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Bershtein LL, Boldueva SA, Kochanov IN, Lunina MD, Naiden TV, Evdokimov DS, Tandelov BM, Podmetin PS, Zbyshevskaya EV, Gumerova VE, Savinova EB, Piltakyan VH, Sayganov SA. Variability of Measurement and Feasibility of Assessing Changes in Brachiocepahlic Atherosclerotic Plaque After Acute Coronary Syndrome. Kardiologiia 2023; 63:20-28. [PMID: 37815136 DOI: 10.18087/cardio.2023.9.n2460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/02/2023] [Indexed: 10/11/2023]
Abstract
Aim Analysis of inter- and intra-study variability of changes in the atherosclerotic plaque (ASP) total height and total area, the main quantitative indexes that were planned to be used in the present study for assessment of the atherosclerotic load of carotid arteries.Material and methods The incidence of recurrent cardiovascular complications (CVC) within 1 year after acute coronary syndrome (ACS) ranges from 7-9 % (in studies) to 34 % (in clinical practice). This indicates insufficient efficacy of traditional approaches to secondary prevention of coronary heart disease. We proposed a study to test a hypothesis that the dynamics of ASP parameters in carotid and subclavian regions can serve as an alternative criterion for the adequacy of secondary prevention after ACS. The analysis was performed on subgroups of main study participants. These patients had ACS of any type documented by coronary angiography with an ASP confirmed by ultrasound of the brachiocephalic arteries (BCA) during the index hospitalization. BCA ultrasound was performed to analyze the inter- and intra-study variability of BCA atherosclerotic load, the ASP total height (Hsum) and total area (ASPTA), in 20 and 24 patients of the main study, respectively. Results of the repeated ultrasound were evaluated in 30 patients of the main study after 6 months of follow-up.Results The inter-study variability of each index was significantly higher than the intra-study variability which was consistent with results of previous studies. The intra-study variability of Hsum was 0.10 (95 % confidence interval, CI - 0.23-0.44) mm and ASPTA, 1.05 (95 % CI, - 0.54-2.63) mm2. The variability values were considerably smaller than the changes for 6 months: Hsum, 0.92 (95 % CI, - 0.64-2.49) mm and ASPTA, 3.67 (95 % CI, 0.42-6.91) mm2, although the difference did not reach statistical significance. The above results were obtained at an early stage of the study during the adaptation of specialists to the protocol.Conclusion The study results suggest a possibility of a fairly reliable assessment of the dynamics of quantitative indexes of carotid ultrasound 6 months after ACS.
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Affiliation(s)
- L L Bershtein
- Mechnikov North-Western State Medical University, St-Petersburg
| | - S A Boldueva
- Mechnikov North-Western State Medical University, St-Petersburg
| | - I N Kochanov
- Mechnikov North-Western State Medical University, St-Petersburg
| | - M D Lunina
- Mechnikov North-Western State Medical University, St-Petersburg
| | - T V Naiden
- Mechnikov North-Western State Medical University, St-Petersburg
| | - D S Evdokimov
- Mechnikov North-Western State Medical University, St-Petersburg
| | - B M Tandelov
- Mechnikov North-Western State Medical University, St-Petersburg
| | - P S Podmetin
- Mechnikov North-Western State Medical University, St-Petersburg
| | | | - V E Gumerova
- Mechnikov North-Western State Medical University, St-Petersburg
| | | | | | - S A Sayganov
- Mechnikov North-Western State Medical University, St-Petersburg
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Evdokimov DS, Feoktistova VS, Boldueva SA, Ermolov SY, Gaykovaya LB. [Endothelial Dysfunction in Patients With Takotsubo Syndrome and its Role in Acute and Long Terms Of the Disease]. Kardiologiia 2023; 63:21-27. [PMID: 37061857 DOI: 10.18087/cardio.2023.3.n2364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/26/2022] [Indexed: 04/17/2023]
Abstract
Aim To evaluate the endothelial function using an Endo-PAT2000 instrument before and after mental stress tests in patients with Tacotsubo syndrome (TS) during acute and long-term periods and to compare the obtained results with laboratory markers of endothelial dysfunction (ED).Material and methods This study included 45 patients with TS (mean age, 63.5±13.7 years) and 40 healthy volunteers (control group, CG). All patients of the main group during the acute period (first 7-14 days) and long-term period (at 1 and 2 years), as well as CG subjects, underwent evaluation of the endothelial function with an Endo-PAT 2000 instrument, and the reactive hyperemia index (RHI) was determined before and after mental stress tests. Also, concentrations of endothelin 1 (ET-1) and numbers of circulating endothelial cells (CEC) were measured after a two-year follow-up of TS patients.Results During the acute period of disease, all TS patients (n=45) had ED: RHI was below the threshold level of 1.67; furthermore, 42 (93.3 %) patients retained a lower RHI following mental stress. At one year (n=40), 16 (40%) patients showed ED at rest along with a significantly increased mean RHI. Mental stress produced at one year was associated with ED in 28 (70 %) TS patients. At two years (n=44), resting RHI was lower than normal in 19 (43.2 %) patients. Mental stress tests performed at two years were associated with ED in 29 (65.9 %) patients (RHI ≤1.67). Only 10% of CG subjects had a lower-than-normal RHI, which was significantly less than in the main group of TS patients during the acute and long-term periods (p<0.05). Mean values of laboratory markers for ED also were significantly different between TS patients during the long-term period of disease (n=41) and CG subjects (n=40; p<0.01).Conclusion During acute and long-term periods of disease, most of TS patients had impaired vascular reactivity both at rest and during mental stress. The laboratory markers of ED, ET-1 and CEC can be used in clinical practice for evaluation of the risk for TS.
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Affiliation(s)
- D S Evdokimov
- Mechnikov North-Eastern State Medical University, St.- Petersburg
| | - V S Feoktistova
- Mechnikov North-Eastern State Medical University, St.- Petersburg
| | - S A Boldueva
- Mechnikov North-Eastern State Medical University, St.- Petersburg
| | - S Yu Ermolov
- Mechnikov North-Eastern State Medical University, St.- Petersburg
| | - L B Gaykovaya
- Mechnikov North-Eastern State Medical University, St.- Petersburg
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Shumkov VA, Zagorodnikova KA, Boldueva SA, Murzina AA. The effect of rs776746 polymorphism in the <i>CYP3A5</i> gene on heart rate when using bisoprolol in patients with acute coronary syndrome. Racionalʹnaâ farmakoterapiâ v kardiologii 2022. [DOI: 10.20996/1819-6446-2022-08-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. The aim of this work was to study the occurrence of the rs776746 allelic variant of the CYP3A5 gene and its effect on heart rate (HR) when using bisoprolol in patients hospitalized with acute coronary syndrome (ACS).Materials and methods. The study included patients with ACS who were prescribed bisoprolol for clinical indications. All patients underwent molecular genetic testing. In order to evaluate the effectiveness of the therapy with bisoprolol, all patients underwent Holter electrocardiogram (ECG) monitoting on days 10, the following parameters were assessed: minimum, average, maximum heart rate and heart rate during an exercise test. The stress test was performed as a ladder test.Results. The study involved 97 patients (63,5±10,5 years), including 60 men and 37 women. The frequency of occurrence of the desired alleles of the CYP3A5 gene was: CYP3A5*3 - 93%, and CYP3A5*1 - 7%, which corresponds to its prevalence in the European population. 84 carriers of the CYP3A5*3*3 genotype (87%), 12 heterozygous carriers of the *1 allele (12%) and one patient with the *1*1 genotype (1%) were identified. In order to search for differences in the effects of bisoprolol depending on the genetically predetermined activity of CYP3A5, we divided the general group of patients into two subgroups: subgroup 1 (CYP3A5*3*3), represented by carriers of the genotype associated with the synthesis of the inactive form of CYP3A5, and subgroup 2 (CYP3A5*1*3 and CYP3A5*1*1), represented by carriers of at least one allele encoding the synthesis of a fully functional protein CYP3A5, coupled with an increased metabolic rate. Patients did not differ in clinical and demographic characteristics. By the time of daily ECG monitoring, both groups reached comparable heart rate values. In carriers of at least one CYP3A5*1 allele (n = 13), associated with an increased metabolic rate, the daily dose of bisoprolol on the 10th day of hospitalization was significantly higher (p <0.05). The only carrier of the homozygous CYP3A5 *1*1 variant receives bisoprolol at a daily dose of 10 mg. Taking into account the close to significant differences in glomerular filtration rate (GFR) in patients in the groups with the studied genetic variants, and the known eliminating role of the kidneys for bisoprolol, a linear regression model was built with the inclusion of factors that could affect the dose of bisoprolol: GFR, functional class of chronic heart failure, gender, age, number of simultaneously assigned CYP3A5 substrates. Of the parameters listed, only the CYP3A5 genotype significantly predicted the dose of bisoprolol (F=8.5; p<0.005; R2=0.096).Conclusion. In this study, it was demonstrated for the first time that patients with different genetic variants of CYP3A5, in particular with respect to the rs776746 polymorphism, may differ in individual requirements for the dose of bisoprolol.
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Affiliation(s)
- V. A. Shumkov
- North-Western State Medical University named after I.I. Mechnikov
| | | | - S. A. Boldueva
- North-Western State Medical University named after I.I. Mechnikov
| | - A. A. Murzina
- North-Western State Medical University named after I.I. Mechnikov
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Boldueva SA, Evdokimov DS, Rozhdestvenskaya MV, Rukoyatkina EA. Acute Heart Failure in a Pregnant Woman with Preeclampsia: a Rare Case of Takotsubo Syndrome. Racionalʹnaâ farmakoterapiâ v kardiologii 2022. [DOI: 10.20996/1819-6446-2022-08-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The mechanisms of takotsubo syndrome, better known as stress-induced cardiomyopathy, are not fully understood. The article presents a clinical case of the development of acute left ventricular failure in a 39-year-old pregnancy against the background of severe preeclampsia. Echocardiography revealed a decrease in global myocardial contractility, hypo-akinesia of the apex and all median parts of the left ventricle, hyperkinesis of the basal parts. After 2 weeks, myocardial contractility was normal, no contractility impairment was found. Two months after the acute episode of the disease, magnetic resonance imaging of the heart was performed, according to which no pathological changes were detected. Based on the clinical picture, electrocardiogram changes, laboratory data and typical transient echocardiographic changes, it was suggested that the patient had takotsubo syndrome.
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Shumkov VA, Zagorodnikova KA, Boldueva SA, Murzina AA, Petrova VB. Patient Age and CYP2D6*4/CYP2D6*3 Genotype on Maximal Heart Rate in Patients after Acute Coronary Syndrome Treated with Bisoprolol. Adv Gerontol 2021. [DOI: 10.1134/s2079057021040135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Shumkov VA, Zagorodnikova KA, Boldueva SA, Petrova VB. Influence of carriage of genetic variants CYP2D6 * 4 / CYP2D6 * 3 on maximum heart rate when using bisoprolol in patients with acute coronary syndrome. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Bisoprolol is one of the most effective and frequently prescribed beta-blockers. The widespread use of bisoprolol is due to its high efficiency in the treatment of patients with various cardiological pathologies: arterial hypertension, ischemic heart disease, chronic heart failure. Bisoprolol, like all members of the group of beta-adrenergic blockers, is effective in the treatment of patients with acute myocardial infarction, reducing the risk of complications such as rhythm disturbances and sudden cardiac death. In vitro studies indicate that bisoprolol is a substrate for two isoforms of cytochrome P450 - 3A4 and 2D6.
Purpose
The purpose of this work was to analyze the effect of CYP2D6 activity on the chronotropic effect of bisoprolol therapy in patients with acute coronary syndrome (ACS).
Materials and methods
The study included patients with ACS who was assigned bisoprolol according to clinical indications. All patients included in the study were Holter monitor on the 10th day of hospitalization - the minimum, mean, maximum heart rate during the day and the maximum heart rate were assessed at the time of exercise was evaluated against the background of the current therapy. All patients included in the study also underwent molecular genetic testing. The detection of polymorphic variants of СYP2D6 (*3/*4) gene was carried out by real-time PCR.
Results
A total of 93 patients, 58 males and 35 females were included in the study. The average age of patients is 63 years. In the studied population, CYP2D6 * 3 was not detected. The CYP2D6 * 4 mutation occurred with a frequency of 15%, which is comparable to previously published data on the Russian population. The distribution of alleles corresponded to the Hardy-Weinberg law (Chi square, p> 0.05). In order to determine the effect of genetically determined CYP2D6 activity on the effectiveness of bisoprolol therapy in patients with ACS, we identified a group of patients - carriers of the allelic CYP2D6 * 4 variant in homozygous or heterozygous form (AA / AG) (group with a reduced metabolic rate), and a group with the CYP2D6 genotype GG (group with normal and increased metabolic rate). In the correlation analysis, carriage of CYP2D6 * 4 in heterozygous or homozygous form was associated with a lower maximum heart rate during exercise (r-0.21; p <0.05). Maximum heart rate during exercise in carriers of CYP2D6 * 4 was 107 [105; 119], in the comparison group - 114 [108; 120]. The difference was significant with p <0.05 (values are expressed as median [25%; 75%]).
Conclusion
In this study, for the first time, the role of the influence of allelic variants of the CYP2D6 gene on the achievement of maximum heart rate during exercise was revealed when using bisoprolol in patients with ACS. These data may have promising implications for maximizing the personalization of therapy for patients, including those with ACS.
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Affiliation(s)
- VA Shumkov
- North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation
| | - KA Zagorodnikova
- Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - SA Boldueva
- North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation
| | - VB Petrova
- North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation
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Evdokimov D, Boldueva SA. Assessment of left ventricular myocardial deformation according to Speckle-tracking echocardiography in the long-term period in patients with takotsubo syndrome. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): North-Western State Medical University named after I.I. Mechnikov
Complete improvement of left ventricle systolic function is an essential feature of takotsubo syndrome (TTS). Speckle -tracking echocardiography (STE) provides quantitative information about myocardial deformation, more accurately than conventional echocardiography.
Objective
to assess the global longitudinal strain (GLS) and global circumferential strain (GCS) by speckle-tracking echocardiography in patients with TTS in the long-term period.
Materials and methods
14 female with TTS were monitored, average age 57.5 ± 28.5. The diagnosis was verified by ventriculography and echocardiography. 1 year after the attack, complaints of the patients, cardiovascular events (CE) and signs of heart failure were evaluated. All patients underwent echocardiography using a Vivid-4 (General Electric) with a Speckle-tracking function. The ejection fraction (EF) of the left ventricle (LV), the zone of disorders of local contractility, the level of GLS and GCS were evaluated.
Results
after an 1 year of observation, all patients had a good clinical condition, there were no CE, and heart failure was absent. The EF level was 56.3 ± 3.45%; no zones of disorders of local contractility were found in any patient. A GLS level below normal was observed in 7 patients (-12.05% ± 5.15%), and was normal in 7 patients (less than -18%), GCS level was reduced in 3 (21.4%) patients (- 9.7 ± 3.4%) at a normal level of -18 and below.
Conclusions
despite the absence of global and local contractility disorders in echocardiography, GLS was revealed in 50% of patients, GCS in 20% of patients. Thus, speckle-tracking shows that in some patients changes in LV contractility persist in the long term. It can be explained by a change in the orientation of the myocardial fibers due to remodeling, but this requires further evaluation.
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Affiliation(s)
- D Evdokimov
- North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation
| | - SA Boldueva
- North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation
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Petrova VB, Boldueva SA, Leonova IA, Petrova AI, Petrova AB. Endothelial dysfunction and features of nociceptive sensitivity in patients with microvascular angina. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): фГБ ОУ ВО СЗГМУ им. И.И. Мечникова
Introduction. The pathogenesis of microvascular angina pectoris (MVA) is not completely clear to the end, some authors consider the violation of pain (nociceptive) sensitivity to be an important cause of this disease. The purpose of this study was to study the perception of pain and serum endothelin-1 in patients with MVA.
Materials and methods. The criteria for inclusion in the group with MVA (49 patients): chest pain, positive stress test, unchanged coronary artery according to coronary angiography, the presence of a violation of myocardial perfusion and a decrease in the coronary reserve according to the positron emission tomography (PET) of the myocardium in rest, with a sample with adenosine and a cold test. Pain in the chest was noted in all 49 patients. Assessment of the nature of the pain syndrome was carried out using a 10-point visual-analogue scale (VAS), verbal rank scale (VRS). All subjects underwent a study of the functional activity of nociceptive and antinociceptive systems using the nociceptive flexor reflex method on the Nicolet VikingSelect expert class equipment, the pain threshold (Pb), the threshold of the reflex (Pr), and ratio coefficient (Pb / Pr), which in healthy people is approximately 0.9-1.0. The content of endothelin-1 in the serum of peripheral blood was determined by the method of enzyme immunoassay using test systems "Endotelin 1-21" (the normal values are up to 0.26 fmol / l) Fresh samples immediately after collection of blood were placed on ice and centrifuged during the day.
Results. The intensity of pain in the usual attacks in patients with MVA according to the VAS data (5.51 ± 0.2) in most cases was moderate and none of the subjects reached the maximum possible values. According to VRS, moderate pain was described by 60% of patients with MVA, strong - 34.3%.In the study of NFR in patients with MVA, the group as a whole showed a decrease in the pain threshold, the threshold of the reflex, and the ratio coefficient (Pb / Pr) as compared with normal values. In the MVA group, Pb was equal to 9.5 ± 0.58 mA; Pr = 12.1 ± 0.58 mA; Pb / Pr = 0.78 ± 0.02. When studying the level of endothelin-1 in patients with MVA the level of this peptide was raised to 2.9 ± 0.82 fmol / l. According to the correlation analysis between endothelin-1 and the parameters of NFR, an inverse correlation was observed: between endothelin-1 and pain threshold (r = -0.4; p <0.01); between the level of endothelin-1 and the ratio coefficient of PB / PR (r = -0.9; p <0.01).
Based on the results of the correlation analysis of the pain intensity index on the VAS scale and endothelin-1 level in patients with MVA, a significant relationship was found (r = 0.6, p <0.01)
Conclusions. In patients with MVA, a decrease in the pain threshold and an elevated level of endothelin-1 were found. Thus, the severity of endothelial dysfunction in patients with MVA was interrelated with the process of perception of pain.
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Affiliation(s)
- VB Petrova
- North-western State Medical University named after I.I.Mechnikov, Saint Petersburg, Russian Federation
| | - SA Boldueva
- North-western State Medical University named after I.I.Mechnikov, Saint Petersburg, Russian Federation
| | - IA Leonova
- North-western State Medical University named after I.I.Mechnikov, Saint Petersburg, Russian Federation
| | - AI Petrova
- North-western State Medical University named after I.I.Mechnikov, Saint Petersburg, Russian Federation
| | - AB Petrova
- Federal Almazov Medical Research Centre, Saint Petersburg, Russian Federation
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Petrova VB, Shumkov VA, Boldueva SA, Petrova AI. Syndrome of senile asthenia and anxiety-depressive disorders in elderly patients with acute coronary syndrome. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Northwestern State Medical University named after I.I. Mechnikov
Introduction. The syndrome of senile asthenia (ASA) ("fragility") in combination with anxiety-depressive symptoms in patients contributes to an increase in the frequency of hospitalizations, reduces the effectiveness of treatment and the quality of life. To study the relationship of SSA with anxiety-depressive disorders in elderly patients after acute coronary syndrome (ACS).
Materials and methods. The study included patients with acute coronary syndrome. The inclusion criterion was also a signed voluntary informed consent to participate in the study. A total of 76 patients, 44 men and 32 women hospitalized for ACS were included in this prospective observational study. The average age of the patients is 73.2 years. A questionnaire was conducted with a validated questionnaire "Age is not a hindrance", and the hospital anxiety and depression scale (HADS) was also used.
Results. SSA was found in 32% (p = 0.01) of hospitalized elderly patients, in the majority of women (71%) than men (29%). The average overall score according to the questionnaire "Age is not a hindrance" in elderly patients with ACS was 4.58. The results of the HADS survey showed that anxiety and depressive symptoms in fragile elderly patients occurred in 53.7% and 46.8%, respectively. There was a pronounced relationship between the occurrence of SSA and the symptoms of anxiety according to HADS (p <0.001), however, the more severe depressive symptoms were, the less frequent was SSA (p = 0.007).
Conclusions. "Fragility" in elderly hospitalized patients with ACS is associated with increased anxiety and depressive symptoms. In addition, a significant relationship was demonstrated between high scores on «the age is not a hindrance» questionnaire and the presence of anxiety, but not depression.
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Affiliation(s)
- VB Petrova
- North-western State Medical University named after I.I.Mechnikov, Saint Petersburg, Russian Federation
| | - VA Shumkov
- North-western State Medical University named after I.I.Mechnikov, Saint Petersburg, Russian Federation
| | - SA Boldueva
- North-western State Medical University named after I.I.Mechnikov, Saint Petersburg, Russian Federation
| | - AI Petrova
- North-western State Medical University named after I.I.Mechnikov, Saint Petersburg, Russian Federation
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Petrova VB, Boldueva SA, Leonova IA, Petrova AB, Petrova AI. Nociceptive disorders in patients with microvascular angina pectoris and patients with silent myocardial ischemia. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): North-western State Medical University named after I.I.Mechnikov
The purpose of this study was to study the diagnostic value of the nociceptive flexor reflex (NFR) method in patients with MVA and patients with silent myocardial ischemia.
Materials and methods. A total of 158 people were examined, including 131 patients with ischemic heart disease and 31 healthy volunteers (control group). Patients with coronary artery disease were represented by three groups: patients with MVA - 49 people (main group), patients with angina pectoris due to atherosclerotic lesions of the coronary arteries - 40 people (comparison group 1), patients with a diagnosis of painless myocardial ischemia (SMI) - 42 people (comparison group 2). To determine pain indicators, the method of nociceptive flexor reflex (NFR) was used during electrical stimulation of the sural nerve (Nicolet Viking (USA)).
Results. The coefficient (k) of pain threshold / reflex threshold (Pb / Pr) in the control group of healthy volunteers was 0.94 ± 0.01, which corresponds to the accepted norms (1-0.9) according to literature data. In the study of NFR in patients with MVA, a decrease in the pain threshold, reflex threshold and ratio (Pb / Pr) was revealed. In the MVS group, PB= 9.5 ± 0.58 mA; Pr = 12.1 ± 0.58 mA; Pb / Pr = 0.78 ± 0.02. The pain threshold in patients with MBS turned out to be statistically significantly lower in comparison with comparison group 1 and comparison group 2 and control group (p <0.01; p <0.001; p <0.001, respectively). The reflex threshold in patients with MVA is statistically significantly lower than in comparison group 1, comparison group 2 (SIM) and control group (p <0.02; p <0.001; p <0.01, respectively). In patients with angina pectoris, PB = 13.8 ± 0.31 mA; Pr = 14.8 ± 0.33 mA; Pb / Pr = 0.94 ± 0.01. In patients with SIM, PB = 24.9 ± 0.99 mA; Pr = 22.9 ± 0.79 mA; Pb / Pr = 1.2 ± 0.02. There was a significant increase in the pain threshold, reflex threshold and the pain threshold / reflex threshold ratio in the group of patients with silent myocardial ischemia compared with similar indicators in the control group, the main group and comparison group 1 (p <0.001; p <0.001; p <0.001 respectively).
Conclusions. In patients with MVA compared with healthy individuals in the control group and comparison groups, there is a decrease in NFR indices, which indicates the presence of nociceptive disorders. In patients with SIM, the reflex threshold values are lower in value than the pain threshold. Thus, in patients with SIM the muscle response occurs before the onset of the subjective sensation of pain.
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Affiliation(s)
- VB Petrova
- North-western State Medical University named after I.I.Mechnikov, Saint Petersburg, Russian Federation
| | - SA Boldueva
- North-western State Medical University named after I.I.Mechnikov, Saint Petersburg, Russian Federation
| | - IA Leonova
- North-western State Medical University named after I.I.Mechnikov, Saint Petersburg, Russian Federation
| | - AB Petrova
- Federal Almazov Medical Research Centre, Saint Petersburg, Russian Federation
| | - AI Petrova
- North-western State Medical University named after I.I.Mechnikov, Saint Petersburg, Russian Federation
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Maznev DS, Boldueva SA, Aronova EM, Shloydo EA, Ikonnikov PP. [The case of recurrent tako-tsubo syndrome on the background of coronary atherosclerosis]. Kardiologiia 2021; 61:106-112. [PMID: 33715616 DOI: 10.18087/cardio.2021.2.n1160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/06/2020] [Accepted: 07/13/2020] [Indexed: 11/18/2022]
Abstract
Takotsubo syndrome (TS) is characterized with a reversible disorder of left ventricular contractility. At present time, it is established that various factors, both psycho-emotional and clinical, can trigger this disease. Notably, according to current opinions, coronary atherosclerosis may accompany TS and not be its exclusion criteria as it was previously thought. This article presents a clinical case of TS relapse in a female patient aged 83 years at 5 years following the first episode associated with progression of coronary atherosclerosis.
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Affiliation(s)
- D S Maznev
- North-West State Medical University named after I.I. Mechnikov, Ministry of Health of Russia, St. Petersburg, Russia
| | - S A Boldueva
- North-West State Medical University named after I.I. Mechnikov, Ministry of Health of Russia, St. Petersburg, Russia
| | - E M Aronova
- "City Multiservice Hospital #2", St. Petersburg, Russia
| | - E A Shloydo
- "City Multiservice Hospital #2", St. Petersburg, Russia
| | - P P Ikonnikov
- "City Multiservice Hospital #2", St. Petersburg, Russia
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12
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Shumkov VA, Zagorodnikova KA, Boldueva SA, Murzina AA, Petrova VB. [Patient age and CYP2D6*4/CYP2D6*3 genotype on maximal heart rate in patients after acute coronary syndrome treated with bisoprolol.]. Adv Gerontol 2021; 34:48-53. [PMID: 33993661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We have analyzed influence of genetic variants CYP2D6*3 (2549delA) and CYP2D6*4 (1846G>A), as well as other factors on effects of bisoprolol in patients with acute coronary syndrome. The study included 97 patients with acute coronary syndrome. Mean age was 63±10 years; 60 men and 37 women. We have found association between carriage of CYP2D6*4 (1846G>A) and maximal heart rate at exertion (R-0,21; р<0,05). When the correction for potential confounders was made, age was the only significant predictor of maximal heart rate (β=0,6; SE=0,07; p<0,001). At the same time it was found that CYP2D6*4 was associated with more advanced age of the patients (r=0,2; p<0,05).
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Affiliation(s)
- V A Shumkov
- I.I.Mechnikov North-Western State Medical University, 41 Kirochnaya str., St. Petersburg 191015, Russian Federation, e-mail:
| | - K A Zagorodnikova
- I.I.Mechnikov North-Western State Medical University, 41 Kirochnaya str., St. Petersburg 191015, Russian Federation, e-mail:
| | - S A Boldueva
- I.I.Mechnikov North-Western State Medical University, 41 Kirochnaya str., St. Petersburg 191015, Russian Federation, e-mail:
| | - A A Murzina
- I.I.Mechnikov North-Western State Medical University, 41 Kirochnaya str., St. Petersburg 191015, Russian Federation, e-mail:
| | - V B Petrova
- I.I.Mechnikov North-Western State Medical University, 41 Kirochnaya str., St. Petersburg 191015, Russian Federation, e-mail:
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13
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Boldueva SA, Yarmosh IV, Dolinova AN, Kaloeva ZG, Serkova MY, Avramova VM. Clinical Case of Complicated Thrombophilia in a Patient with Ulcerative Colitis. Racionalʹnaâ farmakoterapiâ v kardiologii 2020. [DOI: 10.20996/1819-6446-2020-10-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This article presents the clinical observation of hereditary thrombophilia, complicated by the formation of a thrombus in the cavity of the right ventricle, in a 40-year-old patient with first diagnosed ulcerative colitis. Despite the standard drug therapy, the patient had a persistent fever. Transthoracic echocardiogram revealed a formation in the right ventricle. A differential diagnosis was made between the vegetation and thrombus. Due to the high risk of infective endocarditis, the antibacterial therapy was started. The addition of deep vein and common iliac vein thrombosis required the exclusion of thrombophilia. Molecular genetic testing allowed to diagnose hereditary thrombophilia: heterozygous carriage of mutations in the genes of factor V Leiden, fibrinogen, platelet receptor for collagen, plasminogen activator inhibitor I. The diagnosis of thrombophilia and ineffectiveness of antibacterial therapy led to the conclusion that there was a thrombus in the right ventricle. The treatment of ulcerative colitis was continued. At the same time, anticoagulant therapy was started, and antibiotics were canceled. As a result, clinical remission of ulcerative colitis, regression of venous thrombosis and complete dissolution of the thrombus in the cavity of the right ventricle were achieved. Ulcerative colitis may be complicated by venous trombosis and hereditary thrombophilia increases this risk.
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Affiliation(s)
- S. A. Boldueva
- North-Western State Medical University named after I.I. Mechnikov
| | - I. V. Yarmosh
- North-Western State Medical University named after I.I. Mechnikov
| | - A. N. Dolinova
- North-Western State Medical University named after I.I. Mechnikov
| | - Z. G. Kaloeva
- North-Western State Medical University named after I.I. Mechnikov
| | - M. Yu. Serkova
- North-Western State Medical University named after I.I. Mechnikov
| | - V. M. Avramova
- North-Western State Medical University named after I.I. Mechnikov
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14
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Oblavatckii DV, Boldueva SA, Soloveva MV, Vinnichuk SA, Mikhailov RR. [The Frequency of Type 2 Myocardial Infarction in the Structure of Hospital Mortality According to 7-Years Data of a State University Clinic]. ACTA ACUST UNITED AC 2020; 60:896. [PMID: 32720620 DOI: 10.18087/cardio.2020.6.n896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/08/2020] [Accepted: 03/20/2020] [Indexed: 11/18/2022]
Abstract
Aim To evaluate the proportion of type 2 myocardial infarction (MI) in the structure of mortality at a multidisciplinary hospital; to describe major causes for MI development, and characteristics of patients with a verified diagnosis of type 2 MI by data of postmortem examination.Material and methods 1574 protocols of the autopsies performed at the Central Pathology Department of the I.I. Mechnikov North-West State Medical University from 01.01.10 through 31.12.16 were studied retrospectively by the continuous sampling method. A group with verified diagnosis of type 2 MI was isolated from the total sample of autopsies. Major causes for and the proportion of type 2 MI among the causes of death were studied. Also, major demographic parameters, hospitalization profile, and condition of coronary arteries (CA) were compared in patients with fatal type 2 MI and those who died from atherothrombotic type 1 MI.Results Analysis of 1574 fatal cases among patients of the multidisciplinary hospital showed that in 360 cases (22.87 %), the cause of death was MI, including 137 cases of fatal type 2 MI. Proportions of men and women among the patients with postmortem verification of type 2 MI were comparable. Analysis of the age structure showed the highest incidence of type 2 MI in elderly (48.2 %) and senile (34.3 %) age. Mean age of patients with type 2 MI was 71.7 years (68.2 years for men and 75.3 years for women), which was comparable with the age range of patients with fatal type 1 MI. In both groups, men with fatal MI were significantly younger than women. Analysis of causes for type 2 MI demonstrated that the most frequent ones were tachysystolic arrhythmias (59.12 %) and severe hypoxia of different origin (35.04 %). Analysis of the type of CA lesions showed that significant lesions were significantly more frequently absent in type 2 MI (32.85 %) while in type 1 MI, the proportion of patients with unchanged CA was 1.84 %. In the group of patients with fatal type 1 MI, 67.29 % had multivascular lesions, and one in two patients had an occlusive lesion. In the group with type 2 MI, multivascular lesions were half as frequent (31.38 %), and only 4.38 % of patients had a complete occlusion of a coronary vessel. Comparison of death rate in different departments of the multidisciplinary hospital showed that only 29.2 % of patients with type 2 MI originally were managed at a specialized cardiological department; 45.3 % of patients were admitted to an internal medicine department for different conditions often not related with ischemic heart disease. Furthermore, 25.5 % of patients with subsequently developed type 2 MI originally even received scheduled or emergency medical care for a leading surgical condition.Conclusion Cardiovascular diseases predominate among causes of mortality in a multidisciplinary hospital. This study showed that almost one in four patients dies from MI, and type 2 MI accounts for more than one third of fatal MIs. Among major causes for type 2 MI, tachysystolic arrhythmias (59.12 %) and pronounced hypoxia associated with anemia and severe respiratory failure (35.04 %) should be noted. Gender and age characteristics of patients with type 2 MI were comparable with those of patients with fatal type 1 MI. Furthermore, surgical patients accounted for 25.5 % of fatal cases of type 2 MI.
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Affiliation(s)
- D V Oblavatckii
- North-Western State Medical University named after Metchnikov, St-Peterburg
| | - S A Boldueva
- North-Western State Medical University named after Metchnikov, St-Peterburg
| | - M V Soloveva
- North-Western State Medical University named after Metchnikov, St-Peterburg
| | - S A Vinnichuk
- North-Western State Medical University named after Metchnikov, St-Peterburg
| | - R R Mikhailov
- North-Western State Medical University named after Metchnikov, St-Peterburg
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15
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Boldueva SA, Leonova IA, Zakharova OV. Efficacy of Trimetazidine and Sulodexide in Patients with Microvascular Angina. Racionalʹnaâ farmakoterapiâ v kardiologii 2020. [DOI: 10.20996/1819-6446-2020-06-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- S. A. Boldueva
- North-Western State Medical University named after I.I. Mechnikov
| | - I. A. Leonova
- North-Western State Medical University named after I.I. Mechnikov
| | - O. V. Zakharova
- North-Western State Medical University named after I.I. Mechnikov
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16
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Boldueva SA, Ryzhikova MV, Oblavatckii DV. Embolic myocardial infarction. Literature review and own research results. Cardiovasc Ther Prev 2020. [DOI: 10.15829/1728-8800-2020-2302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Patients with embolic myocardial infarction (MI) represent a high-risk group and, accordingly, require special attention of clinicians. This article discusses the most common causes of MI, related diagnostic criteria, antithrombotic therapy, and myocardial revascularization in this category of patients. The data of own clinical experience are also given.
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17
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Boldueva SA, Petrova VB, Khavinson VK, Samohvalova MV, Petrova AI. Problems in the Diagnostics and Treatment of Transtiretinum Amyloidosis with Heart Disease in the Elderly: Clinical Experience. Adv Gerontol 2020. [DOI: 10.1134/s2079057019040039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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Boldueva SA, Soloveva MV, Oblavatckii DV, Feoktistova VS. [Myocardial Infarction in the Group of Patients With Atrial Fibrillation]. ACTA ACUST UNITED AC 2020; 60:53-61. [PMID: 32245355 DOI: 10.18087/cardio.2020.1.n620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 06/26/2019] [Indexed: 11/18/2022]
Abstract
Prevalence of patients with myocardial infarction (MI) and atrial fibrillation (AF) has been growing every year. These patients represent a highest risk group and, thus, require special attention of clinicians. The article foсused on mechanisms of the AF and MI interaction, special aspects of prediction depending on the type of AF and MI, and the issue of antithrombotic therapy in this patient category. A group of AF-associated, embologenic MIs was isolated, and diagnostic criteria and therapeutic regimens were provided.
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Affiliation(s)
- S A Boldueva
- I.I. Mechnikov North-West State Medical University
| | - M V Soloveva
- I.I. Mechnikov North-West State Medical University
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Petrova VB, Boldueva SA, Leonova IA, Petrova AB. P6434Evaluation of the nociceptive flexor reflex, as a new method for the diagnosis of microvascular angina. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The purpose of this study was to study the diagnostic value of the nociceptive flexor reflex (NFR) method in patients with microvascular angina.
Materials and methods
The study included 49 patients with MVA (main group), 40 patients with classical angina II-III f.c. (comparison group 1), 42 patients with silent myocardial ischemia (comparison group 2) and 32 healthy volunteers (control group). Criteria for inclusion in the group with MVA: chest pain, positive stress test, unchanged coronary arteries according to coronary angiography, the presence of myocardial perfusion disturbance and reduction of the coronary reserve according to positiron-emission tomography of the myocardium at rest, with adenosine and cold one test. Chest pain syndrome was observed in all 49 patients. All subjects studied the functional activity of nociceptive and antinociceptive systems using the nociceptive flexor reflex method on the equipment of expert class electromyography system, the pain threshold (Pb) values, the reflex threshold (Pr) were calculated and the ratio of pain and reflex threshold was calculated to calculate the pain threshold / threshold reflex (Pb/Pr), which in healthy people is about 0.9–1.0.
Results and discussion
In te study of NFR in patients with MVA in the group as a whole, a decrease in the pain threshold, reflex threshold and Pb/Pr ratio compared with normal values were found. The pain threshold in patients in the group was lower (statistically significantly) when compared with the group 1, the group 2 and the control group (p<0.0001; p<0.0001; p<0.0001, respectively). The reflex threshold in patients of the MCC group was also significantly lower when compared with the group 1, the group 2 and the control group (p<0.001; p<0.0001; p<0.001, respectively). Due to the fact that the low pain threshold was found in 84.4% of the examined patients with MVA who had microvascular dysfunction according to positron-emission tomography, we evaluated the prognostic value of the NFR method for diagnosing the disease. To do this, an assessment was made of the odds ratio (OR) of identifying MVA in groups of patients with different levels of index K (the ratio of the pain threshold value to the reflex threshold value). We have chosen the value of index K with the highest specificity and high sensitivity equal to 0.8892.
Based on the data obtained, the diagnostic value of the NFR method was calculated during the verification of the MVA. When conducting a mathematical analysis, it was found that this technique has high sensitivity (84.4%), specificity (95.12%), positive (90.48%) and negative predictive value (91.76%). We have not found information in the literature on the use of the NFR assessment method and its diagnostic value in MVA.
Findings
Due to the high diagnostic value of determining the NFR, we propose to include this method in the MVA diagnostic algorithm as an additional one.
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Affiliation(s)
- V B Petrova
- North-Western State Medical University named after I.I. Mechnikov, Clinic of Cardiology, Saint Petersburg, Russian Federation
| | - S A Boldueva
- North-Western State Medical University named after I.I. Mechnikov, Clinic of Cardiology, Saint Petersburg, Russian Federation
| | - I A Leonova
- North-Western State Medical University named after I.I. Mechnikov, Clinic of Cardiology, Saint Petersburg, Russian Federation
| | - A B Petrova
- North-western State Medical University named after I.I. Mechnikov, St.Petersburg, Russian Federation
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20
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Boldueva SA, Tretyakova NS, Shvetc NS, Feoktistova VS. [Secondary form of Takotsubo syndrome, developed on pulmonary embolism]. Kardiologiia 2019:64-68. [PMID: 29782291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The clinical case of the Takotsubo syndrome (TT) developed in process of treatment pulmonary embolism (PE) in old woman is described. A feature of this observation is the occurrence of TT not in the acute phase of PE, but in a month after the debut of the disease and in a week after the start of successful treatment.
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Affiliation(s)
- S A Boldueva
- State Budgetary Educational Institution of Higher Professional Education, "I. I. Mechnikov North-West State Medical University" of the RF Ministry of Health Care
| | - N S Tretyakova
- State Budgetary Educational Institution of Higher Professional Education, "I. I. Mechnikov North-West State Medical University" of the RF Ministry of Health Care
| | - N S Shvetc
- State Budgetary Educational Institution of Higher Professional Education, "I. I. Mechnikov North-West State Medical University" of the RF Ministry of Health Care
| | - V S Feoktistova
- State Budgetary Educational Institution of Higher Professional Education, "I. I. Mechnikov North-West State Medical University" of the RF Ministry of Health Care
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21
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Oganov RG, Simanenkov VI, Bakulin IG, Bakulina NV, Barbarash OL, Boytsov SA, Boldueva SA, Garganeeva NP, Doshchitsin VL, Karateev AE, Kotovskaya YV, Lila AM, Lukyanov MM, Morozova TE, Pereverzev AP, Petrova MM, Pozdnyakov YM, Syrov AV, Tarasov AV, Tkacheva ON, Shalnova SA. Comorbidities in clinical practice. Algorithms for diagnostics and treatment. Cardiovasc Ther Prev 2019. [DOI: 10.15829/1728-8800-2019-1-5-66] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- R. G. Oganov
- All-Russian fund “Association of general practitioners (family doctors) of Russian Federation”; National medical Association for the Study of the Multimorbidity;
Fund “PROFMEDFORUM”
| | - V. I. Simanenkov
- All-Russian fund “Association of general practitioners (family doctors) of Russian Federation”; National medical Association for the Study of the Multimorbidity;
Fund “PROFMEDFORUM”
| | - I. G. Bakulin
- All-Russian fund “Association of general practitioners (family doctors) of Russian Federation”; National medical Association for the Study of the Multimorbidity;
Fund “PROFMEDFORUM”
| | - N. V. Bakulina
- All-Russian fund “Association of general practitioners (family doctors) of Russian Federation”; National medical Association for the Study of the Multimorbidity;
Fund “PROFMEDFORUM”
| | - O. L. Barbarash
- All-Russian fund “Association of general practitioners (family doctors) of Russian Federation”; National medical Association for the Study of the Multimorbidity;
Fund “PROFMEDFORUM”
| | - S. A. Boytsov
- All-Russian fund “Association of general practitioners (family doctors) of Russian Federation”; National medical Association for the Study of the Multimorbidity;
Fund “PROFMEDFORUM”
| | - S. A. Boldueva
- All-Russian fund “Association of general practitioners (family doctors) of Russian Federation”; National medical Association for the Study of the Multimorbidity;
Fund “PROFMEDFORUM”
| | - N. P. Garganeeva
- All-Russian fund “Association of general practitioners (family doctors) of Russian Federation”; National medical Association for the Study of the Multimorbidity;
Fund “PROFMEDFORUM”
| | - V. L. Doshchitsin
- All-Russian fund “Association of general practitioners (family doctors) of Russian Federation”; National medical Association for the Study of the Multimorbidity;
Fund “PROFMEDFORUM”
| | - A. E. Karateev
- All-Russian fund “Association of general practitioners (family doctors) of Russian Federation”; National medical Association for the Study of the Multimorbidity;
Fund “PROFMEDFORUM”
| | - Yu. V. Kotovskaya
- All-Russian fund “Association of general practitioners (family doctors) of Russian Federation”; National medical Association for the Study of the Multimorbidity;
Fund “PROFMEDFORUM”
| | - A. M. Lila
- All-Russian fund “Association of general practitioners (family doctors) of Russian Federation”; National medical Association for the Study of the Multimorbidity;
Fund “PROFMEDFORUM”
| | - M. M. Lukyanov
- All-Russian fund “Association of general practitioners (family doctors) of Russian Federation”; National medical Association for the Study of the Multimorbidity;
Fund “PROFMEDFORUM”
| | - T. E. Morozova
- All-Russian fund “Association of general practitioners (family doctors) of Russian Federation”; National medical Association for the Study of the Multimorbidity;
Fund “PROFMEDFORUM”
| | - A. P. Pereverzev
- All-Russian fund “Association of general practitioners (family doctors) of Russian Federation”; National medical Association for the Study of the Multimorbidity;
Fund “PROFMEDFORUM”
| | - M. M. Petrova
- All-Russian fund “Association of general practitioners (family doctors) of Russian Federation”; National medical Association for the Study of the Multimorbidity;
Fund “PROFMEDFORUM”
| | - Yu. M. Pozdnyakov
- All-Russian fund “Association of general practitioners (family doctors) of Russian Federation”; National medical Association for the Study of the Multimorbidity;
Fund “PROFMEDFORUM”
| | - A. V. Syrov
- All-Russian fund “Association of general practitioners (family doctors) of Russian Federation”; National medical Association for the Study of the Multimorbidity;
Fund “PROFMEDFORUM”
| | - A. V. Tarasov
- All-Russian fund “Association of general practitioners (family doctors) of Russian Federation”; National medical Association for the Study of the Multimorbidity;
Fund “PROFMEDFORUM”
| | - O. N. Tkacheva
- All-Russian fund “Association of general practitioners (family doctors) of Russian Federation”; National medical Association for the Study of the Multimorbidity;
Fund “PROFMEDFORUM”
| | - S. A. Shalnova
- All-Russian fund “Association of general practitioners (family doctors) of Russian Federation”; National medical Association for the Study of the Multimorbidity;
Fund “PROFMEDFORUM”
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22
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Boldueva SA, Petrova VB, Khavinson VK, Samohvalova MV, Petrova AI. [Problems of diagnostics and treatment of transtiretinum amyloidosis with destruction of the heart in the elderly: Clinical experience.]. Adv Gerontol 2019; 32:137-144. [PMID: 31228380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The article presents a modern understanding of the treatment of cardiac amyloidosis, provides data on the frequency of occurrence, classification and variants of clinical manifestations of transthyretin amyloidosis. This pathology is a slowly progressive disease, the symptoms of which usually appear in the elderly and senile age. This diagnosis may become more common in the future as the population ages and diagnostic methods improve. As an illustration, a description of the clinical case of transtritin amyloidosis of the heart in a 77-year-old patient, which occurred with a primary lesion of the heart and symptoms of chronic heart failure, is given. It shows the difficulties in the lifetime diagnosis of transthyretin amyloidosis.
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Affiliation(s)
- S A Boldueva
- I.I.Mechnikov North-Western State Medical University, 41 Kirochnaya str., St. Petersburg 191015, Russian Federation; e-mail:
| | - V B Petrova
- I.I.Mechnikov North-Western State Medical University, 41 Kirochnaya str., St. Petersburg 191015, Russian Federation; e-mail:
| | - V K Khavinson
- I.I.Mechnikov North-Western State Medical University, 41 Kirochnaya str., St. Petersburg 191015, Russian Federation; e-mail:
| | - M V Samohvalova
- I.I.Mechnikov North-Western State Medical University, 41 Kirochnaya str., St. Petersburg 191015, Russian Federation; e-mail:
| | - A I Petrova
- I.I.Mechnikov North-Western State Medical University, 41 Kirochnaya str., St. Petersburg 191015, Russian Federation; e-mail:
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23
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Shumkov VA, Boldueva SA, Zagorodnikova KA, Petrova VB. 5075Polymorphism RS776746 in the gene of CYP3A5 as a possible predictor of clinical efficiency of bisoprolol in patients transplanted with acute coronary syndrome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- V A Shumkov
- North-Western State Medical University named after I.I. Mechnikov, faculty therapy, Saint Petersburg, Russian Federation
| | - S A Boldueva
- North-Western State Medical University named after I.I. Mechnikov, faculty therapy, Saint Petersburg, Russian Federation
| | - K A Zagorodnikova
- North-Western State Medical University named after I.I. Mechnikov, faculty therapy, Saint Petersburg, Russian Federation
| | - V B Petrova
- North-Western State Medical University named after I.I. Mechnikov, faculty therapy, Saint Petersburg, Russian Federation
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24
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Oganov RG, Denisov IN, Simanenkov VI, Bakulin IG, Bakulina NV, Boldueva SA, Barbarash ON, Garganeeva NP, Doshchitsin VL, Drapkina OM, Dudinskaya EN, Kotovskaya YV, Lila AM, Mamedov MN, Mardanov BU, Miller ON, Petrova MM, Pozdnyakov YM, Runikhina NK, Sayganov SA, Tarasov AV, Tkacheva ON, Urinsky AM, Shalnova SA. COMORBIDITIES IN PRACTICE. CLINICAL GUIDELINES. Kardiovask ter profil 2017. [DOI: 10.15829/1728-8800-2017-6-5-56] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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25
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Boldueva SA, Ryzhikova MV, Shvets NS, Leonova IA, Titova IY, Kochanov IN. TAKOTSUBO SYNDROME AS ACUTE FORM OF MICROVASCULAR ANGINA. CLINICAL CASE. Racionalʹnaâ farmakoterapiâ v kardiologii 2017. [DOI: 10.20996/1819-6446-2017-13-4-489-494] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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26
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Feoktistova VS, Vavilkova TV, Sirotkina OV, Boldueva SA, Gaikovaia LB, Leonova IA, Laskovets AB, Ermakov AI. [THE NEW APPROACH TO EVALUATION OF ENDOTHELIUM DYSFUNCTION: DETECTION OF NUMBER OF CIRCULATING ENDOTHELIUM CELLS USING FLOW CYTOMETRY TECHNIQUE]. Klin Lab Diagn 2015; 60:23-39. [PMID: 26189287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The endothelium dysfunction takes leading place in pathogenesis of development of cardiovascular diseases. The circulating endothelium cells of peripheral blood can act as a direct cell marker of damage and remodeling of endothelium. The study was carried out to develop a new approach to diagnose of endothelium dysfunction by force of determination of number of circulating endothelium cells using flow cytometry technique and to apply determination of circulating endothelium cells for evaluation of risk of development of ischemic heart disease in women of young and middle age. The study embraced 62 female patients with angiography confirmed ischemic heart disease, exertional angina pectoris at the level of functional class I-II (mean age 51 ± 6 years) and 49 women without anamnesis of ischemic heart disease (mean age 52 ± 9 years). The occurrence of more than three circulating endothelium cells by 3 x 105 leukocytes in peripheral blood increases relative risk of development of ischemic heart disease up to 4 times in women of young and middle age and risk of development of acute myocardial infarction up to 8 times in women with ischemic heart disease. The study demonstrated possibility to apply flow cytometry technique to quantitatively specify circulating endothelium cells in peripheral blood and forecast risk of development of ischemic heart disease in women of young and middle age depending on level of circulating endothelium cells.
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Sirotkina OV, Laskovets AB, Lipunova AS, Gaykovaya LB, Boldueva SA, Vavilova TV. POSSIBILITIES OF CLINICAL LABORATORY EVALUATION OF ANTIPLATELET THERAPY EFFECTIVENESS IN PATIENTS WITH ISCHEMIC HEART DISEASE. Racionalʹnaâ farmakoterapiâ v kardiologii 2013. [DOI: 10.20996/1819-6446-2013-9-1-31-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Boldueva SA, Bykova EG, Leonova IA, Iarmosh IV, Arkharov IV, Kaledin AL, Kukharchik GA. [Prognostic value of diastolic dysfunction for sudden cardiac death of patients after myocardial infarction]. Kardiologiia 2011; 51:22-27. [PMID: 21942954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We studied prognostic value of left ventricular (LV) diastolic dysfunction (DD) in relation to sudden cardiac death (SCD) after myocardial infarction (MI). We examined 603 patients in acute period of MI (including 551 with preserved LV systolic function and DD). Duration of follow-up was 1-7 years. According to data of Cox multifactorial regression analysis LVDD was not an independent prognostic factor. ut it increased SCD risk at the account of interrelationship with such predictors as ventricular rhythm disturbances, lowering of heart rate variability, and sensitivity of cardiochronotropic component of arterial baroreflex.
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Boldueva SA, Samokhvalova MV, Bogdanova EV, Solov'eva TS. [Primary systemic amyloidosis with involvement of the heart and coronary arteries]. Kardiologiia 2010; 50:92-94. [PMID: 20659036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Boldueva SA, Shabrov AV, Nesterko AO, Leonova IA, Burak TI, Samokhvalova MV, Trofimova OV, Zhuk VS, Bykova EG. [Factors affecting development of sudden death and risk stratification of patients after myocardial infarction]. Kardiologiia 2006; 46:64-5. [PMID: 16883225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Boldueva SA, Trofimova OV, Zhuk VS. [Psychological features and heart rate variability in sudden death victims and myocardial infarction survivors]. TERAPEVT ARKH 2006; 78:35-40. [PMID: 17294861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
AIM To study effects of psychological factors (anxiety and depression) on risk of sudden death in post-myocardial infarction patients (PMI); correlation of psychological factors with autonomic regulation of cardiac rhythm. MATERIAL AND METHODS Heart rate variability (HRV) and psychological status (Mini-Mult method) were determined and Spilberger-Khanin test was made in 320 PMI patients (mean age 57+/-7.6 years, 246 males and 74 females). RESULTS 56% examinees had anxiodepressive profile of personality by Mini-Mult test and high anxiety by Spilberger-Khanin test. This indicates the presence of depressive symptoms and anxiety in many PMI patients. These patients had lower HRV and more depressed parasympathic tonicity. The correlation analysis of psychological factors and HRV has revealed correlation between HRV deterioration and intensification of anxiety and depression. CONCLUSION Those patients who died of myocardial infarction had more serious psychological disturbances than in the survivors as well as more significant disorders of autonomic regulation of sinus rhythm which contribute to development of fatal arrhythmia.
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Olesin AI, Shabrov AV, Sinenko VI, Popik GS, Boldueva SA, Leonova IA, Poloskina OA. [Possibility of differentiated treatment of ventricular heart rate disturbances based on mechanism of their development]. Kardiologiia 2005; 45:57. [PMID: 16007055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Boldueva SA, Zhuk VS, Leonova IA, Burak TI, Samokhvalova MV, Karpov IA. [Interrelationship between derangements of autonomic regulation of cardiac rhythm, severity of coronary atherosclerosis, and left ventricular contractility in patients with myocardial infarction]. Kardiologiia 2003; 42:60-1. [PMID: 12494021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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Boldueva SA, Zhuk VS, Leonova IV, Burak TY, Samokhvalova MV, Shabrov AV. [Diagnostic value of ventricular late potentials, heart rate variability and QT dispersion in patients with acute myocardial infarction]. Kardiologiia 2003; 42:70-5. [PMID: 12494228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Late ventricular potentials (LVP), heart rate variability (HRV) and dispersion of QT interval (QTd) were studied in 91 patients with myocardial infarction with various ventricular arrhythmias. Patients with episodes of sustained ventricular tachycardia (group 4) had the following characteristics: prevalence of LVP 73.7%, QTd 82.5 ms, standard deviation of RR intervals (SD) 26.5 ms; spectral analysis of HRV revealed preponderance of sympathetic influences and lowered vagal activity. Frequency of LVP detection, QTd and SD in patients with ventricular extrasystoles (Lown classes 3-5) (group 3) were 33.3%, 72.8 ms, and 42.8 ms, respectively. Patients of group 3 also had augmented sympathetic and lowered parasympathetic influences. These data significantly differed from those obtained in patients with Lown class 1-2 ventricular extrasystoles (group 2) and patients without extrasystoles (group 1). Groups 3 and 4 had significantly different prevalences of LVP and values of some HRV parameters but similar QTd. There was close correlation between presence of severe ventricular arrhythmias and some parameters of HRV and signal averaged ECG. Stepwise regression analysis showed that the following group of parameters was related to the presence of malignant ventricular rhythm disturbances: heart rate, SD and total QRS duration (p<0.05). Thus patients with life threatening ventricular arrhythmias were characterized by the presence of LVP and changes of some parameters of HRV and QTd. Registration of these parameters can apparently be used for prediction of potentially fatal ventricular arrhythmias in patients with myocardial infarction.
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Boldueva SA, Vasil'eva MA, Shamurina LI, Zuev IB. [A case of an atypical course of malignant pheochromocytoma of the adrenal glands]. Klin Med (Mosk) 1989; 67:125-7. [PMID: 2747146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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