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Issue. Articles

2(2) // 2003





Cardiovascular diseases in Ukraine: the problems and reserves of people's health preservation

V.N. Kovalenko, A.P. Dorogoy

The question of creation history and organizing and methodical structure of the cardiology service in Ukraine is elucidated in the article. Basic statistical data of cardiovascular diseases are represented. Priority directions of cardiology development with the accent to the problems of primary prophylaxis of cardiovascular diseases were determined. Indices of prevalence, morbidity, mortality of the cardiovascular pathology and especially ischemic heart diseases, myocardial infarction, hypertension, cerebrovascular pathology and other heart and vessels diseases in the country as a whole and in the different Ukrainian regions have been thoroughly analyzed. Attention was paid to the main risk factors of cardiovascular pathology and the principles of population impact strategy have been formulated.

Keywords: Ukrainian cardiological service structure, cardiovascular diseases, epidemiology, public health, primary and secondary prophylaxis.



Treatment of chronic venous insufficiency in patients with varicose disease: new techniques

I.I. Sukharev , G.G. Vlaikov, A.. Gutch, E.B. Medvedskiy

In the article the modern state of chronic venous insufficiency problem, including its pathophysiology, pathohystology, diagnostic, clinic and treatment, was analysed. Based on experience of treatment of 835 patients with chronic venous insufficiency from 1998 till 2003, the treatment algorithm including surgical operations, endoscopic vein surgery, miniphlebectomy, phlebosclerotic therapy, electrocoagulation; pharmacotherapy with mocroionized diosmin (Detralex), compressive therapy is offered. The use of this algorithm allowed to receive good longGterm results in 96,4 % of cases.

Keywords: chronic venous insufficiency, varicose disease, pathogenesis of CVI, Detralex.



24-hour profile of blood pressure and heart rate variability in patients with mild to moderate arterial hypertension

Yu.N. Sirenko, G.D. Radchenko, O.L. Rekovetz

Objective. To evaluate the heart rate variability (HRV) and exercise tolerance depending on the 24-hour blood pressure (BP) profile, to establish correlative relation of 24-hour BP data and HRV in patients with mild and moderate hypertension.

Patients and methods. 41 patients with mild and moderate hypertension were examined. The 1st group consisted of 20 patients — "dippers", the 2nd — of 21 patients with disturbances of 24-hour BP — "non-dippers". Besides, 15 patients group of healthy people was separated. 24-hour BP and ECG monitoring in all patients was performed. According to results HRV were estimated. Bicycle exercise test was performed in 16 patients of the first group and 15 patients at the second one.

Results. There is no differences in patients with mild to moderate hypertension, patients without physiological systolic and diastolic BP decrease at night and patients with permanent BP by 24-hour BP profile, mean data of time and frequency. The disturbances of vegetative regulation in non-dippers in comparison to 3per were esteblished and manifested by reverse correlative relation of HRV and '. Correlative relation in patients with stable BP profile was direct. Non-dippers differs from dippers by the cardio-vascular system reaction to the exercise, which leads to the less BP elevation after exercise in patients of the 1st group.

Keywords: arterial hypertension, dipper, nonGdipper, heart rate variability.



Risk stratification after acute Q-wave myocardial infarction on out-patient stage

E.A. Koval, R.V. Prog

Aim. To study the significance of acute MI phase predictors and their combinations, defined on the 3rd month of postinfarction period with the aim of evaluation of the risk degree of unfavorable cardiac events during one year after non-complicated MI and to development on this basis the risk stratification (RS) algorithm.

Methods and materials.We investigated 110 patients (pts) after 3 months from the first non-complicated MI. Follow-up period was 1 year. Combined end point included serious cardiac events (SCE): cardiac death, nonfatal re-MI, hospitalization due to heart failure worsening. For RS we used: left ventricular (LV) ejection fraction (EF≤ or >40 %); normal or impaired (judging from deceleration time 151—219 ms or ≤ 150 ms or ≥ 220 ms) LV diastolic function; presence or absence of ischemia (Isc) on exercise testing (ET); Holter ECG — average of ventricular premature beats per hour (VPB/h ≥ or <10/h) and preserved or depressed heart rate variability (judging from SDNN >50 or ≤50 ms).

Results. Primarily, pts were distributed on 2 groups: with EF>40 % and ≤40 %. Pts with EF≤40 % had more SCE (p=0,0001) while other predictors didn't have influence on their prognosis. Pts with EF>40 % were distributed on 4 groups: 1st (considered as low risk) without Isc and with VPB<10/h; moderate risk groups (MRG) — 2nd (Isc + VPB<10/h); 3rd (without Isc + VPB≥10/h); 4th (Isc + VPB≥10/h). In 1st there were less SCE than in 2nd (p=0,0001), 4th (p=0,00001) and 3rd (p=0,52). Within MRGs in 3rd there were less SCE than in 2nd (p=0,0004) and 4th (p=0,00001); it was no difference between 2 and 4 (p=0,12). Risk groups comparisons in survival without SCE were: low vs high — log rank test (LRT) 21,65 (p=0,00001); low vs moderate — LRT 6,49 (p=0,0109); moderate vs high — LRT 5,88 (p=0,0153).

Conclusion. EF≤40 % on the 3rd month after MI is the powerful predictor of high risk group. Low risk group is determined by EF>40 %, Isc absence and VPB<10/h after one year. Within MRG pts with Isc have the worst prognosis.

Keywords: ostinfarction period, risk stratification.



Peripheral blood circulation status in patients with chronic heart failure

L.G. Voronkov, I.A. Shkurat

The aim of the work. Evaluation of peripheral haemodynamics status in patients with chronic heart failure (CHF) depending on their clinical and functional condition and etiology of CHF.

Patients and methods. 45 patients with CHF due to ischemic heart disease (29 patients) and dilated cardiomyopathy (16 patients) were investigated. The average NYHA functional class was 2,8±0,7, average left ventricle ejection fraction was 32,4±8,8 %. Ultrasound apparatus "SIEMENS Sonoline Omnia" (Germany) was used for evaluation at heart systolic function. Linear ultrasound probe (7 MHz) was used for investigation at peripheral arteries. Endothelial function we studied by using the test with reactive hyperemia. 6-minute walking test was used for objective estimation of functional heart capacity.

Results. In patients with haemodynamically stable CHF, peak systolic velocity was decreased and vascular resistance in foot and shank arteries was increased. More pronounced dysfunction in patients with CHF, evaluated by the NYHA functional class and 6-minute walking test, was associated with disturbances of peripheral circulation and limited endothelium-related dilation of shoulder's artery without substantial changes in intracardiac haemodynamics.

Keywords: chronic heart failure, peripheral haemodynamics, endothelium-related vasodilatation.



Initial heart failure in patients with different myocardial pathology: analysis of mathematical models of intracardiac haemodynamics

M.P. Boychak, L.L. Sidorova

Objective. Determination of factors leading topromoting heart failure bydevelopment on the basis of analysis of mathematical models of intracardiac haemodynamics in patients with coronarogenic and non-coronarogenic cardiomyopathy (CMP).

Methods. Correlative, dispersive (Analysis of Variances, ANOVA) and regressive analyses of doppler-echocardiographic data of LV and RV morphofunctional condition in 205 patients with chronic ischemic heart disease, 25 patients with CMP due to hypothyroidism, 29 patients with CMP due to chronic alcohol abuse, with abuse. Heartheart failure (HF) corresponded toof the I—II NYHA grades,classes and LVEF>45 %.

Results. Intracardiac haemodynamics models (possessing informativity, adeqyacy,adequacy, descriptive properties) look like: for IHD pts — LVEF = 47,29 + 9,50 AFF LV — 0,74 EDP/EDV + 8,12 ESP/ESV — 0,34 ViA RV (AFF LV — left atrium systolic input in LV filling, EDP — end-diastolic pressure, EDV — end-diastolic volume, ESP/ESN — end-systolic contractility index, ViA RV — right atrium systilicsystolic linear velocity integral); for CMP pts due to hypothyroidism LVEF= 74,09 — 0,50 ESI — 0,14 TPVR+5,44 ESP/ESO (ESI- end-systolic index, TPVR — total periphericperipheral vascular resistance); for CMP pts due to alcohol abuse — LVEF = 33,63 + 0,27 EDI +5,46 ESP/ESO (where EDI — end-diastolic index).

Conclusion. Different factors take part in initial HF formating (or appearing) in pts woththe initial HF development in patients with coronarogenic and non-coronarogenic myocardial pathology.

Keywords: intracardiac haemodynamics, mathematical models, chronic ischemic heart disease , hypothyroidism, chronic alcohol abuse.



Impact of

.. Amosova, E.V. Andreyev

Objective: An open-label, randomized study was designed to compare the impact of long-term treatment with different betablockers on physical working capacity (PWC) and systolic function of the left ventricle (LV) at rest in patients with moderate heart failure (HF).

Matherials and methods. We examined 134 patients suffering from chronic ischaemic heart disease (IHD) and II—III class of HF (according to NYHA classification). The patients received aspirin, furosemide, digoxin and nitrates. On top of this we added beta-blockers in maximal tolerated doses — either metoprolol (mean dose 95 mg, group M, n=23), or talinolol (mean dose 132 mg, group T, n=28), or acebutolol (mean dose 209 mg, group , n=31), or propranolol (mean dose 61 mg, group P, n=28). 24 patients that received verapamil in mean dose of 165 mg were considered as a control group. Echocardiography at rest and bicycle ergometry were performed to all the patients before administration of study drugs, on day 20—24 and in 4—6 months thereafter. Wilkokson and Mann—Whithnie tests were used to evaluate the results.

Results. In the control group no changes in PWC were observed by day 20—24, whereas in patients that received beta-blockers there was a significant increase of threshold power of exercise and of total work up to 84,3 W and 34,3 kJ in the group M (the increase by 32,5 % and 58,6 %, respectively), in the group T 91,2 W and 39,8 kJ (the increase by 28,6 % and 73,7 %, respectively), in the group 91,6 W and 41,2 kJ (the increase by 40,8 % and 83,6 % respectively), and in the group P — 72,8 W and 26,2 kJ (the increase by 22,9 % 52,4 % respectively) (M,T,—P, M—, M—T<0,05). Positive changes of the end diastolic volume (EDV), end systolic volume (ESV), ejection fraction (EF) of the left ventricle and ESP/ESV ratio (ESP — end systolic pressure) were observed later in the groups M, T and (all <0,05) and were not found in the P group and in the control group. The EF increased from 47,9 % to 50,3 % in the group M, from 48,2 % to 51,7 % in the group T, from 46,0 % to 50,7 % in the group . ESP/ESV ratio increased by 7,9 %, 7,2 % and 11,7 % respectively.

Conclusion. The increase of PWC in patients with HF of II—III class is observed beginning from 20—24 days of treatment and is more significant when treated by selective beta-blockers (M, T and ) than non-selective (propranolol). Intrinsic sympathomymethic activity increases this effect (=T>M). The positive effect on the left ventricle systolic function is seen later only when treated by selective beta-blockers, regardless of their intrinsic sympathomymetic activity.

Keywords: moderate heart failure,



Diagnostics and surgical treatment of the heart myxomas

R.M. Vitovsky, V.M. Beshlyaga

The aim of the study was to specify clinical manifestations of heart myxomas, as the most widely spread tumors of this localization to improve diagnostics and the results of surgical treatment.

Material and methods. The study is based on the experience of the treatment of 389 consecutive patients with HM of a different localization, observed in the Institute of Cardiovascular Surgery during the period 1969 to 2001. HM were predominantly localized in the left atrium — 343 (88,2 %) patients. The investigation methods included echocardiography, heart catheterization, angiography, coronarography. Long-term results of surgery were followed up in 316 (92,1 %) discharged patients in terms from 6 months up to 30 years (mean 9,4±1,2 years) after operation.

Results of the study. The exposure rate of patients with the HM increased almost ten folds during the period from 1969 to 2002. The most informative clinical signs of HM are sudden dyspnea onset, dizziness, short-term loss of consciousness, which in most cases depend on the change of the body position (25,2 %); rapid heart failure progression in spite of the use of drug therapy (56,2 %); a short history of the heart disease (less than 1 year) in comparison with the rheumatic heart lesions (67,1 %), embolism of the peripheral or pulmonary vessels on the background of the sinus rhythm (4,4 %); melody of heart valvular disease, more frequently of the mitral stenosis, which is characterized by the variability of the murmurs with change of a body position (87,2 %); general weakness, body weight loss, anaemia, raised ESR, long lasting subfebrile temperature in spite of the antibiotic treatment. The leading role of echocardiography in the diagnostics of the HM is admitted which is evidenced by the complete coincidence of the main preoperative indices in comparison with the operative data in 99,1 % of patients. The optimal conditions for the surgical interventions are have been worked out and introduced, aimed on the prophylaxis of such severe complications as obturation of the heart valvular orifices by the tumor fragmentation with possible embolization of arterial vessels. They include urgency of the surgery, adequacy of a surgical manipulations, the use of original transbiatrial approach to the left atrium, which permitted to remove HM of this localisation without a single case of tumor fragmentation (36 patients). This permitted to decrease surgical mortality substantially: from 22,7 % in the treatment of 22 patients in 1969—1980 to 4,1 % in 1996—2001 in the treatment of 122, and to achieve a complete absence of lethal events in 67 consequently operated patients during the last 3 years.

Conclusion. The use of the informative clinical signs of HM and the use of instrumental methods of diagnostics permits to diagnose this acquired heart lesion in the due time, and observance of the proposed principles of surgical treatment provides the decrease of the frequency of heart valvular orifices obturation by the tumor fragmentation during its removal and the decrease of the surgical mortality from 22,7 % to 0 % during the period from 1969 to 2002.

Keywords: Heart myxomas, diagnostics, surgical treatment, results.



Role of cavopulmonary shunt in the surgery of heart anomalies with functionally single ventricle

A.M. Dovgan, M.F. Zynkovsky, A.V. Krivenky, I.G. Yacovenko

Background. The total right heart bypass is the optimal method for surgical treatment of heart anomalies with functionally single ventricle (FSV). The superior vena-cavo-pulmonary shunt is a part of such correction.

The aim of the study. On the basis of profound study of the cavopulmonary shunt performance in patients with various forms of single ventricle hearts to define the role of this intervention in the system of surgical treatment of cardiac abnormalities with FSV.

Methods and materials. The anastomosis between superior vena cava and right pulmonary artery has been performed in 92 patients with FSV. The medium age of patients was 51,7±44,9 months (of the range from 6 months to 16 years). 13 patients underwent one-and-a-half-ventricular correction (I group). Cavopulmonary shunt was used for 79 patients with single ventricle (SV) or tricuspid atresia (TA) as interim palliation or completive procedure (II group). 88 patients (94,6 %) underwent bidirectional cavopulmonary shunt (BCPS) and 4 (5,4 %) — classic Glen shunt.

Results. Overall hospital mortality rate was 11,9 %. No one died among 13 patients with hypoplastic right heart (HRHS) syndrome after one-and-a-half-ventricular correction. Mortality was 13,9 % for patients with SV and TA. One-and-a-half-ventricular correction HRHS is the effective method of treatment of such pathologies. Arterial oxygen saturation in that group patients increased from 78,4±8 % to 93,7±3,7 % and medium superior vena cava pressure was 14,4± 3,5 mm Hg. As for patients with SV and TA where BCPS was performed with additional source of the pulmonary circulation from the ventricle through pulmonary valve the arterial oxygen saturation and medium superior vena cava pressure were higher than of those whose blood didn't get from ventricle to pulmonary arteries, accordingly (89,3±4,8) %, (16,2±6) mm Hg and (86,5±9,2) %, (13,7±4,9) mm Hg (p>0,05).

Conclusion. Cavopulmonary anastomosis can be used as a stage palliation of SV and TA, and as completive method of surgical treatment for patients with increased risk factors for the Fontan operation, and also can be the element of one-and-a-half-ventricular correction of HRHS. This operation for the patients with SV and TA provides the satisfactory palliative effect, and its results are worse in the cases of additional source of pulmonary circulation supply by the natural way through the pulmonary trunk in the comparison with the cases when the pulmonary circulation was provided only through cavopulmonary shunt.

Keywords: single ventricle, tricuspid atresia, hypoplastic right heart syndrome, cavopulmonary shunt.



Surgical management of various forms of venous thromboembolism

L.V. Kulyk

Objectives. To optimize the approaches to the surgical management of different forms of pulmonary embolism on the basis of the analysis of various diagnostic and strategic algorithms for acute and chronic pulmonary embolism and the results of pulmonary embolectomy and thromboembolectomy.

Materials and methods. Over the period from 1980 up to 2003, 67 patients with acute pulmonary embolism (PE) (1 group) and 36 patients with chronic postembolic pulmonary hypertension (CPPH) (2 group) were undergone the surgical operations. Angiography was the main method of preoperative diagnostics; in the emergency cases of fulminant pulmonary embolism the decision for the operation was made on the basis of Doppler echocardiography.

Results. Out of 67 patients of the 1 group, 16 (23,8 %) died. Postoperative mortality was caused by heart failure due to preoperative cardiogenic shock, brain edema; pulmonary hemorrhage, misdiagnosing. Out of 36 thromboendarterectomies of the 2 group patients, surgical mortality was 22,2 %. The mortality causes included reperfusion syndrome, residual pulmonary hypertension, misdiagnosing. In 27 patients the operations were performed under profound hypothermia (12 to 18 °C) and total circulatory arrest. The overall duration of circulatory arrest varied from 23 to 90 minutes. The complications of the method included choreoatetosis, delirium and cerebral coma.

Conclusions. Pulmonary embolectomy remains the optimal treatment strategy in cases of acute massive PE with critical haemodynamic disturbances. In acute PE with severe respiratory insufficiency and relatively stable haemodynamics, embolectomy is an alternative to thrombolytic therapy. The only method of surgical management for CPPH is the operation performed under conditions of profound hypothermia and total circulatory arrest.

Keywords: pulmonary artery thromboembolism, thromboendarterectomy, postembolic pulmonary hypertension, embolectomy.



Antiplatelet therapy during PTCA and coronary arteries stenting

S.N. Furkalo, A.V. Sharuk

This study demonstrates an up-to-date approach to antiplatelet medication of invasive interventions in patients with coronary artery disease. Complex therapy involving acetylsalicylic acid, thienopyridine preparations and GP IIb/IIIa agentsplatelet receptor agonists made it possible to minimize the risk of complications after PCI and stenting. Our material is presented by an analysis of results of invasive intervention in 50 patients with a marked clinical picture of ischemia. One third of the patients were taken to hospital withhad unstable angina (ACS), signs at hospitalization, 78 % had multiple vessel lesions. Ejection fraction in the group was 46,9±4,6 %. All patients were treated withundergone PTCA and/or stenting. 33 % of them received Aspirin and plavix as an antiplatelet therapy. 17 patientstherapy with aspirin and plavix. 17 patients, mainly with unstable angina, were additionally administrated to receive integrilin (eptifibatide). Stents were implanted to 43 patients (1,8 stent per pt on average). No deaths, Q-wave MI and no emergency CABG were observed. Two registered cases of non-Q MI required repeat angiography and target lesion revascularization. One case of hemorrhage at the site of puncture entailing blood transfusion was detected.

Keywords: schaemic heart disease, transluminal angioplasty, coronary shunting, coronary stents, antiplatelet therapy, antiaggregant therapy.



Pulsed wave tissue Doppler imaging: the method and its clinical applications

Y.A. Ivaniv, A.S. Turkin, A.K. Kurkevych

Tissue Doppler imaging, a new cardiac ultrasound modality becomes a useful noninvasive method complementing other echocardiographic techniques for the myocardial velocities assessment in different clinical conditions. Spectral pulsed TDI allows the measurement of regional systolic and diastolic kinetics during myocardial ischemia at rest and with pharmacological stress tests. This method is particularly useful in the diagnosis of ventricular diastolic relaxation abnormalities of different origin. In the identification of patients with abnormal left ventricular relaxation, recording of Em provides better overall accuracy than Doppler mitral flow velocities alone. The motion of the mitral annulus can be assessed with TDI for determination of global longitudinal left ventricular systolic function. In this review the clinical applications of TDI is summarized to promote the understanding of its diagnostic utility in the evaluation of global and regional myocardial function.

Keywords: Y.A. Ivaniv, A.S. Turkin, A.K. Kurkevych



The treatment of acute limbs' ischemia: the contemporary state and perspectives

O.I. Pityk

The article represents the contemporary state and future prospects of methods of treatment for acute limb ischemia. The data about efficiency of traditional surgical treatment and intraGarterial thrombolysis at this pathology are presented, the comparative analysis of efficiency of these two methods is conducted. The review of perspective percutaneous endovascular methods for recanalization of acute arterial occlusion is done.

Keywords: acute limb ischemia, surgical treatment, intra-arterial thrombolysis, percutaneous thrombectomy.

Current Issue Highlights

4(60) // 2017

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K. M. Amosova 1, I. I. Gorda 1, A. B. Bezrodnyi 1, G. V. Mostbauer 1, Yu. V. Rudenko 1, A. V. Sablin 2, N. V. Melnychenko 2, Yu. O. Sychenko 1, I. V. Prudkiy 1&a

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