Pub Date : 2024-05-01DOI: 10.31928/2664-4479-2024.2.2131
O. V. Petyunina, M. P. Kopytsya, I. R. Vyshnevska, P. O. Petiunin
The aim – to assess subclinical emotional distress in patients with ST-Elevation Myocardial Infarction (STEMI) before and during the ongoing conflict in the Kharkiv Region. Materials and methods. The study encompassed 242 patients exhibiting subclinical emotional distress and hospitalized with STEMI at «L.T. Malaya TNI of NAMSU» before active conflict, compared with 65 patients during the conflict. Adherence to ethical standards was ensured, in line with the 1964 Helsinki Declaration, and the protocol received approval from the local ethics committee (Protocol № 8, dated 29.08.2016, and Protocol № 4, dated 12.05.2022). Participants completed the DASS-21 questionnaire, reflecting their emotional state 10–14 days prior, and received STEMI treatment as per current guidelines.Results. We showed that anxiety more frequent appeared during the active hostilities (p=0.0218). Depression had the influence on excessive smoking (p=0.0199), LV EF decrease (p=0.0057), LDL-C increase (p=0.0393). Anxiety and stress intrude into hypertension frequency (p=0.0171, p=0.0489) consequently as well as anxiety – on LDL-C increase (p=0.0068). All data of subclinical emotional distress during active hostilities associate with the frequency of smoking increase: p=0.0422 for depression, p=0.0275 for anxiety and p=0.0199 for stress. Depression associates with LVEF decrease (p=0.0267), the leucocytes count increase (p=0.0467), high frequency of hypertension (p=0.0410). Anxiety associates with higher heart rate (p=0.0277), depression and stress – with younger age (p=0.0369).Conclusions. Our research demonstrates close associations between the data of subclinical emotional distress both in patients with STEMI before and during the active hostilities in Kharkiv Region. Data were assessed with DASS-21 questionnaire on 10 –14 day prior the event. These results should be undertaken during general practitioner’s appointment to prevent further cardiovascular event.
{"title":"Порівняльний аналіз субклінічного тривожно-депресивного синдрому в пацієнтів із гострим інфарктом міокарда з елевацією сегмента ST до та під час активних бойових дій у Харківській області","authors":"O. V. Petyunina, M. P. Kopytsya, I. R. Vyshnevska, P. O. Petiunin","doi":"10.31928/2664-4479-2024.2.2131","DOIUrl":"https://doi.org/10.31928/2664-4479-2024.2.2131","url":null,"abstract":"The aim – to assess subclinical emotional distress in patients with ST-Elevation Myocardial Infarction (STEMI) before and during the ongoing conflict in the Kharkiv Region. Materials and methods. The study encompassed 242 patients exhibiting subclinical emotional distress and hospitalized with STEMI at «L.T. Malaya TNI of NAMSU» before active conflict, compared with 65 patients during the conflict. Adherence to ethical standards was ensured, in line with the 1964 Helsinki Declaration, and the protocol received approval from the local ethics committee (Protocol № 8, dated 29.08.2016, and Protocol № 4, dated 12.05.2022). Participants completed the DASS-21 questionnaire, reflecting their emotional state 10–14 days prior, and received STEMI treatment as per current guidelines.Results. We showed that anxiety more frequent appeared during the active hostilities (p=0.0218). Depression had the influence on excessive smoking (p=0.0199), LV EF decrease (p=0.0057), LDL-C increase (p=0.0393). Anxiety and stress intrude into hypertension frequency (p=0.0171, p=0.0489) consequently as well as anxiety – on LDL-C increase (p=0.0068). All data of subclinical emotional distress during active hostilities associate with the frequency of smoking increase: p=0.0422 for depression, p=0.0275 for anxiety and p=0.0199 for stress. Depression associates with LVEF decrease (p=0.0267), the leucocytes count increase (p=0.0467), high frequency of hypertension (p=0.0410). Anxiety associates with higher heart rate (p=0.0277), depression and stress – with younger age (p=0.0369).Conclusions. Our research demonstrates close associations between the data of subclinical emotional distress both in patients with STEMI before and during the active hostilities in Kharkiv Region. Data were assessed with DASS-21 questionnaire on 10 –14 day prior the event. These results should be undertaken during general practitioner’s appointment to prevent further cardiovascular event.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"121 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141057059","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 : 2024-05-01DOI: 10.31928/2664-4479-2024.2.720
O. M. Parkhomenko, S. A. Tykhonova, O. Koval, M. Y. Kolesnyk
Treatment of coronary artery disease (CAD) and stable angina, includes lifestyle modification, pharmacological therapy and invasive interventions to achieve stabilization or regression of the disease. Knowledge of the current situation regarding the use of pharmacological therapy and evaluation of its effectiveness is necessary for further management optimization. Trimetazidine (TMZ) has previously been shown to reduce angina symptoms and increase exercise tolerance in patients with CAD and stable angina and may be among an option for optimizing antianginal treatment. However, the effectiveness of long-term treatment depends on patient adherence, so the use of TMZ once daily (OD) at a dose of 80 mg may improve satisfaction and adherence in patients with CAD and stable angina.Methods. The GO-OD study is a 3-month, non-interventional, observational, multicenter prospective study conducted in Ukraine in a real-world outpatient cardiology practice during February – August 2021. Physicians were instructed to continue monitoring and treating patients in accordance with usual practice and international guidelines. No additional diagnostic or monitoring procedures were performed. Clinical, instrumental and laboratory data, frequency of angina attacks, consumption of short-acting nitrates (SAN), adherence to antianginal drugs, as well as the overall efficacy, tolerability of TMZ OD 80 mg in real-world clinical practice were analyzed. The observation includes regular assessment of patients` clinical status, treatment optimization and its effectiveness at follow up visits.Results. The study included 1529 patients (mean age 62.5 years, 56 % men). In the absence of adequate control of risk factors, pharmacological control of symptoms, and limited use of interventional and surgical treatments, the frequency of angina episodes was high, most patients had a pronounced angina functional class according to the Canadian Society of Cardiology classification (10.5 % – CCS I, 60.1 % – CCS II, 29.5 % – CCS III). Thus, the average number of angina attacks per week in CCS I was 3.7, in CCS II – 5.2, and in CCS III – 7, 97 attacks. In addition to the severity of symptoms, the following pattern was observed: the higher the angina class, the more risk factors and comorbidities patients had. After 3 months of follow-up due to optimization of therapy, there was a significant (p<0.001) decrease in the frequency of angina attacks – from (5.8±4.7 to 1.6±2.0)/week, and the use of SAN – from (4.2±4.3 to 0.8±1.6)/week). At the same time, in 3 month the % of patients with CCS II and III significantly decreased, while the % of patients with CCS I increased (48.4 % – CCS I, 45.7 % – CCS II, 6 % – CCS III). Adherence to medication was improved: 49 % of patients reported high adherence (vs. 18 % at baseline) and 12 % – low adherence (vs. 52 % at baseline). After 3 months of follow-up most of doctors rated the overall tolerability and effectiveness of the therapy as «very satisfied». Pat
冠状动脉疾病（CAD）和稳定型心绞痛的治疗包括改变生活方式、药物治疗和侵入性干预，以达到病情稳定或缓解的目的。为了进一步优化治疗，有必要了解药物治疗的使用现状并评估其有效性。三甲脒（TMZ）曾被证明可减轻 CAD 和稳定型心绞痛患者的心绞痛症状并提高运动耐量，可能是优化抗心绞痛治疗的一种选择。然而，长期治疗的效果取决于患者的依从性，因此每天一次（OD）使用 80 毫克剂量的 TMZ 可提高 CAD 和稳定型心绞痛患者的满意度和依从性。GO-OD研究是一项为期3个月、非干预性、观察性、多中心前瞻性研究，于2021年2月至8月期间在乌克兰的一家真实世界心脏病门诊诊所进行。医生被要求继续按照惯例和国际指南对患者进行监测和治疗。没有进行额外的诊断或监测程序。分析了临床、仪器和实验室数据、心绞痛发作频率、短效硝酸盐（SAN）消耗量、抗心绞痛药物的依从性以及 TMZ OD 80 毫克在实际临床实践中的总体疗效和耐受性。观察内容包括定期评估患者临床状态、优化治疗以及随访疗效。研究共纳入1529名患者（平均年龄62.5岁，56%为男性）。在危险因素未得到充分控制、症状未得到药物控制、介入治疗和手术治疗使用有限的情况下，心绞痛发作的频率很高，根据加拿大心脏病学会的分类，大多数患者的心绞痛功能分级明显（10.5% - CCS I，60.1% - CCS II，29.5% - CCS III）。因此，CCS I 的心绞痛平均每周发作 3.7 次，CCS II 的平均每周发作 5.2 次，CCS III 的平均每周发作 797 次。除了症状的严重程度外，还观察到以下模式：心绞痛分级越高，患者的危险因素和合并症越多。由于优化了治疗方案，随访 3 个月后，心绞痛发作频率明显降低（p<0.001），从（5.8±4.7）次/周降至 1.6±2.0）次/周，SAN 的使用也从 4.2±4.3 次/周降至 0.8±1.6）次/周。同时，在三个月内，CCS II 和 III 患者的比例明显下降，而 CCS I 患者的比例则有所上升（48.4% - CCS I，45.7% - CCS II，6% - CCS III）。坚持服药的情况有所改善：49%的患者表示服药依从性高（与基线时的 18%相比），12%的患者表示服药依从性低（与基线时的 52%相比）。经过 3 个月的随访，大多数医生对治疗的总体耐受性和有效性表示 "非常满意"。随访3个月后，患者对TMZ OD 80毫克疗法的满意度为9.5分[1至10分（非常满意）]。患者对日常体力活动的评估显著增加：2.42分，而基线时为5.89分（1至10分（严重受限））。总体而言，目前心脏病专家对门诊患有 CAD 和稳定型心绞痛的患者的管理不够有效，导致心绞痛发作频率很高（每周近 6 次），心绞痛症状严重限制了患者的日常活动。研究中患者的基线治疗符合现行指南，但他汀类药物（78%）和 ACE 抑制剂（54.5%）的处方频率不足；平均使用 2 种或更多抗心绞痛药物的抗心绞痛治疗并非控制心绞痛症状的最佳方法，冠状动脉血管重建手术的频率也不足，主要是在急性心肌梗死期间（58.0%）。根据目前的所有建议，将优化药物治疗作为纠正 CAD 和稳定型心绞痛患者病情的第一步，并在抗心绞痛药物中加入了最初的曲美他嗪 OD 80 毫克，每天一次，同时对患者进行为期 3 个月的积极监测，从而降低了心绞痛发作的频率（无论其最初的 FC 如何），提高了患者对治疗的依从性及其功能活动。
{"title":"Характеристика пацієнтів з ішемічною хворобою серця та стабільною стенокардією в Україні, оцінка підходів до їх лікування за даними багатоцентрового дослідження GO-OD","authors":"O. M. Parkhomenko, S. A. Tykhonova, O. Koval, M. Y. Kolesnyk","doi":"10.31928/2664-4479-2024.2.720","DOIUrl":"https://doi.org/10.31928/2664-4479-2024.2.720","url":null,"abstract":"Treatment of coronary artery disease (CAD) and stable angina, includes lifestyle modification, pharmacological therapy and invasive interventions to achieve stabilization or regression of the disease. Knowledge of the current situation regarding the use of pharmacological therapy and evaluation of its effectiveness is necessary for further management optimization. Trimetazidine (TMZ) has previously been shown to reduce angina symptoms and increase exercise tolerance in patients with CAD and stable angina and may be among an option for optimizing antianginal treatment. However, the effectiveness of long-term treatment depends on patient adherence, so the use of TMZ once daily (OD) at a dose of 80 mg may improve satisfaction and adherence in patients with CAD and stable angina.Methods. The GO-OD study is a 3-month, non-interventional, observational, multicenter prospective study conducted in Ukraine in a real-world outpatient cardiology practice during February – August 2021. Physicians were instructed to continue monitoring and treating patients in accordance with usual practice and international guidelines. No additional diagnostic or monitoring procedures were performed. Clinical, instrumental and laboratory data, frequency of angina attacks, consumption of short-acting nitrates (SAN), adherence to antianginal drugs, as well as the overall efficacy, tolerability of TMZ OD 80 mg in real-world clinical practice were analyzed. The observation includes regular assessment of patients` clinical status, treatment optimization and its effectiveness at follow up visits.Results. The study included 1529 patients (mean age 62.5 years, 56 % men). In the absence of adequate control of risk factors, pharmacological control of symptoms, and limited use of interventional and surgical treatments, the frequency of angina episodes was high, most patients had a pronounced angina functional class according to the Canadian Society of Cardiology classification (10.5 % – CCS I, 60.1 % – CCS II, 29.5 % – CCS III). Thus, the average number of angina attacks per week in CCS I was 3.7, in CCS II – 5.2, and in CCS III – 7, 97 attacks. In addition to the severity of symptoms, the following pattern was observed: the higher the angina class, the more risk factors and comorbidities patients had. After 3 months of follow-up due to optimization of therapy, there was a significant (p<0.001) decrease in the frequency of angina attacks – from (5.8±4.7 to 1.6±2.0)/week, and the use of SAN – from (4.2±4.3 to 0.8±1.6)/week). At the same time, in 3 month the % of patients with CCS II and III significantly decreased, while the % of patients with CCS I increased (48.4 % – CCS I, 45.7 % – CCS II, 6 % – CCS III). Adherence to medication was improved: 49 % of patients reported high adherence (vs. 18 % at baseline) and 12 % – low adherence (vs. 52 % at baseline). After 3 months of follow-up most of doctors rated the overall tolerability and effectiveness of the therapy as «very satisfied». Pat","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"7 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141055790","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 : 2024-05-01DOI: 10.31928/2664-4479-2024.2.5360
O. I. Mitchenko, Y. O. Bila, D. Bilyi
In recent years it has been established that elevated levels of Lp(a) are an independent genetic risk factor for the development of atherosclerotic cardiovascular diseases and aortic stenosis, however, issues of gender and age characteristics remain controversial.The aim of study was to analyze the gender characteristics of the relationship between Lp(a) levels and atherogenic changes in the lipid spectrum of the blood, clinical and instrumental characteristics, taking into account damage to the aortic valve and the results of coronary angiography in patients with stable coronary heart disease. Materials and methods. The 106 patients with chronic coronary heart disease (CAD) were examined. The average age of the subjects was 55.00±1.0 years (95% CI 51.11-58.89), among them: 78 men and 28 women.The entire cohort of patients was divided depending on the Lp(a) levels: 1group (n=58) with a Lp(a) level less than 50 mg/dl; 2 group (n=20) with Lp(a) level 50-100 mg/dl; 3 group (n=8) with Lp(a) level 101-150 mg/dl and 4 group (n=20) with Lp(a) level more than 150 mg/dl.Research methods included: 1. General clinical examination; 2. Laboratory characteristics of lipid (with determination of Lp(a)) and carbohydrate metabolism, as well as standard biochemical parameters; 3. Instrumental examination (electrocardiography, echocardiography, ultrasound peripheral vessels examination, coronary angiography); 4. Mathematical and statistical processing of the results obtained.Results and conclusions. In patients with CAD verified by clinical-instrumental and coronary angiographic criteria, it is noted that Lp(a) levels in women are on average significantly higher (P< 0.05) than in men and increase with the onset of menopause.Close correlations have not been recorded between Lp(a) in mg/dL and total cholesterol, LDL cholesterol and non-HDL cholesterol, as well as the concentrations of glucose, glycosylated hemoglobin, serum creatinine, and the concentration of thyroid-stimulating hormone (TSH).Determined that in patients with documented atherosclerotic lesions of the coronary arteries against the Lp(a) levels above 100 mg/dl, there is a greater need for coronary revascularization. A close relationship is observed between the increase in Lp(a) levels and the percentage of detection of aortic stenosis, which confirms the pathogenetic role of this lipoprotein in the formation of this acquired aortic valve disease.
{"title":"Статеві та клініко-інструментальні паралелі рівнів ліпопротеїн(а) в пацієнтів з дуже високим серцево-судинним ризиком","authors":"O. I. Mitchenko, Y. O. Bila, D. Bilyi","doi":"10.31928/2664-4479-2024.2.5360","DOIUrl":"https://doi.org/10.31928/2664-4479-2024.2.5360","url":null,"abstract":"In recent years it has been established that elevated levels of Lp(a) are an independent genetic risk factor for the development of atherosclerotic cardiovascular diseases and aortic stenosis, however, issues of gender and age characteristics remain controversial.The aim of study was to analyze the gender characteristics of the relationship between Lp(a) levels and atherogenic changes in the lipid spectrum of the blood, clinical and instrumental characteristics, taking into account damage to the aortic valve and the results of coronary angiography in patients with stable coronary heart disease. Materials and methods. The 106 patients with chronic coronary heart disease (CAD) were examined. The average age of the subjects was 55.00±1.0 years (95% CI 51.11-58.89), among them: 78 men and 28 women.The entire cohort of patients was divided depending on the Lp(a) levels: 1group (n=58) with a Lp(a) level less than 50 mg/dl; 2 group (n=20) with Lp(a) level 50-100 mg/dl; 3 group (n=8) with Lp(a) level 101-150 mg/dl and 4 group (n=20) with Lp(a) level more than 150 mg/dl.Research methods included: 1. General clinical examination; 2. Laboratory characteristics of lipid (with determination of Lp(a)) and carbohydrate metabolism, as well as standard biochemical parameters; 3. Instrumental examination (electrocardiography, echocardiography, ultrasound peripheral vessels examination, coronary angiography); 4. Mathematical and statistical processing of the results obtained.Results and conclusions. In patients with CAD verified by clinical-instrumental and coronary angiographic criteria, it is noted that Lp(a) levels in women are on average significantly higher (P< 0.05) than in men and increase with the onset of menopause.Close correlations have not been recorded between Lp(a) in mg/dL and total cholesterol, LDL cholesterol and non-HDL cholesterol, as well as the concentrations of glucose, glycosylated hemoglobin, serum creatinine, and the concentration of thyroid-stimulating hormone (TSH).Determined that in patients with documented atherosclerotic lesions of the coronary arteries against the Lp(a) levels above 100 mg/dl, there is a greater need for coronary revascularization. A close relationship is observed between the increase in Lp(a) levels and the percentage of detection of aortic stenosis, which confirms the pathogenetic role of this lipoprotein in the formation of this acquired aortic valve disease.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"5 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141054427","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 : 2024-05-01DOI: 10.31928/2664-4479-2024.2.4152
V. Tseluyko, R. Askerov
The aim – to determine the factors which have influence on hospital mortality in patients with non-high risk pulmonary embolism (PE).Materials and methods. We analysed 635 medical cards of patients (pts) with diagnosis «Pulmonary Embolism (PE)» who were hospitalised to Kharkiv City Clinical Hospital No.8. during 01.01.2017 – 01.01.2023. The inclusion criteria was diagnosis «PE» verified by multispiral computed tomography angiography (CTPA) of pulmonary arteries and/or by autopsy. Among the 635 pts, 530 were non-high risk. The non-high risk pts were divided into 2 groups: Group I – pts who were discharged with improved status (479 – 90.4 %), Group II – pts who died during hospitalisation (51 – 9.6 %). Clinical, anamnestic, biochemical, instrumental parameters, mortality rates were measured; statistical analysis was done.Results and discussion. The independent factors identified by multivariate vector analysis were associated with in-hospital mortality in pts with non-high risk PE: atrial fibrillation (AF), obesity, history of venous thromboembolism (VTE); lower levels of blood oxygen saturation (SpO2), systolic blood pressure (SBP); higher mean pulmonary arterial pressure (PAP); heart rate (HR) ≥ 110 beats/min. An ROC analysis was also performed to determine the thresholds of factors associated with in-hospital mortality in patients with non-high risk PE: SBP ≤ 124 mm Hg, HR ≥ 110 bts/min, mean PAP ≥ 54 mm Hg. Impact of AF on in-hospital mortality was depicted by Kaplan – Meier.Conclusions. Several factors were associated with increased in-hospital mortality in patients with non-high risk PE: age ˃ 54 years, SBP ≤ 124 mm Hg, history of VTE, obesity, AF; SpO2 ≤ 87 %, mean PAP ≥ 54 mm Hg, HR ≥ 110 bpm.
目的--确定影响非高风险肺栓塞（PE）患者住院死亡率的因素。我们分析了 2017 年 1 月 1 日至 2023 年 1 月 1 日期间在哈尔科夫市第八临床医院住院的 635 名诊断为 "肺栓塞（PE）"的患者（pts）的医疗卡。纳入标准为经肺动脉多螺旋计算机断层扫描（CTPA）和/或尸检证实的 "肺栓塞 "诊断。在 635 例患者中，530 例为非高风险患者。非高风险患者分为两组：第一组--病情好转出院的患者（479 - 90.4%），第二组--住院期间死亡的患者（51 - 9.6%）。对临床、病理、生化、仪器参数和死亡率进行了测量，并进行了统计分析。多变量向量分析确定的独立因素与非高危 PE 患者的院内死亡率相关：心房颤动（AF）、肥胖、静脉血栓栓塞症（VTE）病史；血氧饱和度（SpO2）、收缩压（SBP）水平较低；平均肺动脉压（PAP）较高；心率（HR）≥ 110 次/分。还进行了 ROC 分析，以确定与非高危 PE 患者院内死亡率相关的因素阈值：SBP ≤ 124 mm Hg、HR ≥ 110 bts/min、平均 PAP ≥ 54 mm Hg。心房颤动对院内死亡率的影响用 Kaplan - Meier 表示。有几个因素与非高危 PE 患者的院内死亡率增加有关：年龄˃ 54 岁、SBP ≤ 124 mm Hg、VTE 病史、肥胖、房颤；SpO2 ≤ 87 %、平均 PAP ≥ 54 mm Hg、HR ≥ 110 bpm。
{"title":"Risk factors for adverse outcome among patients with non-high risk pulmonary embolism","authors":"V. Tseluyko, R. Askerov","doi":"10.31928/2664-4479-2024.2.4152","DOIUrl":"https://doi.org/10.31928/2664-4479-2024.2.4152","url":null,"abstract":"The aim – to determine the factors which have influence on hospital mortality in patients with non-high risk pulmonary embolism (PE).Materials and methods. We analysed 635 medical cards of patients (pts) with diagnosis «Pulmonary Embolism (PE)» who were hospitalised to Kharkiv City Clinical Hospital No.8. during 01.01.2017 – 01.01.2023. The inclusion criteria was diagnosis «PE» verified by multispiral computed tomography angiography (CTPA) of pulmonary arteries and/or by autopsy. Among the 635 pts, 530 were non-high risk. The non-high risk pts were divided into 2 groups: Group I – pts who were discharged with improved status (479 – 90.4 %), Group II – pts who died during hospitalisation (51 – 9.6 %). Clinical, anamnestic, biochemical, instrumental parameters, mortality rates were measured; statistical analysis was done.Results and discussion. The independent factors identified by multivariate vector analysis were associated with in-hospital mortality in pts with non-high risk PE: atrial fibrillation (AF), obesity, history of venous thromboembolism (VTE); lower levels of blood oxygen saturation (SpO2), systolic blood pressure (SBP); higher mean pulmonary arterial pressure (PAP); heart rate (HR) ≥ 110 beats/min. An ROC analysis was also performed to determine the thresholds of factors associated with in-hospital mortality in patients with non-high risk PE: SBP ≤ 124 mm Hg, HR ≥ 110 bts/min, mean PAP ≥ 54 mm Hg. Impact of AF on in-hospital mortality was depicted by Kaplan – Meier.Conclusions. Several factors were associated with increased in-hospital mortality in patients with non-high risk PE: age ˃ 54 years, SBP ≤ 124 mm Hg, history of VTE, obesity, AF; SpO2 ≤ 87 %, mean PAP ≥ 54 mm Hg, HR ≥ 110 bpm.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141044675","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 : 2024-05-01DOI: 10.31928/664-4479-2024.2.3240
E. G. Nesukay, V. Kovalenko, S. V. Cherniuk, R. M. Kirichenko, E.Yu. Titov, J. J. Giresh, O. V. Dmitrichenko, A. B. Slyvna
The aim – to evaluate the effectiveness of sacubitril/valsartan and enalapril in heart failure treatment in patients with acute severe myocarditis with reduced left ventricular ejection fraction based on dynamic analysis of the heart structural and functional changes.Materials and methods. The study is based on the results of examinations of 90 patients with a severe course of acute myocarditis (AM) with reduced ejection fraction (EF) of the left ventricle (LV) – ≤40 %. The patients were divided into two groups: the 1st group included 48 patients who were treated with an angiotensin-converting enzyme (ACE) inhibitor – enalapril as part of heart failure (HF) therapy; the 2nd group included 42 patients with AM who received the sacubitril/valsartan combination instead of enalapril in the complex therapy of HF. All patients underwent a 6-minute walk test, echocardiography (EchoCG) with the speckle-tracking method, and cardiac magnetic resonance imaging (CMR). Examinations were carried out three times: in the 1st month from the onset of AM symptoms before the appointment of drug therapy, after 6 and 12 months of observation. Part of the patients from the 1st group, namely 25 patients (52.1 %) in whom the use of ACE inhibitors proved to be ineffective after six months, was transferred to the combination of sacubitril/valsartan (group 1A).Results and discussion. After six months of treatment, compared to the 1st group, the patients of the 2nd group were distinguished by better indicators of the structural and functional state of the heart, which characterise the contractility and volume of the LV – the values of LV EF and LV longitudinal global systolic strain (LGSS) were higher by 13,7 and 26.2 % respectively, LV end-diastolic volume index (EDVi) was 13.2% lower, as well as a 21.7 % lower number of LV segments in which delayed contrast was detected on cardiac MRI. After six months of taking the sacubitril/valsartan combination in 1A group patients, an improvement in the structural and functional state of the heart was also achieved: the values of LVEF and LGSS increased by 19.2 % and 27.9 %, respectively, and LV EDVi decreased by 19.0 %; the number of LV segments in which delayed enhancement was determined on cardiac MRI decreased by 30.7 %. With the help of regression analysis, it was established the presence of a set of factors that determine the priority of prescribing the sacubitril/valsartan combination as initial therapy in patients with severe myocarditis: presence of reduced LVEF – ≤40 %; pronounced decrease in longitudinal and circular global LV strain – ≤8.5 and ≤9.0 %, respectively; pronounced dilatation of the LV – EDVi ≥102 ml/m2; presence of III or higher HF functional class; presence of delayed enhancement in ≥ 5,0 LV segments according to cardiac MRI data.Conclusions. In patients with a severe course of myocarditis, the sacubitril/valsartan combination prescribed as initial therapy showed higher effectiveness compared to ACE inhibitors
{"title":"Вибір блокатора ренін-ангіотензин-альдостеронової системи для лікування серцевої недостатності при гострому міокардиті","authors":"E. G. Nesukay, V. Kovalenko, S. V. Cherniuk, R. M. Kirichenko, E.Yu. Titov, J. J. Giresh, O. V. Dmitrichenko, A. B. Slyvna","doi":"10.31928/664-4479-2024.2.3240","DOIUrl":"https://doi.org/10.31928/664-4479-2024.2.3240","url":null,"abstract":"The aim – to evaluate the effectiveness of sacubitril/valsartan and enalapril in heart failure treatment in patients with acute severe myocarditis with reduced left ventricular ejection fraction based on dynamic analysis of the heart structural and functional changes.Materials and methods. The study is based on the results of examinations of 90 patients with a severe course of acute myocarditis (AM) with reduced ejection fraction (EF) of the left ventricle (LV) – ≤40 %. The patients were divided into two groups: the 1st group included 48 patients who were treated with an angiotensin-converting enzyme (ACE) inhibitor – enalapril as part of heart failure (HF) therapy; the 2nd group included 42 patients with AM who received the sacubitril/valsartan combination instead of enalapril in the complex therapy of HF. All patients underwent a 6-minute walk test, echocardiography (EchoCG) with the speckle-tracking method, and cardiac magnetic resonance imaging (CMR). Examinations were carried out three times: in the 1st month from the onset of AM symptoms before the appointment of drug therapy, after 6 and 12 months of observation. Part of the patients from the 1st group, namely 25 patients (52.1 %) in whom the use of ACE inhibitors proved to be ineffective after six months, was transferred to the combination of sacubitril/valsartan (group 1A).Results and discussion. After six months of treatment, compared to the 1st group, the patients of the 2nd group were distinguished by better indicators of the structural and functional state of the heart, which characterise the contractility and volume of the LV – the values of LV EF and LV longitudinal global systolic strain (LGSS) were higher by 13,7 and 26.2 % respectively, LV end-diastolic volume index (EDVi) was 13.2% lower, as well as a 21.7 % lower number of LV segments in which delayed contrast was detected on cardiac MRI. After six months of taking the sacubitril/valsartan combination in 1A group patients, an improvement in the structural and functional state of the heart was also achieved: the values of LVEF and LGSS increased by 19.2 % and 27.9 %, respectively, and LV EDVi decreased by 19.0 %; the number of LV segments in which delayed enhancement was determined on cardiac MRI decreased by 30.7 %. With the help of regression analysis, it was established the presence of a set of factors that determine the priority of prescribing the sacubitril/valsartan combination as initial therapy in patients with severe myocarditis: presence of reduced LVEF – ≤40 %; pronounced decrease in longitudinal and circular global LV strain – ≤8.5 and ≤9.0 %, respectively; pronounced dilatation of the LV – EDVi ≥102 ml/m2; presence of III or higher HF functional class; presence of delayed enhancement in ≥ 5,0 LV segments according to cardiac MRI data.Conclusions. In patients with a severe course of myocarditis, the sacubitril/valsartan combination prescribed as initial therapy showed higher effectiveness compared to ACE inhibitors ","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141054955","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 : 2024-02-28DOI: 10.31928/2664-4479-2024.1.4658
V. I. Tseluyko, M. V. Kurinna
The aim – to investigate the possible influence of the level of interleukin-6 (IL-6) on the clinical course and remodeling of the right ventricle (RV) in patients with acute pulmonary embolism (PE).Materials and methods. 56 patients with a diagnosis of acute PE, confirmed by сomputed tomographic pulmonary angiography (CTPA), and in whom the level of IL-6 was determined, were studied. The patients were divided into two groups: 1 group with a normal IL-6 level (less than 5.9 pg/ml), 2 group with an elevated IL-6 level (more than 5.9 pg/ml). Clinical and anamnestic and laboratory-instrumental data were analyzed, statistical analysis of the resulting figures was carried out.Results and discussion. When comparing the groups depending on the level of IL-6, it was found that in group 1, not a single case of high-risk PE was recorded (p=0.052), while there was a significantly higher percentage of moderate-low-risk patients, p<0.05. Patients in group 2 had a higher heart rate (p=0.0006), lower SBP (p=0.04) at admission, and a tendency to increase body mass index (p=0.089). In addition, in group 2, the average levels of leukocytes (p=0.046), d-dimer (p=0.007), CRP (p=0.004) were higher, and the level of lymphocytes (p=0.008) was lower than in group 1, and the trend was determined to an increase in neutrophils (p=0.07) and CPK MB (p=0.89) in the 2nd group. According to the ultrasound data, in group 2 there was more often the detection of thrombosis of the veins of the lower extremities (p=0.003), a significantly larger size of the RV (p=0.02), a tendency to increase the size of the right atrium (RA) and a higher level of systolic pulmonary pressure (p=0.068 ). Analysis of the CTPA showed a greater dilatation of the left LA (p=0.0297) and an increase in the LV/LV index (p=0.0072) in the 2nd group. Correlation analysis revealed an inverse connection with the level of SpO2 (p=0.03) and lymphocytes (p=0.0065), a direct connection with heart rate (p<0.001), the ratio of LV/LV index (p=0.046), with the level of troponin I (p=0.014), D-dimer (p=0.026), leukocytes (p=0.026), neutrophils (0.038) and glucose (0.016), as well as the trend regarding the connection between the IL-6 level and the size of the RV according to echocardiography (p=0.07) and CPK MB level (p=0.086). The data of ROC analysis showed the connection of dilatation of the RV and Il-6 from the level of more than 7.65 pg/ml, with a sensitivity of the indicator of 90 %, specificity of 50 %.Conclusions. An Il-6 level increase is more common in elderly patients, patients with venous thrombosis of the lower extremities, tachycardia, hypotension, and with a greater risk of an adverse course during the hospital period. In 2 groups, a higher level of other markers of inflammation (leukocytes, CRP), larger sizes of the RV, a higher level of pulmonary artery pressure according to echocardiography and values of RV/LV according to CTPA results are observed. A direct connection between IL-6 level and heart rate,
{"title":"Зв’язок рівня інтерлейкіну-6 з клінічним перебігом гострої тромбоемболії легеневої артерії","authors":"V. I. Tseluyko, M. V. Kurinna","doi":"10.31928/2664-4479-2024.1.4658","DOIUrl":"https://doi.org/10.31928/2664-4479-2024.1.4658","url":null,"abstract":"The aim – to investigate the possible influence of the level of interleukin-6 (IL-6) on the clinical course and remodeling of the right ventricle (RV) in patients with acute pulmonary embolism (PE).Materials and methods. 56 patients with a diagnosis of acute PE, confirmed by сomputed tomographic pulmonary angiography (CTPA), and in whom the level of IL-6 was determined, were studied. The patients were divided into two groups: 1 group with a normal IL-6 level (less than 5.9 pg/ml), 2 group with an elevated IL-6 level (more than 5.9 pg/ml). Clinical and anamnestic and laboratory-instrumental data were analyzed, statistical analysis of the resulting figures was carried out.Results and discussion. When comparing the groups depending on the level of IL-6, it was found that in group 1, not a single case of high-risk PE was recorded (p=0.052), while there was a significantly higher percentage of moderate-low-risk patients, p<0.05. Patients in group 2 had a higher heart rate (p=0.0006), lower SBP (p=0.04) at admission, and a tendency to increase body mass index (p=0.089). In addition, in group 2, the average levels of leukocytes (p=0.046), d-dimer (p=0.007), CRP (p=0.004) were higher, and the level of lymphocytes (p=0.008) was lower than in group 1, and the trend was determined to an increase in neutrophils (p=0.07) and CPK MB (p=0.89) in the 2nd group. According to the ultrasound data, in group 2 there was more often the detection of thrombosis of the veins of the lower extremities (p=0.003), a significantly larger size of the RV (p=0.02), a tendency to increase the size of the right atrium (RA) and a higher level of systolic pulmonary pressure (p=0.068 ). Analysis of the CTPA showed a greater dilatation of the left LA (p=0.0297) and an increase in the LV/LV index (p=0.0072) in the 2nd group. Correlation analysis revealed an inverse connection with the level of SpO2 (p=0.03) and lymphocytes (p=0.0065), a direct connection with heart rate (p<0.001), the ratio of LV/LV index (p=0.046), with the level of troponin I (p=0.014), D-dimer (p=0.026), leukocytes (p=0.026), neutrophils (0.038) and glucose (0.016), as well as the trend regarding the connection between the IL-6 level and the size of the RV according to echocardiography (p=0.07) and CPK MB level (p=0.086). The data of ROC analysis showed the connection of dilatation of the RV and Il-6 from the level of more than 7.65 pg/ml, with a sensitivity of the indicator of 90 %, specificity of 50 %.Conclusions. An Il-6 level increase is more common in elderly patients, patients with venous thrombosis of the lower extremities, tachycardia, hypotension, and with a greater risk of an adverse course during the hospital period. In 2 groups, a higher level of other markers of inflammation (leukocytes, CRP), larger sizes of the RV, a higher level of pulmonary artery pressure according to echocardiography and values of RV/LV according to CTPA results are observed. A direct connection between IL-6 level and heart rate, ","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"30 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140418610","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 : 2024-02-28DOI: 10.31928/2664-4479-2024.1.7989
O. Matova, L. Mishchenko, T. Talayeva, O. B. Kuchmenko
The aim – to evaluate the incidence of cardiovascular and renal complications and its predictors in resistant hypertensive (RH) patients during the long-term follow-up.Materials and methods. The frequency of cardiovascular and renal events was studied in 240 true resistant hypertensive patients. The duration of observation was 5.1±0.1 years. The comparison group consisted of 228 patients with controlled arterial hypertension (CAH) on a triple combination antihypertensive therapy. Cardiovascular endpoints included stroke/transient ischemic attack, myocardial infarction, cardiovascular death, myocardial revascularization, development of atrial fibrillation, hospitalization due to heart failure, and lower limb arterial disease. Kidney outcomes included dialysis or GFR decline by 40 % or greater. All the endpoints formed a composite primary endpoint. New cases of type 2 diabetes mellitus were also estimated.Results and discussion. The patients with resistant hypertension on multi-component antihypertensive therapy and significant reduction in arterial blood pressure (BP) levels (achievement of controlled office BP in 49.6 % of patients, office and ambulatory BP in 34.2 % of patients), maintained a higher risk of cardiovascular and renal events compared to patients with controlled arterial hypertension. It was found that the frequency of occurrence of the composite primary endpoint in resistant hypertensive patients was four times higher than in the group of patients with controlled hypertension – 30.0 % (72/240) versus 7.0 % (16/228) (p=0.001). The frequency of new cases of type 2 diabetes mellitus in patients with RH exceeded compared to CAH patients by 3.7 times (p=0.03).Conclusions. Independent predictors of the risk of cardiovascular and renal complications in patients with RH were the initial indicators of circulating endothelial progenitor cells if their concentration in the blood was ≤ 1818 cells/ml (HR 0.41; 95 % CI (0.21–0.79); p=0.007), the content of citrulline in the blood is more than 68 μmol/l (HR 1.13; 95 % CI (1.07–1.20); p<0.001); value of initial average daily systolic BP > 163 mm Hg (HR 1.10; 95 % CI (1.03–1.18); p=0.008).
目的--评估长期随访期间抵抗性高血压（RH）患者心血管和肾脏并发症的发生率及其预测因素。对 240 名真正的抵抗性高血压患者的心血管和肾脏事件发生率进行了研究。观察时间为 5.1±0.1 年。对比组包括 228 名接受三联降压疗法的受控动脉高血压（CAH）患者。心血管终点包括中风/短暂性脑缺血发作、心肌梗死、心血管死亡、心肌血运重建、心房颤动、心力衰竭住院和下肢动脉疾病。肾脏结果包括透析或 GFR 下降 40% 或更多。所有终点构成一个综合主要终点。此外，还估算了新增的2型糖尿病病例。与动脉高血压得到控制的患者相比，接受多组分降压治疗并显著降低动脉血压（49.6% 的患者实现了诊室血压控制，34.2% 的患者实现了诊室和非诊室血压控制）的抵抗性高血压患者发生心血管和肾脏事件的风险更高。研究发现，抵抗性高血压患者发生复合主要终点的频率是控制性高血压患者的四倍--30.0%（72/240）对 7.0%（16/228）（P=0.001）。RH患者新发2型糖尿病的频率是CAH患者的3.7倍（P=0.03）。RH患者心血管和肾脏并发症风险的独立预测因素是循环内皮祖细胞的初始指标，如果其在血液中的浓度低于1818个细胞/毫升（HR 0.41; 95 % CI (0.21-0.79); p=0.007），血液中瓜氨酸含量超过 68 μmol/l (HR 1.13; 95 % CI (1.07-1.20); p 163 mm Hg (HR 1.10; 95 % CI (1.03-1.18); p=0.008)。
{"title":"Predictors of cardiovascular and renal complications in patients with resistant arterial hypertension during long-term follow-up","authors":"O. Matova, L. Mishchenko, T. Talayeva, O. B. Kuchmenko","doi":"10.31928/2664-4479-2024.1.7989","DOIUrl":"https://doi.org/10.31928/2664-4479-2024.1.7989","url":null,"abstract":"The aim – to evaluate the incidence of cardiovascular and renal complications and its predictors in resistant hypertensive (RH) patients during the long-term follow-up.Materials and methods. The frequency of cardiovascular and renal events was studied in 240 true resistant hypertensive patients. The duration of observation was 5.1±0.1 years. The comparison group consisted of 228 patients with controlled arterial hypertension (CAH) on a triple combination antihypertensive therapy. Cardiovascular endpoints included stroke/transient ischemic attack, myocardial infarction, cardiovascular death, myocardial revascularization, development of atrial fibrillation, hospitalization due to heart failure, and lower limb arterial disease. Kidney outcomes included dialysis or GFR decline by 40 % or greater. All the endpoints formed a composite primary endpoint. New cases of type 2 diabetes mellitus were also estimated.Results and discussion. The patients with resistant hypertension on multi-component antihypertensive therapy and significant reduction in arterial blood pressure (BP) levels (achievement of controlled office BP in 49.6 % of patients, office and ambulatory BP in 34.2 % of patients), maintained a higher risk of cardiovascular and renal events compared to patients with controlled arterial hypertension. It was found that the frequency of occurrence of the composite primary endpoint in resistant hypertensive patients was four times higher than in the group of patients with controlled hypertension – 30.0 % (72/240) versus 7.0 % (16/228) (p=0.001). The frequency of new cases of type 2 diabetes mellitus in patients with RH exceeded compared to CAH patients by 3.7 times (p=0.03).Conclusions. Independent predictors of the risk of cardiovascular and renal complications in patients with RH were the initial indicators of circulating endothelial progenitor cells if their concentration in the blood was ≤ 1818 cells/ml (HR 0.41; 95 % CI (0.21–0.79); p=0.007), the content of citrulline in the blood is more than 68 μmol/l (HR 1.13; 95 % CI (1.07–1.20); p<0.001); value of initial average daily systolic BP > 163 mm Hg (HR 1.10; 95 % CI (1.03–1.18); p=0.008).","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"52 S28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140422838","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 : 2024-02-28DOI: 10.31928/2664-4479-2024.1.733
Sokolov Maksym, М Ю Соколов, І В Данильчук, Д. І. Беш, А. І. Кланца, В. О. Колесник, Олег Рафалюк, В. М. Сало, С. В. Сало, Л.В. Сорохтей, С.М. Фуркало
In 2022, the number of coronary angiograms in Ukrainian clinics was 51 084, which is 27.6 % more than in 2019, the number of stented patients is 27 513 for all forms of coronary artery disease (scheduled and urgent patients), which is 19.7 % more than in 2019 year and 16 847 stenting were performed in STEMI patients in the first day from the onset of symptoms, which is 12.9 % more than in 2019.During the period of the Register operation, the fact of creation of 66 reperfusion centers was recorded, which are the main part of Regional Reperfusion Networks (RRN) and strive to function in accordance with national unified protocols for the treatment of STEMI, NSTEMI and stable coronary syndromes.Today, the distribution of patients by time from the onset of symptoms to mechanical reperfusion in Ukraine is distributed as follows: in the first 12 hours from the onset of STEMI symptoms, 85 % are present (15 % are «late» patients who are hospitalized at 12–24 hours from the onset of symptoms or later, often requiring urgent coronary angiography and possibly primary stenting). Patients arriving in the «ideal» period for reperfusion (in the first 2 hours) is about 15 %, the largest group of STEMI patients who arrived at the clinic in the first 2–4 hours from the onset of symptoms is 30 %, and the number of patients with AMI in the period of 4–6 hours from the onset of symptoms, the average is 25 %, and the 6–12-hour group completes the analysis by 15 %, respectively.The number of procedures in STEMI patients increased annually, which led to a decrease in hospital mortality in reperfusion centers (55–60 % of patients in catheterization laboratories in Ukraine are STEMI patients) to an average of 4.7 %, and in the general group of AMI in Ukraine to 12.3 %. Unfortunately, 40–45 % of patients are currently hospitalized in clinics without the possibility of primary stenting.A ten-year observation of the dynamics of primary stenting revealed changes, which we called the «reperfusion paradox», which occurred in 2015–2016, which fully confirmed the correct vector of technology development and determined the trend of its development. This phenomenon is the beginning of a natural decrease in the number of fibrinolytic procedures from 27 % (2010 year) to 4.6 % (2021 year), respectively, and an increase in the number of primary procedures in STEMI patients from 4.0 % (2010 year) to 56.4 % (2022 year), which is quite natural and confirms the processes of active development and systemic transformations in interventional cardiology in Ukraine and around the world.As a result, it was found that we have increased 17 times the number of primary percutaneous interventions per million population over the last decade, while European countries have increased the number of similar procedures by only 14 %. This fact indicates the correct direction of development and the speed of movement in this direction.
{"title":"Реєстр перкутанних коронарних втручань: зміни за останні роки (2010–2022)","authors":"Sokolov Maksym, М Ю Соколов, І В Данильчук, Д. І. Беш, А. І. Кланца, В. О. Колесник, Олег Рафалюк, В. М. Сало, С. В. Сало, Л.В. Сорохтей, С.М. Фуркало","doi":"10.31928/2664-4479-2024.1.733","DOIUrl":"https://doi.org/10.31928/2664-4479-2024.1.733","url":null,"abstract":"In 2022, the number of coronary angiograms in Ukrainian clinics was 51 084, which is 27.6 % more than in 2019, the number of stented patients is 27 513 for all forms of coronary artery disease (scheduled and urgent patients), which is 19.7 % more than in 2019 year and 16 847 stenting were performed in STEMI patients in the first day from the onset of symptoms, which is 12.9 % more than in 2019.During the period of the Register operation, the fact of creation of 66 reperfusion centers was recorded, which are the main part of Regional Reperfusion Networks (RRN) and strive to function in accordance with national unified protocols for the treatment of STEMI, NSTEMI and stable coronary syndromes.Today, the distribution of patients by time from the onset of symptoms to mechanical reperfusion in Ukraine is distributed as follows: in the first 12 hours from the onset of STEMI symptoms, 85 % are present (15 % are «late» patients who are hospitalized at 12–24 hours from the onset of symptoms or later, often requiring urgent coronary angiography and possibly primary stenting). Patients arriving in the «ideal» period for reperfusion (in the first 2 hours) is about 15 %, the largest group of STEMI patients who arrived at the clinic in the first 2–4 hours from the onset of symptoms is 30 %, and the number of patients with AMI in the period of 4–6 hours from the onset of symptoms, the average is 25 %, and the 6–12-hour group completes the analysis by 15 %, respectively.The number of procedures in STEMI patients increased annually, which led to a decrease in hospital mortality in reperfusion centers (55–60 % of patients in catheterization laboratories in Ukraine are STEMI patients) to an average of 4.7 %, and in the general group of AMI in Ukraine to 12.3 %. Unfortunately, 40–45 % of patients are currently hospitalized in clinics without the possibility of primary stenting.A ten-year observation of the dynamics of primary stenting revealed changes, which we called the «reperfusion paradox», which occurred in 2015–2016, which fully confirmed the correct vector of technology development and determined the trend of its development. This phenomenon is the beginning of a natural decrease in the number of fibrinolytic procedures from 27 % (2010 year) to 4.6 % (2021 year), respectively, and an increase in the number of primary procedures in STEMI patients from 4.0 % (2010 year) to 56.4 % (2022 year), which is quite natural and confirms the processes of active development and systemic transformations in interventional cardiology in Ukraine and around the world.As a result, it was found that we have increased 17 times the number of primary percutaneous interventions per million population over the last decade, while European countries have increased the number of similar procedures by only 14 %. This fact indicates the correct direction of development and the speed of movement in this direction.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140418347","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 : 2024-02-28DOI: 10.31928/2664-4479-2024.1.3445
O. Shumakov, O. Parkhomenko, Y. Lutay, D. V. Khomiakov
The aim – to develop a diagnostic system that takes into account the peculiarities of clinical, instrumental and laboratory indicators in patients with STEMI against the background of wartime and will allow to objectify a tendency to a more difficult hospital course of ACS.Materials and methods. We studied a cohort of patients (n=133 individuals, 77.4 % men, average age 61.8±0.9 years) with STEMI, part of which (group 1) was hospitalized from February to May 2019 (n=87), while another part of which (group 2) was hospitalized in the period from February 24, 2022 to March 2023 (n=46) within the first 24 hours from the development of symptoms of the disease (average time of admission 5.2±0.4 hours). The groups were compared according to the clinical and anamnestic and laboratory parameters of the first day.Results and discussion. It was found that in the Ukrainian population during wartime, patients with STEMI are admitted to the hospital later, have a more burdensome history of cerebrovascular diseases, a greater number of significant coronary stenoses, a higher percentage of smokers, and also have higher heart rate levels upon admission, ESR, triglycerides, leukocytes (at the expense of lymphocytes and monocytes), as well as platelets (with lower indicators of their size inhomogeneity). Also, invasive treatment of these lesions leads to slightly worse results on the TIMI and MBG scales. Informativeness of hematology analysis indicators and other markers of inflammation/stress on the first day of STEMI in wartime was evaluated for predicting the risk of an complicated course of the hospital period (development of cardiac death, signs of LVEF, ventricular tachyarrhythmias, stent thrombosis, acute renal dysfunction, recurrence of ACS/angina). It was found that predictors of the undesirable course of STEMI during wartime are: heart rate > 70/min, ESR > 10 mm/h, glucose level > 8.5 mmol/l, leukocytes > 13 · 109/l, lymphocytes > 2 · 109/l, platelets > 270 · 109/l, large (>12 fl) platelets < 27 %, triglycerides > 1.3 mmol/l, as well as combined criteria made up of these indicators. Thus, the 6-component score (heart rate, ESR, glucose, levels of leukocytes, lymphocytes, and platelets) had an area under the ROC curve of 0.87 (for values > 30 units – BP 6.39 (2.16–18.9), p<0.0001) when determining the risk of an undesirable course of ACS in patients during wartime. These predictors are specific to the stress-induced effects of war and are not informative in peacetime STEMI patients.Conclusions. The coexistence of acute stress caused by STEMI with chronic exposure to stress-associated wartime factors can worsen the course of the hospital period of STEMI, which is associated with an increase in heart rate, ESR, glucose level, leukocytes, lymphocytes, triglycerides, platelets with a decrease in their inhomogeneity in size. Taking into account these features allows predicting the risk of a complicated course of the hospital period of the STEMI in wartime.
{"title":"Diagnostic value of clinical-instrumental and hematological indicators in predicting complications of the hospital period of STEMI in conditions of chronic stress caused by wartime","authors":"O. Shumakov, O. Parkhomenko, Y. Lutay, D. V. Khomiakov","doi":"10.31928/2664-4479-2024.1.3445","DOIUrl":"https://doi.org/10.31928/2664-4479-2024.1.3445","url":null,"abstract":"The aim – to develop a diagnostic system that takes into account the peculiarities of clinical, instrumental and laboratory indicators in patients with STEMI against the background of wartime and will allow to objectify a tendency to a more difficult hospital course of ACS.Materials and methods. We studied a cohort of patients (n=133 individuals, 77.4 % men, average age 61.8±0.9 years) with STEMI, part of which (group 1) was hospitalized from February to May 2019 (n=87), while another part of which (group 2) was hospitalized in the period from February 24, 2022 to March 2023 (n=46) within the first 24 hours from the development of symptoms of the disease (average time of admission 5.2±0.4 hours). The groups were compared according to the clinical and anamnestic and laboratory parameters of the first day.Results and discussion. It was found that in the Ukrainian population during wartime, patients with STEMI are admitted to the hospital later, have a more burdensome history of cerebrovascular diseases, a greater number of significant coronary stenoses, a higher percentage of smokers, and also have higher heart rate levels upon admission, ESR, triglycerides, leukocytes (at the expense of lymphocytes and monocytes), as well as platelets (with lower indicators of their size inhomogeneity). Also, invasive treatment of these lesions leads to slightly worse results on the TIMI and MBG scales. Informativeness of hematology analysis indicators and other markers of inflammation/stress on the first day of STEMI in wartime was evaluated for predicting the risk of an complicated course of the hospital period (development of cardiac death, signs of LVEF, ventricular tachyarrhythmias, stent thrombosis, acute renal dysfunction, recurrence of ACS/angina). It was found that predictors of the undesirable course of STEMI during wartime are: heart rate > 70/min, ESR > 10 mm/h, glucose level > 8.5 mmol/l, leukocytes > 13 · 109/l, lymphocytes > 2 · 109/l, platelets > 270 · 109/l, large (>12 fl) platelets < 27 %, triglycerides > 1.3 mmol/l, as well as combined criteria made up of these indicators. Thus, the 6-component score (heart rate, ESR, glucose, levels of leukocytes, lymphocytes, and platelets) had an area under the ROC curve of 0.87 (for values > 30 units – BP 6.39 (2.16–18.9), p<0.0001) when determining the risk of an undesirable course of ACS in patients during wartime. These predictors are specific to the stress-induced effects of war and are not informative in peacetime STEMI patients.Conclusions. The coexistence of acute stress caused by STEMI with chronic exposure to stress-associated wartime factors can worsen the course of the hospital period of STEMI, which is associated with an increase in heart rate, ESR, glucose level, leukocytes, lymphocytes, triglycerides, platelets with a decrease in their inhomogeneity in size. Taking into account these features allows predicting the risk of a complicated course of the hospital period of the STEMI in wartime.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"67 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140419603","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}
Heart failure with preserved ejection fraction (HFpEF) is characterized by signs and symptoms of heart failure in the presence of a normal left ventricular ejection fraction. HFpEF is a heterogeneous syndrome with diverse etiology and pathophysiological factors. HFpEF is a disease that develops by several pathophysiological mechanisms, although many of them remain unclear due to limited access to human heart tissue. At the heart of the mechanisms of HFpEF pathogenesis are disturbances in the handling of calcium ions in cardiomyocytes and endothelial dysfunction, which occurs as a result of numerous factors. Endothelial defects usually include impaired vasodilation, increased vasoconstriction, arterial stiffness, and atherogenesis. Endothelial dysfunction, the main consequence of which is insufficient NO availability, is associated with adverse events in patients with HFpEF. Compared with HFpEF patients without coronary endothelial dysfunction, patients with impaired endothelial function are characterized by more severe clinical outcomes, especially those associated with type 2 diabetes and obesity.In the heart tissue of an adult, there are mixed populations of macrophages. The ratio of macrophages of different origins changes with aging and the progression of various CVDs, depending on gender and type of cardiovascular dysfunction. Macrophages play important roles in the development and progression of СН. The role of macrophages in the pathogenesis of hypertension, obesity, diabetes, renal dysfunction, which are risk factors leading to СН, is crucial.Analysis of human endomyocardial biopsies has shown that HFpEF patients exhibit a gene expression profile distinct from HfrEF patients and normal controls.The study of these and other mechanisms of the pathogenesis of HFpEF will reveal new promising therapeutic targets for the treatment of heart failure.
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