Saratov JOURNAL of Medical and Scientific Research

Kiselev A.R.

Saratov Research Institute of Cardiology (Saratov, Russia), Leading Researcher, D.Sc., MD. Saratov State Medical University (Saratov, Russia), Head of Publication Department of Saratov Journal of Medical Scientific Research. Personal pages: https://www.researchgate.net/profile/Anton_Kiselev; http://scipeople.com/users/8138940. E-mail: antonkis@rambler.ru

Comparative evaluation of autonomic regulation of circulation in patients undergone coronary artery bypass grafting or correction of acquired valvular heart disease

Year: 2018, volume 14 Issue: №1 Pages: 45-49
Heading: Internal Diseases Article type: Short message
Authors: Kiselev A.R., Vulf K.A., Shvartz V.A., Karavaev A.S., Borovkova E.l., Bockeria O.L.
Organization: Bakulev Center of Cardiovascular Surgery, Saratov State Medical University n.a. V.I. Razumovsky Research Institute of Cardiology, Saratov state university
Summary:

The aim of the research was to study the peculiarities of vegetative regulation of blood circulation in cardiac surgery patients who underwent coronary artery bypass grafting (CABG) or correction of acquired valvular heart disease (CAVHD). Material and Methods. In this study we included 42 patients (12 women; 63 (57; 67) years), who underwent CABG, and 36 patients (16 women; 58 (47; 65) years) who underwent CAVHD. The synchronous 15 minutes records of electrocardiogram and photoplethysmogram (PPG) were performed in all patients before and after surgery. Time domain and frequency domain measures of heart rate variability (HRV) and index of synchronization between low-frequency (LF) oscillations in HRV and PPG (index S) were analyzed. Results. Most studied autonomic indices did not have statistically significant differences between patients with CABG and CAVHD in the study stages, except for heart rate, which was higher in patients before CAVHD (p=0,013). Conclusion. The values of HRV and index S do not depend on the difference in the clinical status and the features of performed cardiac surgical interventions between patients with CABG and CAVHD.

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Synchronization of low-frequency rhythms in electroencephalogram by respiration with linear dependent time frequency.

Year: 2016, volume 12 Issue: №4 Pages: 541-548
Heading: Physiology and Pathophysiology Article type: Original article
Authors: Karavaev A.S., Runnova A.E., Borovkova E.l., Ishbulatov Y.M., Khorev V.S., Kiselev A.R., Zhuravlev M.O., Ponomarenko V.I., Prokhorov M.D., Bezruchko B.P., Koronovsky A.A..
Organization: Saratov Branch of Institute of Radio Engineering and Electronics n.a. V.A. Kotelnikov, Saratov State Medical University, Saratov state university
Summary:

The aim of the present study was to investigate the features of interaction of low-frequency rhythms in delta band of electroencephalogram (EEG) and processes in vegetative regulation of circulation with respiration. Materials and methods. 19 leads of EEG, photoplethysmogram (PPG) and respiration were simultaneously recorded in four healthy males (19-25 years old) during 30 minutes physiological test with linearly increasing frequency of respiration. Modern methods of nonlinear dynamics were used to diagnose the presence of phase and frequency synchronization between respiration and low-frequency rhythms in delta band of EEG and in PPG. Results. We found significantly long sections of synchronization of delta rhythms in cervical leads of EEG and low-frequency rhythms in PPG by respiration with linearly increasing frequency. Conclusion. Obtained results correlate well with established hypothesis which suggest that low-frequency rhythms in baroreflectory regulation of circulation are in complex dynamic relationships with structures of brain stem. A method was proposed for quantitative evaluation of synchronization strength between respiration and low-frequency rhythms in electrical brain activity in physiological tests with respiration with frequency linearly increasing in time.

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Investigation of statistical characteristics of interaction between the low-frequency oscillations in heart rate variability and peripheral microcirculation in healthy subjects and myocardial infarction patients

Year: 2015, volume 11 Issue: №4 Pages: 537-542
Heading: cardiac surgery Article type: Original article
Authors: Shvartz V.A., Karavaev A.S., Borovkova E.l., Mironov S.A., Ponomarenko V.I., Prokhorov M.D., Butenko A.A., Gridnev V.I., Kiselev A.R.
Organization: Saratov state university, Saratov Institute of Cardiology, Russia, Saratov Branch of Institute of Radio Engineering and Electronics n.a. V.A. Kotelnikov, Bakulev Center of Cardiovascular Surgery
Summary:

Objective. This study compares the statistical characteristics of interaction between 0.1 Hz oscillations in heart rate variability (HRV) and photoplethysmogram (PPG) in healthy subjects and myocardial infarction (Ml) patients. Material and methods. We studied 23 healthy subjects (20 men and 3 women aged 26±3 years) and 23 patients (12 men and 11 women aged 52±4 years) at about one month after Ml. The 10-minute signals of simultaneously recorded cardioin-tervalogram (CIG) and PPG were studied. We calculated the total percentage of phase synchronization between the studied 0.1 Hz oscillations and estimated the distribution functions of duration of synchronous and non-synchronous epochs, the variability of basic frequency of oscillations, and variance of phase noises in 0.1 Hz oscillations in HRV and PPG. Results. The total percentage of phase synchronization between 0.1 Hz oscillations is significantly greater in healthy subjects than in Ml patients (47±3% and 26±4%, respectively). Significant difference between these two groups in the distribution of duration of synchronous and non-synchronous epochs was not revealed. The Ml patients had greater variance between the basic frequencies of 0.1 Hz oscillations in HRV and PPG than healthy subjects. This phenomenon correlates with the increased level of phase noises in the records of Ml patients. Conclusion. The quality of synchronization between 0.1 Hz oscillations in HRV and PPG is associated with the strength of influence of external factors (noises) and variability of the basic frequency of these oscillations.

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Perspectives of anatomical and clinical criteria use in revascularization of patients with stable coronary artery disease

Year: 2015, volume 11 Issue: №3 Pages: 280-286
Heading: Internal Diseases Article type: Author's opinion
Authors: Genkal E.N., Posnenkova О.М., Kiselev A.R., Korotin A.S., Gridnev V.I., Dovgalevsky P.Ya.
Organization: Saratov Institute of Cardiology, Russia, Saratov State Medical University
Summary:

The aim of the study is to describe the development of the algorithm for the data analysis of Russian coronary artery disease (CAD) Registry. The algorithm allows determining the need in percutaneous coronary intervention (PCI) and evaluation the validity of PCI in patients with stable CAD on the basis of appropriate use criteria for coronary revascularization by the American College of Cardiology. Two measures propose for clinical decision support and automated assessment of PCI appropriateness «The need in PCI in patients with stable CAD» and «PCI validity in patients with stable CAD».

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Novel approach to evaluation of medical care quality delivered to patients with ST-segment elevation acute coronary syndrome: course to clinical result

Year: 2014, volume 10 Issue: №3 Pages: 408-413
Heading: Internal Diseases Article type: Author's opinion
Authors: Posnenkova О.М., Kiselev A.R., Popova Yu.V., Gridnev V.I., Dovgalevsky P.Ya., Danilov A.N.
Organization: Saratov Institute of Cardiology, Russia
Summary:

The purpose was to implement system analysis of clinical cases for development of healthcare quality indicators for STe-ACS patients, aimed at achievement of clinical result — decrease of in-hospital mortality. Mathehal and Methods. National recommendations on diagnostic and treatment of patients with myocardial infarction with ST-segment elevation on ECG (2007) were used to determine clinical result of treatment and key measures of medical care. To reveal major causes of clinical result non-achievement fishbone diagram was used. Results. Early reperfusion and optimal medical therapy were determined as the key measures of medical care delivered to patients with STe-ACS. The following indicators were developed to control these measures: «Primary reperfusion», «Thrombolysis in 30 minutes», «Primary percutaneous coronary intervention in 90 minutes», «Dual antiplatelet therapy in hospital», «Beta-blockers administration», «ACE-is/ARBs administration». The major causes of in-hospital mortality were separated. Indicators for assessment the major causes of clinical result non-achievement were proposed. Principal stages of performance measures creation were posed. Conclusion. Recommendation-based and clear definition of clinical result of treatment and key measures of the result achievement combined with methods of systems analysis allows development of evidence-based measures for assessment the quality of care delivered to patients with STe-ACS.

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Effect of estrogen deficiency on the lipid profile in women in different age periods

Year: 2014, volume 10 Issue: №3 Pages: 396-400
Heading: Obstetrics and Gynecology Article type: Original article
Authors: Neyfeld I.V., Rogozhina I.E., Kirichuk V.F., Kiselev A.R., Zhirnyakov A.l., Bobyleva I.V.
Organization: Saratov Institute of Cardiology, Russia, Saratov State Medical University
Summary:

The aim of the study is to evaluate influence of estrogen deficiency on lipid profile in women of different age. Material and Methods. 189 women with normal body weight: 44 women with premature menopause (aged <40 years), 69 women with early menopause (aged 40-45 years), and 76 women with natural menopause (aged 46-55 years) have been studied. In all women identification of clinical status has been performed during clinical examination. Results. It is shown that increasing age associated with increasing total cholesterol, triglycerides, low-density lipoprotein (LDL), very low density lipoproteins (VLDL) (p<0.05). We have not observed a significant association between age and level of high-density lipoprotein (HDL) (p=0.117). According with increased age, atherogenic index of plasma (AIP) increases from initial -0.17±0.09 (M±o) to 0.09±0.47 (p<0.05) in women with premature menopause, and to 0.14±0.21 (p<0.05) in other women. Final level of AIP was similar between women aged 40-45 years and women aged 46-55 years (p=0.084). Conclusion. Lipid metabolism disorders were assessed in 73.5% of women with estrogen deficiency. According to the age factor the rate of women with normal lipid metabolism decreases (x2=10,165, p=0.026).

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The possibility of using ACCF/AHA (2009) measures for quality assessment of initial prevention of cardiovascular pathology among employees of criminal executive system in the Saratov region

Year: 2014, volume 10 Issue: №2 Pages: 267-271
Heading: Internal Diseases Article type: Original article
Authors: Balashov S.V., Kiselev A.R., Posnenkova О.М., Zhurkin I.G., Gridnev V.I.
Organization: Saratov Institute of Cardiology, Russia, Center of Medical and Social Rehabilitation of Medical Unit no.64 of Russian Federal Penitentiary Service
Summary:

The aim of the study was to assess the quality of cardiovascular pathology prevention among penitentiary employees of the Saratov region using ACCF/AHA (2009) measures. Material and Methods. The data of 1014 employees (829 male and 185 female) aged 33.4±6.8 years were included in the single-step cohort study. All participants underwent an annual preventive health examination in Center of Medical and Social Rehabilitation of Russian Federal Penitentiary Service in the Saratov Region in the period from 01.10.2012 to 01.10.2013. 13 measures by ACCF/AHA (2009) were used to assess the quality of initial prevention. Results. ACCF/AHA (2009) measures revealed deficiencies in the control of the following cardiovascular risk factors in the studied group: low physical activity, high blood pressure and dys-lipidemia. Conclusion. ACCF/AHA (2009) measures were useful for assessment the quality of cardiovascular pathology prevention in organized cohorts (among penitentiary stuff in particular).

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Association of polymorphism of CYP2D6 and CYP2C9 genes encoding P-450 proteins of cytochrome with arterial hypertension

Year: 2012, volume 8 Issue: №4 Pages: 933-937
Heading: Internal Diseases Article type: Original article
Authors: Borodulin V.B., Shevchenko O.V., Bychkov E.N., Kiselev A.R., Reshetko O.V., Posnenkova O.M., Saratsev A.V., Losev O.E.
Organization: Saratov State Medical University
Summary:

Gene polymorphisms of cytochrome P-450 CYP2 encoding proteins of cytochrome P-450 are essential forantihy-pertensive drugs metabolism. Purpose: We study the associations of functionally defective allele variants of CYP2D6 gene and CYP2C9 gene with the degree of arterial hypertension (AH). Materials and methods: Samples of DNA of leukocytes of blood of 150 patients with AH without the associated clinical conditions (56% of women) at the age of 20-59
years have been investigated. For the study of polymorphism of genes the pharmacogenetic biochip developed in the Institute of Molecular Biology n.a. V. A. Engelgardt has been used. Comparison of frequencies of occurrence of signs has been carried out on the basis of chi-square criterion. Results: It has been revealed that homozygotes by mutant A1075C, C430T alleles of CYP2C9gene and G1934A of CYP2D6 gene have been significantly more common among patients with hypertension III (p=0.01). Conclusion: The research works on genes of system of P-450 cytochrome have important clinical value for rationalization of pharmacotherapy of hypertension. The increased frequency of occurrence of mutant allele of CYP2D6 and CYP2C9 genes in patients with hypertension III requires special attention to the problem of efficiency and safety of application of hypotensive drugs for the patients.

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The role of genetic mutations in development of metabolic disturbances in patients with arterial hypertension

Year: 2012, volume 8 Issue: №3 Pages: 751-756
Heading: Internal Diseases Article type: Original article
Authors: Borodulin V.B., Shevchenko O.V., Bychkov E.N., Reshetko O.V., Kiselev A.R., Posnenkova O.M., Zhelezinskaja N.V., Sarattsev A.V., Losev O.E.
Organization: Saratov State Medical University, Saratov Institute of Cardiology, Russia, First Moscow State Medical University n.a. I.M. Sechenov, Clinical Hospital of Ministry of Internal Affairs of the Russian Federation
Summary:

The article stresses on the study of molecular markers of essential arterial hypertension providing insight into the pathological mechanisms underlying the disease and creation of «genetic passport» for every patient in the future. Objective: To study genetic markers of 5,10-methylenetetrahydrofolate reductase (MTHFR), involved in the metabolism of homocysteine, and N-acetyltransferase 2 (NAT2), ensuring the process of transformation of acetyl-CoAto acetoacetyl-coenzyme A. Methods: The study involved 160 patients with essential hypertension l-lll stages Caucasian (57.5% female.) aged 20-59 years. MTHFR gene polymorphisms and NAT2 in DNA of peripheral blood leukocytes were studied using a set of Wizard Genomic DNA Purification Kit (Promega, USA). Results: It was shown that «slow acetylators» (homozygous for a mutant version of the gene NAT2) were more frequently (p <0.05) determined among patients with hypertension stage 1. It was also revealed the dependence on the presence of hypertension stage mutant allele T (hetero-and homozygous variants) in 677 nucleotide gene MTHFR (r = 0,40, p <0.001). Conclusions: The regularities of the distribution of polymorphic variants of MTHFR and NAT2 gene were found out in hypertensive patients according to the stage of the disease.

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Interdependence of parameters of varia-tional pulsometry, entropy of heart rate, temporal and spectral analyses of heart rate variability in normal state and in ischemic heart disease

Year: 2011, volume 7 Issue: №3 Pages: 607-611
Heading: Internal Diseases Article type: Original article
Authors: Durnova N.Yu., Dovgalevskiy Ya.P., Burlaka A.N., Kiselev A. R., Furman N.V.
Organization: Saratov Institute of Cardiology, Russia
Summary:

The research goal is to study the correlation between indices of variational pulsometry, entropy of heart rate, temporal and spectral analyses and heart rate variability in healthy patients and patients with coronary heart disease. Materials. Of the study are indicators of variational pulsometry and temporal and spectral analyses from 111 patients with coronary heart disease and in 61 healthy individuals. Results. Most parameters of HRV correlated with each other. In healthy patients the greatest independence was characterized by Mo and LF/HF, in patients with coronary artery disease — only by LF/HF Significant correlation with SDNN RMSSD, TP, LF, HF was determined. Conclusion. The variational pulsometry, temporal and spectral analyses of HRV and entropy of heart rate provide HRV assessment. The indices are interdependent and indicate interchangeability of methods

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