Vol 8, No 3 (2017)

Articles
ANTI-HYPERTENSIVE EFFECT OF RENAL ARTERIES RADIOFREQUENCY DENERVATION IN PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION
Gapon L.I., Mikova E.V., Savel`eva N.Y., Kopylova L.N., Aleksandrovich E.L.
Abstract
Objective. To assess the effect of some characteristics of chronic obstructive pulmonary disease (COPD) in patients after elective percutaneous coronary intervention (PCI) on repeat myocardial revascularization frequency in long-term period (up to 3 year). Materials and methods. 135 patients with COPD, who suffered stable ischemic heart disease and were underwent PCI, were included in prospective observational study. Follow-up duration was up to 3 year. Evaluation included comparing the frequency of elective repeat revascularization in regards to frequent COPD exacerbations, COPD severity, lung function and C-reactive protein (CRP) plasm level. Comparing Kaplan-Mayer curves and Cox regression analysis were also applied. Results. Elective repeat myocardial revascularization frequency was 23% and 2,1 times higher among the patients who had frequent COPD exacerbations history (95% CI 1,1-3,9). The difference between Kaplan-Mayers curves was also detected as statistically significant (p=0,016). None of the pulmonary function characteristics had relations with elective repeat revascularization frequency increase. Frequent COPD exacerbations history and CRP plasma level were included in Cox regression model as non-cardiovascular variables (p=0,05 and 0,08 respectively). Conclusions. Frequent COPD exacerbations history and increased CRP plasma level are independent non-cardiovascular variables related to increased risk of elective repeat myocardial revascularization. None of the pulmonary function characteristics had relations with elective repeat revascularization frequency increase.
Journal of Clinical Practice. 2017;8(3):3-9
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METABOLISM AND CHEMILUMINESCENT ACTIVITY OF NEUTROPHILIC GRANULOCYTES IN PATIENTS WITH DIFFERENT SENSITIVITY TO ACETYLSALICYLIC ACID IN ACUTE CORONARY SYNDROME
Grinshtein I.Y., Savchenko A.A., Grinshtein Y.I., Gvozdev I.I.
Abstract
Objective: to study the features of the chemiluminescent state and the activity of NAD (P) -depen- dent dehydrogenases in neutrophilic granulocytes of blood in patients with different sensitivity to acetylsalicylic acid (ACA) in acute coronary syndrome (ACS).Materials and methods: The study included 53 patients with ACS. Evaluation of resistance or sensitivity to ASA was performed in vitro by incubating platelet-rich plasma with adenosine diphosphate and ASA to determine the level of aggregation. The state of respiratory explosion of neutrophils was investigated by the method of chemiluminescence. The activity of enzymes in neutrophils was studied by the bioluminescent method.Results of the study: In patients with ACS-resistant ACS, the rate of synthesis of primary and secondary active forms of oxygen was reduced, and the index of luminol-dependent activation of neutrophils was reduced. The intensity of substrate stimulation of glycolysis and oxidation of glucose by the pentose phosphate pathway is increased.Conclusion: With resistance to ASA in patients with ACS, there are abnormalities in the metabolism and functional activity of neutrophils, which is of interest in studying the intercellular relationships of thrombus formation.
Journal of Clinical Practice. 2017;8(3):10-17
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ASSOCIATIONS OF PSYCHOSOCIAL FACTORS WITH PROBABLE HOSPITAL MORTALITY ACCORDING TO THE TIMI AND GRACE SCALES IN PATIENTS LIVING IN THE NORTH WITH ACUTE CORONARY SYNDROME
Kozhokar K.G., Urvantseva I.A., Lifshits G.I., Nykolaev K.Y.
Abstract
The aim of our research is to study associations of psychosocial factors with the probable hospital mortality according to the TIMI and Grace scales in patients with acute coronary syndrome living in the North. Materials and methods. 269 patients (female n = 57, n = 212 men) with acute coronary syndrome were examined, their average age was 56,0 ± 6,1 years (45-64 years). The complex of diagnostic studies and surveys of patients on a specially designed questionnaire consisting of general questions, the «AUDIT» test and the assessment of the psychological state of the individual was accomplished. An assessment of the severity of the coronary lesion on the SYNTAX scale was conducted; the calculation of the estimated hospital mortality rate on the TIMI and Grace scales was performed.Results. Male gender is associated with the development of alexithymia in a group of patients with a low and moderate risk of a possible hospital mortality rate on the Grace scale (r = 0.20, p <0.01). Continuance of residence in the North is associated with the development of myocardial infarction (r= 0.18, p <0.01) in the group of people with a low and moderate risk of probable hospital mortality. The direct associations of nonconventional factors with high risk of hospital-related mortality on the Grace scale in patients with acute coronary syndrome are high personal levels (OR = 1.593, 95% CI 1.373- 1.943, p = 0.027) and situational anxiety (OR = 1.728, 95% CI 1.037 -2.881, p = 0.036). The leading factors determining the severity of coronary artery disease on the SYNTAX scale in the group of patients with the high risk of possible hospital mortality according to the Grace scale are the low level of social integration (OR = 0.205, 95% CI 0.043-0.394, p = 0.012) and satisfaction with social support ( OR = 0.714, 95% CI 0.546-0.935, p = 0.014). Personal anxiety is associated with an increase in the incidence of alexithymia in high-risk patients for the probable hospital mortality rate on the TIMI scale (r = 0.40, p <0.01). Determining factors of the high risk of the probable hospital mortality on the TIMI scale are: the time from the moment of the onset of the pain syndrome to the admission of the patient to the hospital (OR = 0.580, 95% CI 0.338-0.995, p = 0.048) and low ejection fraction (OR = 0.930, 95% CI 0.875-0.988, p = 0.019).Conclusion. Directly determining nonconventional factors of high risk of possible hospital mortality on the Grace scale in patients with acute coronary syndrome living in the North are high levels of personal and situational anxiety. The age of patients and the continuance of stay in the North in patients with acute coronary syndrome do not significantly affect the level of probable hospital mortality on the Grace scale. The combination of indicators of long-term residence in the North and significant coronary bed lesion on the SYNTAX scale determine a high risk of a possible hospital mortality rate on the TIMI scale in patients with acute coronary syndrome.
Journal of Clinical Practice. 2017;8(3):18-27
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THE PROBLEM OF HEART TRANSPLANT REJECTION AND WAYS OF OPTIMIZING THE ASSESSMENT OF ENDOMYOCARDIAL BIOPSY RESULTS
Stavenchuk T.V., Kosmachova E.D., Shelestova I.A., Slavinsky A.A., Terman E.A., Verevkin A.A., Medvedeva L.A., Barbuhatty K.O., Tatarintseva Z.G., Porchanov V.A.
Abstract
The following article describes tactics of recipient management when a rejection episode of a heart transplant is being suspected. We have discovered some new figures to assess biopsy samples through computerised morphometric study, which can both improve and clarify biopsy results. CD3+ (T-cells) and CD 68+ (macrophages) figures make it possible to determine the extent of transplant rejection in accordance with the International Society for Heart and Lung Transplantation diagnostic criteria (sensitivity 91%, specificity 91%).
Journal of Clinical Practice. 2017;8(3):28-33
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CORONARY ANGIOGRAPHY IN PATIENTS WITH PREMATURE ACUTE CORONARY SYNDROME AND FAMILY HYPERCHOLESTEROLEMIA
Averkova A.O., Brazhnik V.A., Koroleva O.S., Zubova E.A., Sizgunov D.S., Rogozhina A.A., Zateyshchikov D.A.
Abstract
Familial hypercholesterolemia (FH) is an autosomal dominant genetic disorder with a prevalence of 1/200-1/500 in the general population. The aim of the study was to assess the specific features of coronary angiography in young patients with acute coronary syndrome (ACS) and FH diagnosed using Dutch Lipid Clinic Network (I) and Simone Broome Register (II) criteria. 224 pts with early onset of ACS who underwent coronary angiography were selected (≤ 55 years of age for men and ≤ 60 years of age for women). Two, three vessel disease/left coronary artery (LCA) impairment was observed in 12 of 13 (92,3%) pts with definite/possible FH (I, p=0,036) and in 28 of 29 (96,6%) pts with probable FH (II, p=0,001). In patients with family history of cardiovascular disease three ves-sel disease or LCA impairment was observed in 54 of 73 (74%) pts (p=0,024). Comparing two groups of patients with LDL over and below 4,6 mmol/l (the concentration was obtained by ROC analysis) it was shown that 20 of 29 (69%) and 58 of 144 (40,3%) pts (p=0,036) respectively had culprit vessel thrombosis. Thus, we can suppose that in pts with higher LDL level atherosclerotic plaque rupture is observed more frequently in case of ACS. Therefore, it has been shown that multivessel and LCA stem impairment in young patients with ACS and FH is associated with both main factors used for not genetic FH diagnosis: high LDL cholesterol level and family history of cardiovascular disease.
Journal of Clinical Practice. 2017;8(3):34-41
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REPEAT MYOCARDIAL REVASCULARIZATION IN LONG-TERM PERIOD AFTER PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND STABLE ANGINA PECTORIS
Zafiraki V.K., Kosmacheva E.D.
Abstract
Objective. To assess the effect of some characteristics of chronic obstructive pulmonary disease (COPD) in patients after elective percutaneous coronary intervention (PCI) on repeat myocardial revascularization frequency in long-term period (up to 3 year).Materials and methods. 135 patients with COPD, who suffered stable ischemic heart disease and were underwent PCI, were included in prospective observational study. Follow-up duration was up to3 year. Evaluation included comparing the frequency of elective repeat revascularization in regards to frequent COPD exacerbations, COPD severity, lung function and C-reactive protein (CRP) plasm level. Comparing Kaplan-Mayer curves and Cox regression analysis were also applied.Results. Elective repeat myocardial revascularization frequency was 23% and 2,1 times higher among the patients who had frequent COPD exacerbations history (95% CI 1,1-3,9). The difference between Kaplan-Mayers curves was also detected as statistically significant (p=0,016). None of the pulmonary function characteristics had relations with elective repeat revascularization frequency increase. Frequent COPD exacerbations history and CRP plasma level were included in Cox regression model as non-cardiovascular variables (p=0,05 and 0,08 respectively).Conclusions. Frequent COPD exacerbations history and increased CRP plasma level are indepen- dent non-cardiovascular variables related to increased risk of elective repeat myocardial revasculariza- tion. None of the pulmonary function characteristics had relations with elective repeat revasculariza- tion frequency increase.
Journal of Clinical Practice. 2017;8(3):42-47
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NEUTROPHIL-LYMPHOCYTE RATIO AS A PREDICTOR OF ADVERSE IN PATIENTS WITH HEART FAILUREOF NONCORONAROGENIC ETIOLOGY
Bakhchoyan M.R., Kosmacheva E.D., Slavinsky A.A.
Abstract
Aim of the study. To determine the prognostic significance of NLR ratio in patients with noncoronarogenic etiology HF during the hospital period and after hospital stay.Materials and methods. Totally, 75 patients were studied. LVEF<40%. The primary endpoint was a lethal outcome. Patients were divided into groups: 1) “dilated cardiomyopathy” (DCM) (n = 51); 2) “myocarditis” (n = 7); 3) “postmyocarditis cardiosclerosis” (n = 10); 4) “other” (n = 7). A general blood test was performed on the day of hospitalization and 7 days later. The long-term prognosis was analyzed according to the data of telephone contacts with patients, their relatives, outpatient cards.Results. A statistically significant relationship was established between NLR on the day of hospitalization and the overall mortality in the group “myocarditis” (NLR (%) = 2.23 + 0.78, p <0.05). NLR of the deceased in the group “DCM” was 3.98 + 0.60, which is significantly higher in comparison with the surviving patients in the same group (NLR 2.28 + 0.17, p<0.001). NLR was significantly decreased in all groups after 7 days (p<0.05 for the “DCM”, and NLR was practically comparable with the data of healthy people in the “PMCC”).Conclusions. The dynamic growth NLR of blood can serve as a predictor of death in patients suffering from DCM with LV EF<40%. NLR should be adopted for stratification of risk in this group of patients.
Journal of Clinical Practice. 2017;8(3):48-53
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AGE PECULIARITIES OF COMORBID PATHOLOGY IN PATIENTS UNDERGOING PLANNED CORONARY ARTERYBYPASS GRAFTING
Barbarash O.L., Zhidkova I.I., Shibanova I.A., Ivanov S.V., Sumin A.N., Samorodskaya I.V.
Abstract
Background: The number of elderly patients undergoing coronary artery bypass grafting (CABG) is increasing worldwide. Therefore, the assessment of comorbidities based on the age factor in patients with coronary artery disease (CAD) is highly relevant.Aim: To assess the associations between the age factor and comorbidities in patients undergoing CABG. Material and Methods: Data of 680 patients [538 (79.10%) men and 142 (20.90%) women], undergoing elective CABG in the period 2011-2012, included in the CABG Registry were used to detect comorbidities.All patients were enrolled into 4 age groups: below 50 years, 51-60 years, 61-70 years, over 70 years.Results: Aging was associated with an increase in the proportion of women suffering from arterial hypertension (AH), and multivessel disease. Similarly, the proportion of patients with higher func-tional class (FC) of angina, heart failure (CH), and heart rhythm disturbances increased. The number of patients referred to elective CABG with previous myocardial infarction (MI) was the highest among young adults (77%). Aging was associated with an increase in the number of patients with chronic pyelonephritis (44.30%) and thyroid pathology (3.40%).Conclusion: Patients’ aging is associated with an increase in cardiovascular comorbidities, but not MI. Importantly, there was no any increase in the rate of non-cardiovascular comorbidities.
Journal of Clinical Practice. 2017;8(3):54-60
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ASPECTS OF DETECTING PATIENTS WITH FAMILY HYPERCHOLESTEROLEMIA
Kurbanismailova P.M., Popova A.B., Dranenko N.Y., Sergienko I.V.
Abstract
The review presents current data regarding the etiology and epidemiology of familial hypercholesterolemia (FH), algorithms for identifying patients with FH using clinical scales, genetic testing, cascade screening. The current tactics of treatment of family hypercholesterolemia, including in children and pregnant women, are given.
Journal of Clinical Practice. 2017;8(3):61-69
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PCSK9: BIOLOGICAL ACTIVITY REGULATION AND CONNECTION WITH LIPID AND CARBOHYDRATE METABOLISM
Averkova A.O.
Abstract
Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a serine protease which plays an important role in the regulation of LDL receptor (LDLR) expression and apolipoprotein B (apoB) lipoprotein cholesterol metabolism. It is well known that hepatic PCSK9 expression, its activity and secretion influence cholesterol homeostasis. An upregulation of PCSK9 causes an increase of LDLR degradation, which results in decrease of apoB lipoprotein uptake, and a consequent increase in plasma lipoprotein concentration, including LDL. Therefore, PCSK9 has become a new target for lipid lowering therapy. The aim of this review is to consider current data on metabolic and dietary regulation of PCSK9 and its effect on cholesterol and apoB lipoproteins metabolism and risk of cardiovascular disease.
Journal of Clinical Practice. 2017;8(3):70-75
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NUTRIOGENETIC TEST IN CLINICAL PRACTICE: GOALS AND OPPORTUNITIES
Zelenskaya E.M., Kokh N.V., Slepukhina A.A., Lifshits G.I.
Abstract
Nutgenogenetics is the science of the influence of genetically determined differences on the assimilation of nutrients and their metabolism. The goal of nutrigenetics is to create an individual diet that will allow to optimize health status and prevent deseases. This test assesses the genetic contribution to the individual effectiveness of low-fat, low-carb diets and various types of sport exercises in order to reduce body weight. In the presence of some genetically determined conditions (Gilbert’s syndrome, hemochromatosis) - there is a need to follow a certain diet for the prevention of complications. A relative risk of insulin resistance and dyslipidemia, features of eating behavior can also be determined.
Journal of Clinical Practice. 2017;8(3):76-82
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