[Decreased Heart Rate Variability in Sickle Cell Anemia as Effect of Pulmonary Arterial Hypertension].

Decreased heart rate variability (HRV) is associated with increased mortality risk in various diseases. The objective of this investigation:to study HRV in patients with sickle cell anemia (SCA) and to assess the effect of pulmonary arterial hypertension (PAH) on HRV in these patients. Materials and methods. HRV registration and Doppler echocardiographic assessment of systolic pulmonary arterial pressure (PAP) was carried out in 61 stable patients with SCA and 24 healthy subjects. Results. Low frequency power (LFP) and high frequency power (HFP) were decreased in SCA patients compared to healthy subjects. Among SCA patients, PAH patients had lower  LFP and HFP than patients without PAH. In SCA patients, systolic PAP showed significant negative correlation with LFP and HFP. Conclusion. HRV is significantly decreased in SCA patients, especially in those with PAH. HRV may be particularly useful in early detection of PAH patients who may have worse prognosis and higher mortality risk.

[Ischemic Heart Disease: Focus on Acute Infarction of the Right Ventricular Myocardium].

Ischemic heart disease and acute myocardial infarction (AMI) in particular remain widely spread and contribute seriously in total mortality of population. This literature review is devoted to the right ventricular (RV) AMI as the least studied problem of contemporary cardiology. We present here description of specific characteristics of blood supply to ventricles of the heart, clinical picture, diagnostic criteria and prognosis of RV infarction. We also present current strategy of management of patients with RV AMI including early revascularization with the help of percutaneous coronary intervention.

[Radial Approach for Percutaneous Coronary Interventions in Patients With Ischemic Heart Disease: Advantages and Disadvantages, Complications Rate in Comparison With Femoral Approach].

During recent 10-15 years, percutaneous coronary interventions (PCI) have reached a new level of efficacy and safety. Rate of serious coronary complications has decreased. That to a greater degree exposes the problem of peripheral complications at the site of arterial approach. At the same time portion of patients older than 75 years in the total pool of PCI constantly increases. Number of patients with pronounced obesity also grows each year. Radial approach for PCI allows to substantially decrease rate of peripheral complications at the account of lowered rate of bleedings, and to shorten duration of hospitalization. In this literature review we present results of a number of relevant clinical studies including those which contained groups of elderly patients and of patients with obesity. We also have summarized main advantages and disadvantages of radial approach as compared with femoral approach for coronary angiography and PCI.

[Diagnostic Possibilities of Speckle-Tracking Echocardiography].

The review is devoted to merits and demerits of a new method of assessment of condition of the heart - speckle-tracking echocardiography. Speckle-tracking echocardiography is a perspective method allowing to register disorders of both global and regional contractile motion.

[Ability to Overcome the Thrombocyte Resistance to Acetylsalicylic Acid in Patients With Coronary Artery Disease After Myocardial Revascularization With Coronary Stenting].

Resistance to acetylsalicylic acid (ASA) in patients with coronary artery disease is a poor predictor for the development of atherothrombotic complications. In 277 patients with coronary artery disease suffered uncomplicated coronary angioplasty with stent implantation, we was estimated arachidon-induced platelet aggregation during treatment with acetylsalicylic acid by bedside VerifyNow Assay test at 28-90 days after the intervention. It was found that 18.9% of the 144 patients receiving a combination of ASA 75 mg with 15.2 mg of magnesium hydroxide had true (laboratory) resistance to ASA. At the same time on the original enteric coated ASA 100 mg, we can found only 0.8% resistance to ASA among 129 patients. We made switch from combination of ASA 75 mg with 15.2 mg of magnesium hydroxide to original enteric coated ASA 100 mg and repeat VerifyNow Assay test at 2-4 days and found lost of resistance in 92% of 28 patients. Thus, resistance to the ASA is not constant, it depends on the form and the applied dose of ASA, and eliminating more than 92% when ASA changes from ineffective to effective form.

[Application of Methods of Assessment of Vascular Wall Stiffness in Clinical Practice: Capabilities of Cardio-Ankle Vascular Index].

This paper contains discussion of application of methods of assessment of vascular stiffness in clinical practice, comparison of such parameters as pulse wave velocity, ankle-brachial and cardio-ankle vascular index (CAVI), as well as analysis of advantages of cardio-ankle CAVI for diagnosis, evaluation of effectiveness of treatment, and prognosis in various cardiovascular diseases.

[Application of CAVI Index in Clinical Practice: Calculated Vascular Age as a Tool for Decision on Additional Examination of Patients With Cardiovascular Diseases].

OBJECTIVE: to analyze correspondence between determination of vascular age of patients with cardiovascular diseases by volumetric sphygmography and their chronological age, and to assess the influence of lipid factors and atherosclerotic lesions in carotid arteries (CA) on parameters associated with the cardio-ankle vascular index (CAVI). MATERIAL AND METHODS: Clinical, laboratory and instrumental examination which included volumetric sphygmography was carried out in 185 patients with various cardiovascular diseases. Calculated vascular age was determined on the basis of graphic conversion of ratio of CAVI and true age of a patient. RESULTS: Calculated vascular age exceeded chronological age in 43 patients (23.4%). Analysis of the data obtained in this subgroup, except natural interrelation between such characteristics as age, ankle-brachial index, CAVI and calculated vascular age revealed statistically significant correlations (p < 0.05) between following parameters: R-CAVI and male gender (r = 0.35), calculated vascular age (based on R-CAVI) and TG (r = -0,34), L-CAVI and BMI (r = -0.36), R-ABI and the presence of atherosclerotic plaques in carotid arteries (r = -9.34). Comparison of influence of lipid factors and CA atherosclerotic lesions on CAVI associated parameters revealed no significant differences between groups. CONCLUSION: Volumetric sphygmography with calculation of vascular age is an easily reproducible and accessible method of screening of early changes in the vascular wall. Determination of vascular age of patients with cardiovascular diseases by volumetric sphygmography suggests advisability of thorough medical examination at least in a quarter of total number of patients.

[Chiari Network and Pulmonary Embolism].

We present the case of a patient with acute pulmonary embolism, Chiari network thrombus, and deep vein thrombosis in lower extremities. Chiari networks are present in the right atrium in a minority of population and are usually of no clinical significance. On the other hand it may be associated with such pathological changes as patent foramen ovale, intraatrial thrombus, or atrial arrhythmias. In our case thrombus was trapped by a Chiaris network.

[Chiari network and pulmonary embolism].

We present the case of a patient with acute pulmonary embolism, Chiari network thrombus, and deep vein thrombosis in lower extremities. Chiari networks are present in the right atrium in a minority of population and are usually of no clinical significance. On the other hand it may be associated with such pathological changes as patent foramen ovale, intraatrial thrombus, or atrial arrhythmias. In our case thrombus was trapped by a Chiari's network.

[Comparative Clinical Biochemical Assesment of the State of Mycardium After Coronary Artery Bypass Surgery Performed Using Various Techniques].

We compared parameters of the state of myocardium after coronary artery bypass surgery (CABS) performed according to the following techniques--with complete cardiopulmonary bypass (CABS-CBP), beating heart bypass grafting with parallel normothermic perfusion (CABS- BH-NP), and beating heart bypass grafting (CABS-BH). Patients (n = 100, 86% men, 14% women, age 56-69 years) were divided into 3 groups with comparable sex, age, state of the myocardium, and EUROSCORE surgical risk. In group 1 patients (n = 35) we used CABS-CHB, in group 2 (n = 32)--CABS-BH-NP, in group 3 (n = 33)--CABS-BH. The following parameters were obtained on day 1 after surgery: left ventricular ejection fraction (EF, echocardiography), blood plasma levels of creatine phosphokinase (CPK), CPK-MB, and cardiac troponin I (TnI). There was no significant difference in parameters studied between groups 1 and 2 with a tendency to their more pronounced positive dynamics in group 2. In group 3 compared with groups 1 and 2 we observed significant lowering of levels of CPK (by 21.2-30.9%, p < 0.05), CPK-MB (by 9.1-13.1%, p <0.05), Tnl (by 0.6-0.7%, p < 0.05), and elevation of EF (by 9.8-11.6%, p < 0.05). Rate of development of myocardial infarction in group 3 (6.8%) was lower than in groups 1 and 2 (14.2 and 9.8%, respectively). In all groups we observed close correlation between biochemical parameters and left ventricular EF (r = 0.74-0.82, p < 0.01).

[Comparative Clinical Biochemical Assessment of the State of Myocardium After Coronary Artery Bypass Surgery Performed Using Various Techniques].

We compared parameters of the state of myocardium after coronary artery bypass surgery (CABS) performed according to the following techniques - with complete cardiopulmonary bypass (CABS-CBP), beating heart bypass grafting with parallel normothermic perfusion (CABS-BH-NP), and beating heart bypass grafting (CABS-BH). Patients (n=100, 86% men, 14% women, age 56-69 years) were divided into 3 groups with comparable sex, age, state of the myocardium, and EUROSCORE surgical risk. In group 1 patients (n=35) we used CABS-CHB, in group 2 (n=32) - CABS-BH-NP, in group 3 (n=33) - CABS-BH. The following parameters were obtained on day 1 after surgery: left ventricular ejection fraction (EF, echocardiography), blood plasma levels of creatine phosphokinase (CPK), CPK-MB, and cardiac troponin I (TnI). There was no significant difference in parameters studied between groups 1 and 2 with a tendency to their more pronounced positive dynamics in group 2. In group 3 compared with groups 1 and 2 we observed significant lowering of levels of CPK (by 21.2-30.9%, p<0.05), CPK-MB (by 9.1-13.1%, p<0.05), TnI (by 0.6-0.7%, p<0.05), and elevation of EF (by 9.8-11.6%, p<0.05). Rate of development of myocardial infarction in group 3 (6.8%) was lower than in groups 1 and 2 (14.2 and 9.8%, respectively). In all groups we observed close correlation between biochemical parameters and left ventricular EF (r=0.74-0.82, p<0.01).

[Effect of design of standard metallic stents on neointimal hyperplasia and restenosis].

Coronary stents became an integral part of treatment of ischemic heart disease (IHD). Number of percutaneous coronary interventions (PCI) in patients with IHD in Russia constantly growing. At a certain stage of development of interventional cardiology drug eluting stents (DES) were created and became actively used. Compared with metallic stents (MS) drug eluting stents allow to substantially reduce risk of restenosis. However DES did not replace MS and the latter are still used in about 50% of PCI in Russia. Design of standard MS and thickness of struts might affect extent of neointimal proliferation which develops after stent implantation and eventually determines remote outcomes of IHD treatment. Thereby choice of optimal MS remains an actual problem. In this review we present results of clinical studies which compared MS with different design and thickness of struts.

[Signs of diabetic cardiomyopathy in patients with controlled arterial hypertension and early postprandial hyperglycemia].

AIM: To study signs of diabetic cardiomyopathy (DCM) in nondiabetic patients with controlled arterial hypertension (AH) and glycemic response during first hour of glucose tolerance test (GTT). MATERIAL AND METHODS: Patients (n = 47) with controlled AH were divided into 2 groups according to results of GTT with 75 g of glucose: patients of group 1 (n = 22) had glucose level ≤ 200 mg/dl during 1-st hour of GTT; other patients (n = 25) composed group 2. Examination of all patients included transthoracic echocardiography, ultrasound Dopplerography, tissue Doppler (TD) and 24-hour Holter ECG monitoring. Using data of these methods we calculated left ventricular (LV) mass and the following characteristics of mitral ring: E/A, TD e', TD a', TD s', TD e'/a'/. The following characteristics of heart rate variability were obtained: standard deviation of normal RR intervals (SDNN), low and high frequency (LF, HF) power, LF/HF ratio. RESULTS: Patients of group 2 had higher LV mass (229.5 ± 58.2 vs. 192.1 ± 50.6 g; p = 0.036), more pronounced changes of TD e'/a' (0.71 ± 0.25 vs. 1.06 ± 0.58; p = 0.011), lower SDNN both during day (85.4 ± 14.1 vs. 112.5 ± 31.3 ms, p = 0.007) and night (82.2 ± 22.1 vs. 105.9 ± 28.5 ms, p = 0,004) time, higher nocturnal LF/HF ratio (3.75 ± 4.02 vs. 1.72 ± 0.81, p = 0,029). CONCLUSION: In patients with controlled arterial hypertension (AH) and glycemic response during first hour of GCT we revealed various pronounced manifestations of DCM. These data constitute a basis for further studies.

[Significance of echocardiography in acute coronary syndrome].

The paper contains description of possibilities and limitations of ultrasound diagnosis in patients with acute coronary syndrome (ACS). Main attention is paid to possibilities of echocardiographic diagnosis of myocardial infarction (MI) and its complications, as well as to differential diagnostics of ACS and nonischemic conditions causing chest pain and infarction-like ECG changes. Data are presented demonstrating substantial lowering of rates of some complications of MI in patients subjected to thrombolytic therapy or interventional procedures of myocardial revascularization.

[Nicorandil in the treatment of patients with ischemic heart disease].

Adequate drug therapy of stable ischemic heart disease directed at reduction and prevention of main clinical symptoms of the disease, increase of exercise tolerance to physical effort, improvement of quality of life and prognosis remains an actual problem. Nicorandil combines properties of an antianginal drug and cardioprotective effects. Its pharmacological action is related to capabilities to be an nitrous oxide donor and to activate ATP-dependent potassium channels. In this review we present data on mechanism of action of nicorandil, on its clinical effectiveness, and on comparison with antianginal drugs of other groups. We have also analyzed experience of the use of nicorandil in patients with acute coronary syndrome and in conjunction with during invasive interventions.

[Clinical significance of filiform structures (Lambls excrescences) on cusps of cardiac valves].

This literature review is devoted to clinical significance of filiform structures (Lambls excrescences) which can be revealed on cusps of cardiac valves by transesophageal echocardiography. The review contains analysis of frequency of detection of these structures at pathomorphological investigation and transesophageal echocardiography as well as consideration of their histological construction and mechanisms of formation. Special emphasis is made on mechanisms of related embolic complications and data on association of Lambls excrescences with strokes. Differential diagnosis of these structures and other pathological elements on heart valves is also presented.

[The diagnostic efficiency of the methods of separate and combined registration of oronasal airflow and pulse oximetry for detection of the obstructive sleep apnea/hypopnea syndrome].

The diagnostic efficiency of the methods of separate and combined registration of oronasal airflow and pulse oximetry in order to identify the obstructive sleep apnea/hypopnea syndrome (OSAHS) is studied in this work. Patients with cardiovascular diseases with complaints on sleep disorders were included in the study. Combined registration of oronasal airflow and pulse oximetry during sleep were performed for all examined patients (diagnostic system ApneaLink with pulse oximetry, ResMed). Registration results of oronasal airflow and pulse oximetry were analyzed separately and together. Apnea/hypopnea index (classic, recommended), desaturation index with a threshold of desaturation of 4% and 3% were evaluated as the diagnostic criteria for the identification of OSAHS. Also, in this paper the "apnea/hypopnea combined index" summarizing hypopnea episodes, which are associated with significant desaturation and without desaturation, was tested. As a method of comparison, polysomnography (Embla N7000, MedCare Flaga), which was carried out simultaneously with the main study, was used. The diagnostic efficiency of test methods and their criteria assessed by ROC-analysis (receiver operator characteristic, the characteristic curve analysis). The results of the study showed that combined registration of respiratory oronasal airflow and pulse oximetry during sleep was most effectively identified OSAHS and can be used as a screening method. The most accurate diagnostic criterion for identification of OSAHS is an "apnea/hypopnea combined index".

[Mechanisms of development of thromboembolic complications in patients with atrial fibrillation].

Thomboembolism is the most threatening complication in patients with atrial fibrillation. Main source of embolism is the left atrial thrombosis. Mechanisms of development of thromboembolic complications in patients with arrhythmias are far from being deciphered. In this review we discuss possible mechanisms of formation of intracardiac thrombus - abnormalities of functioning of the hemostasis system, endothelial dysfunction, inflammatory reactions, fibrosis of the left atrial wall, genetic traits.

[Effect of intracoronary and intravenous administration of tirofiban loading dose in patients underwent percutaneous coronary interventions because of acute coronary syndrome].

Aim of this multicenter retrospective study was assessment of effect of intracoronary administration of tirofiban loading dose in troponin positive patients with acute coronary syndrome (ACS). We analyzed multicenter data base of patients subjected to percutaneous coronary interventions (PCI) because of ST-elevation or non-ST elevation ACS from October 2010 to October 2011. Patients who received loading doses of aspirin (300 mg) and clopidogrel (600 mg) before PCI and tirofiban (10 mg/kg bolus with subsequent infusion 0.15 mg/kg/min for 24 h) were selected for the study (n=133, 89 with intravenous and 44 - intracoronary administration of tirofiban loading dose). We assessed hospital mortality, myocardial reinfarctions (reMI), necessity of target vessel revascularization (TVR) and pronounced bleedings. There were no significant differences in mortality, reMI, and TVR between two groups. However major adverse cardiac events was significantly less in patients who received intracoronary tirofiban (6.8 vs. 21.3% in i.v. group; p=0.046). Hospital stay was significantly shorter in intracoronary compared with i.v. group (3.84+/-0.96 vs. 4.55+/-1.11 days; p=0.001). Rates of bleedings did not differ significantly between groups. Thus compared with i.v. intracoronary administration of tirofiban loading dose allows lower rate of major adverse cardiac events as well as to shorten length of hospital stay of patients with ACS.

[Clinico-economical aspects of cardioversion of paroxysmal atrial fibrillation at phehospital stage and during hospitalization].

We carried out clinico-economical analysis of 2 tactics of rhythm restoration in patients with paroxysmal atrial fibrillation (AF) lasting less than 48 hours: cardioversion at prehospital stage with intravenous procainamide and inhospital cardioversion with any method. This retrospective study was based on the data from department of urgent aid of an outpatient clinic. The results showed that within 48 hours inhospital was a was more effective, safe, and more economically profitable compared with administration of procainamide at prehospital stage. Intravenous procainamide resulted in effective cardioversion in 70.6% of patients. It was associated with arterial hypotension and proarrhythmogenic action in 14,7% of cases. Patients with effective cardioversion with procainamide had lesser mean values of left ventricular anterior-posterior dimension (echocardiography) and shorter duration of arrhythmia.