Pub Date : 2022-10-12DOI: 10.38109/2225-1685-2022-3-74-82
L. Gelis, A. Miadzvedzeva, N. Shibeko, S. Kurganovich, I. Haidzel, T. T. Gevorkyan
The aim is to study the effect of microvascular reperfusion injury (RI) of myocardium on structural and functional changes of heart in patients with acute coronary syndrome with ST segment elevation (STE-ACS) and endovascular revascularization. Materials and Methods. The study included 146 patients with STE-ACS (mean age 54 ± 10 years, 89 % men). Depending on the presence of microvascular RI, according to CMR, performed on 5 ± 3 days after myocardial infarction, patients were divided into groups: the first group included 73 patients (50 %) with microvasculature lesions, the second group consisted of 73 patients (50 %) without microvasculature lesions. All patients underwent endovascular myocardial revascularization within 12 hours of symptoms onset. The assessment of structural and functional parameters of heart was performed by CMR with contrast enhancement on 5 ± 3, 30 and 90 days, by echocardiography on 1-2 days, 1, 6 and 12 months after myocardial infarction. Results. In our study microvascular RI was accompanied by a significant size of infarction, a high transmurality index (TI), a large size of edema and a low myocardial salvage index, was associated with LV dilatation, a decrease in global and local myocardial contractility during the 12 months post-infarction period (p < 0.05). The risk of developing pathological remodeling of left ventricle with microvascular RI size >1.2 % of LV mass is OR=6.25, 95 % CI 2.25–17.35 (p < 0.001), myonecrosis size on day 5 ± 3 of MI >11.7 % of LV mass (OR=10.1, 95 % CI 4.72–21.69, p < 0.001), TI > 64.3 (OR=5.63, 95 % CI 2.37–13.39, p < 0.001), edema size >24.7 % of LV mass (OR = 2.33, 95 % CI 1.09–4.97, p < 0.02). Conclusion. Microvascular RI of myocardium is associated with pathological remodeling of the left ventricle.
目的是研究心肌微血管再灌注损伤(RI)对急性冠状动脉综合征ST段抬高(STE-ACS)患者心脏结构和功能改变及血管内重建的影响。材料与方法。研究纳入了146例STE-ACS患者(平均年龄54±10岁，89%为男性)。根据有无微血管RI，在心肌梗死后5±3天进行CMR，将患者分为两组:第一组73例(50%)有微血管病变，第二组73例(50%)无微血管病变。所有患者均在症状出现后12小时内行血管内心肌血运重建术。心肌梗死后5±3天、30天和90天采用CMR增强，1 ~ 2天、1个月、6个月和12个月采用超声心动图评估心脏结构和功能参数。结果。在我们的研究中，微血管RI伴有明显的梗死面积，高跨壁指数(TI)，大水肿和低心肌挽救指数，与左室扩张相关，梗死后12个月内整体和局部心肌收缩力下降(p < 0.05)。微血管RI大小>左室体积的1.2%时发生病理性左室重构的风险OR=6.25, 95% CI 2.25 ~ 17.35 (p < 0.001)， MI第5±3天肌坏死大小>左室体积的11.7% (OR=10.1, 95% CI 4.72 ~ 21.69, p < 0.001)， TI > 64.3 (OR=5.63, 95% CI 2.37 ~ 13.39, p < 0.001)，水肿大小>左室体积的24.7% (OR= 2.33, 95% CI 1.09 ~ 4.97, p < 0.02)。结论。心肌微血管RI与左心室病理性重构有关。
{"title":"Cardiac structural and functional changes in ischemia-reperfusion injury of myocardium","authors":"L. Gelis, A. Miadzvedzeva, N. Shibeko, S. Kurganovich, I. Haidzel, T. T. Gevorkyan","doi":"10.38109/2225-1685-2022-3-74-82","DOIUrl":"https://doi.org/10.38109/2225-1685-2022-3-74-82","url":null,"abstract":" The aim is to study the effect of microvascular reperfusion injury (RI) of myocardium on structural and functional changes of heart in patients with acute coronary syndrome with ST segment elevation (STE-ACS) and endovascular revascularization. Materials and Methods. The study included 146 patients with STE-ACS (mean age 54 ± 10 years, 89 % men). Depending on the presence of microvascular RI, according to CMR, performed on 5 ± 3 days after myocardial infarction, patients were divided into groups: the first group included 73 patients (50 %) with microvasculature lesions, the second group consisted of 73 patients (50 %) without microvasculature lesions. All patients underwent endovascular myocardial revascularization within 12 hours of symptoms onset. The assessment of structural and functional parameters of heart was performed by CMR with contrast enhancement on 5 ± 3, 30 and 90 days, by echocardiography on 1-2 days, 1, 6 and 12 months after myocardial infarction. Results. In our study microvascular RI was accompanied by a significant size of infarction, a high transmurality index (TI), a large size of edema and a low myocardial salvage index, was associated with LV dilatation, a decrease in global and local myocardial contractility during the 12 months post-infarction period (p < 0.05). The risk of developing pathological remodeling of left ventricle with microvascular RI size >1.2 % of LV mass is OR=6.25, 95 % CI 2.25–17.35 (p < 0.001), myonecrosis size on day 5 ± 3 of MI >11.7 % of LV mass (OR=10.1, 95 % CI 4.72–21.69, p < 0.001), TI > 64.3 (OR=5.63, 95 % CI 2.37–13.39, p < 0.001), edema size >24.7 % of LV mass (OR = 2.33, 95 % CI 1.09–4.97, p < 0.02). Conclusion. Microvascular RI of myocardium is associated with pathological remodeling of the left ventricle.","PeriodicalId":11859,"journal":{"name":"Eurasian heart journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88474320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-12DOI: 10.38109/2225-1685-2022-3-58-64
A. A. Shmalts, S. Gorbachevsky, T. Martynyuk, S. Nakonechnikov
In December, 2021 at the IXth All-Russian Congress «Pulmonary Hypertension 2021» the first Eurasian guidelines for the diagnosis and treatment of pulmonary hypertension associated with congenital heart disease in adults were approved. The expert group discussed many contentious issues, including the need for diagnostic tests for vasoreactivity. Invasive registration of the reaction of the pulmonary vessels to vasodilators – a vasoreactivity testing – in idiopathic, hereditary and drug- and toxin-induced pulmonary arterial hypertension (PAH) is used to determine indications for calcium antagonist therapy, in PAH associated with uncorrected congenital heart disease (CHD) in children – to determine the indications for surgical treatment. The use of a vasoreactivity testing to assess the operability of adult patients with congenital heart disease is inappropriate. An overview of the performance technique, specific pulmonary vasodilators and criteria for evaluating the test for vasoreactivity in various subgroups of PH associated with CHD is given.
{"title":"Vasoreactivity testing in pulmonary hypertension associated with congenital heart disease","authors":"A. A. Shmalts, S. Gorbachevsky, T. Martynyuk, S. Nakonechnikov","doi":"10.38109/2225-1685-2022-3-58-64","DOIUrl":"https://doi.org/10.38109/2225-1685-2022-3-58-64","url":null,"abstract":" In December, 2021 at the IXth All-Russian Congress «Pulmonary Hypertension 2021» the first Eurasian guidelines for the diagnosis and treatment of pulmonary hypertension associated with congenital heart disease in adults were approved. The expert group discussed many contentious issues, including the need for diagnostic tests for vasoreactivity. Invasive registration of the reaction of the pulmonary vessels to vasodilators – a vasoreactivity testing – in idiopathic, hereditary and drug- and toxin-induced pulmonary arterial hypertension (PAH) is used to determine indications for calcium antagonist therapy, in PAH associated with uncorrected congenital heart disease (CHD) in children – to determine the indications for surgical treatment. The use of a vasoreactivity testing to assess the operability of adult patients with congenital heart disease is inappropriate. An overview of the performance technique, specific pulmonary vasodilators and criteria for evaluating the test for vasoreactivity in various subgroups of PH associated with CHD is given.","PeriodicalId":11859,"journal":{"name":"Eurasian heart journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88496906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-28DOI: 10.38109/2225-1685-2022-2-124-128
M. Beishenkulov, Z. Chazymova, K. Kaliev, A. Toktosunova, Y. M. Madyarova, M. K. Dadabaev
The development of heart failure in any patient causes a lot of concerns in view of the deterioration of quality of life of the latter. A clinical case of a patient with severe heart failure with a low left ventricular ejection fraction is described. The uniqueness of the demonstrated case consisted in the possibility of not only preserving the remaining resources of the heart muscle, but also in a significant restoration of systolic heart function due to adequate conservative therapy. The article presents a clinical case of successful restoration of contractile function of the heart in ischemic cardiomyopathy against the background of adequate conservative therapy. The diagnosis was not accompanied by difficulties. The patient underwent electrocardiography, echocardiography, coronary angiography, laboratory tests. According to the results patient was diagnosed with severe decompensated heart failure with reduced ejection fraction caused by coronary heart disease with NT-proBNP level of 286 ng/L. The results of coronary angiography did not reveal critical stenosis of the coronary arteries, and therefore the patient underwent drug treatment. Guideline-directed medical therapy treatment of chronic heart failure (angiotensin converting enzyme inhibitors, aldosterone antagonist, loop diuretics, beta-blockers, SGLT2 inhibitors) has allowed to achieve a good clinical result. Twelve months after beginning of the treatment left ventricular volume dimensions had changed significantly (LVEDV decreased from 220ml3 to 94ml3; LVESV from 162ml3 to 50 ml3), improvement of left ventricular ejection fraction from 17% to 42% (by Simson). The assessed 6-minute walk test showed functional class III according to the NYHA classification.
{"title":"A case of successful conservative therapy of patient with severe heart failure caused by ischemic heart disease: case report","authors":"M. Beishenkulov, Z. Chazymova, K. Kaliev, A. Toktosunova, Y. M. Madyarova, M. K. Dadabaev","doi":"10.38109/2225-1685-2022-2-124-128","DOIUrl":"https://doi.org/10.38109/2225-1685-2022-2-124-128","url":null,"abstract":"The development of heart failure in any patient causes a lot of concerns in view of the deterioration of quality of life of the latter. A clinical case of a patient with severe heart failure with a low left ventricular ejection fraction is described. The uniqueness of the demonstrated case consisted in the possibility of not only preserving the remaining resources of the heart muscle, but also in a significant restoration of systolic heart function due to adequate conservative therapy. The article presents a clinical case of successful restoration of contractile function of the heart in ischemic cardiomyopathy against the background of adequate conservative therapy. The diagnosis was not accompanied by difficulties. The patient underwent electrocardiography, echocardiography, coronary angiography, laboratory tests. According to the results patient was diagnosed with severe decompensated heart failure with reduced ejection fraction caused by coronary heart disease with NT-proBNP level of 286 ng/L. The results of coronary angiography did not reveal critical stenosis of the coronary arteries, and therefore the patient underwent drug treatment. Guideline-directed medical therapy treatment of chronic heart failure (angiotensin converting enzyme inhibitors, aldosterone antagonist, loop diuretics, beta-blockers, SGLT2 inhibitors) has allowed to achieve a good clinical result. Twelve months after beginning of the treatment left ventricular volume dimensions had changed significantly (LVEDV decreased from 220ml3 to 94ml3; LVESV from 162ml3 to 50 ml3), improvement of left ventricular ejection fraction from 17% to 42% (by Simson). The assessed 6-minute walk test showed functional class III according to the NYHA classification.","PeriodicalId":11859,"journal":{"name":"Eurasian heart journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77540738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-28DOI: 10.38109/2225-1685-2022-2-110-117
S. Komissarova, O. Krasko, N. M. Rinejskaya, T. Sevruk, A. Efimova
The aim is to evaluate the results of long-term follow-up of patients with various clinical forms of NCCM, associated clinical outcomes, as well as 3-year survival.Materials and methods. 211 patients with NCCM (median age 39 [18; 72] years) were examined, of which: 94 (44.5 %) were diagnosed with an isolated phenotype and 117 (55.5 %) with a combination with other cardiomyopathies, including 103 (48.8 %) patients with a combination with DCM; 14 (6.6 %) with HCM, who, in addition to traditional clinical research methods, underwent CMR imaging with late gadolinium enhancement. The endpoints of the study included SCD, SCD with successful resuscitation and implantation of ICD and the implementation of OHT.Results. During the follow–up period (median follow–up 36 [6-211] months), of 211 patients with NCCM, 24 (11.4 %) had adverse outcomes, including 1 (0.5 %) – SCD, 10 (4.7 %) – SCD with successful resuscitation and ICD implantation, 13 (6.2 %) had OHT. SCD occurred in 11 (5.2 %) patients with FC I-II NYHA, including 10 patients with successful ICD resuscitation and implantation after 23 (from 5 to 152) months after diagnosis. OHT was performed in 13 patients with FC III NYHA at 30 (from 8 to 113) months after diagnosis in a group of patients with a combination of NCCM and DCM. The average age at the time of SCD or OHT was 37±12 years.The 3-year survival rate in the group of patients with the isolated form was 98.9 (96.7-100) %, and significantly differed with the group of patients with a combination of NCCM with DCM 86.5 (79.6-94) %, and with the group of patients with a combination of NCCM with HCM 72.9 (50.7-100) %, p=0.0012. Whereas the 3-year survival rate in the group with a combination of NCCM with DCM and NCCM with HCM did not significantly differ from each other. Conclusion. The prognosis of patients with an isolated form of NCCM is generally favorable and their 3-year survival rate was 98.9 (96.7-100) %. The presence of a combination of NCCM with other cardiomyopathies predicts the risk of adverse clinical outcomes and the 3-year survival rate of a combination of NCCM with DCM was 86.5 (79.6-94) %, and when combined with NCCM with HCM 72.9 (50.7-100) %, which may be useful when choosing a management strategy for patients with NCCM.
{"title":"Non-compaction cardiomyopathy: clinical forms, outcomes and survival in a cohort of belarusian patients","authors":"S. Komissarova, O. Krasko, N. M. Rinejskaya, T. Sevruk, A. Efimova","doi":"10.38109/2225-1685-2022-2-110-117","DOIUrl":"https://doi.org/10.38109/2225-1685-2022-2-110-117","url":null,"abstract":"The aim is to evaluate the results of long-term follow-up of patients with various clinical forms of NCCM, associated clinical outcomes, as well as 3-year survival.Materials and methods. 211 patients with NCCM (median age 39 [18; 72] years) were examined, of which: 94 (44.5 %) were diagnosed with an isolated phenotype and 117 (55.5 %) with a combination with other cardiomyopathies, including 103 (48.8 %) patients with a combination with DCM; 14 (6.6 %) with HCM, who, in addition to traditional clinical research methods, underwent CMR imaging with late gadolinium enhancement. The endpoints of the study included SCD, SCD with successful resuscitation and implantation of ICD and the implementation of OHT.Results. During the follow–up period (median follow–up 36 [6-211] months), of 211 patients with NCCM, 24 (11.4 %) had adverse outcomes, including 1 (0.5 %) – SCD, 10 (4.7 %) – SCD with successful resuscitation and ICD implantation, 13 (6.2 %) had OHT. SCD occurred in 11 (5.2 %) patients with FC I-II NYHA, including 10 patients with successful ICD resuscitation and implantation after 23 (from 5 to 152) months after diagnosis. OHT was performed in 13 patients with FC III NYHA at 30 (from 8 to 113) months after diagnosis in a group of patients with a combination of NCCM and DCM. The average age at the time of SCD or OHT was 37±12 years.The 3-year survival rate in the group of patients with the isolated form was 98.9 (96.7-100) %, and significantly differed with the group of patients with a combination of NCCM with DCM 86.5 (79.6-94) %, and with the group of patients with a combination of NCCM with HCM 72.9 (50.7-100) %, p=0.0012. Whereas the 3-year survival rate in the group with a combination of NCCM with DCM and NCCM with HCM did not significantly differ from each other. Conclusion. The prognosis of patients with an isolated form of NCCM is generally favorable and their 3-year survival rate was 98.9 (96.7-100) %. The presence of a combination of NCCM with other cardiomyopathies predicts the risk of adverse clinical outcomes and the 3-year survival rate of a combination of NCCM with DCM was 86.5 (79.6-94) %, and when combined with NCCM with HCM 72.9 (50.7-100) %, which may be useful when choosing a management strategy for patients with NCCM.","PeriodicalId":11859,"journal":{"name":"Eurasian heart journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89289738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-28DOI: 10.38109/2225-1685-2022-2-118-122
S. Tazina, I. Belyaev, T. Fedorova, N. Semenenko, S. A. Tazin
The article, using the example of two clinical cases, discusses the severity of the course of COVID-19 depending on the presence of cardiovascular diseases and the effectiveness of their treatment. Randomized clinical trials and meta-analyses of the coronavirus infection indicate a greater likelihood of developing severe forms of COVID-19 in patients with high and very high cardiovascular risk, in older age groups, with comorbid pathology, especially with arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF), diabetes mellitus (DM). Considering effectiveness, safety and influence on the prognosis, an adequately selected therapy for concomitant diseases can reduce the number of adverse outcomes of the coronavirus infection. A key role in the development and progression of cardiovascular pathology is played by the renin-angiotensin-aldosterone system (RAAS), so RAAS blockers remain the first-line medicine in the treatment of cardiac patients. The experts of the European Society of Cardiology, the American College of Cardiology and the Russian Society of Cardiology confirm the importance of continuing therapy with this class of medicine in patients having already received RAAS blockers according to such indications as AH, CHD and CHF during COVID-19 and emphasize the danger of their cancellation in high-risk patients. Most patients need to take several groups of medicine which affect complementary pathogenetic mechanisms. It is shown that the reason for the lack of achieving blood pressure control in clinical practice is monotherapy or non-optimally combined therapy of free acceptable but not rational combinations of antihypertensive medicine. Optimization of the therapeutic regimen using fixed combinations of indapamide/perindopril and amlodipine/perindopril has made it possible to achieve an effective reduction in blood pressure according to routine measurement and ambulatory blood pressure monitoring, to reduce blood pressure variability, to increase patients’ adherence to the treatment. The use of such medicine is becoming the most relevant during the COVID-19 pandemic.
{"title":"Two case reports: clinical experience with fixed combinations of indapamide/perindopril and amlodipine/perindopril in patients with arterial hypertension during the COVID-19 pandemic","authors":"S. Tazina, I. Belyaev, T. Fedorova, N. Semenenko, S. A. Tazin","doi":"10.38109/2225-1685-2022-2-118-122","DOIUrl":"https://doi.org/10.38109/2225-1685-2022-2-118-122","url":null,"abstract":"The article, using the example of two clinical cases, discusses the severity of the course of COVID-19 depending on the presence of cardiovascular diseases and the effectiveness of their treatment. Randomized clinical trials and meta-analyses of the coronavirus infection indicate a greater likelihood of developing severe forms of COVID-19 in patients with high and very high cardiovascular risk, in older age groups, with comorbid pathology, especially with arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF), diabetes mellitus (DM). Considering effectiveness, safety and influence on the prognosis, an adequately selected therapy for concomitant diseases can reduce the number of adverse outcomes of the coronavirus infection. A key role in the development and progression of cardiovascular pathology is played by the renin-angiotensin-aldosterone system (RAAS), so RAAS blockers remain the first-line medicine in the treatment of cardiac patients. The experts of the European Society of Cardiology, the American College of Cardiology and the Russian Society of Cardiology confirm the importance of continuing therapy with this class of medicine in patients having already received RAAS blockers according to such indications as AH, CHD and CHF during COVID-19 and emphasize the danger of their cancellation in high-risk patients. Most patients need to take several groups of medicine which affect complementary pathogenetic mechanisms. It is shown that the reason for the lack of achieving blood pressure control in clinical practice is monotherapy or non-optimally combined therapy of free acceptable but not rational combinations of antihypertensive medicine. Optimization of the therapeutic regimen using fixed combinations of indapamide/perindopril and amlodipine/perindopril has made it possible to achieve an effective reduction in blood pressure according to routine measurement and ambulatory blood pressure monitoring, to reduce blood pressure variability, to increase patients’ adherence to the treatment. The use of such medicine is becoming the most relevant during the COVID-19 pandemic.","PeriodicalId":11859,"journal":{"name":"Eurasian heart journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88249032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-28DOI: 10.38109/2225-1685-2022-2-96-102
A. A. Shmalts, T. Martynyuk, S. Nakonechnikov
In December, 2021 at the IXth All-Russian Congress «Pulmonary Hypertension – 2021» the first Eurasian guidelines for the diagnosis and treatment of pulmonary hypertension associated with congenital heart disease (CHD) in adults were approved. In this review, the expert group presents the basic principles of calculating hemodynamics according to Fick for the systemic and pulmonary circulation. The method is indispensable for congenital heart defects. Theoretical and practical aspects of calculating hemodynamics with arteriovenous, venoarterial and bidirectional shunting are considered. The calculation of the cardiac index of each of the circles of blood circulation is performed on the basis of oxygen consumption, the oxygen capacity of the blood and the oxygen arteriovenous difference of each of the circles of blood circulation. Formulas are given for calculating the cardiac index of the systemic and pulmonary circulation, the cardiac index of effective blood flow, arteriovenous and venoarterial shunt, pulmonary and peripheral vascular resistance, as well as the classical table and the LaFarge and Miettinen formula for the calculated oxygen consumption depending on gender, age and heart rate. The review is illustrated with three clinical examples. Calculation of hemodynamics according to Fick should be started after getting acquainted with the anatomy and clinic of congenital heart disease: diagnosis, typical hemodynamic disorders, number and possible direction of shunts, saturation by pulse oximeter on the arms and legs; a purely mechanistic approach that does not take into account the clinical picture can reduce the information content and reliability of the method. The Fick method is somewhat limited by the impossibility of catheterization of the left atrium with an intact interatrial septum. Inaccuracies that are possible when assessing absolute indicators by the indirect Fick method are leveled when calculating their relative values, and the values are identical in reliability to the direct method. The Fick method, due to the obviously high error, is not advisable to use if there is another source of pulmonary blood flow besides the pulmonary artery system, as well as with a low arteriovenous difference in circulatory circles.
{"title":"Calculation of hemodynamics by the Fick method in pulmonary hypertension associated with congenital heart defects","authors":"A. A. Shmalts, T. Martynyuk, S. Nakonechnikov","doi":"10.38109/2225-1685-2022-2-96-102","DOIUrl":"https://doi.org/10.38109/2225-1685-2022-2-96-102","url":null,"abstract":"In December, 2021 at the IXth All-Russian Congress «Pulmonary Hypertension – 2021» the first Eurasian guidelines for the diagnosis and treatment of pulmonary hypertension associated with congenital heart disease (CHD) in adults were approved. In this review, the expert group presents the basic principles of calculating hemodynamics according to Fick for the systemic and pulmonary circulation. The method is indispensable for congenital heart defects. Theoretical and practical aspects of calculating hemodynamics with arteriovenous, venoarterial and bidirectional shunting are considered. The calculation of the cardiac index of each of the circles of blood circulation is performed on the basis of oxygen consumption, the oxygen capacity of the blood and the oxygen arteriovenous difference of each of the circles of blood circulation. Formulas are given for calculating the cardiac index of the systemic and pulmonary circulation, the cardiac index of effective blood flow, arteriovenous and venoarterial shunt, pulmonary and peripheral vascular resistance, as well as the classical table and the LaFarge and Miettinen formula for the calculated oxygen consumption depending on gender, age and heart rate. The review is illustrated with three clinical examples. Calculation of hemodynamics according to Fick should be started after getting acquainted with the anatomy and clinic of congenital heart disease: diagnosis, typical hemodynamic disorders, number and possible direction of shunts, saturation by pulse oximeter on the arms and legs; a purely mechanistic approach that does not take into account the clinical picture can reduce the information content and reliability of the method. The Fick method is somewhat limited by the impossibility of catheterization of the left atrium with an intact interatrial septum. Inaccuracies that are possible when assessing absolute indicators by the indirect Fick method are leveled when calculating their relative values, and the values are identical in reliability to the direct method. The Fick method, due to the obviously high error, is not advisable to use if there is another source of pulmonary blood flow besides the pulmonary artery system, as well as with a low arteriovenous difference in circulatory circles.","PeriodicalId":11859,"journal":{"name":"Eurasian heart journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77903114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-28DOI: 10.38109/2225-1685-2022-2-104-109
O. V. Nilova, S. Kolbasnikov
The aim of the study:to analyze ABPM readings in patients with stage II HTN receiving antihypertensive therapy in order to plan a personalized algorithm for managing HTN patients at the stage of the outpatient care. Materials and methods. 60 patients with stage II HTN were examined. ABPM readings were assessed on the background of planned antihypertensive therapy (ARBs and diuretics) and after the adjustment of the therapy (perindopril and amlodipine).Results. The use of long period monitoring provides comprehensive information about the patterns of blood pressure changesthroughout the day. Patients with stage II HTN receiving planned antihypertensive therapy with ARBs and diuretics did not have targeted BP during the day and had a systolic HTN of stage I, while there was a statistically significant increase in BP variability during the day and in the readings indicating a hypertensive load of target organs in comparison with a group of patients receiving a combination of perindopril and amlodipine for 3 months. In addition, there was a statistically significant (ANOVA, p<0.05) difference in the rate of morning BP rise, which can serve as a precursor for the development of cardiovascular events in the morning compared to the group of patients with theadjusted therapy. Among hypertensive patients receiving ARBs and diuretics a disturbed circadian rhythm predominated in the structure of the diurnal BP profilecompared with the patients who received combined therapy with perindopril and amlodipine. In addition, the proportion of night-peakers among patients taking ARBs and diuretics was 2 times higher than among patients whose therapywas adjusted 3 months ago.Conclusion. Thus, in the group of patients whose antihypertensive therapy was timely adjusted, there was an improvement in hemodynamics: due to the achievement of targeteddiurnal blood pressurereadings, a significant decrease in BP variability during the day and the rate of the morning rise in blood pressure, as well as the proportion of patients with a normal diurnal blood pressure profileincreased.
{"title":"Readings of 24-hour ambulatory blood pressure monitoring (ABPM) in patients with stage II arterial hypertension (HTN) receiving planned antihypertensive therapy","authors":"O. V. Nilova, S. Kolbasnikov","doi":"10.38109/2225-1685-2022-2-104-109","DOIUrl":"https://doi.org/10.38109/2225-1685-2022-2-104-109","url":null,"abstract":"The aim of the study:to analyze ABPM readings in patients with stage II HTN receiving antihypertensive therapy in order to plan a personalized algorithm for managing HTN patients at the stage of the outpatient care. Materials and methods. 60 patients with stage II HTN were examined. ABPM readings were assessed on the background of planned antihypertensive therapy (ARBs and diuretics) and after the adjustment of the therapy (perindopril and amlodipine).Results. The use of long period monitoring provides comprehensive information about the patterns of blood pressure changesthroughout the day. Patients with stage II HTN receiving planned antihypertensive therapy with ARBs and diuretics did not have targeted BP during the day and had a systolic HTN of stage I, while there was a statistically significant increase in BP variability during the day and in the readings indicating a hypertensive load of target organs in comparison with a group of patients receiving a combination of perindopril and amlodipine for 3 months. In addition, there was a statistically significant (ANOVA, p<0.05) difference in the rate of morning BP rise, which can serve as a precursor for the development of cardiovascular events in the morning compared to the group of patients with theadjusted therapy. Among hypertensive patients receiving ARBs and diuretics a disturbed circadian rhythm predominated in the structure of the diurnal BP profilecompared with the patients who received combined therapy with perindopril and amlodipine. In addition, the proportion of night-peakers among patients taking ARBs and diuretics was 2 times higher than among patients whose therapywas adjusted 3 months ago.Conclusion. Thus, in the group of patients whose antihypertensive therapy was timely adjusted, there was an improvement in hemodynamics: due to the achievement of targeteddiurnal blood pressurereadings, a significant decrease in BP variability during the day and the rate of the morning rise in blood pressure, as well as the proportion of patients with a normal diurnal blood pressure profileincreased.","PeriodicalId":11859,"journal":{"name":"Eurasian heart journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77493602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-28DOI: 10.38109/2225-1685-2022-2-80-85
V. Ionin
This publication discusses the relevance of the problem of blood pressure control in patients with resistance to drug therapy in real clinical practice. Data on the prevalence of true resistant arterial hypertension and clinical features of patients are presented. At the same time, taking into account the wider prevalence of patients with pseudo resistant arterial hypertension, special attention is paid to diagnostic algorithms in the publication, and the criteria for excluding pseudo resistant arterial hypertension are analyzed in detail. Presented are modern ideas about the most common secondary causes of arterial hypertension, such as obstructive sleep apnea syndrome, the possibility of correcting this condition and the choice of drug therapy. For this publication, modern recommendations were used in the strategy for choosing the optimal antihypertensive therapy, taking into account the pharmacokinetic properties and the possibility of personalized choice in various clinical situations. We analyzed data on the benefits of antihypertensive therapy using fixed combinations to increase adherence to therapy with a blood pressure control strategy and reduce the risk of cardiovascular risks. Various search engines were used to search for data and material: PubMed, Google Academy, Elsevier, information resources of the Russian Society of Cardiology and the European Society of Cardiology.
本出版物讨论了实际临床实践中耐药患者血压控制问题的相关性。数据的流行真正的顽固性动脉高血压和患者的临床特点提出。同时，考虑到伪顽固性动脉高血压患者的患病率较广，文中特别关注了诊断算法，并对排除伪顽固性动脉高血压的标准进行了详细分析。介绍了动脉高血压最常见的继发性原因，如阻塞性睡眠呼吸暂停综合征，纠正这种情况的可能性和药物治疗的选择。在本出版物中，考虑到药代动力学特性和在不同临床情况下个性化选择的可能性，在选择最佳降压治疗策略时使用了现代建议。我们分析了使用固定联合降压治疗的益处数据，以增加对血压控制策略治疗的依从性并降低心血管风险。使用各种搜索引擎搜索数据和材料:PubMed, Google Academy, Elsevier，俄罗斯心脏病学会和欧洲心脏病学会的信息资源。
{"title":"Resistant arterial hypertension: is it really so or have we missed something?","authors":"V. Ionin","doi":"10.38109/2225-1685-2022-2-80-85","DOIUrl":"https://doi.org/10.38109/2225-1685-2022-2-80-85","url":null,"abstract":"This publication discusses the relevance of the problem of blood pressure control in patients with resistance to drug therapy in real clinical practice. Data on the prevalence of true resistant arterial hypertension and clinical features of patients are presented. At the same time, taking into account the wider prevalence of patients with pseudo resistant arterial hypertension, special attention is paid to diagnostic algorithms in the publication, and the criteria for excluding pseudo resistant arterial hypertension are analyzed in detail. Presented are modern ideas about the most common secondary causes of arterial hypertension, such as obstructive sleep apnea syndrome, the possibility of correcting this condition and the choice of drug therapy. For this publication, modern recommendations were used in the strategy for choosing the optimal antihypertensive therapy, taking into account the pharmacokinetic properties and the possibility of personalized choice in various clinical situations. We analyzed data on the benefits of antihypertensive therapy using fixed combinations to increase adherence to therapy with a blood pressure control strategy and reduce the risk of cardiovascular risks. Various search engines were used to search for data and material: PubMed, Google Academy, Elsevier, information resources of the Russian Society of Cardiology and the European Society of Cardiology.","PeriodicalId":11859,"journal":{"name":"Eurasian heart journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82047641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-28DOI: 10.38109/2225-1685-2022-2-72-78
O. Mironova
The prevalence of hyperuricemia is due to the epidemic of obesity, changes in eating behavior in the population with the rise of purines, alcohol and fructose consumption, as well as the increased use of diuretics. It’s important to mention that over the past 20 years there has been an increase in the prevalence of such concomitant diseases and conditions as arterial hypertension (+15%), diabetes mellitus (+19%), decreased kidney function (+17%), hyperlipidemia (+40%) and obesity (+19%). Hyperuricemia (and/or gout) can be both a cause and a consequence of various comorbid conditions. That is why their treatment is closely connected with the treatments of hyperuricemia, especially of asymptomatic one.It’s important to determine not only the upper limit of the uric acid in patients, when the therapy is being initiated, but to assess the target levels of uric acid, that must be achieved in patients receiving optimal treatment.In this review article the main principles of both non-pharmacological and pharmacological treatment in patients with cardiovascular diseases are described. The need for medical treatment, target serum urate levels in patients with cardiovascular risk factors are discussed, as well as further perspectives in the field of research in patients with hyperuricemia and cardiovascular diseases.Allopurinol is currently the key drug prescribed to patients with hyperuricemia and cardiovascular risk factors. The most important advantage is its safety profile. Patients receiving renal replacement therapy can also safely receive the drug.The need to reduce the level of uric acid in patients with cardiovascular disease is currently beyond doubt. In the group of patients with additional risk factors, such as diabetes mellitus, metabolic syndrome and CKD, lifestyle modification in combination with urate-lowering therapy improves both the quality of life and prognosis. Currently, allopurinol is the drug of choice for the treatment of AH in combination with AH, taking into account both the efficacy and safety of its administration to this group of patients. However, it is obvious that further studies with clearer inclusion criteria are needed to analyze the effect of therapy on cardiovascular events, as well as combined endpoints.
{"title":"Hyperuricemia: contemporary treatment in patients with cardiovascular disease","authors":"O. Mironova","doi":"10.38109/2225-1685-2022-2-72-78","DOIUrl":"https://doi.org/10.38109/2225-1685-2022-2-72-78","url":null,"abstract":"The prevalence of hyperuricemia is due to the epidemic of obesity, changes in eating behavior in the population with the rise of purines, alcohol and fructose consumption, as well as the increased use of diuretics. It’s important to mention that over the past 20 years there has been an increase in the prevalence of such concomitant diseases and conditions as arterial hypertension (+15%), diabetes mellitus (+19%), decreased kidney function (+17%), hyperlipidemia (+40%) and obesity (+19%). Hyperuricemia (and/or gout) can be both a cause and a consequence of various comorbid conditions. That is why their treatment is closely connected with the treatments of hyperuricemia, especially of asymptomatic one.It’s important to determine not only the upper limit of the uric acid in patients, when the therapy is being initiated, but to assess the target levels of uric acid, that must be achieved in patients receiving optimal treatment.In this review article the main principles of both non-pharmacological and pharmacological treatment in patients with cardiovascular diseases are described. The need for medical treatment, target serum urate levels in patients with cardiovascular risk factors are discussed, as well as further perspectives in the field of research in patients with hyperuricemia and cardiovascular diseases.Allopurinol is currently the key drug prescribed to patients with hyperuricemia and cardiovascular risk factors. The most important advantage is its safety profile. Patients receiving renal replacement therapy can also safely receive the drug.The need to reduce the level of uric acid in patients with cardiovascular disease is currently beyond doubt. In the group of patients with additional risk factors, such as diabetes mellitus, metabolic syndrome and CKD, lifestyle modification in combination with urate-lowering therapy improves both the quality of life and prognosis. Currently, allopurinol is the drug of choice for the treatment of AH in combination with AH, taking into account both the efficacy and safety of its administration to this group of patients. However, it is obvious that further studies with clearer inclusion criteria are needed to analyze the effect of therapy on cardiovascular events, as well as combined endpoints.","PeriodicalId":11859,"journal":{"name":"Eurasian heart journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86146104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-28DOI: 10.38109/2225-1685-2022-2-6-70
I. Chazova, S. V. Gorbachevskij, T. Martynyuk, A. A. Shmal’c, Z. Valieva, I. Baryshnikova, L. Glushko, V. Gramovich, V. Azizov, T. Veselova, N. Danilov, P. A. Zelveyan, S. Ivanov, I. Lazareva, Y. Matchin, M. Mukarov, S. Nakonechnikov, A. Sarybaev, O. Stukalova, S. Shalaev
.
．
{"title":"Eurasian guidelines for the diagnosis and treatment of pulmonary hypertension associated with congenital heart defects in adults (2021)","authors":"I. Chazova, S. V. Gorbachevskij, T. Martynyuk, A. A. Shmal’c, Z. Valieva, I. Baryshnikova, L. Glushko, V. Gramovich, V. Azizov, T. Veselova, N. Danilov, P. A. Zelveyan, S. Ivanov, I. Lazareva, Y. Matchin, M. Mukarov, S. Nakonechnikov, A. Sarybaev, O. Stukalova, S. Shalaev","doi":"10.38109/2225-1685-2022-2-6-70","DOIUrl":"https://doi.org/10.38109/2225-1685-2022-2-6-70","url":null,"abstract":"<jats:p>.</jats:p>","PeriodicalId":11859,"journal":{"name":"Eurasian heart journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79929801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：