Pub Date : 2020-12-10DOI: 10.31928/1608-635x-2020.5.2233
M. Sokolov, Y. Kashuba, Yuriy Sokolov
The aim – to conducted in order to determine the effect of myocardial revascularization performed at different times from the onset of symptoms in patients with non-ST-segment elevation myocardial infarction (NSTEMI) on the function of left ventricular (LV) contractility during long-term follow-up (within 1 year) according to echocardiography. In addition, the study evaluated the functional state of the LV in patients with NSTEMI who did not undergo revascularization of the myocardium.Materials and methods. Patients with NSTEMI included in the study (n=128) were divided into 5 groups according to the time of revascularization (emergent or selective revascularization), as well as by the method of revascularization (stenting or bypass grafting), including a group of patients who did not undergo revascularization. Group 1 consisted of patients (n=28) who underwent emergent coronary angiography and ad hoc stenting in the first 72 hours from the onset of symptoms. Group 2 included patients (n=61) who underwent coronary angiography and coronary stenting in a planned manner after 72 hours or more from the onset of symptoms. Group 3 included patients (n=12) who underwent a scheduled bypass operation selectively. Group 4 consisted of patients with NSTEMI (n=27) who, after emergent coronary angiography, did not undergo revascularization control group. And group 5 is a general revascularization group, which consists of patients from all of the above groups (n=101) who underwent revascularization in any way. Patients of all groups underwent initial coronary angiography, determined the initial level of cardiac troponins, performed an ultrasound examination of the left ventricle using a standard technique to evaluate the initial indicators of regional and general myocardial contractility. In the absence of contraindications (patients of groups 2 and 3), tests with dosed physical activity were performed (to identify the class of angina pectoris). During the short-term (upon discharge from the hospital, after 1 month and after 3 months), as well as long-term (after 6 months and after 1 year), the parameters of the left ventricular contractile function – the ejection fraction (LVEF) were repeatedly measured and the functional class of angina was determined.Results and discussion. An analysis of the results of testing with dosed physical activity revealed the following: if class 0–I angina before stenting in patients with NSTEMI stenting was 0 % of cases, then after 6 months of observation this figure was 70.6 %, and 12 months after stenting – 73.8 %. The number of cases of severe angina pectoris decreased from 44.1 % during the initial examination to 7.7 % after 12 months of follow-up. An analysis of the results of indicators of regional and general LV contractility revealed a significantly significant improvement in these parameters in patients with NSTEMI after 12 months in both the urgent group and the planned stenting group. The number of normokinetic segment
{"title":"Functional condition of the left ventricle after myocardial revascularization in patients with non-ST-segment elevation myocardial infarction at different times from the onset of symptoms","authors":"M. Sokolov, Y. Kashuba, Yuriy Sokolov","doi":"10.31928/1608-635x-2020.5.2233","DOIUrl":"https://doi.org/10.31928/1608-635x-2020.5.2233","url":null,"abstract":"The aim – to conducted in order to determine the effect of myocardial revascularization performed at different times from the onset of symptoms in patients with non-ST-segment elevation myocardial infarction (NSTEMI) on the function of left ventricular (LV) contractility during long-term follow-up (within 1 year) according to echocardiography. In addition, the study evaluated the functional state of the LV in patients with NSTEMI who did not undergo revascularization of the myocardium.Materials and methods. Patients with NSTEMI included in the study (n=128) were divided into 5 groups according to the time of revascularization (emergent or selective revascularization), as well as by the method of revascularization (stenting or bypass grafting), including a group of patients who did not undergo revascularization. Group 1 consisted of patients (n=28) who underwent emergent coronary angiography and ad hoc stenting in the first 72 hours from the onset of symptoms. Group 2 included patients (n=61) who underwent coronary angiography and coronary stenting in a planned manner after 72 hours or more from the onset of symptoms. Group 3 included patients (n=12) who underwent a scheduled bypass operation selectively. Group 4 consisted of patients with NSTEMI (n=27) who, after emergent coronary angiography, did not undergo revascularization control group. And group 5 is a general revascularization group, which consists of patients from all of the above groups (n=101) who underwent revascularization in any way. Patients of all groups underwent initial coronary angiography, determined the initial level of cardiac troponins, performed an ultrasound examination of the left ventricle using a standard technique to evaluate the initial indicators of regional and general myocardial contractility. In the absence of contraindications (patients of groups 2 and 3), tests with dosed physical activity were performed (to identify the class of angina pectoris). During the short-term (upon discharge from the hospital, after 1 month and after 3 months), as well as long-term (after 6 months and after 1 year), the parameters of the left ventricular contractile function – the ejection fraction (LVEF) were repeatedly measured and the functional class of angina was determined.Results and discussion. An analysis of the results of testing with dosed physical activity revealed the following: if class 0–I angina before stenting in patients with NSTEMI stenting was 0 % of cases, then after 6 months of observation this figure was 70.6 %, and 12 months after stenting – 73.8 %. The number of cases of severe angina pectoris decreased from 44.1 % during the initial examination to 7.7 % after 12 months of follow-up. An analysis of the results of indicators of regional and general LV contractility revealed a significantly significant improvement in these parameters in patients with NSTEMI after 12 months in both the urgent group and the planned stenting group. The number of normokinetic segment","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"80 1","pages":"22-33"},"PeriodicalIF":0.0,"publicationDate":"2020-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75746341","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-2020.5.7885
G. Isayeva, S. Trypilka
The article presents a clinical case of Takayasu’s disease (nonspecific aortoarteritis). On the example of the course of the disease in a young woman, the features of clinical symptoms and diagnostic difficulties are analyzed. Particular attention is paid to the visualization of vascular lesions and the assessment of the dynamics of changes in the vessels as the disease progresses. Changes in laboratory parameters are presented in details according with ongoing therapy. The analysis of literature data of the effectiveness of drug therapy for the disease was carried out. It is emphasized that there is a very limited number of quality placebo-controlled studies in the literature. The practicing physician can only rely on the results of observational studies in his decision’s making process. Also, all studies presented in the literature included a very small number of patients. The algorithm of therapy prescription is given, the first line of which is glucocorticoids. Although there are very few literature data, it is noted that the achievement of remission with isolated glucocorticoid therapy is observed in 50 % of patients. According to the updated EULAR recommendations, after disease verification, therapy should be initiated immediately, the recommended starting dose is 40–60 mg of prednisolone (or equivalent). After achieving control of the disease, it is recommended to gradually reduce the dose to the target 15–20 mg/day for 2 to 3 months after 1 year to 10 mg/day. The next step is to prescribe a non-glucocorticoid immunosuppressant in order to provide both a «steroid sparing» effect and long-term control under the disease. All available information on the efficacy of methotrexate, mycophenolate mofetil, cyclophosphophomide, leflunamide, and azathioprine comes from open-label prospective or retrospective studies with a limited number of participants. Tumor necrosis factor inhibitors and tocilizumab are recommended as second-line drugs. A satisfactory clinical and laboratory response was observed in more than 80 % of patients receiving tocilizumab therapy. In this clinical case, tocilizumab was used and the effects of the drug during treatment for 8 months are described in detail. Immunobiological therapy with tocilizumab was associated with a good clinical and laboratory response, a decrease in vascular stenosis, and an improvement in the patient’s well-being.
{"title":"Nonspecific aortoarteritis (Takayasu’s disease)","authors":"G. Isayeva, S. Trypilka","doi":"10.31928/1608-635x-2020.5.7885","DOIUrl":"https://doi.org/10.31928/1608-635x-2020.5.7885","url":null,"abstract":"The article presents a clinical case of Takayasu’s disease (nonspecific aortoarteritis). On the example of the course of the disease in a young woman, the features of clinical symptoms and diagnostic difficulties are analyzed. Particular attention is paid to the visualization of vascular lesions and the assessment of the dynamics of changes in the vessels as the disease progresses. Changes in laboratory parameters are presented in details according with ongoing therapy. The analysis of literature data of the effectiveness of drug therapy for the disease was carried out. It is emphasized that there is a very limited number of quality placebo-controlled studies in the literature. The practicing physician can only rely on the results of observational studies in his decision’s making process. Also, all studies presented in the literature included a very small number of patients. The algorithm of therapy prescription is given, the first line of which is glucocorticoids. Although there are very few literature data, it is noted that the achievement of remission with isolated glucocorticoid therapy is observed in 50 % of patients. According to the updated EULAR recommendations, after disease verification, therapy should be initiated immediately, the recommended starting dose is 40–60 mg of prednisolone (or equivalent). After achieving control of the disease, it is recommended to gradually reduce the dose to the target 15–20 mg/day for 2 to 3 months after 1 year to 10 mg/day. The next step is to prescribe a non-glucocorticoid immunosuppressant in order to provide both a «steroid sparing» effect and long-term control under the disease. All available information on the efficacy of methotrexate, mycophenolate mofetil, cyclophosphophomide, leflunamide, and azathioprine comes from open-label prospective or retrospective studies with a limited number of participants. Tumor necrosis factor inhibitors and tocilizumab are recommended as second-line drugs. A satisfactory clinical and laboratory response was observed in more than 80 % of patients receiving tocilizumab therapy. In this clinical case, tocilizumab was used and the effects of the drug during treatment for 8 months are described in detail. Immunobiological therapy with tocilizumab was associated with a good clinical and laboratory response, a decrease in vascular stenosis, and an improvement in the patient’s well-being.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"29 1","pages":"78-85"},"PeriodicalIF":0.0,"publicationDate":"2020-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80355263","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-2020.5.5359
D. A. Bahrij, O. Starzhynska, V. Zhebel
The aim – to determine the place of soluble ST2 (sST2) as a possible biomarker of remodeling and heart dysfunction in patients with essential hypertension of varying severity.Materials and methods. Examined 150 men with confirmed essential hypertension (EН) of varying severity, including 50 people with EН complicated by heart failure (HF) IIA stage according to the classification of UAHF (groups were representative by age, mean age 50.17±0.48 y.о.), 70 men in the control group (mean age 48.82±0.78 y.о.) The following inclusion criteria were used: age 40 to 60 years, male, verified diagnosis of EH. The structure and function of the heart were studied using echocardiography with Doppler. The serum level of sST2 was determined by immuno assay.Results and discussion. The serum level of sST2 in patients of the control group was 22.14±0.86 ng/ml. It was found, that the peptide concentration in plasma of male patients without cardiovascular disease does not significantly correlate with physical or age parameters, renal function, the condition of systemic or intracardiac hemodynamics. It was found, that for patients with EH the serum level of sST2 was significantly higher than in the control group (p<0.05). The formation of left ventricular hypertrophy (LVH) leads to a significant increase of the peptide concentration in plasma in patients with EH. However, in patients with different types of LVH – concentric and eccentric – the indicator does not differ significantly (26.87±1.04 ng/ml vs. 29.15±1.15 ng/ml, p≥0.05). It was determined, that in case of confirmed diastolic dysfunction (DD) without LVH, the level of the peptide does not increase significantly. And only in patients with a combination of DD and LVH the serum level of sST2 is significantly higher (27.64±1.17 ng/ml, p≥0.05). Also in patients with EH and left ventricular ejection fraction (LV EF) less than 40 %, the serum level of peptide is significantly higher, than in patients with preserved LV EF (25.65±1.14 ng/ml vs. 29.07±1.22 ng/ml, p≥0.01).Conclusions. Thus, in male patients with EH of varying severity, the serum level of sST2 is significantly higher than in people without cardiovascular disease. Peptide concentration in plasma in both cases is not related to age or physical parameters. In patients with uncomplicated EH, significantly higher serum level of sST2 is associated with the development of LVH, regardless of its type, and impaired diastolic function of the heart. In case of HF on the background of EH, the serum level of sST2 also is significantly higher, especially in case of the formation of systolic heart dysfunction with LV FE < 40 %.
{"title":"Plasma concentrations soluble ST2 and сardiac dysfunction in patients with essential hypertension","authors":"D. A. Bahrij, O. Starzhynska, V. Zhebel","doi":"10.31928/1608-635x-2020.5.5359","DOIUrl":"https://doi.org/10.31928/1608-635x-2020.5.5359","url":null,"abstract":"The aim – to determine the place of soluble ST2 (sST2) as a possible biomarker of remodeling and heart dysfunction in patients with essential hypertension of varying severity.Materials and methods. Examined 150 men with confirmed essential hypertension (EН) of varying severity, including 50 people with EН complicated by heart failure (HF) IIA stage according to the classification of UAHF (groups were representative by age, mean age 50.17±0.48 y.о.), 70 men in the control group (mean age 48.82±0.78 y.о.) The following inclusion criteria were used: age 40 to 60 years, male, verified diagnosis of EH. The structure and function of the heart were studied using echocardiography with Doppler. The serum level of sST2 was determined by immuno assay.Results and discussion. The serum level of sST2 in patients of the control group was 22.14±0.86 ng/ml. It was found, that the peptide concentration in plasma of male patients without cardiovascular disease does not significantly correlate with physical or age parameters, renal function, the condition of systemic or intracardiac hemodynamics. It was found, that for patients with EH the serum level of sST2 was significantly higher than in the control group (p<0.05). The formation of left ventricular hypertrophy (LVH) leads to a significant increase of the peptide concentration in plasma in patients with EH. However, in patients with different types of LVH – concentric and eccentric – the indicator does not differ significantly (26.87±1.04 ng/ml vs. 29.15±1.15 ng/ml, p≥0.05). It was determined, that in case of confirmed diastolic dysfunction (DD) without LVH, the level of the peptide does not increase significantly. And only in patients with a combination of DD and LVH the serum level of sST2 is significantly higher (27.64±1.17 ng/ml, p≥0.05). Also in patients with EH and left ventricular ejection fraction (LV EF) less than 40 %, the serum level of peptide is significantly higher, than in patients with preserved LV EF (25.65±1.14 ng/ml vs. 29.07±1.22 ng/ml, p≥0.01).Conclusions. Thus, in male patients with EH of varying severity, the serum level of sST2 is significantly higher than in people without cardiovascular disease. Peptide concentration in plasma in both cases is not related to age or physical parameters. In patients with uncomplicated EH, significantly higher serum level of sST2 is associated with the development of LVH, regardless of its type, and impaired diastolic function of the heart. In case of HF on the background of EH, the serum level of sST2 also is significantly higher, especially in case of the formation of systolic heart dysfunction with LV FE < 40 %.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"138 1","pages":"53-59"},"PeriodicalIF":0.0,"publicationDate":"2020-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78971119","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-2020.5.7177
Y. Marushko, G. Mankovsky, M. Meshkova, S. Kuzmenko, O. Riznyk, Yu. I. Suslina, G. Yemets, I. Yemets
The aim – to present the first in Ukraine experience of using the LAAO Cardia device for the procedure of the left atrial appendage occlusion in patients with atrial fibrillation.Materials and methods. The article represents clinical cases of four patients aged 24 to 68 years with atrial fibrillation and ineffective anticoagulant therapy or contraindications for it.Results and discussion. All patients underwent transcatheter occlusion of the left atrial appendage. Complete occlusion of the ostium was achieved without residual paradevice leaks. In 30–45 days after the procedure, no dislocation of the device or its thrombosis was detected.Conclusions. Cardia left atrial appendage occlusion system allows transcatheter occlusion of the left atrial appendage with good immediate results and good safety profile of the procedure.
{"title":"The first in Ukraine experience of using the Ultrasept system for occlusion of the left atrial appendage in patients with atrial fibrillation","authors":"Y. Marushko, G. Mankovsky, M. Meshkova, S. Kuzmenko, O. Riznyk, Yu. I. Suslina, G. Yemets, I. Yemets","doi":"10.31928/1608-635x-2020.5.7177","DOIUrl":"https://doi.org/10.31928/1608-635x-2020.5.7177","url":null,"abstract":"The aim – to present the first in Ukraine experience of using the LAAO Cardia device for the procedure of the left atrial appendage occlusion in patients with atrial fibrillation.Materials and methods. The article represents clinical cases of four patients aged 24 to 68 years with atrial fibrillation and ineffective anticoagulant therapy or contraindications for it.Results and discussion. All patients underwent transcatheter occlusion of the left atrial appendage. Complete occlusion of the ostium was achieved without residual paradevice leaks. In 30–45 days after the procedure, no dislocation of the device or its thrombosis was detected.Conclusions. Cardia left atrial appendage occlusion system allows transcatheter occlusion of the left atrial appendage with good immediate results and good safety profile of the procedure.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"27 1","pages":"71-77"},"PeriodicalIF":0.0,"publicationDate":"2020-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83272473","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-2020.5.6070
L. Voronkov, N. Tkach, O. L. Filatova, T. Gavrilenko, G. Dudnik, N. Lipkan, L. Mhitaryan
The aim – to compare clinical and instrumental parameters and cumulative survival of women and men with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LV EF), depending on the presence of type II diabetes mellitus.Materials and methods. A retrospective analysis of 490 case histories of patients observed in the heart failure department in the period from 2011 to 2018, with CHF, II–IV NYHA functional class, LVEF ≤ 40 %, 40–80 years of age (median (quartiles)) – 64 (56.00; 69.00) years). The study group included mainly patients with coronary heart disease in combination with hypertension – 403 (82.2 %) patients, with isolated coronary heart disease – 55 (11.2 %) and with isolated hypertension – 32 (6.6 %). Most patients (278 (56.7 %)) had a permanent form of atrial fibrillation. Among the subjects were 373 (76.1 %) men and 117 (23.9 %) women. Comparisons were performed in populations of men and women depending on the presence of type 2 diabetes. Patients were included in the study in the phase of clinical compensation, in the euvolemic state.Results and discussion. The analysis revealed that the prevalence of type 2 diabetes mellitus in the population of men with CHF and reduced LV EF is significantly lower than in the female population. There were no significant differences between the study groups by etiology, the NYHA class, as well as the structure of comorbid conditions. Also there were no significant differences in age, mean daily heart rate, systolic and diastolic blood pressure. Despite expectations, insulin levels in both male and female cohorts did not differ significantly in patients with and without concomitant diabetes. In the cohort of men with CHF and reduced LV EF with concomitant diabetes the body mass index, anteroposterior left atrial size, GFR values were significantly higher, whereas the level of circulating citrulline and urea nitrogen were significantly lower compared to women. Women with CHF with reduced LV EF and concomitant diabetes compared to women without diabetes had lower LV EF and left atrial size, higher circulating citrulline levels, and E/е´ ratios. Analysis of the kidneys functional state showed deterioration of nitrogen excretory function in all study groups in the presence of type 2 diabetes mellitus. The five-year survival of men with CHF and reduced LV EF did not differ depending on the presence of type 2 diabetes mellitus. Instead, when analyzing the effect of type 2 diabetes mellitus on life expectancy in women with CHF and reduced LV EF, we observed a significantly worse prognosis.Conclusions. Woman with CHF and reduced LV EF with concomitant type 2 diabetes mellitus is characterized by a worse clinical course of the disease, which is combined with signs of more pronounced damage to target organs (heart, kidneys). At the same time, in women with diabetes, compared with men, the nitrogen-excreting renal function is significantly lower. Cumulative 5-year survival in the male cohor
{"title":"Clinical and instrumental characteristics and five-year survival of men and women with chronic heart failure and reduced left ventricular ejection fraction depending on the presence of type II diabetes mellitus","authors":"L. Voronkov, N. Tkach, O. L. Filatova, T. Gavrilenko, G. Dudnik, N. Lipkan, L. Mhitaryan","doi":"10.31928/1608-635x-2020.5.6070","DOIUrl":"https://doi.org/10.31928/1608-635x-2020.5.6070","url":null,"abstract":"The aim – to compare clinical and instrumental parameters and cumulative survival of women and men with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LV EF), depending on the presence of type II diabetes mellitus.Materials and methods. A retrospective analysis of 490 case histories of patients observed in the heart failure department in the period from 2011 to 2018, with CHF, II–IV NYHA functional class, LVEF ≤ 40 %, 40–80 years of age (median (quartiles)) – 64 (56.00; 69.00) years). The study group included mainly patients with coronary heart disease in combination with hypertension – 403 (82.2 %) patients, with isolated coronary heart disease – 55 (11.2 %) and with isolated hypertension – 32 (6.6 %). Most patients (278 (56.7 %)) had a permanent form of atrial fibrillation. Among the subjects were 373 (76.1 %) men and 117 (23.9 %) women. Comparisons were performed in populations of men and women depending on the presence of type 2 diabetes. Patients were included in the study in the phase of clinical compensation, in the euvolemic state.Results and discussion. The analysis revealed that the prevalence of type 2 diabetes mellitus in the population of men with CHF and reduced LV EF is significantly lower than in the female population. There were no significant differences between the study groups by etiology, the NYHA class, as well as the structure of comorbid conditions. Also there were no significant differences in age, mean daily heart rate, systolic and diastolic blood pressure. Despite expectations, insulin levels in both male and female cohorts did not differ significantly in patients with and without concomitant diabetes. In the cohort of men with CHF and reduced LV EF with concomitant diabetes the body mass index, anteroposterior left atrial size, GFR values were significantly higher, whereas the level of circulating citrulline and urea nitrogen were significantly lower compared to women. Women with CHF with reduced LV EF and concomitant diabetes compared to women without diabetes had lower LV EF and left atrial size, higher circulating citrulline levels, and E/е´ ratios. Analysis of the kidneys functional state showed deterioration of nitrogen excretory function in all study groups in the presence of type 2 diabetes mellitus. The five-year survival of men with CHF and reduced LV EF did not differ depending on the presence of type 2 diabetes mellitus. Instead, when analyzing the effect of type 2 diabetes mellitus on life expectancy in women with CHF and reduced LV EF, we observed a significantly worse prognosis.Conclusions. Woman with CHF and reduced LV EF with concomitant type 2 diabetes mellitus is characterized by a worse clinical course of the disease, which is combined with signs of more pronounced damage to target organs (heart, kidneys). At the same time, in women with diabetes, compared with men, the nitrogen-excreting renal function is significantly lower. Cumulative 5-year survival in the male cohor","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"173 1","pages":"60-70"},"PeriodicalIF":0.0,"publicationDate":"2020-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74974666","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-2020.5.921
L. Kulyk, Y. Sirenko, G. Radchenko, L. Vasylyeva, I. Zhyvylo, L. Solovey, I. Protsyk, D. Beshley, A. A. Schnaydruk, S. Lishchenko, Y. Ivaniv, P. Bodak
The aim – to present to the medical community the functioning algorithm of the heart team concept in the diagnosis and surgical treatment of chronic thromboembolic pulmonary hypertension (CTEPH) in Ukraine. The concept of the CTEPH team implies a multi-disciplinary approach to the diagnosis and, consequently, surgical treatment of CTEPH with the participation of a radiologist, a pulmonologist, a cardiologist, a hematologist, a neurologist, and a cardiac surgeon. Considering the low incidence of the disease, the need for high-tech diagnostic tools, including CT angiography and angiopulmonography, as well as challenges of evaluating the operability of patients and the technical complexity of operations, patients with CTEPH are get together in the so-called reference centers. Within the framework of the CTEPH team concept, specific protocols and «road maps» have been developed for both diagnosis and treatment of the disease. In order to eliminate subjectivity in determining the operability of a patient with CTEPH, a special algorithm has been developed, which is applied to a clinical case for illustration. Monitoring patients with pulmonary embolism who are qualifed for a newly coined definition – postembolic pulmonary syndrome, has become a new task of the reference centers. The new syndrome is suggested to include CTEPH, as well as a similar, but not identical pathological condition, named chronic thromboembolic lung disease. The treatment of choice for CTEPH is pulmonary thrombendarterectomy. Mandatory elements of the surgical protocol include the creation of a «dry» operating field by means of a temporary circulatory arrest under deep hypothermia of 18 °C. Operations for distal lesions of the pulmonary arteries have become a recent achievement. The success of the operation depends on the anatomical type of the lesions, the degree of distal arteriopathy, the extent of the intervention, and the comorbid factors. Immediate and long-term results of the operation are evaluated as good and very good. The long-term survival of patients after surgery is significantly higher than of those who were administered medical treatment.Conclusions. Patients with suspected CTEPH should be referred to a reference expert center for diagnosis verification and operability determining. The standard diagnosis of CTEPH is angiopulmonography with simultaneous measurement of pressure in the right heart; the standard treatment is pulmonary thrombendarterectomy.
{"title":"The role of the heart team in the diagnosis and treatment of chronic thromboembolic pulmonary hypertension","authors":"L. Kulyk, Y. Sirenko, G. Radchenko, L. Vasylyeva, I. Zhyvylo, L. Solovey, I. Protsyk, D. Beshley, A. A. Schnaydruk, S. Lishchenko, Y. Ivaniv, P. Bodak","doi":"10.31928/1608-635x-2020.5.921","DOIUrl":"https://doi.org/10.31928/1608-635x-2020.5.921","url":null,"abstract":"The aim – to present to the medical community the functioning algorithm of the heart team concept in the diagnosis and surgical treatment of chronic thromboembolic pulmonary hypertension (CTEPH) in Ukraine. The concept of the CTEPH team implies a multi-disciplinary approach to the diagnosis and, consequently, surgical treatment of CTEPH with the participation of a radiologist, a pulmonologist, a cardiologist, a hematologist, a neurologist, and a cardiac surgeon. Considering the low incidence of the disease, the need for high-tech diagnostic tools, including CT angiography and angiopulmonography, as well as challenges of evaluating the operability of patients and the technical complexity of operations, patients with CTEPH are get together in the so-called reference centers. Within the framework of the CTEPH team concept, specific protocols and «road maps» have been developed for both diagnosis and treatment of the disease. In order to eliminate subjectivity in determining the operability of a patient with CTEPH, a special algorithm has been developed, which is applied to a clinical case for illustration. Monitoring patients with pulmonary embolism who are qualifed for a newly coined definition – postembolic pulmonary syndrome, has become a new task of the reference centers. The new syndrome is suggested to include CTEPH, as well as a similar, but not identical pathological condition, named chronic thromboembolic lung disease. The treatment of choice for CTEPH is pulmonary thrombendarterectomy. Mandatory elements of the surgical protocol include the creation of a «dry» operating field by means of a temporary circulatory arrest under deep hypothermia of 18 °C. Operations for distal lesions of the pulmonary arteries have become a recent achievement. The success of the operation depends on the anatomical type of the lesions, the degree of distal arteriopathy, the extent of the intervention, and the comorbid factors. Immediate and long-term results of the operation are evaluated as good and very good. The long-term survival of patients after surgery is significantly higher than of those who were administered medical treatment.Conclusions. Patients with suspected CTEPH should be referred to a reference expert center for diagnosis verification and operability determining. The standard diagnosis of CTEPH is angiopulmonography with simultaneous measurement of pressure in the right heart; the standard treatment is pulmonary thrombendarterectomy.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"7 1","pages":"9-21"},"PeriodicalIF":0.0,"publicationDate":"2020-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83682814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.31928/1608-635x-2020.4.6268
A. Fedorchuk, M. Kucheriava, G. Mankovsky, S. Kuzmenko, N. Rudenko
The aim – to analyze of the complex treatment of a patient with coronary artery disease and subclavian-vertebral robbery syndrome, diagnostic methods of examination, observation and treatment.Materials and methods. The patient with coronary artery disease and occlusion of the left subclavian artery. Physical assessment methods were used? Such as: examination of the patient, anamnesis; laboratory and instrumental investigations – general blood analysis, biochemical blood analysis, electrocardiogram, echocardiography, coronary angiography of the carotid and subclavian arteries.Results and discussion. This complex interventional method of treating the patient had rather good angiographic result. The implantation of the stent system into the area of critical lesion of the main left coronary artery and stent system in the occlusion of the left subclavian artery led to avoid the open surgical operation in the patient and to reduce the period of rehabilitation with a low postoperative risk.Conclusion. According to the international experience, in cases of planned phased treatment of coronary and peripheral arteries that require surgical intervention, it is better to give preference to the endovascular technique in patients with hemodynamically significant lesions. Percutaneous transluminal angioplasty and stenting should be the first therapeutic method for eliminating the problem of symptomatic lesions of the coronary and peripheral arteries.
{"title":"Comprehensive intervention approach to the diagnosis and treatment of a patient with coronary artery disease and subclavian-vertebral robbery syndrome","authors":"A. Fedorchuk, M. Kucheriava, G. Mankovsky, S. Kuzmenko, N. Rudenko","doi":"10.31928/1608-635x-2020.4.6268","DOIUrl":"https://doi.org/10.31928/1608-635x-2020.4.6268","url":null,"abstract":"The aim – to analyze of the complex treatment of a patient with coronary artery disease and subclavian-vertebral robbery syndrome, diagnostic methods of examination, observation and treatment.Materials and methods. The patient with coronary artery disease and occlusion of the left subclavian artery. Physical assessment methods were used? Such as: examination of the patient, anamnesis; laboratory and instrumental investigations – general blood analysis, biochemical blood analysis, electrocardiogram, echocardiography, coronary angiography of the carotid and subclavian arteries.Results and discussion. This complex interventional method of treating the patient had rather good angiographic result. The implantation of the stent system into the area of critical lesion of the main left coronary artery and stent system in the occlusion of the left subclavian artery led to avoid the open surgical operation in the patient and to reduce the period of rehabilitation with a low postoperative risk.Conclusion. According to the international experience, in cases of planned phased treatment of coronary and peripheral arteries that require surgical intervention, it is better to give preference to the endovascular technique in patients with hemodynamically significant lesions. Percutaneous transluminal angioplasty and stenting should be the first therapeutic method for eliminating the problem of symptomatic lesions of the coronary and peripheral arteries.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"56 1","pages":"62-68"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73581188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.31928/1608-635x-2020.4.5461
L. Rasputina, D. Didenko, A. Solomonchuk
The aim – to create a regional registry of patients who have suffered an acute myocardial infarction (AMI), to determine the frequency of endpoints: death, recurrent myocardial infarction, recurrent coronary angiography (CA), coronary artery bypass grafting (CABG), acute cerebrovascular accident (ACVA), bleeding, hospitalization after MI.Materials and methods. 33 centers of Vinnytsya and Vinnytsya region were involved in the study. During the period 2017–2018, 2120 patients of middle age 75.9±7.7 years were included in the register. Among them 1361 (64.2 %) men, middle age 67.5±8.4 years and 759 (35.8 %) women, middle age 76.3±8.2 years. There were 1658 patients with Q-MI and 462 (21.8 %) patients with MI without Q-wave.Results and discussion. It was found that after discharge from the hospital 419 people (13.4 %) did not visit family doctors and cardiologists. Among them were 262 (62.5 %) men and 157 (37.5 %) women. These patients did not differ significantly in gender and age structure from those who were under medical supervision. In both groups, men predominated and there were significantly more people over the age of 60. Twelve months after AMI, 37 (1.7 %) cases of CABG were documented among patients who visited doctors, 29 patients (1.4 %) were diagnosed with ACVA, and 101 patients (4.8 %) were hospitalized for recurrent AMI and 156 people (7.4 %) underwent CA. In patients with interventional AMI treatment tactics, there were significantly fewer cases of recurrent MI (p=0.022), hospitalization (p=0.025) and death (р<0,001) within 12 months. In patients with AMI, an inverse correlation was found between age and mortality, hospitalized bleeding, and CA. The connection between the fact of performing prehospital thrombolysis and hospitalization for heart failure during the year after AMI was determined. There is a negative correlation between CA and hospitalization for heart failure, bleeding that required hospitalization, re-CA and ACVA.Conclusions. Among patients treated for acute coronary syndrome, 13.4 % do not seek outpatient medical care after discharge from the hospital. Among them are significantly more men, people over 60 years old, residents of countryside. Twelve months after AMI, 1.7 % of patients undergo CABG, 1.4 % are diagnosed with ACVA, and 1.7 % have bleeding that requires hospitalization. 25.7 % of patients are re-hospitalized during the year, 9.5 % die. Among patients who undergo emergency CA and coronary artery stenting, there are more people who have CABG and who have been diagnosed with bleeding that requires hospitalization. In this group, there is a significant reduction in cases of recurrent MI, hospitalizations and deaths during the year.
{"title":"Experience in implementing a regional registry of patients with acute coronary syndrome","authors":"L. Rasputina, D. Didenko, A. Solomonchuk","doi":"10.31928/1608-635x-2020.4.5461","DOIUrl":"https://doi.org/10.31928/1608-635x-2020.4.5461","url":null,"abstract":"The aim – to create a regional registry of patients who have suffered an acute myocardial infarction (AMI), to determine the frequency of endpoints: death, recurrent myocardial infarction, recurrent coronary angiography (CA), coronary artery bypass grafting (CABG), acute cerebrovascular accident (ACVA), bleeding, hospitalization after MI.Materials and methods. 33 centers of Vinnytsya and Vinnytsya region were involved in the study. During the period 2017–2018, 2120 patients of middle age 75.9±7.7 years were included in the register. Among them 1361 (64.2 %) men, middle age 67.5±8.4 years and 759 (35.8 %) women, middle age 76.3±8.2 years. There were 1658 patients with Q-MI and 462 (21.8 %) patients with MI without Q-wave.Results and discussion. It was found that after discharge from the hospital 419 people (13.4 %) did not visit family doctors and cardiologists. Among them were 262 (62.5 %) men and 157 (37.5 %) women. These patients did not differ significantly in gender and age structure from those who were under medical supervision. In both groups, men predominated and there were significantly more people over the age of 60. Twelve months after AMI, 37 (1.7 %) cases of CABG were documented among patients who visited doctors, 29 patients (1.4 %) were diagnosed with ACVA, and 101 patients (4.8 %) were hospitalized for recurrent AMI and 156 people (7.4 %) underwent CA. In patients with interventional AMI treatment tactics, there were significantly fewer cases of recurrent MI (p=0.022), hospitalization (p=0.025) and death (р<0,001) within 12 months. In patients with AMI, an inverse correlation was found between age and mortality, hospitalized bleeding, and CA. The connection between the fact of performing prehospital thrombolysis and hospitalization for heart failure during the year after AMI was determined. There is a negative correlation between CA and hospitalization for heart failure, bleeding that required hospitalization, re-CA and ACVA.Conclusions. Among patients treated for acute coronary syndrome, 13.4 % do not seek outpatient medical care after discharge from the hospital. Among them are significantly more men, people over 60 years old, residents of countryside. Twelve months after AMI, 1.7 % of patients undergo CABG, 1.4 % are diagnosed with ACVA, and 1.7 % have bleeding that requires hospitalization. 25.7 % of patients are re-hospitalized during the year, 9.5 % die. Among patients who undergo emergency CA and coronary artery stenting, there are more people who have CABG and who have been diagnosed with bleeding that requires hospitalization. In this group, there is a significant reduction in cases of recurrent MI, hospitalizations and deaths during the year.","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"1 1","pages":"54-61"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88237990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.31928/1608-635x-2020.4.917
T. Talayeva, O. Parkhomenko, I. Tretyak, O. Dovhan, O. Shumakov
The aim – to determine the extent of different subpopulations of blood monocytes in acute myocardial infarction (AMI) with ST-segment elevation patients on day 1 and 7 and to evaluate the relationship between their content and the dynamics of changes and the risk of complications after AMI.Materials and methods. The composition of individual subpopulations of monocytes in the peripheral venous blood (and general clinical and biochemical blood tests) was evaluated in 50 pts with STEMI (who were admitted within 6 hours after the onset of the disease) at admission (before primary PCI) and on day 7. All patients received standard recommended therapy. Dynamic heart echocardiography was also performed on the 1st and 7th day. All patients were divided into 2 groups depending on the dynamical increase (1 group – 21 pts) or decrease (2 group – 29 pts) of classical monocytes (CD14hiCD16–) subpopulation during 7 days of follow-up. The control group included 15 healthy subjects with no signs of coronary heart disease and 23 pts with chronic coronary heart disease without AMI.Results and discussion. In subgroup 1, the percentage of the «classical» fraction of monocytes during the observation increased to 89.0±1.2 %, which was 4.2 % more than on the 1st day and 12.5 % more than in the control group (р<0.05), while the absolute amount of classic monocytes on day 7 increased by 48 % compared to initial value (р<0.01). The percentage of «intermediate» (CD14hiCD16+) blood monocytes in patients of this subgroup on the 1st day of hospitalization was 70 % higher than in the control group, and 42 % higher than in the 2nd subgroup of patients (р<0,001), however, on the 7th day it decreased by 30 % compared to baseline, although it remained by 8 % more than in the control group (the absolute number of «intermediate» monocytes did not change). The activation index (IA) of the «intermediate» monocytes on the first day did not differ between subgroups and was 40 % higher than in the control group (р<0.001). However, in the dynamics of observation, in patients of subgroup 1, this figure did not change, while in subgroup 2 IA decreased by 60 % (р<0.001). Despite the fact that the absolute number of anti-inflammatory («patrolling») (CD14+lowCD16++) monocytes did not change until the 7th day of observation (and their percentage decreased slightly), their IA was significantly lower than in the control group (95 %) and in patients of subgroup 2 (92 %, р<0,001). In patients of subgroup 2, the decrease of the percentage of «classic» monocytes was –7.7 % (from 90.4±0.8 to 83.4±1.2 %). Despite the fact that the number and percentage of intermediate monocytes increased in dynamics, their IA decreased almost 2 times, which may indicate a decrease in the pro-inflammatory ability these monocytes. The percentage and number of «patrolling» monocytes increased in dynamics by 37.4 % (р<0.0001) and by 268.3 % (р<0.01), respectively. IA of patrolling monocytes was almost 12 and 7 times higher
{"title":"Relationship between dynamic changes in subpopulations of blood monocytes and the development of complications in patients with acute myocardial infarction","authors":"T. Talayeva, O. Parkhomenko, I. Tretyak, O. Dovhan, O. Shumakov","doi":"10.31928/1608-635x-2020.4.917","DOIUrl":"https://doi.org/10.31928/1608-635x-2020.4.917","url":null,"abstract":"The aim – to determine the extent of different subpopulations of blood monocytes in acute myocardial infarction (AMI) with ST-segment elevation patients on day 1 and 7 and to evaluate the relationship between their content and the dynamics of changes and the risk of complications after AMI.Materials and methods. The composition of individual subpopulations of monocytes in the peripheral venous blood (and general clinical and biochemical blood tests) was evaluated in 50 pts with STEMI (who were admitted within 6 hours after the onset of the disease) at admission (before primary PCI) and on day 7. All patients received standard recommended therapy. Dynamic heart echocardiography was also performed on the 1st and 7th day. All patients were divided into 2 groups depending on the dynamical increase (1 group – 21 pts) or decrease (2 group – 29 pts) of classical monocytes (CD14hiCD16–) subpopulation during 7 days of follow-up. The control group included 15 healthy subjects with no signs of coronary heart disease and 23 pts with chronic coronary heart disease without AMI.Results and discussion. In subgroup 1, the percentage of the «classical» fraction of monocytes during the observation increased to 89.0±1.2 %, which was 4.2 % more than on the 1st day and 12.5 % more than in the control group (р<0.05), while the absolute amount of classic monocytes on day 7 increased by 48 % compared to initial value (р<0.01). The percentage of «intermediate» (CD14hiCD16+) blood monocytes in patients of this subgroup on the 1st day of hospitalization was 70 % higher than in the control group, and 42 % higher than in the 2nd subgroup of patients (р<0,001), however, on the 7th day it decreased by 30 % compared to baseline, although it remained by 8 % more than in the control group (the absolute number of «intermediate» monocytes did not change). The activation index (IA) of the «intermediate» monocytes on the first day did not differ between subgroups and was 40 % higher than in the control group (р<0.001). However, in the dynamics of observation, in patients of subgroup 1, this figure did not change, while in subgroup 2 IA decreased by 60 % (р<0.001). Despite the fact that the absolute number of anti-inflammatory («patrolling») (CD14+lowCD16++) monocytes did not change until the 7th day of observation (and their percentage decreased slightly), their IA was significantly lower than in the control group (95 %) and in patients of subgroup 2 (92 %, р<0,001). In patients of subgroup 2, the decrease of the percentage of «classic» monocytes was –7.7 % (from 90.4±0.8 to 83.4±1.2 %). Despite the fact that the number and percentage of intermediate monocytes increased in dynamics, their IA decreased almost 2 times, which may indicate a decrease in the pro-inflammatory ability these monocytes. The percentage and number of «patrolling» monocytes increased in dynamics by 37.4 % (р<0.0001) and by 268.3 % (р<0.01), respectively. IA of patrolling monocytes was almost 12 and 7 times higher","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"28 1","pages":"9-17"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74838987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.31928/1608-635x-2020.4.3544
V. Tseluyko, D. Korchagina
The aim – to assess the effects of different fixed double combinations of antihypertensive drugs and analyze their impact on heart remodeling in patients with arterial hypertension and hypothyroidism. Materials and methods. The study included 50 patients with hypertension and hypertension, which were divided into 2 groups by the method of blind envelopes of 25 people each. Patients in group 1 were assigned a fixed combination of perindopril with indapamide, patients in group 2 were assigned a fixed combination of perindopril with amlodipine. The groups were statistically compared by age, duration of hormonal substitution therapy, duration of hypertension, level of office SBP, DBP at inclusion in the study. In terms of body mass index, the study groups were comparable, but the number of obese patients was higher in group 2 (p=0.05). Observation of patients lasted 12 months.Results and discussion. The studied fixed combinations of antihypertensive drugs, namely perindopril with indapamide and perindopril with amlodipine provide a reduction in blood pressure in patients with hypertension with concomitant hypothyroidism according to the results of ambulatory blood pressure monitoring. Control of blood pressure in patients with arterial hypertension and concomitant hypothyroidism during a year of antihypertensive therapy provides a reduction in the severity of heart remodeling, the nature and extent of which depends on both the presence of obesity and the choice of a fixed combination of antihypertensive drugs.Conclusions. The results showed that in patients with AН and hypothyroidism achievement of euthyroid state contributes to BP reduction, but requires further administration of antihypertensive therapy. We studied fixed combinations of antihypertensive drugs, namely perindopril with indapamide and perindopril with amlodipine in patients with AG and associated hypothyroidism provide reliable blood pressure reduction according to the results of outpatient blood pressure monitoring (р<0.05). The fixed combination of perindopril with amlodipine compared with the fixed combination of perindopril with indapamide provides a significantly more significant effect on the regression of left ventricular myocardial hypertrophy, namely, a decrease in myocardial mass index by a degree of 2.7 in patients with obesity (р<0,01) myocardial mass index by body surface area in patients without obesity (p=0.06).
{"title":"The comparative effects of different fixed combinations of antihypertensive drugs in patients with arterial hypertension and hypothyroidism","authors":"V. Tseluyko, D. Korchagina","doi":"10.31928/1608-635x-2020.4.3544","DOIUrl":"https://doi.org/10.31928/1608-635x-2020.4.3544","url":null,"abstract":"The aim – to assess the effects of different fixed double combinations of antihypertensive drugs and analyze their impact on heart remodeling in patients with arterial hypertension and hypothyroidism. Materials and methods. The study included 50 patients with hypertension and hypertension, which were divided into 2 groups by the method of blind envelopes of 25 people each. Patients in group 1 were assigned a fixed combination of perindopril with indapamide, patients in group 2 were assigned a fixed combination of perindopril with amlodipine. The groups were statistically compared by age, duration of hormonal substitution therapy, duration of hypertension, level of office SBP, DBP at inclusion in the study. In terms of body mass index, the study groups were comparable, but the number of obese patients was higher in group 2 (p=0.05). Observation of patients lasted 12 months.Results and discussion. The studied fixed combinations of antihypertensive drugs, namely perindopril with indapamide and perindopril with amlodipine provide a reduction in blood pressure in patients with hypertension with concomitant hypothyroidism according to the results of ambulatory blood pressure monitoring. Control of blood pressure in patients with arterial hypertension and concomitant hypothyroidism during a year of antihypertensive therapy provides a reduction in the severity of heart remodeling, the nature and extent of which depends on both the presence of obesity and the choice of a fixed combination of antihypertensive drugs.Conclusions. The results showed that in patients with AН and hypothyroidism achievement of euthyroid state contributes to BP reduction, but requires further administration of antihypertensive therapy. We studied fixed combinations of antihypertensive drugs, namely perindopril with indapamide and perindopril with amlodipine in patients with AG and associated hypothyroidism provide reliable blood pressure reduction according to the results of outpatient blood pressure monitoring (р<0.05). The fixed combination of perindopril with amlodipine compared with the fixed combination of perindopril with indapamide provides a significantly more significant effect on the regression of left ventricular myocardial hypertrophy, namely, a decrease in myocardial mass index by a degree of 2.7 in patients with obesity (р<0,01) myocardial mass index by body surface area in patients without obesity (p=0.06).","PeriodicalId":23419,"journal":{"name":"Ukrainian Journal of Cardiology","volume":"157 1","pages":"35-44"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74876448","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：