Pub Date : 2022-04-06DOI: 10.3897/bgcardio.28.e80835
A. Kaneva
Cardiac catheterization with direct measurements of pressure and saturation in cardiac chambers and great vessels and calculation of systemic and pulmonary blood fl ow, pulmonary and systemic resistance, and pulmonary vascular reactivity are the gold standard for assessing the hemodynamics of congenital heart malformations with a left to right shunt in both children and adults. They are the basis for determining the indications for surgical or interventional treatment. Assessment of the blood fl ow according to Fick’s principle and the resistance according to Ohm‘s law are the theoretical basis of hemodynamic calculations. The steps in assessing hemodynamics in a patient with a left-to-right shunt are presented consequently: pulmonary to systemic blood fl ow ratio, calculation of pulmonary vascular resistance (PVR) in case of pulmonary hypertension (PHy), and assessment of pulmonary vascular reactivity and their clinical signifi cance as well. Special attention is paid to the assessment of hemodynamics and indications for closure in elderly patients with atrial septal defect (ASD) and left ventricular dysfunction. The limitations and sources of errors in hemodynamic calculations are presented.
{"title":"Hemodynamic assessment of congenital heart malformations with left to right shunt","authors":"A. Kaneva","doi":"10.3897/bgcardio.28.e80835","DOIUrl":"https://doi.org/10.3897/bgcardio.28.e80835","url":null,"abstract":"Cardiac catheterization with direct measurements of pressure and saturation in cardiac chambers and great vessels and calculation of systemic and pulmonary blood fl ow, pulmonary and systemic resistance, and pulmonary vascular reactivity are the gold standard for assessing the hemodynamics of congenital heart malformations with a left to right shunt in both children and adults. They are the basis for determining the indications for surgical or interventional treatment. Assessment of the blood fl ow according to Fick’s principle and the resistance according to Ohm‘s law are the theoretical basis of hemodynamic calculations. The steps in assessing hemodynamics in a patient with a left-to-right shunt are presented consequently: pulmonary to systemic blood fl ow ratio, calculation of pulmonary vascular resistance (PVR) in case of pulmonary hypertension (PHy), and assessment of pulmonary vascular reactivity and their clinical signifi cance as well. Special attention is paid to the assessment of hemodynamics and indications for closure in elderly patients with atrial septal defect (ASD) and left ventricular dysfunction. The limitations and sources of errors in hemodynamic calculations are presented.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44760824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-06DOI: 10.3897/bgcardio.28.e81592
Dobrislav Dobrev, A. Kaneva, Stojan D. Lazarov, I. Velkovski, Svetla Dineva
Accurate imaging of the morphology in a child with a rare and complex congenital heart disease (CHD) is crucial for the surgical planning and, if possible – the minimization of operative risk. We present a case of a 3-month-old child with a rare variant of Total Anomalous Pulmonary Venous Return (TAPVR) – mixed type – which illustrates the benefi t of additional imaging modalities and techniques for the operative planning. The patient’s anomalous drainage of the pulmonary veins (PV) is as follows: left and right lower PVs drained in the coronary venous sinus, left upper PV drained via a vertical vein into the innominate vein and the right upper PV drained into the superior vena cava (SVC). Clinical fi ndings consist of heart failure (HF), pulmonary venous congestion and mild hypoxemia developing within the fi rst days after birth. Transthoracic echocardiography (TTE) demonstrates the features of TAPVR, but the modality is unable to differentiate all of the described anatomic details. Accurate morphological diagnosis is obtained via contrast Computed Tomography (CT). The. additional techniques of 3D modelling and 3D printing of a patient-specifi c model, based on the acquired CT, contributed to the planning of the surgical strategy. The patient underwent a radical operation at age of 3 months. The unique aspect of the case is the application of all possible operative techniques for correction of TAPVR – coronary sinus deroofi ng, anastomosis of a draining vessel into the left atrial appendage and Warden procedure which involves tunnelling of the right upper PVs from the SVC into the left atrium. Feedback from the surgical team shows that the additional imaging methods and the printed 3D model represent the pathology in detail that completely corresponds to the intra-operative fi ndings
{"title":"Rare case of a mixed type total anomalous pulmonary venous return – benefits of a patient specific 3D model in the preoperative preparation","authors":"Dobrislav Dobrev, A. Kaneva, Stojan D. Lazarov, I. Velkovski, Svetla Dineva","doi":"10.3897/bgcardio.28.e81592","DOIUrl":"https://doi.org/10.3897/bgcardio.28.e81592","url":null,"abstract":"Accurate imaging of the morphology in a child with a rare and complex congenital heart disease (CHD) is crucial for the surgical planning and, if possible – the minimization of operative risk. We present a case of a 3-month-old child with a rare variant of Total Anomalous Pulmonary Venous Return (TAPVR) – mixed type – which illustrates the benefi t of additional imaging modalities and techniques for the operative planning. The patient’s anomalous drainage of the pulmonary veins (PV) is as follows: left and right lower PVs drained in the coronary venous sinus, left upper PV drained via a vertical vein into the innominate vein and the right upper PV drained into the superior vena cava (SVC). Clinical fi ndings consist of heart failure (HF), pulmonary venous congestion and mild hypoxemia developing within the fi rst days after birth. Transthoracic echocardiography (TTE) demonstrates the features of TAPVR, but the modality is unable to differentiate all of the described anatomic details. Accurate morphological diagnosis is obtained via contrast Computed Tomography (CT). The. additional techniques of 3D modelling and 3D printing of a patient-specifi c model, based on the acquired CT, contributed to the planning of the surgical strategy. The patient underwent a radical operation at age of 3 months. The unique aspect of the case is the application of all possible operative techniques for correction of TAPVR – coronary sinus deroofi ng, anastomosis of a draining vessel into the left atrial appendage and Warden procedure which involves tunnelling of the right upper PVs from the SVC into the left atrium. Feedback from the surgical team shows that the additional imaging methods and the printed 3D model represent the pathology in detail that completely corresponds to the intra-operative fi ndings","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44795134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-06DOI: 10.3897/bgcardio.28.e80076
Z. Vassileva, A. Kaneva, Anna Dasheva, K. Genova
Cardiac involvement by COVID-19 in children occurs most often as a part of the multisystem infl ammatory syndrome by children (MIS-C) and rarely as an isolated fi nding; affected children are predominantly older males. We present retrospective analysis data of 10 children with myocardial involvement within COVID-19, who were admitted at the Pediatric Cardiology Department of the National Heart Hospital – Sofi a. The main clinical symptoms were fever, heart failure, and gastrointestinal complaints, and the typical laboratory constellation included pronounced leukocytosis with extreme granulocytosis, signifi cant elevation of infl ammatory markers, increased serum troponin levels, and serologic evidence of contact with SARS-CoV2. Chest X-ray showed cardiomegaly and pulmonary hypervolemia; ECG changes were diverse and included abnormal repolarization and rhythm and conduction disturbances. Echocardiography revealed left ventricular dilation with depressed contractility, and cardiac MRI demonstrated myocardial edema and necrosis. Following immunomodulatory treatment, rapid recovery was observed. However, in most cases, the MRI changes persisted 6 months after the onset of symptoms, which makes the long-term prognosis unclear. We have reviewed our results considering the recent publications in the international databases regarding cardiac involvement by COVID-19 in children.
{"title":"Cardiаc involvement by COVID-19 in children: retrospective analysis of 10 cases and literature review","authors":"Z. Vassileva, A. Kaneva, Anna Dasheva, K. Genova","doi":"10.3897/bgcardio.28.e80076","DOIUrl":"https://doi.org/10.3897/bgcardio.28.e80076","url":null,"abstract":"Cardiac involvement by COVID-19 in children occurs most often as a part of the multisystem infl ammatory syndrome by children (MIS-C) and rarely as an isolated fi nding; affected children are predominantly older males. We present retrospective analysis data of 10 children with myocardial involvement within COVID-19, who were admitted at the Pediatric Cardiology Department of the National Heart Hospital – Sofi a. The main clinical symptoms were fever, heart failure, and gastrointestinal complaints, and the typical laboratory constellation included pronounced leukocytosis with extreme granulocytosis, signifi cant elevation of infl ammatory markers, increased serum troponin levels, and serologic evidence of contact with SARS-CoV2. Chest X-ray showed cardiomegaly and pulmonary hypervolemia; ECG changes were diverse and included abnormal repolarization and rhythm and conduction disturbances. Echocardiography revealed left ventricular dilation with depressed contractility, and cardiac MRI demonstrated myocardial edema and necrosis. Following immunomodulatory treatment, rapid recovery was observed. However, in most cases, the MRI changes persisted 6 months after the onset of symptoms, which makes the long-term prognosis unclear. We have reviewed our results considering the recent publications in the international databases regarding cardiac involvement by COVID-19 in children.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42896316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-06DOI: 10.3897/bgcardio.28.e81196
L. Simeonov, Dimitar Pechilkov, A. Kaneva
Exercise capacity assessment in patients with congenital heart disease (CHD) is essential for cardiovascular adaptation and is a key parameter in quality of life assessment. In daily practice, the majority of tests are performed at rest, and some even require sedation. Cardiopulmonary exercise testing (CPET) allows the assessment of the patient's haemodynamic status during exercise and provides important information about heart rate, rhythm, ST-segment analysis, arterial pressure, and parameters such as oxygen consumption, oxygen pulse and the ratio of minute ventilation to carbon dioxide produced, which helps to describe in detail the physiology of the patient in a dynamic state. This allows for assessment of aerobic capacity and helps to distinguish the causes of its limitation - cardiovascular, pulmonary or deconditioning. Objectification of exercise capacity provides a basis for better decision-making regarding follow-up plans, exercise recommendations and future interventions. This review will discuss in detail CPET and its implementation in children with CHD.
{"title":"Cardiopulmonary exercise testing in children with congenital heart disease","authors":"L. Simeonov, Dimitar Pechilkov, A. Kaneva","doi":"10.3897/bgcardio.28.e81196","DOIUrl":"https://doi.org/10.3897/bgcardio.28.e81196","url":null,"abstract":"Exercise capacity assessment in patients with congenital heart disease (CHD) is essential for cardiovascular adaptation and is a key parameter in quality of life assessment. In daily practice, the majority of tests are performed at rest, and some even require sedation. Cardiopulmonary exercise testing (CPET) allows the assessment of the patient's haemodynamic status during exercise and provides important information about heart rate, rhythm, ST-segment analysis, arterial pressure, and parameters such as oxygen consumption, oxygen pulse and the ratio of minute ventilation to carbon dioxide produced, which helps to describe in detail the physiology of the patient in a dynamic state. This allows for assessment of aerobic capacity and helps to distinguish the causes of its limitation - cardiovascular, pulmonary or deconditioning. Objectification of exercise capacity provides a basis for better decision-making regarding follow-up plans, exercise recommendations and future interventions. This review will discuss in detail CPET and its implementation in children with CHD.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48494965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-31DOI: 10.18087/cardio.2022.3.n1648
A. V. Bocharov, L. V. Popov, M. D. Lagkuev
Aim To evaluate the incidence of atrial infarction (AI) based on a retrospective review of 287 case reports of patients with supraventricular arrhythmia and a positive qualitative test for troponin I after pharmacological arrest of arrhythmia; to determine the target localization of lesions and diagnostic signs, that appear in acute ischemic atrial damage, by selective coronary angiography (CA).Material and methods A retrospective review was performed of 287 case reports of patients admitted to cardiology departments for atrial fibrillation paroxysm with narrow QRS complexes on electrocardiogram (ECG) from 2018 through 2020. At the prehospital stage, verapamil had been administered intravenously with no effect. In the hospital, the sinus rhythm was successfully restored pharmacologically in all patients. Then ECG, repeated qualitative determination of troponin I, echocardiography, and CA were performed.Results 77 (27 %) patients of the study group had AI signs; 27 (9.5 %) of these patients had confirmed AI, and 50 (17.5 %) patients had probable AI. The existence of acute ischemic injury was considered absolutely confirmed in the presence of a combination of ECG changes, positive markers of myocardial damage, and reduced blood flow velocity in the left atrial branch of the sinoatrial nodal artery as shown by CA; in the presence of only ECG and biochemical criteria, acute AI was considered probable. According to selective CA, coronary injuries requiring an intervention were absent, and signs of the above-mentioned artery thrombosis were not visualized. However, the blood flow velocity was reduced to the TIMI II level in 9.5 % of cases; other atrial branches had an extremely small diameter.Conclusion Atrial infarction needs to be excluded for patients with supraventricular arrhythmias, a characteristic clinical picture, and increased levels of myocardial injury enzymes.
{"title":"The frequency of atrial infarction in patients with supraventricular arrhythmias.","authors":"A. V. Bocharov, L. V. Popov, M. D. Lagkuev","doi":"10.18087/cardio.2022.3.n1648","DOIUrl":"https://doi.org/10.18087/cardio.2022.3.n1648","url":null,"abstract":"Aim To evaluate the incidence of atrial infarction (AI) based on a retrospective review of 287 case reports of patients with supraventricular arrhythmia and a positive qualitative test for troponin I after pharmacological arrest of arrhythmia; to determine the target localization of lesions and diagnostic signs, that appear in acute ischemic atrial damage, by selective coronary angiography (CA).Material and methods A retrospective review was performed of 287 case reports of patients admitted to cardiology departments for atrial fibrillation paroxysm with narrow QRS complexes on electrocardiogram (ECG) from 2018 through 2020. At the prehospital stage, verapamil had been administered intravenously with no effect. In the hospital, the sinus rhythm was successfully restored pharmacologically in all patients. Then ECG, repeated qualitative determination of troponin I, echocardiography, and CA were performed.Results 77 (27 %) patients of the study group had AI signs; 27 (9.5 %) of these patients had confirmed AI, and 50 (17.5 %) patients had probable AI. The existence of acute ischemic injury was considered absolutely confirmed in the presence of a combination of ECG changes, positive markers of myocardial damage, and reduced blood flow velocity in the left atrial branch of the sinoatrial nodal artery as shown by CA; in the presence of only ECG and biochemical criteria, acute AI was considered probable. According to selective CA, coronary injuries requiring an intervention were absent, and signs of the above-mentioned artery thrombosis were not visualized. However, the blood flow velocity was reduced to the TIMI II level in 9.5 % of cases; other atrial branches had an extremely small diameter.Conclusion Atrial infarction needs to be excluded for patients with supraventricular arrhythmias, a characteristic clinical picture, and increased levels of myocardial injury enzymes.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"76 1","pages":"28-31"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86562165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-31DOI: 10.18087/cardio.2022.3.n1206
K. E. Krivoshapova, E. A. Vegner, O. Barbarash
This review presents results of clinical studies of senile asthenia ("fragility") syndrome and chronic heart failure (CHF). Recent reports of the "fragility" prevalence in patients with CHF are described. The review presents specific features of pathophysiological pathways underlying the development of both senile asthenia syndrome and CHF; the role of "fragility" in the progression and complications of CHF is addressed. Senile asthenia syndrome associated with CHF is regarded as an independent predictor of unfavorable prognosis and high mortality in this patient category. The authors concluded that methods for "fragility" evaluation in CHF patients followed by risk stratification and selection of individual management tactics should be implemented in clinical practice.
{"title":"[Frailty syndrome as an independent predictor of adverse prognosis in patients with chronic heart failure].","authors":"K. E. Krivoshapova, E. A. Vegner, O. Barbarash","doi":"10.18087/cardio.2022.3.n1206","DOIUrl":"https://doi.org/10.18087/cardio.2022.3.n1206","url":null,"abstract":"This review presents results of clinical studies of senile asthenia (\"fragility\") syndrome and chronic heart failure (CHF). Recent reports of the \"fragility\" prevalence in patients with CHF are described. The review presents specific features of pathophysiological pathways underlying the development of both senile asthenia syndrome and CHF; the role of \"fragility\" in the progression and complications of CHF is addressed. Senile asthenia syndrome associated with CHF is regarded as an independent predictor of unfavorable prognosis and high mortality in this patient category. The authors concluded that methods for \"fragility\" evaluation in CHF patients followed by risk stratification and selection of individual management tactics should be implemented in clinical practice.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"21 1","pages":"89-96"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74449520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-31DOI: 10.18087/cardio.2022.3.n2010
O. Tasbulak, T. Aktemur, A. Şahin, A. Demir, A. Güler, Ç. Topel, A. Turkvatan, H. Pusuroğlu, M. Erturk
Aim The aim of this study was to determine the association between the dipping pattern of BP and coronary artery disease in hypertensive patients.Material and methods A total of 356 hypertensive patients were included in the study. The results of ambulatory BP monitoring, echocardiography, and coronary computerised tomographic angiography were evaluated retrospectively. The patients were divided into two groups on the basis of their ambulatory BP monitoring: 1) patients with the dipping pattern of BP; 2) patients with the non-dipping pattern (NDP).Results Among the 356 patients, 145 were male (40.7 %). The smoking status was higher in patients with NDP (p=0.023). The statin usage in patients with the dipping pattern was higher in patients with NDP (p=0.027). There were no significant differences in the echocardiographic findings. 58.6 % of the patients without plaque formation had the dipping pattern of BP (p<0.05), however 84.4 % of patients with >50 % plaque formation had the NDP of BP (p<0.001).Conclusion The NDP of BP might be related to the increased atherosclerotic process in coronary arteries, and pa-tients with NDP might have an increased atherosclerotic burden for coronary arteries when compared with patients with a dipping pattern.
{"title":"Association of dipping pattern of blood pressure and atherosclerotic burden of coronary arteries in hypertensive patients.","authors":"O. Tasbulak, T. Aktemur, A. Şahin, A. Demir, A. Güler, Ç. Topel, A. Turkvatan, H. Pusuroğlu, M. Erturk","doi":"10.18087/cardio.2022.3.n2010","DOIUrl":"https://doi.org/10.18087/cardio.2022.3.n2010","url":null,"abstract":"Aim The aim of this study was to determine the association between the dipping pattern of BP and coronary artery disease in hypertensive patients.Material and methods A total of 356 hypertensive patients were included in the study. The results of ambulatory BP monitoring, echocardiography, and coronary computerised tomographic angiography were evaluated retrospectively. The patients were divided into two groups on the basis of their ambulatory BP monitoring: 1) patients with the dipping pattern of BP; 2) patients with the non-dipping pattern (NDP).Results Among the 356 patients, 145 were male (40.7 %). The smoking status was higher in patients with NDP (p=0.023). The statin usage in patients with the dipping pattern was higher in patients with NDP (p=0.027). There were no significant differences in the echocardiographic findings. 58.6 % of the patients without plaque formation had the dipping pattern of BP (p<0.05), however 84.4 % of patients with >50 % plaque formation had the NDP of BP (p<0.001).Conclusion The NDP of BP might be related to the increased atherosclerotic process in coronary arteries, and pa-tients with NDP might have an increased atherosclerotic burden for coronary arteries when compared with patients with a dipping pattern.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"9 1","pages":"56-64"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81882933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-31DOI: 10.18087/cardio.2022.3.n1761
V. Lakomkin, A. Abramov, E. Lukoshkova, I. Studneva, A. V. Prosvirin, V. Kapelko
Aim To study left ventricular (LV) hemodynamics in presence of decreased blood inflow to the heart as well as changes in myocardial content of energy metabolites in diabetic rats.Material and methods Diabetic cardiomyopathy is characterized by impaired heart contractility and by transition of cardiomyocyte energy metabolism fatty acids exclusively as a source of energy. This reduces the efficiency of energy utilization and increases the heart vulnerability to hypoxia. This study was performed on rats with type 1 diabetes mellitus induced by administration of streptozotocin (60 mg/kg). The LV pump function was studied with a catheter that allows simultaneous measurement of LV pressure and volume in each cardiac cycle.Results Blood glucose was approximately sixfold increased at 2 weeks. Heart failure was detected with decreases in ejection fraction by 27%, minute volume by 39%, and stroke work by 41%. Systolic dysfunction was based on a decrease in LV peak ejection velocity by more than 50%. Furthermore, the LV developed pressure and contractility index were within the normal range, while 1.5 times increased arterial stiffness was the factor that hampered ejection. The sum of adenine nucleotides was decreased by 21%, the ATP content was decreased by 29%, and also creatine phosphate formation was reduced in the myocardium of diabetic rats. Lactate content in the diabetic myocardium was increased almost threefold, which indicated mobilization of aerobic glycolysis. With the reduced preload, equal diastolic volume (0.3 ml), and equal blood pressure (60 mm Hg), the diabetic heart pump function did not differ from the control.Conclusion In type 1 diabetes mellitus, decreases in functional load and oxygen consumption normalize the myocardial pump function with disturbed energy metabolism.
目的研究糖尿病大鼠左心室血流动力学及心肌能量代谢物含量的变化。材料和方法糖尿病性心肌病的特点是心脏收缩能力受损，心肌细胞能量代谢脂肪酸的过渡完全作为能量来源。这降低了能量利用的效率，增加了心脏对缺氧的脆弱性。本研究采用链脲佐菌素(60 mg/kg)诱导的1型糖尿病大鼠。使用导管研究左室泵功能，该导管可同时测量每个心动周期的左室压力和容积。结果2周时血糖升高约6倍。射血分数下降27%，分钟容量下降39%，卒中功下降41%，从而检测出心力衰竭。收缩功能障碍是基于左室峰值射血速度下降超过50%。左室发展压力和收缩指数在正常范围内，动脉僵硬度升高1.5倍是阻碍射血的因素。糖尿病大鼠心肌腺嘌呤核苷酸总数减少21%，ATP含量减少29%，磷酸肌酸生成减少。糖尿病心肌乳酸含量几乎增加了三倍，这表明有氧糖酵解的动员。在预负荷降低、舒张容积相等(0.3 ml)、血压相等(60 mm Hg)的情况下，糖尿病患者的心脏泵功能与对照组没有差异。结论1型糖尿病患者功能负荷和耗氧量的降低使心肌泵功能恢复正常，能量代谢紊乱。
{"title":"Normalisation of diabetic heart pump function at decreased functional load.","authors":"V. Lakomkin, A. Abramov, E. Lukoshkova, I. Studneva, A. V. Prosvirin, V. Kapelko","doi":"10.18087/cardio.2022.3.n1761","DOIUrl":"https://doi.org/10.18087/cardio.2022.3.n1761","url":null,"abstract":"Aim To study left ventricular (LV) hemodynamics in presence of decreased blood inflow to the heart as well as changes in myocardial content of energy metabolites in diabetic rats.Material and methods Diabetic cardiomyopathy is characterized by impaired heart contractility and by transition of cardiomyocyte energy metabolism fatty acids exclusively as a source of energy. This reduces the efficiency of energy utilization and increases the heart vulnerability to hypoxia. This study was performed on rats with type 1 diabetes mellitus induced by administration of streptozotocin (60 mg/kg). The LV pump function was studied with a catheter that allows simultaneous measurement of LV pressure and volume in each cardiac cycle.Results Blood glucose was approximately sixfold increased at 2 weeks. Heart failure was detected with decreases in ejection fraction by 27%, minute volume by 39%, and stroke work by 41%. Systolic dysfunction was based on a decrease in LV peak ejection velocity by more than 50%. Furthermore, the LV developed pressure and contractility index were within the normal range, while 1.5 times increased arterial stiffness was the factor that hampered ejection. The sum of adenine nucleotides was decreased by 21%, the ATP content was decreased by 29%, and also creatine phosphate formation was reduced in the myocardium of diabetic rats. Lactate content in the diabetic myocardium was increased almost threefold, which indicated mobilization of aerobic glycolysis. With the reduced preload, equal diastolic volume (0.3 ml), and equal blood pressure (60 mm Hg), the diabetic heart pump function did not differ from the control.Conclusion In type 1 diabetes mellitus, decreases in functional load and oxygen consumption normalize the myocardial pump function with disturbed energy metabolism.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"57 1","pages":"34-39"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83419768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-31DOI: 10.18087/cardio.2022.3.n1799
S. Biswas, A. Mukherjee, S. Chakraborty, A. Chaturvedi, Bidisha Samanta, D. Khanra, S. Ray, Ranjan Sharma
Aim The objective was to assess the correlation of fasting plasma glucose (FPG), HbA1c, and the duration of type 2 diabetes mellitus (T2DM) with SYNTAX score (SS) II in patients with non-ST elevation myocardial infarction (NSTEMI).Material and methods FPG and HbA1C were measured in 398 patients presenting with NSTEMI at admission. SS II was calculated using an online calculator. Patients were stratified according to SS II (≤21.5, 21.5-30.6, and ≥30.6), defined as SS II low, mid, and high, respectively.Results 37.7 % of subjects were diabetic. Correlations of FPG (R=0.402, R2=0.162, p<0.001) and HbA1c (R=0.359, R2=0.129, p<0.001) with SS II were weak in the overall population. Duration of T2DM showed very strong correlation with SS II (R=0.827, R2=0.347). For the prediction of high SS II in the study population, FPG≥98.5 mg / dl demonstrated a sensitivity of 58 % and a specificity of 60 %, and HbA1c ≥6.05 demonstrated a sensitivity of 63 % and a specificity of 69 %. Duration of T2DM (adjusted odds ratio (OR): 1.182; 95 % confidence interval (CI): 1.185-2.773) and FPG (OR: 0.987; 95 % CI: 0.976-0.9959) were significantly associated with high SS II after controlling for other risk factors. Duration of T2DM (Beta=0.439) contributed strongly to variance of SS II, whereas HbA1c (Beta=0.063) contributed weakly.Conclusion Duration of T2DM is a very important risk factor for severity of coronary artery disease.
{"title":"Impact of plasma glucose and duration of type 2 diabetes mellitus on SYNTAX Score II in patients suffering from non ST-elevation myocardial infarction.","authors":"S. Biswas, A. Mukherjee, S. Chakraborty, A. Chaturvedi, Bidisha Samanta, D. Khanra, S. Ray, Ranjan Sharma","doi":"10.18087/cardio.2022.3.n1799","DOIUrl":"https://doi.org/10.18087/cardio.2022.3.n1799","url":null,"abstract":"Aim The objective was to assess the correlation of fasting plasma glucose (FPG), HbA1c, and the duration of type 2 diabetes mellitus (T2DM) with SYNTAX score (SS) II in patients with non-ST elevation myocardial infarction (NSTEMI).Material and methods FPG and HbA1C were measured in 398 patients presenting with NSTEMI at admission. SS II was calculated using an online calculator. Patients were stratified according to SS II (≤21.5, 21.5-30.6, and ≥30.6), defined as SS II low, mid, and high, respectively.Results 37.7 % of subjects were diabetic. Correlations of FPG (R=0.402, R2=0.162, p<0.001) and HbA1c (R=0.359, R2=0.129, p<0.001) with SS II were weak in the overall population. Duration of T2DM showed very strong correlation with SS II (R=0.827, R2=0.347). For the prediction of high SS II in the study population, FPG≥98.5 mg / dl demonstrated a sensitivity of 58 % and a specificity of 60 %, and HbA1c ≥6.05 demonstrated a sensitivity of 63 % and a specificity of 69 %. Duration of T2DM (adjusted odds ratio (OR): 1.182; 95 % confidence interval (CI): 1.185-2.773) and FPG (OR: 0.987; 95 % CI: 0.976-0.9959) were significantly associated with high SS II after controlling for other risk factors. Duration of T2DM (Beta=0.439) contributed strongly to variance of SS II, whereas HbA1c (Beta=0.063) contributed weakly.Conclusion Duration of T2DM is a very important risk factor for severity of coronary artery disease.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"30 1","pages":"40-48"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87152724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-31DOI: 10.18087/cardio.2022.3.n1992
O. Ostroumova, T. Ostroumova, A. V. Arablinsky, V. N. Butorova, A. Kochetkova
The anticoagulant therapy with a priority of direct oral anticoagulants is an approach to the prevention of recurrent stroke in patients with atrial fibrillation (AF) that has presently proved its efficacy and is stated in international clinical guidelines. An extensive evidence-based database demonstrates advantages of rivaroxaban over other drugs of this class in secondary prevention of stroke in AF. Furthermore, these advantages are combined with the optimal safety profile. The rivaroxaban treatment may provide the most favorable prognosis due to the prevention of recurrent stroke in AF, reducing the rate of kidney disease progression, and slowing vascular atherosclerosis. An important beneficial feature of rivaroxaban is once-a-day intake, which is important in the context of a high incidence of cognitive disorders in this patient category, and may improve their compliance and, thus, help achieving the expected profile of treatment efficacy. Thus, rivaroxaban can be regarded as a drug of choice for secondary prevention of stroke in AF.
{"title":"[Modern issues of improving the prognosis in patients with atrial fibrillation after ischemic stroke].","authors":"O. Ostroumova, T. Ostroumova, A. V. Arablinsky, V. N. Butorova, A. Kochetkova","doi":"10.18087/cardio.2022.3.n1992","DOIUrl":"https://doi.org/10.18087/cardio.2022.3.n1992","url":null,"abstract":"The anticoagulant therapy with a priority of direct oral anticoagulants is an approach to the prevention of recurrent stroke in patients with atrial fibrillation (AF) that has presently proved its efficacy and is stated in international clinical guidelines. An extensive evidence-based database demonstrates advantages of rivaroxaban over other drugs of this class in secondary prevention of stroke in AF. Furthermore, these advantages are combined with the optimal safety profile. The rivaroxaban treatment may provide the most favorable prognosis due to the prevention of recurrent stroke in AF, reducing the rate of kidney disease progression, and slowing vascular atherosclerosis. An important beneficial feature of rivaroxaban is once-a-day intake, which is important in the context of a high incidence of cognitive disorders in this patient category, and may improve their compliance and, thus, help achieving the expected profile of treatment efficacy. Thus, rivaroxaban can be regarded as a drug of choice for secondary prevention of stroke in AF.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"131 1","pages":"65-72"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73046952","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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