Pub Date : 2023-04-28DOI: 10.20996/1819-6446-2023-03-09
D. Tsaregorodtsev, M. A. Khalikova, S. S. Vasyukov, M. Beraya, A. V. Sedov
Aim. To study the efficacy of class IC arrhythmic drugs (AAD) and catheter ablation (CA) for paroxysmal form of atrial fibrillation (AF) in patients with without structural heart disease.Material and methods. The study included 122 patients (44 men, 78 women, mean age 63 [55;68] years) with symptomatic AF paroxysms. Patients was divided into the lappaconitine hydrobromide group (LH group; n=26), the propafenone group (P group; n=25) – 25 patients, the diethylaminopropionylethoxycarbonylaminophenothiazine hydrochloride (DH group; n=23), the CA groups: radiofrequency ablation (RFA group; n=24) and cryoballoon ablation (CRYO group; n=24) groups each included 24 patients. The primary endpoint was the AF recurrence within 6 and 12 months from the onset of antiarrhythmic drug therapyand in RFA and CRYO groups – within 6 and 12 months after the end of the blinding period. Additionally, in AAD groups a composite endpoint was assessed: the frequency of recurrence of AF within 6 months and the frequency of side effects requiring drug withdrawal.Results. Within the 6 months AF recurrence was observed in 13 (50%) patients of the LH group, 11 (44%) patients of the P group, and 13 (56.5%) patients of the DH group (p=0.687). Side effects requiring drug withdrawal were observed in the LH group in 2 patients (7.7%), in the P group in 3 patients (12%) and in the DH group in 3 patients (13%) (p=0.801). The difference in frequency of reaching the composite endpoint was not significant (p = 0.581) and the incidence was 57.7%, 56%, 69.5%, respectively in groups LH, P and DH. The efficacy of CA was higher than class IC AADs: 77% vs 39% (that including the withdrawals of AADs due to side effects) (p˂0.001). At the same time, there was no significant difference in the effectiveness of RFA and CRYO: AF recurrences within 6 months after the end of the blinding period were registered in the RFA group in 29% of cases, in the CRYO group – in 16.7% of cases (p=0.247). The overall effectiveness of CA after 12 months was 69%, which was significantly higher than the effectiveness of AADs that was 38% (p˂0.001).Conclusion. Starting the AAD therapy with IC class in patients with paroxysmal AF in the absence of structural pathology, despite acceptable safety, one should take into account that, regardless of the initially prescribed drug, less than half of patients can achieve prevention of AF recurrence within 1 year. CA for AF can be considered as a first line therapy or can be recommended if one of IC class AADs is ineffective.
{"title":"Effectiveness of Class IC Antiarrhythmics in Patients with Paroxysmal Form of Atrial Fibrillation in Absence of Structural Heart Disease","authors":"D. Tsaregorodtsev, M. A. Khalikova, S. S. Vasyukov, M. Beraya, A. V. Sedov","doi":"10.20996/1819-6446-2023-03-09","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-03-09","url":null,"abstract":"Aim. To study the efficacy of class IC arrhythmic drugs (AAD) and catheter ablation (CA) for paroxysmal form of atrial fibrillation (AF) in patients with without structural heart disease.Material and methods. The study included 122 patients (44 men, 78 women, mean age 63 [55;68] years) with symptomatic AF paroxysms. Patients was divided into the lappaconitine hydrobromide group (LH group; n=26), the propafenone group (P group; n=25) – 25 patients, the diethylaminopropionylethoxycarbonylaminophenothiazine hydrochloride (DH group; n=23), the CA groups: radiofrequency ablation (RFA group; n=24) and cryoballoon ablation (CRYO group; n=24) groups each included 24 patients. The primary endpoint was the AF recurrence within 6 and 12 months from the onset of antiarrhythmic drug therapyand in RFA and CRYO groups – within 6 and 12 months after the end of the blinding period. Additionally, in AAD groups a composite endpoint was assessed: the frequency of recurrence of AF within 6 months and the frequency of side effects requiring drug withdrawal.Results. Within the 6 months AF recurrence was observed in 13 (50%) patients of the LH group, 11 (44%) patients of the P group, and 13 (56.5%) patients of the DH group (p=0.687). Side effects requiring drug withdrawal were observed in the LH group in 2 patients (7.7%), in the P group in 3 patients (12%) and in the DH group in 3 patients (13%) (p=0.801). The difference in frequency of reaching the composite endpoint was not significant (p = 0.581) and the incidence was 57.7%, 56%, 69.5%, respectively in groups LH, P and DH. The efficacy of CA was higher than class IC AADs: 77% vs 39% (that including the withdrawals of AADs due to side effects) (p˂0.001). At the same time, there was no significant difference in the effectiveness of RFA and CRYO: AF recurrences within 6 months after the end of the blinding period were registered in the RFA group in 29% of cases, in the CRYO group – in 16.7% of cases (p=0.247). The overall effectiveness of CA after 12 months was 69%, which was significantly higher than the effectiveness of AADs that was 38% (p˂0.001).Conclusion. Starting the AAD therapy with IC class in patients with paroxysmal AF in the absence of structural pathology, despite acceptable safety, one should take into account that, regardless of the initially prescribed drug, less than half of patients can achieve prevention of AF recurrence within 1 year. CA for AF can be considered as a first line therapy or can be recommended if one of IC class AADs is ineffective. ","PeriodicalId":20812,"journal":{"name":"Rational Pharmacotherapy in Cardiology","volume":"11 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90925113","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 : 2023-04-28DOI: 10.20996/1819-6446-2023-03-05
A. Rubanenko
Atrial fibrillation (AF) is associated with dramatic increasing of stroke risk. Development of this serious complication is accompanied by high mortality and disability. Nowadays we know many different scores that predict stroke risk,butthe most popular is CHA2DS2-VASc risk score. At the same time, this score does not have high predictive accuracyand that is why a lot of modifications with inclusion/deletion of different indicators were introduced.The aim of this review was to estimate the different modifications of CHADS2 и CHA2DS2-VASc scores in predicting stroke risk in patients with AF. In this review R2CHADS2, CHA2DS2-VASc-R, CHA2DS2-VA, mCHA2DS2-VASc and CHA2DS2-VAK scores are evaluated with the use of C-statistics and net reclassification index compared to the original CHA2DS2-VASc score. The search of studies was performed according to PubMed database (https://pubmed.ncbi.nlm.nih.gov/) from 2011 until 2021 years. In this review were included studies written in English with free full text. Literature reviews, books, abstracts books, studies performed on less than 900 patients and studies without C-statistics data available were excluded from this review. Despite of the numerous attempts to improve the quality of CHA2DS2-VASc score, existing modifications nowadays could not become more popular in clinical practice. At the same time, developing of the new score systems, that will have better predictive values in stroke prognosis than CHA2DS2-VASc score, is still an actual problem in modern cardiology.
{"title":"Evolution of CHA2DS2-VASc Score for Predicting Risk of Stroke Development in Patients with Atrial Fibrillation","authors":"A. Rubanenko","doi":"10.20996/1819-6446-2023-03-05","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-03-05","url":null,"abstract":"Atrial fibrillation (AF) is associated with dramatic increasing of stroke risk. Development of this serious complication is accompanied by high mortality and disability. Nowadays we know many different scores that predict stroke risk,butthe most popular is CHA2DS2-VASc risk score. At the same time, this score does not have high predictive accuracyand that is why a lot of modifications with inclusion/deletion of different indicators were introduced.The aim of this review was to estimate the different modifications of CHADS2 и CHA2DS2-VASc scores in predicting stroke risk in patients with AF. In this review R2CHADS2, CHA2DS2-VASc-R, CHA2DS2-VA, mCHA2DS2-VASc and CHA2DS2-VAK scores are evaluated with the use of C-statistics and net reclassification index compared to the original CHA2DS2-VASc score. The search of studies was performed according to PubMed database (https://pubmed.ncbi.nlm.nih.gov/) from 2011 until 2021 years. In this review were included studies written in English with free full text. Literature reviews, books, abstracts books, studies performed on less than 900 patients and studies without C-statistics data available were excluded from this review. Despite of the numerous attempts to improve the quality of CHA2DS2-VASc score, existing modifications nowadays could not become more popular in clinical practice. At the same time, developing of the new score systems, that will have better predictive values in stroke prognosis than CHA2DS2-VASc score, is still an actual problem in modern cardiology. ","PeriodicalId":20812,"journal":{"name":"Rational Pharmacotherapy in Cardiology","volume":"46 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89948293","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 : 2023-03-07DOI: 10.20996/1819-6446-2023-02-03
E. Kotova, A. Moiseeva, Z. Kobalava, E. Domonova, A. S. Pisaruk, O. Y. Silveistrova, P. V. Kakhktsyan, V. Vladimirov
Aim. Assessment of impact of the duration of preoperative antimicrobial therapy (AMT) on the sensitivity of microbiological examination and polymerase chain reaction (PCR) of blood/tissues of resected valves in operated patients with infective endocarditis (IE).Materials and methods. 52 operated patients with active IE were included prospectively (Duke criteria, 2015). All patients underwent microbiological examination of blood before admission to the cardiac surgery hospital, as well as parallel simultaneous microbiological examination and PCR of blood/tissues of excised valves, followed by Sanger sequencing. The duration of preoperative treatment was calculated from the first day of AMT according to IE diagnosis to the day of surgery.Results. The causative agent of IE was established in 84.6% (n=44) patients by means of complex etiological diagnosis. A significant decrease in the sensitivity of microbiological examination of venous blood was revealed when performed in the period before and after hospitalization to a surgical hospital (up 44.2% to 17.3%, p<0.05). When comparing microbiological examination of blood/tissues of resected valves and PCR of blood/tissues of resected valves, molecular biological methods demonstrated the greatest sensitivity, with a great advantage when examining the tissues of resected valves (17.3% and 19.2% vs. 38.5% and 75.0%, respectively; p<0.001). The microbiological examination of venous blood performed at an early date before admission to the cardiac surgery hospital was comparable in sensitivity to the PCR blood test performed at a later date after prolonged AMT, and significantly less sensitive in relation to the PCR of resected valve tissues [44.2% and 38.5% (p>0.05) vs. 75.0% (p<0.05)]. In course of AMT 1-28 days, there were comparable results of microbiological examination with PCR blood examination and significantly better results of PCR of resected valve tissues [31.0% and 34.5% and 41.4% (p>0.05) vs 72.4% (p<0.001), respectively], and with AMT ≥ 29 days, microbiological examination of any biological material was negative in all patients, and PCR of blood/tissues of resected valves retained high sensitivity (0% and 0% vs. 34.8% and 78.3%, respectively; p<0.01).Conclusion. Long-term preoperative AMT significantly reduced the sensitivity of microbiological examination of resected valve blood/tissue in operated patients with IE, whereas PCR of resected valve blood/tissue was highly sensitive even with preoperative AMT for more than 29 days.
的目标。评估术前抗菌治疗(AMT)时间对感染性心内膜炎(IE)手术患者切除瓣膜血液/组织微生物检查敏感性及聚合酶链反应(PCR)的影响材料和方法。前瞻性纳入52例手术后活动性IE患者(Duke标准，2015)。所有患者入院前均行血液微生物学检查，并对切除瓣膜的血液/组织进行平行同步微生物学检查和PCR，然后进行Sanger测序。术前治疗时间从根据IE诊断进行AMT的第一天到手术当天计算。通过复杂的病因学诊断，84.6% (n=44)的患者确定了IE的病原体。显著降低微生物检查的敏感性静脉血时显示在执行之前和之后去医院外科住院(增长44.2%至17.3%,p0.05)和75.0% (p0.05)和72.4% (p < 0.001),分别),和AMT≥29天,微生物检查任何生物材料-在所有的病人,和PCR的血液/组织切除阀门保留高灵敏度(分别为0%和0%和34.8%和78.3%;.Conclusion p < 0.01)。术前长期AMT显著降低了IE手术患者切除瓣膜血/组织微生物检查的敏感性，而即使术前AMT超过29天，切除瓣膜血/组织PCR检测仍高度敏感。
{"title":"Effect of Antibiotic Therapy on the Sensitivity of Etiological Diagnostic Methods in Patients with Infective Endocarditis after Surgery","authors":"E. Kotova, A. Moiseeva, Z. Kobalava, E. Domonova, A. S. Pisaruk, O. Y. Silveistrova, P. V. Kakhktsyan, V. Vladimirov","doi":"10.20996/1819-6446-2023-02-03","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-02-03","url":null,"abstract":"Aim. Assessment of impact of the duration of preoperative antimicrobial therapy (AMT) on the sensitivity of microbiological examination and polymerase chain reaction (PCR) of blood/tissues of resected valves in operated patients with infective endocarditis (IE).Materials and methods. 52 operated patients with active IE were included prospectively (Duke criteria, 2015). All patients underwent microbiological examination of blood before admission to the cardiac surgery hospital, as well as parallel simultaneous microbiological examination and PCR of blood/tissues of excised valves, followed by Sanger sequencing. The duration of preoperative treatment was calculated from the first day of AMT according to IE diagnosis to the day of surgery.Results. The causative agent of IE was established in 84.6% (n=44) patients by means of complex etiological diagnosis. A significant decrease in the sensitivity of microbiological examination of venous blood was revealed when performed in the period before and after hospitalization to a surgical hospital (up 44.2% to 17.3%, p<0.05). When comparing microbiological examination of blood/tissues of resected valves and PCR of blood/tissues of resected valves, molecular biological methods demonstrated the greatest sensitivity, with a great advantage when examining the tissues of resected valves (17.3% and 19.2% vs. 38.5% and 75.0%, respectively; p<0.001). The microbiological examination of venous blood performed at an early date before admission to the cardiac surgery hospital was comparable in sensitivity to the PCR blood test performed at a later date after prolonged AMT, and significantly less sensitive in relation to the PCR of resected valve tissues [44.2% and 38.5% (p>0.05) vs. 75.0% (p<0.05)]. In course of AMT 1-28 days, there were comparable results of microbiological examination with PCR blood examination and significantly better results of PCR of resected valve tissues [31.0% and 34.5% and 41.4% (p>0.05) vs 72.4% (p<0.001), respectively], and with AMT ≥ 29 days, microbiological examination of any biological material was negative in all patients, and PCR of blood/tissues of resected valves retained high sensitivity (0% and 0% vs. 34.8% and 78.3%, respectively; p<0.01).Conclusion. Long-term preoperative AMT significantly reduced the sensitivity of microbiological examination of resected valve blood/tissue in operated patients with IE, whereas PCR of resected valve blood/tissue was highly sensitive even with preoperative AMT for more than 29 days.","PeriodicalId":20812,"journal":{"name":"Rational Pharmacotherapy in Cardiology","volume":"73 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86256778","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 : 2023-03-07DOI: 10.20996/1819-6446-2023-01-01
V. A. Mareyeva, A. Klimenko, N. Shostak
Pulmonary hypertension and right heart dysfunction often complicate the course of chronic heart failure. At the same time, the addition of these pathological conditions significantly increases the frequency of hospitalizations and worsens survival prognosis. That is why the assessment of the unfavorable outcome’s risk in the group of such patients is extremely important. This problem draws an interest for a more detailed study, considering the fact that the most convenient, accessible and minimally invasive prognosis marker has still being searched for nowadays. In this review article, which is based on the analysis of literature over the past 20 years dedicated to the problem of pulmonary hypertension and chronic heart failure, right ventricular-arterial coupling, has been considered as a relatively new parameter and as an example of one of these prognostic markers. This parameter can be assessed by echocardiography examination and our article describes several options of calculating it, including one of the most popular and valuable ratio of tricuspidal anular plane systolic excursion to the systolic pulmonary artery pressure (TAPSE/sPAP).
{"title":"Chronic Heart Failure and Pulmonary Hypertension: Difficulties in Assessment of Prognosis and Potential Solutions","authors":"V. A. Mareyeva, A. Klimenko, N. Shostak","doi":"10.20996/1819-6446-2023-01-01","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-01-01","url":null,"abstract":"Pulmonary hypertension and right heart dysfunction often complicate the course of chronic heart failure. At the same time, the addition of these pathological conditions significantly increases the frequency of hospitalizations and worsens survival prognosis. That is why the assessment of the unfavorable outcome’s risk in the group of such patients is extremely important. This problem draws an interest for a more detailed study, considering the fact that the most convenient, accessible and minimally invasive prognosis marker has still being searched for nowadays. In this review article, which is based on the analysis of literature over the past 20 years dedicated to the problem of pulmonary hypertension and chronic heart failure, right ventricular-arterial coupling, has been considered as a relatively new parameter and as an example of one of these prognostic markers. This parameter can be assessed by echocardiography examination and our article describes several options of calculating it, including one of the most popular and valuable ratio of tricuspidal anular plane systolic excursion to the systolic pulmonary artery pressure (TAPSE/sPAP).","PeriodicalId":20812,"journal":{"name":"Rational Pharmacotherapy in Cardiology","volume":"59 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72711256","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 : 2023-03-07DOI: 10.20996/1819-6446-2023-02-04
E. P. Kalaydzhyan, N. Kutishenko, Y. Lukina, D. P. Sichinava, S. Martsevich, O. Drapkina
Aim. To assess adherence to the recommended therapy at the stage of outpatient follow-up and its impact on long-term outcomes in patients after acute myocardial infarction based on the materials of the prospective PROFILE-IM registry.Material and methods. The PROFILE-IM register included 160 patients who applied to one of the polyclinics in Moscow after a myocardial infarction. The combined endpoint (CE) included death from any cause, cardiovascular events (nonfatal myocardial infarction, nonfatal cerebral stroke), emergency hospitalizations for cardiovascular diseases, significant cardiac arrhythmias. Patients' adherence to therapy was assessed using the original questionnaire "Scale of Adherence of the National Society of Evidence-based Pharmacotherapy" (NODF) and a direct standardized patient survey by a doctor about taking medications. Visits to the doctor were carried out every two months, data from the first year of patient follow-up are presented.Results. In a personal interview with a doctor, the ratio of the proportion of committed, partially committed and non-committed patients did not change significantly over the entire follow-up period, while the proportion of committed patients was 81-85%. The "NODF Adherence Scale" showed that the proportion of non-committed patients was about 10 times higher than with direct patient responses to the doctor, and the proportion of non-committed and partially committed patients remained high at all stages of follow-up (respectively 28% and 10% at the beginning of the study, 18% and 10% at the end of the study). Among the main factors of non-commitment, there was a decrease in the importance of forgetfulness and an increase in factors such as fear of side effects of medications, doubt about the need for long-term use of medications and well-being. A direct relationship of adherence with the male sex, the presence of hypertension, a feedback relationship with alcohol consumption was revealed. The risk of CE in non-committed patients was higher compared to the group of committed and partially committed patients (p<0.01).Conclusion. The proportion of non-committed and partially committed patients remained high at all stages of follow-up. There was a direct relationship between adherence to therapy with the male sex, the presence of hypertension in the anamnesis, and a feedback relationship with alcohol consumption. Low adherence to therapy significantly increased the risk of cardiovascular events.
{"title":"The Study of Adherence to Drug Therapy at the Stage of Outpatient Follow-up in Patients with Acute Myocardial Infarction (Data from the PROFIL-IM Registry)","authors":"E. P. Kalaydzhyan, N. Kutishenko, Y. Lukina, D. P. Sichinava, S. Martsevich, O. Drapkina","doi":"10.20996/1819-6446-2023-02-04","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-02-04","url":null,"abstract":"Aim. To assess adherence to the recommended therapy at the stage of outpatient follow-up and its impact on long-term outcomes in patients after acute myocardial infarction based on the materials of the prospective PROFILE-IM registry.Material and methods. The PROFILE-IM register included 160 patients who applied to one of the polyclinics in Moscow after a myocardial infarction. The combined endpoint (CE) included death from any cause, cardiovascular events (nonfatal myocardial infarction, nonfatal cerebral stroke), emergency hospitalizations for cardiovascular diseases, significant cardiac arrhythmias. Patients' adherence to therapy was assessed using the original questionnaire \"Scale of Adherence of the National Society of Evidence-based Pharmacotherapy\" (NODF) and a direct standardized patient survey by a doctor about taking medications. Visits to the doctor were carried out every two months, data from the first year of patient follow-up are presented.Results. In a personal interview with a doctor, the ratio of the proportion of committed, partially committed and non-committed patients did not change significantly over the entire follow-up period, while the proportion of committed patients was 81-85%. The \"NODF Adherence Scale\" showed that the proportion of non-committed patients was about 10 times higher than with direct patient responses to the doctor, and the proportion of non-committed and partially committed patients remained high at all stages of follow-up (respectively 28% and 10% at the beginning of the study, 18% and 10% at the end of the study). Among the main factors of non-commitment, there was a decrease in the importance of forgetfulness and an increase in factors such as fear of side effects of medications, doubt about the need for long-term use of medications and well-being. A direct relationship of adherence with the male sex, the presence of hypertension, a feedback relationship with alcohol consumption was revealed. The risk of CE in non-committed patients was higher compared to the group of committed and partially committed patients (p<0.01).Conclusion. The proportion of non-committed and partially committed patients remained high at all stages of follow-up. There was a direct relationship between adherence to therapy with the male sex, the presence of hypertension in the anamnesis, and a feedback relationship with alcohol consumption. Low adherence to therapy significantly increased the risk of cardiovascular events.","PeriodicalId":20812,"journal":{"name":"Rational Pharmacotherapy in Cardiology","volume":"36 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90088182","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 : 2023-03-07DOI: 10.20996/1819-6446-2023-02-01
S. Y. Volkova, L. A. Boyarskaya, P. Y. Toropygin, I. Morozov, E. A. Boyarskaya
Aim. The analysis of the experience of using PCSK9 inhibitors (alirocumab) in patients with very high cardiovascular risk, аccording to long observations in real clinical practice.Material and methods. In study evaluated the data for 31 people (23 men and 8 women, the average age of those surveyed was 59.4±5.8 years) of very high cardiovascular risk with atherogenic dyslipidemia and no achievement of the target lipid levels. Alirokumab was administered in a dose of 150 mg subcutaneously once every 2 weeks in the day hospital of a multidisciplinary clinic. The primary endpoint was reached the target level of low density lipoprotein cholesterol (HS-LDL) level and/or reduce HS-LDL levels by 50% or more. Liver tests, level of creatinine and glycemia were studied to assess safety; side effects studied/Results. The long-term use of alirocumab (on average 7,5±2,3 months) is well tolerated without adverse reactions and withdrawal syndrome, in the day hospital of a multidisciplinary clinic. 90% of patient have achieved either a target level of HS-LDL less than 1.4 mmol/l or a reduction in HS-LDL by 50% or more. The remaining third of patients achieved both target levels. It can be distinguished a group of patients with a good response to the medication, in the first months of administration of alirokumab.Conclusion. The results of conducting an efficiency assessment for use of the alirocumab in a dose of 150 mg subcutaneously within two weeks showed that this therapy has the high efficacy and good tolerability without any adverse reactions, in the day hospital of a multidisciplinary clinic.
{"title":"Analysis of The Use of PCSK9 Inhibitors in Clinical Practice","authors":"S. Y. Volkova, L. A. Boyarskaya, P. Y. Toropygin, I. Morozov, E. A. Boyarskaya","doi":"10.20996/1819-6446-2023-02-01","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-02-01","url":null,"abstract":"Aim. The analysis of the experience of using PCSK9 inhibitors (alirocumab) in patients with very high cardiovascular risk, аccording to long observations in real clinical practice.Material and methods. In study evaluated the data for 31 people (23 men and 8 women, the average age of those surveyed was 59.4±5.8 years) of very high cardiovascular risk with atherogenic dyslipidemia and no achievement of the target lipid levels. Alirokumab was administered in a dose of 150 mg subcutaneously once every 2 weeks in the day hospital of a multidisciplinary clinic. The primary endpoint was reached the target level of low density lipoprotein cholesterol (HS-LDL) level and/or reduce HS-LDL levels by 50% or more. Liver tests, level of creatinine and glycemia were studied to assess safety; side effects studied/Results. The long-term use of alirocumab (on average 7,5±2,3 months) is well tolerated without adverse reactions and withdrawal syndrome, in the day hospital of a multidisciplinary clinic. 90% of patient have achieved either a target level of HS-LDL less than 1.4 mmol/l or a reduction in HS-LDL by 50% or more. The remaining third of patients achieved both target levels. It can be distinguished a group of patients with a good response to the medication, in the first months of administration of alirokumab.Conclusion. The results of conducting an efficiency assessment for use of the alirocumab in a dose of 150 mg subcutaneously within two weeks showed that this therapy has the high efficacy and good tolerability without any adverse reactions, in the day hospital of a multidisciplinary clinic.","PeriodicalId":20812,"journal":{"name":"Rational Pharmacotherapy in Cardiology","volume":"30 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77764982","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 : 2023-03-07DOI: 10.20996/1819-6446-2023-01-08
K. Protasov, O. A. Barahtenko, E. Batunova, E. A. Rasputina
Aim. To study the perioperative dynamics of myocardial injury biomarkers high-sensitivity cardiac troponin I (hs-cTnI), ischemia-modified albumin (IMA) and soluble ST2 (sST2) when taking nicorandil in lung cancer patients with concomitant coronary heart disease (CHD) undergoing surgical lung resection.Material and methods. The study included 54 patients (11 women and 43 men) with non-small cell lung cancer and concomitant stable CHD who underwent lung resection in the volume of lobectomy or pneumonectomy. Patients were randomly assigned to the nicorandil group (oral administration 10 mg BID for 7 days before and 3 days after surgery; n=27) and the control group (n=27). In the study groups, the perioperative dynamics of hscTnI, IMA and sST2, determined in the blood before and 24 and 48h after surgery, were compared. We calculated the incidence of acute myocardial injury in the groups, which was diagnosed in cases of postoperative hs-cTnI increase of more than one 99th percentile of the upper reference limit. The associations of nicorandil intake and acute myocardial injury were evaluated.Results. The groups were comparable in gender, age, basic clinical characteristics, as well as baseline levels of myocardial injury biomarkers. After the intervention, both samples showed an increase in the hs-cTnI and sST2 levels and a decrease in IMA concentration (all p<0.02 for related group differences). In the nicorandil group, in comparison with the control one, 48h after surgery, we found lower mean levels of hs-cTnI [16.7 (11.9;39.7) vs 44.3 (15.0;130.7) ng/l; p<0.05) and sST2 [62.8 (43.6;70.1) vs 76.5 (50.2;87.1) ng/ml; p<0.05), concentration increase rates of hs-cTnI [14.8 (0.7;42.2) vs 32.5 (14.0;125.0) ng/l; p<0.01) and sST2 [24.4 (10.3;42.4) vs 47.4 (17.5;65.3) ng/ml; p<0.05), as well as highest concentrations for the entire postoperative period of hs-cTnI [30.7 (12.0;53.7) vs 79.0 (20.3;203.3) ng/L, p<0.01] and sST2 [99.8 (73.6;162.5) vs 147.8 (87.8;207.7) ng/mL; p<0.05]. The serum IMA decreased when taking nicorandil to a greater extent [-8.0 (-12.6; -2.0) vs -2.7 (-6.0; +5.5) ng/ ml; p<0.01] 24h after surgery. Acute myocardial injury was diagnosed in 7 people in the nicorandil group (25.9%) and in 15 in the control one (55.6%; pχ2=0.027). The adjusted odds ratio of acute myocardial injury when taking nicorandil was 0.35 (95% confidence interval 0.15-0.83, p=0.017).Conclusion. Taking nicorandil in patients with lung cancer and concomitant CHD who underwent surgical lung resection is associated with a lower postoperative increase in hs-cTnI and sST2 and a reduced risk of acute myocardial injury, which may indicate the cardioprotective effect of nicorandil under acute surgical stress conditions.
{"title":"Incidence and Severity of Acute Myocardial Injury after Thoracic Surgery: Effects of Nicorandil","authors":"K. Protasov, O. A. Barahtenko, E. Batunova, E. A. Rasputina","doi":"10.20996/1819-6446-2023-01-08","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-01-08","url":null,"abstract":"Aim. To study the perioperative dynamics of myocardial injury biomarkers high-sensitivity cardiac troponin I (hs-cTnI), ischemia-modified albumin (IMA) and soluble ST2 (sST2) when taking nicorandil in lung cancer patients with concomitant coronary heart disease (CHD) undergoing surgical lung resection.Material and methods. The study included 54 patients (11 women and 43 men) with non-small cell lung cancer and concomitant stable CHD who underwent lung resection in the volume of lobectomy or pneumonectomy. Patients were randomly assigned to the nicorandil group (oral administration 10 mg BID for 7 days before and 3 days after surgery; n=27) and the control group (n=27). In the study groups, the perioperative dynamics of hscTnI, IMA and sST2, determined in the blood before and 24 and 48h after surgery, were compared. We calculated the incidence of acute myocardial injury in the groups, which was diagnosed in cases of postoperative hs-cTnI increase of more than one 99th percentile of the upper reference limit. The associations of nicorandil intake and acute myocardial injury were evaluated.Results. The groups were comparable in gender, age, basic clinical characteristics, as well as baseline levels of myocardial injury biomarkers. After the intervention, both samples showed an increase in the hs-cTnI and sST2 levels and a decrease in IMA concentration (all p<0.02 for related group differences). In the nicorandil group, in comparison with the control one, 48h after surgery, we found lower mean levels of hs-cTnI [16.7 (11.9;39.7) vs 44.3 (15.0;130.7) ng/l; p<0.05) and sST2 [62.8 (43.6;70.1) vs 76.5 (50.2;87.1) ng/ml; p<0.05), concentration increase rates of hs-cTnI [14.8 (0.7;42.2) vs 32.5 (14.0;125.0) ng/l; p<0.01) and sST2 [24.4 (10.3;42.4) vs 47.4 (17.5;65.3) ng/ml; p<0.05), as well as highest concentrations for the entire postoperative period of hs-cTnI [30.7 (12.0;53.7) vs 79.0 (20.3;203.3) ng/L, p<0.01] and sST2 [99.8 (73.6;162.5) vs 147.8 (87.8;207.7) ng/mL; p<0.05]. The serum IMA decreased when taking nicorandil to a greater extent [-8.0 (-12.6; -2.0) vs -2.7 (-6.0; +5.5) ng/ ml; p<0.01] 24h after surgery. Acute myocardial injury was diagnosed in 7 people in the nicorandil group (25.9%) and in 15 in the control one (55.6%; pχ2=0.027). The adjusted odds ratio of acute myocardial injury when taking nicorandil was 0.35 (95% confidence interval 0.15-0.83, p=0.017).Conclusion. Taking nicorandil in patients with lung cancer and concomitant CHD who underwent surgical lung resection is associated with a lower postoperative increase in hs-cTnI and sST2 and a reduced risk of acute myocardial injury, which may indicate the cardioprotective effect of nicorandil under acute surgical stress conditions.","PeriodicalId":20812,"journal":{"name":"Rational Pharmacotherapy in Cardiology","volume":"31 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84207674","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 : 2023-03-07DOI: 10.20996/1819-6446-2023-01-05
D. A. Kuzhel, G. V. Matyushin, E. Savchenko
Mitral valve prolapse (MVP) has long been the subject of intense discussions regarding the prognosis and follow-up tactics. In most cases, this condition has a benign prognosis. However, recent autopsy and follow-up studies have shown risks of developing sudden cardiac death (SCD) in some subgroups of patients who have this clinical phenomenon. The proposed literature review uses the population of patients with MVP with the highest probability of developing life-threatening ventricular tachyarrhythmias. Patients with the presence of a complex of changes, including bicuspid MVP, negative T waves in the inferior and lateral leads on a standard 12-lead electrocardiogram (ECG), and a special anatomical phenomenon called mitral annular disjunction (MAD), are at high risk of developing ventricular ectopias and VSS. A reflection of the high risk of SCD in such patients is the increase of ventricular ectopy according to Holter monitoring. The presence of a bicuspid MVP and the MAD phenomenon, which is a separation of the line of attachment of the posterior mitral leaflet from the basal inferior wall segment towards the atrial wall, determines the presence of a special form of MVP, the so-called arrhythmogenic MVP. Hence, in most cases MVP has a benign prognosis. However, patients with the aforementioned ar- rhythmic MVP signs must be given particular attention and annual follow-up including ECG control, Holter monitoring and echocardiographic examination of the heart to reduce the risk of ventricular tachyarrhythmias and SCD development.
{"title":"Arrhythmic Mitral Valve Prolapse: New Menaces of the Known Disease","authors":"D. A. Kuzhel, G. V. Matyushin, E. Savchenko","doi":"10.20996/1819-6446-2023-01-05","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-01-05","url":null,"abstract":"Mitral valve prolapse (MVP) has long been the subject of intense discussions regarding the prognosis and follow-up tactics. In most cases, this condition has a benign prognosis. However, recent autopsy and follow-up studies have shown risks of developing sudden cardiac death (SCD) in some subgroups of patients who have this clinical phenomenon. The proposed literature review uses the population of patients with MVP with the highest probability of developing life-threatening ventricular tachyarrhythmias. Patients with the presence of a complex of changes, including bicuspid MVP, negative T waves in the inferior and lateral leads on a standard 12-lead electrocardiogram (ECG), and a special anatomical phenomenon called mitral annular disjunction (MAD), are at high risk of developing ventricular ectopias and VSS. A reflection of the high risk of SCD in such patients is the increase of ventricular ectopy according to Holter monitoring. The presence of a bicuspid MVP and the MAD phenomenon, which is a separation of the line of attachment of the posterior mitral leaflet from the basal inferior wall segment towards the atrial wall, determines the presence of a special form of MVP, the so-called arrhythmogenic MVP. Hence, in most cases MVP has a benign prognosis. However, patients with the aforementioned ar- rhythmic MVP signs must be given particular attention and annual follow-up including ECG control, Holter monitoring and echocardiographic examination of the heart to reduce the risk of ventricular tachyarrhythmias and SCD development.","PeriodicalId":20812,"journal":{"name":"Rational Pharmacotherapy in Cardiology","volume":"106 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87874227","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 : 2023-03-07DOI: 10.20996/1819-6446-2023-02-05
E. Ryngach, A. Tatarinova, E. Zhabina, O. N. Zhdanova, T. Treshkur
The pathogenetic mechanisms of arrhythmias, including high-grade ventricular arrhythmias (including non-sustained ventricular tachycardia), in patients with coronary heart disease may be different. Therefore, the characteristics of ventricular arrhythmias must be considered based on the totality of data, taking into account all the available features. The importance of a personalized approach to the management of a patient with coronary heart disease who had extensive myocardial infarction 18.5 years ago, followed by mammary coronary artery bypass grafting, aneurysmectomy and the development of heart failure with a low ejection fraction, in whom ventricular arrhythmias occurred against the background of a stable course of coronary disease , but after emotional stress, is reflected in this work. An extended examination, as well as a detailed study of the nature of ventricular arrhythmias, made it possible to determine the main provoking factor and select an individualized pathogenetic treatment with a good antiarrhythmic result that persists for several years of observation. Conducting mental tests and psychological questioning can be recommended for patients with coronary heart disease and chronic heart failure as an additional examination to assess the contribution of the psycho-emotional factor to arrhythmogenesis after excluding the ischemic and sympathetic nature of ventricular ectopia. It is incorrect to consider that all ventricular arrhythmias in patients with coronary heart disease are ischemic in nature, and in some clinical situations this statement is even erroneous.
{"title":"A Case of Successful Medical Treatment of Ventricular Tachycardia in a Patient With Ischemic Heart Disease and Heart Failure","authors":"E. Ryngach, A. Tatarinova, E. Zhabina, O. N. Zhdanova, T. Treshkur","doi":"10.20996/1819-6446-2023-02-05","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-02-05","url":null,"abstract":"The pathogenetic mechanisms of arrhythmias, including high-grade ventricular arrhythmias (including non-sustained ventricular tachycardia), in patients with coronary heart disease may be different. Therefore, the characteristics of ventricular arrhythmias must be considered based on the totality of data, taking into account all the available features. The importance of a personalized approach to the management of a patient with coronary heart disease who had extensive myocardial infarction 18.5 years ago, followed by mammary coronary artery bypass grafting, aneurysmectomy and the development of heart failure with a low ejection fraction, in whom ventricular arrhythmias occurred against the background of a stable course of coronary disease , but after emotional stress, is reflected in this work. An extended examination, as well as a detailed study of the nature of ventricular arrhythmias, made it possible to determine the main provoking factor and select an individualized pathogenetic treatment with a good antiarrhythmic result that persists for several years of observation. Conducting mental tests and psychological questioning can be recommended for patients with coronary heart disease and chronic heart failure as an additional examination to assess the contribution of the psycho-emotional factor to arrhythmogenesis after excluding the ischemic and sympathetic nature of ventricular ectopia. It is incorrect to consider that all ventricular arrhythmias in patients with coronary heart disease are ischemic in nature, and in some clinical situations this statement is even erroneous.","PeriodicalId":20812,"journal":{"name":"Rational Pharmacotherapy in Cardiology","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89688312","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 : 2023-03-07DOI: 10.20996/1819-6446-2023-01-07
E. A. Zakharyan, D. V. Shatov, A. O. Povoroznyj, T. B. Bujar
An increase in life expectancy contributes to a steady growth of diseases of the cardiovascular system. In recent years, there has been a stable increase in the prevalence of rhythm disturbances in the population. Fibrillation and atrial flutter are among the most common causes of a decrease in the quality of life and an increase in mortality. However, the effectiveness of various methods of treatment is not absolute, and therefore the development and introduction of new antiarrhythmic drugs is particularly relevant. Thus, the use of a class III antiarrhythmic drug (niferidil) is of unconditional interest, and literature data describing the effectiveness of its use for the relief of atypical atrial flutter are extremely few. The article presents a case of successful relief of a persistent form of atypical atrial flutter in a 79-year-old patient using three consecutive intravenous injections of niferidil at a dose of 10 mcg/kg with a 15-minute interval in 19 hours after the start of therapy. The presented clinical case confirms the effectiveness of drug cardioversion with the use of niferidil and makes it possible to consider it as an alternative to electrical cardioversion in patients with atypical atrial flutter.
{"title":"Relief of persistent atypical atrial flutter: experience with the use of niferidil","authors":"E. A. Zakharyan, D. V. Shatov, A. O. Povoroznyj, T. B. Bujar","doi":"10.20996/1819-6446-2023-01-07","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-01-07","url":null,"abstract":"An increase in life expectancy contributes to a steady growth of diseases of the cardiovascular system. In recent years, there has been a stable increase in the prevalence of rhythm disturbances in the population. Fibrillation and atrial flutter are among the most common causes of a decrease in the quality of life and an increase in mortality. However, the effectiveness of various methods of treatment is not absolute, and therefore the development and introduction of new antiarrhythmic drugs is particularly relevant. Thus, the use of a class III antiarrhythmic drug (niferidil) is of unconditional interest, and literature data describing the effectiveness of its use for the relief of atypical atrial flutter are extremely few. The article presents a case of successful relief of a persistent form of atypical atrial flutter in a 79-year-old patient using three consecutive intravenous injections of niferidil at a dose of 10 mcg/kg with a 15-minute interval in 19 hours after the start of therapy. The presented clinical case confirms the effectiveness of drug cardioversion with the use of niferidil and makes it possible to consider it as an alternative to electrical cardioversion in patients with atypical atrial flutter.","PeriodicalId":20812,"journal":{"name":"Rational Pharmacotherapy in Cardiology","volume":"63 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77774657","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}
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