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Issue. Articles

№4(40) // 2012






Causes of myocardial ischemia in hypertrophic cardiomyopathy

G.V. Knyshov, Ye.K. Gogayeva, K.V. Rudenko, L.S. Dzakhoyeva, A.V. Rudenko, Yu.V. Panichkin, V.P. Zakharova

The purpose – to examine the causes of myocardial ischemia in hypertrophic cardiomyopathy (HCM). During the 7 years patients with various forms of HCM were observed in M.M. Amosov National Institute of Cardiovascular Surgery. Coronary ventriculography was performed while using standard diagnostic methods (echocardiography, electrocardiography, Holter monitoring of electrocardiogram) and the detection of myocardial ischemia. Increased tortuosity of coronary arteries (CA) was often found during coronary ventriculography. 50 % of patients revealed systolic compression of CA typical for myocardial bridge (MB). Characteristically, in all cases, MB was localized over the middle third part of the anterior interventricular branch of the left CA. Treatment was carried out taking into account the length of the MB, degree of systolic compression of CA, as well as forms of HCM. Death case in group of surgical treatment confirms the value of that anomaly in patients with HCM. MB in patients with HCM is a burdensome factor in the course of the disease.

Keywords: hypertrophic cardiomyopathy, myocardial ischemia, myocardial bridge.



«Ischemic cardiomiopathy»: іmmediate and delayed results of surgical and drug treatment

V.I. Ursulenko, L.V. Yacob

The purpose – to analyze the immediate and delayed results of the surgery, created and used by us in patients with severe forms of «ischemic cardiomiopathy» (IC); to compare them with the results of a related patient group, treated with drugs.

Materials and methods. 118 patients with a severe form of IC were examined in M.M. Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine in the period from 2003 till 2011. Depending on the recommended and used method of treatment, they were divided in two groups: drug treatment group (n = 59) and surgically treated group (n = 59).

Results and discussion. The technique of surgical treatment of IC based on grafting of coronary arteries by the off-pump method allowed us to reach good immediate results without lethal outcomes and to reach better clinical state in 70 % of surgically treated patients in the long-term period. In the drug treatment group, during the monitoring period (on the average in 4.6 years), 46.0 % patients died, 48.7 % achieved unsatisfactory results, and only 3 patients (on the average in 2.6 years) had satisfactory results.

Conclusions. Surgical treatment of IC by off-pump coronary artery bypass grafting allows inhibiting the progression of heart insufficiency, improving the pump function of the heart and the prognosis for life, which proves the effectiveness of the created method that can be recommended for patients with such pathology.

Keywords: «ischemic cardiomyopathy», coronary artery bypass grafting, heart failure.



Polymorphic variants of the T(–786)C and G894T gene of endothelial NO-synthase and state of vasodilating endothelial function in patients with chronic heart failure

L.H. Voronkov, N.H. Horovenko, I.D. Mazur, I.A. Shkurat, L.S. Mkhitarіan, N.М. Orlova

The purpose – to examine the relationship of endothelial-dependent vasodilation (EDVD) with polymorphic variants of the T(–786)C and G894T gene of endothelial NO-synthase (eNOS) in patients with chronic heart failure (CHF).

Materials and methods. The study involved 96 patients with CHF of ischemic origin of II–III NYHA functional class (FC) and systolic left ventricular (LV) dysfunction – LV EF ≤ 45 % who received standard therapy. Condition of EDVD was studied using samples with reactive hyperemia. According to the median increase in diameter of the brachial artery in the phase of reactive hyperemia (DD 6.4 %), all patients were divided into two groups: group A with DD less than 6.4 % and group B with DD over 6.4 %. Allelic polymorphisms T(–786)C and G894T were determined by polymerase chain reaction. Spectrophotometric and spectrofluorometric methods were used in blood plasma for the study of oxidative stress indexes – diene conjugate (DC) and malondialdehyde (MD), antioxidant protection – superoxide dismutase (SOD) and glutathione reductase activities and activity of angiotensin-converting enzyme (ACE).

Results and discussion. FC by NYHA in homozygotes CC of polymorphism T(–786)C was 2.9 ± 1.1, in heterozygotes TS – 2.7 ± 0.8, in homozygotes TT – 2.7 ± 1.0. No reliability was observed during the comparison of groups (p > 0.05). LV EF was 38.0 [30.0; 44.0] %, 37.0 [28.0; 43.5] % and 33.0 [25.0; 37.0] %, respectively, (p > 0.05). Carriers of genotypes TC and CC polymorphism T(–786)C dominated in group A, carriers of TT genotype (p = 0.038) – in group B. Median DD was 7.4 [5.1; 8.6] % in TT genotype carriers, 6.9 [4.5; 8.7] % in heterozygotes TC, and 4.1 [2.3; 6.0] % in genotype CC carriers, which is significantly less than in TT genotype carriers (p = 0.011) and TC genotype carriers (p = 0.012). DC content was 1.8 [1.5; 2.5] arbitrary units/ml in CC genotype carriers, 1.8 [1.0; 2.2] arbitrary units/ml in TC carriers, 1.8 [1.2; 2.8] arbitrary units/ml (p > 0.05) in TT genotype carriers; MD was 9.4 [8.6; 10.1] μmol/ml, 9.4 [7.8; 10.1] μmol/ml and 9.4 [8.6, 11.5] μmol/ml, respectively (p > 0.05); SOD levels were 2143.0 [1667.0; 2500.0] units/l, 2282.0 [1505.3; 2557.0] units/l and 2075.0 [1563.0; 2480.5] units/l, respectively, (p > 0.05); the levels of glutathione reductase were 17.3 [13.3; 30.0] units/l, 17.4 [15.4, 24.1] units/l and 19.4 [15.4, 22.9] units/l, respectively (p > 0.05). ACE activity in plasma was 9.4 [7.7; 11.1] nmol/(ml · min) in patients with CC genotype, 9.2 [8.0; 10.4] nmol/(ml · min) in patients with TC genotype, 9.8 [8.0, 12.1] nmol/(ml · min) in patients with TT genotype (p > 0.05). NYHA FC was 2.7 ± 1.1 in TT homozygotes of G894T polymorphism, 2.8 ± 0.9 in heterozygotes GT, 2.6 ± 1.2 in homozygotes GG (p > 0.05). LV EF was 33.0 [27.0; 38.0] %, 32.0 [30.0; 44.0] and 34.0 % [25.8; 40.0] %, respectively (p > 0, 05). Patients with genotypes GT and TT of polymorphism G894T of eNOS gene predominated in group A, carriers of GG genotype (p = 0.041) – in group B. DC content was 1.8 [1.4; 3.7] arbitrary units/ml in carriers of TT genotype, 1.6 [0.8, 2.5] arbitrary units/ml in carriers of GT genotype, 1.9 [1.2; 2.5] arbitrary units/ml in carriers of GG genotype (p > 0.05); MD was 10.1 [8.8; 15.0] μmol/ml, 9.4 [8.6; 9.4] μmol/ml and 9.4 [8.6; 10.9] μmol/ml, respectively (p > 0.05), SOD levels were 2276.0 [1776.3; 2467.0] units/l, 2118.0 [1429.0; 2688.5] units/l and 2059.0 [1563.0; 2500.0] units/l, respectively (p > 0.05); glutathione reductase activity levels were 22.2 [16.2; 27.3] units/l, 17.4 [14.5; 22.7] units/l and 18.8 [15.4; 23.2] units/l, respectively (p > 0.05). ACE activity in plasma was 9.4 [7.1; 11.0] nmol/(ml · min) in patients with TT genotype, 9.6 [8.3; 11.8] nmol/(ml · min) in patients with GT genotype, 9.0 [7.8; 11.1] nmol/(ml · min) in patients with GG genotype (p > 0.05).

Conclusions. Among patients with CHF of ischemic origin and systolic LV dysfunction, the frequency of genotypes of polymorphism of the eNOS gene promoter was: TT – 41.7 %, CT – 42.7 %, rare genotype CC – 15.6 %; the frequency of genotypes of seventh exon polymorphism of the eNOS gene G894T was: GG – 56.3 %, GT – 31.2 %, rare TT genotype – 12.5 %. Patients with a less common genotype of CC polymorphism of T(–786)C promoter of gene eNOS manifested significantly worse endothelial-dependent vasodilation response compared with heterozygotes TC and homozygotes TT. Worse values of flowdependent vasodilation response (DD < 6.2 %) are associated with the presence in the genotype of the T allele polymorphism G894T of gene eNOS. The difference between flowdependent vasodilation responses in patients with different genotypes of polymorphic variants of the eNOS gene does not depend on NYHA class, LV EF values, systemic oxidative stress indicators, maintenance doses of ACE inhibitor and loop diuretics.

Keywords: endothelium vasodilatation, polymorphism of T(–786)C promoter, polymorphism G894T of seventh exon, gene of endothelial NO-synthase, chronic heart failure.



«Ишемическая кардиомиопатия»: непосредственные и отдаленные результаты хирургического и медикаментозного лечения

В.И. Урсуленко, Л.В. Якоб

Цель работы — оценить непосредственные и отдаленные результаты использования разработанной нами операции у больных с тяжелыми формами «ишемической кардиомиопатии» (ИКМП); сопоставить показатели с данными группы пациентов, леченных медикаментозно.

Материалы и методы. В НИССХ им. Н.М. Амосова НАМН Украины за период с 2003 по 2011 г. находились на обследовании с тяжелой формой ИКМП 118 больных. В зависимости от рекомендованного и использованного метода лечения они были разделены на две равные группы: медикаментозного лечения (n = 59) и хирургического (n = 59).

Результаты и обсуждение. Разработанная и используемая методика хирургического лечения ИКМП, предусматривающая шунтирование коронарных артерий на работающем сердце, позволила получить хорошие непосредственные результаты без летальных исходов, а в отдаленный период улучшить клиническое состояние у 70 % оперированных больных. В группе медикаментозного лечения за период наблюдения (в среднем через 4,6 года) умерли 46,0 % пациентов, у 48,7 % результат оценен как неудовлетворительный, и только 3 пациента (в среднем через 2,6 года) свое состояние оценили как удовлетворительное.

Выводы. Хирургическое лечение ИКМП методом шунтирования коронарных артерий на работающем сердце позволяет приостановить прогрессирование сердечной недостаточности, улучшить показатели насосной функции сердца и прогноз жизни, что свидетельствует об эффективности разработанного метода, который может быть рекомендован при операциях у пациентов с такой патологией.

Keywords: «ишемическая кардиомиопатия», шунтирование коронарных артерий, сердечная недостаточность.



Comparative impact assessment of ivabradine combination with metoprolol and metoprolol monotherapy on longitudinal systolic and diastolic function of the left ventricle and level of NT-proANP in plasma of patients with acute myocardial infarction of ante

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

The purpose – to assess the dynamics of longitudinal systolic and diastolic function of the left ventricle (LV) according to pulsed tissue Doppler sonography and the level of NT-proANP in patients with acute myocardial infarction (MI) of anterior localization and early systolic dysfunction of LV in achieving the target heart rate (HR) using a combination of ivabradine with metoprolol compared with metoprolol monotherapy.

Materials and methods. The study involved 42 MI patients with ejection fraction (EF) of LV < 45 %, sinus rhythm and heart rate > 80 per 1 min at the time of hospitalization. Patients of group 1 (n = 18) were treated with metoprolol tartrate in the average final dose of (115.4 ± 5.6) mg/day. Patients of group 2 (n = 24) were treated with metoprolol tartrate in the average final dose of (64.3 ± 1.5) mg/day, from day 5 – with additional ivabradine in the average final dose of (11.7 ± 0.7) mg/day. Patients of both groups were comparable for clinical and demographic characteristics, therapy in the hospital for 25 days of observation which was generally accepted. All patients underwent Doppler sonography with assessment of end-diastolic index (EDI) and LV EF on the 2nd, 5th, 7th and 25th days and had the following parameters measured: velocity of early diastolic filling (E), early (E’) and late (A’) diastolic mitral ring movement, deceleration time of early diastolic filling (DT) of LV, isovolumic relaxation time (IVRT) of LV, peak systolic velocity of interventricular septum (Ssept), lateral (Slat), anterior (Sant) and inferior (Sinf) departments of fibrous mitral valve ring on the 5th and 25th days, NT-proANP levels in plasma on the 2nd and 25th days. The following indexes were also calculated: Е/А, E’/A’sept, E’/A’lat, E’/A’ant, E’/A’inf, E/E’.

Results and discussion. Heart rate was similar in both groups: 5th day – (68.4 ± 1.5) and (68.1 ± 1.4) per 1 min, 25th day – (60.7 ± 1.7) and (61.8 ± 1.6) per 1 min, respectively, (all p > 0.05). Groups did not differ in initial indicators of EDI, EF, Ssept, Slat, Sant, Sinf, E/E’ and NT-proANP: (72.4 ± 1.5) and (72.6 ± 1.5) ml/m2, (38.5 ± 1.5) and (38.7 ± 1.4) %, (6.08 ± 0.15) and (6.18 ± 0.13) cm/s, (7.28 ± 0.17) and (7.43 ± 0.15) cm/s, (5.99 ± 0.16) and (5.95 ± 0.15) cm/s, (9.24 ± 0.13) and (9.31 ± 0.12) cm/s, (8.96 ± 0.18) and (8.63 ± 0.17), (3498.5 ± 275.6) and (3512.8 ± 285.3) pmol/l, respectively, (all p > 0.05). On the 25th day in group 2, EDI increased to (76.4 ± 1.3) ml/m2 (p < 0.05), EF – to (46.5 ± 1.4) % (p < 0.05), Ssept – to (6.95 ± 0.14) cm/s (p < 0.05), Slat – to (7.93 ± 0.16) cm/s (p < 0.01), Sant – to (6.97 ± 0.15) cm/s (p < 0.01), while E/E’, NT-proANP and Sinf decreased to (8.12 ± 0.16), (2315.3 ± 203.5) pmol/l and (7.93 ± 0.16) cm/s (p < 0.05 and p < 0.01) compared to baseline. At the same time in the 1st group, all these parameters, except for the EDI (increased to (81.2 ± 1.5) ml/m2, p < 0.01) and Sinf (decreased to (8.41 ± 0.11) cm/s, p < 0.01), did not change compared with the initial values (EF – (40.2 ± 1.4) %, Ssept – (6.45 ± 0.13) cm/s, Slat – (7.45 ± 0.15) cm/s, Sant – (6.41 ± 0.14) cm/s, E/E’ – 8.71 ± 0.17 and NT-proANP – (3519.6 ± 2197.3) pmol/l (all p > 0.05). On the 25th day in group 2, the values of EF, Ssept, Slat, Sant and Sinf were higher (p < 0.01, p < 0.05; p < 0.05, p < 0.01 and p < 0.05, respectively), while both E/E’ and NT-proANP decreased (p < 0.05 and p < 0.01, respectively,) compared with the 1st group. In an analysis of diastolic function in both groups, we determined equally marked increase in IVRT, DT and decrease in E/A, E’/A’sept, E’/A’lat, E’/A’ant and E’/A’inf (all p < 0.01) compared with the healthy persons. By the 25th day, IVRT significantly decreased and returned to normal in both groups (p < 0.01) compared to the initial value. This was accompanied by positive dynamics of E/A (p < 0.01). In this case, the E/A ratio of patients in group 2 was 6.7 % higher than that of patients in group 1 (p < 0.05). Indicator DT did not change significantly during 1 month follow-up in the 1st group (all p > 0.05), while in the 2nd group it significantly (p < 0.01) decreased to the 25th day and was significantly lower than in the 1st group (p < 0.05). On the 25-th day, patients in both groups manifested positive dynamics of E’/A’sept, E’/A’lat, E’/A’ant and E’/A’inf indicators (all p < 0.01) which in the 2nd group were higher than in the 1st one (p < 0.01).

Conclusions. According to the pulsed tissue Doppler sonography, ivabradine combination with metoprolol improves global and segmental systolic and diastolic left ventricular function on the 25th day of treatment of patients with anterior MI localization with the Q wave and LV EF < 45 %, moderate acute left ventricular failure and sinus rhythm. In case of monotherapy with higher doses of metoprolol providing similar control of heart rate such effects were not observed. Early achievement of the target heart rate in these patients by using combination therapy with ivabradine and metoprolol is accompanied by 34.1 % decrease of NT-proANP levels in plasma on 25th day. Such dynamics of this indicator during monotherapy with high doses of β-blockers is absent.

Keywords: myocardial infarction, systolic and diastolic function of the left ventricle, heart rate, metoprolol, ivabradine.



Crossectomy value in recurrence of varicose veins

I.M. Gudz, V.Z. Lavrynets, O.I. Gudz, I.V. Dmytriv, M.M. Bahriі

The purpose – to examine the role of crossectomy (CE) in recurrence of varicose veins (RVV) and develop ways of its prevention.

Materials and methods.We analysed treatment of 68 patients who were operated on for varicose veins under currently existing standards. All patients complied with CEAP classification, category C2 S4ErAsPr. Depending on the objectives of the study they were divided into two groups. Group 1 (primary) consisted of 32 patients. While performing CE in them we used our own method of forming the anatomical barrier to prevent possible neoangiogenesis (NA) in the zone of sapheno-femoral-junction (SFJ). Group 2 (control) contained 36 patients who underwent traditional CE with vein ligation by suture material that does not resolve. To study the possible role of varicose-altered wall of great saphenous vain stump in the development of NA processes, we took fragments of the indicated vein from SFJ zone of some patients for morphological studies. After discharge from the hospital, the patients were prescribed compression therapy for 3 months and phlebotonic drugs for a long-term period. At that we followed the recommendations of evidence-based medicine, according to which the drug of choice today is the original micronized purified flavonoid fraction. Control examinations were conducted in 12, 24 and 36 months. In addition to the clinical examination and filling out questionnaire CIVIQ, color duplex scanning of SFJ area was necessarily performed to identify possible neoreflux.

Results and discussion. Controlling ultrasonic study found that within 3 years after varicose avulsion resulting from incorrect CE, the incidence of pathological refluxes in SFJ zone was 16.6 % in the control group and 3.12 % in the main group. Phenomena of neovascularization in case of traditional CE were registered in other 16.6 % patients. At the same time, no cases of NA were observed in the main group as a result of applying our proposed barrier technology. Thus, nearly one of three patients that were operated on using the traditional operative technique in CE area manifested neoreflux phenomena. Signs of pathological reflux in SFJ area only in one third of cases were accompanied by clinically significant manifestations of RVV.

Conclusions.Within 3 years after varicose veins avulsion resulting from incorrect CE in SFJ area, the incidence of pathological reflux was 16.6 % in the control group and 3.12 % in the main group. Signs of neovascularization in case of traditional CE were registered in other 16.6 % patients. At the same time, no such signs were observed in any patient after using our barrier technology. The signs of pathological refluxes in SFJ area were accompanied by clinically significant manifestations of RVV only in one third of cases. We can predict that in the future such neorefluxes will lead to varicose transformation of subcutaneous veins with the development of a true RVV.

Keywords: crossectomy, varicose veins, recurrence.



Adherence to the treatment of patients in a year after acute myocardial infarction with Q wave according to the Ukrainian register STIMUL

S.V. Valuуeva

The purpose – to assess the adherence of patients to treatment in a year after myocardial infarction (MI) with Q wave and the factors that were associated with poor adherence.

Materials and methods. 1103 patients with acute coronary syndrome (ACS) with ST segment elevation were included in the first in Ukraine register of ACS with ST segment elevation STIMUL, Monitoring was conducted for patients who had had MI with Q wave. At the time of discharge from the hospital, there were 872 of them. During the first year after MI with Q wave 140 (16.1 %) patients died. The connection was lost with 328 (31.6 %) patients. The group of 480 patients (55.1 %) was not significantly different from the group at the beginning of the study, except for a bigger number of men (79.6 and 74.3 %, respectively, p < 0.05), patients with previous MI (28.5 and 24.2 %, respectively, p < 0.05), persons with burdened family history (40.2 % and 31.8 %, respectively, p < 0.05) and those who underwent reperfusion therapy (39.6 and 29.39 %, respectively, p < 0.001). The first group consisted of 20 patients who did not take any drugs with a proven positive impact on prognosis (acetylsalicylic acid, clopidogrel, statins, b-blockers and angiotensin-converting enzyme) in (12.0 ± 0.5) months after discharge. The second group included 301 persons who received 1–2 of essential drugs. The third group consisted of 159 patients taking 3–5 preparations. The patients with varying adherence to treatment were compared by risk factors for major cardiovascular events, anamnestic data. The duration of period from the onset of symptoms to hospitalization, signs of acute heart failure, the risk by scale GRACE, the frequency of reperfusion and drug therapy, in-hospital complications were estimated.

Results and discussion. During the year, 140 patients (16.1 %) died, 75 developed a second non-fatal MI (15.6 %), 121 (25.2 %) underwent a planned revascularization. Only 44 (9.2 %) of the persons listed in the register continued receiving antiplatelet and lipid-lowering therapy in a year. Among the patients who discontinued the recommended therapy, the rate of hospitalization due to recurrent non-fatal MI was highest (30.0 %) during 12 months. Among those who took the regular treatment in full it was the lowest (6.3 %, p < 0.001).

Conclusions. 12 months after acute myocardial infarction with Q wave, dual antiplatelet therapy was received by 14.4 % of the patients, lipid-lowering therapy – by 24.2 %, β-blockers – by 63.3 %, angiotensin converting enzyme inhibitors – by 53.1 %. 20 (4.2 %) patients stopped taking all recommended drugs. Relatively better adherence to treatment after discharge was associated with younger age of patients, male gender and a history of arterial hypertension.

Keywords: myocardial infarction, register, annual monitoring, adherence to treatment, prognosis.



Age peculiarities of pre-diabetic disorders of carbohydrate metabolism and their relationship with functional state of microvasculature endothelium and indicators of blood lipid profile

V.P. Chуzhova

The purpose – to examine age peculiarities of pre-diabetic disorders of carbohydrate metabolism and their relationship with functional state of microvasculature endothelium and indicators of blood lipid profile

Materials and methods. The study included a total of 151 non-diabetic subjects: age 20–39 – 42 persons, age 40–59 – 40 persons and age 60 and older – 69. All of them underwent a standard glucose tolerance test (SGTT) with determination of glucose (glucose oxidase autoanalyser) and insulin (ELISA using standard sets of DRG, Germany). We also calculated the indices of insulin resistance (HOMA), insulin sensitivity (Matsuda index), the size of the area under the curves of glucose and insulin. Lipid levels and functional state of the endothelium were assessed.

Results and discussion. Violation of glucose was detected in 11.9 % of people aged 20–39 years, 35 % of those aged 40–59 and 50.7 % of patients aged 60 years and older. Combined glucose intolerance (GI) was not observed in patients aged 20–39 years; this disorder was found in 7.5 % of those aged 40–59 years and 19 % of patients aged 60 and older. HOMA index was 3.2 ± 0.4 in persons aged 60 years and older with a combined GI. In the persons of the same age without carbohydrate metabolism disorders it was 1.9 ± 0.3 (p < 0.05). Older people with GI compared with persons of the same age without GI revealed higher initial glucose – (6.7 ± 0.2) and (5.3 ± 0.1) mmol/l (p < 0.01), insulin – (8.9 ± 1.4) and (5.0 ± 0.6) μU/ml (p < 0.05), indicators of area under the curve of glucose – (1100 ± 44) and (814 ± 27) mmol/(l · min) (p < 0.01) and insulin – (5150 ± 614) and (2546 ± 546) μU/(ml · min) (p < 0.01), total cholesterol – (6.0 ± 0.3) and (5.2 ± 0.2) mmol/l (p < 0.05), triglycerides – (1.8 ± 0.2) and (1.1 ± 0.1) mmol/l (p < 0.01), low density lipoprotein cholesterol – (4.0 ± 0.2) and (3.2 ± 0.2) mmol/l (p < 0.05), lower level of high density lipoprotein cholesterol – (1.3 ± 0.01) and (1.5 ± 0.03) mg/l (p < 0.01). These changes correlate with decreased insulin sensitivity index (r = 0.58; p < 0.01) and aggravated endothelial dysfunction at the level of peripheral microvasculature.

Conclusions. In healthy people, matched by gender and body mass index, the frequency of pre-diabetic abnormalities increases with age: impaired glucose tolerance on an empty stomach was detected in 11.9 % of persons aged 20–39 years, 35 % of those aged 40–59 and 50.7 % of 60 years old people and older. Combined glucose intolerance is not typical for 20–39 years old persons, but it was found in 7.5 % of patients aged 40–59 years and 19 % of those aged 60 and older. Pre-diabetic changes in carbohydrate metabolism and hyperinsulinemia are associated with the development of atherogenic hyper(dis)lipidemia in middle-aged persons. They have a more distinctive character in individuals over 60 years old and are accompanied by deterioration of age changes in functions of endothelium of microcirculatory level of vasculature, according to estimates of volumetric rate of skin blood flow at rest and at reactive hyperemia.

Keywords: insulin resistance, pre-diabetic state, standard oral glucose tolerance test, index of insulin resistance, endothelial dysfunction, microcirculation, dyslipidemia.



Simultaneous endovascular stenting of aortic coarctation, descending aortic aneurysm and atrial septal defect II by transcatheter

Yu.V. Panichkin, I.А. Ditkоvskіі, B.V. Cherpak, N.S. Yashchuk

Simultaneous endovascular stenting of aortic coarctation, descending aortic aneurysm and atrial septal defect II closure in a 21 year-old patient is described in this case report.

Keywords: aortic coarctation, aortic aneurysm, atrial septal defect II, endovascular treatment.



Rare case of abdominal aorta hypоplasia with its atherosclerotic occlusion

Yu.S. Spirin, I.V. Arbuzov, V.I. Arbuzov, R.V. Ivashko, S.I. Yushchuk, I.I. Bolianovskii, Ye.N. Bezrukova

In this paper a case of successful surgical revascularization of lower limbs in a patient with abdominal aorta hypоplasia with its atherosclerotic occlusion was described. The open endarterectomy from abdominal aorta and right common iliac artery with next aortoplastic (Gore patch) was performed. The postoperative course was uneventful. Revascularization of lower limbs was archived.

Keywords: hypоplasia, occlusion of abdominal aorta.



Strain indicators and their use in ultrasound diagnosis of myocardial contractility impairment

M.V. Kostylіev A.S. Matіashchuk

Mapping of strain is a new noninvasive ultrasonic technique of heart examination which greatly extends the capabilities of echocardiography, particularly in the diagnosis of coronary heart disease. The method allows to determine the velocity, strain, strain rate and displacement of any fragment of the myocardium in any spatial dimension, and to compare these figures with those of other fragments both on two dimensional graphs and on a semi-quantitative spatiotemporal diagram. In addition to the regional strain indices, global strain and global strain rate are calculated. The method has high sensitivity and specificity in the diagnosis of coronary heart disease compared to other non-invasive ultrasound techniques. It is optimal for observing the dynamics after surgical revascularization of myocardium and for intraoperative monitoring of myocardial contractility during surgery on a beating heart. The paper presents the theoretical basis of the method and a review of its clinical use, with emphasis on the diag-
nostic value and prospects.

Keywords: echocardiography, coronary heart disease, strain, strain rate, strain mapping.



Vascular endothelial growth factor system and arterial hypertension

T.A. Mangіliova

Vascular endothelial growth factor (VEGF) is the main regulator of angiogenesis. It promotes vasodilatation, increases vascular permeability, affects inflammatory process and has some extravascular effects. Neoplastic diseases, diabetes mellitus, rheumatoid arthritis, endometriosis, arterial hypertension, atherosclerotic vascular diseases and some other pathologic conditions are accompanied by elevated VEGF level in blood and tissues. VEGF blockers and VEGF receptors (VEGFRs) are used in malignant neoplasms treatment. Blockade of VEGF/VEGFR axis leads to rise of blood pressure, while VEGF infusion causes blood pressure lowering. Consequently VEGF system actively takes part in blood pressure regulation. Theoretically VEGF concentration in patients with arterial hypertension which is characterized by microvascular rarefaction has to be reduced. But clinical and experimental studies revealed increased VEGF concentration in patients with elevated blood pressure. This contradiction may exist due to complexity of structure and function of VEGF/VEGFR system which consists of different variants and isoforms of ligands and receptors with proand antiangiogenic properties. Perhaps increased VEGF expression reflects activation of compensatory-adaptive mechanisms in response to blood pressure elevation.

Keywords: vascular endothelial growth factor, arterial hypertension.



Generics of statins in treatment of cardiovascular diseases

V.G. Mishalov, N.Yu. Litvinova

Cardiovascular diseases is a major cause of death and disability in Europe. Several large population studies and their meta-analyzes have shown a positive effect of statins on the decrease of mortality and morbidity of cardiovascular disease by applying them both for primary and secondary prevention. Using generic drugs that are bioequivalent to original products, may help to reduce the cost of treatment. However, doctors and patients have doubts about receiving generics because of the assumption that original drugs may be clinically more effective. The aim of the research is to analyze the effectiveness of statin therapy for primary and secondary prevention of cardiovascular diseases.

Keywords: statins, primary prevention, secondary prevention, generic substitution, cardiovascular diseases, atherosclerosis.



Clinical characteristics and treatment of patients with persistent atrial fibrillation

О.І. Zharinov, N.P. Levchuk

Contradictory aspects of evaluation and management of persistent atrial fibrillation (AF) are discussed in this problem article. The results of RealiseAF survey show that according to the level of cardiovascular risk, persistent AF is in the middle between paroxysmal and permanent AF, being considered as an important stage of heart disease progression. The surveys and randomized clinical studies show potential advantages of strategy of sinus rhythm restoration and maintenance. Despite this, rate control strategy is mostly chosen in elderly patients, as well as patients with heart failure and other comorbidities in clinical practice. There is great necessity in finding more effective medications and interventional approaches to management of persistent AF.

Keywords: persistent atrial fibrillation, heart failure, treatment, rate control.



Показатели деформации и использование их в ультразвуковой диагностике нарушений сократительной функции миокарда

М.В. Костылев, А.С. Матящук

Картирование деформации является новой неинвазивной ультразвуковой методикой исследования сердца, которая значительно расширяет возможности эхокардиографии, особенно в диагностике ишемической болезни сердца. Метод позволяет определить скорость, деформацию, скорость деформации и смещение любого фрагмента миокарда в любом пространственном измерении и сравнить полученные показатели с соответствующими показателями других фрагментов как на двумерных графиках, так и на полуколичественной пространственно-временной диаграмме. Дополнительно к регионарным показателям деформации рассчитывают глобальную деформацию и глобальную скорость деформации. Метод обладает высокой чувствительностью и специфичностью в диагностике ишемической болезни сердца по сравнению с другими неинвазивными ультразвуковыми методиками, является оптимальным для наблюдения в динамике после хирургической реваскуляризации миокарда, а также для интраоперационного мониторинга сократительной активности миокарда во время операций на работающем сердце. В статье представлены теоретические основы метода и обзор его клинического применения с акцентом на диагностическую ценность и перспективы.

Keywords: эхокардиография, ишемическая болезнь сердца, деформация, скорость деформации, картирование деформации.



Генерики статинов в лечении сердечно-сосудистых заболеваний

В.Г. Мишалов, Н.Ю. Литвинова

Сердечно-сосудистые заболевания являются ведущей причиной смерти и инвалидности в Европе. Несколько больших популяционных исследований и их метаанализы показали положительное влияние статинов на снижение смертности и заболеваемости сердечно-сосудистыми заболеваниями при применении этих препаратов как для первичной, так и для вторичной профилактики. Использование генерических препаратов, которые биоэквивалентны оригинальным средствам, может помочь снизить расходы на лечение. Тем не менее, относительно приема генериков есть опасения у пациентов и врачей вследствие предположения, что оригинальные препараты могут быть клинически эффективнее. Цель исследования — провести анализ эффективности терапии статинами для первичной и вторичной профилактики сердечно-сосудистых заболеваний.

Keywords: статины, первичная профилактика, вторичная профилактика, замена генериком, сосудистые заболева ния, атеросклероз.

Current Issue Highlights

№4(60) // 2017

Cover preview

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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