Saratov JOURNAL of Medical and Scientific Research

№3

Comorbidity in patients with acute coronary syndrome in real (everyday) clinical practice

Year: 2019, volume 15 Issue: №3 Pages: 821-825
Heading: Cardiology Article type: Original article
Authors: Furman N.V., Dolotovskaya P.V., Malinova L.I., Reshetko O.V.
Organization: Saratov State Medical University
Summary:

The purpose of the study was to assess prevalence of comorbidity in the population of patients with acute coronary syndrome in Saratov region. Material and Methods. Inpatient and outpatient records of 484 patients with acute coronary syndrome (ACS) were analysed (64% of them residents of Saratov). Cases of cardiac and non-cardiac comorbidity were evaluated, Charlson Comorbidity Index (CCI) was calculated. Results. Only 20.5% of patients were without cardiac or non-cardiac comorbidity. Comorbid non-cardiac diseases were observed in 37.5% of patients (the most common diseases of the digestive system — 43% of all cases of non-cardiac comorbidity). Comorbid cardiovascular diseases were detected in 76.9% of patients, among the most common ones were arterial hypertension (88.4% of all cases of non-cardiac comorbidity) and documented hypercholesterolemia 42.2%). A correlation was found between the CCI and an unfavorable hospital outcome (0.227, P<0.0001). Conclusion. Patients with ACS in the vast majority of cases have at least one concomitant disease (cardiovascular or non- cardiac) that can significantly affect their prognosis. To determine individual prognosis for ACS patients with concomitant diseases, it is advisable to calculate the Charlson comorbidity index.

AttachmentSize
2019_03-1_821-825.pdf293.79 KB

Protracted course of myocardial infarction in a senior patient against the background of acute calculous cholecystitis (clinical case)

Year: 2019, volume 15 Issue: №3 Pages: 817-821
Heading: Cardiology Article type: Case report
Authors: Romanova N.A., Lipatova Т.Е., Parshina S.S., Haibekova T.V..
Organization: Saratov State Medical University
Summary:

The article describes the clinical case of protracted course of myocardial infarction in a senior patient against the background of acute calculous cholecystitis, discusses medical examinations and treatment; attention is drawn to the need for a particularly careful assessment of temporal dynamics of the ST segment and T wave of electrocardiograms in polymorbid patients to confirm the protracted course of myocardial infarction.

AttachmentSize
2019_03-1_817-821.pdf823.51 KB

Drug treatment of stable coronary artery disease in the context of guidelines on myocardium revascularization

Year: 2019, volume 15 Issue: №3 Pages: 812-817
Heading: Cardiology Article type: Original article
Authors: Posnenkova О.М., Genkal E.N., Popova Yu.V., Kiselev A.R., Gridnev V.I.
Organization: Saratov State Medical University
Summary:

Purpose: to assess the quality of medical treatment in patients with stable coronary artery disease (CAD) based on 2018 European guidelines on coronary revascularization (ESC 2018) and 2017 Appropriate Use Criteria (AUC 2017) using the data from Russian multicenter registry. Material and Methods. The data from 1531 patients with stable CAD (mean age 61.7±9.8 yrs, 76% men) were studied. The source of data was Russian multicenter registry of hypertension, CAD and chronic heart failure. Administration of optimal medical therapy (OMT) in terms of ESC 2018, maximal antiischemic therapy (MAT) in terms of AUC 2017 and agreement with both criteria were evaluated. OMT included at least one antiischemic drug + antiplatelet agent + statin + short acting nitrate + RAAS blocker in patients with hypertension, diabetes and heart failure. MAT included at least two antiischemic grugs. Correspondence with these criteria was determined in the groups of patients who underwent coronary revascularization and who received only medical treatment. The criteria were also determined in the groups of patients, for whom invasive treatment were indicated primarily, for whom it could be delayed and among patients who did not need revascularization according to ESC 2018 and AUC 2017 Results. In patients treated conservatively (n=924) OMT was administered in 18% of cases, in the group of revascularization — in 9% of cases (p<0.001). MAT was also administered significantly more frequently in the group of medical treatment (34% vs 24% in the group of revascularization, p=0.001). Medical treatment met ESC 2018 and AUC 2017 criteria in the groups with and without intervention in 7 and 3% of cases correspondingly (p<0.001). Conclusion. The data of Russian multicenter registry have shown that medical treatment of stable CAD fit with European and American clinical guidelines on myocardium revascularization in only insignificant part of patients independently from selected treatment strategy.

AttachmentSize
2019_03-1_812-817.pdf491.86 KB

Peculiarities of psychoemotional status and myocardium's response to heliogeomagnetic disturbances under emotional load in volunteers residing in the middle latitudes

Year: 2019, volume 15 Issue: №3 Pages: 806-812
Heading: Cardiology Article type: Original article
Authors: Parshina S.S., Kodochigova A.l., Samsonov S.N., Afanasyeva T.N., Petrova V.D., Petrova P.G., Strekalovskaya A.A., Manykina V.I., Kasimov O.V., Tokayeva L.K., Komzin K.V., Ramazanova Z.G.
Organization: Clinical Hospital "RZD-Medicine", Saratov, North-Eastern Federal University n. a. M.K. Ammosov, Saratov State Medical University, Yu. G. Shafer Institute of Cosmophysical Research and Aeronomy of the Siberian Branch of the Russian Academy of Sciences
Summary:

The purpose of the study is to evaluate psychoemotional features of volunteers residing in the middle latitudes and the impact of emotional stress on the synchronization status of the myocardium and heliogeomagnetic disturbances. Material and Methods. In the course of 60 days volunteers (31 people) were daily assessed concerning the state of the myocardium according to the coefficient of symmetry of the T-wave (CST) in the phase portrait of ECG at rest, after emotional stress, and after rest. Geomagnetic activity was assessed with the help of global planetary index of geomagnetic activity (Kp- index), while psychoemotional state of volunteers — with the help of questionnaires and projective techniques. Results. Personality characteristics of volunteers residing in the middle latitudes include optimism and friendliness, combined with a reduction of adaptability when building stress coping behavior against the background of polar intrapsychic tendencies. Emotional stress causes transient change in the synchronization state of the myocardium and heliogeomagnetic disturbances (CST-Kp). 3 types of violations of CST-Kp synchronization were identified. We were the first to describe the phenomenon of CST-Kp synchronization inversion: the increase of myocardium tension after geomagnetic disturbance reduction. Conclusion. Emotional stress in volunteers residing in the middle latitudes against the background of their characteristic of reduced psycho-emotional adaptation, leads to blockage of myocardium's reaction to weak geomagnetic disturbances and may contribute to the emergence of sensitivity to powerful geomagnetic disturbances.

AttachmentSize
2019_03-1_806-812.pdf628.43 KB

Terahertz therapy at frequencies of the molecular spectrum of nitric oxide: results and prospects of clinical use

Year: 2019, volume 15 Issue: №3 Pages: 800-806
Heading: Cardiology Article type: Original article
Authors: Parshina S.S., Afanasyeva T.N., Vodolagin A.V., Petrova V.D., Ushakov V.Yu., Kaplanova T.l., Potapova M.V., Ramazanova Z.G.
Organization: Saratov State Medical University, Clinical Hospital "RZD-Medicine", Saratov
Summary:

The purpose of the study is to summarize the results of clinical use of terahertz therapy at molecular spectrum of nitric oxide frequencies (150,176... 150,664 GHz) (THZ-therapy-NO) in cardiology, to identify general regularities and peculiarities of terahertz therapy influence. Material and Methods. We examined 312 patients with angina pectoris (150 patients with unstable angina pectoris, and 162 patients with stable angina of III-IV f. to.). Results. Antianginal effect of THZ-therapy-NO does not depend on the form of angina, sex, age, mode of exposure, hypocoagulation effect of smoking. We identified 2 types of effects of THZ-therapy-NO on hemostasis and blood rheology: active antithrombotic and protective (prevents the development of hypercoagulation shifts against the standard drug treatment). Procoagulant hemostasis is most sensitive to terahertz exposure. Reducing the duration of course exposure leads to expansion of antithrombotic effect by increasing the activity of natural anticoagulants (antithrombin III). Conclusion. Antianginal effect of THZ-therapy-NO does not depend on its hypocoagulation action. Irradiation mode "3/15" is optimal for patients with angina. Mode "2/5" does not have its own antithrombotic effect, therefore it is suitable for patients with angina with a tendency to hypocoagulation. Smoking does not affect the efficiency of the THZ-therapy-NO.

AttachmentSize
2019_03-1_800-806.pdf373.14 KB

Assessment of system's adaptive reserves by indicators of heart rate variability in young men at the initial stages of university education

Year: 2019, volume 15 Issue: №3 Pages: 796-800
Heading: Cardiology Article type: Original article
Authors: Olenko E.S., Fomina Е.М., Kirichuk V.F., Kodochigova A.l., Yupatov V.D., Konovalova A.A.
Organization: Saratov State Medical University
Summary:

The purpose of the study is to assess the activity index of regulatory systems and mechanisms of neurohumoral regulation of heart activity in healthy young men at the initial stage of university education. Material and Methods. We studied the activity index of regulatory systems (PARS) and features of the mechanisms of neurohumoral regulation of cardiac activity on a sample of 150 young men [19.0 (18.0; 19.0) years old], based on the analysis of heart rate variability. Results. 40.0% (n=60) of young men had a satisfactory state of adaptive reserves of the body, 23.3% (n=35) were in a state of low functional stress, 24.7% (n=37) had poor adaptation, and 12.0% (n=18) failed to adapt. Conclusion. In male students with satisfactory, tense, and unsatisfactory adaptation, as disadaptation increases, the total effect of all levels of regulation on the heart rate increases with an increase in the effect on the cardiac activity of the parasym-pathetic division of the ANS and a decrease in the activity of cerebral subcortical structures responsible for adaptation, against the background of an increase in psychoemotional stress. In healthy male students, the disruption of systems' adaptive reserves is often accompanied by the total decrease in all levels of regulation with a predominance of sympathetic influences on the heart rhythm and is less frequently associated with a sharp increase in all levels of regulation and the predominance of parasympathetic division of the ANS for the CVS.

AttachmentSize
2019_03-1_796-800.pdf523.87 KB

Prospective study of patients with old myocardial infarction: influence of presence or absence of type 2 diabetes mellitus on adherence to treatment

Year: 2019, volume 15 Issue: №3 Pages: 791-796
Heading: Cardiology Article type: Original article
Authors: Naumova Е.А., Bulaeva Yu.V., Semenova O.N.
Organization: Saratov State Medical University
Summary:

The purpose of the study is to conduct a prospective study of patients with old myocardial infarction with the presence or absence of type 2 diabetes mellitus and to identify factors associated on adherence to therapy. Material and Methods. 80 hospitalized patients with old myocardial infarction were included into the study: group one with type 2 diabetes mellitus (50%), group two — without it (50%). Standard clinical, laboratory and instrumental examination, calculation of metabolic indices were performed. 6 months discharge by phone viewed the continuation and regularity of therapy, end points. Results. The results of a study regarding adherence to therapy were evaluated over the phone 6 months after discharge from hospital; factors associated with continuation of therapy are presented. Conclusion. Patients with old myocardial infarction and diabetes mellitus are more adherents to treatment. Increased waist circumference, patient satisfaction with therapy, low rate of re-hospitalization and positive emotional evaluation of aspects of the therapy are factors is associated with high adherence to therapy.

AttachmentSize
2019_03-1_791-796.pdf422.87 KB

Low-frequency skin microvascular oscillations: dynamics, synchronization and compliance with changes in vascular tone during the tilt test

Year: 2019, volume 15 Issue: №3 Pages: 783-790
Heading: Cardiology Article type: Original article
Authors: Mironov S.A., Kiselev A.R., Simonyan M.A., Shvartz V.A., Karavaev A.S., Borovkova E.l., Ishbulatov Yu.M., Popova Yu.V., Posnenkova O.M., Gridnev V.I.
Organization: Central Clinical Military Hospital (Moscow), Saratov State Medical University
Summary:

The purpose is to study the dynamics of low-frequency oscillations (LF; basic frequency of about 0.1 Hz) in the spectra of fingerprint photoplethysmograms (PPG), their synchronization with a similar LF-rhythm in cardiointervalo-gram (CIG) and compliance with changes in vascular tone during the tilt test in healthy volunteers. Material and Methods. Synchronous cardiointerval recording, breathing recording, left shoulder rheovasography and PPG records from the palm surfaces of distal phalanges of anonymous fingers were analyzed, as well as central hemodynamics data by impedance rheocardiography in 30 healthy volunteers during the tilt test. Dynamics of LF-oscillations in PPG signals, their interaction (including synchronization) with similar oscillations in CIG and vascular tone parameters were studied. Results. At the stages of tilt test the values of LF-oscillations power in the spectra of PPG had no statistically significant differences. During the tilt test the index of synchronization of LF-oscillations increased (p<0.01). No correlations were found between the power of LF-oscillations in PPG spectra and vascular tone parameters. Conclusion. Absence of significant changes in LF-oscillations power in PPG spectra in the group of healthy volunteers at the stages of tilt test does not correspond to the dynamics of vascular tone parameters, estimated according to rheography data. At the same time, increased interaction between the autonomic regulation subsystems (heart rhythm — distal blood flow) was observed and resulted in the increase of of LF-oscillations synchronization.

Platelet functional pools under pharmacological suppression of aggregation in ST segment elevation myocardial infarction

Year: 2019, volume 15 Issue: №3 Pages: 779-783
Heading: Cardiology Article type: Original article
Authors: Malinova L.I., Dolotovskaya P.V., Furman N.V., Puchinyan N.F., Lipatova Т.Е.
Organization: Saratov State Medical University
Summary:

The purpose of the study is to investigate clinical significance of peripheral pool platelets functional heterogeneity, assessed with combination of collagen and ADP, under pharmacological suppression of platelet aggregation in acute coronary syndrome. Material and Methods. The study involved 374 patients with acute coronary syndrome (ACS). Functional activity of platelets (FAT) was studied on the first, the 7th and 30th days after ACS manifestation in the whole blood by impedance and luminescent aggregometry. The functional heterogeneity of platelets was studied using our own method with an estimate of AAk (functional subpopulation of platelets aggregation (cluster II)), ASk (the functional subpopulation of platelets secretion (cluster II)) and ДА (a parameter of platelets functional heterogeneity). The follow-up period was 24 months after ACS manifestation. Results. In the study sample ADP- and collagen-induced platelet aggregation remained almost constant during the whole observation period. It was established that in patients treated with double antiplatelet therapy parameters of functional platelet heterogeneity statistically significantly decreased by the seventh day of observation: ЛАк 2(0; 3)vs 1 (0; 2) Ohm, p=0,049; AS 0.26 (0.15; 0.47) vs 0.19 (0; 0.26) nmol, p=0.07. The excess of ЛАР measured on the second day after ACS manifestation, a threshold of 2 Ohms, was associated with a significant increase in the 30-day risk of rethrombotic events (HR 1.8; Cl 1.2; 3.1). Conclusion. The dynamics of platelet functional heterogeneity was revealed in patients with acute coronary syndrome treated with double antiplatelet therapy. A high degree of platelet functional heterogeneity in patients with acute coronary syndrome was associated with a significant increase in the 30-day risk of rethrombotic events.

AttachmentSize
2019_03-1_779-783.pdf562.29 KB

Tentative analytic biomarker panel of maladaptive myocardial remodeling (systematic review)

Year: 2019, volume 15 Issue: №3 Pages: 773-779
Heading: Cardiology Article type: Review
Authors: Malinova L.I., Denisova Т.Р., Furman N.V., Dolotovskaya P.V., Puchinyan N.Ph., Povarova T.V.
Organization: Saratov Road Clinical Hospital, Saratov State Medical University
Summary:

The purpose is to design a tentative analytical panel of biomarkers (BM) of maladaptive myocardial remodeling/extracellular myocardial matrix dysfunction. eLibrary.ru and PubMed were used for data extraction. Reproducibility of the obtained data was calculated, as well as the intragroup correlations of BM maladaptive myocardial remodeling/extracellular myocardial matrix dysfunction with the clinical phenotype of heart failure (HF) — т. The tentative BM panel design was carried out using the ranking method (R). Analysis included data from 5085 publications. The highest reproducibility was traced in nautriuretic peptides ((3 0.91 and 0.89) and cardiac troponins ((3 0.84), while the highest correlation ratios of BM and the clinical phenotype of CH were detected in natriuretic peptides and ST2 (т 0.81; 0.77 and 0.71). PIIINP and decorin did not reveal any significant correlation with the HF clinical phenotype. A rank of >0.5 was identified in galectin-3, GDF-15, and osteopontin. A set of biomarkers with a proven participation in the pathogenesis of heart failure, which potentially has the greatest diagnostic and prognostic value was designed, i. e. a tentative analytical panel of biomarkers of maladaptive myocardial remodeling/extracellular myocardial matrix dysfunction: NT-proBNP, BNP, cardiac rf-troponins, ST2, GDF-15, galectin-3 and osteopontin.

AttachmentSize
2019_03-1_773-779.pdf342.44 KB