Saratov JOURNAL of Medical and Scientific Research

Posnenkova O.M.

Saratov Institute of Cardiology, Russia

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.

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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.

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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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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Evaluation of five-year risk of lethal outcome and development of cardiovascular disorders in patients with acute myocardial infarction on basis of 0.1-Hz rhythms synchronization in cardiovascular system

Year: 2010, volume 6 Issue: №2 Pages: 328-338
Heading: Internal Diseases Article type: Original article
Authors: KiselevA.R., Gridnev V.I., KaravaevA.S., O.M. Posnenkova., V.I. Ponomarenko., M.D. Prokhorov., B.P. Bezruchko.,V.A. Shvartz
Organization: Saratov National Research University n.a. N. G. Chernyshevsky, Saratov Institute of Cardiology, Russia, Saratov Branch of Institute of Radio Engineering and Electronics n.a. V.A. Kotelnikov
Summary:

The research goal is to evaluate the impact of autonomic heart control indices on five-year risk of lethal outcome and development of cardiovascular disorders in patients with acute myocardial infarction (AMI) and to study the dynam¬ics of indices in short- and long-term period. 125 patients with AMI (42% female), ages 30 to 83 years, were enrolled in prospective observational study. Observation period lasted 6 years. Control checking was carried out in 1 week, 3 weeks, 6 months, 1 year and then annually. The dynamics of heart rate variability (HRV) and the synchronization of 0.1-Hz rhythms of heart and microcirculation (S) were studied during the first year. Outcomes proved to be death, MI, stroke. Development of acute heart failure Killip 2-4 and indices S < 20% during the first week of AMI (х2 = 10,5, p = 0,005 for the Cox model) played a significant role in evaluation of five-year risk of death after AMI. Sensitivity (Se) and specificity (Sp) of index S < 20% during the first week of AMI were 76% and 43% correspondingly. The Cox model showed that indices of HRV and 0.1-Hz rhythms synchronization were not of great value in evaluation of five-year risk of death after AMI. The article concludes that indices S < 20% in patients with AMI possess better prognostic value than common clinical parameters

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Comparison of dynamic of autonomic control indices in cardiovascular system under the treatment by ACE inhibitor (Enalapril) and beta-blocker (Metoprolol) in patients with hypertension

Year: 2010, volume 6 Issue: №1 Pages: 061-072
Heading: Internal Diseases Article type: Original article
Authors: A.R. Kiselev, A.S. Karavaev, V.I. Gridnev, O.M. Posnenkova, V.A. Shvartz, V.I. Ponomarenko, M.D. Prokhorov, B.P. Bezruchko
Organization: Saratov National Research University n.a. N. G. Chernyshevsky, Saratov Institute of Cardiology, Russia, Saratov Branch of Institute of Radio Engineering and Electronics n.a. V.A. Kotelnikov
Summary:

The objective of the present research was to compare the influence of Enalapril and Metoprolol on synchronization of 0.1 Hz-regulation of heart and blood microcirculation. 42 patients aged 49±9 years old with hypertension I, II were included in the study. 0.1 Hz-oscillations in heart rate variability (HRV) and blood microcirculation were registered during the passive orthostatic sign while breathing spontaneously. The duration of each test was 10 minutes. Synchronization was estimated as a phase difference between 0.1 Hz-rhythms in heart rate and in filling of blood microcirculation. Quantitative measures of synchronization were also estimated. In addition frequency values of HRV spectrum in LF- and HF-ranges were assessed. Enalapril and Metoprolol had comparable effect on blood pressure reduction. Treatment with both Enalapril and Metoprolol in patients with significant vegetative dysfunction resulted in repair of functional interaction between 0.1 Hz-regulation of heart and blood microcirculation. Enalapril was preferred in hypertensive patients
with prevalence of disorders of vegetative regulation of blood microcirculation. Metoprolol influenced positively on 0,1 Hz-rhythm synchronization in patients with predominance of heart vegetative regulation dysfunction and in patients with sympathicotonia. In patients with hypertension and initially normal level of synchronization of 0.1 Hz-mechanisms treatment with Enalapril or Metoprolol caused functional dissociation. Differentiated approach to the choice of hypertensive therapy should consider individual peculiarities of system vegetative dysfunction. The level of synchronization of 0.1 Hz-rhythms in cardiovascular system should especially be evaluated initially and during the treatment

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Clinical audit of medical care quality by computer informational analytical system in patients with hypertension followed in Saratov polyclinic

Year: 2009, volume 5 Issue: №4 Pages: 548-554
Heading: Internal Diseases Article type: Original article
Authors: О.М. Posnenkova, V.I. Gridnev, A.R. Kiselev, V.A. Shvartz
Organization: Saratov Institute of Cardiology, Russia
Summary:

The research goal is to point out potentiality of clinical audit of care quality carried out by IAS "Register AH" in hypertensive patients followed in Saratov polyclinic.
Data of medical cards of 205 hypertensive patients (average age 52,8±9,1 years) followed in Saratov polyclinic have been analyzed with the help of IAS "Register AH" indicators set. Implementation of clinical recommendations on diagnosis, treatment and following-up of hypertensive patients from 2007 till 2008 has been assessed.
There was no correspondence between statements of recommendations of diagnostic measures for clinical status, treatment and following-up of hypertensive patients. Clinical aim of treatment to support the principal blood pressure has not been achieved in 85% of patients. The main cause has consisted in the patient's clinical status without taking into account the treatment and dynamic follow-up.
Clinical audit has allowed the complex evaluation of medical care process in hypertensive patients followed in the studied polyclinic and allowed to reveal a cause of inappropriate results of care. The use of IAS "Register AH" systematizes medical data contained in ambulatory cards, automatizes the process of obtaining indicators results. It increases the reliability assessments

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