Impact of microvascular injury various types on function of left ventricular in patients with primary myocardial infarction with ST segment elevation.

AIM: To analyze the long-term effect of microvascular injury various types on the structural and functional parameters of the left ventricle assessed by echocardiography in patients with primary ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS: The study included 60 patients with primary STEMI admitted within the first 12 hours after the onset of disease who underwent stenting of the infarct-associated coronary artery. Each patient included in the study underwent CMR imaging on the second day post-STEMI. MVO and IMH were assessed using late gadolinium enhancement and T2-weighted CMR imaging. Subsequently, all patients underwent the standard echocardiographic protocol on the 7th day and 3 months after MI. RESULTS: We divided all patients into 4 groups: the 1st group didn't have any phenomena of IMH and MVO, the 2nd group had only MVO, patients of the 3rd group had only IMH and in the 4th group there was a combination of MVO and IMH. LV ejection fraction was significantly lower in patients with combination of MVO and IMH, if compared to those without it. Correlation analysis showed a moderate inverse correlation between the MVO area and LV contractile function: the larger the area, the lower the LVEF (R=-0,60; p=0,000002). CONCLUSIONS: The combination of IMH and MVO is a predictor of a reduction in LVEF and an increase of volumetric measurements within 3 months after MI. In comparison with patients without microvascular injury isolated MVO is associated with lower LVEF. The size of MVO is directly correlated with the LV contractile function decrease. Isolated IMH was not associated with deterioration of left ventricular function.

[Peripartum cardiomyopathy or takotsubo cardiomyopathy? The clinical case with arterial hypotension and pulmonary edema].

A 29-year old female patient without a history of cardiovascular diseases was admitted on emergency to a surgical hospital with acute calculous cholecystitis in 3 months after uncomplicated term birth. During laparoscopic cholecystectomy, she developed arterial hypotension with pulmonary edema, which required intravenous sympathomimetics. On the next day, after improvement of the condition and stabilization of hemodynamics, cardiac ultrasound showed diffuse left ventricular (LV) hypokinesis with the ejection fraction (EF) of 38 %. Electrocardiogram detected transient left bundle branch block followed by persistent negative T waves in leads I, aVL, and V2 V6. Troponin I concentration was increased to 1.2 ng /ml. Beta-blocker and angiotensin-converting enzyme inhibitor were administered. At 10 days, the LV contractile function completely recovered with LV EF of 59 %. Magnetic resonance imaging did not reveal any signs of myocardial infarction or myocarditis. A differential diagnosis was performed between peripartum cardiomyopathy and Takotsubo syndrome. Considering the fast recovery of LV systolic function, the patient was discharged with a diagnosis of Takotsubo syndrome.

[Cardiogenic Shock in Patients with Myocardial Infarction].

This review article contains presentation of modern diagnostic criteria and prognostic scales for cardiogenic shock in patients with myocardial infarction as well as analysis of current clinical guidelines. Main results of clinical trials underlying recommendations of these guidelines are discussed. The article focuses on controversial and unfounded recommendations and issues requiring further research.

Two-Stage Revascularization in Patients with Acute Myocardial Infarction and Massive Coronary Thrombosis.

AIM: to investigate safety and angiographic efficacy of two-stage revascularization with percutaneous coronary intervention (PCI) with stenting delayed by one day in patients with acute myocardial infarction (MI) and massive coronary thrombosis. MATERIALS AND METHODS: We included in this study 12 patients with massive infarct related coronary artery thrombus which length was greater than thrice the vessel diameter in the presence of TIMI grade II-III blood flow as detected by coronary angiography (CAG). The emergency PCI was not performed, and conservative antithrombotic therapy continued for 24 hours. After this day, CAG was repeated. RESULTS: Repeat CAG in all patients showed thrombus regression which visually appeared as complete lysis in 8, and partial lysis - in 4 patients. Stenting of residual stenosis was performed in 11 patients without complications. In 1 patient residual stenosis was considered insignificant (<50 %) therefore stenting was not performed. No-reflowphenomenon and recurrent MI were not observed. CONCLUSION: These data suggest that in patients with massive coronary artery thrombosis conservative antithrombotic therapy for 24 hours followed by repeated CAG and, if required, by stenting of residual stenosis, is safe treatment tactics that might reduce the risk of the no-reflow phenomenon.

Hypolipidemic and Hepatoprotective Effects of a Polyprenol-Containing Drug in Patients with Acute Coronary Syndrome.

In a double-blind placebo-controlled trial POLYNCOR (registration No. NCT03122340 at clinicaltrials.gov ), lipid-lowering and hepatoprotective effects of polyprenol-containing drug Ropren were evaluated in patients with acute coronary syndrome. After 2-months therapy, total cholesterol and ALT in the patients receiving Ropren were significantly (p<0.05) lower than in the control group. The number of patients who needed to discontinue or reduce the dose of atorvastatin due to an increase in the level of transaminases in the main group was significantly (p<0.05) lower than in the control group: 0 (0%) vs. 5 (33.3%). The more pronounced decrease in cholesterol level and hepatoprotective effect of Ropren allowed recommending this preparation to patients with acute coronary syndrome in addition to standard therapy.

[In-hospital and long-term results of delayed percutaneous coronary intervention after successful thrombolytic therapy in elderly patients with acute myocardial infarction.]

The aim of this study was to investigate the efficacy and safety of percutaneous coronary intervention (PCI) in elderly patients with acute myocardial infarction after thrombolytic reperfusion with indirect reperfusion signs. A total of 96 patients aged 75 years and over with acute myocardial infarction and successful thrombolysis (reduction of ST segment elevation 90 min after thrombolysis) were included in this study. Thirty patients (31%) were selected for delayed PCI. Stent implantation was performed in 70% of cases (21 patients). The bleeding rates did not differ between groups of delayed PCI and conservative therapy. The rate of contrast-induced nephropathy was 6,7%. The rates of recurrent myocardial infarction (ReMI) and lethality did not differ between groups of delayed PCI and conservative therapy. The rates of ReMI after discharge from hospital and the lethality rates within one year did not differ. Then, the patients were assigned to two groups: stented group (n=21) and non-stented group (n=75). The ReMI and lethality rates did not differ between these groups in-hospitally and within one year, but the rate of composite outcome (ReMI + lethality) within one year was lower in stented group: 33,3% vs 41,3% (p=0,039).

[Comparative efficacy of pharmacoinvasive strategy of myocardial reperfusion and primary angioplasty in patients with acute ST elevation myocardial infarction].

In order to assess comparative efficacy of pharmacoinvasive strategy of myocardial reperfusion and primary angioplasty in ST elevation acute myocardial infarction 289 patients were randomized at prehospital stage within first 6 hours of the disease into 2 groups: primary angioplasty (group 1), and prehospital thrombolysis with subsequent rescue or delayed angioplasty depending on efficacy of thrombolysis. We analyzed clinical and anamnestic characteristics of patients, efficacy of reperfusion measures, dimensions of myocardial necrosis, and clinical course of the disease. Pharmacoinvasive myocardial reperfusion with prehospital thrombolysis compared with primary coronary angioplasty decreased time of myocardial ischemia (224.65 +/- 71 vs. 278 +/- 184 min, p < 0.03), increased rate of achievement of TIMI grade 3 flow after percutaneous coronary intervention (80.5% vs. 71.4%, p = 0.002) and more effectively preserved left ventricular ejection fraction (60.0 +/- 14.9% vs. 54.9 +/- 12.3%, p < 0.01). Prehospital thrombolysis before coronary angioplasty compared with primary angioplasty was associated with lower rate of development of no-reflow syndrome (1.4% vs. 11.6%, p < 0.003).

Antithrombotic and thrombolytic effects of a new proteolytic preparation Trombovazim (Russia).

We studied the antithrombotic and thrombolytic effects of Trombovazim, a highly-purified proteolytic enzyme preparation obtained by immobilization of bacterial proteinases (Bacillus) on polyethylene oxide with a molecular weight of 1.5 kDa. Blood absorption of the preparation was evaluated after intragastric administration. In vitro experiments showed that Trombovazim produces anticoagulant and thrombolytic effects, which manifested in inhibition of fibrin clot formation and acceleration of its lysis. Drug concentration in the blood was elevated from the 4th to the 7th hour after intragastric administration of Trombovazim in a dose of 2250 U/kg, being maximum by the 5th hour (0.044+/-0.011 U/ml). Course treatment with Trombovazim (1000 U intragastrically, twice daily for 3 days) had a thrombolytic effect on rats with experimental intravascular thrombosis. This effect was manifested in a decrease in thrombus weight and increase in the percent of rats with recanalization of the occluded carotid artery.

[Aspirin vs ticlid and their combination in patients with acute myocardial infarction]. / Sravnitel'naia éffektivnost' aspirina, tiklida i ikh kombinatsii u bol'nykh ostrym infarktom miokarda.

ADP-induced platelet aggregation was studied in 28 patients with myocardial infarction randomized, at admission, into three groups. Conventional therapy with heparin and antianginal drugs was combined with aspirin (250 mg/day, n = 9), tiklid (500 mg/day, n = 9), tiklid (500 mg/day) + aspirin (250 mg/day, n = 10) in group 1, 2 and 3, respectively. Tiklid diminished platelet aggregation more effectively than aspirin on the disease day 7 and 21. Tiklid + aspirin combination suppresses platelet aggregation more than monotherapy with either of the drugs, provides insignificant attenuation of postinfarction angina but is associated with a high risk of hemorrhagic complications.

[Rheological and hydrodynamic properties of blood from patients with stable angina pectoris: correction with high molecular polyethylene oxide]. / Reologicheskie i gidrodinamicheskie pokazateli krovi u bol'nykh so stabil'noi stenokardiei i ikh korrektsiia vysokomolekuliarnym poliétilenom.

Rheological and hydrodynamic properties of blood taken from patients with stable angina pectoris were investigated in different periods (1, 7 and 28 days) of combined treatment (calcium antagonists, nitrates, beta-blockers, aspirin). The high viscosity syndrome (elevated blood viscosity, red cell aggregation, hyperfibrinogenemia) was registered before treatment, 1, 7 and 28 days after beginning of the treatment. Low hydrodynamic index (the speed of blood flow in turbulent regimen) reflected insufficiency of endogenic antiturbulent factor in the blood. The addition of high-molecular-weight polyethylene oxide to blood samples in concentration 2 x 10(-6) promoted normalization of the hydrodynamic index and decline of red cell hyperaggregation.