[Polymorphic markers Ala455Val of the THBD gene and Arg353Gln of the F7 gene and association with unfavorable outcomes of coronary atherosclerosis in patients with a history of acute ischemic heart disease]

The polymorphic markers Ala455Val of the THBD gene and Arg353Gln of the F7 gene were tested for association with the frequency of unfavorable outcomes in patients with a history of acute ischemic heart disease. The study involved 1145 patients hospitalized in cardiology clinics of Moscow, St. Petersburg, Kazan, Chelyabinsk, Perm, Stavropol, and Rostov-on-Don because of acute ischemic heart disease. The patients were followed up for up to 62.5 months. None of the markers displayed a significant association with the time to an endpoint. The patients were then grouped by sex. In females, the frequency of unfavorable outcomes (fatal or nonfatal myocardial infarction and fatal or nonfatal stroke) was higher in carriers of allele Val of the Ala344Val polymorphic marker of the THBD gene and carriers of genotype Arg/Arg of the Arg353Gln polymorphic marker of the F7 gene, but the difference was not statistically significant. Such an increase in frequency was not observed in males. To study the combined effect of the polymorphic markers of the THBD and F7 genes, the course of ischemic heart disease was compared for two female subgroups. One included carriers of allele Val of the Ala344Val polymorphic marker of the THBD gene and genotype Arg/Arg of the Arg353Gln polymorphic marker of the F7 gene; the other subgroup included carriers ofgenotype Ala/Ala of the Ala455Val polymorphic marker of the THBD gene and allele Gln of the Arg353Gln polymorphic marker of the F7 gene. The frequency of unfavorable outcomes in the first subgroup was higher than in the second one. The time to an endpoin was 40.5 months (95% confidence interval (CI) 33.5-47.6) in the first subgroup and 51.6 months (95% CI 45.0-58.1) in the second subgroup (chi2 = 4.15, P = 0.042). The results made it possible to assume that the F7 and THBD genes play an important role in genetic predisposition to unfavorable outcomes in patients with a history of acute ischemic heart disease.

Clinico-demographic characteristics of the patients with decompensated chronic heart failure Clinico-demographic characteristics of the patients with decompensated chronic heart failure

Aim. To study clinico-demographical characteristics of the patients with decompensated chronic heart failure (CHF). Material and methods. The analysis included the data of 112 patients hospitalised at Moscow City Clinical Hospital No. 68 due to decompensated CHF. The follow-up period lasted 30 days. Results. The mean age of the patients (33 % men, 67 % women) was 70,3±9,9 years. Older age (>70 years) was significantly more prevalent in women than in men (р=0,005). The main reason for CHF decompensation was inadequate pre-hospital therapy. The mean duration of the in-hospital treatment was 17,5±6,4 days. The level of 30-day fatality was 12,5 % (n=14). According to correlation analysis results, systolic blood pressure (SBP) level <100 mm Hg positively correlated with 30-day fatality (r=0,4; р=0,0001). Hemoglobin level <100 g/l also positively correlated with 30-day fatality (r=0,3; р=0,05). Conclusion. The prevalence of decompensated CHF is higher in women. Compared to men, women develop CHF in more advanced age. The main fatality-associated factors were low hemoglobin level, SBP <100 mm Hg, and age >70 years. The leading causes of death were pulmonary thromboembolism and diuretic therapy resistance.

[Prognostic value of aortic stenosis in patients after acute coronary syndrome]

With the aim to assess prevalence of aortic stenosis (AS) and prognostic value of its detection among survivors of acute coronary syndrome (ACS) we examined 851 patients included into multicenter prospective study of risk factors of serious vascular events and death after acute coronary syndrome. The patients were enrolled into the study in stable condition on 10th day after onset of myocardial infarction (MI) or unstable angina (UA). Examination involved medical history, laboratory tests and echocardiography. Afterwards all cases of death and serious vascular events were registered. Severity of AS was specified by maximal aortic flow rate: 1st degree > 2.5, 2nd degree 3.0-4.0, 3rd degree > 4.0 m/s. AS was detected in 16 patients (1.9%). AS severity was 1st, 2nd and 3rd degree in 9, 4 and 3 patients, respectively. Patients with AS were significantly older (77.4 vs. 61.3 years, p < 0.001), more often had history of chronic heart failure (CHF) (81.3 vs. 53.2%, p = 0.021) and lowered renal function (66.7 vs. 34.0%, p < 0.041). At multifactorial analysis independent prognostic value in relation to development of serious events showed age > 75 years (OR 1,395 [1.023-1.902], p = 0.036), history of CHF (1.319 [1.015-1.713], p = 0.038), history of MI (1.692 [1.320-2.170], p < 0.001), left ventricular diastolic dimention (1.023 [1.005-1.041], p = 0.012), left atrial diameter (1.024 [1.001-1.047], p = 0.037) and presence of AS (3.211 [1.742-.,916], p < 0.001). Prevalence of preexisting AS among patients who have had MI/UA is 1.9% what is similar to data of European Heart Survey ACS-II (1.8%). Presence of AS of any severity in a survivor of ACS worsens prognosis independently of other known risk factors.

[Analysis of efficacy and safety of administration of moxonidine in patients with arterial hypertension and hypertensive crises]

In the review we present detailed analysis of antihypertensive action of 3-nd generation sympatholytic moxonidine. Due to selective interaction with imidazoline I1-receptors moxonidine diminishes sympathetic activity causing lowering of peripheral vascular resistance. This leads to significant lowering of systolic and diastolic arterial pressure. Efficacy and safety of the drug has been shown both for the management of uncomplicated hypertensive crises and long term treatment of arterial hypertension (AH). Appropriateness of the use of moxonidine in patients with AH combined with diabetes mellitus, metabolic syndrome, chronic obstructive pulmonary disease has been confirmed. Moxonidine is well tolerated; its bioavailability after oral intake reaches 90%. The drug produces neither hypotensive "first dose" nor rebound effects.

[Chronic cardiac failure in the XXI century]

Wide clinical application of modern prophylactic, diagnostic and therapeutic methods has significantly improved clinical outcomes of cardiovascular disorders. However, much progress is not seen in survival of patients with chronic cardiac failure (CCF). Three possible causes of this situation are analysed: absence of evidence base in the treatment of CCF patients free of systolic dysfunction, difficulties in management of patients with end-stage CCF, need in new markers of CCF. Approaches to solution of these problems and CCF treatment optimization in general are discussed.

[The statistical analysis of prevalence of anemia in patients with chronic heart failure]

Development of anemia in patients with congestive heart failure (CHF) is associated with worsening of disease what has been shown in numerous trials. According to various data prevalence of the syndrome varies depending on chosen populations of patients and criteria of anemia. We observed 1122 patients (mean age 71.5 +/- 0.56 years) with CHF NYHA class II-IV (average 3.08 +/- 0.022). Anemia was found in 317 patients (28.3%); 59.3% of these patients were women and 40.7% - men. There were significantly more subjects with NYHA class IV CHF among patients with anemia (p < 0.001). Hospital mortality was 14.8 and 13.4% among patients with anemia and normal hemoglobin, respectively (p = 0.038). Analysis of mortality structure showed that among patients with anemia compared with those without there were fewer deaths due to pulmonary embolism (27.6 vs. 43.5%, p = 0.044) and more deaths due to decompensation of CHF (60.3 vs. 41.7%, p = 0.022). So this study demonstrated high rate of anemia among hospitalized patients with CHF and its association with higher NYHA class and worse prognosis.

[Clinico-statistical analysis of arterial hypertension complicated with hypertensive crisis in Moscow in 2005-2009]

Clinicostatistical analysis of arterial hypertension complicated with hypertensive crisis using data of Moscow A.S.Puchkov Station of Urgent and Emergent Medical Aid revealed 14% rise in number of hypertensive crises during the period from 2005 to 2009. Number of hypertensive crises increased among persons of young age (18-35 years). Frequency of cerebrovascular complications of hypertensive crises was age dependent with maximal values among men aged 36-74 years and women older than 75 years.

[Analysis of causes of development of anemia in patients with chronic heart failure]

High prevalence of anemia and its direct relation with morbidity and mortality in congestive heart failure (CHF) has been shown in numerous studies. Among etiology factors of anemia are hemodilution, chronic kidney insufficiency, deficiency of iron, folate, and vitamin 12, high level of inflammatory cytokines. Aims of this study were elucidation of causes of anemia in patients with CHF and assessment of dependence of prognosis of these patients on etiology of anemia. We examined 317 patients hospitalized with diagnosis of NYHA class II-IVCHF and anemia (129, [40.7%] men and 188 [59.3%] women, mean age 74.4+/-1.75 years, duration of CHF 4.4+/-0.2 years; 46, 42, 12% with NYHA class IV, III and II, respectively). Causes of anemia were chronic kidney insufficiency, iron deficiency, vitamin B12-deficiency, hemodilution, and chronic diseases. Glomerular filtration rate (GFR) below 50 ml/min was found in 27 patients (8.5%), deficiency of iron with lowered ferritin concentration and/or saturation of transferrin was revealed in 104 (32.8 %), vitamin B12-deficiency in 4 (1.3%), hemodilution in 40 (12.6%) patients. In 142 patients (44.8%) anemia was associated with chronic diseases. Hospital mortality in the whole group was 18.3%. Death rates in patients with hemodilution, chronic kidney insufficiency, vitamin B12-deficiency, anemia due to chronic diseases, and iron deficiency anemia were 32.5, 25.9, 25, 16.2 and 13.5%.

[Efficacy of levosimendan vs dopamine in patients with resistant cardiac failure]

AIM

Effects of levosimendan treatment compared to dopamine treatment on a clinical course, central hemodynamics and prognosis in patients with resistant cardiac failure (RCF).

MATERIAL AND METHODS

A total of 30 RCF patients (16 females and 14 males aged 50-80 years) were divided into two groups. Patients of group 1 received inotropic drug levosimendan intravenously in the initial dose 12-24 mcg/kgfor 10 min with subsequent 24-hour infusion in a dose 0.1 mcg/kg/min. Patients of group 2 received dopamine intravenously for 24 hours in a mean dose 2.2 mcg/kg/min. The patients were followed up for 6 months.

RESULTS

In group 1 cardiac failure regressed earlier than in group 2. Left ventricular performance index after infusion hour 1 increased from 2.9 to 3.3 (kg.m)/m2, in group 2 it decreased from 2.6 to 2.3 (kg.m)/m2; p = 0.028). To infusion hour 24 this index in group 1 was 3.2 (kg.m)/m2, in group 2--2.6 (kg.m)/m2. Cardiac index (CI) in group 1 increased from 23 l/min/m2 at infusion min 1 to 2.7 l/min/ m2 after 10 min of infusion and 29 l/min/m2 after 24 hours, i.e. there was a 26% rise (p = 0.025). In group 2 the CI rise was insignificant--from 2.4 to 2.5 l/min/m2. To the end of levosimendan injection, systemic vascular resistance fell from 1520.9 to 1174.6 dyne.s.cm(-5) (p = 0.031), in group 2 no significant changes were seen. Hospital mortality in group 1 was 1 patient, in group 2--6 patients.

CONCLUSION

Inotropic treatment in RCF patients with levosimendan vs dopamine produces earlier regress of cardiacfailure symptoms, better improvement of myocardial contractivity, is associated with a good prognosis.

[Gene IL6 G(-174)C and gene IL10 G(-1082)A polymorphisms are associated with unfavourable outcomes in patients with acute coronary syndrome]

We investigated the association of gene IL6 G(-174)C polymorphism and gene IL10 G(-1082)A polymorphism with coronary artery disease (CAD) in the Russian population. A total of 1145 patients with CAD diagnose on the basis of clinical studies in cardiological hospitals of Moscow, St -Petersburg, Kazan, Chelyabinsk, Perm, Stavropol and Rostov-on-Don. Supervision term was 9.10 +/- 5.03 months (the maximum term 18 months). In case of gene IL10 G(-1082)A polymorphism we determined that patients with CAD diagnose and A alleles gene IL10 had unfavorable outcome more often than patients with homozygous G alleles. Survival time from end point from carrier genotype GA and AA is 11.68 +/- 0.67 months against 12.69 +/- 0.65 months from carrier phenotype GG gene IL10 (chi2 = 4.13, p = 0.042). The group studied do not differ significantly with respect to the distributions of gene IL6 G(-174)C alleles and genotypes. However in case combined group studies of gene IL10 G(-1082)A polymorphism and IL6 G(-174)C polymorphism we determined that patients with CAD diagnose and carrier genotype GG gene IL6 and genotype GA and AA gene IL10 had unfavorable outcome more often (survival time 11.01 +/- 1.24 months) than patients with genotype CC and CG gene IL6 and genotype GG gene IL10 (survival time 13.28 +/- 0.83 months) chi2 = 10.23, p = 0.017. The obtained data allows assuming the important role of the IL6 and IL10 genes which are responsible for functioning of inflammation system, in the accelerated formation of failures at the patients who had a coronary syndrome.

[Polymorphic markers G(-455)A of gene FGB and C(-1654)T of gene PROC and genetic predisposition to unfavorable outcomes patients undergoing acute coronary syndrome]

We investigated the association of polymorphisms of genes FGB G(-455)A and PROCC(-1654)T with coronary artery disease (CAD) in the Russian population. A total of 1145 patients with CAD diagnose on the basis of clinical studies in cardiological hospitals of Moscow, St. Petersburg, Kazan, Chelyabinsk, Perm, Stavropol and Rostov-on-Don. Supervision term was 1.14 +/- +/- 0.33 years (the maximum term 3.2 years). The group studied do not differ significantly with respect to the distributions of G(-455)A alleles and genotypes. However in case of gene PROC C(-1654)T polymorphism we determined that patients with CAD diagnose and Talleles of PROC gene had unfavorable outcome more often than patients with homozygous C alleles. Survival time from end point from carrier phenotype TT and CTis 2.19 +/- 0.18 r. years against 2.46 +/- 0.16 from carrier phenotype CCgene PROC. The obtained data allows to assume the important role of the genes which are responsible for functioning of system of a hemostasis, in the accelerated formation of failures at the patients who had a coronary syndrome.

[Long-term results of implantation of bioengineered and drug-eluting stents in patients with coronary heart disease: comparative characteristics of predictors of poor prognosis]

The purpose of the investigation was to study the morphological and clinical characteristics affecting the long-term prognosis after implantation of bioengineered and drug-eluting stents in patients with coronary heart disease (CHD). The investigation covered 2362 patients with CHD. Genous bioengineered stents were implanted in 316 patients; Cypher rapamycin-eluting stents were in 2046 patients. The independent poor factor for complications was discontinuation of antiaggregatory therapy due to surgical interventions of different types in the drug-eluting stent group and stenting of extensive stenoses in the bioengineered stent group.

[Baroreflex sensitivity in patients with chronic heart failure: the clinical significance and impact of therapy]

The review deals with the baroreflex regulation of circulation in chronic heart failure (CHF). The pathophysiological aspects of development of dysfunction of the baroreflex clinically estimated from its sensitivity are presented; the clinical value of this indicator is discussed in relation to the etiology of the underlying disease and clinicohemodynamic status. Data on the impact of some components of current therapy for CHF and nondrug treatments on the values of baroreflex sensitivity are shown.

[Myocardial metastasis of Wilms' tumor as a cause of focal electrocardiographic changes]

Nephroblastoma (Wilms' tumor) is an embryonic tumor, an adenomyosarcoma that is casuistically rarely encountered in adults. It most commonly develops in children aged 1 to 5 years. This type of malignancy does not usually spread to the myocardium. The paper presents a clinical case of Wilms' tumor in an adult female patient with a solitary metastasis in the heart.

[Inflammatory cardiomyopathy: state-of-the-art]

Cardiomyopathy (CMP) is a major cause of early disability and death in young cardiac patients, remaining at the same time a little studied problem. The generally accepted term "dilated cardiomyopathy" is only a portrayal of morphological signs. As of now, the foreign literature most commonly uses the term "inflammatory cardiomyopathy" to denote CMP caused by viral and/or bacterial agents. Owing to the wide use of novel laboratory and instrumental diagnostic techniques, namely: molecular genetic and immunohistochemical studies and endomyocardial biopsy, there has been a possibility to conduct a more accurate and fuller study of inflammatory CMP. Despite the fact that the problems in nosology, classification, choice of the optimal diagnostic methods and management tactics for these patients.