[Vasoprotective effect of effective lipid-lowering therapy in patients with ST-segment elevation myocardial infarction].

AIM: To study the vasoprotective effects of atorvastatin depending on the achievement of the target level of low-density lipoprotein cholesterol (LDL-C) in patients with ST-segment elevation myocardial infarction (STEMI) within 48 weeks of follow-up. MATERIALS AND METHODS: Included were 112 STEMI patients who received atorvastatin 20-40-80 mg. On days 7-9 from the onset of the disease, after 24 and 48 weeks, ultrasound examination of the carotid arteries with RF technology and applanation tonometry were performed, the lipid profile was determined. The patients were divided into groups: group 1 (n=41) of highly effective therapy (HET) - who achieved the target LDL-C after 24 and 48 weeks; group 2 (n=29) in relatively effective therapy (RET) - achieving target values at 24th or 48th week; group 3 (n=42) insufficiently effective therapy (IET) - did not reach the target LDL-C. RESULTS: When examining the carotid arteries in the HET group, the intima-media thickness (IMT) decreased by 10.7-13.1%, the b index - by 14.9-26.3% after 24-48 weeks. In the RET group, the IMT regression was 10.4-13.3%; b index - 23.9% by the 48th week. In the IET group, the b index decreased by the 48th week by 14.3%. According to applanation tonometry in the HET group, the central pressure did not change. In the RET group, systolic pressure in the aorta increased by 10-15.7% after 24-48 weeks, pulse pressure - by 33.9% by the end of observation. With IET, the increase was 8.6-6.8 and 19.8-25.9%, respectively. The odds ratio of developing endpoints in the RET group was 4.7 (95% CI 1.2-26.4; p=0.02), in the IET group - 3.9 (95% CI 1.1-24.8; p=0.03) compared with HET. CONCLUSION: The most pronounced vasoprotective effect and a decrease in cardiovascular risk are associated with the achievement of the target LDL-C throughout the entire treatment period.

[Non-compact right ventricular myocardium - diagnostic and clinical features: A review].

Non-compact right ventricular myocardium is a rare type of cardiomyopathy, it usually results from arrested myocardial development during embryogenesis. This disease can be characterized by excessive prominent trabeculations and deep inter-trabecular recesses in the ventricular wall. It might be a component of biventricular non-compact cardiomyopathy or an isolated form. The article presents a review of the literature on the clinic and radiation diagnostics of non-compact right ventricular myocardium with the presentation of the issues of differential diagnosis.

Relationship between electrical myocardial instability and postinfarction remodeling in patients with ST-segment elevation myocardial infarction.

Aim      To study the clinical value of markers for myocardial electrical instability in combination with echocardiographic parameters for predicting the risk of cardiovascular complications (CVC) in the postinfarction period.Material and methods  This study included 118 patients with ST segment elevation myocardial infarction (STEMI) and hemodynamically significant stenosis of one coronary artery. A percutaneous coronary intervention (PCI) with stenting of the infarct-related artery was performed for all patients. On day 7-9 and at 24 and 48 weeks after the treatment, ECG Holter monitoring was performed, which included analyses of ventricular late potentials, dispersion of QT interval duration, heart rate turbulence (HRT) and variability (HRV), and heart chronotropic load (HCL). At baseline and during postinfarction week 12, all patients underwent echocardiography with calculation of indexes of end-diastolic volume (iEDV) and end-systolic volume (iESV) to verify the signs of left ventricular (LV) myocardial remodeling. The criteria for LV pathological remodeling included increases in iEDV >20 % and/or iESV >15 % at 12 weeks after STEMI. The group without remodeling, R(-), consisted of 79 (67 %) patients and the group with signs of LV pathological remodeling, R(+), consisted of 39 (33 %) patients. Quality of life and achieved endpoints were evaluated during 144 weeks.Results By week 48 in group R(-), the stabilization of electrical processes in the myocardium was more pronounced as indicated by a decrease in HFLA by 12 % (р=0.004) and by a fourfold increase in RMS (р=0.047). Only in this group, the baroreflex sensitivity restored; pathological ТРС decreased from 20 to 5% (p=0.002) by the end of the active treatment. Stabilization of the repolarization phase duration in various parts of the myocardium was more active in patients without pathological remodeling as shown by decreases in disp QTa (р=0.009), disp QTe (р=0.03), sd QTa (р=0.006), and sd QTe (р=0.009). This was not observed in the group R(+). The recovery of vagosympathetic balance due to leveling the sympathetic component also was more effective in the group R(-), which was reflected in increased spectral and temporal HRV indexes (р<0.05). Both groups showed reduced HCL values at 24 weeks (р=0.047 and р=0.006); however, the HCL regression remained also at 48 weeks only in the group R(-) (р=0.006). Group R(-) patients reported higher quality of life (р=0.03) than group R(+) patients. Endpoints were achieved more frequently in the group R(+): 87.1 % vs. 27.8 % (odds ratio, 11.8; 95 % confidence interval, 4.6-30.8; р=0.00001).Conclusion      Pathological myocardial remodeling in early postinfarction period is associated with electrophysiological instability of the myocardium, which results in the development of CVC and low quality of life in patients with STEMI.

A New Approach to Evaluating the Pumping Function of the Heart by the Myocardial Work.

The function of left ventricular (LV) contractility consists of two aspects, the force of myocardial contraction, which provides a sufficient pressure gradient to open the heart valves, and deformation, which determines the actual cardiac output [1, 2]. The relationship between the characteristics of LV deformation and LV volume parameters remains poorly understood. The LV work may reflect the dependence between the volume and deformation characteristics of the left ventricle. Myocardial work indexes can more accurately describe the systolic LV function when the LV ejection fraction (EF) and global longitudinal strain (GLS) are not informative enough [3, 4]. A new approach was proposed for evaluating the LV pumping function, and a parameter was developed to characterize the efficiency of myocardial work for the cardiac cycle period from the aortic valve opening (AVO) to its closure (AVC), that is, the phase of blood ejection from the left ventricle.

Early Predictors of Heart Failure Progression in Patients After Myocardial Infarction.

Aim      To identify early predictors for progression of chronic heart failure (CHF) in patients with ST-segment elevation myocardial infarction (STEMI).Material and methods  The study included 113 patients with STEMI aged 52 (95 % confidence interval, 36 to 65) years. 24-h ECG monitoring was performed with assessment of ventricular late potentials, QT dispersion, heart rhythm turbulence (HRT), and heart rhythm variability (HRV); XStrain 2D echocardiograpy with determination of volumetric parameters, myocardial strain characteristics and velocities; and measurement of brain natriuretic peptide (BNP) concentrations. The endpoint was CHF progression during 48 weeks of follow-up, which was observed in 26 (23 %) patients. Based on the outcome, two groups were isolated, with CHF progression (Prg) (26(23%)) and with a relatively stable CHF postinfarction course (Stb) (87 (77 %)).Results At 12 weeks following MI, the Prg group showed increases in left ventricular (LV) end-diastolic dimension (EDD) (р<0.05) and end-diastolic and end-systolic volumes (EDV, ESV), (р<0.01), and EDV and ESV indexes (EDVi and ESVi, р<0.01). In this group, global longitudinal strain (GLS) was decreased at 24 weeks (р<0.05) and global radial strain (GRS) was decreased at 48 weeks (р=0.0003). In the Prg group, values of strain parameters (GLS, global circular strain (GCS), and GRS) were lower at all times. At 7-9 days, 24 weeks, and 48 weeks, the proportion of patients with pathological HRT was higher in the Prg group (38, 27, and 19 % for the Prg group vs 14 % (р=0.006); 3,4 % (р=0.001), and 2.3 % (р=0.002) for the Stb group, respectively). Only in the Stb group, increases in HRV were observed (SDNNi by 13 % (р=0.001), rMSSD by 24 % (р=0.0002), TotP by 49 % (р=0.00002), VLfP by 23 % (р=0.003), LfP by 22 % (р=0.008), and HfP by 77 % (р=0.002). At 7-9 days of MI, the Stb group had greater values of SDANN (р=0.013) and HfP (р=0.01). CHF progression correlated with abnormal values of turbulence onset (TO), disturbed HRT, increased BNP levels and LV ESD, and low values of GLS, GCS, and GRS. Combined assessment of HRT, LV ESD, and GLS at 7-9 days after STEMI allows identifying patients with high risk for CHF progression in the next 48 weeks.Conclusion      The markers for CHF progression after STEMI include abnormal TO values, disturbed HRT, increased BNP levels and LV ESD, and low values of GLS, GCS, and GRS. The multifactor logistic regression analysis revealed early predictors of CHF in the postinfarction period, including abnormal TO, increased LV ESD, and reduced GLS.

[The myocardial infarction size measuring using modern methods].

An accurate quantitative assessment of myocardium necrosis area and the viable zone (stunned and hibernating) in patients with myocardial infarction is crucial for the preoperative patient selection and predicting the cardiac surgery effectiveness. Currently, researchers and clinicians are most interested in the problem of determining the viable myocardium zone. However, only the necrosis zone area directly correlates with the patients prognosis and determines the heart pathological remodeling processes. In the distant period, the data obtained can be used to predict the post-infarction period course or for analysis the relationship of the necrosis zone with arrhythmogenesis, and a number of other indicators. Thus, the necrosis zone and the viable myocardium zone are two parameters that need to be monitored in dynamics in all patients after myocardial infarction. The most accurate and reproducible method for determining the necrosis area is contrast magnetic resonance imaging of the heart, however, this technique is still inaccessible in most hospitals. In this regard, it remains relevant to estimate the necrotic myocardium area by ubiquitous non-invasive methods such as electrocardiography and echocardiography.

[The Impact of Effective Therapy With Atorvastatin on the Dynamics of Parameters of Electrical Instability in Patients with ST-Elevation Myocardial Infarction].

AIM: To assess the dynamics of parameters of myocardial electrical instability in patients with ST-elevation (STE) myocardial infarction (MI) treated with various doses of atorvastatin. MATERIALS AND METHODS: Patients with STEMI (n=70), who received atorvastatin 20 or 80 mg/day for 48 weeks, were divided into two groups: group "Е" - 38 patients (54.3 %) in whom by 48­th week target values of low density lipoprotein cholesterol (LDLC) were achieved, and group "NE" - 32 patients (45.7 %) in whom these levels were not achieved. On days 7-9, at 24th and 48th weeks after onset of MI the patients underwent 24­hour 12­leads ECG monitoring with subsequent analysis of parameters of myocardial electrical inhomogeneity: late ventricular potentials (LVP), dispersion of QT-interval duration, heart rate variability (HRV) and turbulence. RESULTS: After of treatment with atorvastatin target value of LDLC was achieved in 73.5 and 36.1 % of patients receiving 80 and 20 mg/day, respectively. In the group "E" we observed positive dynamics of LVP parameters (QRSf - p.

[The state of the great arteries in type 2 diabetes mellitus patients with obstructive sleep apnea syndrome]. / Sostoyanie magistral'nykh arterii u bol'nykh sakharnym diabetom 2-go tipa, stradayushchikh sindromom obstruktivnogo apnoe vo sne.

AIM: To evaluate the impact of hyperglycemia concurrent with obstructive sleep apnea syndrome (OSAS) on endothelial function (EF) and vessel remodeling in patients with Grade 1-2 hypertension. MATERIAL AND METHODS: A total of 101 patients with Grade 1-2 hypertension were examined. A study group (SG) consisted of 74 hypertensive patients with type 2 diabetes mellitus (T2DM). A control group (CG) comprised 27 persons with isolated blood pressure (BP) elevation. The patients with T2DM underwent cardiorespiratory sleep monitoring, the readings of which were used to divide SG into 2 subgroups: 1) patients with an apnea-hypopnea index of <30 episodes/h (SG-1); 2) those with an index of >30 episodes/h (SG-2). 24-hour BP and vascular stiffness monitoring was made; EF was evaluated; common carotid artery diameter (CCAD) and intima-media thickness (IMT) were determined. RESULTS: The diabetic patients showed lower central diastolic BP and higher aortic pulse BP. Unlike the comparison group, the diabetic patients with severe OSAS were found to have the highest central pulse wave propagation velocity at night. There was a preponderance of an average nocturnal arterial rigidity index, average daily and average nocturnal BP rising rates, and shorter reflected wave propagation time in the diabetic patients. The mean level of flow-mediated vasodilation was significantly reduced in SG-2. The diabetic patients, unlike the controls, were ascertained to have decreased absolute responsiveness index values. There were increases in IMT and CCAD in SG-2. CONCLUSION: OSAS worsens EF and vessel rigidity in patients with T2DM concurrent with hypertension.

Use of the Speckle tracking method for determining global parameters of heart contractility in healthy individuals.

The speckle tracking method allows one to quantify the temporal and spatial characteristics of myocardial contraction. Importantly, it does not depend on a scanning angle and allows one to record the movement of speckles in 2D mode in any direction, unlike tissue Doppler imaging. This examination is non-invasive, safe for patients, and economically more beneficial in comparison with other modern methods of assessing heart contractility: MRI and scintigraphy. Diagnostic thresholds are suggested for obtaining peak values of all types of global strains and strain rates by sampling a healthy group, which can reveal early signs of left ventricle contractility failure. Correlation relationships of deformation parameters between themselves and with left ventricular hemodynamic indices, as well as anthropometric parameters in healthy subjects highlight the features of heart contraction biomechanics. However, currently this method is scarcely studied because no generally accepted normal range of strain values exists. •It is necessary to have sufficient qualification and skills in dealing with the XStrain™ Esaote software to obtain optimal values ​​of myocardial deformation.•The study results expand the database of this software for users and determine the normal range of the left ventricular contractility parameters.•The revealed interrelationships of strain values ​​in healthy individuals are relevant for understanding how the contractility mechanisms are altered in patients, and open up the prospect of studying the heart's compensatory possibilities.