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Issue. Articles

3(51) // 2015





Percutaneous Coronary Interventions Registry: advanced comparative analysis, reperfusion therapy in Ukraine, Survey PCI 2015

«Ukrainian Association of Interventional Cardiology» established the Percutaneous Coronary Interventions Registry (PCI Registry) in the mid 2010. The first protocol was filled 12.04.2010. By now (31.07.2015, 10:00) the PCI Registry contains 53,736 protocols of patients (August 2012 — 25,252, in August 2013 — 39,841) who underwent coronary angiography (CA), PCI, or both procedures at the same session. During 2014 year in the PCI Registry clinics the following procedures were performed: CA — 24,820, PCI — 9,257 and STEMI patients — 3,618. A moderate reduction in the number of diagnostic and therapeutic procedures for 7.3 and 8.1 % respectively, was partially compensated by an increase for 6.0 % of PCI in STEMI patients. Number of PCI in patients with STEMI per million population compared with 2013 has increased by 25 % and amounted to 2014 year — 100 patients /mil population (no data on the Donetsk, Lugansk regions and the Crimea). An increased number of STEMI patients was admitted for percutaneous reperfusion at an earlier period (in the first 2 hours after the onset of symptoms — 11 % (in 2013 year) and 21 % (in 2014 year)). First time an analysis of the number of STEMI (59.4 %) and NSTEMI (40.6 %) patients was conducted. The indicator of reperfusion therapy in Ukraine (except for Donetsk, Lugansk regions and Crimea) in STEMI patients was 43.1 %, including PCI — 15.4 % and fibrinolysis — 27.7 %. The analysis of long term results, according to the PCI 12 month observation of 1000 patients, included in the PCI Survey (part of PCI Registry) indicators of general mortality and AMI patient groups STEMI, NSTEMI and stable CAD amounted 6.9; 7.0 and 4.5 % and 4.0; 6.7 and 2.5 %, respectively.

Keywords: percutaneous coronary intervention, coronary angiography, reperfusion therapy, acute myocardial infarction, coronary heart disease.



Dynamic characteristics morphological background of the heart left ventricle myocardium

. M. Trembovetska, G. V. Knyshov, V. P. Zakharova, . V. Rudenko, M. . Moroz

The aim — to study peculiarities of the three-dimensional organization of left heart ventricle (LV) and to compare the results speckle tracking echocardiography with morphological data.

Materials and methods. The paper is presented with the analysis of speckle tracking echocardiograph of 35 healthy volunteers; 20 pigs hearts macro dissection; serial histological sections microscopy of 14 fetuses hearts of 22 gestation weeks and 3 hearts of healthy individuals.

Results and discussion. Apical segments deform only on the account of counterclockwise rotation, due to internal separate cardiomyocytes (CMC) beams which go obliquely counterclockwise and are bonded with longitudinally oriented trabeculae. In the LV middle part most CMCs are located circularly, but its array is crossed by thin longitudinal muscle bundles; myocardium movement is directed towards the cavity centre and LV apex. Basal myocardium segments demonstrate maximal longitudinal displacement and clockwise rotation; myocardium near the atrioventricular sulcus turns to basal ends of trabeculae. Fibrous annulus of mitral and aortic valves have connection with special trabeculae too. Behind aortic ostium there is vertical muscle bundle with lateral circular branches. They form complicated circular layer with LV segments which under systole demonstrate the maximal longitudinal displacement and simultaneously clockwise rotation.

Conclusions. The myocardium is a complex, closed, syncytium-like structure. The trajectory of myocardium movement is determined by: a) direction of CMC in compact layer of ventricular wall; b) trabeculae and the special dorsal vertical muscle bundle that serve as dynamic fulcrum for the compact myocardium. Blood ejection from LV is carried out due to constriction, longitudinal displacement of the base to the apex and because of twisting effect due to apex and basis rotation in different directions.

Keywords: heart, myocardium, left ventricle, morphology, speckle tracking echocardiography.



Endovascular ablation electrodes application for the aze surgery in patients with atrial septal defect complicated by atrial fibrillation or flutter

O. A. Lozovyy, V. P. Zalevskiy, O. Z. Paratsiy

The aim — to valuate the efficacy of the designed method of endovascular ablation electrodes application for the aze surgery during retarded correction in patients with atrial septal defect complicated by atrial fibrillation or flutter, to verify the results stability for early and long-term post surgery period

Materials and methods. In total, 73 patients with ASD with concomitant AF/AFL, including 31 (42.5 %) men and 42 (57.5 %) women (average age 37.2 ± 0.14) were examined. The diagnosis was evidenced by data of EchoKG, ECG and Holter monitoring data. All 73 patients underwent ASD surgical correction and RFA (procedure aze). In comparison group we included 27 patients with ASD complicated with AF/AFL, including 13 (48 %) men and 14 (52 %) women, average age was 39.4 ± 16 years, who underwent plastic surgery of ASD. Long-term results were studied in 69 patients from the study group and 27 patients from the control group. Heart rate variability was valuated at discharge, after 12 and 24 months after surgery by Holter-ECG data.

Results and discussion. The maintenance of sinus rhythm (SR) at discharge was observed in 65 (89 %) patients in the control group and 25 (92 %) patients in the comparison group, due to performance direct current cardioversion open heart during surgery. Patients of the main group in the early postoperative period demonstrated lower average values. Results of RFA impact study on sinus rhythm preservation at 12 and 60 months after surgery showed: in the control group patients’ SR was preserved in 83.3 % and 63 %, respectively. In the study group SR was observed in 7.4 % after 12 and 24 months after surgery and subsequent comparison with the control group was not held due to the obvious negative result.

Conclusions. RFA (procedure aze) is an effective complement for ASD plastic surgery complicated with AF/AFL. Correction of ASD complicated with AF/AFL without performing aze surgery does not cause the regression of arrhythmia in the remote observational period in 92 % of cases. Implementation modification of endovascular ablation electrodes while performing aze surgery, additional to correction of ASD, provides more sustainable treatment of the initial arrhythmia in a remote postoperative period after 12, 24, 36, 48 and 60 months of follow-up in 83.3; 81.6; 76.7; 76.7 and 63.0 % cases respectively. The proposed technology is effective in the treatment of AF/AFL patients with ASD and can be recommended for use in this group of patients.

Keywords: atrial septal defect, atrial fibrillation, atrial flutter, surgical treatment of arrhythmia.



Cystatin C as marker of myocardial remodeling in hypertensive males without chronic kidney disease

M. Yu. Kolesnyk

The aim — to estimate the diagnostic accuracy of cystatin C as marker of cardiac remodeling in males with arterial hypertension (AH) by valuation of the correlation between its serum concentration and cardiac structure, left ventricle (LV) diastolic function and deformation properties.

Materials and methods. The open non-randomized cohort study included 274 males with uncomplicated AH aged from 35 to 65 years with sinus rhythm before treatment. The control group consisted of 43 healthy males of similar age. The exclusion criteria were secondary hypertension, coronary heart disease, congenital and acquired valve disorders, cardiomyopathies, chronic lung diseases, type 1 diabetes mellitus and type 2 diabetes mellitus on insulin therapy, active infectious and oncologic diseases, LV ejection fraction less than 45 %, glomerular filtration rate less than 60 ml/min by MDRD, presence of pathological findings in urinalysis. Ambulatory blood pressure monitoring and transthoracic echocardiography were performed to all participants. The LV deformation properties were investigated by speckle tracking echocardiography. Cystatin C concentration was determined in serum by immunoturbidimetric method.

Results and discussion. The median of cystatin C was 0.89 (0.78 — 0.99) mg/L in patients with AH and 0.8 (0.7 — 0.93) mg/L in healthy individuals (p = 0.0017). Elevation of cystatin C was associated with an increase of LV wall thickness, the left atrium size, a tendency to concentric geometry remodeling. Median of cystatin C was 0.91 (0.82 — 1.02) mg/L in patients with LV diastolic dysfunction compared to 0.86 (0.77 — 0.96) mg/L in patients with normal diastole (p = 0.0043). The positive correlation was found between cystatin C and the linear size of the left atrium (r = 0.18; p = 0.003), interventricular septum thickness (r = 0.2; p = 0.0007) and LV posterior wall (r = 0.2 ; p = 0.0009). The negative correlation was identified with medial (r = –0.23; p = 0.0001) and lateral (r = –0.26; p = 0.003) mitral annulus early diastolic velocity. Increasing of cystatin C was associated with deterioration of the LV longitudinal and circular deformation. Correlation analysis identified a negative association between cystatin C and LV global longitudinal strain (r = –0.18; p = 0.02), early diastolic strain rate (r = –0.17; p = 0.03), basal circular strain (r = –0.19; p = 0.01) and strain rate (r = –0.17; p = 0.03).

Conclusions. Increased cystatin C level in blood serum is detected in hypertensive males without kidney disorders comparing to healthy individuals. High levels of cystatin C are associated with increase of LV wall thickness, left atrium size and deterioration of LV diastolic function and deformation properties.

Keywords: arterial hypertension, left ventricular, diastolic function, myocardial deformation, cystatin C.



State of neutrophil granulocytes system as a risk factor for post surgery complications in abdominal aortic aneurysm

I. V. Gomolyako, P. I. Nikulnikov, O. V. Liksunov, T. O. Dubovich, N. E. Klochkova, A. V. Ratushnyuk

The aim — to study neutrophil granulocytes (NG) system state in abdominal aortic aneurysm (AA) patients with complicated and uncomplicated postoperative period.

Materials and methods. The retrospective analysis of NG system state was carried out in 44 patients at AA, patients were admitted to hospital for planned surgery. Two groups of observation were selected: group — patients with severe, lethal complications — thrombosis of mesenteric vessels and necrosis of the bowel; II group — patients with uncomplicated postoperative period. The results were compared with results from clinically healthy individuals aged 45 to 65 years (comparison group).

Results and discussion. The patients at AA in preoperative period have a different degree of neutrophil granulocytes system failure affecting the further course of the disease. , V and V degrees of neutrophil granulocytes system failure are observed in 60 % of patients from the I group. In the group — only in 14.7 % patients have the same complications.

Conclusions. The degree of NG system impairment determines the risk of complications. The results testify the advisability of neutrophil granulocytes system failure degree determination for diagnostic and prognostic purposes to reveal the patients with increased risk of postoperative complications.

Keywords: neutrophil granulocytes, aortic aneurysm.



State of platelet aggregation as one of the risk factors in the performance of distal arterial reconstructions

O. I. Gudz, O. L. Tkachuk, I. M. Gudz

The aim — to examine changes in the functional state of platelets and the possibility of their drug correction in the course of the shunting reconstruction popliteal-tibial artery to reduce the risk of the reconstruction zone early thrombosis.

Materials and methods. The study involved 33 patients (average age 51.4 ± 11.3 years), 20 of them with chronic critical lower limb ischemia (CLI) underwent distal bypass surgery. In order to minimize the effects of operational trauma and anesthesia on blood aggregate properties, a control group was formed of 13 patients with varicose veins of the lower limbs without venous disorders, and they underwent a planning venexerese. The state of the aggregation properties of blood was studied in both groups intraoperatively.

Results and discussion. Patients with CLI stated aggregate properties of blood elevation. Distal bypass surgery led to platelet activation process intensification: 10 minutes after the separation of collateral blood flow the degree of platelet aggregation increased in 3.31 times (p < 0.02), the rate of aggregation — in 3.32 times (p < 0.01); a maximum aggregation time increased for 9.4 % (no reliability), von Willebrand factor activity — a 1.74-fold (p < 0.05) compared to the control group. 20 min ischemia resulted in blood aggregate properties intensification and these changes did not return to the norm within 10 min after the restoration of blood flow to the limb. At the same time intraoperative infusion of arginine hydrochloride contributed to the normalization of platelet aggregation, a maximum aggregation time did not change significantly, the rate of platelet aggregation was 1.21 times lower than the control group data, von Willebrand factor activity decreased by 10.6 % (p < 0.05) compared to baseline. In general, the use of nitric oxide donator did not lead to normalization of platelet aggregation state, but showed a positive dynamic during maintenance limb ischemia and after restoration of blood flow.

Conclusions. CLI patients demonstrated the marked platelets functional state impairments, which are confirmed by increase of speed, extent and timing of aggregation, activation of von Willebrand factor compared to normal values. During distal bypass surgery the platelet aggregation is enhanced. The proposed approach (intraoperative infusion of nitric oxide donators arginine hydrochloride) can be considered as one of the alternative correction active state of platelets.

Keywords: platelet aggregation, distal arterial reconstructions.



Toxicokinetic mechanisms of endothelial dysfunction formation as an early clinical manifestation of chronic lead poisoning

O. P. Yavorvsky, O. O. Karlova, B. S. Sheiman

The aim — To determine the basic mechanisms of toxemia formation, the nature of nitric oxide content changes and its metabolites, depending on the concentration of lead in the blood of cable networks electricians.

Results and discussion. The features of the endotoxemia formation depending on the level of lead in the blood were determined. There is an accumulation of toxins in the toxin-carrying fractions of blood plasma under the lead exposure and it causes the development of toxin-induced cytolytic (direct) and autoimmune (mediated) reactions on the toxemia severe level. The«toxic proteome» affect resides in their vasotropic action with the formation of endothelial dysfunction in occupational lead exposure and it is accompanied by hyperoxidazothemia with the accumulation of S-nitrosothiols and 2.4-dinitrosyl iron complexes in the blood serum of workers from surveyed groups. The threshold levels of indicators were determined with the use of mathematical analysis (ROC-analysis) for nitrite-nitrate (7.0 mcmol/l) for the S-nitrosothiols (1.78 nmol/ml) for 2.4-DNKZ (5 5 mcmol/l), which correspond the critical level of lead in the blood and indicate a possible vaso-toxic effects of lead.

Conclusions. The severe toxemia occurs at occupational lead exposure and its autoimmune mechanisms and cytolytic activity depend on the content of lead in the blood. The marked changes in the content of nitric oxide and its stable metabolites in the blood of workers with occupational lead exposure can serve as markers for the early diagnosis of endothelial dysfunction in lead intoxication.

Keywords: toxemia, lead, nitrates, nitrites, S-nitrosothiols, dinitrosyl iron complexes, markers, diagnosis, prevention.



Dissection of the carotid artery as a cause of ischemic cerebrovascular lesions in young people

Yu.I. Kuzyk, M. V. Syroyid

The article deals with the etiology, pathogenesis, classification, clinical changes, diagnosis and treatment dissection carotid arteries (DCA). DCA is considered to be one of the main causes of ischemic cerebrovascular lesions, including ischemic stroke. Remain questionable etiology and mechanisms of vascular dissection neck, diagnostic approaches and treatment, due to the insufficient study of pathological changes in the vascular wall.

Keywords: dissection carotid arteries, ischemic stroke at a young age, non-atherosclerotic carotid disease.



Biodegradable occluder for atrial septal defect closure

. . Vyshnevetska, V. V. Kozyar, . . Skiba

This article deals with the designs and materials which are used to create occluders for atrial septal defect closure in order to identify major complications that occur in vivo. Concept of fully biodegradable atrial septal defect closure occluder is reviewed in this paper. The assessment of biodegradable metals, alloys and polymers application for occluders is introduced in the paper.

Keywords: biodegradable septal occluder, biodegradable metals, atrial septal defect.



Immature teratoma of the left ventricle clinical features

R. M. Vitovsky, V. P. Zakharova, O. A. Pishchurin, I. V. Martyshchenko, V. V. Isaenko, E. O. Bilynsky, O. Z. Paratsii, O. V. Kryvenkyi, S. I. Dorofeeva, T. I. Dedkova, . R. Vitovsky

The article describes the features of a clinical case of immature heart teratoma. The primary manifestation of tumor was the occlusion of the left anterior descending artery and acute myocardial infarction.

Keywords: cardiac tumors, teratoma, acute myocardial infarction, surgical treatment.

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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