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Issue. Articles

№2(38) // 2012






The role of two-level infrainguinal reconstructions in treatment of chronic critical lower limb ischemia

V.N. Pshenіchnyі

The aim – to carry out a comparative analysis of immediate and mid-term results of two-level infrainguinal reconstructions and tibial grafting in patients with chronic critical lower limb ischemia (CCLLI).

Materials and methods. A retrospective review of graft patency and limb salvage included 77 patients who had undergone 79 bypass procedures consisting of: two-level infrainguinal arterial reconstructions (n = 36); femoral-tibial (n = 36) and femoral-plantar (n = 7) bypass. Segment of popliteal artery combined with lesion of its trifurcation and femoral artery occlusion had been isolated in all patients. Reversed vein, orthograd, orthotopic in situ vein grafts were used. Graft patency was monitored in dynamics by Doppler surveillance. Two groups of patients underwent a comparative study of demographic and risk factors using Student's criterion and test χ2.

Results and discussion. Life-table analysis showed that a better primary patency of grafts (76.2 %) was observed after two-level infrainguinal arterial reconstructions than after femoral-tibial or plantar bypasses (60.4 %; p < 0.05). Early perioperative mortality occurred in 2 patients (2.5 %). Early and mid-term graft thromboses appeared to be more frequent in the femoral-tibial and plantar bypass groups (18.6 % vs 11.4 %; p = 0.38 and 30.8 % vs 10.3 %; p = 0.04).

Conclusions. Two-level infrainguinal arterial reconstructions in patients with CCLLI provide a better patency of the graft and a higher rate of limb salvage as compared to femoral-tibial (plantar) bypass and have to be considered an accepted alternative to these interventions.

Keywords: critical lower limb ischemia, surgical treatment, infrainguinal reconstractions.



The influence of heart rate in patients with Q-wave myocardial infarction and decreased left ventricular systolic function on the clinical course and short-term outcomes of diseases

Ye.N. Amosova, Yao Xu, A.B. Bezrodnyi, I.V. Prudkіi, Yu.V. Rudenko, O.M. Gerula

The aim – to assess the influence of heart rate (HR) at admission on the clinical course and immediate outcomes in patients with Q-wave myocardial infarction (MI) and left ventricular (LV) ejection fraction (EF) < 45 % in the early stages of the disease within retrospective single-center cohort study.

Materials and methods. Retrospective analysis was conducted of 680 patients with Q-wave MI, LV EF < 45 % and acute left ventricular failure (ALVF) of I–ІII Killip class at admission. The patients were divided into two groups: 1st – 154 patients whose heart rate at admission was > 70 per 1 min, and 2nd – 526 patients with HR at admission > 70 per 1 min. The average patient’s age was (68.7 ± 0.5) years (from 32 to 96 years old), 404 (59.4 %) of them were males and 276 (40.6 %) – females. The patients underwent a routine clinical, electrocardiographic, laboratory studies, as well as Doppler echocardiography in the first 3 days of illness. We determined: end-diastolic (EDI), end-systolic (ESI) and LV stroke indexes, anteroposterior size of left atrial (LA) and anteroposterior size of right ventricle (RV), end-diastolic posterior wall (PW) and interventricular septum thicknesses (IVS). The endpoints were: hospital mortality, the increase rate of ALVF by one class or more, the emergence of resistant ventricular tachycardia and ventricular fibrillation, recurrent MI and postinfarction angina. The risk on TIMI scale, the incidence of persistent and paroxysmal atrial fibrillation were estimated. Independent predictors of hospital mortality were determined with multivariate analysis by stepwise logistic regression analysis of the following parameters: HR > 70 per 1 min at admission, male sex, age, MI, diabetes mellitus, arterial hypertension (AH), stable angina and smoking in anamnesis, MI localization, hospital admission in less than 12 hours from the onset of symptoms, ALVF of IІ–ІII class at admission, revascularization, treatment with β-adrenergic blockers (β-AB) and angiotensin-converting enzyme (ACE) inhibitors.

Results and discussion. Patients of both groups did not differ by age, sex, incidence of such diseases in anamnesis as AH, MI, unstable angina and stable exertional angina, as well as by frequency of smoking and localization of MI (all p > 0.05). In the absence of significant differences in average values of systolic and diastolic blood pressure in patients of 1st and 2nd groups, the occurrences of ALVF of IІ–ІII class at admission were respectively 19.5 and 36.5 % (p < 0.001), risk on TIMI scale at admission – respectively (4.9 ± 0.1) and (6.0 ± 0.1) points (p < 0.001), frequency of ALVF’s increase in hospital by one class – respectively 15.6 and 26.6 % (p < 0.01), hospital mortality – respectively 18.8 and 30.8 % (p < 0.01). The study of LV systolic function parameters in patients of 1st and 2nd groups in the first 3 days registered such results: ESI – respectively (45.8 ± 1.3) and (50.7 ± 0.7) ml/m2 (p < 0.01), EDI – respectively (75.3 ± 1.9) and (81.9 ± 0.9) ml/m2 (p < 0.01), LV EF – respectively (39.8 ± 0.4) and (37.5 ± 0.3) % (p < 0.01), LA size – respectively (3.71 ± 0.05) and (3.85 ± 0.03) cm (p < 0.01), PW thickness – respectively (1.01 ± 0.01) and (1.02 ± 0.01) cm (p > 0.05), and IVS thickness – (1.02 ± 0.01) and (1.01 ± 0.01) cm (p > 0.05). In multivariate analysis, HR > 70 per 1 min at admission was an independent from ALVF (relative risk (RR) = 2.38; p < 0.001) predictor of unfavorable outcome and was associated with 2.16-fold increase of hospital mortality (p = 0.002). The factors of significant increase in risk of hospital mortality were: male gender (RR = 1.960; 95 % confidence interval (CI) = 1.313–3.548; p = 0.002), age over 60 years (RR = 2.231; 95 % CI 1.137–4.378; p = 0.02), presence of AH in anamnesis (RR = 2.057; 95 % CI 1.119–3.782; p = 0.02) and stable angina in anamnesis (RR = 1.686; 95 % CI 1.081–2.630; p = 0.021). Revascularization (RR = 0.643; 95 % CI 0.465–0.890; p = 0.008), treatment with β-AB (RR = 0.284; 95 % CI 0.171–0.472; p < 0.001) and ACE inhibitors (OR = 0.172; 95 % CI 0.096–0.309; p < 0.001) associated with a significantly lower risk of hospital mortality.

Conclusions. In patients with Q-wave myocardial infarction and early systolic dysfunction of LV, heart rate greater than 70 per 1 min at admission is a significant independent predictor of hospital mortality (relative risk 2.2). HR greater than 70 per 1 min at admission in patients with Q-wave myocardial infarction and LV EF < 45 % contributes to significantly more frequent in comparison with HR ϑ 70 per 1 min increase of ALVF by one class or more, but has no effect on the incidence of potentially fatal ventricular arrhythmias and recurrent MI.

Keywords: heart rate, myocardial infarction, left ventricular ejection fraction, hospital mortality, ivabradine.



Factors influencing the course of coronary heart disease after coronary artery stenting: a five-year prospective study data

Ye.A. Koval, N.P. Anosova, S.A. Hrabov, D.B. Kornilov, S.V. Romanenko, A.S. Skoromnaуа, A.V. Khomich

The aim – to study the effect of the previous clinical course of coronary heart disease (CHD), type of coronary artery lesions, volume of myocardial revascularization, nature and duration of dual antiplatelet therapy (DAT), achievement of the target lipid level on a 5-year survival without adverse cardiovascular events in patients after coronary artery (CA) stenting.

Materials and methods. The case histories of 198 patients with various forms of CHD that underwent coronary angiography (CAG), followed by revascularization during 2004–2008 were retrospectively studied. On average in (4.6 ± 1.3) years after the intervention the frequency of adverse cardiovascular events (CVE), lipid profile data and CAG were assessed. The combined primary endpoint included: death from any cause, death from cardiovascular disease, nonfatal myocardial infarction, repeated myocardial revascularization, stent thrombosis, resumption of angina symptoms, episodes of atrial fibrillation occurring for the first time, onset and progression of heart failure, as well as combinations of these events.

Results and discussion. General mortality during the observation period of 4.6 years (on average 55 months) was 1.5 % (3 patients). Recurrent angina was noted in 29 (12.6 %) patients. Complete revascularization was performed in 141 (72.7 %) patients, death and adverse CVE over the entire period of observation were fixed in 31 (22 %) patients of this group. 57 (37.4 %) patients underwent incomplete revascularization, and 20 (36.4 %) adverse CVE were noted for the entire period of observation. The relative difference of survival rate without CVE (within 55 months) in both groups was 14 % (p = 0.03) – mainly due to the resumption of angina symptoms. Stenosis of type B was associated with absence of adverse CVE and significantly better (by 23 %, p = 0.00028) survival rate than stenosis of type C. There was a significant decrease of survival rate in patients without adverse CVE depending on low density lipoprotein cholesterol level (LDL CL) (p = 0.014). Adverse CVE were observed in 11 (23.9 %) out of 46 (48.9 %) patients who had been taking clopidogrel for less than 6 months and in 12 (25 %) (p = 0. 86) of those who had been taking clopidogrel for more than 12 months.

Conclusions. The level of a five-year survival rate of patients without adverse CVE after CA stenting, including 21.2 % of primary percutaneous coronary interventions, was reliably associated in descending order with the presence and severity of stable angina before stenting, the achievement of target LDL CL rather than total cholesterol level while taking statins, absence of long term episodes (more than 5 years) of arterial hypertension and chronic ischemic heart disease (IHD), morphological type of stenosis B, and volume of revascularization. Prolonged use (≥ 12 months) of DAТ compared with ≤ 6 months DAТ was not associated with improvement of long-term survival rate and absence of adverse CVE, which could be related to a greater clinical severity of the disease and angiographically more significant lesions of CA in the group of patients receiving DAТ for a long time, as well as to the predominant reception of clopidogrel generic formulations.

Keywords: chronic ischemic heart disease, coronary artery stenting, antiplatelet drugs, statins.



Surgical aspects of coronary and renal pathology in myocardial revascularization on beating heart

V.I. Ursulenko, A.V. Rudenko, А.V. Kupchynskіi, А.A. Beregovоi, K.N. Zakon, Ye.O. Lebedeva, D.S. Sobinov, I.I. Prudkiі

The aim – to assess the effect of angioplasty of renal artery stenosis (RAS) on renal function, and to assess the need and timing of this procedure during coronary artery bypass grafting (CABG).

Materials and methods. Changes in renal function parameters (urea, urea nitrogen and creatinine levels) were analyzed in 81 patients with RAS in combination with ischemic heart disease. The patients were divided into 4 groups depending on the timing of RAS angioplasty in relation to CABG operation.

Results and discussion. Retrospective analysis of the data showed that regardless of time of RAS angioplasty and even without performing it the investigated parameters of renal function hardly changed; the decrease of blood pressure in all groups was apparent.

Conclusions. The elimination of RAS had no positive effect on renal function but helped to reduce blood pressure. Routine procedure of renal artery stenting aimed at renal function improvement before CABG surgery has no advantages.

Keywords: renal artery stenosis, angioplasty, ischemic heart disease.



Indicators of elastic properties of carotid arteries in patients with essential hypertension and ungraded connective tissue dysplasia

V.О. Diedova

The aim – to determine the parameters of elastic properties of the common carotid arteries and their remodeling in patients with essential hypertension (EH) of I–II stage accompanied by signs of connective tissue dysplasia (CTD) and to compare them with those in patients without evidence of CTD.

Materials and methods. The study involved 54 patients with I–II stage of AH, 2–3 stage of blood pressure elevation and high or very high risk (39 women, 15 men) whose average age was (47.39 ± 7.76) years. 34 patients with symptoms of CTD composed the 1st group, 20 patients without them – the 2nd. The patients of both groups were comparable in gender, age, stage, extent and duration of AH. Using high-resolution sonography of multifrequency sensor in the range 3 – 12 MHz we investigated the diameter of common carotid arteries (CCA) in systole and diastole, the thickness of the intima-media. The following parameters were calculated: Young’s and Peterson’s moduli, the coefficients of radial strain and linear elasticity, stiffness index, pulse wave velocity (PWV) by Moens-Korteweg’s formula, arterial mass of the vascular segment, the ratio of wall / lumen and the degree of CCA remodeling.

Results and discussion. It was revealed that indicators of OCA elastic properties in patients with symptoms of CTD were shifted towards the decrease of rigidity. There were significant differences in indicators such as Peterson’s modulus (the main group and the comparison group, respectively: on the right – (442.01 ± 31.27) and (547.63 ± 33.33) mm Hg. per unit of relative deformation; p < 0.05, on the left – (467.41 ± 33.11) and (582.62 ± 31.23) mm Hg. per unit of relative deformation; p <0.05), Young’s modulus (the main group and the comparison group, respectively: on the right – (1503.96 ± 119.42) and (1838.05 ± 114.19) mm Hg. per unit of relative deformation; p <0.05, on the left – (1589.06 ± 121.87) and (1931.77 ± 118.65) mm Hg. per unit of relative deformation; p <0.05), coefficient of linear elasticity (the main group and the comparison group, respectively: on the right – (0.0031 ± 0.0002) and (0.0024 ± 0.0002) conv. units; p <0.01, on the left – (0.0023 ± 0.0002) and (0.0010 ± 0.0002) conv. units; p <0.01), stiffness index (the main group and the comparison group, respectively: on the right – (4.19 ± 0.29) and (4.93 ± 0.23) conv. units; p <0.05, on the left – (4.49 ± 0.33) and (5.41 ± 0.28) conv. units; p <0.05) and PWV (the main group and the comparison group, respectively: on the right – (5.17 ± 0.18) and (5.76 ± 0.22) m/s, p <0.05, on the left – (5.32 ± 0.18) and (5.93 ± 0.24) m/s; p <0.05). Differences were traced between the studied parameters of right and left CCA in patients of both groups. At the same time the difference between the coefficient of linear elasticity on the left and on the right reached the correct values (p <0.05). Lack of CCA remodeling was found in 97% (n = 33) patients of the main group and in 95% (n = 19) patients of the comparison group, eccentric hypertrophy was observed in 3% (n = 1) patients of the main group and in 5% ( n = 1) patients of the comparison group.

Conclusions. According to the high-resolution sonography, indicators of CCA elastic properties in patients with I-II stage of EH and signs of CTD differ substantially from those in patients without signs of CTD, comparable by the main clinical and demographic characteristics, suggesting that the former have slightly higher elasticity of these vessels. There are distinctions between the studied indices of the right and left CCAs, which reach the correct value for the coefficient of linear elasticity in patients with AH and signs of CTD as well as in patients without these signs. CCA remodeling was absent in the vast majority of patients with I-II stage of AH and signs of CTD as well as in those without these signs.

Keywords: arterial hypertension, elastic properties of blood vessels, connective tissue dysplasia.



Ways of myocardial regeneration

O.I. Dieltsova, S.B. Herashchenko, Yu.B. Chaikovskyі, Yu.V. Silkina

The article highlights scientific progress in the search of regenerative capacity of cardiomyocytes throughout life and in case of damage. Different areas of scientific research have been characterized dealing with myocyte self-repair processes, myocardial regeneration by stem cells of different origin and processes of transdifferentiation of other programmed differentiation cells. Mature cardiomyocytes are capable of mitotic division and self-renewal by autophagy. Transplantation of stem cells from red bone marrow into the damaged myocardium, activation of stem cells' native myocardial reserves can be an alternative solution to the problem of loss of cardiomyocytes and their recovery.

Keywords: myocardium, regeneration, stem cells, autophagy, proliferation.



Cardiac myocytes apoptosis in myocardial ischemia and infarction

А.V. Ushakov, I.Ya. Horіanskaуа

The review presents modern views on the problem of cardiac myocytes apoptosis in ischemia and myocardial infarction: mechanisms of development, role of extracellular factors and intracellular signalling systems. The issues of apoptosis in myocardial reperfusion, role of preconditioning and post-conditioning in the induction and inhibiting of cardiac myocytes apoptosis, its involvement in cardiac remodelling caused by myocardial ischemia and infarction are reviewed.

Keywords: apoptosis, cardiomyocyte, myocardial infarction, ischemia.



Possibilities of non-invasive diagnosis of distal arterial system condition in patients with chronic critical ischemia of lower limb

O.I. Gudz, I.M. Gudz

Non-invasive diagnosis of lesions of cardiovascular system has moved to a new level due to the rapid development of scientific and technological progress and the emergence of new highly informative instruments. The article analyzes the latest data in the world literature concerning the diagnostic capabilities of colour duplex scanning, multispiral computer tomography and magnetic-resonance angiography in the study of the state of distal arterial system in patients with chronic critical ischemia of lower limb.

Keywords: non-invasive diagnosis, distal arterial system, chronic critical ischemia, lower limb.



Depressive disorders and cardiovascular diseases

N.T. Vatutin, N.V. Kalinkina, Ye.V. Dziuba, M.А. Khristichenko

The new literature data about the most common mental disorder accompanying cardiovascular diseases, depression, are presented in this review. Aspects of history and epidemiology are discussed. The main mechanisms of development of these diseases (autonomic nervous system and hypothalamus-pituitary-adrenal system dysfunction, lesion of structure and function of platelets, endothelial and lipid metabolism dysfunction etc.) as well as their risk factors are displayed. Clinical features, main methods of diagnosis and treatment of depressive disorders are disclosed.

Keywords: depressive disorder, cardiovascular diseases.



Multicomponent splitting of second sound and nonspecificity of midsystolic click

Ya.V. Shpak, T.V. Martуniuk, I.V. Kolesnikov

Two clinical cases have been presented. Additional first sound was auscultated and multicomponent splitting of second sound, undescribed in literature, was revealed in one patient who had severe mitral insufficiency developed against postinfarction cardiosclerosis and left ventricular aneurysm. Similar multicomponent splitting of second sound was also found in the second patient with severe mitral insufficiency. Diagnostic value of first sound and splitting of second sound were considered. The conclusions about nonspecificity of isolated first sound for the diagnosis of mitral valve prolapse have been made.

Keywords: cardiac auscultation, first sound, splitting of second sound.



Пути регенерации миокарда

Е.И. Дельцова, С.Б. Геращенко, Ю.Б. Чайковский, Ю.В. Силкина

В статье освещены научные достижения в вопросах поиска регенеративных возможностей кардиомиоцитов на протяжении жизни и в случае повреждения. Охарактеризованы различные направления научных разработок по изучению процессов ауторепарации миоцитов, а также регенерации миокарда за счет стволовых клеток различного происхождения и процессов трансдифференцировки клеток других дифферонов. Зрелые кардиомиоциты способны к митотическому делению и к самообновлению путем аутофагии. Трансплантация в поврежденный миокард стволовых клеток из красного костного мозга, активизация собственных миокардиальных резервов стволовых клеток могут стать альтернативным решением проблемы потери кардиомиоцитов и их восстановления.

Keywords: миокард, регенерация, стволовые клетки, аутофагия, пролиферация.

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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