ASSESSMENT OF CORONARY COLLATERAL CIRCULATION PREDICTORS AMONG PATIENTS WITH ACUTE CORONARY SYNDROME IN POPULATION GEORGIA.

Coronary collateral circulation (CCC) has been shown to have a prognostic role in acute myocardial infarction (MI). We aimed to identify factors associated with CCC development in patients with acute myocardial ischemia. In the present analysis, 673 consecutive patients aged 27 - 94 years (64.7±11.48) with acute coronary syndrome (ACS), who underwent coronary angiography within the first 24 hours after symptom onset were included. Baseline data, including sex, age, cardiovascular risk factors, medication, antecedent angina, prior coronary revascularization, EF%, blood pressure levels were obtained from patient medical records. The study individuals were divided into two groups: patients with Rentrop grade 0 to 1 were classified as the poor collateral group (456 patients), and the patients with grade 2 to 3 - as the good collateral group (217 patients). Prevalence of good collaterals of 32% was found. Odds of good collateral circulation increases with higher eosinophil count - OR=17.36 (95% CI: 3.25-92.86); history of MI (OR=1.76; 95% CI:1.13-2.75); multivessel disease - OR=9.78 (95% CI: 5.65-16.96); culprit vessel stenosis - OR=3.91 (95% CI: 2.35-6.52); presence of angina pectoris > 5 years - OR=5.55 (95% CI:2.66-11.57) and decreases with high N/L- OR=0.37 (95% CI:0.31-0.45) and male gender - OR=0.44 (95% CI:0.29-0.67). High N/L is a predictor of poor collateral circulation, with 68.4 sensitivity and 72.8% specificity (cutoff: 2.73*109). Relative chance of good collateral circulation increases with the higher number of eosinophils, presence of angina pectoris with duration of more than 5 years, history of past myocardial infarction, culprit vessel stenosis, multivessel disease, and reduces if patient is male and has high N/L ratio. Peripheral blood parameters may serve as an additional simple risk assessment tool in ACS patients.

[THE BIOMARKERS OF MYOCARDIAL DAMAGE AND THEIR ROLE IN THE PROGRESSION OF HEART FAILURE (REVIEW)].

Despite the success achieved in the study and treatment of chronic heart failure, this syndrome still remains one of the most difficult and predictable unreliable pathologies. Moreover, in recent years there has been a tendency of growth of such patients. Based on the above, the attention of scientists focuses on new concepts that involve the study of new biomarkers of cardiac damage and the definition of their role in the progression of heart failure. Based on studies conducted by numerous authors, the paper analyzes the importance of new biomarkers of myocardial damage in the development of heart failure. The manuscript describes biomarkers of damage (troponin T, galectin 3, lipocalin, Cystatin C): nature: the causes and mechanisms of their growth, increase and activity. Biomarkers of myocardial damage are shown to have diagnostic and high predicted values. Their temporary definition provides additional information for stratifying the risks of possible complications. It also gives us the opportunity to allocate patients with high risks in a timely manner and eliminate possible adverse complications.

DIFFERENCES IN ECG CHARACTERISTICS AND CO-MORBIDITIES AMONG PATIENTS WHO UNDERWENT ELECTIVE SURGICAL REPAIR.

The aim of the study was to assess differences in ECG features and prevalence of comorbidies between two groups of patiens: with Abdominal Aortic Aneurism (AAA) and Aorto-Iliac Occlusive Desieses-Lerish Syndrome (LS). Data was collected for all consecutive adult patients who underwent elective surgical repair of AAA (fusiform aneurysm) or LS at "The Center of Vascular and Heart Diseases" (Tbilisi, Georgia) between 2010 and 2014. We studied a prevalence of Arterial Hypertension (AHT); Diabetes mellitus (DM); Renal Failure (RF),Peripheral Artery Disease (PAD), Coronary Artery Disease (CAD) and rate of coronary revascularization in these patients; We also, investigate some of the electrocariographic characteristics: Corrected QT interval(QTC),QT dispersion(QTD). The majority of patients were mail (92% in both groups). Prevalence rate of CAD didn't differ significantly between groups with LS and AAA (37% and 39%P=0.7000 respectively). Rate of revascularization was (7% and 6% P=0.577 respectively). Prevalence rate of DM was higher in patients with LS compared with AAA (27%and 8%P=0.0000 respectively); PAD was more prevalent in LS group (98% and 48% P=0.0000 respectively). RF was less prevalent in patients with LS as compared with AAA (51% and 64%P=0.0200). Prevalence rate of AHT was significantly low in LS than in AAA (49% and 65%P=0.0000 respectively). A prevalence rate of increased QTd (>0.07ms) was high in LS group but the difference between these two groups was not statistically significant (16% and 9% P=0.1563 respectively). Absolute number of prolonged QTd was high in LS group in comparison with AAA and this difference was statistically significant (0.04±0.026 and 0.02±0.028 P=0.0092 respectively).QTC remained in normal range in both groups. Rates of CAD and coronary revascularization did not differ between patients with AAA and LS. The high incidence of DM and PAD was found in patients with LS as well as high HR and prolonged QTd. Prevalence Rate of AHT, RF was higher in patients with AAA as compared with LS group. These findings indicates: a)Different composition of risk factors in two groups. However, both groups of patients are at increased risk of development of coronary events and this circumstance may be considered as a predictor of worse prognosis. b) High incidence of renal failure in AAA group may contribute a progression of renal dysfunction in this patients during /after surgery.c) A prolonged QTd was high in LS group which may contribute heightened risk of fatal arrhythmias in this patients. Further studies are needed for evaluation a prevalence rate of prolonged QTd in the large population.

[Heart rhythm abnormalities in middle-aged veteran elite athletes].

UNLABELLED: Disrrhythmia is frequent finding in high competitive athletes. Majority of heart rhythm abnormalities in athletes, suggested being benign, however, prognostic value of it is not yet well established. Purpose of the present study was to investigate heart rhythm and relationship of heart rhythm abnormalities with LV mass in veteran elite athletes. 30 veteran elite athletes (16 soccer players and 14 water-polo players) aged 30-50 were studied. They formed main group. INCLUSION CRITERIA: >10 years of active sports activity and >5 years after competitive sports cessation. All athletes were symptom free. Control group consists of 30 age - matched sedentary healthy individuals. In all study subjects ambulatory 24 hour ECG was recorded and, LV mass, dimensions and function by ultrasound-Doppler technique was evaluated. LV mass by Devereux formula was calculated and indexed to body surface area. Student's t-test for continuous variables, Descriptive statistics and Fisher's exact test for categorical variables were used. A P-value of <0.05 was considered to be statistically significant. Mean heart rate in former athletes group was 62+/-6 ,and 69+/-9, in control group. Night HR in athletes group was 48+/-8 and 55+/-5 in control group. Differences between groups were statistically significant (p<0,01). Complex arrhythmias were found in 4 athletes and none in control group First degree AV block presented in 6 athletes and in 2 controls. Second degree AV block (Mobitz II) was found in 4 athletes and none in controls. LV mass index was higher in ex-athletes (91,42 g/m, than in controls (84,02 g/m ) .differences between groups was statistically significant - p<0,05. Profound Bradycardia and heart conductivity abnormalities as well as complex arrhythmias were more frequent findings in athletes as compared with healthy sedentary subjects. Heart Rhythm abnormalities were associated with enhanced LV mass in Veteran athletes. Hence, veteran elite athletes may be at increased risk of life threatening arrhythmias. However, prognostic value of heart rhythm disturbances in veteran athletes has to be studied.

Exercise induced QT dispersion changes in middle-aged veteran elite athletes.

UNLABELLED: Present work was aimed to study QT dispersion changes during exercise and relation of it with LV myocardium mass in veteran elite athletes. 31 veteran athletes aged 30-50 years and 31 age-matched healthy controls were studied. In all of them QT dispersion (QTd) at rest and during exercise test was evaluated. LV mass by ultrasound method was measured. INCLUSION CRITERIA: at least 10 years of competitive sports activity and 5 years after active sports cessation, absence of cardiovascular diseases. Differences in QTd at rest and exercise peak among athletes and control groups weren't statistically significant p<0, 05. However, in part of athletes (19%) QTd increased at peak of exercise (marker of pathological hypertrophy), in contrast of controls. Athletes group was divided in two subgroups: athletes with increased QTd at exercise peak (group A) and without of it (gourd B). LV mass index in group A (142,1; SD -4,5; 95% CI 139.31-144.69) was significantly higher, than in control group (106,5; SD -5,56; 95% CI 104.52-107.48) P<0,05. LV mass correlated with QT dispersion changes during exercise in veteran athletes (r =0,87). In former athletes increased QT dispersion during exercise was associated with LV mass enhancement. It is suggested that these findings are caused by incomplete regression of athletic heart hypertrophy or residual hypertrophy and it may not be pure physiological phenomenon.

[Anti-arrhythmic effectiveness of neogilurhythmal in extrasystolic arrhythmia]. / Antiaritmicheskaia éffektivnost' neogiluritmala pri ékstrasistolicheskoi aritmii.

The paper provides the results of differential neogilurythmal therapy in 20 patients with high-grade atrial and ventricular premature contractions in the presence of coronary heart disease. The detection of cardiac arrhythmias and evaluation of the antiarrhythmic efficacy of neogilurythmal were performed by Holter monitoring and transesophageal electrophysiological study. After the baseline studies, the antiarrhythmic efficacy of the drug was evaluated during an acute drug test and then during a 8-day course of the therapy. In the acute drug test, the dose of neogilurythmal was 50% of the daily dosage. The studies indicated that neogilurythmal in a dose of 80 mg/day was beneficial in affecting both the atrial and ventricular extrasystolic arrhythmia. The agent failed to alter heart rate, sinus nodal function and atrioventricular conduction. Thus, neogilurythmal is low toxic and produces no adverse effects when given in the definite dosage range.