Predictors of atrial fibrillation in patients with ischemic stroke of undetermined etiology.

Aim    To identify a complex of predictors and to create a mathematical model for prognosis of atrial fibrillation (AF) in patients with ischemic stroke of undetermined etiology. Material and methods    The study included 981 patients with ischemic stroke. Effects of the following factors were evaluated: gender, a history of stroke, a history of thromboembolism, presence of diabetes mellitus, grade of arterial hypertension, functional class (FC) of chronic heart failure (CHF), age, data of blood biochemistry, and data of coagulogram. The prognostic model was constructed using the binary logistic regression. The value of area under the ROC curve for the proposed prognostic model was calculated.Results    The main predictors of AF in patients with ischemic stroke of undetermined etiology were CHF FC, a history of stroke, age, gender, values of cholesterol and prothrombin index, which were included into the final prognostic model. The sensitivity of the developed model was 83.5 % and the specificity was 85.5 %. The area under the ROC curve corresponding to the interrelation between the prognosis of AF and the regression function value was 0.921±0.012 with 95 % confidence interval: 0.898-0.944.Conclusion    According to the results of the study, the probability of AF in patients with ischemic stroke increased with CHF progression, recurrent stroke, older age, female gender, and reduced prothrombin index and cholesterol level.

[Resynchronization Therapy for Chronic Heart Failure: Diagnostic and Therapeutic Approaches].

Chronic heart failure (CHF) remains one of the most important problems of modern cardiology. One of the effective treatment methods is resynchronization therapy (RT). The article presents an analysis of literature data on the effectiveness of RT in improving the quality of life, reducing the number of hospitalizations and mortality in patients with heart failure with severe left ventricular systolic dysfunction and expanding QRS complex, and also discusses key methods for optimizing RT.

[Factors associated with atrial fibrillation in patients with hypertension and preserved left ventricle systolic function].

The objective of our study was to define factors associated with atrial fibrillation (AF) in patients with hypertension (HTN) and preserved left ventricle systolic function. MATERIAL AND METHODS: Overall, 273 consecutive patients with HTN residing in urban area were included in the study. Patients were divided into 2 groups: the first - 60 patients with paroxysmal and persistent AF (33% men, age 62, 28 (10,02), the second - 213 patients without AF (33% men, age 59,37 (8,27). RESULTS: Stepwise logistic regression analysis demonstrated AF presence was associated with alcohol intake ≥ 7 drinks per week (OR 4,12; 95%CI: 1,04-16,35), low physical activity (OR 3,18; 95% CI: 1,32-7,68), higher hip circumference (OR 1,19; 95% CI: 1,08-1,31) and history of HTN (OR 1,10; 95% CI: 1,04-1,17). BMI was not associated with presence of AF (OR 0,75; 95% CI: 0,61-0,91). CONCLUSION: Thus in our urban population with hypertension, AF is associated with alcohol intake ≥ 7 drinks per week, low physical activity, increased hip circumference and history of hypertension.AF prevention should include modification of lifestyle.

[Heart rate variability in patients with neurocardiogenic syncopes].

AIM: To investigate chronotropic heart regulation and prognostic significance of heart rate variability (HRV) in patients with neurocardiogenic syncopes (NCS). MATERIAL AND METHODS: A total of 90 patients (25 healthy controls and 65 patients with documented HRV, mean age 33.9 +/- 17.4 years) were divided into 3 groups depending on an NCS type (cardioinhibitory, n = 18; vasodepressive, n = 25; mixed, n = 22). All the examinees have undergone a long-term passive head-up tilt table test with registration and analysis of HRV. RESULTS: A cardioinhibitory NCS variant was characterized by slow heart rate (both at rest and test), increased mode amplitude--Amo (by 28, 1, 21, 6 and 46.8% at rest, tilt test, in rehabilitation, respectively), range of deviation (RD) (by 47, 1, 62, 5 and 52.9%, respectively). A simultaneous rise of indices characterizing activity of the sympathic and parasympathic parts of the autonomic nervous system led to the absence of significant differences of the integral parameters (Amo/RD; index of regulatory system tension) vs control. Still more marked changes in the indices of cardiovascular vegetative regulation were registered in a vasodepressive NCS, but the differences with the control were moderate. Vegetative tonicity and reactivity in mixed NCS represent an intermediate variant between cardioinhibitory and vasodepressory types. CONCLUSION: In NCS patients circadian HRV was less than in the controls. The parasympathic tonicity prevails in all NCS types. Moreover, NCS is affected by episodes of activation of sympathico-adrenal system. Typical HRV in different NCS variants allows using this method for their diagnosis, prognosis and follow-up of the patients.

[Wolf-Parkinson-White syndrome: stratification of syncope risk factors].

AIM: To evaluate risk factors of syncopes in patients with Wolf-Parkinson-White syndrome (WPWS) using transesophageal pacing (TEP). MATERIAL AND METHODS: 82 WPWS patients were divided into two groups: the study group (n = 46) with syncopes and presyncopes, the control group (n = 36) without syncopes. The groups were matched by sex and age. TEP protocol included two stages: before radiofrequency ablation (RFA) and on day 2 after RFA (control test). RESULTS: Highly significant differences between the groups were detected only in induction of ortodromic tachycardia. In patients of the study group the cycle duration (CD) was 317 +/- 38.9 ms, in the control group - 365.25 +/- 96.3 ms (R = 0.003), heart rate--197.7 +/- 15.03 vs 167.3 +/- 31.65 per 1 min (R = 0.003), heart rate--197.7 +/- 15.03 vs 167.3 +/- 31.65 per 1 min (R = 0.0001), ventricular interval--122.5 +/- 17.5 and 153.1 +/- 44.4 ms (R = 0.0001). A correlation was found between syncope risk and baseline heart rate, CD, Venkebach point, antegrade effective refractory period of additional atrioventricular connection, ventriculoatrial interval during tachycardia, WPWS manifestation, atrial fibrillation, arrhythmia history. CONCLUSION: The detected electrophysiological changes allow early detection of patients at high syncope risk among WPWS patients and reduction of sudden cardiac death risk in these patients.

[Optimization of hypotensive therapy in hypertensive patients with new beta-1 selective long-acting adrenoblocker]. / Puti optimizatsii gipotenzivnoi terapii bol'nykh gipertonicheskoi bolezn'iu novym beta1-selektivnym adrenoblokatorom prolongirovannogo deistviia.

20 hypertensive subjects entered the trial of kerlon (Searle, USA). Central hemodynamics was studied by tetrapolar chest rheography according to J. Franz. Therapeutic response to beta-1-adrenoblocker kerlon in hypertension was assessed by hemodynamic indices and acute pharmacological test. The effect was found to depend on the initial hemocirculation type. In hyperkinetic hemodynamics lowering of blood pressure was due to diminution of the cardiac index, in eukinetic and hypokinetic types- to a decrease in the total peripheral vascular resistance.