Pub Date : 2020-10-01DOI: 10.31928/1608-635x-2020.4.6977
O. Onyshchenko, O. Yepanchintseva, D. V. Riabenko, B. Todurov
A clinical case of the development of classic Dressler syndrome in a young patient with acute diffuse myocarditis is described. Timely diagnosis, administration of glucocorticoid and long-term complex therapy using beta-blockers (carvedilol), mineralocorticoid receptor blockers (eplerenone) not only led to the disappearance of Dressler’s syndrome, but also to a fairly rapid recovery of the patient from the underlying disease.
{"title":"A case of the development of Dressler syndrome in a patient with acute diffuse myocarditis","authors":"O. Onyshchenko, O. Yepanchintseva, D. V. Riabenko, B. Todurov","doi":"10.31928/1608-635x-2020.4.6977","DOIUrl":"https://doi.org/10.31928/1608-635x-2020.4.6977","url":null,"abstract":"A clinical case of the development of classic Dressler syndrome in a young patient with acute diffuse myocarditis is described. Timely diagnosis, administration of glucocorticoid and long-term complex therapy using beta-blockers (carvedilol), mineralocorticoid receptor blockers (eplerenone) not only led to the disappearance of Dressler’s syndrome, but also to a fairly rapid recovery of the patient from the underlying disease.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"16 1","pages":"69-77"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81963791","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 : 2020-10-01DOI: 10.31928/1608-635x-2020.4.1824
V. V. Matiy, M. Rishko, O. O. Kutsin
The aim – to investigate the clinical and functional parameters features in acute coronary syndrome and coronary artery bypass grafting history patients.Materials and methods. 68 patients with acute coronary syndrome (ACS) were examined according to the current protocols, in 30 of them there was a history of coronary artery bypass grafting (ACS and CABG group) and 38 patients who didn’t undergo CABG (ACS without CABG group). Physical and laboratory-instrumental methods of investigation, including ECG, echocardiography, coronary ventriculography, coronary artery bypass graft angiography and methods of variation statistics were used in the work.Results and discussion. Among patients with ACS and CABG, a history of a higher incidence and duration of stable angina pectoris, arterial hypertension, diabetes mellitus, and multiple concomitant pathology had been found in comparison with the ACS without CABG group. History of ACS and CABG patients comprised a higher incidence of ACS without ST segment elevation in comparison with ACS without CABG group, repeated ACS, heart failure progression and those patients needed significantly longer stay in ICU than ACS without CABG group. Electrocardiograms of patients with ACS and CABG vs ACS without CABG group were characterized by a significantly higher incidence of pathological Q, atrial and ventricular fibrillation, as well as a combined disturbances of rhythm and conduction. Echocardiography revealed a significantly lower ejection fraction, increase in left atrium size and an E/A ratio in the ACS and CABG group, indicating worse heart failure compensation as well as systolic and diastolic dysfunction with dysfunctional of left ventricular than in ACS without CABG patients.Conclusions. Acute coronary syndrome with coronary artery bypass grafting history patients are characterized by a complicated history and clinical course with more significant electrocardiogram and echocardiography changes in comparison to the group of acute coronary syndrome patients without prior coronary artery bypass grafting history.
{"title":"Clinical and functional features of patients with acute coronary syndrome and history of coronary artery bypass grafting","authors":"V. V. Matiy, M. Rishko, O. O. Kutsin","doi":"10.31928/1608-635x-2020.4.1824","DOIUrl":"https://doi.org/10.31928/1608-635x-2020.4.1824","url":null,"abstract":"The aim – to investigate the clinical and functional parameters features in acute coronary syndrome and coronary artery bypass grafting history patients.Materials and methods. 68 patients with acute coronary syndrome (ACS) were examined according to the current protocols, in 30 of them there was a history of coronary artery bypass grafting (ACS and CABG group) and 38 patients who didn’t undergo CABG (ACS without CABG group). Physical and laboratory-instrumental methods of investigation, including ECG, echocardiography, coronary ventriculography, coronary artery bypass graft angiography and methods of variation statistics were used in the work.Results and discussion. Among patients with ACS and CABG, a history of a higher incidence and duration of stable angina pectoris, arterial hypertension, diabetes mellitus, and multiple concomitant pathology had been found in comparison with the ACS without CABG group. History of ACS and CABG patients comprised a higher incidence of ACS without ST segment elevation in comparison with ACS without CABG group, repeated ACS, heart failure progression and those patients needed significantly longer stay in ICU than ACS without CABG group. Electrocardiograms of patients with ACS and CABG vs ACS without CABG group were characterized by a significantly higher incidence of pathological Q, atrial and ventricular fibrillation, as well as a combined disturbances of rhythm and conduction. Echocardiography revealed a significantly lower ejection fraction, increase in left atrium size and an E/A ratio in the ACS and CABG group, indicating worse heart failure compensation as well as systolic and diastolic dysfunction with dysfunctional of left ventricular than in ACS without CABG patients.Conclusions. Acute coronary syndrome with coronary artery bypass grafting history patients are characterized by a complicated history and clinical course with more significant electrocardiogram and echocardiography changes in comparison to the group of acute coronary syndrome patients without prior coronary artery bypass grafting history.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"2079 1","pages":"18-24"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91331255","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 : 2020-10-01DOI: 10.31928/1608-635x-2020.4.2534
N. Tkach, O. L. Filatova, T. Gavrilenko, G. Dudnik, N. Lipkan, L. Voronkov
The aim – to compare clinical and instrumental parameters in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF) depending on the presence of type II diabetes mellitus.Materials and methods. 490 case histories of patients in the period from 2011 to 2018 with CHF, 40–80 years of age (median – 64 years), II–IV NYHA functional class, LVEF ≤ 40 % were analyzed. The study group included mainly patients with coronary heart disease (CHD) in combination with hypertension – 403 (82.2 %) patients, with isolated CHD – 55 (11.2 %) and with hypertension – 32 (6.6 %) patients. Most patients (278 (56.7 %)) had a permanent form of atrial fibrillation. Among the subjects were 373 (76.1 %) men and 117 (23.9 %) women. Patients were included in the study in the phase of clinical compensation, i.e. in the euvolemic state. All patients were divided into two groups: group I included 338 (69 %) patients with CHF and reduced LVEF without diabetes; group II consisted of 152 (31 %) patients with CHF and reduced LVEF with type II diabetes.Results and discussion. The analysis revealed no significant differences among patients in the study groups by age, general hemodynamic parameters, mean daily heart rate, NYHA functional class, concomitant chronic obstructive pulmonary disease and the duration of CHF. A lower percentage of patients with atrial fibrillation in group II, a higher BMI in patients in group I, Е/е´ and left ventricular myocardial mass index were higher in patients without concomitant diabetes. In the study, we obtained a significantly higher uric acid level in patients with concomitant diabetes mellitus 2 and did not receive statistical differences in oxidative stress and proinflammatory markers, NT-proBNP and insulin. There was also no significant difference in the values of flow-dependent endothelial dysfunction. The combination of coronary heart disease and diabetes mellitus 2 has been shown to be a major factor of high mortality in patients with CHF. However, we did not find a difference in the life expectancy of patients with CHF and reduced LVEF with and without diabetes. We also had a significantly worse survival of patients with HbA1с above 7.4 %.Conclusions. The 5-year survival of patients with CHF with reduced LVEF with and without diabetes mellitus 2 does not differ significantly, while among the general group of patients the worst 5-year survival was demonstrated by those with HbA1с higher than 7.4 %.
{"title":"Clinical and instrumental characteristics of patients with chronic heart failure and reduced left ventricular ejection fraction depending on the presence of type II diabetes mellitus","authors":"N. Tkach, O. L. Filatova, T. Gavrilenko, G. Dudnik, N. Lipkan, L. Voronkov","doi":"10.31928/1608-635x-2020.4.2534","DOIUrl":"https://doi.org/10.31928/1608-635x-2020.4.2534","url":null,"abstract":"The aim – to compare clinical and instrumental parameters in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF) depending on the presence of type II diabetes mellitus.Materials and methods. 490 case histories of patients in the period from 2011 to 2018 with CHF, 40–80 years of age (median – 64 years), II–IV NYHA functional class, LVEF ≤ 40 % were analyzed. The study group included mainly patients with coronary heart disease (CHD) in combination with hypertension – 403 (82.2 %) patients, with isolated CHD – 55 (11.2 %) and with hypertension – 32 (6.6 %) patients. Most patients (278 (56.7 %)) had a permanent form of atrial fibrillation. Among the subjects were 373 (76.1 %) men and 117 (23.9 %) women. Patients were included in the study in the phase of clinical compensation, i.e. in the euvolemic state. All patients were divided into two groups: group I included 338 (69 %) patients with CHF and reduced LVEF without diabetes; group II consisted of 152 (31 %) patients with CHF and reduced LVEF with type II diabetes.Results and discussion. The analysis revealed no significant differences among patients in the study groups by age, general hemodynamic parameters, mean daily heart rate, NYHA functional class, concomitant chronic obstructive pulmonary disease and the duration of CHF. A lower percentage of patients with atrial fibrillation in group II, a higher BMI in patients in group I, Е/е´ and left ventricular myocardial mass index were higher in patients without concomitant diabetes. In the study, we obtained a significantly higher uric acid level in patients with concomitant diabetes mellitus 2 and did not receive statistical differences in oxidative stress and proinflammatory markers, NT-proBNP and insulin. There was also no significant difference in the values of flow-dependent endothelial dysfunction. The combination of coronary heart disease and diabetes mellitus 2 has been shown to be a major factor of high mortality in patients with CHF. However, we did not find a difference in the life expectancy of patients with CHF and reduced LVEF with and without diabetes. We also had a significantly worse survival of patients with HbA1с above 7.4 %.Conclusions. The 5-year survival of patients with CHF with reduced LVEF with and without diabetes mellitus 2 does not differ significantly, while among the general group of patients the worst 5-year survival was demonstrated by those with HbA1с higher than 7.4 %.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"14 1","pages":"25-34"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75813312","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 : 2020-10-01DOI: 10.31928/1608-635x-2020.4.9098
O. Kovalyova
The article is dedicated to the strategy of management of arterial hypertension in older patients based on the Guidelines of the International Society of Hypertension, the European Society of Cardiology, the European and the American Society of Hypertension, the American College of Physicians and the American Academy of Family Physicians. According to the results of epidemiological and clinical investigations is shown the influence of high blood pressure on cardiovascular outcomes and mortality in the population of older persons. Due to the analyses of randomised controlled trials is pointed out the convicing data the need for differtntiated control of blood pressure according to the level of arterial hypertension and factors of cardiovascular risk. The methodology of initial antihypertensive therapy in persons of different age groups is taken in comparative aspects. The main discussed questions related to the blood pressure targets in the dynamics of antihypertensive treatment in patients 65–79 years and age ≥ 80 years are emphasized. The requirements for individual medical tactics of older hypertensive patients taken into account anamnesis, fit and mental state, clinical features, comorbidity, complications and hypertension-mediated organ damages are recommended.
{"title":"Treatment of hypertension in older patients","authors":"O. Kovalyova","doi":"10.31928/1608-635x-2020.4.9098","DOIUrl":"https://doi.org/10.31928/1608-635x-2020.4.9098","url":null,"abstract":"The article is dedicated to the strategy of management of arterial hypertension in older patients based on the Guidelines of the International Society of Hypertension, the European Society of Cardiology, the European and the American Society of Hypertension, the American College of Physicians and the American Academy of Family Physicians. According to the results of epidemiological and clinical investigations is shown the influence of high blood pressure on cardiovascular outcomes and mortality in the population of older persons. Due to the analyses of randomised controlled trials is pointed out the convicing data the need for differtntiated control of blood pressure according to the level of arterial hypertension and factors of cardiovascular risk. The methodology of initial antihypertensive therapy in persons of different age groups is taken in comparative aspects. The main discussed questions related to the blood pressure targets in the dynamics of antihypertensive treatment in patients 65–79 years and age ≥ 80 years are emphasized. The requirements for individual medical tactics of older hypertensive patients taken into account anamnesis, fit and mental state, clinical features, comorbidity, complications and hypertension-mediated organ damages are recommended.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"373 1","pages":"90-98"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76193142","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 : 2020-10-01DOI: 10.31928/1608-635x-2020.4.4553
N. Bezditko
The aim – assessment of pharmacoeconomic feasibility of use for the prevention of thromboembolic complications (cerebral or systemic embolism) in patients with atrial fibrillation indirect anticoagulant warfarin compared with oral anticoagulants direct action in the modern Ukrainian health care system.Materials and methods. Used pharmacoeconomic methods to minimize costs, the mysterious cost of the disease. The supply of medications was determined according to the methodology of PBX/DDD, the economic affordability of medications was determined according to the value of the indicator Ca.s.Results and discussion. Drug consumption was determined according to the ATC/DDD methodology based on the data of the drug market research system Pharmexplorer, the economic availability of drugs was determined according to the value of Ca.s. An analysis of the comparative efficacy and safety of NOAC and warfarin according to the latest systematic reviews and meta-analyzes. According to the results of the analysis of the pharmaceutical market, it is established that currently in active retail sale in Ukraine there are 15 drugs NOAC (2 drugs apixaban, 6 drugs dabigatran and 7 drugs rivaroxaban) and 11 medications warfarin from 4 manufacturers. It is determined which drugs containing the same substance are the cheapest in terms of the cost of one DDD. It is established that the indicator of Ca.s. 80 % of warfarin drugs are moderately available, and all NOAC s are not available. The level of total consumption of anticoagulant drugs in Ukraine in 2019 was 1.7 DDDs, which, taking into account the prevalence of AF, suggests the existence of a significant number of patients with AF who do not receive appropriate anticoagulant therapy. It is established that the level of drug consumption does not depend on the cost of the drug.Conclusions. Under the current conditions of the health care system of Ukraine, warfarin is a more cost-effective drug for the treatment of atrial fibrillation in comparison with NOAC, which should be taken into account when implementing individualized pharmacotherapy of patients. According to the analysis of consumption volumes, it can be assumed that in Ukraine there is a large number of patients with AF who do not receive anticoagulant therapy.
{"title":"Pharmacoeconomic aspects of warfarin and new oral anticoagulants use as prevention of thromboembolic complications in patients with atrial fibrillation","authors":"N. Bezditko","doi":"10.31928/1608-635x-2020.4.4553","DOIUrl":"https://doi.org/10.31928/1608-635x-2020.4.4553","url":null,"abstract":"The aim – assessment of pharmacoeconomic feasibility of use for the prevention of thromboembolic complications (cerebral or systemic embolism) in patients with atrial fibrillation indirect anticoagulant warfarin compared with oral anticoagulants direct action in the modern Ukrainian health care system.Materials and methods. Used pharmacoeconomic methods to minimize costs, the mysterious cost of the disease. The supply of medications was determined according to the methodology of PBX/DDD, the economic affordability of medications was determined according to the value of the indicator Ca.s.Results and discussion. Drug consumption was determined according to the ATC/DDD methodology based on the data of the drug market research system Pharmexplorer, the economic availability of drugs was determined according to the value of Ca.s. An analysis of the comparative efficacy and safety of NOAC and warfarin according to the latest systematic reviews and meta-analyzes. According to the results of the analysis of the pharmaceutical market, it is established that currently in active retail sale in Ukraine there are 15 drugs NOAC (2 drugs apixaban, 6 drugs dabigatran and 7 drugs rivaroxaban) and 11 medications warfarin from 4 manufacturers. It is determined which drugs containing the same substance are the cheapest in terms of the cost of one DDD. It is established that the indicator of Ca.s. 80 % of warfarin drugs are moderately available, and all NOAC s are not available. The level of total consumption of anticoagulant drugs in Ukraine in 2019 was 1.7 DDDs, which, taking into account the prevalence of AF, suggests the existence of a significant number of patients with AF who do not receive appropriate anticoagulant therapy. It is established that the level of drug consumption does not depend on the cost of the drug.Conclusions. Under the current conditions of the health care system of Ukraine, warfarin is a more cost-effective drug for the treatment of atrial fibrillation in comparison with NOAC, which should be taken into account when implementing individualized pharmacotherapy of patients. According to the analysis of consumption volumes, it can be assumed that in Ukraine there is a large number of patients with AF who do not receive anticoagulant therapy.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"17 1","pages":"45-53"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84837805","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 : 2020-10-01DOI: 10.31928/1608-635x-2020.4.7889
V. Kovalenko, E. Nesukay, S. Cherniuk, N. S. Polenova, R. Kirichenko, I. Giresh, E. Titov, A. Kozliuk, Yu. A. Botsiuk
Nowadays the diagnosis and prognosis of myocarditis is one of the most pressing, complex and incompletely solved problems in modern cardiology, that exist due to the large polymorphism of clinical manifestations of this disease and because of the lack of specific symptoms and diagnostic criteria. In most cases, the occurrence of heart failure, pain, heart rhythm and conduction disorders or other clinical manifestations are observed on the 2nd week after the onset of infectious disease, but inflammatory heart disease may not have a clear connection with the infection. Among the main methods used to diagnose myocarditis in clinical practice are electrocardiography (ECG), Holter monitoring (HM) ECG, echocardiography (echocardiography) and speckle-tracking (ST) echocardiography, cardiac magnetic resonance (CMR) imaging and endomyocardial biopsy. ECG and HMECG are highly informative methods for detection, prediction and dynamic monitoring of frequent complications of myocarditis – arrhythmias and conduction disorders. Two-dimensional echocardiography is a mandatory technique for assessing myocardial contractility that allows to assess the size of the heart chambers, systolic and diastolic function, global and regional contractility, the presence of thrombosis in the cavities, pericardial effusion and, most importantly. In recent years, there has been increasing data on the use of CT echocardiography for the diagnosis of myocarditis, based on the assessment of myocardial deformation and its rate in the longitudinal, radial and circular directions. Contrast-enhanced magnetic resonance imaging of the heart is non-invasive and one of the most informative methods for detecting signs of inflammatory myocardial damage. CMR allows to visualize the anatomy, study the structure and characterize the tissue of the heart, determine the functional features of the atria and ventricles. However, the gold standard for verifying the diagnosis of myocarditis to this day remains endomyocardial biopsy. Laboratory methods of diagnosis are additional researches, that in a complex with instrumental methods allow to estimate changes of myocardial inflammatory process at long supervision.
{"title":"Diagnosis of myocarditis as one of the actual problems in cardiology","authors":"V. Kovalenko, E. Nesukay, S. Cherniuk, N. S. Polenova, R. Kirichenko, I. Giresh, E. Titov, A. Kozliuk, Yu. A. Botsiuk","doi":"10.31928/1608-635x-2020.4.7889","DOIUrl":"https://doi.org/10.31928/1608-635x-2020.4.7889","url":null,"abstract":"Nowadays the diagnosis and prognosis of myocarditis is one of the most pressing, complex and incompletely solved problems in modern cardiology, that exist due to the large polymorphism of clinical manifestations of this disease and because of the lack of specific symptoms and diagnostic criteria. In most cases, the occurrence of heart failure, pain, heart rhythm and conduction disorders or other clinical manifestations are observed on the 2nd week after the onset of infectious disease, but inflammatory heart disease may not have a clear connection with the infection. Among the main methods used to diagnose myocarditis in clinical practice are electrocardiography (ECG), Holter monitoring (HM) ECG, echocardiography (echocardiography) and speckle-tracking (ST) echocardiography, cardiac magnetic resonance (CMR) imaging and endomyocardial biopsy. ECG and HMECG are highly informative methods for detection, prediction and dynamic monitoring of frequent complications of myocarditis – arrhythmias and conduction disorders. Two-dimensional echocardiography is a mandatory technique for assessing myocardial contractility that allows to assess the size of the heart chambers, systolic and diastolic function, global and regional contractility, the presence of thrombosis in the cavities, pericardial effusion and, most importantly. In recent years, there has been increasing data on the use of CT echocardiography for the diagnosis of myocarditis, based on the assessment of myocardial deformation and its rate in the longitudinal, radial and circular directions. Contrast-enhanced magnetic resonance imaging of the heart is non-invasive and one of the most informative methods for detecting signs of inflammatory myocardial damage. CMR allows to visualize the anatomy, study the structure and characterize the tissue of the heart, determine the functional features of the atria and ventricles. However, the gold standard for verifying the diagnosis of myocarditis to this day remains endomyocardial biopsy. Laboratory methods of diagnosis are additional researches, that in a complex with instrumental methods allow to estimate changes of myocardial inflammatory process at long supervision.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"59 1","pages":"78-89"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83583991","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 : 2020-09-03DOI: 10.31928/1608-635x-2020.3.89106
G. Radchenko, S. Kushnir, Y. Sirenko
This paper presents clinical case of pulmonary hypertension associated with left heart diseases (PH-LHD) in 63 year old woman with heart failure and preserved ejection fraction (HFpEF). The history of disease (arterial hypertension, atrial fibrillation, diabetes mellitus, acute pulmonary embolism, obesity, chronic obstructive lung disease) and results of standard investigations (no signs of thrombi in pulmonary arteries, significant enlargement of right heart and normal size of left heart, high level of calculated systolic blood pressure in pulmonary artery, high level of B-type natriuretic peptide) did not help to classify the type of pulmonary hypertension (PH). Only after right heart catheterization it was possible to state right diagnosis – post capillary combined PH-LHD. There are also discussed the latest guidelines in diagnosis and treatment of HFpEF and PH-LHD. Some considerations in favor of new step algorithm for diagnosis of HFpEF that was proposed by European Cardiology Congress in Paris (2019) were done and there was demonstrated its possible use in Ukraine. Some questions of morphological and pathogenic differences between precapillary pulmonary arterial hypertension (PAH) and post-capillary PH-LHD were discussed. Conclusion about not using of specific PAH therapy in PH-LHD patients was based on some arguments. There are elucidated some drug interventions in patients with HFpEF. Especial emphasized the necessity of risk factor and concomitant state corrections, including life style modification and non-drug treatment.
{"title":"Pulmonary hypertension associated with left heart diseases (clinical case)","authors":"G. Radchenko, S. Kushnir, Y. Sirenko","doi":"10.31928/1608-635x-2020.3.89106","DOIUrl":"https://doi.org/10.31928/1608-635x-2020.3.89106","url":null,"abstract":"This paper presents clinical case of pulmonary hypertension associated with left heart diseases (PH-LHD) in 63 year old woman with heart failure and preserved ejection fraction (HFpEF). The history of disease (arterial hypertension, atrial fibrillation, diabetes mellitus, acute pulmonary embolism, obesity, chronic obstructive lung disease) and results of standard investigations (no signs of thrombi in pulmonary arteries, significant enlargement of right heart and normal size of left heart, high level of calculated systolic blood pressure in pulmonary artery, high level of B-type natriuretic peptide) did not help to classify the type of pulmonary hypertension (PH). Only after right heart catheterization it was possible to state right diagnosis – post capillary combined PH-LHD. There are also discussed the latest guidelines in diagnosis and treatment of HFpEF and PH-LHD. Some considerations in favor of new step algorithm for diagnosis of HFpEF that was proposed by European Cardiology Congress in Paris (2019) were done and there was demonstrated its possible use in Ukraine. Some questions of morphological and pathogenic differences between precapillary pulmonary arterial hypertension (PAH) and post-capillary PH-LHD were discussed. Conclusion about not using of specific PAH therapy in PH-LHD patients was based on some arguments. There are elucidated some drug interventions in patients with HFpEF. Especial emphasized the necessity of risk factor and concomitant state corrections, including life style modification and non-drug treatment.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"93 1","pages":"89-106"},"PeriodicalIF":0.0,"publicationDate":"2020-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73034381","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 : 2020-08-27DOI: 10.31928/1608-635x-2020.3.6072
O. Shumakov, O. Parkhomenko, O. Dovhan, O. Gurjeva
The aim – to assess the additional prognostic information of metabolic syndrome (MS) components in groups of patients with acute myocardial infarction with segment elevation ST (STEMI), equalized in terms of commonly used acute coronary syndrome (ACS) risk factors. Materials and methods. Retrospective analysis of the 820 cases of STEMI included: evaluation of risk factors according to the scales TIMI, GRACE, PURSUIT, and evaluation of components of the metabolic syndrome at entry (the presence of diabetes mellitus and/or increasing glucose levels > 7 mmol/l, overweight, hypertension, dyslipidemia), as well as the assessment of the indicators of clinical course of hospital period of MI, treatment and results of follow-up of patients, including the information about cases of cardiac death. Results and discussion. Via automated «case-match-control» algorhythm from the basic cohort 2 groups were selected: group 1 (n=41, patients with MS) and group 2 (n=123, patients without MS). Matching criteria included following 13 risk factors: age, height, presence of heart failure, smoking, systemic hypotension at the 1 day of AMI, presence of anterior STEMI, the peak level of the MB-CK and AST, a history of angina and the period of unstable angina before STEMI, the presence of previous MI, baseline heart rate, baseline glomerular filtration rate (CKD-EPI), male gender. Groups were exactly matched by the first 4 matching criteria, and among other criteria maximum mismatch of 3 criteria was allowed (mean mismatch was 1.87 criteria from 13 per pair, and there were no significant differences in groups by each of 13 matching criteria). Otherwise, group 1 was characterized by more severe baseline profile, clinical course of hospital period, but it has the more intensive medical treatment also (including more frequent prescription of ACE inhibitors). According to the follow-up data, patients in group 1 had smaller end-systolic and end-diastolic indexes, more signed improvement in acute heart failure rate, higher heart rate variability and smaller dispersion of repolarisation at the 10th day. Also there was observed a trend toward a lower 3-year mortality (4,9 versus 17,1 %; p=0.05). Conclusions. The presence of MS accompanying STEMI is associated with poorer course of acute period of the disease and, in a contrary, with more favorable course of post-infarction period because of more intensive cardiac therapy in this group of patients.
{"title":"The effect of the presence of metabolic syndrome criteria on the post-infarction course in patients with acute myocardial infarction with ST-segment elevation","authors":"O. Shumakov, O. Parkhomenko, O. Dovhan, O. Gurjeva","doi":"10.31928/1608-635x-2020.3.6072","DOIUrl":"https://doi.org/10.31928/1608-635x-2020.3.6072","url":null,"abstract":"The aim – to assess the additional prognostic information of metabolic syndrome (MS) components in groups of patients with acute myocardial infarction with segment elevation ST (STEMI), equalized in terms of commonly used acute coronary syndrome (ACS) risk factors. Materials and methods. Retrospective analysis of the 820 cases of STEMI included: evaluation of risk factors according to the scales TIMI, GRACE, PURSUIT, and evaluation of components of the metabolic syndrome at entry (the presence of diabetes mellitus and/or increasing glucose levels > 7 mmol/l, overweight, hypertension, dyslipidemia), as well as the assessment of the indicators of clinical course of hospital period of MI, treatment and results of follow-up of patients, including the information about cases of cardiac death. Results and discussion. Via automated «case-match-control» algorhythm from the basic cohort 2 groups were selected: group 1 (n=41, patients with MS) and group 2 (n=123, patients without MS). Matching criteria included following 13 risk factors: age, height, presence of heart failure, smoking, systemic hypotension at the 1 day of AMI, presence of anterior STEMI, the peak level of the MB-CK and AST, a history of angina and the period of unstable angina before STEMI, the presence of previous MI, baseline heart rate, baseline glomerular filtration rate (CKD-EPI), male gender. Groups were exactly matched by the first 4 matching criteria, and among other criteria maximum mismatch of 3 criteria was allowed (mean mismatch was 1.87 criteria from 13 per pair, and there were no significant differences in groups by each of 13 matching criteria). Otherwise, group 1 was characterized by more severe baseline profile, clinical course of hospital period, but it has the more intensive medical treatment also (including more frequent prescription of ACE inhibitors). According to the follow-up data, patients in group 1 had smaller end-systolic and end-diastolic indexes, more signed improvement in acute heart failure rate, higher heart rate variability and smaller dispersion of repolarisation at the 10th day. Also there was observed a trend toward a lower 3-year mortality (4,9 versus 17,1 %; p=0.05). Conclusions. The presence of MS accompanying STEMI is associated with poorer course of acute period of the disease and, in a contrary, with more favorable course of post-infarction period because of more intensive cardiac therapy in this group of patients.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"64 1","pages":"60-72"},"PeriodicalIF":0.0,"publicationDate":"2020-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88950928","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 : 2020-08-27DOI: 10.31928/1608-635x-2020.3.2535
I. Polivenok, О. V. Gritsenko, О. S. Sushkov, О. О. Berezin, О. Е. Berezin
The aim – to search for risk factors of adverse clinical outcome of acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Materials and methods. In pilot retrospective study 1,292 consecutive patients with AMI treated by emergent percutaneous coronary intervention (PCI) in the reperfusion center of Zaitsev V.T. Institute for General and Emergency Surgery NAMS of Ukraine were selected. 54 out of 1292 patients (4.2 %) matched the Society for Cardiovascular Angiography and Interventions (SCAI) criteria of CS stage C and higher either on admission or during hospitalization. Results and discussion. The overall hospital mortality in patients with CS due to AMI in our series was 59.3 %. Univariant analysis revealed that the age of 65 and higher, left ventricular ejection fraction < 40 %, a single-vessel coronary lesion, absence of concomitant chronic total occlusion (CTO), reperfusion deterioration and cardiac arrest were the only risk factors for hospital death in CS patients. The risk of CS progression was independently associated with anemic syndrome (Hb < 118 g/l), chronic total occlusion, and multivessel coronary disease. In a multivariant logistic regression the preexisting LV EF < 40 %, single-vessel disease and absence of CTO were found as the independent predictors of hospital mortality in СS. Conclusions. СS in patients with AMI still be a significant challenge even after successful PCI, associated with high in-hospital mortality (59.3 %). There is an unmet need for development and implementation of an adjusted registry-based national protocol for CS management in order to improve patient survival.
{"title":"Predictors of unfavorable clinical outcomes of myocardial infarction complicated cardiogenic shock: results of single center retrospective study","authors":"I. Polivenok, О. V. Gritsenko, О. S. Sushkov, О. О. Berezin, О. Е. Berezin","doi":"10.31928/1608-635x-2020.3.2535","DOIUrl":"https://doi.org/10.31928/1608-635x-2020.3.2535","url":null,"abstract":"The aim – to search for risk factors of adverse clinical outcome of acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Materials and methods. In pilot retrospective study 1,292 consecutive patients with AMI treated by emergent percutaneous coronary intervention (PCI) in the reperfusion center of Zaitsev V.T. Institute for General and Emergency Surgery NAMS of Ukraine were selected. 54 out of 1292 patients (4.2 %) matched the Society for Cardiovascular Angiography and Interventions (SCAI) criteria of CS stage C and higher either on admission or during hospitalization. Results and discussion. The overall hospital mortality in patients with CS due to AMI in our series was 59.3 %. Univariant analysis revealed that the age of 65 and higher, left ventricular ejection fraction < 40 %, a single-vessel coronary lesion, absence of concomitant chronic total occlusion (CTO), reperfusion deterioration and cardiac arrest were the only risk factors for hospital death in CS patients. The risk of CS progression was independently associated with anemic syndrome (Hb < 118 g/l), chronic total occlusion, and multivessel coronary disease. In a multivariant logistic regression the preexisting LV EF < 40 %, single-vessel disease and absence of CTO were found as the independent predictors of hospital mortality in СS. Conclusions. СS in patients with AMI still be a significant challenge even after successful PCI, associated with high in-hospital mortality (59.3 %). There is an unmet need for development and implementation of an adjusted registry-based national protocol for CS management in order to improve patient survival.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"26 1","pages":"25-35"},"PeriodicalIF":0.0,"publicationDate":"2020-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85731988","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 : 2020-08-27DOI: 10.31928/1608-635x-2020.3.3648
V. Shumakov, I. Malynovska, N. Tereshchenko, L. Babii, O. V. Voloshina
The aim – to study the clinical and functional characteristics of patients after myocardial infarction (MI) who referred stage II of cardiac rehabilitation (CR) with physical training (PT) during 3 years follow-up. Materials and methods. The study included 91 patients with primary Q-MI in the absence of contraindications to the CR. Criteria for inclusion were an early postinfarct angina, large aneurysm of the left ventricle, intracavitary formation of thrombus, the reduction of the EF to 35 % and below, complex cardiac arrhythmias and disturbances of conduction, the atrial fibrillation at the time of inclusion in the study, multivessel lession of coronary arteries, left bundle branch block, disorders of the musculoskeletal system, which prevented holding bicycle ergometry test, acute violation of cerebral circulation in the anamnesis, cancer and decompensation of comorbidities. Treatment was carried out according to modern recommendations; at admission coronary angiography with stenting of the infarct-occluded coronary artery was performed. Depending on the volume of rehabilitation measures, the patients were divided into two groups: group 1 consisted 47 patients who in the early post-hospital phase accomplished the program of PT on the bicycle ergometer; group 2 consisted of 44 patients in whom CR was carried out only in the form of distance walking and complexes of therapeutic exercises. Dosed physical load test on a bicycle ergometer, echocardiography, lipid metabolism indexes were evaluated in all patients at discharge from hospital. All exams were performed in dynamics in 4 months (the period corresponding to the end of the program 30 PT), after 1, 2 and 3 years. Results and discussion. At baseline the patients of both groups did not differ in any of the clinical-functional and anamnestic data. The clinical course was evaluated by the following indices: recurrent MI, coronary artery bypass grafting and stenting. Events increased after 2 (7 patients in 1 and 9 patients in 2 group) and 3 (6 and 15 patients, respectively) years. During the first year, all patients took 100 % of P2Y12 receptor blockers, rosuvastatin and beta-blockers; aspirin was used in 95 % of patients in each group; the number of patients who have received ACE inhibitors increased to 81 % in group 1 and 91 % in group 2. A decrease in the doses of statins at the outpatient stage as they move away from acute MI has led to an increase in LDL cholesterol over the years. This index in 4 months after MI in 1st group was 1.82 (1.39–2.20) and 2nd group was 1.83 (1.49–2.21) mmol/l, after 1 year – 1.79 (1.48–2.04) and 2.80 (2.33–3.21) mmol/l, after 2 years – 2.48 (2.12–2.98) and 2.34 (1,93–3.01) mmol/l, after 3 years – 2.29 (2.15–2.49) and 2.40 (2.26–2.61) mmol/l, respectively. The tolerance to physical load with the best hemodynamic efficiency of the work has increased significantly to (140.0; 125.0–150.0) W after 1 year compared with the 2nd group (p<0,01). For 3 years, it remained h
{"title":"Clinical and functional features of the post-infarction course of coronary heart disease on the background of cardiac rehabilitation (with cycling training in the II phase) at 3-year follow-up","authors":"V. Shumakov, I. Malynovska, N. Tereshchenko, L. Babii, O. V. Voloshina","doi":"10.31928/1608-635x-2020.3.3648","DOIUrl":"https://doi.org/10.31928/1608-635x-2020.3.3648","url":null,"abstract":"The aim – to study the clinical and functional characteristics of patients after myocardial infarction (MI) who referred stage II of cardiac rehabilitation (CR) with physical training (PT) during 3 years follow-up. Materials and methods. The study included 91 patients with primary Q-MI in the absence of contraindications to the CR. Criteria for inclusion were an early postinfarct angina, large aneurysm of the left ventricle, intracavitary formation of thrombus, the reduction of the EF to 35 % and below, complex cardiac arrhythmias and disturbances of conduction, the atrial fibrillation at the time of inclusion in the study, multivessel lession of coronary arteries, left bundle branch block, disorders of the musculoskeletal system, which prevented holding bicycle ergometry test, acute violation of cerebral circulation in the anamnesis, cancer and decompensation of comorbidities. Treatment was carried out according to modern recommendations; at admission coronary angiography with stenting of the infarct-occluded coronary artery was performed. Depending on the volume of rehabilitation measures, the patients were divided into two groups: group 1 consisted 47 patients who in the early post-hospital phase accomplished the program of PT on the bicycle ergometer; group 2 consisted of 44 patients in whom CR was carried out only in the form of distance walking and complexes of therapeutic exercises. Dosed physical load test on a bicycle ergometer, echocardiography, lipid metabolism indexes were evaluated in all patients at discharge from hospital. All exams were performed in dynamics in 4 months (the period corresponding to the end of the program 30 PT), after 1, 2 and 3 years. Results and discussion. At baseline the patients of both groups did not differ in any of the clinical-functional and anamnestic data. The clinical course was evaluated by the following indices: recurrent MI, coronary artery bypass grafting and stenting. Events increased after 2 (7 patients in 1 and 9 patients in 2 group) and 3 (6 and 15 patients, respectively) years. During the first year, all patients took 100 % of P2Y12 receptor blockers, rosuvastatin and beta-blockers; aspirin was used in 95 % of patients in each group; the number of patients who have received ACE inhibitors increased to 81 % in group 1 and 91 % in group 2. A decrease in the doses of statins at the outpatient stage as they move away from acute MI has led to an increase in LDL cholesterol over the years. This index in 4 months after MI in 1st group was 1.82 (1.39–2.20) and 2nd group was 1.83 (1.49–2.21) mmol/l, after 1 year – 1.79 (1.48–2.04) and 2.80 (2.33–3.21) mmol/l, after 2 years – 2.48 (2.12–2.98) and 2.34 (1,93–3.01) mmol/l, after 3 years – 2.29 (2.15–2.49) and 2.40 (2.26–2.61) mmol/l, respectively. The tolerance to physical load with the best hemodynamic efficiency of the work has increased significantly to (140.0; 125.0–150.0) W after 1 year compared with the 2nd group (p<0,01). For 3 years, it remained h","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"13 1","pages":"36-48"},"PeriodicalIF":0.0,"publicationDate":"2020-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86996724","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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