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Issue. Articles

3(59) // 2017

 

 

1. Original researches

 

Worsening renal function in acute decompencated heart failure: clinical significance with account of reversibility and predictors of irreversibility (UKR)

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. Prudkyi 1&a

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

The aim —  to determine the frequency of worsening renal function (WRF) and its clinical significance with reversibility/irreversibility and their predictors in so-called «wet and warm» patients with acute decompensated heart failure (ADHF).
Materials and methods. The prospective study involved 141 patients with ADHF aged from 38 to 85 years old (mean age 66.4 ± 2.2) who were sequentially hospitalized in the cardiological departments of Oleksandrivska Clinical Hospital in Kyiv during 2012 — 2014. 38 patients had WRF, among them 30 — were transient and 8 were persistent. On the first, the third and on a discharge days (D1, D3 and Ddsc) the amount of NT pro-BNP and neutrophil gelatinase-associated lipocalin NGAL were detected in the serum in 67 patients by immunoassay.
Results and discussion. Patients with WRF, despite reversibility, demonstrated more critical condition, than patients without WRF, taking into account manifestations of heart failure at admission and at discharge as well (p < 0.05 ). According to orthopnea-edema index A. Lala, the condition of the group with persistent WRF was more critical than the group without WRF: at admission (3.92 ± 0.12 vs 3.33 ± 0.10, p < 0.05), at D3 (3.63 ± 0.11 vs 2.70 ± 0.08, p < 0.01) and at Ddsc (2.72 ± 0.08 vs 2.03 ± 0.05, p < 0.01). The duration of hospital treatment was significantly different between all groups and the group with persistent WRF had the longest duration, in comparison with the group with transient WRF (p < 0.01) as well.
Conclusions. WRF is observed in 27 % of patients with ADHF with the so-called «wet and warm» phenotype, and in most cases (79 %) it is of a transient type. Predictor of resistant WRF is increased biochemical marker of kidney damage NGAL upon admission and its further increase in 48 hours.

Keywords: worsening renal function, acute decompensated heart failure, neutrophil gelatinase-associated lipocalin, decongestion and glomerular filtration rate.

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Original language: Ukrainian

2. Original researches

 

Predictors of 36-month survival in patients with chronic heart failure and reduced left ventricular ejection fraction depending on gender (UKR)

L. G. Voronkov, O. L. Filatova, A. V. Lyashenko, N. A. Tkach, P. N. Babych

S «National Scientific Centre „M.D. Strazhesko Institute of Cardiology“ of NAMS of Ukraine», Kyiv

The aim —  comparison of survival rates and predictors of the onset of lethal outcome in men and women with chronic heart failure (CHF) with reduced left ventricular ejection fraction (LVEF) during 36 month follow-up.
Materials and methods. 356 patients with ischemic CHF (NYHA II — V) and LVEF < 40 % were examined according to European Cardiologists Associoation recommendations. Cumulative survival was calculated by Kaplan —Meier method. Comparison of survival in groups was performed by F Mantel — Cox test. Predictors survival were determined by multiple logistic regression, cluster analysis, descriptive statistics and interval estimation.
Results and discussion. Analysis of survival in patients with CHF and reduced LVEF showed that cumulative survival at the end of 3 years of follow-up was not significantly different (p = 0.137), and comprised 49 % for men and 51 % for women. Factors associated with poor prognosis varied significantly depending on gender. For example, the predictors of a lethal outcome during 36 months in men were: high urea in blood, a large (> 340 ml) size of the left ventricular end diastolic volume, the size of the LVEF less than 20 %, left and right ventricle wall thickness, low (< 85 g/l) hemoglobin level, serum potassium level, volumetric and linear (including indexed) parameters of LV chambers. The rates associated with the onset of the lethal outcome in women during the observation period were: high glucose blood, creatinine and urea levels, right ventricular wall thickness, stroke volume, of the LV, body mass index, size of the LVEF < 28 %, creatinine clearance.
Conclusions. Survival of men and women with CHF and reduced LVEF during 3 years of follow-up is not significantly different, while the predictors of a lethal outcome are non similar.

Keywords: heart failure, survival, predictors, gender.

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Original language: Ukrainian

3. Original researches

 

Development nd biological testing f new spiral occluder made on the basis of low modulus beta-zirconium alloy for ductus arteriosus endovascular closure (RUS)

Yu. V. Panichkin 1, I. O. Skiba 2, V. P. Zakharova 1, V. M. Besleaga 1,
E. V. Besleaga 1, Yu. O. Ruzhin 1, V. M. Shivanyuk 2, M. V. Pogorelov 3

1 SI «M. M. Amosov National Institute of Cardiovascular Surgery of NAMS of Ukraine», Kyiv
2 G. V. Kurdyumov Institute for Metal Physics of NAS of Ukraine, Kyiv
3 Sumy National University

The aim —  the development and biological testing of the new domestic occluder for closing a patent ductus arteriosus, made on the basis of low modulus of beta-zirconium alloy.
Materials and methods. Preclinical studies of mechanical and bio-compatibility of the occluder were performed on the biological model — 15 clinically healthy pigs (three-pedigree hybrid Yorkshire 1/3, Landrace 1/3, Duroc 1/3), weight 35.0 ± 2.5 kg. Experimental implantation of occluders (19 pieces) was performed under general anesthesia by puncture of the femoral artery or vein, followed by implantation of articles into the cavity of the right ventricle, iliac and femoral arteries. All intravascular and intracardiac manipulations were echocardiography monitored. The starting dates of the study were 1, 3 and 6 months from the start of the experiment. Then the animals were excluded from the experiment, vessels specimen and surrounding tissue sections were taken together with the occluder. After the standard histological wiring sections were prepared and treated with hematoxylin and eosin, picro fuchsin according to van Gisone, fuchselin according to Weigert and method of laser by Lukasiewicz — Zerbino. The specimens were examined under a microscope to determine the extent of endothelization, thrombus formation, inflammation, necrosis and calcification.
Results and discussion. Macroscopic tissue examinations in the area of implantation demonstrated that occluders were partially or completely (depending on a term of implantation) covered with endothelium. The position of every device corresponded the initial positioning. Clots, vegetations, abnormal structures were not found either in devices or surrounding tissues. The breakages or fragmentation of devices was not observed. Microscopic examinations demonstrated that the implantation of foreign bodies (occluders) of β-zirconium alloy in the bloodstream of pigs caused pronounced proliferative response on the part of the vessel wall. Intensivity of manifestations depended on the the mechanical effect of the occluder on the underlying tissues and it is largely determined by structural features of the product.
Conclusions. Implantation of the occlude, made on the basis of low modulus tsirkonievgo beta alloy, into pigs’ vessels caused marked proliferative reaction from walls of vessels. Proliferation of neointimal elements extends distally from the occluder.

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

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Original language: Russian

4. Original researches

 

Gender features of an acute course and long-term prognosis of patients with myocardial infarction of the right ventricle against the background of Q-myocardial infarction of the left ventricle posterior wall (RUS)

V. Y. Tseluyko 1, T. A. Lozova 2, I. M. Martsovenko 3

1 Kharkv Medical Academy of Postgraduate Education
2 City Clinical Hospital N 1, Sumy
3 Regional Cardiology Clinic, Sumy

The aim — to evaluate the gender difference between  patients with an  acute phase of myocardial infarction (MI) and patients with MI of the right ventricle (RV) against the background of the Q-MI of the left ventricular posterior wall (PWLV) during 30.6 months of follow-up observation.
Materials and methods. 155 patients with MI of the RV due the Q-MI of the PMLV aged 64.11 ± 0.78 years were examined. Patients were divided into two groups: the 1st group comprised 103 male patients (66.4 %), and the 2nd group included 52 (33.6 %) female patients. The follow-up observation was 30.6 ± 4.5 months. The examination endpoints were: unstable angina (UA), recurrent MI (Re-MI), stroke, cardiovascular (CV) death and HF-hospitalizations.
Results and discussion. In the acute period of RV MI life-threatening cardiac arrhythmias, cases of early postinfarction angina (p = 0.026), acute HF (Killip II) (p = 0.02) and cardiogenic shock (p = 0.016) were more often registered among female patients.  During 30.6 months study 65 (41.9 %) patients reached the endpoints: UA — 50 (32.2 %), Re-MI — 15 (9.6 %), stroke — 9 (5.8 %), HF-hospitalization — 22 (14.2 %), CV-death — 16 (10.3 %). CV-events occurred in 44 (42.7 %) male patients, the number did not differ significantly from the number of women with CV-complications — 24 (46 %), (Cox’s F-Test: p = 0.15675). At the end of the follow-up period the groups did not differ significantly with the frequency of  Re-MI (p = 0.257), stroke (p = 0.476), UA (p = 0.418) and HF-hospitalizations (p = 0.245), but the number of the CV-deaths was significantly higher among female patients (p = 0.042).
Conclusions. RV MI in female is associated with  higher  incidences of fatal complications in the acute period and a significant increase in the risk of the CV-mortality within 30.6 months of follow-up.

Keywords: myocardial infarction, right ventricle, gender differences, cardiovascular events.

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Original language: Russian

5. Original researches

 

Parameters of ventricular-vascular coupling and central hemodynamics in patients with mild and moderate uncomplicated arterial hypertension, depending on the presence of left ventricle diastolic dysfunction and their relationship (UKR)

K. M. Amosova, N. V. Shyshkina, O. I. Rokyta, I. Yu. Katsitadze, Yu. V. Rudenko, K. P. Lazareva, K. I. Chernyaeva

O. O. Bogomolets National Medical University, Kyiv

The aim —  to conduct a comparative analysis of ventricular-vascular coupling, central blood pressure (BP), and wave reflections parameters in patients with mild and moderate uncomplicated arterial hypertension, depending on the presence or absence of left ventricle (LV) diastolic dysfunction and their relationship.
Materials and methods. From 170 patients with uncomplicated essential hypertension 70 patients were selected  by a case-control method.  Patients were comparable in age, gender, brachial systolic blood pressure: 35 had LV diastolic dysfunction and 35 without it. All patients underwent general clinical examinations, brachial blood pressure measurements, a pulse wave analysis and a measurement of the carotid-femoral pulse wave velocity (PWV) by applanation tonometry, dopplerechocardiography, and the ventricular-vascular coupling parameter (Ea/Ees) was determined by  a calculation method.
Results and discussion. Patients in groups were comparable in wave reflections parameters, however, in patients with diastolic dysfunction PWV was higher (9.6 ± 2.5 and 8.4 ± 1.9 m/s, p < 0,05).  Patients with diastolic dysfunction  had larger size of the left atrium (p < 0.01), left ventricular mass index (LVMI) (p < 0.05), lower values of e′ and higher E/e′ ( p < 0.01) Groups were comparable in parameters of effective arterial (Ea) and ventricular elastance (Ees), as well as Ea/Ees (p > 0.05). According to the results of linear regression analysis, the Ea/Ees parameter was associated with the augmentation pressure (β = –0.52, p = 0.001) and the augmentation index (β = –0.48, p = 0.004) in the group of patients with diastolic dysfunction. In both groups, Ea/Ees is associated with E/e′ (β = 0.37, p = 0.029 and β = 0.45, p = 0.034), and in group without diastolic dysfunction — with LVMI (β = –0, 43, p = 0.039).
Conclusions.  Patients with mild and moderate uncomplicated hypertension with left ventricle diastolic dysfunction had higher PWV (by 12.5 %) in the absence of differences in ventricular-vascular coupling, elastance and wave reflections parameters  in contrast to patients without diastolic dysfunction but matched by age, gender and brachial blood pressure. In patients with mild and moderate uncomplicated hypertension, the value of the ventricular-vascular coupling parameters correlated with the parameters of wave augmentation only in case of left ventricle diastolic dysfunction.

Keywords: blood pressure, arterial hypertension, diastolic dysfunction, arterial stiffness, ventricular-vascular coupling.

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Original language: Ukrainian

6. Original researches

 

Bland  White  Garland syndrome: pathomorphological analysis of a rare case (UKR)

O. I. Boko 1, 2, P. I. Dudash 2, K. V. Kutsir 3, V. I. Grigoriichuk 3, O. V. Kharysh 3

1 Danylo Halytsky Lviv National Medical University
2 Lviv Regional Pathologicoanatomic Bureau
3 Lviv Regional Forensic Medicine Office

This article presents the clinical and pathomorphological analysis of a fatal case of 11-month-old boy with abnormal origin of the left coronary artery from the pulmonary trunk (Bland — White — Garland syndrome). Pathomorphological changes were investigated in the «infantile» variant of the Bland — White — Garland syndrome: abnormal origin of the left coronary artery from the anterior wall of the pulmonary trunk; the increased size and mass of the heart with pronounced hypertrophy of all its chambers, dilatation of the cavities; chronic ischemic changes of the heart with the presence of a postinfarction cardiosclerosis; focal intimal hyperplasia of the left coronary artery. Decompensation of cardiac hemodynamics was caused by an acute respiratory viral infection. Acute cardiopulmonary insufficiency was the immediate cause of the child’s death.

Keywords: Bland  White  Garland syndrome, left coronary artery, anomaly, pathomorphological changes.

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Original language: Ukrainian

7. Reviews

 

Newly diagnosed atrial fibrillation: clinical course, prognosis and management (UKR)

Yu. I. Zalizna 1, 2, O. J. Zharinov 1

1 Shupyk National Medical Academy of Postgraduate Education, Kyiv
2 Kyiv Regional Cardiology Clinics

The accumulation of evidence-based medicine data on the role of newly diagnosed atrial fibrillation (NDAF) as a powerful predictor of cardiovascular morbidity and mortality causes need to systematize terminology and contemporary concepts on NDAF course, risk factors of complications and recurrence of arrhythmia. One of the most important criteria for assessing patient with NDAF and determining the treatment tactics are the clinical symptoms associated with arrhythmia. This diversity of clinical manifestations led to transition from use of the term «first episode of AF» to the term «first diagnosed AF». An important objective of examination of patients with NDAF is to determine its cause, whether the new AF is a manifestation of the disease (myocardial infarction, pneumonia, intoxication, hyperthyroidism, etc.) or a marker of the worsening course of chronic diseases, including the progression of cardiac dysfunction and heart failure. In the case of a clearly defined symptomatic episode of AF, a strategy for restoring sinus rhythm should be considered as a baseline. Identifying predictors of cardiovascular complications and recurrences of arrhythmia will help to detail the algorithms of NDAF management, particularly regarding antiarrhythmic and antithrombotic therapy.

Keywords: newly diagnosed atrial fibrillation, clinical course, prognosis, treatment.

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Original language: Ukrainian

8. Reviews

 

Non-invasive diagnostic assessment of the left atrial damage: diagnostic limitations of speckle tracking echocardiography (review and own observations) (UKR)

M. Yu. Kolesnyk, M. V. Sokolova

Zaporizhzhia State Medical University
Educational and Scientific Medical Center «University Clinic», Zaporizhzhia

A condition of the left atrium (LA) reflects the severity of cardiovascular remodeling of the myocardium generally and indicates the degree of compensation a number of cardiovascular diseases. Transthoracic echocardiography determines linear and volumetric parameters of LA, but it has limitations in early diagnosics of the LA damage. Speckle tracking echocardiography is a new non-doppler method of heart state assessment. This technology does not depend on the scanning angle, high frame rate and is characterized by high reproducibility of the results. The method allows to analyze the mechanical function of LA on new conceptual bases. Principles of speckle tracking echocardiography are outlined in the review. Limitations of the method are discussed, in particular, the problem of standardization and the choice of the starting point for LA strain analysis — the beginning of the P-wave or the peak of R-wave of ECG. Data on the normal parameters of LA strain are presented. Based on our own observations and literature data the change of the deformation properties of LA are presented in such pathological conditions as arterial hypertension, mitral stenosis, mitral regurgitation, atrial fibrillation, left ventricular diastolic dysfunction and heart failure with preserved left ventricular ejection fraction. According to their results, it is established that the strain and strain rate of LA are early and sensitive markers of LA damage.

Keywords: left atrial damage, strain, speckle tracking echocardiography.

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Original language: Ukrainian

9. Reviews

 

Pathophysiological role of the renin-angiotensin-aldosterone system in the development and maintenance of atrial fibrillation. Blockers of renin-angiotensin-aldosterone system as a perspective approach for upstream therapy (UKR)

V. P. Ivanov, . D. Danilevych

National Pirogov Memorial Medical University, Vinnytsia

Atrial fibrillation  is a prevailing  problem of modern cardiology. Among all disorders of the heart rhythm, atrial fibrillation is the most common arrhythmia, which is associated with a large number of complications. The article includes an overview of the literature data about the role of the renin-angiotensin-aldosterone system in  the development of atrial fibrillation, the current state of the problem, the unsolved current problems , the perspective approaches of the  treatment and prevention of this arrhythmia.

Keywords: atrial fibrillation, blockers of the renin-angiotensin-aldosterone system, upstream therapy.

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Original language: Ukrainian

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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