Pub Date : 2023-05-03DOI: 10.31928/2664-4479-2023.1-2.6772
O. Irkin, D. Bilyi
Despite the long-standing problem of intracavitary thrombus formation, the question of treatment is still quite difficult for any clinician who encounters it. The doctor always has the choice of which of the anticoagulants to give preference to, when starting the treatment of blood clots. Errors in the selection of the drug and dosage cause a high risk of bleeding in the patient and on the other hand the risk of developing complications in the presence of thrombus formation in the left ventricular cavity.Therefore, in our review, we decided to draw the attention of doctors to this problem by referring to and analyzing data from registries, meta-analyses, pilot and randomized multicenter clinical trials.
{"title":"Thrombosis in the left ventricular cavity. Part 2. Treatment options","authors":"O. Irkin, D. Bilyi","doi":"10.31928/2664-4479-2023.1-2.6772","DOIUrl":"https://doi.org/10.31928/2664-4479-2023.1-2.6772","url":null,"abstract":"Despite the long-standing problem of intracavitary thrombus formation, the question of treatment is still quite difficult for any clinician who encounters it. The doctor always has the choice of which of the anticoagulants to give preference to, when starting the treatment of blood clots. Errors in the selection of the drug and dosage cause a high risk of bleeding in the patient and on the other hand the risk of developing complications in the presence of thrombus formation in the left ventricular cavity.Therefore, in our review, we decided to draw the attention of doctors to this problem by referring to and analyzing data from registries, meta-analyses, pilot and randomized multicenter clinical trials.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"83 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76789185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-11DOI: 10.31928/2664-4479-2022.5-6.7190
O. O. Kutsin, A. Kedyk
SGLT2 inhibitors are drugs that «changed the rules of the game» in endocrinology, cardiology and nephrology. Empagliflozin has notable cardio-renal organoprotective properties regardless of the presence of type 2 diabetes and it is probably the most versatile molecule among SGLT2 inhibitors. The mechanisms of simultaneous empagliflozin blockade of SGLT2-channels and NHE3-channels were considered in scientific review as the cause of the natriuretic effect of the drug. NHE channels blockade in myocardial cells causes a decrease in the load of cells with sodium and calcium. Attention is focused on the ability of empagliflozin to lower blood pressure, selectively reduce the volume of interstitial fluid, affect the geometry of the LV, inhibiting its remodeling. The first large EMPA-REG OUTCOME trial in patients with atherosclerotic cardiovascular disease was reviewed, which found a clinically meaningful effect of empagliflozin on 3P-MACE, reduced risk of cardiovascular death, all-cause death, and heart failure hospitalization. It was analyzed the results of studies of empagliflozin in patients with chronic heart failure (CHF) with different LVEF and in patients with acute heart failure (AHF) (EMPEROR-REDUCED, EMPEROR-PRESERVED and EMPULSE). Attention is focused on the fact that empagliflozin currently has a sufficient evidence base to be a mandatory drug for the whole spectrum of patients with CHF and AHF with an early start of therapy even before discharge from the hospital.
{"title":"Changing the «rules of the game» in the treatment of patients with heart failure: a focus on empagliflozin","authors":"O. O. Kutsin, A. Kedyk","doi":"10.31928/2664-4479-2022.5-6.7190","DOIUrl":"https://doi.org/10.31928/2664-4479-2022.5-6.7190","url":null,"abstract":"SGLT2 inhibitors are drugs that «changed the rules of the game» in endocrinology, cardiology and nephrology. Empagliflozin has notable cardio-renal organoprotective properties regardless of the presence of type 2 diabetes and it is probably the most versatile molecule among SGLT2 inhibitors. The mechanisms of simultaneous empagliflozin blockade of SGLT2-channels and NHE3-channels were considered in scientific review as the cause of the natriuretic effect of the drug. NHE channels blockade in myocardial cells causes a decrease in the load of cells with sodium and calcium. Attention is focused on the ability of empagliflozin to lower blood pressure, selectively reduce the volume of interstitial fluid, affect the geometry of the LV, inhibiting its remodeling. The first large EMPA-REG OUTCOME trial in patients with atherosclerotic cardiovascular disease was reviewed, which found a clinically meaningful effect of empagliflozin on 3P-MACE, reduced risk of cardiovascular death, all-cause death, and heart failure hospitalization. It was analyzed the results of studies of empagliflozin in patients with chronic heart failure (CHF) with different LVEF and in patients with acute heart failure (AHF) (EMPEROR-REDUCED, EMPEROR-PRESERVED and EMPULSE). Attention is focused on the fact that empagliflozin currently has a sufficient evidence base to be a mandatory drug for the whole spectrum of patients with CHF and AHF with an early start of therapy even before discharge from the hospital.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78481940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-11DOI: 10.31928/2664-4479-2022.5-6.5970
V. Tseluyko, N. E. Mishchuk, L. V. Ivanitska
Lecture is devoted to hyponatremia (HNa), the most common electrolyte disturbance in hospitalized patients, which is related to the risk of potentially life-threatening complications and prognosis worsening. Etiology factors and pathophysiological mechanisms of HNa development, particularly in patients with decompensated heart failure (HF), are considered, as well as clinical manifestations of acute and chronic HNa. Clinical interpretation algorithm for HNa, diagnostics and differential diagnostic, principles of initial and long-term management of HF patients with certain type of HNa are discussed. Practical management of the patient with severe HF complicated with HNa is illustrated with clinical case.
{"title":"Hyponatremia in patients with decompensated heart failure","authors":"V. Tseluyko, N. E. Mishchuk, L. V. Ivanitska","doi":"10.31928/2664-4479-2022.5-6.5970","DOIUrl":"https://doi.org/10.31928/2664-4479-2022.5-6.5970","url":null,"abstract":"Lecture is devoted to hyponatremia (HNa), the most common electrolyte disturbance in hospitalized patients, which is related to the risk of potentially life-threatening complications and prognosis worsening. Etiology factors and pathophysiological mechanisms of HNa development, particularly in patients with decompensated heart failure (HF), are considered, as well as clinical manifestations of acute and chronic HNa. Clinical interpretation algorithm for HNa, diagnostics and differential diagnostic, principles of initial and long-term management of HF patients with certain type of HNa are discussed. Practical management of the patient with severe HF complicated with HNa is illustrated with clinical case.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72634515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-11DOI: 10.31928/2664-4479-2022.5-6.4351
V. O. Ruzhanska, L. M. Chorna, I. Pashkova, S. L. Ocheretniy, A. Ryzhenko
Pericarditis with or without pericardial effusion, which occurs as a result of pericardial damage, is a postcardiac trauma syndrome. Most reported cases of post-traumatic pericarditis document a history of direct trauma to the chest, such as chest trauma from a steering wheel, which was observed during car accidents or caused by mechanical damage to the chest of various genesis. Many methods of treatment of inflammatory diseases of the pericardium have been proposed – from palliative to radical. The most common among them are percutaneous pericardial puncture, extrapleural pericardiotomy, or fenestration, partial or subtotal resection of the pericardium. The choice of surgical tactics largely depends on the specialist who performs it and the clinic where this treatment takes place, and not on the specific situation. Inflammatory pericardial syndrome can be established in the presence of at least 2 of the following 4 criteria: pericardial chest pain; pericardial murmur; the appearance of a new widespread convex elevation of the ST segment or depression of the PR segment (in several leads excluding aVR and sometimes V1) on the electrocardiogram; pericardial effusion (new, or an increase in the severity of the existing one according to echocardiography and radiography of the chest cavity). Additional signs include: an increase in the concentration of inflammatory markers (C-reactive protein, erythrocyte sedimentation rate, leukocytosis) and markers of myocardial damage (CFC, troponin I); signs of the inflammatory process in the pericardium during imaging methods (computed tomography, magnetic resonance imaging).
{"title":"Clinical case: treatment of acute pericarditis in patient with a mine-explosive injury","authors":"V. O. Ruzhanska, L. M. Chorna, I. Pashkova, S. L. Ocheretniy, A. Ryzhenko","doi":"10.31928/2664-4479-2022.5-6.4351","DOIUrl":"https://doi.org/10.31928/2664-4479-2022.5-6.4351","url":null,"abstract":"Pericarditis with or without pericardial effusion, which occurs as a result of pericardial damage, is a postcardiac trauma syndrome. Most reported cases of post-traumatic pericarditis document a history of direct trauma to the chest, such as chest trauma from a steering wheel, which was observed during car accidents or caused by mechanical damage to the chest of various genesis. Many methods of treatment of inflammatory diseases of the pericardium have been proposed – from palliative to radical. The most common among them are percutaneous pericardial puncture, extrapleural pericardiotomy, or fenestration, partial or subtotal resection of the pericardium. The choice of surgical tactics largely depends on the specialist who performs it and the clinic where this treatment takes place, and not on the specific situation. Inflammatory pericardial syndrome can be established in the presence of at least 2 of the following 4 criteria: pericardial chest pain; pericardial murmur; the appearance of a new widespread convex elevation of the ST segment or depression of the PR segment (in several leads excluding aVR and sometimes V1) on the electrocardiogram; pericardial effusion (new, or an increase in the severity of the existing one according to echocardiography and radiography of the chest cavity). Additional signs include: an increase in the concentration of inflammatory markers (C-reactive protein, erythrocyte sedimentation rate, leukocytosis) and markers of myocardial damage (CFC, troponin I); signs of the inflammatory process in the pericardium during imaging methods (computed tomography, magnetic resonance imaging).","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87029465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-11DOI: 10.31928/2664-4479-2022.5-6.5258
O. Irkin, D. Bilyi
More than 100 years have passed since the first description of intracavitary thrombi, but the problem of diagnosis of thrombi, risk factors for development, as well as the impact of myocardial revascularization remain is a very relevant problem today, which definitely affects the prevalence of thrombi formation in the cavity of the left ventricle (LV). This review is devoted to the description and analysis of the main methods of diagnosing the presence of a thrombus in the cavity of the LV and factors affecting the formation of a thrombus. The most adequate method for diagnosing left ventricular thrombosis is a cardiac magnetic resonance imaging, but a simpler method such as transthoracic echocardiography can be used as a screening method for most patients. Determining the causes of LV thrombosis, such as reduced ventricular mobility, local myocardial damage, the presence of hyper coagulation and inflammatory phenomena, contributes to the adequate treatment of patients and the necessary prevention of thrombus formation.
{"title":"Thrombosis in the cavity of the left ventricle. Part 1. Causes, diagnosis, prevention of formation","authors":"O. Irkin, D. Bilyi","doi":"10.31928/2664-4479-2022.5-6.5258","DOIUrl":"https://doi.org/10.31928/2664-4479-2022.5-6.5258","url":null,"abstract":"More than 100 years have passed since the first description of intracavitary thrombi, but the problem of diagnosis of thrombi, risk factors for development, as well as the impact of myocardial revascularization remain is a very relevant problem today, which definitely affects the prevalence of thrombi formation in the cavity of the left ventricle (LV). This review is devoted to the description and analysis of the main methods of diagnosing the presence of a thrombus in the cavity of the LV and factors affecting the formation of a thrombus. The most adequate method for diagnosing left ventricular thrombosis is a cardiac magnetic resonance imaging, but a simpler method such as transthoracic echocardiography can be used as a screening method for most patients. Determining the causes of LV thrombosis, such as reduced ventricular mobility, local myocardial damage, the presence of hyper coagulation and inflammatory phenomena, contributes to the adequate treatment of patients and the necessary prevention of thrombus formation.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"93 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83494944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-10DOI: 10.31928/2664-4479-2022.5-6.1729
O. Rekovets, Y. Sirenko, N. Krushynska, O. Torbas
The aim – to assess the arterial stiffness changes in patients with arterial hypertension (AH) and obstructive sleep apnea (OSA) and possibilities of its correction by continuous positive airway pressure (CPAP)-therapy.Materials and methods. 185 patients with mild and moderate AH (49.8±0.8 years old) were enrolled in the study and divided into groups: 1st group – patients who had OSA (n=148), 2nd group – patients without OSA (control group, n=37). They underwent clinical and special examination: unattended somnography by dual-channel portable monitor device, estimation of daily sleepiness by Epworth Sleepiness Scale, office and ambulatory blood pressure monitoring, echocardiography and applanation tonometry. In 10 months follow-up study were included 105 patients, who were divided into 4 subgroups: A – patients with moderate to severe OSA on CPAP (n=23); B – patients with moderate to severe OSA without CPAP (n=29); C – patients with mild OSA (n=29); D – patients without OSA (controls, n=24). All patients received similar antihypertensive therapy according to 2013 ESH/ESC Guidelines.Results and discussion. Patients with AH and OSA (mean apnea-hypopnea index (AHI) 38.10±2.51 event/h) in comparison with patients without OSA (mean AHI 3.02±0.25 event/h) had significantly higher body mass index (35.20±0.57 vs 30.60±0.79 kg/m, p<0.001), blood glucose level (107.2±2.2 vs 98.0±2.5 mg/dl, p=0.045), uric acid level (6.17±0.10 vs 5.5±0.3 mg/dl, p=0.048) and left ventricular mass index (LVMI) (115.80±2.39 vs 104.60±4.56 g/m, p=0.035). Also the patients with AH and OSA in comparison with patients without OSA had higher carotid-femoral pulse wave velocity (PWVcf) (11.19±0.20 vs 10.10 m/s, p=0.014) and central systolic blood pressure (CSBP) (133.43±1.67 vs 125.22±3.41 mm Hg, p=0.027). During 10 month follow-up in patients with AH and OSA on CPAP-therapy there were significantly decrease of PWVcf (from 12.20±0.63 to 10.05±0.43 m/s, p=0.009) with achievement of normal level (<10 m/s) in 60.9 % patients, office systolic blood pressure (from 143.8±132.7 to 132.70±2.33 mm Hg, p=0.021) and diastolic blood pressure (from 93.80±3.31 to 86.00±3.19 mm Hg, p=0.012) with achievement of target levels. In patients central systolic BP decreased (from 130.30±3.97 to 119.70±2.97 mm Hg, p=0.012) and diastolic BP decreased (from 94.70±3.31 to 87.10±2.36 mm Hg, p=0.013).Conclusions. Combination of continuous positive airway pressure (CPAP)-therapy and antihypertensive treatment had decrease of arterial stiffness and helps to achieve target blood pressure in patients with AH and moderate to severe OSA.
目的是评估动脉高血压(AH)和阻塞性睡眠呼吸暂停(OSA)患者的动脉硬度变化以及持续气道正压通气(CPAP)治疗对其纠正的可能性。材料和方法。185例轻中度AH患者(49.8±0.8岁)被纳入研究，分为两组:第一组有OSA患者(n=148)，第二组无OSA患者(对照组，n=37)。他们接受了临床和特殊检查:使用双通道便携式监护仪进行无人监护的睡眠描记，使用Epworth嗜睡量表评估每日嗜睡程度，办公室和动态血压监测，超声心动图和压胸测压。在10个月的随访研究中纳入105例患者，将其分为4个亚组:A - CPAP治疗中重度OSA患者(n=23);B -无CPAP的中重度OSA患者(n=29);C -轻度OSA患者(n=29);D -无OSA患者(对照组，n=24)。所有患者均按照2013年ESH/ESC指南接受类似的降压治疗。结果和讨论。AH合并OSA患者(平均呼吸暂停-低通气指数(AHI) 38.10±2.51事件/h)的体重指数(35.20±0.57 vs 30.60±0.79 kg/m, p<0.001)、血糖水平(107.2±2.2 vs 98.0±2.5 mg/dl, p=0.045)、尿酸水平(6.17±0.10 vs 5.5±0.3 mg/dl, p=0.048)和左心室质量指数(LVMI)(115.80±2.39 vs 104.60±4.56 g/m, p=0.035)显著高于无OSA患者(平均AHI 3.02±0.25事件/h)。与非OSA患者相比，AH合并OSA患者颈股动脉脉波速度(PWVcf)(11.19±0.20 vs 10.10 m/s, p=0.014)和中枢收缩压(CSBP)(133.43±1.67 vs 125.22±3.41 mm Hg, p=0.027)较高。经cpap治疗的AH合并OSA患者随访10个月，60.9%患者PWVcf(从12.20±0.63降至10.05±0.43 m/s, p=0.009)达到正常水平(<10 m/s)，收缩压(从143.8±132.7降至132.70±2.33 mm Hg, p=0.021)和舒张压(从93.80±3.31降至86.00±3.19 mm Hg, p=0.012)达到目标水平。患者中央收缩压下降(从130.30±3.97降至119.70±2.97 mm Hg, p=0.012)，舒张压下降(从94.70±3.31降至87.10±2.36 mm Hg, p=0.013)。持续气道正压治疗(CPAP)联合降压治疗可降低AH合并中重度OSA患者的动脉僵硬度，有助于达到目标血压。
{"title":"Influence of therapy continuous positive airway pressure on arterial stiffness in patients with arterial hypertension and obstructive sleep apnea","authors":"O. Rekovets, Y. Sirenko, N. Krushynska, O. Torbas","doi":"10.31928/2664-4479-2022.5-6.1729","DOIUrl":"https://doi.org/10.31928/2664-4479-2022.5-6.1729","url":null,"abstract":"The aim – to assess the arterial stiffness changes in patients with arterial hypertension (AH) and obstructive sleep apnea (OSA) and possibilities of its correction by continuous positive airway pressure (CPAP)-therapy.Materials and methods. 185 patients with mild and moderate AH (49.8±0.8 years old) were enrolled in the study and divided into groups: 1st group – patients who had OSA (n=148), 2nd group – patients without OSA (control group, n=37). They underwent clinical and special examination: unattended somnography by dual-channel portable monitor device, estimation of daily sleepiness by Epworth Sleepiness Scale, office and ambulatory blood pressure monitoring, echocardiography and applanation tonometry. In 10 months follow-up study were included 105 patients, who were divided into 4 subgroups: A – patients with moderate to severe OSA on CPAP (n=23); B – patients with moderate to severe OSA without CPAP (n=29); C – patients with mild OSA (n=29); D – patients without OSA (controls, n=24). All patients received similar antihypertensive therapy according to 2013 ESH/ESC Guidelines.Results and discussion. Patients with AH and OSA (mean apnea-hypopnea index (AHI) 38.10±2.51 event/h) in comparison with patients without OSA (mean AHI 3.02±0.25 event/h) had significantly higher body mass index (35.20±0.57 vs 30.60±0.79 kg/m, p<0.001), blood glucose level (107.2±2.2 vs 98.0±2.5 mg/dl, p=0.045), uric acid level (6.17±0.10 vs 5.5±0.3 mg/dl, p=0.048) and left ventricular mass index (LVMI) (115.80±2.39 vs 104.60±4.56 g/m, p=0.035). Also the patients with AH and OSA in comparison with patients without OSA had higher carotid-femoral pulse wave velocity (PWVcf) (11.19±0.20 vs 10.10 m/s, p=0.014) and central systolic blood pressure (CSBP) (133.43±1.67 vs 125.22±3.41 mm Hg, p=0.027). During 10 month follow-up in patients with AH and OSA on CPAP-therapy there were significantly decrease of PWVcf (from 12.20±0.63 to 10.05±0.43 m/s, p=0.009) with achievement of normal level (<10 m/s) in 60.9 % patients, office systolic blood pressure (from 143.8±132.7 to 132.70±2.33 mm Hg, p=0.021) and diastolic blood pressure (from 93.80±3.31 to 86.00±3.19 mm Hg, p=0.012) with achievement of target levels. In patients central systolic BP decreased (from 130.30±3.97 to 119.70±2.97 mm Hg, p=0.012) and diastolic BP decreased (from 94.70±3.31 to 87.10±2.36 mm Hg, p=0.013).Conclusions. Combination of continuous positive airway pressure (CPAP)-therapy and antihypertensive treatment had decrease of arterial stiffness and helps to achieve target blood pressure in patients with AH and moderate to severe OSA.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85235634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-10DOI: 10.31928/2664-4479-2022.5-6.3742
A. Gabriyelyan, V. Smorzhevskyi, I. V. Kudlai
Dilated cardiomyopathy (DCM) is a common disease with a pessimistic prognosis. Heart transplantation is a radical method of treating DCM patients with severe chronic heart failure. But given the lack of donor organs, the development of new methods for the treatment of DCM is relevant. The use of stem cells in the complex treatment of patients with DCM according to the literature improves the results of treatment and is associated with an improvement of the systolic function of the left ventricle and normalization of the diastolic function of the left ventricle, a decrease of the functional class of CHF and an improvement of the life quality of such patients. The article presents a 3-year observation of a patient with dilated cardiomyopathy, who received cord blood mesenchymal stem cells as a treatment. Patient’s dilated cardiomyopathy was developed after a severe chronic myocarditis. The patient was examined by clinical and instrumental methods, including echocardiography, cardiac MRI with gadolinium contrast, ECG Holter monitoring, BNP study, 6-minute gait test, and the patient’s quality of life was assessed according to the Minnesota questionnaire. The prescribed drug therapy included torasemide at a dose of 20–10 mg/day, spironolactone at a dose of 25 mg/day, carvedilol 6.25 mg/day, ramipril 1.25 mg/day, dapagliflozin 10 mg/day, amiodarone 200 mg/day. After 5 months of drug therapy, a more significant effect was not observed. The patient was injected intravenously with a cell preparation of donor umbilical cord blood. During the study, there was a positive dynamic of the clinical condition, improvement of the contractile function of the left ventricle, improvement of the life quality. The patient was taken off the waiting list for a heart transplant. Patient’s observation continues.
{"title":"Treatment of a patient with dilated cardiomyopathy using mesenchymal stem cells","authors":"A. Gabriyelyan, V. Smorzhevskyi, I. V. Kudlai","doi":"10.31928/2664-4479-2022.5-6.3742","DOIUrl":"https://doi.org/10.31928/2664-4479-2022.5-6.3742","url":null,"abstract":"Dilated cardiomyopathy (DCM) is a common disease with a pessimistic prognosis. Heart transplantation is a radical method of treating DCM patients with severe chronic heart failure. But given the lack of donor organs, the development of new methods for the treatment of DCM is relevant. The use of stem cells in the complex treatment of patients with DCM according to the literature improves the results of treatment and is associated with an improvement of the systolic function of the left ventricle and normalization of the diastolic function of the left ventricle, a decrease of the functional class of CHF and an improvement of the life quality of such patients. The article presents a 3-year observation of a patient with dilated cardiomyopathy, who received cord blood mesenchymal stem cells as a treatment. Patient’s dilated cardiomyopathy was developed after a severe chronic myocarditis. The patient was examined by clinical and instrumental methods, including echocardiography, cardiac MRI with gadolinium contrast, ECG Holter monitoring, BNP study, 6-minute gait test, and the patient’s quality of life was assessed according to the Minnesota questionnaire. The prescribed drug therapy included torasemide at a dose of 20–10 mg/day, spironolactone at a dose of 25 mg/day, carvedilol 6.25 mg/day, ramipril 1.25 mg/day, dapagliflozin 10 mg/day, amiodarone 200 mg/day. After 5 months of drug therapy, a more significant effect was not observed. The patient was injected intravenously with a cell preparation of donor umbilical cord blood. During the study, there was a positive dynamic of the clinical condition, improvement of the contractile function of the left ventricle, improvement of the life quality. The patient was taken off the waiting list for a heart transplant. Patient’s observation continues.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83970689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-10DOI: 10.31928/2664-4479-2022.5-6.3036
O. Mitchenko, K. Timokhova
The aim – to investigate clinical and laboratory parallels in patients with «possible» familial hypercholesterolemia (FH) depending on the degree of carbohydrate metabolism disorders.Materials and methods. The research protocol included 97 patients with CAD, hypertension and dyslipidemia on the background of comorbid pathology (type 2 diabetes, obesity). Patients were divided into 2 groups depending on concomitant comorbid pathology. The obese group was further divided into two subgroups (2A and 2B) depending on the presence of prediabities.Results and discussion. In the group with diabetes, direct correlations between carbohydrate and lipid disorders were revealed, as well as a high dependence of the level of lipid profile atherogenicity on degree of destabilization of diabetes. In the group with obesity, no significant correlation was found between BMI, WC and changes in the lipid profile. After dividing the obese group into subgroups 2A and 2B, no significant differences in clinical characteristics and lipid profile were found, and there were no correlations between the level of carbohydrate metabolism disorder and lipid changes.Conclusions. The group of patients with «possible» FH (with LDL-C ≥ 5.0 mmol/l) is heterogeneous and may include patients with secondary dyslipidemia on the background of destabilized comorbid pathology. The percentage of detection of «possible» FH according to the criterion of LDL-C ≥ 5.0 mmol/l was higher in patients with type 2 diabetes and decreased in parallel with the decrease in the degree of carbohydrate metabolism disorders. The absence of direct parallelism and close correlations between LDL-C and the characteristics of the glycemic profile in obese patients with prediabities, which does not exclude the possibility of influence of polygenic genetic mutations on the lipid characteristics.
{"title":"Clinical and laboratory parallels in patients with «possible» familial hypercholesterolemia on the background of carbohydrate metabolism disorders","authors":"O. Mitchenko, K. Timokhova","doi":"10.31928/2664-4479-2022.5-6.3036","DOIUrl":"https://doi.org/10.31928/2664-4479-2022.5-6.3036","url":null,"abstract":"The aim – to investigate clinical and laboratory parallels in patients with «possible» familial hypercholesterolemia (FH) depending on the degree of carbohydrate metabolism disorders.Materials and methods. The research protocol included 97 patients with CAD, hypertension and dyslipidemia on the background of comorbid pathology (type 2 diabetes, obesity). Patients were divided into 2 groups depending on concomitant comorbid pathology. The obese group was further divided into two subgroups (2A and 2B) depending on the presence of prediabities.Results and discussion. In the group with diabetes, direct correlations between carbohydrate and lipid disorders were revealed, as well as a high dependence of the level of lipid profile atherogenicity on degree of destabilization of diabetes. In the group with obesity, no significant correlation was found between BMI, WC and changes in the lipid profile. After dividing the obese group into subgroups 2A and 2B, no significant differences in clinical characteristics and lipid profile were found, and there were no correlations between the level of carbohydrate metabolism disorder and lipid changes.Conclusions. The group of patients with «possible» FH (with LDL-C ≥ 5.0 mmol/l) is heterogeneous and may include patients with secondary dyslipidemia on the background of destabilized comorbid pathology. The percentage of detection of «possible» FH according to the criterion of LDL-C ≥ 5.0 mmol/l was higher in patients with type 2 diabetes and decreased in parallel with the decrease in the degree of carbohydrate metabolism disorders. The absence of direct parallelism and close correlations between LDL-C and the characteristics of the glycemic profile in obese patients with prediabities, which does not exclude the possibility of influence of polygenic genetic mutations on the lipid characteristics.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81181291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-10DOI: 10.31928/2664-4479-2022.5-6.716
Y. Lutay, O. Parkhomenko, D. Khomyakov, O. Irkin, S. Kushnir, Yu.V. Kornatskyi
The aim – to analyze in-hospital mortality in pts with acute cardiovascular pathology (ACP) and a co-infection with COVID-19.Materials and methods. 139 pts with ACP who were diagnosed with COVID-19 were examined. 69 (49.6 %) pts had ACS (47 pts with AMI), 33 (23.7 %) pts – hypertensive urgency, 24 (17.3 %) pts – ADHF, 9 (6.5 %) pts – tachysystolic paroxysm of atrial fibrillation, 2 (1.4 %) pts – acute pulmonary embolism, and 2 (1.4 %) pts – syncope. The average age was 67.9±12.7 y.o., 70 (50.4 %) pts were male. Concomitant arterial hypertension was found in 87.1 %, DM – 20.9 %, CHF – 30.9 %, COPD – 9.4 % of pts, history of AMI – 20.1 % and ischemic stroke – 9.4 % of pts. In 79 (56.8 %) pts COVID-19 was diagnosed and laboratory confirmed before hospitalization (hospitalized in 5.3±3.6 days after symptoms onset). 31 (22.3 %) pts were diagnosed with COVID-19 upon admission, and 29 (20.9 %) – during their stay in the hospital. 20 (15.6 %) pts were vaccinated against COVID-19. The initial SpO2 level was 91.6±10.3 %, while more than half of pts (53.2 %) had SpO2 < 95 % and almost every fourth (23.2 %) patient had SpO2 < 90 %.Results and discussion. During the hospital period, 20 (14.4 %) pts died. The mortality rate was 28.0 % in pts with ADHF, 19.1 % in pts with AMI and significantly less in pts hospitalized for unstable angina, hypertensive urgency or atrial fibrillation – 5.2 % (р<0.05 in comparison with pts with AMI or ADHF). The main cause of death was the development of cardiopulmonary failure – 14 (70.0 %) pts. 4 (20.0 %) pts died from AMI complications, 1 – from pulmonary embolism and 1 – from acute ischemic stroke. Two critical periods of in-hospital mortality can be distinguished: 1 – the first two days of hospitalization (mainly complications of acute cardiovascular pathology and thrombotic events); 2 – from 7 to 10 days after hospitalization (development of multiple organ failure due to hypoxia and heart failure progression). The mortality rate of patients with ACP and COVID-19 was significantly higher than that of simultaneously hospitalized patients without comorbid respiratory infection (14.4 % vs. 6.4 %, p=0.012) and patients who were hospitalized before the pandemic (14.4 % vs. 2.9 %, р<0.001). Vaccinated patients were significantly less likely to develop acute kidney injury, acute hypoxic delirium, had higher average blood SpO2, and less often required non-invasive ventilation. Only 1 vaccinated patient died from the development of cardiogenic shock against the background of anterior AMI and multivessel coronary artery disease (mortality – 15.7 % in unvaccinated pts vs 5.0 % in vaccinated, p=0.076).Conclusions. Co-infection with COVID-19 worsens treatment outcomes and in-hospital mortality of patients with ACP. Vaccination significantly reduces the likelihood of complications and tends to reduce mortality.
目的是分析急性心血管病理(ACP)患者合并COVID-19感染的住院死亡率。材料和方法。对诊断为COVID-19的139例ACP患者进行了检查。69例(49.6%)患者患有ACS(47例合并AMI)， 33例(23.7%)患者患有高血压急症，24例(17.3%)患者患有ADHF, 9例(6.5%)患者患有心房颤动过速发作，2例(1.4%)患者患有急性肺栓塞，2例(1.4%)患者患有晕厥。平均年龄67.9±12.7岁，男性70例(50.4%)。伴有动脉高血压的患者占87.1%，DM占20.9%，CHF占30.9%，COPD占9.4%，AMI病史占20.1%，缺血性卒中占9.4%。79例(56.8%)患者在入院前(症状出现后5.3±3.6天)确诊并实验室确诊为COVID-19。31名(22.3%)患者在入院时被诊断为COVID-19, 29名(20.9%)患者在住院期间被诊断为COVID-19。20例(15.6%)患者接种了COVID-19疫苗。初始SpO2水平为91.6±10.3%，超过一半(53.2%)的患者SpO2 < 95%，几乎四分之一(23.2%)的患者SpO2 < 90%。结果和讨论。住院期间死亡20例(14.4%)。ADHF患者的死亡率为28.0%，AMI患者的死亡率为19.1%，而因不稳定型心绞痛、高血压急症或房颤住院的患者的死亡率为5.2%(与AMI或ADHF患者相比，<0.05)。主要死亡原因是心肺功能衰竭- 14例(70.0%)。4例(20.0%)患者死于AMI并发症，1例死于肺栓塞，1例死于急性缺血性脑卒中。可区分住院死亡率的两个关键时期:1 -住院头两天(主要是急性心血管病理并发症和血栓形成事件);2 -住院后7 - 10天(因缺氧和心力衰竭进展而出现多器官衰竭)。ACP合并COVID-19患者的死亡率显著高于未合并呼吸道感染的同时住院患者(14.4% vs. 6.4%， p=0.012)和大流行前住院患者(14.4% vs. 2.9%， p <0.001)。接种疫苗的患者发生急性肾损伤、急性低氧性谵妄的可能性显著降低，平均血氧饱和度较高，并且较少需要无创通气。只有1名接种疫苗的患者死于心源性休克，背景是AMI和多支冠状动脉疾病(未接种疫苗的患者死亡率为15.7%，而接种疫苗的患者死亡率为5.0%，p=0.076)。合并感染COVID-19使ACP患者的治疗结果和住院死亡率恶化。疫苗接种可显著降低并发症发生的可能性，并有降低死亡率的趋势。
{"title":"Analysis of in-hospital complications in patients with acute cardiovascular pathology and co-infection with COVID-19: a registry of one center","authors":"Y. Lutay, O. Parkhomenko, D. Khomyakov, O. Irkin, S. Kushnir, Yu.V. Kornatskyi","doi":"10.31928/2664-4479-2022.5-6.716","DOIUrl":"https://doi.org/10.31928/2664-4479-2022.5-6.716","url":null,"abstract":"The aim – to analyze in-hospital mortality in pts with acute cardiovascular pathology (ACP) and a co-infection with COVID-19.Materials and methods. 139 pts with ACP who were diagnosed with COVID-19 were examined. 69 (49.6 %) pts had ACS (47 pts with AMI), 33 (23.7 %) pts – hypertensive urgency, 24 (17.3 %) pts – ADHF, 9 (6.5 %) pts – tachysystolic paroxysm of atrial fibrillation, 2 (1.4 %) pts – acute pulmonary embolism, and 2 (1.4 %) pts – syncope. The average age was 67.9±12.7 y.o., 70 (50.4 %) pts were male. Concomitant arterial hypertension was found in 87.1 %, DM – 20.9 %, CHF – 30.9 %, COPD – 9.4 % of pts, history of AMI – 20.1 % and ischemic stroke – 9.4 % of pts. In 79 (56.8 %) pts COVID-19 was diagnosed and laboratory confirmed before hospitalization (hospitalized in 5.3±3.6 days after symptoms onset). 31 (22.3 %) pts were diagnosed with COVID-19 upon admission, and 29 (20.9 %) – during their stay in the hospital. 20 (15.6 %) pts were vaccinated against COVID-19. The initial SpO2 level was 91.6±10.3 %, while more than half of pts (53.2 %) had SpO2 < 95 % and almost every fourth (23.2 %) patient had SpO2 < 90 %.Results and discussion. During the hospital period, 20 (14.4 %) pts died. The mortality rate was 28.0 % in pts with ADHF, 19.1 % in pts with AMI and significantly less in pts hospitalized for unstable angina, hypertensive urgency or atrial fibrillation – 5.2 % (р<0.05 in comparison with pts with AMI or ADHF). The main cause of death was the development of cardiopulmonary failure – 14 (70.0 %) pts. 4 (20.0 %) pts died from AMI complications, 1 – from pulmonary embolism and 1 – from acute ischemic stroke. Two critical periods of in-hospital mortality can be distinguished: 1 – the first two days of hospitalization (mainly complications of acute cardiovascular pathology and thrombotic events); 2 – from 7 to 10 days after hospitalization (development of multiple organ failure due to hypoxia and heart failure progression). The mortality rate of patients with ACP and COVID-19 was significantly higher than that of simultaneously hospitalized patients without comorbid respiratory infection (14.4 % vs. 6.4 %, p=0.012) and patients who were hospitalized before the pandemic (14.4 % vs. 2.9 %, р<0.001). Vaccinated patients were significantly less likely to develop acute kidney injury, acute hypoxic delirium, had higher average blood SpO2, and less often required non-invasive ventilation. Only 1 vaccinated patient died from the development of cardiogenic shock against the background of anterior AMI and multivessel coronary artery disease (mortality – 15.7 % in unvaccinated pts vs 5.0 % in vaccinated, p=0.076).Conclusions. Co-infection with COVID-19 worsens treatment outcomes and in-hospital mortality of patients with ACP. Vaccination significantly reduces the likelihood of complications and tends to reduce mortality.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84516165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-19DOI: 10.31928/2664-4479-2022.3-4.4955
I. Vyshnevska, O. Petyunina
The definite proofs of injury of SARS-CoV-2 infection on cardiovascular system are existing. Heart damage may be as primary without lung injury mentioned in literature «the heart phenotype», as secondary which is developed under lung injury and named «mixed cardio-pulmonary phenotype». The reason of prevalence of one or another phenotype is unknown but with confidence it can be confirmed that myocardial injury worsens the patient’s prognosis. The clinical case concernes the 19-year-old patient after new coronavirus infection COVID-19. The ilness courced in mild form, without lung injury. Myocarditis is clinically fixed after 2 weeks after coronavirus symptoms beginning. In our case repeated сonsistent hypertermia observed since 17 day of disease, the level of C-reactive proteine was elevated. The patient was evaluated after COVID-19. Echocardiography was done, it has been revealed segmentary and global strain decrease. Acute myocarditis was suggested and confirmed by magnetic resonance investigation (MRI) with gadolinium enhancement. Carvedilol 3,125 mg twice daily with dose titration to 25 mg twice, zophinapril 7,5 mg twice a day, spironolacton 25 mg daily, colchicin 0,5 mg twice daily, trimetazidiin 80 mg daily, phisical load restricition, rational nutrition were prescribed to the patient. Repeated MRI demonstrated resolution of acute myocarditis, only elements of light focal unischemic myocardial fibrosis were remained. Conclusion is that in patients with COVID-19 can develop myocarditis. The mechanism of development of this complication is unknown and needs further investigation.
{"title":"Development of acute myocarditis as a complication of COVID-19","authors":"I. Vyshnevska, O. Petyunina","doi":"10.31928/2664-4479-2022.3-4.4955","DOIUrl":"https://doi.org/10.31928/2664-4479-2022.3-4.4955","url":null,"abstract":"The definite proofs of injury of SARS-CoV-2 infection on cardiovascular system are existing. Heart damage may be as primary without lung injury mentioned in literature «the heart phenotype», as secondary which is developed under lung injury and named «mixed cardio-pulmonary phenotype». The reason of prevalence of one or another phenotype is unknown but with confidence it can be confirmed that myocardial injury worsens the patient’s prognosis. The clinical case concernes the 19-year-old patient after new coronavirus infection COVID-19. The ilness courced in mild form, without lung injury. Myocarditis is clinically fixed after 2 weeks after coronavirus symptoms beginning. In our case repeated сonsistent hypertermia observed since 17 day of disease, the level of C-reactive proteine was elevated. The patient was evaluated after COVID-19. Echocardiography was done, it has been revealed segmentary and global strain decrease. Acute myocarditis was suggested and confirmed by magnetic resonance investigation (MRI) with gadolinium enhancement. Carvedilol 3,125 mg twice daily with dose titration to 25 mg twice, zophinapril 7,5 mg twice a day, spironolacton 25 mg daily, colchicin 0,5 mg twice daily, trimetazidiin 80 mg daily, phisical load restricition, rational nutrition were prescribed to the patient. Repeated MRI demonstrated resolution of acute myocarditis, only elements of light focal unischemic myocardial fibrosis were remained. Conclusion is that in patients with COVID-19 can develop myocarditis. The mechanism of development of this complication is unknown and needs further investigation.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84064171","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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