[Decreased Heart Rate Variability in Sickle Cell Anemia as Effect of Pulmonary Arterial Hypertension]

Decreased heart rate variability (HRV) is associated with increased mortality risk in various diseases. The objective of this investigation:to study HRV in patients with sickle cell anemia (SCA) and to assess the effect of pulmonary arterial hypertension (PAH) on HRV in these patients. Materials and methods. HRV registration and Doppler echocardiographic assessment of systolic pulmonary arterial pressure (PAP) was carried out in 61 stable patients with SCA and 24 healthy subjects. Results. Low frequency power (LFP) and high frequency power (HFP) were decreased in SCA patients compared to healthy subjects. Among SCA patients, PAH patients had lower  LFP and HFP than patients without PAH. In SCA patients, systolic PAP showed significant negative correlation with LFP and HFP. Conclusion. HRV is significantly decreased in SCA patients, especially in those with PAH. HRV may be particularly useful in early detection of PAH patients who may have worse prognosis and higher mortality risk.

[Radial Approach for Percutaneous Coronary Interventions in Patients With Ischemic Heart Disease: Advantages and Disadvantages, Complications Rate in Comparison With Femoral Approach]

During recent 10-15 years, percutaneous coronary interventions (PCI) have reached a new level of efficacy and safety. Rate of serious coronary complications has decreased. That to a greater degree exposes the problem of peripheral complications at the site of arterial approach. At the same time portion of patients older than 75 years in the total pool of PCI constantly increases. Number of patients with pronounced obesity also grows each year. Radial approach for PCI allows to substantially decrease rate of peripheral complications at the account of lowered rate of bleedings, and to shorten duration of hospitalization. In this literature review we present results of a number of relevant clinical studies including those which contained groups of elderly patients and of patients with obesity. We also have summarized main advantages and disadvantages of radial approach as compared with femoral approach for coronary angiography and PCI.

[Ability to Overcome the Thrombocyte Resistance to Acetylsalicylic Acid in Patients With Coronary Artery Disease After Myocardial Revascularization With Coronary Stenting]

Resistance to acetylsalicylic acid (ASA) in patients with coronary artery disease is a poor predictor for the development of atherothrombotic complications. In 277 patients with coronary artery disease suffered uncomplicated coronary angioplasty with stent implantation, we was estimated arachidon-induced platelet aggregation during treatment with acetylsalicylic acid by bedside VerifyNow Assay test at 28-90 days after the intervention. It was found that 18.9% of the 144 patients receiving a combination of ASA 75 mg with 15.2 mg of magnesium hydroxide had true (laboratory) resistance to ASA. At the same time on the original enteric coated ASA 100 mg, we can found only 0.8% resistance to ASA among 129 patients. We made switch from combination of ASA 75 mg with 15.2 mg of magnesium hydroxide to original enteric coated ASA 100 mg and repeat VerifyNow Assay test at 2-4 days and found lost of resistance in 92% of 28 patients. Thus, resistance to the ASA is not constant, it depends on the form and the applied dose of ASA, and eliminating more than 92% when ASA changes from ineffective to effective form.

[Ischemic Heart Disease: Focus on Acute Infarction of the Right Ventricular Myocardium]

Ischemic heart disease and acute myocardial infarction (AMI) in particular remain widely spread and contribute seriously in total mortality of population. This literature review is devoted to the right ventricular (RV) AMI as the least studied problem of contemporary cardiology. We present here description of specific characteristics of blood supply to ventricles of the heart, clinical picture, diagnostic criteria and prognosis of RV infarction. We also present current strategy of management of patients with RV AMI including early revascularization with the help of percutaneous coronary intervention.

Current Role of Laser Angioplasty of Restenotic Coronary Stents

Treatment of in-stent restenosis (ISR) with conventional percutaneous transluminal coronary angioplasty (PTCA) causes significant recurrent neointimal tissue growth in 30-85%. Therefore, laser ablation of intrastent neointimal hyperplasia before balloon dilation can be an attractive alternative. However, the long-term outcomes of such treatment have not been studied thoroughly enough. This prospective case-control study evaluated angiographic and clinical outcomes of PTCA alone and a combination of excimer laser coronary angioplasty (ELCA) and adjunct PTCA in 125 patients with ISR. ELCA was performed before balloon dilation in 67 patients, PTCA alone was performed in 58 patients. Basic demographic and clinical data were comparable in both groups. Lesions included in ELCA group were longer (17.1 ±9.9 vs 13.6 ±9.1 mm; p=0.034), more complex (36.5% type C stenoses vs 14.3%; p=0.006), and more frequently had reduced distal blood flow (TIMI <3: 18.9% vs 4.8%; p=0.025) compared to lesions in the PTCA group. Immediate angiographic results of PTCA and ELCA + PTCA appeared to be comparable. PTCA alone was successful in 57 patients (98.3%), ELCA + PTCA, in 66 patients (98.5%). The rates of hospital complications were comparable (3.0% in ELCA group vs 8.6% in PTCA group). The 1-year follow-up showed that the rates of major adverse cardiac events (MACE) were comparable in the 2 groups (37.3% in ELCA group vs 46.6% in PTCA group). The rates of target vessel revascularization (TVR) within 1 year after the intervention were also similar in the 2 groups (32.8% vs 34.5%). The data mean that ELCA in patients with complex ISR is efficient and safe. Despite a higher complexity of lesions in the ELCA group, no increase in the rate of complications was registered.

[Diagnostic Possibilities of Speckle-Tracking Echocardiography]

The review is devoted to merits and demerits of a new method of assessment of condition of the heart - speckle-tracking echocardiography. Speckle-tracking echocardiography is a perspective method allowing to register disorders of both global and regional contractile motion.

[Comparative Clinical Biochemical Assessment of the State of Myocardium After Coronary Artery Bypass Surgery Performed Using Various Techniques]

We compared parameters of the state of myocardium after coronary artery bypass surgery (CABS) performed according to the following techniques - with complete cardiopulmonary bypass (CABS-CBP), beating heart bypass grafting with parallel normothermic perfusion (CABS-BH-NP), and beating heart bypass grafting (CABS-BH). Patients (n=100, 86% men, 14% women, age 56-69 years) were divided into 3 groups with comparable sex, age, state of the myocardium, and EUROSCORE surgical risk. In group 1 patients (n=35) we used CABS-CHB, in group 2 (n=32) - CABS-BH-NP, in group 3 (n=33) - CABS-BH. The following parameters were obtained on day 1 after surgery: left ventricular ejection fraction (EF, echocardiography), blood plasma levels of creatine phosphokinase (CPK), CPK-MB, and cardiac troponin I (TnI). There was no significant difference in parameters studied between groups 1 and 2 with a tendency to their more pronounced positive dynamics in group 2. In group 3 compared with groups 1 and 2 we observed significant lowering of levels of CPK (by 21.2-30.9%, p<0.05), CPK-MB (by 9.1-13.1%, p<0.05), TnI (by 0.6-0.7%, p<0.05), and elevation of EF (by 9.8-11.6%, p<0.05). Rate of development of myocardial infarction in group 3 (6.8%) was lower than in groups 1 and 2 (14.2 and 9.8%, respectively). In all groups we observed close correlation between biochemical parameters and left ventricular EF (r=0.74-0.82, p<0.01).

[Chiari network and pulmonary embolism]

We present the case of a patient with acute pulmonary embolism, Chiari network thrombus, and deep vein thrombosis in lower extremities. Chiari networks are present in the right atrium in a minority of population and are usually of no clinical significance. On the other hand it may be associated with such pathological changes as patent foramen ovale, intraatrial thrombus, or atrial arrhythmias. In our case thrombus was trapped by a Chiari's network.

[Chiari Network and Pulmonary Embolism]

We present the case of a patient with acute pulmonary embolism, Chiari network thrombus, and deep vein thrombosis in lower extremities. Chiari networks are present in the right atrium in a minority of population and are usually of no clinical significance. On the other hand it may be associated with such pathological changes as patent foramen ovale, intraatrial thrombus, or atrial arrhythmias. In our case thrombus was trapped by a Chiaris network.

[Comparative Clinical Biochemical Assesment of the State of Mycardium After Coronary Artery Bypass Surgery Performed Using Various Techniques]

We compared parameters of the state of myocardium after coronary artery bypass surgery (CABS) performed according to the following techniques--with complete cardiopulmonary bypass (CABS-CBP), beating heart bypass grafting with parallel normothermic perfusion (CABS- BH-NP), and beating heart bypass grafting (CABS-BH). Patients (n = 100, 86% men, 14% women, age 56-69 years) were divided into 3 groups with comparable sex, age, state of the myocardium, and EUROSCORE surgical risk. In group 1 patients (n = 35) we used CABS-CHB, in group 2 (n = 32)--CABS-BH-NP, in group 3 (n = 33)--CABS-BH. The following parameters were obtained on day 1 after surgery: left ventricular ejection fraction (EF, echocardiography), blood plasma levels of creatine phosphokinase (CPK), CPK-MB, and cardiac troponin I (TnI). There was no significant difference in parameters studied between groups 1 and 2 with a tendency to their more pronounced positive dynamics in group 2. In group 3 compared with groups 1 and 2 we observed significant lowering of levels of CPK (by 21.2-30.9%, p < 0.05), CPK-MB (by 9.1-13.1%, p <0.05), Tnl (by 0.6-0.7%, p < 0.05), and elevation of EF (by 9.8-11.6%, p < 0.05). Rate of development of myocardial infarction in group 3 (6.8%) was lower than in groups 1 and 2 (14.2 and 9.8%, respectively). In all groups we observed close correlation between biochemical parameters and left ventricular EF (r = 0.74-0.82, p < 0.01).

[Effect of design of standard metallic stents on neointimal hyperplasia and restenosis]

Coronary stents became an integral part of treatment of ischemic heart disease (IHD). Number of percutaneous coronary interventions (PCI) in patients with IHD in Russia constantly growing. At a certain stage of development of interventional cardiology drug eluting stents (DES) were created and became actively used. Compared with metallic stents (MS) drug eluting stents allow to substantially reduce risk of restenosis. However DES did not replace MS and the latter are still used in about 50% of PCI in Russia. Design of standard MS and thickness of struts might affect extent of neointimal proliferation which develops after stent implantation and eventually determines remote outcomes of IHD treatment. Thereby choice of optimal MS remains an actual problem. In this review we present results of clinical studies which compared MS with different design and thickness of struts.

[Signs of diabetic cardiomyopathy in patients with controlled arterial hypertension and early postprandial hyperglycemia]

AIM

To study signs of diabetic cardiomyopathy (DCM) in nondiabetic patients with controlled arterial hypertension (AH) and glycemic response during first hour of glucose tolerance test (GTT).

MATERIAL AND METHODS

Patients (n = 47) with controlled AH were divided into 2 groups according to results of GTT with 75 g of glucose: patients of group 1 (n = 22) had glucose level ≤ 200 mg/dl during 1-st hour of GTT; other patients (n = 25) composed group 2. Examination of all patients included transthoracic echocardiography, ultrasound Dopplerography, tissue Doppler (TD) and 24-hour Holter ECG monitoring. Using data of these methods we calculated left ventricular (LV) mass and the following characteristics of mitral ring: E/A, TD e', TD a', TD s', TD e'/a'/. The following characteristics of heart rate variability were obtained: standard deviation of normal RR intervals (SDNN), low and high frequency (LF, HF) power, LF/HF ratio.

RESULTS

Patients of group 2 had higher LV mass (229.5 ± 58.2 vs. 192.1 ± 50.6 g; p = 0.036), more pronounced changes of TD e'/a' (0.71 ± 0.25 vs. 1.06 ± 0.58; p = 0.011), lower SDNN both during day (85.4 ± 14.1 vs. 112.5 ± 31.3 ms, p = 0.007) and night (82.2 ± 22.1 vs. 105.9 ± 28.5 ms, p = 0,004) time, higher nocturnal LF/HF ratio (3.75 ± 4.02 vs. 1.72 ± 0.81, p = 0,029).

CONCLUSION

In patients with controlled arterial hypertension (AH) and glycemic response during first hour of GCT we revealed various pronounced manifestations of DCM. These data constitute a basis for further studies.

[The diagnostic efficiency of the methods of separate and combined registration of oronasal airflow and pulse oximetry for detection of the obstructive sleep apnea/hypopnea syndrome]

The diagnostic efficiency of the methods of separate and combined registration of oronasal airflow and pulse oximetry in order to identify the obstructive sleep apnea/hypopnea syndrome (OSAHS) is studied in this work. Patients with cardiovascular diseases with complaints on sleep disorders were included in the study. Combined registration of oronasal airflow and pulse oximetry during sleep were performed for all examined patients (diagnostic system ApneaLink with pulse oximetry, ResMed). Registration results of oronasal airflow and pulse oximetry were analyzed separately and together. Apnea/hypopnea index (classic, recommended), desaturation index with a threshold of desaturation of 4% and 3% were evaluated as the diagnostic criteria for the identification of OSAHS. Also, in this paper the "apnea/hypopnea combined index" summarizing hypopnea episodes, which are associated with significant desaturation and without desaturation, was tested. As a method of comparison, polysomnography (Embla N7000, MedCare Flaga), which was carried out simultaneously with the main study, was used. The diagnostic efficiency of test methods and their criteria assessed by ROC-analysis (receiver operator characteristic, the characteristic curve analysis). The results of the study showed that combined registration of respiratory oronasal airflow and pulse oximetry during sleep was most effectively identified OSAHS and can be used as a screening method. The most accurate diagnostic criterion for identification of OSAHS is an "apnea/hypopnea combined index".

[Mechanisms of development of thromboembolic complications in patients with atrial fibrillation]

Thomboembolism is the most threatening complication in patients with atrial fibrillation. Main source of embolism is the left atrial thrombosis. Mechanisms of development of thromboembolic complications in patients with arrhythmias are far from being deciphered. In this review we discuss possible mechanisms of formation of intracardiac thrombus - abnormalities of functioning of the hemostasis system, endothelial dysfunction, inflammatory reactions, fibrosis of the left atrial wall, genetic traits.

[Clinical significance of filiform structures (Lambls excrescences) on cusps of cardiac valves]

This literature review is devoted to clinical significance of filiform structures (Lambls excrescences) which can be revealed on cusps of cardiac valves by transesophageal echocardiography. The review contains analysis of frequency of detection of these structures at pathomorphological investigation and transesophageal echocardiography as well as consideration of their histological construction and mechanisms of formation. Special emphasis is made on mechanisms of related embolic complications and data on association of Lambls excrescences with strokes. Differential diagnosis of these structures and other pathological elements on heart valves is also presented.

[Effect of intracoronary and intravenous administration of tirofiban loading dose in patients underwent percutaneous coronary interventions because of acute coronary syndrome]

Aim of this multicenter retrospective study was assessment of effect of intracoronary administration of tirofiban loading dose in troponin positive patients with acute coronary syndrome (ACS). We analyzed multicenter data base of patients subjected to percutaneous coronary interventions (PCI) because of ST-elevation or non-ST elevation ACS from October 2010 to October 2011. Patients who received loading doses of aspirin (300 mg) and clopidogrel (600 mg) before PCI and tirofiban (10 mg/kg bolus with subsequent infusion 0.15 mg/kg/min for 24 h) were selected for the study (n=133, 89 with intravenous and 44 - intracoronary administration of tirofiban loading dose). We assessed hospital mortality, myocardial reinfarctions (reMI), necessity of target vessel revascularization (TVR) and pronounced bleedings. There were no significant differences in mortality, reMI, and TVR between two groups. However major adverse cardiac events was significantly less in patients who received intracoronary tirofiban (6.8 vs. 21.3% in i.v. group; p=0.046). Hospital stay was significantly shorter in intracoronary compared with i.v. group (3.84+/-0.96 vs. 4.55+/-1.11 days; p=0.001). Rates of bleedings did not differ significantly between groups. Thus compared with i.v. intracoronary administration of tirofiban loading dose allows lower rate of major adverse cardiac events as well as to shorten length of hospital stay of patients with ACS.

[Significance of echocardiography in acute coronary syndrome]

The paper contains description of possibilities and limitations of ultrasound diagnosis in patients with acute coronary syndrome (ACS). Main attention is paid to possibilities of echocardiographic diagnosis of myocardial infarction (MI) and its complications, as well as to differential diagnostics of ACS and nonischemic conditions causing chest pain and infarction-like ECG changes. Data are presented demonstrating substantial lowering of rates of some complications of MI in patients subjected to thrombolytic therapy or interventional procedures of myocardial revascularization.

[Nicorandil in the treatment of patients with ischemic heart disease]

Adequate drug therapy of stable ischemic heart disease directed at reduction and prevention of main clinical symptoms of the disease, increase of exercise tolerance to physical effort, improvement of quality of life and prognosis remains an actual problem. Nicorandil combines properties of an antianginal drug and cardioprotective effects. Its pharmacological action is related to capabilities to be an nitrous oxide donor and to activate ATP-dependent potassium channels. In this review we present data on mechanism of action of nicorandil, on its clinical effectiveness, and on comparison with antianginal drugs of other groups. We have also analyzed experience of the use of nicorandil in patients with acute coronary syndrome and in conjunction with during invasive interventions.

[The pulse wave velocity and fatal events rate in hypertensive patients have gone through acute coronary syndrome]

There are several stratification scales of major cardiovascular events rate for patients have gone through acute coronary syndrome (ACS). None of them is perfect one. Arterial hypertension is included into some scales for post ACS patients but the features of it and its impact on coronary artery disease after ACS have never studied before. We studied the reasonability of Pulse Wave Velocity (PWV) measurement for fatal events rate in hypertensive patients have gone through ACS. 326 patients were examined. They were enrolled into the study in stable condition on 10th day after ACS has occurred. As a result of two years observation the increase PWV on carotid-femoral segment associated with the most negative (fatal) events in hypertensive patients have gone through ACS.

[Clinico-economical aspects of cardioversion of paroxysmal atrial fibrillation at phehospital stage and during hospitalization]

We carried out clinico-economical analysis of 2 tactics of rhythm restoration in patients with paroxysmal atrial fibrillation (AF) lasting less than 48 hours: cardioversion at prehospital stage with intravenous procainamide and inhospital cardioversion with any method. This retrospective study was based on the data from department of urgent aid of an outpatient clinic. The results showed that within 48 hours inhospital was a was more effective, safe, and more economically profitable compared with administration of procainamide at prehospital stage. Intravenous procainamide resulted in effective cardioversion in 70.6% of patients. It was associated with arterial hypotension and proarrhythmogenic action in 14,7% of cases. Patients with effective cardioversion with procainamide had lesser mean values of left ventricular anterior-posterior dimension (echocardiography) and shorter duration of arrhythmia.

[Newly developed atrial fibrillation among patients under active observation by an outpatient clinic]

We carried out prospective cohort study of incidence of new cases of atrial fibrillation (AF) in a sample of Moscow population (patients under observation in our policlinic). Total incidence of AF between 2003 and 2009 was 7.7 per 1000 patient/years, it was higher among men than among women. Incidence of AF progressively increased with age reaching maximum in age group more or equal 85 years. Most frequent baseline disease in patients with first appearance of AF was hypertensive disease (71%). Ischemic heart disease diagnosed according to strict criteria (postinfarction cardiosclerosis, revascularization procedures) was registered in 20.1%, diabetes - in 15.7%, chronic heart failure - in 13%, valvular heart disease - in 5.6%, and history of acute ischemic stroke - in 2.5% of patients.

[Two years experience of the use of a penetration catheter (Tornus) recanalization during percutaneous coronary interventions on chronic total occlusions]

We included in this study 43 patients chronic total occlusions (CTO) subjected percutaneous coronary interventions (PCI) with the use of penetration catheter (Tornus) in 2009-2010. Penetration catheter was applied only in those cases when it was not possible to introduce low profile coronary dilatation catheter into the site of occlusion. After penetration of CTO by a guide wire a channel was formed by a manually rotated penetration catheter. The Tornus catheter was successfully passed into distal part of an artery in 81.4% of cases. In other.

[The use of computer pulse oximetry monitoring for screening of sleep apnea in patients of a hospital cardiology department]

In order to assess the overall prevalence of sleep apnea of obstructive and central origin in of patients hospital cardiology department we performed continuous pulse oximetry monitoring during sleep in all patients admitted over 2 months. Of the 139 patients reliable results were obtained in 125 (89.9%). In 72% of patients desaturation index was 5 or more, indicating probability of sleep apnea. In 36% of patients oxygen desaturation index was > or = 15, which corresponded to moderate forms of sleep apnea. And only 28% of patients had no pathological changes in the nocturnal oxygen saturation curve. Thus, in patients hospital cardiology department we revealed extremely high prevalence of sleep apnea of various origins. Showed the technical feasibility of the continuous pulse oximetry monitoring for mass screening of apnea during sleep.

[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.

[Pulmonary arterial hypertension: changing approaches to management]

The review is devoted to different aspects of pulmonary arterial hypertension (PAH); new classification of PAH is published in 2010. There are idiopathic PAH and PAH associated with other diseases. Current guidelines recommend to treat PAH only after the verification of diagnosis with right heart catheterization and acute tests with vasodilators. Patients-reactors should be treated with calcium antagonists. The following drugs related to one of three categories should be used in PAH: (1) prostanoids (epoprostenol, iloprost et al.); (2) blockers of endothelin receptors (bosentan, ambrisentan, sitaxsentan); (3) phosphodiesterase 5 type inhibitors (sildenafil, tadalafil et al.) In majority of cases the combined treatment is used, usually the combination of bosentan and sildenafil is used.

[The use of screening methods in diagnosis of disturbances of respiration during sleep in patients with cardiac pathology]

Disturbances of respiration during sleep especially those of obstructive character are sufficiently widespread phenomena. In addition to worsening of the quality of sleep itself they facilitate formation and development of concomitant pathology of cardiovascular system, endocrine system, cognitive sphere. This results in lowering of quality of life and its duration. At present standard method of diagnosis of disturbances of respiration during sleep is polysomnographical examination. At the same time more accessible screening methods are also actively used with the aim of detection of subjects with high probability of respiratory disturbances during sleep. Among them cardiorespiratory monitoring, nocturnal pulsoximetry, registration of oro-nasal flow during sleep, are questionnaires most widely-spread.

[Drug prevention of pulmonary embolism in orthopedic practice: traditional and novel approaches]

We consider in this review traditional and novel approaches to drug prevention of pulmonary embolism (PE) which in predominant number of cases is related to deep vein thrombosis of lower extremities. Risk of PE development is especially high in patients after orthopedic hip or knee surgery. Modern recommendations contemplate use of unfractionated and low molecular weight heparins, vitamin K antagonists (warfarin in the first place), fondaparinux. Oral direct anticoagulants related to selective inhibitors of blood coagulation factors IIa (thrombin) and Xa have appeared recently and proved their preventive efficacy and safety in randomized controlled studies. Preventive efficacy and safety of dabigatran among direct selective factor IIa (thrombin) inhibitors and of rivaroxaban, apixaban, and edoxaban among direct selective factor IIa inhibitors have been studied best.

[Detection of risk factors and early manifestations of cardiovascular diseases during ambulatory examination of working age persons]

We have studied prevalence of risk factors (RF) of cardiovascular diseases (CVD) recorded for statistical purposes in subjects of able bodied age during 10 year period of observation in a policlinic as well as prevalence of early and/or oligosymptomatic CVD manifestations in 11762 subjects of working age with RF of CVD development according to results of complex noninvasive examination of cardiovascular system in ambulatory conditions during the period from 2000 to 2009 year. Numbers of men and women were 45.3 and 54.7%, respectively. The program of examination included analysis of ECG, echocardiography (EchoCG), ultrasound examination of brachiocephalic vessels, 24-hour Holter ECG monitoring, exercise test on treadmill. In 2006 and 2007 complex examination was supplemented with 24-hour monitoring of arterial pressure, stress EchoCG, noninvasive arteriography. Complex ambulatory examination of subjects of working age with FR of CVD development with the use of noninvasive methods of functional diagnostics allowed to diagnose in 56% of studied persons various early and/or oligosymptomatic CVD manifestations which often appeared in combination, including ischemic heart disease (in 15%), hypertensive disease- (in 42%), cerebral atherosclerosis - (in 23.5%).

[The use of multi-spiral computer tomography for early diagnosis of coronary artery stenoses in patients with high risk of development ischemic heart disease]

Results of the study of clinico-diagnostic value of multispiral computed tomography in patients with suspected ischemic heart disease (IHD) are described in this paper. We have used 64-slice spiral computer tomography in examination of 49 patients with high IHD risk referred to the cardiological hospital for IHD exclusion. We have demonstrated high capacity of this method in diagnosis of early stages of atherosclerotic coronary artery involvement. This will allow timely detection of such patients and to intervene on modifiable IHD risk factors with the aim of lowering risk of development of unfavorable clinical manifestations of IHD, such as acute coronary syndrome and sudden death.

[Possibilities of recanalization of chronic coronary occlusions with penetration catheter <<Tornus>>]

Percutaneous coronary interventions (PCI) for chronic total occlusions (CTO) remain one of most difficult parts of interventional cardiology. Introduction of novel devices and methods of recanalization of CTO have facilitated fulfillment of these interventions and increased number of successful procedures. Howere a number of cases it is impossible to position a balloon in the site of occlusion even after its successful crossing with a guidewere. Penetration catheter Tornus was specifically created for such cases. It allows to form a channel in CTO for subsequent dilation and stent implantation. We present a review of available clinical studies assessing efficacy of the use of Tornus catheter during PCI for CTO, as well as results of its comparison with efficacy of rotational atherectomy. Authors of these studies concluded that Tornus catheter was highly effective in cases when it was not possible to pass a catheter for changing usual "RotaWire" guide with the aim of conducting rotational atherectomy, or in cases of impossibility to pass a balloon along a guidewere for predilation of the occlusion site. At the same time the use of penetration catheter had no advantages over rotational atherectomy.

[Diagnosis and effective surgical treatment of constrictive pericarditis]

Constrictive pericarditis is a rare and severe disease. Timely and correct differential diagnosis of this pathology facilitates choice of necessary tactics of treatment and thus improve prognosis and quality of life. In this paper we present clinical case report of a patient with constrictive pericarditis. The disease was diagnosed on the basis of clinical picture, data of X-ray and echocardiographic investigation, and confirmed by multispiral computed tomography (MSCT). The patient was subjected to pericardioectomy with positive clinical effect and results of repeated echocardiography and MSCT.

[Cystatin C level is independently related to risk of unfavorable outcome after acute coronary syndrome in individuals with normal or moderately reduced renal function]

We studied relation between cystatin C level and risk of unfavorable outcome (unstable angina, fatal and nonfatal myocardial infarction [MI], fatal and nonfatal stroke, and death) in patients stabilized after exacerbation of ischemic heart disease. Patients (n=272) were included on day 10 after onset of acute coronary syndrome. No relationship between studied outcomes and cystatin was found in a group as a whole. In patients with normal of slightly reduced renal function (glomerular filtration rate more or equal 60 ml/min/1.73 m2) unfavorable outcomes were independently associated with history of myocardial infarction and stroke, elevated levels of brain natriuretic peptide and cystatin. In subjects with moderately or severely reduced renal function elevation of cystatin level lost its significance. Risk of development of unfavorable outcomes among these subjects was independently related to history of MI and GFR &lt;60 ml/min/1.73 m2 (OR 2.130, 95% CI 1.010-4,489; =0,047). Our data confirm possibility of use of cystatin C level measured early after ACS in patients with normal or slightly lowered renal function as a parameter characterizing risk of cardiovascular complications and death.

[Clinical value of antracycline toxicity: modern approaches to diagnosis, prevention, and treatment]

In this literature review we present analysis of various aspects of the problem of cardiotoxicity of antracyclines used for the treatment of the breast cancer. We consider mechanisms of their cardiotoxic action, role of risk factors, clinical manifestations of acute and chronic cardiotoxicity, and dependence of their severity on treatment duration and drug dose. We give data on contemporary methods of diagnostics of early toxic cardiac effects of antracyclines from the side of cardiovascular system. We also conducted assessment of possibility of prevention of toxic action of antracyclines with the use of combination of different methods including dose sparing regimens and schemes of treatment, combinations of drugs, use of cardioprotectors as well as novel preparations from the antracycline group, possessing lesser cardiotoxicity. Clinical and experimental data on the treatment of manifestations of cardiotoxicity with consideration of pathogenetic mechanisms of their development are given.

[Prognostic value of levels of brain natriuretic peptide and genetic factors in patients after acute coronary syndrome]

Prognostication of the course of disease in patients with high risk of unfavorable outcome of ischemic heart disease (IHD) is of great importance for creation of individualized strategy of treatment. We have investigated contribution of levels of brain natriuretic peptide (BNP) and genetic factors in the risk of development of complications of atherosclerosis in patients who have had acute coronary syndrome. We started to follow 324 patients on day 10 of stable state after acute coronary syndrome (55.1% with Q-wave myocardial infarction, 18.5% with non-Q myocardial infarction, 25.5% with unstable angina, men BNP level 624.5+/-32.13 mol/ml [70.3 - 4276.6]). Duration of followup was 2 years. Baseline BNP level in patients with unfavorable outcome during followup (fatal and nonfatal myocardial infarction and stroke) was 872.47+/-91.42 compared with 592.45+/-35.97 mol/ml in patients without unfavorable outcome (p=0,001). Multifactorial Cox analysis showed that carriage of T allele of polymorphic marker (--1654) of protein C gene, elevated BNP level, symptomatic atherosclerosis of peripheral arteries, history of MI, and use of thiazide diuretics were independently associated with unfavorable outcomes (p=0.026, &lt;0.0001, &lt;0.0001, =0.001, =0.024, respectively). Thus genetic factors and study of BNP allow to improve prediction of unfavorable outcome after exacerbation of IHD.

[Stratification of risk of cardiovascular complications in government employees and results of 10-year prospective observation]

We investigated prognostic value of the SCORE scale in working age government employees with 3 or more risk factors (RF) of cardiovascular diseases (CVD) and metabolic syndrome (MS, 2001 criteria) according to results of 10-year prospective observation in a policlinic. The study comprised 268 practically healthy men: 168 patients with 3 or more RF of CVD (mean age 47.76+/-6.9 years) (group 1) and 100 patients with MS (mean age 47.73+/-7.97 years) (group 2). Prospective follow up of group I patients with low or moderate CVD risk calculated with the SCORE scale demonstrated concordance of predicted and actual rates of lethal outcomes. In the group of patients with MS and high CVD risk lowering of number and level of RF took place due to in-depth examination and high compliance to therapy. This resulted in lowering of CVD and postponement rate their later development.

[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.

[Echocardiographical evaluation of mean pulmonary artery pressure in patients with chronic obstructive pulmonary disease]

We compared Dopplerographic methods and invasive assessment of mean pulmonary artery pressure (MPAP) in 20 men with chronic obstructive pulmonary disease (COPD). We demonstrated possibility of evaluation of mean pulmonary artery pressure by Doppler methods of calculation using diastolic gradient of pressure of pulmonary regurgitation and ratio of flow acceleration time in right ventricular outflow tract and ejection time. In patients with COPD overestimation of MPAP is possible especially in patients with pronounced elevation of MPAP. Methods of evaluation of MPAP based on measurements of intervals of pulmonary blood flow do not allow to adequately evaluate MPAP in patients with COPD.

[Implantation of the paclitaxel-eluting stent Apollo in patients with stable angina pectoris: long-term angiographic and clinical results]

AIM

to assess the long-term angiographic and clinical results of percutaneous coronary interventions (PCI) with implantation of the drug-eluting stent (DES) Apollo in patients with stable angina pectoris.

SUBJECTS AND METHODS

The study enrolled 48 patients with stable angina who had been implanted with 59 stents. A follow-up of the patients lasted 12 months.

RESULTS

The intervention was successful in 100% patients. Following 12 months, 81.3% of the patients underwent angiography that demonstrated that the vascular diameter decreased by 0.32 +/- 0.45 mm and the rate of restenosis was reduced by only 5.3%. The frequency of evident cardiac complications over 12 months was as high as 11.6%.

CONCLUSION

The DES Apollo provides a way of safely performing PCI, by achieving a high of angiographic success rate. The application of this stent yields long-term good angiographic and clinical results in patients with stable angina pectoris.

[In-hospital and long-term (to 3 years) results of using bare-metal stents in patients with coronary artery disease and chronic kidney disease]

Patients (n=727) who had been subjected to implantation of one or several standard stents in 2004 were included into this study. These patients were divided into 3 groups according to initial level of glomerular filtration rate (GFR, MDRD equation): group 1 - 466 patients with GFR >60 ml/min/1,73 m(2), group 2 - 233 patients with GFR 30 - 60 ml/min/1,73 m(2), group 3 - 38 patients with GFR <30 ml/min/1,73 m(2). In all group 2 and 3 patients prevention of contrast induced nephropathy (CIN) was implemented: hydration before and after angiography, limitation of intake of nephrotoxic drugs, N acetylcysteine 600 mg/day orally. In all group 2 and 3 patients only contrast preparation iodixanol was used. Total amount of contrast did not exceed 350 ml in patients with GFR 45-59 ml/min/1.73 m(2) and 250 ml - with GFR <45 ml/min/1.73 m(2). In all patients with GFR 60 ml/min/1.73 m(2) low osmolar contrast preparations were used (total amount - less then 600 ml per patient). Immediate success of PCI was similar in all groups (99.4%, 98.2% 97.4%, respectively). Rate of CIN rose significantly in groups 2 and 3 (0.4%, 4.9%, 13.2%, respectively, <0.001). Before 6 months after PCI restenosis developed more frequently with lowering of GFR (group 1 - 11%, group 2 - 22%, group 3 - 34%, <0.001). Myocardial infarction developed by 3 years in 6, 10, and 26% of patients in groups 1, 2, and 3, respectively. Lethality during 3 years was 5, 10, and 24% in groups 1, 2, and 3, respectively. Regression analysis showed that as a whole 3 years rate of myocardial infarction rose 1.57 times in group 2 compared with group 1, and 3.91 times in group 3 compared with group 1. Mortality by 3 years rose 1.93 times in group 2 compared with group 1, and 4.52 times in group 3 compared with group 1. Thus, presence of initially lowered GFR increases risk of CIN after elective implantations of standard stents, leads to rise of restenosis rate by 6 months and increase of mortality and rate of nonfatal myocardial infarction by 3 years.

[The risk factors and predictors of the clinically significant progression of atherosclerosis in patients with chronic lower extremity ischemia]

AIM

To define the risk factors and predictors of atherosclerosis progression leading to clinical worsening in patients with chronic lower extremity ischemia (CLEI).

SUBJECTS AND METHODS

Two hundred and forty patients with lower extremity arterial (LEA) atherosclerosis were examined. All the patients underwent color duplex ultrasound scanning of the great arteries supplying blood to the brain and LEA. Later on an annual observation was made for 11 months to 11 years (mean 45.6 months). To evaluate the influence of various factors on the progression of LEA atherosclerosis, the authors estimated overall survival without progression of CLEI.

RESULTS

The one-year overall CLEI progression-free survival was 93.5% (SE = 0.016); 5- and 7-year survival was 66.9% (SE = 0.040) and 53.7% (SE = 0.054), respectively. Over 5 years, a clinically significant progression of CLEI was noted in 32% of the smokers and in 8% of the non-smokers, also in 26% of the patients with grade 1 or 2 hypertensive disease (HD) and in 43% of those with grade 3 HD. The overall CLEI progression-free survival did not depend on the severity of type 2 diabetes mellitus (patients with the severe course were excluded from the analysis). LEA atherosclerosis showed a significantly rapider progression in patients with increased common carotid intima-media thickness (IMT) (p = 0.004). During 5 years, CLEI progression occurred in 18% of the patients with an IMT of < or = 1.0 mm and in 38% of those with an IMT of more than 1.0 mm, in 15% of the patients without hemodynamically significant stenosis (HDSS) of brachiocephalic arteries (BCA) and in 52% of those with HDSS of BCA, as well as in 20% of the patients without ischemic heart disease (IHD) and in 36% of those with symptoms of IHD.

CONCLUSION

Smoking that increases the risk of CLEI progression by 2.1 times and severe hypertension are the most important factor influencing the progression of atherosclerosis. The IMT index is a universal predictor of progressive atherosclerosis. It may be presumed that there is a higher process development rate in the detection of HDSS of one of the arterial beds (LEA, BCA, and symptoms of IHD) at the first examination.

[The role of reduction of glomerular filtration rate in outcomes of drug-eluting stents implantation in patients with ischemic heart disease and chronic kidney disease]

Patients (n=432) subjected to percutaneous coronary interventions (PCI) with implantation of one or more drug eluting stents (DES) in 2005 were included in this study. These patients were divided into 3 groups according to baseline glomerular filtration rate (GFR): group 1 - GFR 60 ml/min/1.73 m2, n=271, group 2 - GFR 30-60 ml/min/1.73 m2, n=132, group 3 - GFR <30 ml/min/1.73 m2, n=29. In all patients only contrast preparation iodixanol was used and prevention of contrast induced nephropathy (CIN) was implemented. Immediate success of PCI was higher and comparable between groups. Rate of development of CIN turned out significantly higher in groups 2 and 3 (6.8 and 17.2% compared with 0.7% in group 1, <0.001). During 12 months of follow up restenosis rate was higher in groups 2 and 3 (15.9 and 27.6% compared with 6.6% in group 1, <0.001). Lowered GFR became predictor of long term (up to 3 years) mortality in patients with CKD as for group 2 compared with group 1 relative risk (RR) of death was 1.77 (95%CI 1.19-3.74, =0.001), and for group 3 compared with group 1 - 3.69 (95%CI 1.58-6.87), =0.001. In addition lowered GFR was predictor of nonfatal myocardial infarction (MI) up to 3 years: for group 2 compared with group 1 RR 1.69 95%CI 1.12-3.07, =0.009, for group 3 compared with group 1 RR 3.44 95%CI 1.37-6.19, =0.001. The conducted study showed that initially lowered GFR after stenting increased risk of development of CIN, led to rise of restenosis rate and repeat revascularizations up to 12 months, and also appears to be predictor of death and nonfatal MI in remote period up to 3 years.

[Inhospital and 12-months results of percutaneous coronary interventions with implantation of Paclitaxel eluting stents in patients with long de novo coronary artery lesions]

We implanted 59 paclitaxel eluting Apollo stents to 48 patients with ischemic heart disease (IHD) and long de novo coronary artery lesions in 2007 with 100% immediate success rate without inhospital major cardiac complications. One patient developed hematoma at femoral artery puncture site. There were no cases of restenosis among 18 patients subjected to control angiography after 6 months. One patient had acute myocardial infarction in area supplied by nontarget artery. Control angiography after 12 months was carried out in 81.3% of patients while 14.6% of patients who refused angiography were examined with stress tests. Restenosis of stented segments was found in 3 (5.3%) patients, diameter loss was 0.32+/-0.45 mm. All these patients were subjected to repeat PCI. During follow up myocardial infarctions were registered in 4.2% of patients, overall rate of serious cardiac complications was 11.6%. PCI with implantation of paclitaxel was safe and effective with acceptable rate of major cardiac complications. Our results evidence in favor of further use of these stents.