[Atrial Fibrillation After Coronary Artery Bypass Grafting].

PURPOSE: to identify the role of factors of inflammation and myocardial ischemia in the development of atrial fibrillation (AF) in the early postoperative period after coronary artery bypass grafting (CABG). METHODS: We enrolled in this study 96 patients with ischemic heart disease who had undergone CABG. Patients were divided into 2 groups: (1) without postoperative AF (n=67, 80.6% men, mean age 57.9+/-7.3 years), (2) with early new-onset AF after CABG (n=29, 86% men, mean age 64.0+/-8.4 years). RESULTS: AF occurred on average 4.9+/-3.8 days after surgery. Concentrations of interleukin-10, C-reactive protein, fibrinogen, troponin were not significantly different between two groups both before and after CABG. At multivariate analysis the following parameters were related to development of AF in postoperative period: left atrial dimension >41 mm (odds ratio [OR] 3.6 (95% confidence interval [CI] 1.2-5.8, p=0.0002), interleukin-6 level >68 pg/ml (OR 3.2, 95%CI 1.8-4.7, p=0.009), interleukin-8 level >9.5 pg/ml (OR 2.9, 95% CI 1.4-6.7, p=0.009). CONCLUSION: Our research shows significant increase of interleukin-6 and interleukin-8 in patients with AF after CABG what confirms the role of inflammation factors in development of this complication.

[Volume of Coronary Artery Bypass Surgery and Risk of Postoperative Atrial Fibrillation].

PURPOSE: To identify prevalence of atrial fibrillation (AF) in dependence of volume of coronary artery bypass grafting (CABG) as assessed by the number of grafts. MATERIAL AND METHODS: The study included 431 patients with ischemic heart disease (IHD) who underwent CABG. Group 1 comprised patients with single-vessel bypass graft (n=47, 78.7% men, mean age 59.6+/-5.6 years), group 2 - with multivessel bypass grafts (n=384, 76.8% men, mean age 61.0+/-8,1 years). During the observation period postoperative AF developed in 3 patients (6.4%) with single vessel bypass graft and 69 patients (18.0%) with multivessel bypass grafts. At multivariate analysis predictive values were significant for the following parameters: aortic cross-clamping time >36 min - 1.7 (95% confidence interval [CI], 1.1-3.2, p=0.03), ischemia time >19 min - 2.0 (95% CI, 1.1-3.7, p=0.02), age >59 years - 2.4 (95% CI, 1.3-4.4, p=0.005), left atrial dimension >39 mm - 3.7 (95% CI, 2.1-6.6, p<0.0001), left ventricular ejection fraction <51% - 1.9 (95% CI, 1.3- 3.3, p=0.04). Predictive value of cardiopulmonary bypass time >56 min 1.2 (95% CI, 0.56-2.8) was not significant (p=0.5). CONCLUSION: In our study AF in the early postoperative period more often occurred in patients who underwent multivessel coronary bypass surgery. The most powerful predictor of AF in these patients was left atrial dimension exceeding 39 mm.

[Factors Associated With Development of Atrial Fibrillation After Coronary Artery Bypass Grafting].

PURPOSE: to identify factors associated with development of atrial fibrillation (AF) in the early postoperative period of coronary artery bypass grafting (CABG). METHODS: A total of 376 patients with ischemic heart disease who underwent CABG were enrolled in the study. RESULTS: During the observation period AF occurred in 74 patients (19.7%, 93% men, mean age 64.0+/-6.4 years), an average of 3.6+/-2 days after surgery. Multivariate regression analysis showed that odds ratio (OR) for AF in patients with age >59 years was 1.5 (95% confidence interval [CI], 1.1-3.5; p=0.04), aortic cross-clamping time >43 min - 2.4 (95% CI, 1.05-6.2; p=0.03), left atrial dimension (LAD) >39 mm - 5.0 (95% CI, 2.0-12.6; p=0.0006), left ventricular ejection fraction (LVEF) <51% - 3.6 (95% CI, 1.6-8.3, p=0.002). During ROC - analysis the high sensitivity was observed for LAD >39 mm (82%, =0.001), high specificity - for LVEF <51% (80%, =0.0009), highest positive likelihood ratio for LVEF <51% - 2.56 (=0.0009), greatest negative likelihood ratio for LAD >39 mm - 0.31 (=0.001). CONCLUSION: In our study, the risk of AF development in the early postoperative period of CABG depended on the patients age, left atrial size, left ventricular ejection fraction, and aortic cross-clamping time during CABG.

[Results of Russian Hospital Chronic Heart Failure Registry in Three Subjects of Russian Federation].

Aim of the RUssian hoSpital Heart Failure Registry (RUS-HFR) was to analyze clinical and epidemiological characteristics, application of modern drug and non-drug therapy among hospitalized patients with systolic chronic heart failure (CHF) in 3 subjects of Russian Federation. MATERIAL AND METHODS: We conducted a prospective multicenter observational study in 3 cardiological centers (Petersburg, Orenburg, Samara) in which we recruited patients aged 18-75 years with left ventricular ejection fraction less or equal 40% without ongoing myocardial infarction or pulmonary thromboembolism. RESULTS: Between October 2012 and June 2014 we included 524 patients (mean age 60 years, >79% men) mostly with NYHA class III CHF. Main etiological factors were ischemic heart disease and arterial hypertension, which was not corrected by the time of admission in 20-40.7% of patients. Portions of patients who had undergo the myocardial revascularization, surgery because of valvular heart defects, and implantation of permanent pacemaker including device for cardiac resynchronizing therapy were 11-41, 0-4, and 0-19.5%, respectively. In up to 25% of patients therapy with one of main medications or diuretic was initiated after hospitalization. At discharge 82.3-8.3, 76.3-95.8, 65.9-81.1, 80.7-94.6% of patients received ACEI/ARB, -adrenoblockers, MRA, diuretic therapy, respectively. Implantation of cardioverter ICD/CRT, ICD and heart transplantation were considered indicated in 0-21.2 and 0-6.6% of patients, respectively. Duration of hospitalization was 26+/-14, 15+/-10, and 13+/-5 bed-days in Petersburg, Orenburg, and Samara, respectively. CONCLUSIONS: Compared with data obtained 10 years earlier portrait of a patient with in general remained unchanged. However portion of patients who had undergone cardio-surgical and electrophysiological interventions became tangible, and numbers of patients receiving therapy with ACEI/ARB, -adrenoblockers, and MRA became comparable with those in European registries. Significant deviations from guidelines on drug therapy were revealed at prehospital stage; and high-technology methods of therapy were insufficiently often recommended in participating hospitals. Portion of hospitalizations not related to acute decompensation was 5-37%, while duration of such hospitalizations as well as hospitalizations because of acute decompensation of CHF significantly exceeded this parameter in EU and USA. Absence of obligatory drug therapy prior to admission in a part of patients in RUS-HF raises questions on correction of patients compliance and on creation of a system of specialized ambulatory surveillance of CHF patients after discharge from hospital.

[The rational approach to the estimation of the myocardial infarction size].

The paper contains review of published data on various methods of quantitative assessment of myocardial infarction (MI) with demonstration of their advantages and drawbacks. Comparative analysis of applicability of existing biochemical markers of necrosis for measurement of the volume of myocardial damage is also presented. Troponin I level measured in 72 hours after onset of chest pain appears to be the most reliable predictor of MI size but its use is justified only in patients with restored perfusion. Troponin T level measured in 72 hours after onset of acute coronary syndrome also correlates closely with MI size but does not depend on the character of reperfusion. Estimation of MI size based on blood concentration of troponins is more precise than methods based on levels of creatine phosphokinase and its MB fraction.

[Ischemic heart disease complicated by heart failure: possibilities of surgical treatment].

Aim of the study was to assess remote results of surgical reconstruction of the left ventricle (LV) in patients with ischemic heart disease (IHD) and chronic heart failure (CHF). During 1996-2010 136 patients with IHD complicated by CHD were subjected to surgery. The patients were divided into 2 groups: with LV aneurism (group 1, n=70) and with ischemic cardiomyopathy (group 2, n=66). In all patients we performed coronary bypass surgery and Dor LV reconstruction. Moderate and high degree mitral regurgitation was corrected. Hospital mortality was 5.4% in group 2. There were no inhospital deaths in group 1. In all survivors we noted reduction of LV dimensions and sphericity of LV cavity, increase of LV ejection fraction. Ten year survival was 78 and 56,5% in groups 1 and 2, respectively. In 10 years after surgery 80.2 and 68% of patients, respectively, had no signs of high NYHA class (III-IV) CHF. Thus surgical intervention on all components of intracardiac pathology in patients with IHD with CHF allowed to achieve satisfactory long term results.

[Wall motion abnormalities and hemodynamic parameters in patients with left bundle branch block during exercise echocardiography].

Study aim was to investigate dynamics of local contractility and hemodynamic parameters during exercise stress echocardiography (EEcho) in patients with left bundle branch block (LBBB). We examined 23 patients (15 men, 8 women) aged 48-65 years (mean age 53.9+/-8.1 years). Bicycle EEcho was accomplished according to standard protocol. Patients without clinical signs of ischemic heart disease (n=11) comprised group 1, patients after myocardial infarction (n=12) - group 2 (subgroup 2A - with negative test result, subgroup 2B - with worsening of local left ventricular contractility during EEcho). At baseline group 1 patients had significantly better hemodynamic parameters (ejection fraction - EF, left ventricular end diastolic volume - LVEDV) and no abnormalities of local contractility. Exercise tolerance was also the highest in this group. Insignificant worsening of postexercise EF occurred in patients of subgroup 2B (from 46+/-10.5 to 44,2+/-9.4%). In group 1 EF significantly increased (from 56.8+/-10.5% to 64.7+/-15.4%, <0.05), in subgroup 2A tendency to EF increase up to 48.7+/-9.9% was registered. Lowering of local contractility abnormalities index was noted also only in patients of subgroup 2B (from 1.54+/-0.4 to 2.17+/-0.37 (p<0.01). LVEDV compared with initial values tended to decrease in both groups (however differences between groups were not significant). Positive echocardiographic response was associated with significant changes of transmitral blood flow. Angiographically clean coronary arteries were found in 8 of 10 patients in group 1. Six group 2 patients with history of typical clinical picture of angina and myocardial infarction) had multivessel lesions in coronary vascular bed. EEcho result was positive in 5 of 6 group 2 patients. Thus EEcho possesses high potential for diagnosis of coronary atherosclerosis in patients with LBBB. This allows recommending it as a first line method in patients with this pathology.

[Permanent cardiac pacing in vasovagal syncope and carotid sinus syndrome].

Vasovagal syncope and carotid sinus syndrome are common conditions in young and elderly people, respectively, mostly with benign prognosis. Nevertheless, severe or "malignant" syncopal attacks in some patients may be associated with life-threatening injury. Unfortunately, up to now almost all drug trials have failed to demonstrate any benefit in preventing syncope and interventional approach (pacemaker) may be appropriate. This article contains literature review and discussion of indications for pacing in vasovagal syncope and carotid sinus syndrome.

[Distributions of polymorphisms of genes of some components of hemostasis in patients with ischemic heart disease].

We have studied structure of polymorphisms of genes of blood clotting factors II, V, VII, platelet membrane glycoprotein IIIa (GPIIIa) and enzyme methylenetetrahydrofolate reductase (MTHFR) in patients with ischemic heart disease (IHD). In this cohort of patients most prevalent are polymorphism PLAA1/A2 of GPIIIa gene and 677T/T polymorphism of MTHFR gene. Inconsistency of existing evidence on effect of R/Q genotype of FVII gene on early development of IHD and myocardial infarction (MI) is underlined, and data on the absence of protective effect of Q allele on early development of MI are presented. Activating effect of PLAA1/A2 polymorphism of GPIIIa gene and 677T/T polymorphism of MTHFR gene on morphofunctional state of platelets is proved.

[Features of forming oxidative stress in blood of postinfarct cardiosclerosis patients during aortocoronary bypass]. / Osobennosti formirovaniia okislitel'nogo stressa v krovi bol'nykh postinfarktnym kardiosklerozom pri operatsiiakh aortookoronarnogo shuntirovaniia.

Patients with postinfarction cardiosclerosis in association with angina (NYHA class III) during coronary artery bypass grafting usually develop oxidative stress in erythrocytes which is characterized by enhanced free radical oxidation and depression of antioxidative enzymes. This process is of especially great importance and lasts longer in patients with the reperfusion syndrome. The consequences of this process could be revealed as derangement of the functional and structural state of erythrocytes, "rheological crises", further depression of the postischemic myocardium, rhythm and coronary flow disturbances. The results obtained show the effective prophylactics and antioxidant treatment of the oxidative stress syndrome to be necessary.

[Surgical treatment of infective endocarditis of the right sections of the heart]. / Khirurgicheskoe lechenie infektsionnogo éndokardita pravykh otdelov serdtsa.

The authors present results of surgical treatment of infective endocarditis of the right chambers of the heart in 22 patients subjected to 23 operations. Primary endocarditis was diagnosed in 14 patients, secondary endocarditis in 8 patients. Four patients died. In 12 patients the operations were performed during the active phase of the process. Positive bacterial hemoculture was detected in 11 patients. The operations were performed on the open heart. For correction of valve lesions artificial heart valves were used either with special antimicrobial cuffs ("Silzone") or cuffs impregnated with silver ions ("St. Inda Med.") or treated with a solution of Rifampicin during operation.

[Immediate results of reconstructive surgery in end-stage dilated cardiomyopathy]. / Neposredstvennye rezul'taty rekonstruktivnoi khirurgii terminal'noi stadii dilatatsionnoi kardiomiopatii.

First experiences with multistage surgical reconstruction of the left ventricle, heart valves and coronary arteries in patients with the end stage dilated cardiomyopathy are summarized. During the last three years operations have been made on 21 patients aged from 24 to 63, eight patients having idiopathic cardiomyopathy and 13 ischemic cardiomyopathy. They had markedly disturbed hemodynamics, ejection fraction of the left ventricle less than 30% and its diastolic diameter more than 70 mm. Most of the patients were candidates for heart transplantation. The Batista and Dor operations were made in combination with plastic operations on the mitral and tricuspid valves. In patients with ischemic heart disease myocardial revascularization was also performed. Four patients died after operation from arrhythmia and heart failure, the others' state had improved with less sizes of the heart and 10-12% greater ejection fraction. A conclusion was made that such operations were expedient.

[Gastrointestinal complications after aortocoronary bypass]. / Zheludochno-kishechnye oslozhneniia posle aortokoronarnogo shuntirovaniia.

Under analysis are gastrointestinal complications (hemorrhage, perforation of the duodenum, acute pancreatitis) which were observed in 10 of 177 patients after aortocoronary bypass. Risk factors of these complications, their specific diagnosis, treatment and prophylactics are discussed.