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Issue. Articles

3(31) // 2010





Comparative evaluation of myocardium damage parameters during cardiac surgery with cardioplegia and artificial ventricular fibrillation

V.I. Ursulenko, I.I. Prudkyi, L.S. Dzakhoeva, A.A. Berehovoy, L.V. Yacob, L.A. Klymenko, S.H. Klymenko, N.S. Osypenko

The aim to assess the relative degree of myocardial damage after operations performed under cardioplegia and at fibrillatory heart in patients with complicated forms of coronary heart disease, and when it is combined with valve pathology.

Materials and methods. Clinical material consisted of 36 operated patients with complicated forms of coronary heart disease (CHD), such as a postinfarction left ventricular aneurysm, mitral insufficiency, ventricular septal rupture, and CHD with concomitant valve pathology.

Results and discussion. It is shown that the activity of enzymes markers of damage to myocardium cell structures when using cardioplegia and during operations on the fibrillatory heart is the same. The method of pathology correction at fibrillatory heart can be used in some complicated forms of CHD.

Conclusions. Analysis of the activity of serum enzymes markers of damage to myocardial cellular structures revealed no significant difference in increasing their activity both in case of using cardioplegia and during operations on the fibrillatory heart. The use of cardioplegic solution for myocardial protection is justified and performs well during long open heart surgery. The disadvantage of this method is its complexity, duration, and cost. In some complicated forms of CHD, interatrial defects and some valve defect, the method of pathology correction at fibrillatory heart can be used that is labor-saving, cost-effective and reduces operation time and the period the patients stay in the intensive care unit.

Keywords: cardioplegy, fibrillation, markers of myocardial damage.



Surgical prophylaxis of infrainguinal thrombotic reocclusions in patients with multilevel lower limb arterial damages

V.N. Pshenychny

The aim to determine the relation between the vessel damage mode, the amount of infrainguinal revascularization and the number of immediate and mid-term thrombotic complications in patients with multilevel lower limb arterial damages.

Materials and methods. The results of the examination and surgical treatment of 710 patients with chronic critical lower limb ischemia (CCLLI) caused by atherosclerosis of the infrainguinal arteries have been analyzed. Combined affection of the femoropopliteal and popliteotibial segments has been found in 73.1 % patients. 4 types of peripheral arteries patency rate have been determined. Combined patency of the arteries in popliteal and tibioplantar segments has been diagnosed in 59.1 % patients. A number of thrombotic complications after different methods of reconstruction depending on the artery patency type have been studied.

Results and discussion. The most frequent interventions were: femoro-proxymal popliteal bypass (FpPB) in 243 (34.2 %), femoro-tibial bypass (FTB) in 149 (21 %), femoro-distal popliteal bypass (FdPB) in 97 (13.7 %), two-level aorto-femoral and femoro-popliteal (AFB+FPB) in 194 (18.9 %), two-level femoro-popliteo-tibial (plantar) bypass (FPTB) in 50 (7 %). A reliably greater occurrence was revealed of mid-term thrombotic reocclusions in patients with combined femoro-popliteo-tibial segment damage and without it after FpPB (84.7 % and 45.8 %, = 0.00001), FdPB (81.0 % and 40.0 %, = 0.007), FTB (52.4 % and 32.1 %, = 0.1). The best results in the group with combined patency have been obtained after two-level infrainguinal reconstructions (20 % of thromboses) as compared to FpPB ( = 0.00001), FdPB ( = 0.00001) and FTB ( = 0.006).

Conclusions. A differentiated approach to limb revascularisation in CCLLI caused by multilevel infrainguinal arterial occlusions with the consideration of different types of peripheral artery patency makes it possible to avoid mid-term thrombosis in 67.980 % patients.

Keywords: thrombosis, prophylaxis, infrainguinal reconstractions, surgical treatment.



Relationship between plasma neuropeptide Y and circadian rhythm of blood pressure in hypertensive patients

V.A. Vizir, I.N. Voloshyna

The aim to define the content of the plasma neuropeptide Y (NPY) in patients with essential hypertension (EH) of IIIII stage and its relationship with the circadian rhythm of blood pressure (BP).

Materials and methods. A total of 64 patients (36 men, 28 women) with hypertension of IIIII stage, the average age 54 2.7 years, were included in the study. The control group consisted of 32 healthy normotensive persons (17 males and 15 females), mean age 50 4.2 years. All individuals underwent 24-hour BP monitoring with the definition of average systolic (SBP) and diastolic BP, heart rate (HR), SBP variability (VarSAT) and the analysis of circadian rhythms on the unit ardiotens (Meditech, Hungary), and determination of plasma NPY and norepinephrine content by immunoenzyme method.

Results and discussion. The average level of NPY in patients with EH was 44.2 5.8 pg/ml, levels of norepinephrine 205.1 2.8 pg/ml, which was significantly higher than in the control group 9.3 1.9 pg/ml (p < 0.001) and 168.3 5.3 pg/ml (p < 0.001), respectively. The correlation coefficient between the daily index (DI) and the level of norepinephrine was 0.45 (p < 0.001); a nonlinear dependence as the U-curve was revealed between the DI and the level of NPY. This dependence was described by the regression equation: NPY = 53.3998 1.5257 DI (p = 0.0047). Patients with hypertension and night-piker BP were characterized by significantly higher levels of plasma norepinephrine (223.6 6.7 pg/ml), NPY (98.3 13.5 pg/ml) and 24-hour variability of SBP (17.2 0.9 mm Hg) than both the control group (n = 32, NPY 9.3 1.9 pg/ml, norepinephrine 168.3 5.3 pg/ml, VarSBP 11.3 1.2 mm Hg), and the hypertensive patients who had types of circadian blood pressure profile dipper (n = 17, NPY 11.2 2.5 pg/ml, norepinephrine 197.6 5.7 pg/ ml, VarSBP 13.4 1.1 mm Hg). In the subgroup of patients with non-dipper type, VarSBP did not differ from that in night-piker subgroup (n = 24, VarSBB 16.1 0.8 mm Hg), and levels of sympathetic mediators were significantly lower (NPY 30.7 3.7 pg/ml, norepinephrine 207.3 3.7 pg/ml). In the subgroup of patients with over-dipper type (7 patients), the level of NPY reached 102.4 17.1 pg/ml, and did not differ from that in the night-piker subgroup, whereas the level of norepinephrine (173.7 2.4 pg/ml) did not differ from that in the healthy persons (p > 0.05).

Conclusions. Hypertensive patients with changes in BP circadian rhythm by the night-piker type are characterized by the simultaneous significant increase in plasma levels of NPY and norepinephrine, which are less distinct in patients with non-dipper profile. Patients with BP circadian rhythm by over-dipper type reveal the association of significant increase in the level of NPY with a constant level of norepinephrine.

Keywords: essential hypertension, neuropeptide Y, norepinephrine, 24-hour blood pressure monitoring.



Minimally invasive technique of harvesting the great saphenous vein with the use of a laryngoscope

A.V. Rudenko, V.P. Zakharova, S.S. Galych

The aim to evaluate the advantages and disadvantages of minimally invasive technique of vein harvest with the use of a laryngoscope.

Material and methods. 30 coronary artery bypass grafting operations were performed with the use of minimally invasive technique of harvesting the great saphenous vein. Evaluation of the method included macroscopic estimation of the integrity of the vascular wall of the vein segment, harvested with minimally invasive method, histological examination of the vein wall, the study of the degree of pain in the post-operative wound at rest and during walk. The cosmetic results of the post-operative wound were also evaluated.

Results and discussion. 2 cases of significant damage to the venous wall when using minimally invasive technique were revealed. The results of histological analysis showed damage to the venous wall in the subcutaneous tunnel in 5 cases, compared with 8 in open areas. In the post-operative period, the patients of the experimental group had considerably fewer complaints of pain, which may be related to preserving the integrity of skin and subcutaneous structures in the most functional zones (ankle and knee joints).

Conclusions. Similar to the traditional open technique, the minimally invasive vein harvesting method with the use of a laryngoscope allows obtaining the requiring length of a vessel with minimal traumas to its walls, but it significantly reduces the incidence of pain and improves the cosmetic quality of the stitch.

Keywords: coronary artery bypass grafting, vein harvest, laryngoscope, histological research.



Transforming growth factor beta and cardiac remodeling in patients with essential arterial hypertension

T.A. Kozhanova

The aim – to study interrelationships of transforming growth factor beta 1 (TGF-β1) serum levels with structural and functional parameters of heart in patients with essential arterial hypertension (AH).

Materials and methods. The study included 89 patients with I–II degree AH (46 males and 43 females; mean age 52.9 ± 0.9 years-having cardiac remodeling manifested by change of left ventricle (LV) myocardium mass index (MMI) and LV relative wall thickness (RWT) caused by AH and 20 control patients without AH and cardiac remodeling. Besides the standard clinical and instrumental study, serum levels of active TGF-β1 were measured in all patients by enzyme multiplied immunoassay. Structural remodeling of LV was assessed by means of transthoracic echocardiography and evaluated according to American Society of Echocardiography criteria.

Results and discussion. 50 (56 %) patients’ serum levels of TGF-β1 were increased (on the average (8.89 ± 0.20) vs (4.18 ± 0.43) ng/ml in the controls; p < 0.0005). The group of patients with increased TGF-β1, as compared to the subgroup with normal TGF-β1, was characterized by higher LV MMI (153.8 ± 3.89) and (145.56 ± 5.17) g/m2; < 0.05), interventricular septum thickness (1.36 ± 0.02) and (1.29 ± 0.06) cm; < 0.05), LV RWT (0.50 ± 0.01 and 0.48 ± 0.01; < 0.05), lower ratio of maximal early and late diastolic filling rate of LV (/) (0.72 ± 0.01 and 0.81 ± 0.01; < 0.05) and higher isovolumic relaxation time (125.00 ± 4.05) and (115.00 ± 4.20) ms; < 0.05). In the presence of hypertrophic type of diastolic dysfunction in all patients, there was no difference in eccentric hypertrophy and concentric remodeling occurrence in the groups with normal and elevated TGF-β1 levels. Correlative analysis revealed strong positive relation of TGF-β1 level and / both in AH patients (r = +0.61; p < 0.001) and in the control group (r = + 0.58; p = 0.008).

Conclusions. Increase of TGF-β1 serum level in I-II stage AH patients is associated with a more expressed LV MMI, LV absolute and relative wall thickness and LV diastolic dysfunction (hypertrophic type). At the same time, TGF-β1 had inverse relationship with / both in AH patients and in healthy controls.

Keywords: arterial hypertension, cardiac remodeling, diastolic function, transforming growth factor beta.



Relationship between atherosclerotic lesion of coronary and extracardiac arteries in patients with coronary heart disease

T.V. Anikeeva, V.K. Grin, O.V. Synyachenko

The aim to identify the relationship between the degree of atherosclerotic lesions of coronary and extracardiac arteries in patients with coronary heart disease.

Materials and methods. The study followed 142 patients with coronary heart disease (CHD) aged 36 to 78 years (an average of (60.7 0.64) years), among them 78 % were men and 22 % were women. In 79 % of cases, extracardiac atherosclerotic lesions of arteries were diagnosed. 72 (50.7 %) patients had myocardial infarction in history within the period from 1 year to 15 years (mean (4.9 0.46) years). All patients underwent electrocardiography, echocardiography, Holter monitoring, angiography, ultrasound of the vessels. Reactivity of the arteries was assessed by endothelium dependent and endothelium independent vasodilation.

Results and discusions. The presence of the relationship was revealed between the degree of atherosclerotic lesion of the coronary and extracardiac arteries. Forecast-negative factors against CHD are atherosclerosis of the femoral, popliteal, and subclavian vessels. The presence and severity of peripheral arteriosclerosis are directly proportional to the development of disorders of excitability and electrical conductivity of the heart, the degree of heart failure, the parameters of endothelium dependent and endothelium independent vasodilation.

Conclusions. Investigation of extracardiac vessels is indicated to all patients with CHD for the early diagnosis of peripheral atherosclerosis, and coronary angiography is appropriate in case of peripheral atherosclerosis without clinical manifestation of CHD.

Keywords: coronary heart disease, atherosclerosis, coronary and extracardiac arteries, relationship.



Disorder of cardiovascular risk factors in patients with arterial hypertension depending on social and economic status

Yu.V. Levadnaya, L.V. Bohun, I.G. Bereznyakov, D.Yu. Sidorov, M.N. Levitskaya

The aim to study the prevalence of cardiovascular (CV) risk factors (RF) in patients with arterial hypertension (AH) depending on level of education as the main determinant of the socio-economic status (SES).

Materials and methods.We used a questionnaire survey of 149 patients with AH, mean age (53.7 3.2) years, 51.3 % were males. 94 patients (63.1 %) suffered from concomitant type 2 diabetes mellitus (DM). We estimated some CV RF (smoking habits, male gender, obesity, insufficient arterial pressure (AP) control, low physical activity) and some social factors such as presence of employ) ment or pension, marital status and level of education. Absence of higher education (125 patients or 83.9 %) has been considered a low SES. On the contrary, the presence of higher education (24 patients or 16.1 %) has been an evidence of a high SES.

Results and discussion. Patients with a low SES more frequently suffered from obesity (93.6 versus 33.3 %, p < 0.01) and type 2 DM (68.0 versus 37.5 %, p < 0.05) and less frequently achieved target AP (5.6 % versus 20.8 %; p < 0.05). Lack of physical fitness was registered more frequently among patients with high SES (50.0 versus 30.4 %; p < 0.05). Such features as more frequent receipt of a pension (25 versus 4.0 %, p < 0.01) and a bigger number of married people (84.0 versus 72.0 %, p < 0.05) can be used as indirect signs of a lower level of social stress in patients with a high SES.

Conclusions. In patients with hypertension, low educational level as an indicator of socio-economic status is associated with a larger spread of obesity, type 2 DM, worse control of blood pressure levels and lower frequency of smoking in the past. High SES, which was assessed by level of education, was characterized by lower level of social stress, as evidenced by the lower frequency of obesity, higher frequency of marriage and a pension.

Keywords: arterial hypertension, diabetes mellitus, socio-economic status, risk factors, cardiovascular diseases.



Changes in the level of protein -SH and-S-S- groups in the blood of patients with acute myocardial infarction with ST-segment elevation before and after myocardial reperfusion with thrombolytic therapy

N.V. Kostyushova, V.M. Yurlov, Yu.V. Zhurba

The aim identification and clinical evaluation of changes in the level of protein -SH and -S-S- groups in the serum of patients with myocardial infarction with ST-segment elevation (ST-MI) before and after adequate, according to the ECG and laboratory criteria, myocardial reperfusion with thrombolytic therapy.

Materials and methods. The study involved 11 patients with uncomplicated ST-MI who underwent thrombolytic therapy (TLT). Its efficacy was proved by the reduction of ST-segment elevation by not less than 50 % after 90 min, and increased activity of MB fraction of creatine phosphokinase and myoglobin content in patients with ST-MI in 2 hours from the beginning of alteplase introduction. The content of protein -SH and -SS- groups (micromole/l) was measured by reverse amperometric titration and SH/SS protein coefficient was calculated by their correlation in the serum of patients before alteplase introduction and 2 and 14 h after the beginning of its introduction. Normal values of these parameters were obtained by examining healthy volunteers and blood donors from the control group.

Results and discussion. In the control group, the content of protein groups -SH and -S-S- and protein coefficient SH/SS were 581 4.0; 129 3.0; 4.58 0.11, respectively. A significant reduction in the level of protein groups -SH (278 27.3; p < 0.05), increased amounts of protein groups -SS- (370 39.2; p < 0.05) and reduced protein coefficient SH/SS (0.77 0.09; p < 0.05) were found in patients with ST-MI before thrombolysis as compared with the control group. In patients with ST-MI, after the introduction of alteplase clear signs of positive dynamics of the content of the studied parameters were established. So, after 2 h, these patients manifested a significant increase of the initially reduced level of -SH (497 41.9; p < 0.05) and reduction in the initially high level of groups -S-S-(183 16.2; p < 0.05), accompanied by an increase of the initially reduced protein coefficient SH/SS (2.79 0.39; p < 0.05). After 14 h these patients, as compared to the benchmarks, also displayed significantly increased levels of -SH (462 47.9; p < 0.05) and reduction in the level of group -S-S- (205 15.2; p < 0.05), which was accompanied by an increase in protein coefficient SH/SS (2.27 0.22; p < 0.05).

Conclusions. The elevation of initially reduced serum content of protein -SH groups and the reduction of initially high levels of protein groups -SS-, as well as the disappearance of the inversion of their ratio (protein coefficient SH/SS) were registered in patients with acute MI with ST-segment elevation in 2 hours from the beginning of alteplase introduction, effective on myocardial reperfusion, according to the ECG and biochemical parameters.

Keywords: acute myocardial infarction, protein -SH and-S-S- groups, pharmacological reperfusion, alteplase.



Surgical treatment for acute varicophlebitis in patients of elderly and senile age

V.A. Prasol

The aim to improve the results of surgical treatment of acute varicophlebitis (AVP) of the great saphenous vein (GSV) in patients of elderly and senile age.

Materials and methods. From 2005 to 2009 we operated on 72 patients aged from 60 to 81 years with acute varicophlebitis AVP of GSV. Among them 65 (90.3 %) patients (mean age (66.2 4.3) years) were elderly people, and 7 (9.7 %) (average age (78.1 3.2) years) senile. The patients also had ischemic heart disease (90.3 % of the cases), hypertension (81.9 %) pneumosclerosis (15.3 %) and cancer (8.03 %). Functional ultrasound venography was performed to assess the status of surface and deep veins of the lower extremities. Urgent surgery was indicated to all patients. Radical surgery in the volume of combined venectomy of GSV with ligation of insolvent tibia perforators was performed in 45 (62.5 %) patients, whose physical condition corresponded to the low (2nd degree) level of operation and anesthetic risk; palliative interventions (crossectomy or ligation of GSV at sapheno-femoral anastomosis (SFA)) alone or in combination with venous thrombectomy were performed in 27 (37.5 %) patients with moderate (3rd degree) level of operation and anesthetic risk.

Results and discussion. The feasibility of active differentiated surgical treatment of elderly and senile patients with AVP was proved. The introduction of this tactic has helped to prevent pulmonary embolism (PE) and to avoid severe complications during and after surgery on the veins of lower extremities. Not a single episode of PE was registered when performing surgery and postoperatively in this category of patients.

Conclusions. The best treatment mode of thrombosis of varicose GSV in patients of elderly and senile age is a radical operation, but it is advisable only in low-level operation and anesthetic risk. Palliative surgery (crossectomy or ligation of GSV at SFA) in addition to venous thrombectomy is provided to prevent pulmonary embolism in patients with AVP and moderate operation-anesthetic risk.

Keywords: acute varicophlebitis, radical and palliative surgery.



Chronic heart failure and pharmacogenetics: focus on beta-blockers

Yu.S. Rudyk, S.N. Pivovar, T.V. Lozik, A.L. Oparin

The problem of chronic heart failure (CHF) is of high priority because of the huge extent of morbidity and mortality of patients. Chronic activation of β-adrenergic receptors (β-AR) plays a key role in the pathogenesis of CHF. The blockade of β-AR is accompanied by improved prognosis of patients with systolic dysfunction of the left ventricle. There is evidence that the polymorphism of β-adrenoceptor genes is associated with prognosis of CHF patients and may determine their sensitivity to β-blockers. Individual approach to the patient with CHF, based on an assessment of genetic polymorphism of β-AR, will identify patients with poor prognosis and low susceptibility to β-blockers.

Keywords: heart failure, β-blockers, β-adrenergic receptors, gene, polymorphism.



Cardiac syndrome X

N.T. Vatutin, N.V. Kalinkina, E.V. Sklyannaya, O.S. Khitrenko

Cardiac syndrome X (CSX) is angina caused by functional or organic failure of distal coronary bed with angiographically intact and nonparoxysmal large (epicardial) coronary arteries (CA). Among patients with typical angina clinic, prevalence of CSX reaches 10 %. Women get sick more often, especially during menopause. Angina with CSX is believed to be caused by violation of microvascular blood flow with underlying disorder of endothelium dependent and endothelium independent vasodilation, increased aggregation of platelets and red blood cells, and excessive rigidity of the vessels. These patients are also characterized by impairment of pain perception they are more sensitive to nociceptive stimuli. The clinical picture with CSX meets the diagnostic criteria of exertional angina, but atypical chest pain can be observed. CSX is diagnosed when exertional angina is combined with objective signs of myocardial ischemia (ST-segment depression on electrocardiogram, ischemic changes in scintigraphy, etc.) and intact CA according to selective coronary angiography. Treatment includes antianginal, analgesic and hormonal agents, statins and cytoprotectors, psychotherapy and physical training. Although the prognosis for life in these patients is favorable (seven-year survival rate reaches 96 %), recurrent angina pain is often the cause of repeated hospital admissions.

Keywords: cardiac syndrome X, microvascular dysfunction, ischemic heart disease.



Treatment of cardiac arrhythmias. Role of propafenone in complex of antiarrhythmic therapy

A.N. Solovyan

The article analyzes the efficacy of propafenone for cardiac arrhythmias. Propafenone – is an antiarrhythmic preparation of IC class. Its main electrophysiological effect is the pronounced inhibition of transmembrane fast sodium channels, which reduces the maximum speed of rapid depolarization of the action potential of myocardial cells of the atria and ventricles. As a class IC antiarrhythmic drug, propafenone is partly a beta-blocker, blocker of potassium and calcium channels. Propafenone is a highly effective preparation for restoring and maintaining sinus rhythm in patients with paroxysmal and persistent atrial fibrillation. Considering the safety of propafenone for oral administration, it can be used for reduction of paroxysmal atrial fibrillation in an outpatient setting. In case of ventricular arrhythmias, propafenone should be prescribed with consideration of their severity and organic heart disease. In patients with ventricular extrasystole and «jogging» ventricular tachycardia, propafenone effectively suppresses these arrhythmias. In patients with malignant ventricular arrhythmias and the use of propafenone is limited because of their modest efficacy and risk of pro-arrhythmia. Propafenone should not be prescribed for patients with low ejection fraction.

Keywords: cardiac arrhythmias, sinus rhythm, drug therapy, propafenone, efficiency, pro-arrhythmia.



Stem cells in cardiology

K.M. Amosova, I.V. Prudkyi, I.Yu. Katsitadze, O.V. Sopko

Cardiovascular diseases are among the most tangible components of the structure of mortality and morbidity. The search of alternative methods of treating patients with heart failure is urgent. One promising direction is the use of stem cells (SC), capable of differentiating into myocardial cells and restoring the damaged heart area. In recent years, many kinds of SC for the resumption of myocardial damage have been proposed, and some of them have undergone preclinical studies and entered the clinic. The article presents current views on treating patients with heart failure of SC, describes the basic mechanisms of heart repair and the effects of SC, gives an overview of clinical studies with the use of SC. Of much interest is the problem of determining the optimal number of transplanted cells, the method of their delivery into the zone of damage, methods of tracking the «fate» of these cells in the body after transplantation, as well as the safety of this procedure.

Keywords: heart failure, stem cells, cardiomyocytes.

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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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