgraduate Education, Ministry of Health Care of Ukraine

The aim — investigation of relationship between galectin-3 (Gal-3) level and clinical manifestations in patients with hypertrophic cardiomyopathy (HCMP).
Materials and methods. The study included 90 patients with HCMP, confirmed by clinical, instrumental and anamnestic data in accordance with the recommendations of the European Society of Cardiology (2014). The methods of examination were electrocardiography, echocardiography, daily ECG monitoring, and level of Gal-3 in the blood serum. Gal-3 content was performed by ELISA.
Results and discussion. The level of Gal-3 in patients with HCMP is characterized by high variability and increases with age. No significant differences were found in the level of Gal-3 depending on the hemodynamic variants, degree of hypertrophy, localization, prevalence and symmetry of lesion. The relationship was established between the level of Gal-3 and the nature of the patients’ complaints. The correlation was found between Gal-3 level and pain in the heart (rs = 0.288, p = 0.021), dyspnea (rs = 0.293, p = 0.005), impaired cardiac rhythm (rs = 0.259, p = 0.014) and general weakness (rs = 0.218, p = 0.04). The level of Gal-3 was higher in patients with heart failure and atrial fibrillation.
Conclusions. Increase of Gal-3 level in patients with HCMP is associated with the severity of clinical manifestations of the disease, presence and severity of heart failure, atrial fibrillation.

Keywords: hypertrophic cardiomyopathy, clinical and anamnestic data, galectin-3, correlation analysis.

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Original language: Russian

6. Original researches

 

State of arterial hemodynamics according to analysis of pulse wave in young adults with juvenile idiopathic arthritis (UKR)

K. M. Amosova1, M. B. Dzhus1, T. V. Marushko2, N. V. Shyshkina1, O. I. Rokyta1, H. V. Mostbauer1, T. A. Karasevska1, O. I. Ivashkivskyy3

1 O. O. Bogomolets National Medical University, Kyiv
2 P. L. Shupyk National Medical Academy of Postgraduate Education, Kyiv
3 Oleksandrivska Clinical Hospital, Kyiv

The aim — the determination of arterial hemodynamics condition according to the analysis of the pulse wave in adult patients with juvenile idiopathic arthritis (JIA) and comparison with clinical course and traditional cardiovascular risk factors.
Materials and methods. The study involved 57 adults with JIA history regardless of the presence or absence of active inflammation at the time of inspection. 38 (82.6 %) patients examined by us had active disease. The control group consisted of 37 healthy patients, age and sex matched. Non-invasive measurement of vascular stiffness and central blood pressure (BP) was performed by tonometry. Augmentation index (Ax), central and brachial blood pressure were measured. Pulse wave velocity (PWV) in the aorta was measured by sphygmographic method on SphygmoCor PWX. Registration of pulse wave in carotid and radial arteries was performed.
Results and discussion. A comparison of cardiovascular (CV) risk factors of patients with JIA and control group showed no difference in smoking, level of total cholesterol and glucose level, Framingham CV risk (all p > 0.05). However, patients with JIA had significantly higher CRP (p = 0.001). Arterial hemodynamics analysis according to pulse wave data of patients with JIA in comparison with healthy control (all > 0.05) showed no difference in brachial and central BP, augmentation pressure (AP), Ax75, and PWV (all > 0.05). Patients with JIA were divided into two groups: I group— 16 patients with IV x-ray stage of joint space narrowing, which determined more aggressive course of JIA, II group — 41 patients with I — II x-ray stage of joint space narrowing. According to the traditional CV risk factors and their integral indices by Framingham scale, the two groups had no significant difference between each other (all p > 0.05) except the lower body weight in I group (p < 0.005). The comparison of arterial hemodynamics in two groups of JIA patients showed Δ systolic BP (measured as difference between central BP and brachial BP) reduction in I group and the absence of differences in indices in II group compared to controls (p > 0.05). At the same time average values of AP and AIx 75 in I group were higher than in II group (p < 0.05 and p < 0.001, respectively). PWV in both groups did not differ. The results of the present study of adult patients (mean age 23.2 ± 6.73 years) with a prolonged course of JIA (12.7 ± 6.2 years) compared with healthy group, matched by age, sex and by all traditional CV factors, showed no change in the PWV in general group of patients. No change in PWV values can be explained to a certain extent by the fact that it was determined on the muscular arteries of the upper extremities and not on aorta and iliac arteries, which is the subject of the next phase of our work. Indicators of arterial hemodynamics in I group differed from those in II group by increasing AP, Ax 75 (p < 0.001) at the same levels of brachial and central BP. Increased levels of AIx 75 may be connected both with the seal of aorta and increase of PWV on it, and with the increased tone of small arteries and/or their initial remodeling. JIA patients with the initial signs of a pulsating hemodynamic disorder require careful control of the traditional risk factors during clinical supervision, in particular, BP control, glucose and lipid metabolism control in order to make timely correction of possible changes, including prescription of statins and inhibitors of the renin-angiotensin system.
Conclusions. JIA patients (average age 23.2 ± 6.7 years) with severe joint space narrowing (IV x-ray stage), resulting from aggressive disease in childhood, show increased AP and and reduced Δ systolic BP according to pulse wave analysis of arterial hemodynamics, compared to healthy individuals and patients with JIA without severe destructive changes in the joints (I — II x-ray stage)

Keywords: juvenile idiopathic arthritis, joint destruction, surrogate markers of atherosclerosis, pulse wave velocity, augmentation index, blood pressure.

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Original language: Ukrainian

7. Original researches

 

Model of formation of contolled hind limb ischemia in a rabbit (UKR)

N. Yu. Litvinova, V. A. Chernyak, D. Ye. Dubenko

O. O. Bogomolets National Medical University, Kyiv

The aim — to develop an anatomically based model of controlled chronic hind limb ischemia (HLI) in a rabbit, which does not lead to acute arterial anemia in the laboratory animal, does not increase early postoperative mortality and makes it possible to recreate chronic HLI of early stages in laboratory animals.
Materials and methods. We operated on four rabbits of Chinchilla breed. In 4 weeks we studied the state of the hind limb and general condition of the animal according to the following criteria: one-time traveled distance, duration of sleep, sparing of the operated limb during walking and running, the results of microcirculation study by laser flowmetry, data of histology research.
Results and discussion. One-time traveled distance of operated rabbits was 6.1 ± 0.4 m (narrowing of 1/3 of the lumen) and 1.9 ± 0.2 (narrowing of 1/2 of the lumen), temperature of the operated limb decreased to 34.6 ± 1.1 °C (narrowing of 1/3 of the lumen) and 33.7 ± 1.4 °C (narrowing of 1/2 of the lumen). Daily sleep duration of operated rabbits decreased to 7.5 ± 0.2 h (narrowing of 1/3 of the lumen) and to 6.9 ± 0.5 h (narrowing of 1/2 of the lumen). According to laser flowmetry, all operated rabbits had decrease of microcirculation indexes in the operated limb by 20 — 40 % ( < 0.05). Most models of controlled hind limb ischemia in the rabbit were based on the development of collateral vessels between the internal and external iliac arteries. However, this approach is not optimal.
Conclusions. We have developed a model of controlled hind limb ischemia which leads to ischemic changes in the hind limb of the rabbit, corresponding to stages III — IV of Fontaine classification. The proposed model of controlled hind limb ischemia in the rabbit is anatomically reasonable, does not cause acute ischemia of the operated limb, does not lead to the development of septic complications on the part of the wound in view of a single-step intervention and primary closure of the wound.

Keywords: controlled hind limb ischemia in a rabbit, chronic hind limb ischemia, atherosclerosis, peripheral artery disease.

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Original language: Ukrainian

8. Original researches

 

Renal function in patients with systolic chronic heart failure depending on quality of life (UKR)

V. P. Ivanov, Yu. V. Savicjka

M. I. Pirogov Vinnitsa National Medical University

The aim — to determine the renal function in patients with systolic chronic heart failure (CHF) depending on the quality of life (QOL) based on MHFLQ and SF-36 questionnaire.
Materials and methods. We examined 113 patients with systolic CHF of II — III functional class (FC) by NYHA of ischemic and hypertensive etiology aged 60.2 ± 0.7. The allocation of different clinical groups was based on QOL indicators: total score on MHFLQ questionnaire, physical (PH) and mental health (MH) components of the SF-36 questionnaire. To evaluate the functional state of the kidney, serum creatinine levels were determined in plasma, glomerular filtration rate (GFR) was calculated and albumin content in a daily urine sample was assessed.
Results and discussion. Proteinuria was recorded in 30.1 % and microalbuminuria (MAU) — in 36.2 % cases. The average level of albuminuria was (163 ± 12.2) mg/day, creatinine in blood plasma — 100.2 ± 1.6 mmol/l, GFR — 66.7 ± 1.0 ml/(min · 1.73 m2) and lower. In this case, 69.9 % of cases were recorded of GFR over 60 ml/(min · 1.73 m2) and in the remaining 30.1 % — 60 ml/(min · 1.73 m2) and less. Assessment of renal function, depending on the quality of life by MHFLQ questionnaire and PH and MH components according to SF-36 questionnaire showed a significant increase in creatinine and albuminuria levels in plasma as well as a decrease in glomerular filtration rate and increase in frequency of GFR of 60 ml/(min · 1.73 m2) or less among patients with relatively low indicators of quality of life, PH and MH components compared to patients with relatively satisfactory and relatively high indicators of quality of life, PH and MH components.
Conclusions. Patients with systolic heart failure of II — III FC by NYHA of ischemic and hypertensive etiology manifest proteinuria in 30.1 % cases, MAU — in 36.2 % cases, GFR > 60 ml/(min · 1.73 m2) — in 69.9 % cases, GFR ≤ 60 ml/(min · 1.73 m2) — in 30 1 % cases. Relatively low QOL by MHFLQ, PH and MH by SF-36 questionnaire in patients with systolic CHF of II — III FC by NYHA of ischemic and hypertensive etiology is associated with quite severe functional impairment of the kidneys, particularly with a significant increase in serum creatinine, MAU and a growing proportion of people with GFR ≤ 60 ml/(min · 1.73 m2).

Keywords: chronic heart failure, quality of life, physical health component, mental health component, microalbuminuria, glomerular filtration rate.

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Original language: Ukrainian

9. Original researches

 

Comparative evaluation of pulse wave velocity measurement with the use of reography and Doppler ultrasound (RUS)

L. V. Zhuravlyova1, N. A. Lopina1, 2, I. V. Kuznetsov2, T. I. Ermolenko1,
O. V. Pechenin3, V. G. Sergeev3, D. Y. Volkov4, D. O. Lopin4

1 Kharkiv National Medical University
2 Regional Hospital — Center for Emergency Medical Care and Disaster Medicine, Kharkiv
3 M. Y. Zhukovsky National Aerospace University «Kharkiv Aviation Institute»
4 SI «V. T. Zaytsev Institute of General and Emergency Surgery of NAMS of Ukraine», Kharkiv

The aim — of research was to develop a technique for measuring pulse wave velocity (PWV) using ReoCom rheograph and to hold a  comparative evaluation of the PWV measurement results based on rheograph and Doppler ultrasound data.
Materials and methods. 52 patients with coronary artery disease (32 men, 20 women), mean age of 59.6 ± 9.1 years, were examined in the cardiology department of Regional Hospital — Center for Emergency Medical Care and Disaster Medicine in Kharkiv. The control group consisted of 20 healthy volunteers of corresponding gender and age. The measurements of PWV were carried out on ReoCom rheograph (HAI Medica, Ukraine). Doppler assessment of PWV was also measured on Toshiba Aplio 400 unit (Japan) with ECG synchronization. Blend—Altman method was used to assess the reproducibility of the technique suggested by us. The coefficient of variation was calculated to evaluate the variability of traits. To evaluate the specificity and sensitivity of the diagnostic model aimed at assessment of the vascular stiffness we used ROC-analysis and calculation of the area under the ROC-curve. Comparability of qualitative indicators was assessed by Κ (kappa) index.
Results and discussion. A strong correlation was revealed between the two values of PWV measured in two ways — by using Doppler ultrasound and ReoCom rheograph (r = 0.99, p < 0.0001). The assessment of intraoperative and interoperative reproducibility of method for measuring PWV with ReoCom rheograph showed the values of variation coefficient of 4.28 % and 5.31 %, respectively, which did not exceed 10 % — a permissible value for well-reproducible indices. Good agreement of measurements was revealed during intraoperative and interoperative assessment of PWV using ReoCom rheograph, as well as consistency of measurements conducted using rheograph and ultrasonic technique according to Blend—Altman diagrams. Informative value for the presence of increased vascular stiffness in our study was 8.4 m/s for the value of PWV, the sensitivity and specificity of the proposed technique for identifying patients with increased vascular stiffness were high — 95.3 % and 91.7 %, respectively. The area under the ROC curve (AUC) was 0.964 ± 0.015 (95 % CI — 0.921 — 0.988; p < 0.0001). Assessment of the consistency of PWV measurement results using ReoCom rheograph with the selected standard of comparison — ultrasound technique —revealed a high degree of consistency of the results (Κ index of 0.894 ± 0.016).
Conclusions. Rheography using ReoCom four-channel rheograph allows to measure PWV with high sensitivity and specificity, acceptable intraoperative and interoperative reproducibility, and high consistency of measurement results with Doppler ultrasound data.

Keywords: pulse wave velocity, vascular stiffness, rheography.

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10. Original researches

 

First experience of using tissue Doppler for verification of chronic heart failure with preserved ejection fraction of left ventricle: clinical characteristics and evaluation of morphological and functional condition of the heart (RUS)

K. I. Cherniaieva, A. B. Bezrodnyi

O. O. Bogomolets National Medical University, Kyiv

The aim — to evaluate clinical characteristic, type of diastolic dysfunction based on the results of transmitral flow, character and prevalence of non-cardiac comorbidities in patients with chronic heart failure (CHF) and preserved ejection fraction (EF) of left ventricle (LV) which was verified according to the criteria of European Society of Cardiology (ESC), 2016, based on the data of tissue Doppler.
Materials and methods. 17 hemodynamically stable patients were selected with the diagnosis of CHF of IIa or IIb stage and preserved LV EF of II or III functional class (FC) by NYHA. The selection criteria were: clinical symptoms and signs of CHF, LV EF > 45 %, left ventricle hypertrophy, dilatation of the left atrium, absence of valvular heart disease, pulmonary arterial hypertension and venous thromboembolism, myocarditis, pericarditis. Tissue Doppler was performed with the definition of ratio of the early diastolic transmitral flow E velocity and early diastolic lateral and septal motion of segments of the mitral ring ′ (E/e′). 15 patients were selected with a score of E/e’ greater than 13. Types of diastolic dysfunction were determined according to the transmitral blood flow — E/A, DT and IVRT.
Results and discussion. The patients’ age was 64.1 ± 3.0 years, 58.8 % (10 patients) were over 60 years old, the majority were men — 12 (70.6 %) patients. In 15 patients, CHF with preserved LV EF met the criteria ESC, 2016. According to the results of tissue Doppler they had: LV EF — 54.8 ± 1.2 %; LV wall thickness — 1.3 ± 0.02 cm; diameter of left atrium — 4.4 ± 0.13 cm; square of left atrium — 21.4 ± 0.7 cm2; diameter of right ventricle — 2.5 ± 0.0 cm; /′ — 14.44 ± 0.15; pulmonary artery pressure > 30 mm Hg in 14 (93.3 %) patients. The velocity of the mitral annulus movement was 4.8 ± 0.3 cm/sec for the lateral wall and 5.3 ± 1.4 cm/sec for the septum. There were 10 patients (73.4 %) with IIa and 4 patients (26.6 %) with IIb stage of CHF according to Strazhesko—Vasylenko classification. According to NYHA classification, II functional class was found in 10 (73.4 %) patients and functional class — in 4 (26.6 %) patients. Comorbidities were revealed: obesity (BMI > 30 kg/m2) — in 60 % patients; anemia (hemoglobin < 120 g/l (for women), hemoglobin < 130 g/l (for men)) — in 13.3 %; chronic obstructive pulmonary disease (post-bronchodilation value of FEV1/FVC less than 70 %) — in 13.3 %; chronic kidney disease (glomerular filtration rate less than 60 ml/(min · 1.73 m2)) — in 20 %, type 2 diabetes (glycosylated hemoglobin ≥ 6.5 %) — in 26.7 %, permanent form of atrial fibrillation — in 6.6 % patients. According to the type of diastolic dysfunction, the patients were distributed as follows: type I — in 4 (26.7 %), type II — in 11 (73.3 %), type III was not found in any of the patients.
Conclusions. Indexes of transmitral flow based on the Doppler echocardiography not necessarily reflect diagnostically significant impairment of left ventricle diastolic function. Type III of diastolic dysfunction was not identified in any patients, type I was found in 26.7 % of patients, type II — in 73.3 % of 15 patients with E/E ‘more than 13 and symptoms and clinical signs of CHF (including symptoms of systemic venous congestion in 20 % of patients), LVEF more than 45 %, LV wall thickness of more than 1.1 cm in diameter, left atrium diameter of more than 4 cm. There was at least 1 noncardiac concomitant disease, more often obesity (60 %), in all of our patients, 2 comorbidities — in 7 patients, and 3 or more comorbidities — in 4 patients.

Keywords: chronic heart failure, ejection fraction, tissue Doppler, comorbidity.

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11. CASE FROM PRACTICE

 

First case of use of rotary atherectomy in patient with ostial calcified lesion of right coronary artery (RUS)

S. . Furkalo1, S. V. Salo2, I. V. Khasyanova1

1 SI «O. O. Shalimov National Institute of Surgery and Transplantation of NAMS of Ukraine», Kyiv
2 SI «M. M. Amosov National Institute of Cardiovascular Surgery of NAMS of Ukraine», Kyiv

Rotational coronary atherectomy is one of the supporting methods aimed to improve the results of endovascular treatment. The main indication for use is the narrowing of the coronary arteries, which make it impossible to apply the conventional balloon angioplasty with the use of a usual plastic balloon-catheter, so-called «non-dilatable» stenoses. In most cases, they are calcium-containing artery stenosis, ostial arterial stenosis, restenotic lesions and bifurcation lesions in some cases. Currently rotational ablation is used in about 3 — 5 % cases. A case was presented of successful use of rotational atherectomy in the treatment of a patient with chronic ischemic heart disease and significant calcification of coronary arteries.

Keywords: calcification, rotational atherectomy, angioplasty.

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12. CASE FROM PRACTICE

 

Aneurysm of the deep femoral artery or soft tissue tumor? (UKR)

V. M. Rogovsky1, B. M. Koval2, Yu. V. Nagalyuk2, K. V. Krynychka3

1 National Military Clinical Medical Centre «MMCH» Ministry of Defense of Ukraine, Kyiv
2 O. O. Bogomolets National Medical University, Kyiv
3 «Vyshgorod Central District Hospital»

Post-traumatic aneurysms are the most common among the aneurysms of the femoral artery. Most aneurysms of femoral artery are symptomatic, in some cases they have few symptoms or are asymptomatic, which complicates the diagnostic process due to the «mimicry» with soft tissue tumors. Considering that, according to statistics, about half of patients with peripheral arterial aneurysms are admitted to hospital in the stage of complications, the treatment involves an active surgical approach because of the great risk of further complications (rupture, thrombosis, embolism). A clinical case of diagnosis and surgical treatment of a false aneurysm of the deep femoral artery of the lower limb has been described.

Keywords: aneurysm, false aneurysm, post-traumatic aneurysm, deep femoral artery.

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13. CLINICAL CASE STUDIES

 

Clinical-morphological changes after selective arterial embolization for benign prostatic hyperplasia (UKR)

S. V. Golovko1, O. F. Savitsky2, A. A. Kobirnichenko1, A. V. Lysak3, I. L. Troitskiy1

1 National Military Clinical Medical Centre «Chief Military Clinical Hospital» of DM Ukraine, Kyiv
2 Ukrainian Military Medical Academy, Kyiv
3 Central Pathological Anatomical Laboratory of DM Ukraine, Kyiv

Selective arterial embolization (SAE)  is a method of treatment of patients with symptomatic benign prostatic hyperplasia (BPH). The treatment is a safe, minimally invasive intervention with a low risk of complications and minimal side effects. This method provides effective relief of symptoms in lower urinary tract of patients, for whom the previous non-invasive methods of treatment were ineffective. Knowledge of histological characteristics of prostatic tissue after SAE is limited at the moment. In our investigation, microscopic characteristics of prostatic tissues of one patient after SAE for BPH are presented. Detection and comparison of changes appearing after application of this method of treatment play an important role in the differential diagnosis of chronic granulomatous reactions in prostatic tissue.

Keywords: selective arterial embolization, benign prostatic hyperplasia.

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14. Reviews

 

Role of dietery fibres in prevention of cardiovascular diseases (UKR)

H. D. Fadieienko, H. S. Isaeva, L. A. Reznik

L. T. Mala National Therapy Institute of NAMS of Ukraine, Kharkiv

One of the most effective approaches to prevention of cardiovascular diseases is commitment to healthy and nutritious food. In our review we present the results of clinical trials and meta-analyses which showed an association between dietary fiber intake and risk of cardiovascular disease, as well as mortality from them. It has been shown that an increase in fiber intake reduces the risk of cardiovascular disease. Most relation is established for the insoluble fiber and cereal fiber. The fiber source is fruits which reduce the risk of cardiovascular disease in general, but has no effect on the risk of coronary heart disease. Analysis of the relationship between the dose of fiber consumption and mortality showed that 10 g increase in dietary fiber intake of per day is associated with reduced mortality from cardiovascular disease by 9 % and from coronary heart disease — by 11 %. This paper analyzes the most important pathogenetic mechanisms of the beneficial effects of dietary fiber on the cardiovascular system.

Keywords: cardiovascular disease prevention, dietary fibre.

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15. Reviews

 

Methods of percutaneous interventions in pathology of mitral valve in patients with high surgical risk (UKR)

E. Yu. Marushko, O. A. Shapovalova, G. B. Mankovsky, K. A. Revenko,
O. S. Gurieva, S. O. Kuzmenko, N. M. Rudenko, I. M. Yemets

SI «Scientific and Practical Medical Center of Pediatric Cardiology and Cardiac Surgery of Ministry of Health of Ukraine», Kyiv

Review and analysis of the literature was performed on the methods of percutaneous interventions on the mitral valve in patients with severe mitral insufficiency and high surgical risk. The unique interventional tools and prosthetic devices described in the article provide for conducting a plurality of percutaneous interventions in the pathology of the mitral valve in patients with a high surgical risk.

Keywords: mitral valve, percutaneous interventions.

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16. Reviews

 

Ischemic heart disease in patients with granulomatosis and polyangiitis (UKR)

H. V. Mostbauer, M. B. Dzhus, D. Sh. Sichinava

O. O. Bogomolets National Medical University, Kyiv

Granulomatosis with polyangiitis (GPA) is necrotizing granulomatous inflammation of the upper or lower respiratory tract and necrotizing vasculitis of blood vessels of small and medium diameter (capillaries, venules, arterioles, arteries and veins) that is often associated with necrotizing glomerulonephritis. However, other organs and systems may be involved in the pathological process. The involvement of the cardiovascular system in GPA occurs in 6 — 44 % of cases and influences the desease prognosis. In most cases, pericarditis or coronaritis develop, rarely myocarditis, endocarditis occur with the development of heart valve disease, acute myocardial infarction, heart rhythm disturbances and conduction. Subclinical  or asymptomatic forms are typical for heart involvement in GPA. The literature data on the accelerated development of atherosclerosis in this disease are limited and contradictory.

Keywords: granulomatosis with polyangiitis, cardiovascular system, atherosclerosis, ischemic heart disease, acute myocardial infarction.

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17. Reviews

 

Complications of coronarography and percutaneous coronary intervention (RUS)

. . Yankevich

Kharkiv National Medical University

Interventional cardiology has become a powerful tool of medical care for patients with ischemic heart disease in the recent days. The growing number of coronarography and percutaneous coronary intervention procedures requires better understanding of possible complications. There are some predisposing factors, like use of some medications, arterial access site or method of hemostasis achievement, which can be effectively modified by medical care providers to decrease related risk. In addition, good awareness of specific peculiarities of complications allows prompt recognizing and managing of them. In this review, a wide spectrum of periprocedural complications is discussed: from those causing little discomfort to life-threatening events.

Keywords: complications, coronarography, percutaneous coronary intervention.

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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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