Visual Scale as a Non-Invasive Method for Evaluation of Risk and Severity of Coronary Atherosclerosis.

Aim      To evaluate quantitative and qualitative characteristics of atherosclerotic plaques (ASP) in carotid arteries (CA) and femoral arteries (FA) and to use these data for developing a visual scale (VS) for noninvasive diagnosis and determination of severity of coronary atherosclerosis.Material and methods  This study included 216 patients (115 men and 101 women) aged 24 to 87 years (mean age, 61.5±10.73 years). All patients underwent coronary angiography (CAG) for detecting and determining severity of CA atherosclerosis and duplex scanning (DS) for detecting atherosclerosis of CA and FA.Results Analysis of ultrasound parameters of ASP in CA and FA showed that the maximal ASP height, moderate stenosis and maximal stenosis of the arterial bed had higher predictive values than other ultrasound parameters. These parameters were used for forming diagnostic complexes, on the basis of which two individual VSs for CA and FA were developed. Based on the high prognostic value of both scales, they were combined into one that was named VSCOMB. A ROC analysis determined cut-off points of the VSCOMB for diagnosis of CA atherosclerosis of various severity. VSCOMB scores  >4 indicated pronounced CA atherosclerosis with sensitivity of 86.1 % and specificity of 87.5 % whereas VSCOMB scores  ≤4 excluded it. Thus, VSCOMB score 0-1 indicated the absence of CA atherosclerosis; score 2-4 indicated the presence of subclinical CA atherosclerosis; and score >4 indicated severe CA atherosclerosis.Conclusion      A VSCOMB was developed that includes a set of ultrasound parameters for CA and FA and is useful for noninvasive diagnosis of CA atherosclerosis of various severity. Simple and convenient use of VSCOMB allows it to be used at the screening stage to detect subclinical CA atherosclerosis and to prevent its progression.

[Radiofrequency Pulmonary Artery Ablation for Treatment of Residual Pulmonary Hypertension After Pulmonary Endarterectomy].

OBJECTIVE: to assess the safety and efficiency of radiofrequency pulmonary artery ablation for treatment of residual pulmonary hypertension after pulmonary endarterectomy. MATERIAL AND METHODS: Radiofrequency pulmonary artery denervation (PADN) was performed in 16 patients (10 men, mean age 39 years [26; 51]). Indication for PADN was mean pulmonary artery pressure (PAP) >25 mm Hg with absence of proximal pulmonary artery lesion according to computer tomography. PADN procedure was performed with nonfluoroscopic 3D navigation system. RESULTS: After PADN mean PAP decreased from 37.3 mm Hg [29; 38] to 24.6 mm Hg [17; 30] (p=0.01); pulmonary vascular resistance decreased from 672 dyn·s·c -5 [387; 566] to 386 dyn·s·c -5 [155; 449] (р=0.02); cardiac output increased from 3.4 l / min [3.2; 3.4] to 3.5 l / min [3.2; 4.0] (p=0.4); 6­minute walk test distance increased from 427 meters [352; 510] to 447 meters [370; 525] (p=0.16), respectively. CONCLUSION: Initial results allow to assume that radiofrequency pulmonary artery denervation combined with optimal medical therapy may take its rightful place in the treatment of this category of patients.

Radiofrequency Pulmonary Artery Ablation for Treatment of Residual Pulmonary Hypertension After Pulmonary Endarterectomy.

OBJECTIVE: to assess the safety and efficiency of radiofrequency pulmonary artery ablation for treatment of residual pulmonary hypertension after pulmonary endarterectomy. MATERIAL AND METHODS: Radiofrequency pulmonary artery denervation (PADN) was performed in 16 patients (10 men, mean age 39 years [26; 51]). Indication for PADN was mean pulmonary artery pressure (PAP) >25 mm Hg with absence of proximal pulmonary artery lesion according to computer tomography. PADN procedure was performed with nonfluoroscopic 3D navigation system. RESULTS: After PADN mean PAP decreased from 37.3 mm Hg [29; 38] to 24.6 mm Hg [17; 30] (p=0.01); pulmonary vascular resistance decreased from 672 dyn∙s∙c-5 [387; 566] to 386 dyn∙s∙c-5 [155; 449] (р=0.02); cardiac output increased from 3.4 l/min [3.2; 3.4] to 3.5 l/ min [3.2; 4.0] (p=0.4); 6-minute walk test distance increased from 427 meters [352; 510] to 447 meters [370; 525] (p=0.16), respectively. CONCLUSION: Initial results allow to assume that radiofrequency pulmonary artery denervation combined with optimal medical therapy may take its rightful place in the treatment of this category of patients.

[Reperfusion therapy for ST-segment elevation acute coronary syndrome: development trends in the Russian Federation].

Based on the 2010-2012 data from the National Registry of Myocardial Infarction, the authors analyzed the scope and pattern of emergency medical care for patients with ST-segment elevation acute coronary syndrome (ACS). The proportion of patients undergoing emergency endovascular interventions of the total number of those with ST-segment elevation ACS was 22.3% in 2010, 22.1% in 2011, and 28.5% in 2012. Thrombolytic therapy rates were 27.6% in 2010, 30.2% in 2011, and 30.3% in 2012. The percentage of patients who did not receive any reperfusion was 50, 46, and 42% in 2010, 2011, and 2012, respectively. At the same time, the proportion of patients who were admitted to hospital within 12 hours after a pain attack, but received no revascularization was 25.7% in 2010, 19.3% in 2011, and 16.9% in 2012. Hospital deaths due to ST-segment ACS were 7.7, and 7.0, and 6.8% in 2010, 2011, and 2012, respectively. The reduction in hospital mortality rates of myocardial infarction was due to both the wide introduction of high technology care and the increased therapeutic window of the most available reperfusion method, such as thrombolytic therapy.

[Nonpharmacological methods of prevention of thromboembolic complications in patients with atrial fibrillation].

We present in this review modern methods of prevention of thromboembolic complications in patients with atrial fibrillation and give comparative description of evidence base, efficacy and safety of available techniques.

[Clinical results of the use of new bioengineering technologies (endothelial precursor cell-capturing stents) in the treatment of coronary heart disease].

OBJECTIVE: to study the long-term results of the use of precursor cell-capturing stents (bioengineering stents) and to analyze the factors influencing late prognosis. SUBJECTS AND METHODS: The study included 447 coronary heart disease patients with primary atherosclerotic lesion in the coronary bed, damage to aortocoronary shunts, and restenosis of a previously implanted stent. The clinical and morphological risk factors for stent restenosis and late stent thrombosis were analyzed during a 2-year follow-up. RESULTS: In the first year of the follow-up, there were no fatal outcomes, evolving myocardial infarction was observed in 2.6% of cases; recurrent angina pectoris was noted in 10.7%. No late stent thromboses were identified; the incidence of stent restenosis was 8.3%. The risk of restenosis was significantly increased after interventions on arteries less than 2.75 mm in diameter and extended lesions. During the 2-year follow-up, 2 (0.4%) patients died; 14 (1.4%) patients experienced transmural myocardial infarction; 35 (3.3%) patients had non-Q wave myocardial infarction. Forty-four (9.8%) and 15 (1.5%) patients underwent repeated endovascular revascularization and coronary artery bypass grafting, respectively. Late stent thromboses were absent; the incidence of restenosis was 11.7%. CONCLUSION: Within the 2-year follow-up after implantation of bioengineering stents, recurrent angina was seen in 14.8% of the patients, which required repeated endovascular interventions in 9.8% of cases and coronary artery bypass surgery in 1.5% of cases. The incidence of bioengineering stent restenosis was 11.7%; no late thrombotic events were found. The risk factors for bioengineering stent restenosis were extended lesions and small-diameter vessel interventions.

[Efficiency of endovascular re-interventions for evolving restenosis of different types of stents].

The paper compares the results of different treatment options (balloon angioplasty and restenting) for in-stent restenosis in case of evolving restenosis of drug- and nondrug eluting stents. The investigation enrolled 496 coronary heart disease patients with clinical presentation of angina pectoris and/or signs of myocardial ischemia, as well as hemodynamic restenosis of a previously implanted stent. Of them, 216 and 280 patients had restenosis of previously implanted drug- and nondrug-eluting stents, respectively. In the patients with non-drug-eluting stent restenosis, recurrent angina pectoris and the frequency of repeated restenosis were significantly more frequently observed after balloon dilatation than after drug-eluting stent implantation (28.4 and 10.2%; p < 0.05; 19.9 and 8.7%; p < 0.05). In those with drug-eluting stent restenosis, recurrent angina pectoris and the frequency of repeated restenosis did not differ significantly between balloon dilatation of restenosis and implantation of a second drug-eluting stent.

[Results of implantation of drug-eluting stents in extensive lesion of the coronary bed according to angiographic and intravascular ultrasound findings].

OBJECTIVE: To study the results after stenting extensive stenoses, the incidence of restenosis according to angiographic findings, as well as changes in endothelization and other morphological parameters in accordance with the data of intravascular ultrasound study (IVUSS). SUBJECTS AND METHODS: The study included 220 coronary heart disease patients with extensive stenoses of the coronary bed. Double antiaggregant therapy was used in 90% of the patients during the first year and in 9.5% during the second year. Contrast-enhanced coronarography was performed in 174 and 82 patients within the first and second years following stent implantation, respectively. IVUSS was made in 26 patents by the end of the first year and in 24 patients by the end of the second year of a followup. Quantitative and qualitative analyses were done in terms of the following indicators: the mean minimal diameter of a stented segment; its mean minimal area; the number of stents with complete endothelization. RESULTS; In the first year, 1 (0.5%) patient had a fatal outcome; the development of Q-wave and non-Q-wave myocardial infarction (MI) was observed in 2 (1%) and 3 (1.5%) patients, respectively. The appearance of angina symptoms during a year was noted in 10 (4.5%) patients; coronary artery bypass grafting (CABG) was performed in 7 (3.2%) patients; 3 (1.5%) cases had endovascular reintervention. At 2-year follow-up, 6 (2.7%) patients died; 7 (3.2%) and 7 (3.2%) patients developed Q-wave and non-Q-wave MI, respectively; recurrent angina pectoris was noted in 22 (10%) patients. CABG was made in 5 (2.3%) patients; endovascular reintervention was done in 15 (6.9%) patients. The total rate of coronary events was significantly higher at 2-year follow-up (19.2% versus 7.3% at 1-year follow-up). According to coronary angiography, stented segment restenosis was 3.8 and 4.9% after one and two years, respectively. IVUSS showed that the morphological indicators characterizing late vessel luminal loss did not differ between different periods of the follow-up. Complete endothelization was observed only in 40% of endoprostheses a year after stent implantation and in 92% of endoprostheses by the end of the second year (p < 0.05). CONCLUSION: Complete endothelization was shown by 40 and 91% of the drug-eluting stents by the end of the first and second years of the follow-up, respectively. Within the first year of the follow-up, the total number of coronary events (death + MI + recurrent angina or repeat revascularization) was significantly smaller than that within the second year.

[Left main coronary artery stenosis and progression of coronary artery atherosclerosis after angioplasty and stenting in patients directed to coronary artery bypass surgery].

Recent investigations demonstrated appearance of left main coronary artery stenosis after PTCA. We performed a retrospective study of specific characteristics of development of coronary lesions after percutaneous coronary interventions (PCI) in patients subjected to coronary artery bypass grafting (CABG) because of angina recurrence after PCI. Data of 150 patients operated because of angina recurrence after PCI were analyzed. The recurrence of angina in 93% of cases was associated with development of significant stenoses in previously intact segments of coronary arteries, but not with restenosis or occlusion of the stented segment. The recurrence of symptoms occurred in 1 year after coronary stenting in 54% of patients. In 19 patients rapid development of a novel left main coronary artery stenosis was observed. Some characteristics of this group (the use of Back-up, XB, AL-catheters, repetitive PCI, manipulations in more than 2 coronary segments, stenting of bifurcations with 2 stents, use of kissing-balloons, small diameter of left coronary artery, and concomitant diabetes) significantly differed from those of the main group. In all patients CABG was successful.

[Efficiency of medical versus endovascular treatment using drug-eluting stents in coronary heart disease patients with extensive lesion of the coronary bed].

The goal of the study was to assess the long-term results of endovascular treatment using drug-eluting stents in coronary heart disease patients with extensive coronary artery lesion. The study covered 478 patients with diffuse coronary artery lesion, including 220 patients receiving endovascular treatment and 258 having medical treatment (a comparison group). The immediate angiographic results and long-term clinical efficiency of endovascular treatment using rapamycin-eluting stents were studied. The follow-up was 2 years. Repeat follow-ups were undertaken1and 2 years later. The immediate angiographic success rate of endovascular treatment for diffuse coronary artery lesions was 89.5%. The two-year follow-up showed the efficiency and expediency of endovascular treatment for extensive coronary artery lesions: the symptoms of angina pectoris occurred significantly less frequently symptoms, the exercise endurance was higher, and the need for antianginal medications was less in the invasively treated patients.

[Long-term results of chronic occlusion recanalization in patients with coronary heart disease].

The study was undertaken to assess the long-term results of recanalization of chronically occluded coronary arteries, by applying drug-eluting stents to patients with coronary heart disease. The study enrolled 585 patients with one-vessel occlusive lesion of one of three great coronary arteries (TIMI 0; occlusion duration, > or = 3 months): 321 patients who underwent successful recanalization of chronic occlusion and further implantation of drug-eluting stents and 264 patients who received drug therapy (a control group). The short- and long-term results of recanalization were investigated. The follow-up averaged 1095 +/- 36 days; reexaminations were made after 1, 2, and 3 years. The direct success rate of recanalization of chronically occluded coronary arteries was 84.9% (321/378). The results of a 3-year follow-up showed the efficiency and expediency of endovascular recanalization of chronic occlusions: the invasively treated patients had the symptoms of angina pectoris and heart failure significantly less frequently, showed higher exercise tolerance and a less need for antianginal therapy, and had a better long-term prognosis.

[Long-term results of implantation of bioengineered and drug-eluting stents in patients with coronary heart disease: comparative characteristics of predictors of poor prognosis].

The purpose of the investigation was to study the morphological and clinical characteristics affecting the long-term prognosis after implantation of bioengineered and drug-eluting stents in patients with coronary heart disease (CHD). The investigation covered 2362 patients with CHD. Genous bioengineered stents were implanted in 316 patients; Cypher rapamycin-eluting stents were in 2046 patients. The independent poor factor for complications was discontinuation of antiaggregatory therapy due to surgical interventions of different types in the drug-eluting stent group and stenting of extensive stenoses in the bioengineered stent group.

[Long-term follow-up use of "cypher" sirolimus-eluting stents in patients with coronary heart disease after coronary artery bypass grafting with occlusive lesions of the coronary artery].

UNLABELLED: The aim of this study is to assess the 1 and 2-year follow-up of treatment with Cypher drug- eluting stents (Cordis, Johnson & Johnson, USA) for chronic symptomatic coronary artery occlusions in CHD patients after coronary artery bypass graft. That was a retrospective study that included 51 patients who had been implanted Cypher stents. A control group comprised 65 symptomatic patients with coronary heart disease (CHD) after coronary artery bypass grafting with occlusive lesions of the coronary artery, who was carried out only conservative treatment (without PTCA). Patients received standard medicamentous treatment. The groups did not differ in clinical characteristics. 79 stenoses in the eluting stent groups were subject to revascularization. The immediate cure rate was 84.3%. During the follow-up, one patient (2.3%) died and 4 (9.3%) underwent coronary bypass surgery in the drug- eluting stent group; there were 3 (4.6%) deaths and 10 (15.4%) patients had coronary bypass surgery in the control group. After stenting we noted a reliable decrease of patients with anginal attacks, of the used nitrates, increase the average physical tolerance by stress- testing (p < 0.05) than by patients in control group. CONCLUSION: stenting chronic coronary artery occlusions in patients with coronary heart disease (CHD) after coronary artery bypass grafting with the use of Cypher drug- eluting stents (Cordis, Johnson & Johnson, USA) is an effective procedure from the viewpoint of long-term results, with low frequency of recurrent angina and repeated myocardial revascularization.

[Comparative analysis of efficacy of endovascular interventions in native vascular bed and grafts in patients with ischemic heart disease after coronary artery bypass surgery].

AIM: Investigation of efficacy of endovascular interventions in native vascular bed and grafts, elucidation of factors, affecting immediate and remote prognosis after endovascular treatment. MATERIAL AND METHODS Coronary stenting was carried out in 212 patients who had previously undergone coronary bypass surgery. Stents were implanted into native vessels and grafts in 116 (native vessels group) and 96 (grafts group) patients, respectively. Frequency of angina recurrence and development of complications were assessed during hospitalization and after 1 year. Coronary angiography was repeated after 1 year in 47 and 36 patients in native vessels and grafts groups, respectively. Multifactorial analysis of predictors of complications and angina recurrence was performed with the use of logistic regression. RESULTS AND CONCLUSION: In grafts group signs of distal embolism were observed in 9 patients (9.4%), shunt thrombosis occurred in 2 of these patients. Risk factors of embolism in grafts group were complicated lesions (type C) and length of stenosis >20 mm. There was 1 non-Q wave myocardial infarction after stenting of native vascular bed (0.8%). Angina recurrence was observed after 1 year in 9 (7.8%) and 26 (27.1%), myocardial infarction developed during 1 year in 2 (1.7%) and 3 (3.1%) patients of native vessels and grafts groups, respectively. Risk factors of recurrence of clinic of ischemic heart disease (IHD) after stenting of grafts were time interval between stenting and bypass surgery >5 years and the use of stents without drug coating. More frequent recurrence of clinic of IHD in patients of grafts group was a consequence of higher level of restenosis in stented segments and more frequent progression of atherosclerosis in previously unaffected segments.

[Antibodies to Chlamydia pneumoniae in blood serum of patients with ischemic heart disease and presence of complicated lesions in coronary arteries].

Levels of IgM, IgG and IgA antibodies to Chlamydia pneumoniae were measured in 107 patients (age 33-75 years) with documented coronary atherosclerosis and 39 subjects with intact coronary arteries. Rates of seropositivity to C. pneumoniae were 77.6 and 25.6% in patients and "healthy" subjects, respectively (p<0.05). Seropositive (n=83) compared with seronegative (n=24) patients had higher prevalence of complicated lesions (p<0.05).