Saratov JOURNAL of Medical and Scientific Research

Saratov Institute of Cardiology, Russia

Prognostic value of level of brain natriuretic peptide in patients with acute coronary syndrome without symptoms of heart failure

Year: 2017, volume 13 Issue: №1 Pages: 041-046
Heading: Internal Diseases Article type: Original article
Authors: Furman N.V., Puchinyan N.F., Dolotovskaya P.V., Dovgalevsky la.P., Panina A.V.
Organization: Saratov Institute of Cardiology, Russia
Summary:

Purpose of the study: to evaluate the prognostic value of brain natriuretic peptide (BNP) as a predictor of cardiovascular events in patients with acute coronary syndrome (ACS) within one year after hospitalization. Material and Methods. The study included 201 patients, including 150 men and 51 women, who were treated in the emergency department of cardiology with ACS including 96 patients without symptoms of CHF and/or AHF. Results. All patients were divided into groups depending on the presence signs of heart failure of CHF and/or AHF at the time of admission: patients with no signs of heart failure were divided into 2 groups: those with BNP levels >101 pg/mL (group 1; n=37) and <100 pg/mL (group 2; n=59); the third group consisted of patients with symptomatic HF (n=105). In patients without clinical signs of CHF and/or AHF with elevated level of the BNP at the time of hospitalization was observed significantly increased risk of unstable angina during the year compared to patients with normal levels (OR 2.83 [95% Cl: 1.1—7.24], p=0.04). In patients without clinical signs of CHF and/or AHF with elevated BNP levels at the time of hospitalization compared to patients with AHF and/or CHF, had no statistically significant differences in the long-term prognosis. Conclusion. Patients with ACS in the absence of CHF and/or AHF but with elevated levels of BNP at admission should be attributed to the group of high risk for cardiovascular complications. Increasing the level of BNP in ACS patients at admission has an adverse value for long-term outcome and can be used as an additional risk marker.

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Evaluation of treatment of patients with essential hypertension at primary care units using structured questionnaires (a polyclinic of the Saratov region as an example)

Year: 2016, volume 12 Issue: №4 Pages: 560-565
Heading: Internal Diseases Article type: Original article
Authors: Gerasimov S.N., Korotin A.S., Alexandrova I.N., Popova Yu.V.
Organization: Saratov Institute of Cardiology, Russia, Krasnoarmeysk Regional Hospital, Engels City Polyclinic №4
Summary:

The aim of the article is to assess patients' view on the treatment of hypertension in polyclinic located in the Saratov region using structured questionnaires. Material and Methods. 83 patients (aged 64.6±9.6 years, males 30%) with the diagnosis of essential hypertension who referred to the polyclinic of workers settlement of the Saratov region during the period from July 1, 2015 to July 7, 2015 were interviewed. The questionnaire for patients with elevated blood pressure (BP) developed by S. N. Gerasimov et al. (2015) was used. The questionnaire included 16 questions organized in the following panels: awareness of hypertension and risk factors, BP self-monitoring, conducted treatment, compliance to therapy, referrals to medical care. Results. 90% of the interviewed patients have known previously about BP elevation; 90% of respondents have had a tonometer; 84% of hypertensives measured BP no rare then once a week, and 54% did it daily; 88% of enrollers regularly take antihypertensive drugs. Only 36% of patients could be classified as compliant to therapy according the Morisky — Green scale (had 4 points). 92% of respondents have received one or more advice on lifestyle modification: 82% — advice on eating, 66% — advice on weight reduction, 55% — advice on physical activity, 28% — advice on smoking cessation, 26% — advice on alcohol consumption. 62.7% of patients were interested in organization of special follow-up program. Conclusion. High frequency of BP self-measurement was identified together with low compliance of patients to antihypertensive therapy, good knowledge on non-pharmacologic treatment interventions.

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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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Assessment of health care quality among penitentiary employees with hypertension in the Saratov region

Summary:

The aim of the study is to assess the quality of health care among penitentiary employees with hypertension in the Saratov region from 2003 to 2013. Material and Methods. The data from 62 employees with hypertension (43 men and 19 women) who followed up in the dispensary of Branch of Center of Medical and Social Rehabilitation of Medical Unit no.64 of Russian Federal Penitentiary Service in 2013 were evaluated. We analyzed retrospectively the quality of health care in every calendar year from 2003 to 2013 according to the following categories: control of blood pressure (BP), control of physical activity, control of smoking, control of weight, control of diet, control of cholesterol. To assess the quality of care we used clinical indicators implemented in the Federal Hypertension Register. Results. During the overall period (2003-2013) counseling on physical activity, smoking, weight and eating was optimal. However, only physical activity was controlled effectively in patients. The measures on control of BP and cholesterol needed improvement. Conclusion. Despite relatively good quality of the majority of health care measures among hypertensive patients in the Center of Medical and Social Rehabilitation, the effectiveness of these measures has been found out to be insufficient. It may be due to poor patients' adherence to recommendations.

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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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Pharmacoepidemiological analysis of the drugs used for secondary prevention of brain infarction on dispensary stage

Year: 2014, volume 10 Issue: №1 Pages: 189-195
Heading: Parmacology Article type: Original article
Authors: Miheyeva N.V., Reshetko O.V., Furman N.V.
Organization: Saratov Institute of Cardiology, Russia, Saratov State Medical University
Summary:

Aim. The secondary prevention of cerebral infarction on dispensary stage to current clinical guidelines was analyzed. Adherence of patients to prescribe medications was evaluated. Material and methods. 106 patients of hospital neurologic department with brain infarction were included in prospective pharmacoepidemiological study of the drugs used for secondary prevention of brain infarction on dispensary stage since 1 January 2009 to 31 December 2009. Duration of outpatient observation was 3 years. Results. All of the patients were of 64,9 ± 10,3 years old. Hypertension was diagnosed in 102 of them (96.2%), atrial fibrillation — in 33 (31.1%) patients. 39 (36.8%) patients died during 3 years after discharge from the hospital. ACE inhibitors/angiotensin II receptor antagonist were prescribed for 83 (78.3%) patients, antiplatelet- 76 (71,7%), statins — 16 (15,1%) patients in discharge from hospital. Warfarin was prescribed only for 1 (3.05%) patient with atrial fibrillation and ischemic stroke.consumption of drugs with evidence efficiency were diminished already after one year of observation in outpatient clinics. Conclusion.Therapy for secondary stroke prevention is not fully comply with current clinical guidelines

Keywords: -
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Features of pharmacotherapy and clinical course of atrial fibrillation in patients with type 2 diabetes in real clinical practice. Saratov Journal of Medical Scientific

Year: 2014, volume 10 Issue: №1 Pages: 178-185
Heading: Parmacology Article type: Original article
Authors: Graifer l.V., Reshetko O.V., Furman N.V., Dolotovskaya P.V.
Organization: Saratov Institute of Cardiology, Russia, Saratov State Medical University
Summary:

The aim of the study was to investigate the clinical status of patients with atrial fibrillation (AF) and diabetes mellitus (DM) type 2 and to identify differences in the treatment of AF, conducted in the cardiology departments of multidisci-plinary teaching hospitals of the Saratov city. Materials and methods. A comparative retrospective analysis of 1041 pharmacoepidemiological solid history of patients with AF who were hospitalized in emergency, and in the planning department of cardiology of 2 multidisciplinary teaching hospitals of the Saratov city consecutively in a calendar year on the AF, recorded on an electrocardiogram. Results. Among all patients with AF, patients with DM accounted for 20.2%. Among them were women, they were younger, they developed fibrillation at a younger age, they differed more severe structural heart disease, among which was significantly greater with myocardial infarction, nearly all had symptoms of heart failure. Patients with DM performed less frequently cardioversion, and to monitor heart rate often preferred a combination of beta-blockers and digoxin. 100% of patients with DM had a higher risk of thromboembolic complications (91.9% without diabetes) in both groups, oral anticoagulants (OAC) prescribed often enough. Conclusion. DM was diagnosed in every fifth patient with AF, especially among women and patients with persistent AF and is associated with the presence of more severe organic heart disease compared with patients without DM. All patients on the background DM was a high risk of thromboembolic complications, i.e. OAC must be assigned in 100% of cases, but in the surveyed hospitals OAC were appointed only in 23% of cases.

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