Limitations of Diagnosis of Ischemic Left Ventricular Dysfunction Using the Values of Strain, Twist and Untwist in Patients With Myocardial Infarction of Various Localization

AIM

To compare capabilities for diagnosing regional and global myocardial dysfunction using the values of longitudinal and circular strain, left ventricular (LV) torsion and untwisting in patients with myocardial infarction (MI) of various locations.

MATERIAL AND METHODS

Patients included in the study (n=121) were divided into three groups: patients with unstable angina (n=30), patients with anterior MI (n=45), and patients with inferior MI (n=46). Clinical, laboratory and instrumental test were performed, including echocardiography. For a quantitative analysis of LV contractility, the maximum systolic peaks of regional and global longitudinal and circular strain, systolic and diastolic rotation, LV torsion and untwisting were measured.

RESULTS

Anterior MI was characterized by injury of the LV apical segments, while inferior MI was characterized by injury of the basal segments. In anterior MI, the longitudinal strain was reduced less than 14.5% and circular strain less than 19.3% in the apical segment of the LV anteroseptal wall (ASW). In akinesia of the LV ASW apical segment, longitudinal and circular strains were reduced less than 10%. The magnitude of the circular strain of the LV ASW apical segment (diagnostic threshold 19.3%, sensitivity (Se) 87%, specificity (Sp) 90%) was superior to that of the longitudinal strain as a diagnostic marker for regional ischemic dysfunction in anterior MI. The magnitude of the circular strain of the basal segment of the LV inferior wall in inferior MI has a greater diagnostic value for identifying regional systolic dysfunction than the value of the longitudinal strain of this LV segment. The diagnostic threshold was 17.3%, Se 79%, Sp 80%.

CONCLUSION

A decrease in the circular strain of the LV ASW less than 19.3% in the LV apical segment is more specific (Sp 90%) for diagnosing regional systolic dysfunction in anterior MI than a decrease in longitudinal strain. A circular strain value of less than 17.3% in the basal segment of the LV inferior wall is more specific (Sp 80%) than the longitudinal strain of this segment for diagnosing regional systolic dysfunction in inferior MI. Predominant injury to the LV apex in anterior MI can cause systolic and diastolic myocardial dysfunction, which is manifested by a decrease in LV circular deformation, torsion and untwisting.

Comparative Pharmacoepidemiological Assessment of Antihypertensive Drugs Administration Structure in Pregnant Women in Routine Medical Practice in Kursk and Chisinau

Aim. To study the structure of antihypertensive drugs prescription in pregnant women in routine practice in Kursk and Chisinau.Material and methods. The study design was observational descriptive cross-sectional. Authors conducted a survey of doctors in medical organizations in Kursk and Chisinau in 2017-2018.Results. Respondents from Kursk and Chisinau preferred methyldopa in prescriptions of central alpha-adrenergic receptor agonists. Doctors from Chisinau used clonidine in 14.3% of cases. The leading place in the group of calcium channel blockers belonged to short-acting nifedipine. Among beta-blockers in Kursk, doctors most often prescribed bisoprolol (43.3%), metoprolol (21.7%) and nebivolol (13.3%), while in Chisinau the preference was given to metoprolol (32.1%), atenolol (19.6%) and bisoprolol (16.1%). From the group of diuretics, Kursk doctors mainly prescribed hydrochlorothiazide (10%), indapamide (6.7%); in Chisinau, indapamide was the leader (19.6%), hydrochlorothiazide was used less frequently (7,1%). From the class of alpha-blockers, prazosin occupied the leading position among respondents in Kursk, and terazosin in Chisinau.Conclusion. The priority drug classes in both regions were calcium channel blockers, central alpha-adrenergic receptor agonists and beta-blockers. A small number of not recommended drugs prescriptions have been registered. In general, the prescribed treatment corresponded to the current guidelines and protocols for the management of patients with arterial hypertension during pregnancy.

[Pharmacotherapy optimization opportunities using fixed combinations in patients with high cardiovascular risk]

This review focuses on the role of arterial hypertension and hyperlipidemia as the most important risk factors of early disability and death. The facts are provided that many persons with those risk factors do not have the adequate control of blood pressure and atherogenic fractions of blood serum lipoproteins. The review addresses prospects for optimizing pharmacotherapy with fixed combinations of drugs for arterial hypertension and dyslipidemia. From the perspective of effective clinical guidelines and the available evidence base, the authors reviewed possibilities for improving the treatment compliance by using combinations of antihypertensive and hypolipidemic drugs in a single dosage form. Implementation of such complex, optimized treatment using a three-component fixed-dose combination is considered.

[The Role of Residual Stenosis of the Coronary Arteries in the Dynamics Systolicdiastolic Left Ventricular Function after Acute Coronary Syndrome]

OBJECTIVE

The aim of the research under consideration was to study the dynamics of a local systolic-diastolic function of patients with various ischemic heart disease (IHD) progressions after survival of an acute coronary syndrome (ACS) provided there are residual stenoses of coronary arteries.

MATERIALS AND METHODS

 There were 112 patients suffering from ACS who took part in the research. The diagnosis was verified (acute myocardial infarction or unstable angina) in accordance with the recommendations of European Society of Cardiology (ESC). All patients were divided into two groups depending on the occurrence of major acute cardiac events (MACE): 59 patients with aggravated IHD progression and 152 patients with non-aggravated course. Echo-cardiography was performed on a scanner Philips iE33 (the Netherlands) with a consideration to systolic and diastolic functions parameters of a left ventricle. Quantitative analysis of the left ventricle was executed in the mode of Tissue Doppler Imaging (TDI) and according to the method of tracing the patches of the ultra-sound image gray scale (ST).

RESULTS

In the course of the aggravated IHD a decrease in systolic-diastolic function of left ventricle has been discovered. It has been found out that the amount of the systolic peak of longitudinal strain of the left ventricle anteroseptal wall less than 12% is associated with a greater extent of coronary atherosclerosis and aggravated progression of IHD. TDI and ST methods have enabled to reveal that in the course of non-aggravated IHD the contractility and the diastolic function of the left ventricle anteroseptal wall improve in combination with the increase in the contractility of the left ventricle inferolateral wall. During an aggravated IHD progression the contractility and diastolic function of the left ventricle anteresoptal wall decreases without an increase in contractility and diastolic function of the inferior and inferolateral walls of the left ventricle. The reason for such results might be a progressing myocardial ischemia of the left ventricle anteroseptal wall despite the sufficient anterior interventricular artery stenting. The presence of the relevant residual stenoses of the circumflex and right coronary arteries increases the possibility of the aggravated IHD progressing especially by the end of the fourth year of observation.

CONCLUSION

The disbalance of the local contractility of anterior, inferior and inferolateral left ventricle walls in the course of aggravated IHD is connected with the CA residual stenoses presence and forwards the decrease in global systolic-diastolic function of the left ventricle. The final results can serve as a foundation for optimization of recommendations for performing PCI on the patients with multivessel disease of CA.

Comparative Analysis of Factors Affecting the Prognosis of Patients with Atrial Fibrillation According to the Results of the REKUR-AF Study

Aim. To conduct a comparative analysis of the significance of the influence of various factors and their combinations on the survival of patients with atrial fibrillation (AF) in the REKUR-AF study.

Material and methods. The database includes 896 patients with AF over 18 years old who applied to medical organizations in the city of Kursk and seven districts of the Kursk region from September 2015 to August 2016. Achievement by the patients of the “end point” (death from any cause) was assessed using a telephone contact for a period of 9.0±0.55 months from the end of the database formation. Data were obtained on 532 patients, of which 60 patients reached the end point. To study the differences in survival in subgroups of patients with different characteristics, two groups of categorized factors were analyzed – clinical (sex, age, form of AF, etc.) and pharmacological (use of different classes of drugs). The necessary information was obtained from outpatient cards analyzed when patients were included in the study.

Results. The survival rate of patients with AF was significantly (p<0.05-0.001) influenced by the following factors and their categories: age (<60 years – 92.5%, 60-65 years – 92.9%, over 75 years – 80.1%); AF form (paroxysmal – 95.1%, persistent – 93.2%, permanent – 84.4%); stable angina (SA) (presence – 86.5%, absence – 90.7%); chronic heart failure functional class (CHF FC) (I-II – 95.9%, III – 91.5%, IV – 69.6%); glomerular filtration rate (GFR) (>50 ml/min – 89.6%, 30-50 ml/min – 85.8%, <30 ml/min – 72.7%); diabetes mellitus (DM) (presence – 81.9%, absence – 90.4%), hospitalization for the year preceding inclusion in the study (presence – 85.5%, absence – 97.3%), the use of oral anticoagulants (OAC) (presence – 96.7%, absence – 87.1%). In subgroups of patients with the above mentioned categories (especially the most severe) of the studied factors, significant (p<0.05-0.01) differences in the proportion of surviving patients depending on the appointment of OAC were revealed: age >75 years – 78.2% and 100%; permanent form of AF – 81.9% and 96.1%, the presence of SA – 85.0% and 94.7%; CHF FC IV – 67.0% and 91.7%; GFR<30 ml/min – 62.5% and 100%; presence of DM – 80.7% and 88.2%.%; the presence of hospitalizations in the last year – 82.9% and 97.2%; >5 points on the CHA2DS2VASc scale – 67.0% and 91.7%, heart rate >90/min – 68.8% and 100% of patients with the absence and presence of the OAC therapy, respectively. Cox regression analy sis revealed clinical predictors contributing to an increase in the risk of death: age over 75 years, permanent form of AF, CHF FC III-IV, the presence of DM, the presence of previous hospitalizations. The absence of the OAC taking was accompanied by an increase in the risk of death by 3.66 times.

Conclusion. The results of the REKUR-AF study allowed to establish the most significant factors affecting the survival of patients with AF: age, form of AF, CHF FC, presence of DM, hospitalization in the last year preceding the inclusion of patients in the study, OAK taking. The prescription of OAC is a priority predictor that improves survival in patients with AF. 

[Evaluation of the efficiency of combined pharmacotherapy with the use of trimetazidine with prolonged release in patients with stable angina in outpatient practice]

OBJECTIVE

To evaluate the effectiveness of complex pharmacotherapy with the inclusion in the treatment regimen of trimetazidine with a prolonged release in patients with stable angina.

MATERIALS AND METHODS

The pilot study included 22 patients aged 45-75 years with combined cardiovascular pathology. In addition to the received therapy, all patients were prescribed the original trimetazidine with a prolonged release at a dose of 80 mg/day (Preductal® OD, Servier, Russia). The observation period was 2 months. The survey included the double implementation of the following methods: the number of strokes per week, the frequency of use of short - acting nitrates per week, blood pressure, heart rate, echocardiography, daily ECG monitoring, assessment of the quality of life (questionnaire SF-36, questionnaire of patients with stable angina SAQ).

RESULTS AND DISCUSSION

When assessing the effect of ongoing pharmacotherapy on clinical and echoCG indicators in patients of the study group, significant positive dynamics was registered in the form of reducing the number of angina attacks and the number of short - acting nitrates used per week, a slight positive dynamics of EF on echoCG, episodes of pain and painless ischemia were eliminated according to the results of Holter monitoring), a significant positive dynamics of quality of life indicators was noted.

CONCLUSION

Combined pharmacotherapy of patients with stable exertional angina with the inclusion of the trimetazidine with a prolonged release at a dose of 80 mg/day (Predductal® OD, Servier, Russia) has a significant positive pharmacodynamic effect in the form of an increase in the antianginal effect, improvement of Holter monitoring indicators and quality of patients life.

[Possibilities of estimation of breast cancer targeted therapy cardiotoxicity in routine clinical practice]

AIMS

To estimate cardiotoxicity of targeted therapy of breast cancer by the results of methods of investigation, which are used in routine clinical practice.

METHODS AND RESULTS

We have made a retrospective analysis of medical documentation of patients with breast cancer, which are given trastuzumab in mono regimen and as a part of antitumor chemotherapy. An average number of chemotherapy's courses is 10,3±1,9. Such methods as echocardiography and electrocardiography, physical examination are ordinary used to estimate the cardiotoxicity in routine clinical practice. Revealed dynamic of indices shows that pathological changes of cardiovascular system developed during using trastuzumab do not reach the level of generally accepted sings of cardiotoxicity.

CONCLUSION

Methods of diagnostics, which are used in routine clinical practice nowadays do not allow to reveal the early sings of myocardial damage. The question about commissioning of modern technologies in aim of early examination of myocardial dysfunction is still relevant.

COMPARATIVE PHARMACOEPIDEMIOLOGICAL ASSESSMENT OF ANTIHYPERTENSIVE DRUGS PRESCRIPTION IN OUTPATIENT PRACTICE IN KURSK AND CHISINAU

Aim. To study the structure of medical prescriptions of antihypertensive agents for patients with arterial hypertension (HT) in the outpatient practice of Kursk (Russia) and Chisinau (Republic of Moldova).

Material and methods. The questioning of doctors of medical organizations in Kursk and Chisinau was carried out as a one-stage descriptive study from October 2015 to February 2016. The questionnaires included questions on the pharmacoepidemiological aspects of prescribing antihypertensive drugs. Total number of respondents was 218, of them – 106 (26 cardiologists and 80 therapists) in Kursk and 112 (28 cardiologists and 84 therapists) in Chisinau.

Results. In the real practice for HT treatment doctors in Kursk used more often beta-adrenoblockers (BAB), somewhat less often – angiotensinconverting enzyme (ACE) inhibitors, then diuretics. The shares of calcium channels blockers (CCB) and angiotensin II receptors blockers (ARB) were small – 8.8 and 5.2%, respectively. In Chisinau doctors gave preference to ACE inhibitors, then diuretics and BAB. Frequency of CCB prescriptions was almost identical to that of ARA – 13.7 and 13.6%, respectively. The additional antihypertensives, including central action drugs and alpha-adrenoblockers, were used rarely in both Chisinau and Kursk (1.3 and 1.6%, respectively). Doctors of Chisinau, when carrying out combined pharmacotherapy, gave priority to free combinations of antihypertensive drugs (64.4%), fixed combinations were used in 26.7% of cases. In Kursk, the ratio of these specified tactics of combined therapy was 53.5 and 34.1%, respectively. Among the pharmaceutical companies whose medicines were preferred by doctors in Kursk and in Chisinau, the leading positions were taken by KRKA (38.0 and 25.4%, respectively), Gideon Richter (13.5 and 28.7%, respectively) and Berlin-Chemie (26.7 and 15.6%, respectively).

Conclusion. ACE inhibitors, diuretics, BAB were priority classes in the prescribing antihypertensive drugs according to survey of doctors in Kursk and Chisinau. In the conditions of the existing pharmaceutical market of Chisinau doctors used ARB and CCB more often than doctors from Kursk. The main share of doctor’s prescriptions in Kursk and Chisinau, considered both for group of antihypertensive drugs, and for certain representatives of each group of drugs, corresponds to the current recommendations on the pharmacotherapy of patients with HT. 

[Quantitative Assessment of Alterations of Reginal Contractility of the Left Ventricle in Patients With Ischemic Heart Disease]

BACKGROUND

An important aspect of ischemic heart disease (IHD) diagnosis is the assessment of alterations of regional contractility (ARC) of the left ventricle. Speckle tracking imaging is a relatively new diagnostic method used for this purpose. Aim of this study was to identify optimal parameters of left ventricular (LV) deformation by speckle-tracking echocardiography which can differentiate quantitatively degrees of ARC of all left ventricular segments in patients with acute and chronic forms of IHD.

MATERIALS AND METHODS

We compared parameters of LV longitudinal, radial, and circular deformation in 216 patients with IHD in dependence on the presence of ARC.

RESULTS

The most sensitive and specific indicator of ARC of LV anterior septal wall was found to be the value of longitudinal systolic deformation of the middle and apical segments (diagnostic thresholds -13.5 % and 14.7 %, respectively). Such indicator for LV inferior wall was value of circular systolic strain (diagnostic threshold for the basal segment -12.9 %, for the middle segment -10.7%).

[Assessment of Efficacy of Combined Pharmacotherapy With Fixed Perindopril/Amlodipine Combination in Patients With Combined Cardiovascular Pathology in Outpatient Practice]

AIM

to study effects of using fixed perindopril/amlodipine combination in complex treatment of patients with combined cardiac pathology in active observation mode, in comparison with other angiotensin converting enzyme (ACE inhibitors) or angiotensin II receptor antagonists (ARA), including free combination with calcium channel blockers (CCB) in conditions of routine outpatient practice.

MATERIALS AND METHODS

The design of the study included two stages: I - monitoring effectiveness of pharmacotherapy performed in routine outpatient practice (duration of 2 months), II - "active treatment (management)" - changing the pharmacotherapy scheme in patients who did not reach the target level of "office" blood pressure (BP), monitoring patients for 6 months and carrying out, if necessary, dose correction of the newly appointed treatment regimen. The study included 50 patients aged 45-65 years with combined cardiovascular pathology: II-III degree arterial hypertension, I-III functional class (FC) stable angina pectoris, I-III FC chronic cardiac failure.

RESULTS

Number of patients who reached target level of office BP by the end of active observation was 41 (p.

Study of Endothelial Protective Activity of Phenol-Derived Thrombin and Arginase-2 Inhibitors KUD-259 and KUD-974

We performed correction of endothelial dysfunction with phenol derivatives KUD-259 and KUD-974 containing heteroatomic and heterocyclic structures. Pharmacological activity of KUD-259 and KUD-974 surpassed that of L-norvaline, a non-selective arginase inhibitor.

[Comparative Assessment of Effects of Free and Fixed Combinations of Hypotensive Drugs on Quality of Life of Patients With Arterial Hypertension of High and Very High Risk]

PURPOSE

comparative assessment of effects of free and fixed combinations of hypotensive drugs on quality of life (QL) of patients with arterial hypertension (AH) of high and very high risk of cardiovascular complications.

MATERIAL

Study group comprised 120 patients (70% men, 30% women, age 45-65 years) with degree II (20.9%) and III (79.1%) A. Duration of AH was 10.6+/-2.89 years. Risk was high in 58 (48.3%), very high - in 62 (51.7%) patients. Patients were randomized into 3 groups with different second step therapy. Patients of group 1 received amlodipine + ramipril, group 2 - amlodipine + lisinopril, group 3 - fixed amlodipine/lisinopril combination. If necessary bisoprolol and indapamide were added at 3-rd and 4-th step, respectively. Assessment of QL was carried out prior to therapy and at the end of 14-th week of intervention by means of Short Form-36 (SF-36).

RESULTS

Use of fixed amlodipine/lisinopril combination in patients with AH with high and very high risk of cardiovascular complications compared with free combinations of amlodipine and lisinopril or ramipril was associated with statistically significant improvement of a number of QL parameters as assessed by SF-36 questionnaire: physical functioning, bodily pain, general health, social functioning, and mental health.