Pub Date : 2021-03-22DOI: 10.31928/1608-635X-2021.1.2633
O. Gogayeva, A. Rudenko, V. Lazoryshynets, L. Dzakhoieva
The aim – to analyze the endocrine status of high-risk patients with coronary artery disease in cardiac surgery.Materials and methods. Retrospective analysis of data from random 354 high-risk patients who were operated on and discharged from M.M. Amosov National Institute of Cardiovascular Surgery of NAMS of Ukraine in the period from 2009 to 2019. The mean age of patients was 61.9±9.7 years. All patients underwent ECG, ECHO, coronary angiography and surgical myocardial revascularization with correction of concomitant cardiac pathology, if necessary. In the perioperative period all patients underwent general clinical and biochemical blood tests. Stratifying the risk according to the EuroSCORE II scale, patients belonged to the high risk group and had > 5 % probability of mortality.Results and discussion. All patients had hemodynamically significant stenosis of the coronary arteries that required surgical revascularization of the myocardium. The analysis showed that 287 (81.07 %) patients were overweight, 281 (79.3 %) – had metabolic syndrome, 90 (25.4 %) – type 2 diabetes mellitus (type 2 DM), 161 (45.45 %) – impaired glucose tolerance. Thyroid disease was diagnosed in 37 (10.4 %) patients, 11 (3.1 %) patients had hypothyroidism. In the postoperative period, paroxysms of atrial fibrillation occurred in 83 (23.4 %) patients, of whom 70 (84.3 %) had type 2 DM and impaired glucose tolerance. Deep sternal infection occurred in 4 (4.4 %) patients with type 2 DM, for 3 (3.3 %) of them sternoplasty performed. Neurological complications – stroke and transient ischemic attack had 10 (2.8 %) patients among which 9 (90 %) had glucose metabolism disturbance. Acute renal failure occurred in 10 (2.8 %) patients, of whom 8 (80 %) had type 2 DM and pre-DM.Conclusions. Despite the high predicted mortality on the EuroSCORE II scale – 8.82 %, the operative mortality in the study group was 0 %, which indicates a coordinated highly skilled Heart-team work, timely verification of comorbid conditions and the involvement of related specialists.
{"title":"Analysis of the endocrine status of patients with coronary artery disease in cardiac surgery","authors":"O. Gogayeva, A. Rudenko, V. Lazoryshynets, L. Dzakhoieva","doi":"10.31928/1608-635X-2021.1.2633","DOIUrl":"https://doi.org/10.31928/1608-635X-2021.1.2633","url":null,"abstract":"The aim – to analyze the endocrine status of high-risk patients with coronary artery disease in cardiac surgery.Materials and methods. Retrospective analysis of data from random 354 high-risk patients who were operated on and discharged from M.M. Amosov National Institute of Cardiovascular Surgery of NAMS of Ukraine in the period from 2009 to 2019. The mean age of patients was 61.9±9.7 years. All patients underwent ECG, ECHO, coronary angiography and surgical myocardial revascularization with correction of concomitant cardiac pathology, if necessary. In the perioperative period all patients underwent general clinical and biochemical blood tests. Stratifying the risk according to the EuroSCORE II scale, patients belonged to the high risk group and had > 5 % probability of mortality.Results and discussion. All patients had hemodynamically significant stenosis of the coronary arteries that required surgical revascularization of the myocardium. The analysis showed that 287 (81.07 %) patients were overweight, 281 (79.3 %) – had metabolic syndrome, 90 (25.4 %) – type 2 diabetes mellitus (type 2 DM), 161 (45.45 %) – impaired glucose tolerance. Thyroid disease was diagnosed in 37 (10.4 %) patients, 11 (3.1 %) patients had hypothyroidism. In the postoperative period, paroxysms of atrial fibrillation occurred in 83 (23.4 %) patients, of whom 70 (84.3 %) had type 2 DM and impaired glucose tolerance. Deep sternal infection occurred in 4 (4.4 %) patients with type 2 DM, for 3 (3.3 %) of them sternoplasty performed. Neurological complications – stroke and transient ischemic attack had 10 (2.8 %) patients among which 9 (90 %) had glucose metabolism disturbance. Acute renal failure occurred in 10 (2.8 %) patients, of whom 8 (80 %) had type 2 DM and pre-DM.Conclusions. Despite the high predicted mortality on the EuroSCORE II scale – 8.82 %, the operative mortality in the study group was 0 %, which indicates a coordinated highly skilled Heart-team work, timely verification of comorbid conditions and the involvement of related specialists.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"272 1","pages":"26-33"},"PeriodicalIF":0.0,"publicationDate":"2021-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73092972","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 : 2021-03-22DOI: 10.31928/1608-635X-2021.1.717
O. Parkhomenko, O. Shumakov, T. Talayeva, I. Tretyak, O. Dovhan
The aim – to create a new method of assessing the development of hospital complications in STEMI patients by studying blood cell composition and its adaptation to practical application in general clinical practice.Materials and methods. The study was involved 317 patients with acute myocardial infarction (AMI) who was admitted from January 2014 to June 2020 to the intensive care unit. Some patients were evaluated retrospectively and were in group 1 (n=214). Group 2 – 103 patients, who were studied prospectively. The group of patients did not differ in clinical and anamnestic characteristics and treatment. An index of hospital complications was created for assessing the criteria of the severity of the clinical course.Results and discussion. A number of correlation analyses were performed to examine the relationships between white blood components, platelet heterogeneity and systemic inflammation, and the hospital complication index. On the basis of these data we have built a complex index – leukocyte-platelet index (LTI): LTI (conditional unit) = ((GRA – MON) / LYM) · 10 + PDWc + P-LCR, where: GRA is the number of granulocytes in the blood test, MON is the number of monocytes, LYM is the number of lymphocytes, PDWc is the percentage of platelet distribution by size, and P-LCR is the percentage of large (> 12fL) platelets. When assessing in group 1 correlations with the index of nosocomial complications and combined indicators: neutrophil-lymphocyte ratio (NLR) and the LTI index created by us showed the highest degree of correlation with the index of hospital complications (р<0.001 and р<0.0005, respectively). When the value of LTI > 137 conventional units can be judged on the increased risk of nosocomial complications of AMI (sensitivity 64 %, specificity 78 %, area under the curve 0.72). Thus, in a prospective approbation study, the LTI on the first day of AMI was significantly (р<0.05) better than other indicators, in particular, better than the widely used leukocyte marker NLR in determining the susceptibility to the undesirable course of the hospital period of the disease.Conclusions. The created computer algorithm for calculating the risk index of complications in patients with AMI on the first day can be widely implemented in modern health care facilities in Ukraine.
{"title":"New opportunities to assessing the risk of hospital complications in patients with ST-elevation myocardial infarction according to the study of the blood cells","authors":"O. Parkhomenko, O. Shumakov, T. Talayeva, I. Tretyak, O. Dovhan","doi":"10.31928/1608-635X-2021.1.717","DOIUrl":"https://doi.org/10.31928/1608-635X-2021.1.717","url":null,"abstract":"The aim – to create a new method of assessing the development of hospital complications in STEMI patients by studying blood cell composition and its adaptation to practical application in general clinical practice.Materials and methods. The study was involved 317 patients with acute myocardial infarction (AMI) who was admitted from January 2014 to June 2020 to the intensive care unit. Some patients were evaluated retrospectively and were in group 1 (n=214). Group 2 – 103 patients, who were studied prospectively. The group of patients did not differ in clinical and anamnestic characteristics and treatment. An index of hospital complications was created for assessing the criteria of the severity of the clinical course.Results and discussion. A number of correlation analyses were performed to examine the relationships between white blood components, platelet heterogeneity and systemic inflammation, and the hospital complication index. On the basis of these data we have built a complex index – leukocyte-platelet index (LTI): LTI (conditional unit) = ((GRA – MON) / LYM) · 10 + PDWc + P-LCR, where: GRA is the number of granulocytes in the blood test, MON is the number of monocytes, LYM is the number of lymphocytes, PDWc is the percentage of platelet distribution by size, and P-LCR is the percentage of large (> 12fL) platelets. When assessing in group 1 correlations with the index of nosocomial complications and combined indicators: neutrophil-lymphocyte ratio (NLR) and the LTI index created by us showed the highest degree of correlation with the index of hospital complications (р<0.001 and р<0.0005, respectively). When the value of LTI > 137 conventional units can be judged on the increased risk of nosocomial complications of AMI (sensitivity 64 %, specificity 78 %, area under the curve 0.72). Thus, in a prospective approbation study, the LTI on the first day of AMI was significantly (р<0.05) better than other indicators, in particular, better than the widely used leukocyte marker NLR in determining the susceptibility to the undesirable course of the hospital period of the disease.Conclusions. The created computer algorithm for calculating the risk index of complications in patients with AMI on the first day can be widely implemented in modern health care facilities in Ukraine.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"11 11 1","pages":"7-17"},"PeriodicalIF":0.0,"publicationDate":"2021-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78808060","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 : 2021-02-17DOI: 10.31928/1608-635X-2020.6.4760
M. Aristov, O. Melnychuk
The aim – to conduct clinical effectiveness, meta-analysis of 30 and 120-days mortality data, pharmacoeconomic evaluation of levosimendan treatment compared with dobutamine in patients with severe acute decompensated chronic heart failure (ADCHF) who require inotropic support. Materials and methods. The PubMed and Cochrane databases were searched for direct randomized clinical trials of levosimendan treatment compared with dobutamine in patients with ADCHF. The clinical efficacy of levosimendan and dobutamine was analyzed. Pharmacoeconomic analysis was carried out using the cost-effectiveness method with an assessment of the incremental cost-effectiveness ratio. A decision tree model of levosimendan or dobutamine treatments was constructed. The efficacy endpoints and impact on the budget were analyzed in terms of long-term effectiveness of levosimendan and dobutamine use. Discounted was conducted with rate of 3 %. Sensitivity analysis was carried out in terms of price changing of drugs, the cost of drugs in mg, the likelihood of re-hospitalization of the patient in a 3-year horizon and survival in the long term.Results and discussion. Analysis of clinical data and meta-analysis of randomized clinical trials found that mortality rates with levosimendan and dobutamine in the 30-day period were 9.6 % and 13.8 %, RR 0.71 (95 % CI 0.53–0.95) and in the 120-day period – 13.5 % and 25.2 %, RR 0.54 (95 % CI 0.32–0.92), respectively. The total cost of the course of treatment, taking into account the price of the drug, medical devices, staff services, diagnostic procedures and treatment of adverse reactions when using levosimendan, was 34 003.02 UAH per patient and 18 787.28 UAH when treated with dobutamine. The weighted average hospital stay was 6.4 days in case of levosimendan treatment and 7.5 days of dobutamine treatment. Extrapolation of the data from clinical trials to the 3-year survival rate of patients allowed us to determine an additional indicator of efficacy – the number of life years saved with levosimendan – 2.64 and 2.37 with dobutamine treatment. A cost-effectiveness analysis found that levosimendan is more efficient but more expensive technology compare to dobutamine. The incremental cost-effectiveness ratio for the additional life year saved of a patient with severe CHF is 43,473.55 UAH, which is 6 times less than the likely threshold of willingness to pay in Ukraine.Conclusions. The multivariate sensitivity analysis detected the model sustainability to the most crucial parameters of the model – drug price; the cost of drugs associated with their actual use in mg, the possibility of re-hospitalization of the patient in a 3-year horizon, and long-term survival, which is associated with the time horizon of the model. The total cost of a cohort of patients with ADCHF in Ukraine when using scenario 1 (100 % distribution of costs for dobutamine treatment) over 5 years is 268 188 351.94 UAH, when using scenario 2 (100 % distribution for treatme
目的是对需要肌力支持的严重急性失代偿性慢性心力衰竭(ADCHF)患者进行左西咪旦治疗与多巴酚丁胺治疗的临床疗效、30天和120天死亡率数据的荟萃分析和药物经济学评价。材料和方法。检索PubMed和Cochrane数据库，寻找左西孟旦与多巴酚丁胺治疗ADCHF患者的直接随机临床试验。分析左西孟旦与多巴酚丁胺的临床疗效。采用成本-效果法进行药物经济学分析，并对增量成本-效果比进行评估。建立了左西孟旦与多巴酚丁胺处理的决策树模型。根据左西孟旦和多巴酚丁胺的长期疗效分析疗效终点和对预算的影响。折现率为3%。对药物价格变化、以mg为单位的药物成本、患者3年内再次住院的可能性和长期生存率进行敏感性分析。结果和讨论。临床资料分析和随机临床试验荟萃分析发现，左西孟旦和多巴酚丁胺在30天内的死亡率分别为9.6%和13.8%，RR为0.71 (95% CI 0.53-0.95)，在120天内的死亡率分别为13.5%和25.2%，RR为0.54 (95% CI 0.32-0.92)。考虑到药物、医疗设备、工作人员服务、诊断程序和使用左西孟旦时不良反应的治疗价格，治疗过程的总成本为每位患者34 003.02澳元，而使用多巴酚丁胺治疗时为18 787.28澳元。左西孟旦组加权平均住院时间为6.4天，多巴酚丁胺组加权平均住院时间为7.5天。将临床试验数据外推到患者的3年生存率，使我们能够确定另一个疗效指标——左西孟旦节省的生命年数——多巴酚丁胺治疗为2.64年和2.37年。一项成本效益分析发现，与多巴酚丁胺相比，左西孟旦更有效，但更昂贵。严重瑞士法郎患者额外节省的生命年的增量成本-效果比为43,473.55 UAH，比乌克兰可能的支付意愿阈值低6倍。多变量敏感性分析检测了模型对模型最关键参数—药品价格的可持续性;与mg实际使用相关的药物成本，患者在3年内再次住院的可能性，以及与模型时间范围相关的长期生存。乌克兰ADCHF患者队列使用情景1(多巴酚丁胺治疗费用100%分配)5年内的总成本为268 188 351.94 UAH，当使用情景2(左西孟旦治疗费用100%分配)时，如果应用情景3(在5年内用多巴酚丁胺治疗ADCHF患者逐渐5%过渡到用左西孟旦治疗)，总预算成本将为485 393 073.09 UAH。预算费用总额为289 916 431.92阿联酋元
{"title":"Use of levosimendan versus dobutamine when inotropic support is needed in patients with severe acute decompensated chronic heart failure","authors":"M. Aristov, O. Melnychuk","doi":"10.31928/1608-635X-2020.6.4760","DOIUrl":"https://doi.org/10.31928/1608-635X-2020.6.4760","url":null,"abstract":"The aim – to conduct clinical effectiveness, meta-analysis of 30 and 120-days mortality data, pharmacoeconomic evaluation of levosimendan treatment compared with dobutamine in patients with severe acute decompensated chronic heart failure (ADCHF) who require inotropic support. Materials and methods. The PubMed and Cochrane databases were searched for direct randomized clinical trials of levosimendan treatment compared with dobutamine in patients with ADCHF. The clinical efficacy of levosimendan and dobutamine was analyzed. Pharmacoeconomic analysis was carried out using the cost-effectiveness method with an assessment of the incremental cost-effectiveness ratio. A decision tree model of levosimendan or dobutamine treatments was constructed. The efficacy endpoints and impact on the budget were analyzed in terms of long-term effectiveness of levosimendan and dobutamine use. Discounted was conducted with rate of 3 %. Sensitivity analysis was carried out in terms of price changing of drugs, the cost of drugs in mg, the likelihood of re-hospitalization of the patient in a 3-year horizon and survival in the long term.Results and discussion. Analysis of clinical data and meta-analysis of randomized clinical trials found that mortality rates with levosimendan and dobutamine in the 30-day period were 9.6 % and 13.8 %, RR 0.71 (95 % CI 0.53–0.95) and in the 120-day period – 13.5 % and 25.2 %, RR 0.54 (95 % CI 0.32–0.92), respectively. The total cost of the course of treatment, taking into account the price of the drug, medical devices, staff services, diagnostic procedures and treatment of adverse reactions when using levosimendan, was 34 003.02 UAH per patient and 18 787.28 UAH when treated with dobutamine. The weighted average hospital stay was 6.4 days in case of levosimendan treatment and 7.5 days of dobutamine treatment. Extrapolation of the data from clinical trials to the 3-year survival rate of patients allowed us to determine an additional indicator of efficacy – the number of life years saved with levosimendan – 2.64 and 2.37 with dobutamine treatment. A cost-effectiveness analysis found that levosimendan is more efficient but more expensive technology compare to dobutamine. The incremental cost-effectiveness ratio for the additional life year saved of a patient with severe CHF is 43,473.55 UAH, which is 6 times less than the likely threshold of willingness to pay in Ukraine.Conclusions. The multivariate sensitivity analysis detected the model sustainability to the most crucial parameters of the model – drug price; the cost of drugs associated with their actual use in mg, the possibility of re-hospitalization of the patient in a 3-year horizon, and long-term survival, which is associated with the time horizon of the model. The total cost of a cohort of patients with ADCHF in Ukraine when using scenario 1 (100 % distribution of costs for dobutamine treatment) over 5 years is 268 188 351.94 UAH, when using scenario 2 (100 % distribution for treatme","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"9 1","pages":"47-60"},"PeriodicalIF":0.0,"publicationDate":"2021-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89258851","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 : 2021-02-04DOI: 10.31928/1608-635X-2020.6.918
К. V. Voitsekhovska, L. Voronkov
A characteristic sign of chronic heart failure (CHF) is a high frequency of comorbid conditions, one of which is the phenomenon of weight loss. Cardiac cachexia is a systemic metabolic disorder characterized by an unintentional decrease in body weight due to loss of all body components, namely, skeletal muscle, adipose tissue and bone tissue, and identified as a marker of nutritional status, has prognostic value in patients with CHF, regardless of age, NYHA class, left ventricular ejection fraction, and peak oxygen consumption. The article discusses the prevalence, criteria, prognostic significance of cardiac cachexia, as well as immune, metabolic and neurohormonal pathogenetic mechanisms that lead to anabolic-catabolic imbalance and contribute to the progression of CHF. Given the methodological difficulties of proper assessment of unintentional body weight loss over a certain previous period of outpatient follow-up in patients with CHF, it becomes urgent to determine the objective («static») characteristics of the nutritional status of patients, which are associated with an unfavorable clinical prognosis. The article demonstrates the results of our own research to determine prognostic factors based on indicators of the nutritional status of patients the clinical significance of the loss of individual body components is highlighted, preventive and therapeutic approaches to influence body weight loss in patients with CHF are described – nutritional support, neurohormonal blockade, the effect on the intestinal microflora, correction of anemia and iron deficiency, the use of appetite stimulants, immunomodulatory agents, anabolic hormones and physical training.
{"title":"The phenomenon of weight loss in patients with chronic heart failure","authors":"К. V. Voitsekhovska, L. Voronkov","doi":"10.31928/1608-635X-2020.6.918","DOIUrl":"https://doi.org/10.31928/1608-635X-2020.6.918","url":null,"abstract":"A characteristic sign of chronic heart failure (CHF) is a high frequency of comorbid conditions, one of which is the phenomenon of weight loss. Cardiac cachexia is a systemic metabolic disorder characterized by an unintentional decrease in body weight due to loss of all body components, namely, skeletal muscle, adipose tissue and bone tissue, and identified as a marker of nutritional status, has prognostic value in patients with CHF, regardless of age, NYHA class, left ventricular ejection fraction, and peak oxygen consumption. The article discusses the prevalence, criteria, prognostic significance of cardiac cachexia, as well as immune, metabolic and neurohormonal pathogenetic mechanisms that lead to anabolic-catabolic imbalance and contribute to the progression of CHF. Given the methodological difficulties of proper assessment of unintentional body weight loss over a certain previous period of outpatient follow-up in patients with CHF, it becomes urgent to determine the objective («static») characteristics of the nutritional status of patients, which are associated with an unfavorable clinical prognosis. The article demonstrates the results of our own research to determine prognostic factors based on indicators of the nutritional status of patients the clinical significance of the loss of individual body components is highlighted, preventive and therapeutic approaches to influence body weight loss in patients with CHF are described – nutritional support, neurohormonal blockade, the effect on the intestinal microflora, correction of anemia and iron deficiency, the use of appetite stimulants, immunomodulatory agents, anabolic hormones and physical training.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"29 1","pages":"9-18"},"PeriodicalIF":0.0,"publicationDate":"2021-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84468868","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 : 2021-02-04DOI: 10.31928/1608-635X-2020.6.6170
V. Kovalenko, E. Nesukay, S. Cherniuk, N. S. Polenova, R. Kirichenko, A. Kozliuk, J. J. Giresh, E. Titov
The choice of adequate tactics for the treatment of myocarditis is particularly relevant today, and the most controversial among modern scientists and practitioners is the question of prescribing etiology-based and pathogenetic treatment. One of the most pressing and complex issues at the present stage is the problem of developing adequate schemes for etiology-based and pathogenetic treatment of severe chronic myocarditis, as so far the only recommended strategy is the treatment of heart failure according to current recommendations. The appointment of etiotropic therapy in patients with myocarditis may be appropriate in the acute phase of the disease and must take into account the results of endomyocardial biopsy. Immunosuppressive therapy should be used only in patients with severe myocarditis in the presence of conclusive evidence of active inflammatory process in the myocardium with mandatory re-examination after completion of its course to monitor safety and efficacy. In the presence of dilatation of the left ventricle and a reduced left ventricle ejection fraction, the basis for the treatment of myocarditis is the patient’s compliance with dietary restrictions and the use of standard heart failure therapy according to current recommendations. However, a large number of issues related to the management of patients with myocarditis remain debatable, so leading world scientists recognize the need for further research to assess the effectiveness of etiology-based and pathogenetic therapy.
{"title":"Treatment of myocarditis: contemporary approaches and perspective trends","authors":"V. Kovalenko, E. Nesukay, S. Cherniuk, N. S. Polenova, R. Kirichenko, A. Kozliuk, J. J. Giresh, E. Titov","doi":"10.31928/1608-635X-2020.6.6170","DOIUrl":"https://doi.org/10.31928/1608-635X-2020.6.6170","url":null,"abstract":"The choice of adequate tactics for the treatment of myocarditis is particularly relevant today, and the most controversial among modern scientists and practitioners is the question of prescribing etiology-based and pathogenetic treatment. One of the most pressing and complex issues at the present stage is the problem of developing adequate schemes for etiology-based and pathogenetic treatment of severe chronic myocarditis, as so far the only recommended strategy is the treatment of heart failure according to current recommendations. The appointment of etiotropic therapy in patients with myocarditis may be appropriate in the acute phase of the disease and must take into account the results of endomyocardial biopsy. Immunosuppressive therapy should be used only in patients with severe myocarditis in the presence of conclusive evidence of active inflammatory process in the myocardium with mandatory re-examination after completion of its course to monitor safety and efficacy. In the presence of dilatation of the left ventricle and a reduced left ventricle ejection fraction, the basis for the treatment of myocarditis is the patient’s compliance with dietary restrictions and the use of standard heart failure therapy according to current recommendations. However, a large number of issues related to the management of patients with myocarditis remain debatable, so leading world scientists recognize the need for further research to assess the effectiveness of etiology-based and pathogenetic therapy.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"14 1","pages":"61-70"},"PeriodicalIF":0.0,"publicationDate":"2021-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89552415","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 : 2021-02-04DOI: 10.31928/1608-635X-2020.6.4146
V. Tseluyko, A. Lukyanenko, L. Yakovleva
The aim – to provide сlinical and functional characteristics of patients with heart failure (HF) admitted to the cardiologic clinic Materials and methods. We studied 150 in-patient cards of the patients who were consecutively admitted to City Clinical Hospital N 8 between August 2018 and September 2019. 124 (80.6 %) patients who had the diagnosis of HF were selected for the future analysis.Results and discussion. Among the examined HF patients, 89 (71.8 %) had HF stage ІІА,18 (14.5 %) had stage IIB and 17 (13.7 %) had stage I. 23 (18,5 %) of patients had left ventricle ejection fraction (LVEF) below 40 %, 101 (81.5 %) had preserved LVEF. 73 (58.9 %) of examined patients with HF were male, 51 (41.1 %) were female. Women were elder then men and were more likely to have stage II arterial hypertension (AH) while men were more likely to have stage 3 AH. Most females had HF with preserved LVEF.Conclusions. Most patients with HF have preserved LVEF which can be the result of HF hyperdiagnistics in the situation of missing NT-proBNP assessment. In the group of patients with preserved LVEF HF 19.8 % of patients have EF of 40–49 % while 20.8 % have LVEF over 62 %. The most common comorbidity in patients with preserved LVEF HF was AH (88.1 %), coronary artery disease (77.2 %), atrial fibrillation (29.4 %).
{"title":"Clinical and functional characteristics of hospitalized patients with heart failure in the routine clinical practice","authors":"V. Tseluyko, A. Lukyanenko, L. Yakovleva","doi":"10.31928/1608-635X-2020.6.4146","DOIUrl":"https://doi.org/10.31928/1608-635X-2020.6.4146","url":null,"abstract":"The aim – to provide сlinical and functional characteristics of patients with heart failure (HF) admitted to the cardiologic clinic Materials and methods. We studied 150 in-patient cards of the patients who were consecutively admitted to City Clinical Hospital N 8 between August 2018 and September 2019. 124 (80.6 %) patients who had the diagnosis of HF were selected for the future analysis.Results and discussion. Among the examined HF patients, 89 (71.8 %) had HF stage ІІА,18 (14.5 %) had stage IIB and 17 (13.7 %) had stage I. 23 (18,5 %) of patients had left ventricle ejection fraction (LVEF) below 40 %, 101 (81.5 %) had preserved LVEF. 73 (58.9 %) of examined patients with HF were male, 51 (41.1 %) were female. Women were elder then men and were more likely to have stage II arterial hypertension (AH) while men were more likely to have stage 3 AH. Most females had HF with preserved LVEF.Conclusions. Most patients with HF have preserved LVEF which can be the result of HF hyperdiagnistics in the situation of missing NT-proBNP assessment. In the group of patients with preserved LVEF HF 19.8 % of patients have EF of 40–49 % while 20.8 % have LVEF over 62 %. The most common comorbidity in patients with preserved LVEF HF was AH (88.1 %), coronary artery disease (77.2 %), atrial fibrillation (29.4 %).","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"29 1","pages":"41-46"},"PeriodicalIF":0.0,"publicationDate":"2021-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89931863","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 : 2021-02-04DOI: 10.31928/1608-635X-2020.6.3340
E. Nesukay
The aim – to evaluate the efficacy and safety of preparation of morpholinium salt of thiazotic acid in patients with stable angina in an open-label clinical non-randomized post-marketing study.Materials and methods. The study EPASS included 30 patients aged an average of (73.1±1.8) years with a diagnosis of coronary heart disease, stable angina pectoris, functional class II–III. All patients in addition to the basic therapy received the study drug (SD) – Antares, solution for injection («Галичфарм», Ukraine) – at a dose of 50 mg/ml 4 ml of solution intramuscularly 2 times a day at a daily dose of 400 mg for 14 days. Then the patients took SD tablets – Antares, tablets («Київмедпрепарат», Ukraine) – 200 mg three times a day at a daily dose of 600 mg: 15 patients for 40 days and 15 patients for an average of 70 days. Patients underwent clinical and laboratory examination, daily monitoring of the electrocardiogram with calculation of frequent and spectral parameters of heart rate variability (HRV), transthoracic echocardiography, test with a 6-minute walking distance (6MWD).Results and discussion. At the end of the course of treatment, all patients noted an improvement in general condition, a decrease in the intensity of pain and shortness of breath. In all patients, the walking distance increased significantly by an average of 21.6 %, in women – by an average of 19.8 %, in men – by an average of 22.7 %. Among patients with a median duration of treatment of 84 days, walking distance increased to a greater extent compared with that in the group of patients who received treatment for 54 days. The analysis of HRV parameters before the appointment of SD revealed a decrease in the activity of both the sympathetic and parasympathetic systems in the regulation of heart rate as a whole by group and depending on gender. After the course of treatment there was an increase in the total power of the spectrum and the restoration of the balance of autonomic regulation of the heart. Throughout the EPASS study, there was no early discontinuation of SD due to the development of serious adverse reactions; individual intolerance or hypersensitivity to thiazotic acid.Conclusions. The results of the EPASS study showed the antianginal efficacy of SD and increased exercise tolerance by the 6MWD test in patients with stable angina in real clinical practice, including in patients older than 79 years. An increase in exercise tolerance with the duration of the course of SD on average 84 days compared with that for 54 days was established. Demonstrated the safety of SD, the absence of side effects and the need to cancel it throughout the study period.
{"title":"Optimization of stable angina treatment: the results of the EPASS study","authors":"E. Nesukay","doi":"10.31928/1608-635X-2020.6.3340","DOIUrl":"https://doi.org/10.31928/1608-635X-2020.6.3340","url":null,"abstract":"The aim – to evaluate the efficacy and safety of preparation of morpholinium salt of thiazotic acid in patients with stable angina in an open-label clinical non-randomized post-marketing study.Materials and methods. The study EPASS included 30 patients aged an average of (73.1±1.8) years with a diagnosis of coronary heart disease, stable angina pectoris, functional class II–III. All patients in addition to the basic therapy received the study drug (SD) – Antares, solution for injection («Галичфарм», Ukraine) – at a dose of 50 mg/ml 4 ml of solution intramuscularly 2 times a day at a daily dose of 400 mg for 14 days. Then the patients took SD tablets – Antares, tablets («Київмедпрепарат», Ukraine) – 200 mg three times a day at a daily dose of 600 mg: 15 patients for 40 days and 15 patients for an average of 70 days. Patients underwent clinical and laboratory examination, daily monitoring of the electrocardiogram with calculation of frequent and spectral parameters of heart rate variability (HRV), transthoracic echocardiography, test with a 6-minute walking distance (6MWD).Results and discussion. At the end of the course of treatment, all patients noted an improvement in general condition, a decrease in the intensity of pain and shortness of breath. In all patients, the walking distance increased significantly by an average of 21.6 %, in women – by an average of 19.8 %, in men – by an average of 22.7 %. Among patients with a median duration of treatment of 84 days, walking distance increased to a greater extent compared with that in the group of patients who received treatment for 54 days. The analysis of HRV parameters before the appointment of SD revealed a decrease in the activity of both the sympathetic and parasympathetic systems in the regulation of heart rate as a whole by group and depending on gender. After the course of treatment there was an increase in the total power of the spectrum and the restoration of the balance of autonomic regulation of the heart. Throughout the EPASS study, there was no early discontinuation of SD due to the development of serious adverse reactions; individual intolerance or hypersensitivity to thiazotic acid.Conclusions. The results of the EPASS study showed the antianginal efficacy of SD and increased exercise tolerance by the 6MWD test in patients with stable angina in real clinical practice, including in patients older than 79 years. An increase in exercise tolerance with the duration of the course of SD on average 84 days compared with that for 54 days was established. Demonstrated the safety of SD, the absence of side effects and the need to cancel it throughout the study period.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"48 1","pages":"33-40"},"PeriodicalIF":0.0,"publicationDate":"2021-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80429076","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 : 2021-02-04DOI: 10.31928/1608-635X-2020.6.7181
V. Kovalenko, E. Nesukay
The recommendations were developed by the Ukrainian Association of Cardiology based on the expert opinion and recommendation documents of the Heart Failure Association, the European Association of Cardiovascular Imaging (EACVI), the Cardiooncology Committee of the European Society of Cardiology (ESC), European Society for Medical Oncology (ESMO), American Echocardiographic Society. They focus on risk assessment, diagnostic and prophylactic approaches to reduce cardiovascular toxicity due to the use of chemotherapeutic drugs and radiation therapy in patients with cancer. Intended for cardiologists, therapists, family physicians, oncologists, researchers, teachers of higher medical education and postgraduate education.
{"title":"Risk determination, diagnosis and prevention of cardiotoxicity with chemotherapeutic medications and radiation therapy Guidelines of the Ukrainian Association of Cardiology","authors":"V. Kovalenko, E. Nesukay","doi":"10.31928/1608-635X-2020.6.7181","DOIUrl":"https://doi.org/10.31928/1608-635X-2020.6.7181","url":null,"abstract":"The recommendations were developed by the Ukrainian Association of Cardiology based on the expert opinion and recommendation documents of the Heart Failure Association, the European Association of Cardiovascular Imaging (EACVI), the Cardiooncology Committee of the European Society of Cardiology (ESC), European Society for Medical Oncology (ESMO), American Echocardiographic Society. They focus on risk assessment, diagnostic and prophylactic approaches to reduce cardiovascular toxicity due to the use of chemotherapeutic drugs and radiation therapy in patients with cancer. Intended for cardiologists, therapists, family physicians, oncologists, researchers, teachers of higher medical education and postgraduate education.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"110 1","pages":"71-81"},"PeriodicalIF":0.0,"publicationDate":"2021-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80553460","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 : 2021-02-04DOI: 10.31928/1608-635X-2020.6.1930
L. Babii, V. Shumakov, O. Pogurelska, A. Rybak, I. Malynovska, Y. Khomenko, N. Tereshchenko, O. V. Voloshina, L. Kisilevich
The aim – to use multislice computed tomography (MSCT)-coronary angiography data to determine the presence of atherosclerotic process progression in coronary vessels in the dynamics of the three-year follow-up period in patients after STEMI and coronary artery stenting.Materials and methods. 66 MSCT-coronary angiography studies were performed in 19 men after primary myocardial infarction with ST-segment elevation (STEMI) and coronary artery stenting. All patients were male, ranging in age from 38 to 66 years, with a mean (Me 55.6; (Q1–Q3 (49–64)) years, and 18 of 19 (94.0 %) patients developed Q-MI. 1 patient (6 %) had non-Q-MI. A month after acute MI, patients underwent MSCT of the heart with coronary vascular contrast. Re-examination was performed one, two and three years after the development of STEMI. According to the results of MSCT coronary angiography determined the functional status of stents, as well as the presence or exclusion of signs of restenosis (about 50 % or more) or thrombosis 100 % – occlusion) in the stent coronary artery and in non-infarction-causing arteries. With the progression of atherosclerotic plaque, an increase in atherosclerotic plaque of more than 20 % was taken into account compared to the previous study.Results and discussion. By the end of the first year after MI in 11 of 19 (57.9 %) patients according to MSCT-coronary angiography, no progression of atherosclerotic lesions of the coronary arteries was observed. 1 patient (5.6 %) had stent restenosis, which was confirmed by CAG data. Progression of atherosclerotic lesions was observed in 7 patients (36.8 %), 3 of them (16.6 %) in the stent artery, and in 4 patients in the non-infarction-causing artery. In the second year after myocardial infarction, compared with the annual examination, in 6 of 14 (42.9 %) no progression of atherosclerosis was observed, and in 7 of 14 (50 %) progression of atherosclerotic lesions not in the stent artery, and only in 1 of 14 – progression of atherosclerosis in the stent artery. In the third year after the development of MI, 10 of 14 (71.4 %) had no progression of atherosclerosis, and 4 patients showed progression in both IOA and other arteries.Conclusions. MSCT coronary angiography is an informative method in assessing the functional status of stents and determining the progression of coronary atherosclerosis in the infarct-causing artery and other coronary arteries in patients after MI and coronary artery stenting in the dynamics of three-year follow-up. The lack of progression of atherosclerosis was accompanied by slightly lower levels of low-density lipoprotein cholesterol, compared with patients with progression of atherosclerosis.
目的是利用多层计算机断层扫描(MSCT)-冠状动脉造影数据来确定STEMI和冠状动脉支架植入术后患者三年随访期间冠状动脉粥样硬化过程进展的动态。材料和方法。对19例原发性心肌梗死合并st段抬高(STEMI)和冠状动脉支架植入术后的男性进行了66例msct冠状动脉造影研究。所有患者均为男性，年龄38 ~ 66岁，平均(Me 55.6;(Q1-Q3(49-64))年，19例患者中有18例(94.0%)发生Q-MI。非q - mi 1例(6%)。急性心肌梗死一个月后，患者接受心脏MSCT冠脉血管造影。在STEMI发生后1年、2年和3年复查。根据MSCT冠状动脉造影的结果确定支架的功能状态，以及支架内冠状动脉和非梗死性动脉是否存在或排除再狭窄(约50%或更多)或血栓形成(100% -闭塞)的迹象。随着动脉粥样硬化斑块的进展，与之前的研究相比，动脉粥样硬化斑块增加了20%以上。结果和讨论。根据msct冠状动脉造影，19例患者中有11例(57.9%)在心肌梗死一年后未观察到冠状动脉粥样硬化病变进展。1例(5.6%)发生支架再狭窄，经CAG数据证实。7例(36.8%)患者出现动脉粥样硬化病变进展，其中3例(16.6%)发生在支架内动脉，4例发生在非梗死动脉。在心肌梗死后的第二年，与年度检查相比，14名患者中有6名(42.9%)未观察到动脉粥样硬化进展，14名患者中有7名(50%)未观察到支架内动脉粥样硬化病变进展，14名患者中只有1名在支架内动脉粥样硬化进展。在发生心肌梗死后的第三年，14例患者中有10例(71.4%)没有动脉粥样硬化进展，4例患者的IOA和其他动脉均有进展。在为期三年的动态随访中，MSCT冠状动脉造影是一种评估支架功能状态和确定心肌梗死和冠状动脉支架置入术后患者梗死致动脉和其他冠状动脉冠状动脉粥样硬化进展的信息方法。与动脉粥样硬化进展的患者相比，没有动脉粥样硬化进展的患者的低密度脂蛋白胆固醇水平略低。
{"title":"Multislice computed tomography in the evaluation of coronary atherosclerosis dynamics: data three-year observation in patients with myocardial infarction-segment elevation ST and stenting of coronary arteries","authors":"L. Babii, V. Shumakov, O. Pogurelska, A. Rybak, I. Malynovska, Y. Khomenko, N. Tereshchenko, O. V. Voloshina, L. Kisilevich","doi":"10.31928/1608-635X-2020.6.1930","DOIUrl":"https://doi.org/10.31928/1608-635X-2020.6.1930","url":null,"abstract":"The aim – to use multislice computed tomography (MSCT)-coronary angiography data to determine the presence of atherosclerotic process progression in coronary vessels in the dynamics of the three-year follow-up period in patients after STEMI and coronary artery stenting.Materials and methods. 66 MSCT-coronary angiography studies were performed in 19 men after primary myocardial infarction with ST-segment elevation (STEMI) and coronary artery stenting. All patients were male, ranging in age from 38 to 66 years, with a mean (Me 55.6; (Q1–Q3 (49–64)) years, and 18 of 19 (94.0 %) patients developed Q-MI. 1 patient (6 %) had non-Q-MI. A month after acute MI, patients underwent MSCT of the heart with coronary vascular contrast. Re-examination was performed one, two and three years after the development of STEMI. According to the results of MSCT coronary angiography determined the functional status of stents, as well as the presence or exclusion of signs of restenosis (about 50 % or more) or thrombosis 100 % – occlusion) in the stent coronary artery and in non-infarction-causing arteries. With the progression of atherosclerotic plaque, an increase in atherosclerotic plaque of more than 20 % was taken into account compared to the previous study.Results and discussion. By the end of the first year after MI in 11 of 19 (57.9 %) patients according to MSCT-coronary angiography, no progression of atherosclerotic lesions of the coronary arteries was observed. 1 patient (5.6 %) had stent restenosis, which was confirmed by CAG data. Progression of atherosclerotic lesions was observed in 7 patients (36.8 %), 3 of them (16.6 %) in the stent artery, and in 4 patients in the non-infarction-causing artery. In the second year after myocardial infarction, compared with the annual examination, in 6 of 14 (42.9 %) no progression of atherosclerosis was observed, and in 7 of 14 (50 %) progression of atherosclerotic lesions not in the stent artery, and only in 1 of 14 – progression of atherosclerosis in the stent artery. In the third year after the development of MI, 10 of 14 (71.4 %) had no progression of atherosclerosis, and 4 patients showed progression in both IOA and other arteries.Conclusions. MSCT coronary angiography is an informative method in assessing the functional status of stents and determining the progression of coronary atherosclerosis in the infarct-causing artery and other coronary arteries in patients after MI and coronary artery stenting in the dynamics of three-year follow-up. The lack of progression of atherosclerosis was accompanied by slightly lower levels of low-density lipoprotein cholesterol, compared with patients with progression of atherosclerosis.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"27 1","pages":"19-30"},"PeriodicalIF":0.0,"publicationDate":"2021-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84069364","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 : 2020-12-10DOI: 10.31928/1608-635x-2020.5.3450
O. Koval
The aim – to define the profile of patients with the arterial hypertension (AH) and overweight (body mass index (BMI): 25–29.9 kg/m2) or obesity (BMI ≥ 30 kg/m2) who do not achieve office blood pressure (BP) < 140/90 mm Hg with the antihypertensive therapy.Materials and methods. One hundred eighty five (185) general practitioners/primary care doctors consecutively, at the visits enrolled 1798 patients with AH, office BP > 140/90 mm Hg and overweight/obesity into the multicenter, open-label, observational, epidemiological study. The patients were surveyed using the standard questionnaire, they had the general clinical examination, their BMI and waist circumference (WC) were measured, they received recommendations regarding the physical activity and nutrition and their antihypertensive therapy was adjusted at the doctor discretion. After 1 month, at Visit 2, BP was monitored, efficacy of the prescribed therapy was evaluated and changes of body weight, BMI, WC and compliance were assessed. After another 1 month, Visit 3 was conducted by telephone.Results and discussion. Mean age of patients was 59,06±11,38 years; there were 1203 females (66.9 %). Overweight was recorded in 33.4 % of patients and obesity in 66.6 % of patients. Mean body weight was 92.06±14.03 kg, BMI was 32.38±4.55 kg/m2, WC in males was 104.92±12.74 cm, in females –99.32±12.74 cm, i.e. abdominal obesity was prevailing. Family history of cardiovascular diseases was reported in 60.7 % of patients and 63.6 % have never smoked. Diabetes mellitus or impaired glucose tolerance was observed in 11.06 % of patients. The systolic BP (SBP) was 163.15±12.21 mm Hg, diastolic BP (DBP) was 95.62±7.78 mm Hg, heart rate (HR) was 78.16±8.98 per minute, i.e. in general, severe AH was recorded. At enrolment 38.4 % of patients received one antihypertensive product, 47.8 % of patients received two products and 13.8 % of patients received three and more products (generally renin-angiotensin-aldosterone system modulators in combination with the calcium antagonists and hydrochlorothiazide, more than half – as individual products). Initial compliance (quantity of positive responses) was 3.33 scores and was low in 73.9 % of patients and high only in 4.0 % of patients. Doctors changed the antihypertensive therapy at Visit 1: 84.43 % of patients were recommended the original fixed combination of perindopril and indapamide at 10/2.5 mg; 14.07 % of patients – at 5/1.25 mg; 0.95 % of patients – at 2.5/0.625 mg; 0.56 % of patients were prescribed another antihypertensive therapy. Following 1-month therapy, SBP decreased by 27.12±13.70 mm Hg, DBP decreased by 13.32±9.08 mm Hg, HR decreased by 5.20±8.16 per minute (all p<0.001), which ensured AH control in 74.9 % of patients and improved compliance (p<0.05). Further 1-month treatment led to further decrease in BP. After 2 months, the mean SBP was 130.29±11.58 mm Hg, DBP was 79.37±6.69 mm Hg; it decreased from baseline by 32.87±12.21 and 16.26±8.93 mm Hg (p<0.0001). A
目的-确定动脉高血压(AH)和超重(体重指数(BMI): 25-29.9 kg/m2)或肥胖(BMI≥30 kg/m2)患者的概况，这些患者的降压治疗未达到血压(BP) < 140/90 mm Hg。材料和方法。185名全科医生/初级保健医生连续入组1798例AH、办公室血压> 140/90 mm Hg和超重/肥胖患者，进行多中心、开放标签、观察性流行病学研究。采用标准问卷对患者进行调查，对患者进行一般临床检查，测量BMI和腰围(WC)，建议患者进行身体活动和营养，并根据医生的判断调整降压治疗。1个月后，在就诊2时监测血压，评估处方治疗的疗效，评估体重、BMI、WC和依从性的变化。又过了一个月，第三次访问通过电话进行。结果和讨论。患者平均年龄59,06±11,38岁;女性1203人(66.9%)。33.4%的患者超重，66.6%的患者肥胖。平均体重92.06±14.03 kg, BMI 32.38±4.55 kg/m2，男性腰围104.92±12.74 cm，女性腰围-99.32±12.74 cm，以腹部肥胖为主。60.7%的患者有心血管疾病家族史，63.6%的患者从不吸烟。11.06%的患者有糖尿病或糖耐量受损。收缩压(SBP)为163.15±12.21 mm Hg，舒张压(DBP)为95.62±7.78 mm Hg，心率(HR)为78.16±8.98 / min，一般为重度AH。在入组时，38.4%的患者使用一种降压药，47.8%的患者使用两种降压药，13.8%的患者使用三种及以上降压药(通常是肾素-血管紧张素-醛固酮系统调节剂与钙拮抗剂和氢氯噻嗪联合使用，超过一半是单独使用)。初始依从性(阳性反应数量)为3.33分，73.9%的患者低，仅4.0%的患者高。就诊1时医生改变降压治疗方案:84.43%的患者推荐培哚普利与吲达帕胺原固定联合用药10/2.5 mg;14.07%的患者- 5/1.25 mg;0.95%的患者- 2.5/0.625 mg;0.56%的患者同时服用其他抗高血压药物。治疗1个月后，收缩压下降27.12±13.70 mm Hg，舒张压下降13.32±9.08 mm Hg，心率下降5.20±8.16 / min(均p<0.001)， 74.9%的患者AH得到控制，依从性提高(p<0.05)。治疗1个月后血压进一步下降。2个月后，平均收缩压为130.29±11.58 mm Hg，舒张压为79.37±6.69 mm Hg;较基线下降32.87±12.21 mm Hg和16.26±8.93 mm Hg (p<0.0001)。所有血压变化均呈剂量依赖性(原培哚普利与吲达帕胺固定联合剂量)，在10/2.5 mg联合使用时血压变化最高。治疗效果和依从性不依赖于既往治疗或患者的年龄。93.09%的患者血压得到控制，71%的患者依从性得到改善。使用培哚普利和吲达帕胺的原始固定组合治疗，通常在既往治疗的AH和超重/肥胖患者中使用最高剂量(10/2.5 mg)是有效的，并且允许93%的患者在治疗2个月后达到血压控制，无论其年龄，并且显着提高依从性。
{"title":"Intensification of antihypertensive therapy in patients with uncontrolled arterial hypertension and overweight/obesity based on results of Ukrainian study SATISFACTION","authors":"O. Koval","doi":"10.31928/1608-635x-2020.5.3450","DOIUrl":"https://doi.org/10.31928/1608-635x-2020.5.3450","url":null,"abstract":"The aim – to define the profile of patients with the arterial hypertension (AH) and overweight (body mass index (BMI): 25–29.9 kg/m2) or obesity (BMI ≥ 30 kg/m2) who do not achieve office blood pressure (BP) < 140/90 mm Hg with the antihypertensive therapy.Materials and methods. One hundred eighty five (185) general practitioners/primary care doctors consecutively, at the visits enrolled 1798 patients with AH, office BP > 140/90 mm Hg and overweight/obesity into the multicenter, open-label, observational, epidemiological study. The patients were surveyed using the standard questionnaire, they had the general clinical examination, their BMI and waist circumference (WC) were measured, they received recommendations regarding the physical activity and nutrition and their antihypertensive therapy was adjusted at the doctor discretion. After 1 month, at Visit 2, BP was monitored, efficacy of the prescribed therapy was evaluated and changes of body weight, BMI, WC and compliance were assessed. After another 1 month, Visit 3 was conducted by telephone.Results and discussion. Mean age of patients was 59,06±11,38 years; there were 1203 females (66.9 %). Overweight was recorded in 33.4 % of patients and obesity in 66.6 % of patients. Mean body weight was 92.06±14.03 kg, BMI was 32.38±4.55 kg/m2, WC in males was 104.92±12.74 cm, in females –99.32±12.74 cm, i.e. abdominal obesity was prevailing. Family history of cardiovascular diseases was reported in 60.7 % of patients and 63.6 % have never smoked. Diabetes mellitus or impaired glucose tolerance was observed in 11.06 % of patients. The systolic BP (SBP) was 163.15±12.21 mm Hg, diastolic BP (DBP) was 95.62±7.78 mm Hg, heart rate (HR) was 78.16±8.98 per minute, i.e. in general, severe AH was recorded. At enrolment 38.4 % of patients received one antihypertensive product, 47.8 % of patients received two products and 13.8 % of patients received three and more products (generally renin-angiotensin-aldosterone system modulators in combination with the calcium antagonists and hydrochlorothiazide, more than half – as individual products). Initial compliance (quantity of positive responses) was 3.33 scores and was low in 73.9 % of patients and high only in 4.0 % of patients. Doctors changed the antihypertensive therapy at Visit 1: 84.43 % of patients were recommended the original fixed combination of perindopril and indapamide at 10/2.5 mg; 14.07 % of patients – at 5/1.25 mg; 0.95 % of patients – at 2.5/0.625 mg; 0.56 % of patients were prescribed another antihypertensive therapy. Following 1-month therapy, SBP decreased by 27.12±13.70 mm Hg, DBP decreased by 13.32±9.08 mm Hg, HR decreased by 5.20±8.16 per minute (all p<0.001), which ensured AH control in 74.9 % of patients and improved compliance (p<0.05). Further 1-month treatment led to further decrease in BP. After 2 months, the mean SBP was 130.29±11.58 mm Hg, DBP was 79.37±6.69 mm Hg; it decreased from baseline by 32.87±12.21 and 16.26±8.93 mm Hg (p<0.0001). A","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"26 1","pages":"34-50"},"PeriodicalIF":0.0,"publicationDate":"2020-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87095640","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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