Vol 84, No 9 (2012)
- Year: 2012
- Articles: 18
- URL: https://bakhtiniada.ru/0040-3660/issue/view/1767
Editorial article
4-10
Deformation, rotation, and axial torsion of the left ventricle in coronary heart disease patients with its severe dysfunction
Abstract
Aim. To evaluate global left ventricular (LV) systolic longitudinal and circumferential strain rates, rotation, and axial torsion in relation to the type of postinfarction LV remodeling in patients with coronary heart disease (CHD) and severe LV dysfunction. Subjects and methods. Studies were performed in 58 patients with sustained anterior myocardial infarction, an ejection fraction of less than 40%, and NYHA Functional Class III-IV heart failure. Three types of postinfarction LV remodeling were identified: 1) with LV apical aneurysm; 2) an intermediate type; 3) with ischemic cardiomyopathy. Global LV systolic longitudinal and circumferential strain rates, end-systolic basal (RotMV/RotMV) and apical (Rotapex/RotRapex) rotation, and axial torsion axis were estimated as an indicator of global LV systolic function. Results. No differences were found in the basal global LV longitudinal and circumferential strain rates, basal rotation, and rotation rate between the patients with 3 types of LV remodeling. In the patients with type 1 LV remodeling, the basal rotation was higher than the apical one (RotMV - Rotapex: -3.085±2.821 versus 2.293±1.021; p=0,002; RotRMV - RotRapex: -22.452±19.823/с-1 versus 13.641±10.745/с-1; p=0.003). In type 2 postinfarction LV remodeling, the basal and apical rotation values did not differ statistically significantly. Impaired apical rotation (in a clockwise direction) was identified in 5 of the 16 patients with type 3 LV remodeling (Rotapex: -1.477±0.392; RotRapex: -30.572±13.735/с-1). There were no differences in the value of LV axial torsion between types 1 and 2 LV postinfarction remodeling (Type 1, 6.714±3.017; Type 2, 7.463±5.416). Conclusion. It was shown for the first time that there were no differences in global LV longitudinal and circumferential strain rates and end-systolic LV rotation between the patients with types 1 and 2 postinfarction LV remodeling.
Terapevticheskii arkhiv. 2012;84(9):11-16
11-16
Prognostic value of SYNTAX score for outcomes and revascularization strategy choice in ST-segment elevation myocardial infarction patients with multivessel coronary artery disease
Abstract
Aim. To study the prognostic significance of the SYNTAX score in the evaluation of outcomes of primary percutaneous coronary interventions (PCIs) and revascularization strategy choice in patients with ST-elevation myocardial infarction (STEMI) with multivessel coronary artery disease. Material and methods. The long-term outcomes of primary PCIs were analyzed in 163 patients with STEMI in terms of the objective assessment of the severity of the coronary bed lesion according to SYNTAX scores. Results. In a cohort of STEMI patients who had undergone primary PCI, the SYNTAX score of ≥23 (a severe lesion) was associated with the higher incidence of acute heart failure (Killip class II) and three-vessel coronary artery disease (odds ratio (OR) 2.8), with the higher risk of death (OR 7.5) and the higher rate of the combined endpoint of death, myocardial infarction, and target vessel revascularization (OR 2.8) as compared with patients with a SYNTAX score of ≤ 22 (a moderate lesion). Conclusion. The SYNTAX score has a prognostic value in assessing the outcomes of primary PCIs in the cohort of STEMI patients with multivessel disease, which can find use in the differential choice of the optimal revascularization strategy and improve treatment results. In the group of patients with a SYNTAX score of ≥ 23, the incomplete revascularization strategy shows the least favorable results as compared to multivessel stenting and staged revascularization.
Terapevticheskii arkhiv. 2012;84(9):17-21
17-21
Aspects of risk stratification in acute coronary syndrome: Prognostic value of evaluation of left ventricular myocardial viability according to the data of pharmacological stress echocardiography
Abstract
Aim. To define the prognostic value of the indicators of left ventricular myocardial viability according to the data of pharmacological stress echocardiography in patients with acute coronary syndrome (ACS). Materials and methods. The results of examinations were analyzed in a total of 91 patients with ACS; 71 of them were found to have areas of asynergy (these cases formed the key basis for statistical processing). An analysis of the outcomes registered in the established follow-up period (mean 14.3±0.7 months) took into consideration death from cardiac diseases, a recurrent acute coronary episode (nonfatal myocardial infarction (MI), unstable angina (UA)). Results. Risk stratification for cardiac events in patients with ACS requires both the assessment of a myocardial viability testing result and the detection of stress-induced ischemia. An analysis of the impact of the indicators of myocardial viability on prognosis in the ACS group showed that the most important predictors of cardiac death were impaired segmental contractility index (ISCI), number of asynergic segments, and total ejection fraction (TEF) at rest; TEF, ISCI, number of segments with a negative response to low-dose drug infusion; TEF, ΔTEF (as compared to the baseline data), and a positive or negative peak stress testing result. The most important predictors of major cardiac events (death MI, UA) were ascertained to be ISCI, number of asynergic segments, resting TEF; TEF, ISCI, number of segments with a negative response to low-dose drug infusion; a positive or negative testing result, TEF, ΔTEF (as compared to the baseline data), and ISCI during the peak stress test. Conclusion. The low myocardial/coronary reserve increases mortality rates; the high one worsens the prognosis of major cardiac events, particularly when the test is positive, which tacitly transfers these patients to a very high risk group.
Terapevticheskii arkhiv. 2012;84(9):22-29
22-29
Time course of changes in brachial artery function in patients with unstable angina pectoris during perindopril therapy
Abstract
Aim. To estimate the time course of changes in brachial artery (BA) functional parameters in patients with unstable angina (UA) treated with angiotensin-converting enzyme inhibitors. Subjects and methods. After examination, 30 patients with Braunwald Classes IB and IIB UA were randomized to two groups to receive perindopril or enalapril as part of combination therapy (Group 1 and Group 2, respectively). The authors carried out BA duplex scanning with a reactive hyperemia test, calculated the values of its viscoelastic properties, and determined pulse wave velocity (PWV) at baseline and after 3 months.Results. The patients of both groups did not differ in BA functional parameters at baseline. Following 3 months, Group 1 showed a reduction in Young's (p=0.046) and Peterson's (p=0.049) modules, an increase in compliance (p=0.016) and distensibility (p=0.02) coefficients, and a decrease in PWV (p=0.23). Estimation of endothelium-dependent vasodilation of BA revealed a significant increase in its diameter increment both at testing minutes 1 (p=0.047) and 2 (p=0.049). In Group 2, only did the distensibility coefficient change significantly (p=0.041). After the reactive hyperemia test, there was a significant rise in BA diameter increment at minute 1 (p=0.047) and no change in this indicator at minute 2. Conclusion. After 3-month treatment, the viscoelastic properties of BA improved in all indicators in the patients taking perindopril as part of combination therapy. The use of enalapril improved only an arterial distensibility index. The BA endothelial function estimated by its diameter increment also displayed better changes in the patients receiving perindopril.
Terapevticheskii arkhiv. 2012;84(9):30-34
30-34
Pharmacogenetic features of the effect of metformin in patients with coronary heart disease in the presence of metabolic syndrome and type 2 diabetes mellitus in terms of PPAR-γ2 gene polymorphism
Abstract
Aim. To define the pharmacogenetic features of the effect of metformin in coronary heart disease (CHD) patients with metabolic syndrome (MS) or type 2 diabetes mellitus (T2DM), by taking into consideration PPAR-γ2 Pro12Ala polymorphism. Subjects and methods. Twenty-four men with CHD and MS and 28 men with CHD and T2DM were examined. The effect of metformin as a short course in combination therapy was evaluated. A population control group consisted of 46 apparently healthy men. The genetic PPRA-γ2 Pro12Ala polymorphism was studied. A number of indicators (total cholesterol (TC), high-density lipoprotein cholesterol, total lipids, triglycerides, Β-lipoproteins, glycated hemoglobin, C-peptide) and proinflammatory markers, such as interleukin (IL)-1Β, IL-6, IL-8, and tumor necrosis factor-α (TNF-α) were determined in the blood. Results. Analysis of the frequencies of Pro and Ala alleles indicated a decrease in the latter in CHD patients with T2DM. The CHD and MS patients who carried the Pro allele showed a significant metformin-induced reduction in weight, waist circumference, body mass index, and concentrations of TC, C-peptide, and cytokines, such IL-1Β, IL-6, IL-8, and TNF-α. Conclusion. Metformin exhibits a high therapeutic efficacy in patients with CHD in the presence of T2DM or MS who have the Pro/Pro genotype, which is of interest in terms of pharmacogenetics and calls for further investigation.
Terapevticheskii arkhiv. 2012;84(9):35-40
35-40
Risk of cardiovascular death in relation to blood lipid composition in male inhabitants of Tyumen: results of a 12-year prospective study
Abstract
Aim. To evaluate the impact of the blood levels of lipoproteins, such as total cholesterol (TC), high-density lipoproteins (HDL), triglycerides (TG), on the risk for cardiovascular death in an open Tyumen male population on the basis of a 12-year prospective follow-up study. Subjects and methods. Standard methods were used to conduct an epidemiological study of a representative sample of Tyumen males aged 25-64 years in 1996. The cardiological screening response rate was 79.5% (n=795). Eighty-five cardiovascular deaths (CVD) were registered in the male cohort during 12 years of the prospective follow-up study. The Cox proportional hazard regression model was employed to assess the relative risk (RR) of CVD. Survival rates were analyzed with the Kaplan-Meier method; the significance of lifespan differences in two groups was estimated using the log-rank test. Results. In the male cohort, a statistically significant increase in the RR of CVD occurred, starting with a TC level of ≥230 mg/dl. The lowest survival rates were noted in the males with hypercholesterolemia (HC). The statistically significant increase in the RR of CVD depending on the levels of TG was found in its 5th quintile (138 mg/dl or more). Lower survival rates were stated in the males with hypertriglyceridemia (HTG) than in those with normal blood TG levels. There were neither statistically significant results in the assessment of RR and survival rates in relation to the level of low-density lipoprotein cholesterol, no data on the effect of the level of HDL cholesterol on the RR of CVD in the males. Conclusion. According to the data of a 12-year cohort study, the open Tyumen male population was found to have a high RR of CVD in those who had TC levels ≥230 mg/dl and TG levels ≥138 mg/dl, which determined the lowest survival rates in males with HC and HTG.
Terapevticheskii arkhiv. 2012;84(9):41-46
41-46
Comparative analysis of the serum level of autoantibodies as a diagnostic tool of myocardial inflammatory diseases
Abstract
Aim. To assess whether the serum levels of autoantibodies (auto-Abs) interacting with myocardial and vascular wall antigens might be used for the differential diagnosis of myocardial inflammatory diseases.Subjects and methods. Seventeen patients with morphologically documented myocarditis were examined. A comparison group comprised 9 patients with acute myocardial infarction (AMI). A control group included 18 apparently healthy individuals and 8 patients with chronic erosive gastritis (CEG). Serum auto-Abs levels were estimated by the ELI test systems standardized for enzyme immunoassay. Results. The individual profiles that reflect relative changes in the levels of 16 study auto-Abs and characterize the integral autoreactivity of a patient have clear intergroup differences. Using the profiles of auto-Abs could confirm the diagnosis of myocarditis in 94% of cases or assign the patient to a group of apparently healthy individuals. The informative value of the method in patients with AMI and CEG was 81.8 and 87.5%, respectively. Conclusion. The proposed method may be used for the noninvasive screening diagnosis of myocardial inflammatory diseases.
Terapevticheskii arkhiv. 2012;84(9):47-52
47-52
Nonspecific inflammation and structural changes in the arteries of hypertensive males at high and moderate risk for cardiovascular events
Abstract
Aim. To study relationships between nonspecific inflammation (NI) of the arterial wall and its structural changes in Stages I-II hypertensive disease (HD) males at moderate and high risks of cardiovascular events (CVE). Subjects and methods. Sixty hypertensive males aged 30 to 65 years (mean age 44±2 years), including 35 patients with grade 1 arterial hypertension (AH) and 25 with grade 2 AH at moderate and high risks of CVE, were examined. The concentrations of C-reactive protein (CRP) and methylglyoxal (MG) were measured. Pulse wave propagation velocity (PWPV) and ankle brachial index (ABI) were studied. Normal PWPV values were calculated in terms of gender and age features. Results. The examined HD group showed a positive correlation of PWPV with systolic blood pressure over 24 hours (r=0.39; p<0.02) and age (r=0.47; p<0.01). In smoking and nonsmoking hypertensive men, PWPV differences failed to achieve statistical significance (14.05±0.53 and 13.07±0.38 m/sec, respectively). PWPW was found to be correlated with CRP values weakly (r=0.31; p=0.07) and with MG levels moderately (r=0.62; p<0.01); there were also positive relationships of ABI to the levels of CRP (r=0.50; p<0.01) and MG (r=0.46; p<0.05). There was a positive correlation between CRP and MG levels (r=0.45; p=0.01). Conclusion. In middle-aged men with grades 1-2 AH at moderate and high risks of CVE, NI processes are not only related to MG metabolism, but also they have a substantial effect on the elastic properties of the wall of predominantly muscle-elastic type arteries, which validates the hypothesis of the involvement of NI processes in the course of HD.
Terapevticheskii arkhiv. 2012;84(9):53-57
53-57
Trends in the risk factors and signs of subclinical atherosclerosis in subjects at low and moderate risk according to the SCORE scale in different medical management tactics: Two-year follow-up results
Abstract
Aim. To comparatively analyze the following parameters of the subclinical manifestations of atherosclerosis: carotid intima-media thickness (IMT), the presence and number of carotid atherosclerotic plaques (ASP), ankle brachial pulse wave velocity (ABPWV) in patients from 2 (active and conventional observation) groups at low and moderate risks according to the SCORE scale in two-year outpatient practice. Subjects and methods. A screening could select 600 able-bodied persons (445 women and 155 men) aged 30 to 65 years at low and moderate risks (according to the SCORE scale without atherosclerosis-associated diseases who were divided into 2 groups: A) active observation (n=400) and B) conventional medical management tactics (n=200). Five hundred and seven (85%) persons (339 in Group A and 168 in Group B) completed the study following 2 years. Carotid duplex scanning, computed sphygmography, and biochemical tests for blood lipid composition were performed. The delta index (%) calculated by the special formula, by subtracting the results during the first visit from those obtained 2 years later, was used to statistically analyze the time course of changes in the parameters under study. Results. Delta IMT (%) statistically significantly increased in Group B men as compared to that in Group A men (p=0.042). The delta parameter of total carotid stenosis, which reflected the percentage of the latter, proved to be high in both Group B women and men (p=0.0001) and the persons with a larger number of ASP were statistically significantly more in Group B (p=0.035). Delta ABPWV (%) was also greater in Group B (p=0.001). Conclusion. Just after 2 years, the active medical observation tactics in patients at low and moderate risks (according to the SCORE scale) can result in a reduction in the rate of subclinical atherosclerosis progression in the carotid artery.
Terapevticheskii arkhiv. 2012;84(9):58-64
58-64
Vascular remodeling indicators and their impact on prognosis in patients with chronic heart failure
Abstract
Aim. To estimate vascular remodeling indicators and their impact on prognosis in patients with chronic heart failure (CHF). Subjects and methods. The study enrolled 128 patients with prior myocardial infarction and CHF and 40 individuals as a comparison group. Endothelium-dependent and -independent vasodilation (EDV and EIDV) was studied in the reactive hyperemia (RH) test and nitroglycerin (NTG) test. Carotid artery (CA) intima-media thickness (IMT) and great arterial rigidity were studied.Results. As compared to the control subjects, the patients with CHF were found to have EDV and EIVD reductions that were more pronounced in those with Functional Class IV CHF, more CA IMT, and abnormal arterial rigidity. There were relationships of EDV and EIDV to CA IMT (r= -0.30; p=0.02) and aortic pulse wave velocity (APWV) (r= -0.30; p=0.05). Multivariate analysis showed that the risk for cardiovascular events (CVE) in the CHF patients with an APWV of >12 m/sec during a year was 2.02 times higher than in those with an APWV of ≤12 m/sec (relative risk 2.02, 95 confidence interval, 1.01-4.03). Conclusion. APWV is an independent risk factor of CVE in patients with CHF.
Terapevticheskii arkhiv. 2012;84(9):65-70
65-70
Prognostic value of pathogenetic therapy-induced changes in NT-proBNP in patients with chronic heart failure
Abstract
Aim. To study the prognostic value of therapy-induced changes in plasma NT-proBNP levels in patients with left ventricular (LV) systolic dysfunction. Subjects and methods. The study covered 84 patients aged 23 to 70 years (mean 54±8.1 years) with LV systolic dysfunction (an ejection fraction of <40%). Plasma NT-proBNP levels were determined in all the patients at baseline and 3 months later to evaluate the efficiency of therapy for heart failure (HF). The median follow-up was 18 months. The follow-up recorded the following outcomes (end points): death from decompensated HF and unplanned hospital admissions for progressive HF symptoms. Results. The baseline and therapy high plasma levels of NT-proBNP (more than 3000 pg/ml) were associated with worsening prognosis. The therapy-induced decrease in NT-proBNP levels was associated with more favorable prognosis. Conclusion. Repeat dynamic determination of plasma NT-proBNP levels allows identification of patients at increased risk of poor outcomes for a more intensive observation and more aggressive pathogenetic therapy.
Terapevticheskii arkhiv. 2012;84(9):71-75
71-75
Total risk for coronary events in cardiac patients due to snoring, daytime drowsiness,and obstructive sleep apnea syndrome
Abstract
Aim. To assess the risk of cardiovascular events due to obstructive sleep apnea syndrome (OSAS) in persons without organic heart diseases. Subjects and methods. Two hundred and forty men complaining about their sleep snoring and/or daytime drowsiness and 209 men without this symptomatology were examined. The presence of OSAS was verified by cardiorespiratory monitoring. Blood lipid composition, blood pressure, heart rate, and body mass index were determined in all the examinees. The risk for cardiovascular diseases (CVD) was assessed using the SCORE and PROCAM scales. Results. When only the subjective manifestations of OSAS were present, there was a preponderance of hypercholesterolemia and an increased risk for CVD as possible markers of preclinical atherosclerosis. Hypertension and smoking, as well as a combination of 4 traditional CVD risk factors are recognized the worst. At the same time, the PROCAM scale allows identification of a high-risk group, the size of which is 1.6 times more than that of the group rated by the SCORE scale. Conclusion. OSAS is an important CVD risk factor and the PROCAM scale is more preferable to identify a group at high risk for CVD among subjects with OSAS.
Terapevticheskii arkhiv. 2012;84(9):76-79
76-79
Radionuclide evaluation of renal function in essential hypertensive patients with chronic kidney disease
Abstract
Aim. To carry out radionuclide evaluation of renal function in patients with arterial hypertension (AH) and chronic kidney disease (CKD). Subjects and methods. Thirty-one AH patients with CKD were examined using dynamic nephroscintigraphy. A control group consisted of 8 CKD patients without AH. Results. The scintigraphic findings reflected statistically significant differences in renal secretory and excretory functions depending on the level of glomerular filtration rate (GFR) decrease in AH patients with CKD. If GFR was 30-59 ml/min, there was a deceleration in the secretory phase in the histogram; but when it was lower than 30 ml/min, the secretory function tended to accelerate, which appeared as a 3-fold reduction in achieving the peak radio tracer concentration (p<0.001).Conclusion. Dynamic nephroscintigraphy can detect early renal secretory and excretory dysfunctions and it is of prognostic value in assessing renal dysfunction, which necessitates early drug correction of revealed disorders.
Terapevticheskii arkhiv. 2012;84(9):80-82
80-82
Possibilities of using levosimendan in patients with idiopathic pulmonary hypertension
Abstract
Aim. To evaluate the efficiency and safety of intravenous infusion of levosimendan in patients with idiopathic pulmonary hypertension (IPH) and its clinical, hemodynamic, and neurohumoral effects. Subjects and methods. The study included 9 patients (mean age 31.8±8.7 years) with Functional Class III and IV IPH and severe right ventricular failure (RVF). Levosimendan was administered as dropwise intravenous infusion. The patients' general condition, blood pressure, heart rate, and 6-minute walk test results were assessed at baseline and 24 hours after levosimendan infusion, and then following 12 weeks. The time course of changes in blood neurohumoral mediators was determined and transthoracic echocardiography performed. Results. At 24 hours after initiation of levosimendan infusion, there were substantial reductions in pulmonary artery systolic pressure, mean pulmonary artery pressure, mean right atrial pressure, and pulmonary vascular resistance. There was a significant increase in exercise tolerance. The blood exhibited lower norepinephrine and NT-proBNP and higher epinephrine concentrations. At 12 weeks after termination of levosimendan infusion, the improved functional status was preserved in the patients with IPH. There were no noticeable changes in the achieved key hemodynamic parameters. Only one patient needed re-administration of the drug 12 weeks later. The achieved changes in vasoactive mediators were retained 12 weeks following levosimendan infusion. Levosimendan treatment was not followed by clinically relevant adverse reactions requiring infusion termination and therapy discontinuation. Conclusion. 24-hour intravenous levosimendan infusion in patents with FC III-IV IPH and severe RVF causes positive changes in the key hemodynamic parameters and neurohumoral status of the patients and promotes stabilization in those with IPH at 12-week follow-up.
Terapevticheskii arkhiv. 2012;84(9):83-88
83-88
Pulmonary hypertension in rheumatic heart disease: current approaches to diagnosis and therapy
Abstract
Pulmonary hypertension is a complex multidisciplinary problem in modern medicine. This review discusses its clinical and pathophysiological type associated with rheumatic heart disease. Current approaches to the pathogenesis and diagnosis of the disease are reflected; basic approaches to its treatment are discussed in terms of current clinical guidelines and new scientific achievements.
Terapevticheskii arkhiv. 2012;84(9):89-96
89-96
The pathogenetic bases of cardiorenal syndrome
Abstract
The term "cardiorenal syndrome" has been introduced to denote the mutual influences of the cardiovascular system and kidneys. According to the definition, the cardiorenal syndrome is a pathophysiological condition of the heart and kidney, in which acute or chronic dysfunction of one of these organs leads to that of the other. The community of pathogenetic components allows one to apply a comprehensive approach to diagnosing, treating, and preventing cardiovascular and renal diseases.
Terapevticheskii arkhiv. 2012;84(9):97-103
97-103
Sergey Petrovich Botkin is the founder of Russian therapeutic school
Abstract
The paper gives basic facts from the life and work of Sergey Petrovich Botkin, one of the coryphaei of Russian medicine, who played a prominent role in the formation and development of Russian clinical medicine and became the founder of the most well-known therapeutic school in Russia. S.P. Botkin's greatest merit is emphasized to be his neurogenic theory of medicine, which has played a great role in the understanding of physiological and pathological processes in the entire organism.
Terapevticheskii arkhiv. 2012;84(9):104-108
104-108