Variability of Measurement and Feasibility of Assessing Changes in Brachiocepahlic Atherosclerotic Plaque After Acute Coronary Syndrome.

Aim      Analysis of inter- and intra-study variability of changes in the atherosclerotic plaque (ASP) total height and total area, the main quantitative indexes that were planned to be used in the present study for assessment of the atherosclerotic load of carotid arteries.Material and methods  The incidence of recurrent cardiovascular complications (CVC) within 1 year after acute coronary syndrome (ACS) ranges from 7-9 % (in studies) to 34 % (in clinical practice). This indicates insufficient efficacy of traditional approaches to secondary prevention of coronary heart disease. We proposed a study to test a hypothesis that the dynamics of ASP parameters in carotid and subclavian regions can serve as an alternative criterion for the adequacy of secondary prevention after ACS. The analysis was performed on subgroups of main study participants. These patients had ACS of any type documented by coronary angiography with an ASP confirmed by ultrasound of the brachiocephalic arteries (BCA) during the index hospitalization. BCA ultrasound was performed to analyze the inter- and intra-study variability of BCA atherosclerotic load, the ASP total height (Hsum) and total area (ASPTA), in 20 and 24 patients of the main study, respectively. Results of the repeated ultrasound were evaluated in 30 patients of the main study after 6 months of follow-up.Results The inter-study variability of each index was significantly higher than the intra-study variability which was consistent with results of previous studies. The intra-study variability of Hsum was 0.10 (95 % confidence interval, CI - 0.23-0.44) mm and ASPTA, 1.05 (95 % CI, - 0.54-2.63) mm2. The variability values were considerably smaller than the changes for 6 months: Hsum, 0.92 (95 % CI, - 0.64-2.49) mm and ASPTA, 3.67 (95 % CI, 0.42-6.91) mm2, although the difference did not reach statistical significance. The above results were obtained at an early stage of the study during the adaptation of specialists to the protocol.Conclusion      The study results suggest a possibility of a fairly reliable assessment of the dynamics of quantitative indexes of carotid ultrasound 6 months after ACS.

[Endothelial Dysfunction in Patients With Takotsubo Syndrome and its Role in Acute and Long Terms Of the Disease].

Aim      To evaluate the endothelial function using an Endo-PAT2000 instrument before and after mental stress tests in patients with Tacotsubo syndrome (TS) during acute and long-term periods and to compare the obtained results with laboratory markers of endothelial dysfunction (ED).Material and methods  This study included 45 patients with TS (mean age, 63.5±13.7 years) and 40 healthy volunteers (control group, CG). All patients of the main group during the acute period (first 7-14 days) and long-term period (at 1 and 2 years), as well as CG subjects, underwent evaluation of the endothelial function with an Endo-PAT 2000 instrument, and the reactive hyperemia index (RHI) was determined before and after mental stress tests. Also, concentrations of endothelin 1 (ET-1) and numbers of circulating endothelial cells (CEC) were measured after a two-year follow-up of TS patients.Results During the acute period of disease, all TS patients (n=45) had ED: RHI was below the threshold level of 1.67; furthermore, 42 (93.3 %) patients retained a lower RHI following mental stress. At one year (n=40), 16 (40%) patients showed ED at rest along with a significantly increased mean RHI. Mental stress produced at one year was associated with ED in 28 (70 %) TS patients. At two years (n=44), resting RHI was lower than normal in 19 (43.2 %) patients. Mental stress tests performed at two years were associated with ED in 29 (65.9 %) patients (RHI ≤1.67). Only 10% of CG subjects had a lower-than-normal RHI, which was significantly less than in the main group of TS patients during the acute and long-term periods (p<0.05). Mean values of laboratory markers for ED also were significantly different between TS patients during the long-term period of disease (n=41) and CG subjects (n=40; p<0.01).Conclusion      During acute and long-term periods of disease, most of TS patients had impaired vascular reactivity both at rest and during mental stress. The laboratory markers of ED, ET-1 and CEC can be used in clinical practice for evaluation of the risk for TS.

[Patient age and CYP2D6*4/CYP2D6*3 genotype on maximal heart rate in patients after acute coronary syndrome treated with bisoprolol.]

We have analyzed influence of genetic variants CYP2D6*3 (2549delA) and CYP2D6*4 (1846G>A), as well as other factors on effects of bisoprolol in patients with acute coronary syndrome. The study included 97 patients with acute coronary syndrome. Mean age was 63±10 years; 60 men and 37 women. We have found association between carriage of CYP2D6*4 (1846G>A) and maximal heart rate at exertion (R-0,21; р<0,05). When the correction for potential confounders was made, age was the only significant predictor of maximal heart rate (ß=0,6; SE=0,07; p<0,001). At the same time it was found that CYP2D6*4 was associated with more advanced age of the patients (r=0,2; p<0,05).

[The case of recurrent tako-tsubo syndrome on the background of coronary atherosclerosis].

Takotsubo syndrome (TS) is characterized with a reversible disorder of left ventricular contractility. At present time, it is established that various factors, both psycho-emotional and clinical, can trigger this disease. Notably, according to current opinions, coronary atherosclerosis may accompany TS and not be its exclusion criteria as it was previously thought. This article presents a clinical case of TS relapse in a female patient aged 83 years at 5 years following the first episode associated with progression of coronary atherosclerosis.

[The Frequency of Type 2 Myocardial Infarction in the Structure of Hospital Mortality According to 7-Years Data of a State University Clinic].

 Aim      To evaluate the proportion of type 2 myocardial infarction (MI) in the structure of mortality at a multidisciplinary hospital; to describe major causes for MI development, and characteristics of patients with a verified diagnosis of type 2 MI by data of postmortem examination.Material and methods  1574 protocols of the autopsies performed at the Central Pathology Department of the I.I. Mechnikov North-West State Medical University from 01.01.10 through 31.12.16 were studied retrospectively by the continuous sampling method. A group with verified diagnosis of type 2 MI was isolated from the total sample of autopsies. Major causes for and the proportion of type 2 MI among the causes of death were studied. Also, major demographic parameters, hospitalization profile, and condition of coronary arteries (CA) were compared in patients with fatal type 2 MI and those who died from atherothrombotic type 1 MI.Results Analysis of 1574 fatal cases among patients of the multidisciplinary hospital showed that in 360 cases (22.87 %), the cause of death was MI, including 137 cases of fatal type 2 MI. Proportions of men and women among the patients with postmortem verification of type 2 MI were comparable. Analysis of the age structure showed the highest incidence of type 2 MI in elderly (48.2 %) and senile (34.3 %) age. Mean age of patients with type 2 MI was 71.7 years (68.2 years for men and 75.3 years for women), which was comparable with the age range of patients with fatal type 1 MI. In both groups, men with fatal MI were significantly younger than women. Analysis of causes for type 2 MI demonstrated that the most frequent ones were tachysystolic arrhythmias (59.12 %) and severe hypoxia of different origin (35.04 %). Analysis of the type of CA lesions showed that significant lesions were significantly more frequently absent in type 2 MI (32.85 %) while in type 1 MI, the proportion of patients with unchanged CA was 1.84 %. In the group of patients with fatal type 1 MI, 67.29 % had multivascular lesions, and one in two patients had an occlusive lesion. In the group with type 2 MI, multivascular lesions were half as frequent (31.38 %), and only 4.38 % of patients had a complete occlusion of a coronary vessel. Comparison of death rate in different departments of the multidisciplinary hospital showed that only 29.2 % of patients with type 2 MI originally were managed at a specialized cardiological department; 45.3 % of patients were admitted to an internal medicine department for different conditions often not related with ischemic heart disease. Furthermore, 25.5 % of patients with subsequently developed type 2 MI originally even received scheduled or emergency medical care for a leading surgical condition.Conclusion      Cardiovascular diseases predominate among causes of mortality in a multidisciplinary hospital. This study showed that almost one in four patients dies from MI, and type 2 MI accounts for more than one third of fatal MIs. Among major causes for type 2 MI, tachysystolic arrhythmias (59.12 %) and pronounced hypoxia associated with anemia and severe respiratory failure (35.04 %) should be noted. Gender and age characteristics of patients with type 2 MI were comparable with those of patients with fatal type 1 MI. Furthermore, surgical patients accounted for 25.5 % of fatal cases of type 2 MI.

[Myocardial Infarction in the Group of Patients With Atrial Fibrillation].

Prevalence of patients with myocardial infarction (MI) and atrial fibrillation (AF) has been growing every year. These patients represent a highest risk group and, thus, require special attention of clinicians. The article foсused on mechanisms of the AF and MI interaction, special aspects of prediction depending on the type of AF and MI, and the issue of antithrombotic therapy in this patient category. A group of AF-associated, embologenic MIs was isolated, and diagnostic criteria and therapeutic regimens were provided.

[Problems of diagnostics and treatment of transtiretinum amyloidosis with destruction of the heart in the elderly: Clinical experience.]

The article presents a modern understanding of the treatment of cardiac amyloidosis, provides data on the frequency of occurrence, classification and variants of clinical manifestations of transthyretin amyloidosis. This pathology is a slowly progressive disease, the symptoms of which usually appear in the elderly and senile age. This diagnosis may become more common in the future as the population ages and diagnostic methods improve. As an illustration, a description of the clinical case of transtritin amyloidosis of the heart in a 77-year-old patient, which occurred with a primary lesion of the heart and symptoms of chronic heart failure, is given. It shows the difficulties in the lifetime diagnosis of transthyretin amyloidosis.

[Secondary form of Takotsubo syndrome, developed on pulmonary embolism].

The clinical case of the Takotsubo syndrome (TT) developed in process of treatment pulmonary embolism (PE) in old woman is described. A feature of this observation is the occurrence of TT not in the acute phase of PE, but in a month after the debut of the disease and in a week after the start of successful treatment.

[THE NEW APPROACH TO EVALUATION OF ENDOTHELIUM DYSFUNCTION: DETECTION OF NUMBER OF CIRCULATING ENDOTHELIUM CELLS USING FLOW CYTOMETRY TECHNIQUE].

The endothelium dysfunction takes leading place in pathogenesis of development of cardiovascular diseases. The circulating endothelium cells of peripheral blood can act as a direct cell marker of damage and remodeling of endothelium. The study was carried out to develop a new approach to diagnose of endothelium dysfunction by force of determination of number of circulating endothelium cells using flow cytometry technique and to apply determination of circulating endothelium cells for evaluation of risk of development of ischemic heart disease in women of young and middle age. The study embraced 62 female patients with angiography confirmed ischemic heart disease, exertional angina pectoris at the level of functional class I-II (mean age 51 ± 6 years) and 49 women without anamnesis of ischemic heart disease (mean age 52 ± 9 years). The occurrence of more than three circulating endothelium cells by 3 x 105 leukocytes in peripheral blood increases relative risk of development of ischemic heart disease up to 4 times in women of young and middle age and risk of development of acute myocardial infarction up to 8 times in women with ischemic heart disease. The study demonstrated possibility to apply flow cytometry technique to quantitatively specify circulating endothelium cells in peripheral blood and forecast risk of development of ischemic heart disease in women of young and middle age depending on level of circulating endothelium cells.

[Prognostic value of diastolic dysfunction for sudden cardiac death of patients after myocardial infarction].

We studied prognostic value of left ventricular (LV) diastolic dysfunction (DD) in relation to sudden cardiac death (SCD) after myocardial infarction (MI). We examined 603 patients in acute period of MI (including 551 with preserved LV systolic function and DD). Duration of follow-up was 1-7 years. According to data of Cox multifactorial regression analysis LVDD was not an independent prognostic factor. ut it increased SCD risk at the account of interrelationship with such predictors as ventricular rhythm disturbances, lowering of heart rate variability, and sensitivity of cardiochronotropic component of arterial baroreflex.

[Psychological features and heart rate variability in sudden death victims and myocardial infarction survivors].

AIM: To study effects of psychological factors (anxiety and depression) on risk of sudden death in post-myocardial infarction patients (PMI); correlation of psychological factors with autonomic regulation of cardiac rhythm. MATERIAL AND METHODS: Heart rate variability (HRV) and psychological status (Mini-Mult method) were determined and Spilberger-Khanin test was made in 320 PMI patients (mean age 57+/-7.6 years, 246 males and 74 females). RESULTS: 56% examinees had anxiodepressive profile of personality by Mini-Mult test and high anxiety by Spilberger-Khanin test. This indicates the presence of depressive symptoms and anxiety in many PMI patients. These patients had lower HRV and more depressed parasympathic tonicity. The correlation analysis of psychological factors and HRV has revealed correlation between HRV deterioration and intensification of anxiety and depression. CONCLUSION: Those patients who died of myocardial infarction had more serious psychological disturbances than in the survivors as well as more significant disorders of autonomic regulation of sinus rhythm which contribute to development of fatal arrhythmia.

[Diagnostic value of ventricular late potentials, heart rate variability and QT dispersion in patients with acute myocardial infarction]. / Diagnosticheskoe znachenie pozdnikh potentsialov zheludochkov, variabel'nosti serdechnogo ritma i dispersii intervala Q-T u bol'nykh infarktom miokarda.

Late ventricular potentials (LVP), heart rate variability (HRV) and dispersion of QT interval (QTd) were studied in 91 patients with myocardial infarction with various ventricular arrhythmias. Patients with episodes of sustained ventricular tachycardia (group 4) had the following characteristics: prevalence of LVP 73.7%, QTd 82.5 ms, standard deviation of RR intervals (SD) 26.5 ms; spectral analysis of HRV revealed preponderance of sympathetic influences and lowered vagal activity. Frequency of LVP detection, QTd and SD in patients with ventricular extrasystoles (Lown classes 3-5) (group 3) were 33.3%, 72.8 ms, and 42.8 ms, respectively. Patients of group 3 also had augmented sympathetic and lowered parasympathetic influences. These data significantly differed from those obtained in patients with Lown class 1-2 ventricular extrasystoles (group 2) and patients without extrasystoles (group 1). Groups 3 and 4 had significantly different prevalences of LVP and values of some HRV parameters but similar QTd. There was close correlation between presence of severe ventricular arrhythmias and some parameters of HRV and signal averaged ECG. Stepwise regression analysis showed that the following group of parameters was related to the presence of malignant ventricular rhythm disturbances: heart rate, SD and total QRS duration (p<0.05). Thus patients with life threatening ventricular arrhythmias were characterized by the presence of LVP and changes of some parameters of HRV and QTd. Registration of these parameters can apparently be used for prediction of potentially fatal ventricular arrhythmias in patients with myocardial infarction.