[Immediate Outcomes of Coronary Artery Bypass Grafting in Patients With Multifocal Atherosclerosis: Gender Differences].

AIM: To assess the impact of presence of multifocal atherosclerosis (MFA) and gender differences on immediate outcomes after coronary artery bypass grafting (CABG) in patients with ischemic heart disease (IHD). MATERIAL AND METHODS: Medical records of patients with MFA, who underwent elective CABG (n=764, 655 men, 109 women) were reviewed retrospectively. RESULTS: Women were older (<0.001), and more often were overweight (<0.001), had diabetes (<0.001), high angina functional class (=0.012) and congestive heart failure (=0.002). Cigarette smoking was more common among men. Men more often had reduced left ventricular ejection fraction (<0.001). Three-vessel coronary artery disease prevailed among women (=0.080). Rate of hemodynamically significant carotid stenosis was higher among women (=0.010), whereas that of peripheral artery disease - among men (=0.001). Total number of perioperative complications was 48.8% among women and 53.0% among men (=0.399). According to multivariate analysis, history of CABG was associated with increased risk of perioperative complications (=0.034), and combined involvement of left main coronary artery (LMCA) and three coronary arteries - with in-hospital mortality (=0.003). CONCLUSION: There were no gender differences in the incidence of perioperative complications. Women more often had carotid lesions, men - lesions in arteries of lower limbs. Women had more risk factors (other than smoking) what could explain high prevalence of three-vessel disease as well as more severe coronary insufficiency and heart failure. Regardless of patients gender and presence of MFA history of previous CABG and presence of combined LMCA and three coronary arteries involvement increased risk of perioperative complications and in-hospital mortality, respectively.

[GENDER-RELATED FEATURES AND QUALITY OF LIFE OF THE PATIENT ONE YEAR AFTER CORONARY ARTERY BYPASS GRAFTING].

AIM: To study the influence of gender features on the quality of life (QL) of the patient one year after coronary artery bypass grafting and to determine factors associated with low QL after surgery. MATERIALS AND METHODS: The study included 408 patients (70 women and 338 men) whose QL was estimated 1 year after surgery based on the SF-36 questionnaire. The groups were compared in terms of QL parameters before and after surgery, clinical data, and peculiarities of surgical treatment. In addition, factors associated with clinical data of QL were assessed in each group by logistic regression analysis. RESULTS: One year after surgery, QL improved in women and men of both groups: depression--48 [45, 54] and 50 [46,55] (p = 0.37], physical component--72 [61,78] and 72 [61, 81] P = 0.61) and psychological component--69 [60, 75] and 67 [56.76] (p = 0.43]. Multifactor analysis revealed association of multifocal atherosclerosis with the low level of physical and psychological components in women and depression in men. Diabetes mellitus had independent influence on the reduction of QL physical component in women. The absence of gender differences 1 year after surgery was due in the first place to the absence of differences between men and women in the number of affected coronary arteries, the number of shunts, the use of artficial circulation, and duration of surgery. CONCLUSION: Decreased frequency of depression, significant increase in the parameters of QL psychological and physical components one year after surgery are independent of the patients' sex due to the absence of differences in QL components between groups, severity of affection of the coronary bed and peculiarities of surgery.

[Predisposition to Psychological Distress in Patients After Coronary Bypass Surgery: Relation to One Year Prognosis].

AIM: to assess effect of type D personality (TDP) on one year prognosis after coronary artery bypass grafting (CABG). MATERIAL AND METHODS: Personality type was evaluated using the DS-14 scale in 683 patients before and in 1 year after CABG; 152 patients had TDP, 531 had not. After 1 year of follow-up we assessed functional class of angina and chronic heart failure, and registered cardiovascular complications (CVC): deaths, myocardial infarctions, strokes, amputations, thromboses of arteries of lower extremities, hospitalizations, requirements in repetitive angiographies of coronary grafts. Rate of development of combined end point comprising all these events was also evaluated. RESULTS: During follow-up CVC developed more often in patients with TDP compared with those without TDP (31.8 and 14.6%, respectively, =0.049). According to multifactorial regression analysis TDP was independently associated with 3.21 fold increase in risk of CVC. CONCLUSION: Detection of TDP after CABG is advisable for conducting subsequent interventions directed at improvement of long term results of treatment.

[Gender-specific features of the prevalence and clinical manifestations of multifocal atherosclerosis].

UNLABELLED: Multifocal atherosclerosis (MFA) has negative effect on prognosis in various groups of patients with cardiovascular diseases. However, gender-specific features of MFA are practically unexplored which provided a rationale for the present work. AIM: To study gender-specific features of MFA in patients with atherosclerosis of different localization. MATERIALS AND METHODS: 1018 patients examined and treated prior to planned surgical intervention on coronary arteries, carotid basin, aorta, and arteries of lower extremities. Group 1 included 193 women aged 59 = 69 (mean 63) years, group 2 was comprised of 825 men aged 53-63 (mean 57 years). All the patients underwent coronarography (CG). Analysis of MFA prevalence was made. RESULTS: The women were older than the men, they were more frequently overweight, suffered arterial hypertension and diabetes mellitus (p < 0.001), showed the higher left ventricular ejection fraction (p = 0.011). Smokers more frequently occurred among men (p < 0.001). CG revealed more lesions in a single vessel (p = 0.023) and less t lesions affecting three vessels (p = 0.015) in men. Signs of MFA were recorded in 28.0% of the men and 24.4% of the women (p = 0.306). Combined lesions of the coronary and carotid basins were more frequent in women (p = 0.048). Clinically significant stenosis of the coronary bed, aortoiliac segment or lower limb arteries occurred more frequently in men (p = 0.012). All three basins were more frequently affected in men (p = 0.061). CONCLUSION: MFA before planned cardiovascular surgery was diagnosed in 27.3% of the cases. Combined lesions in coronary and carotid arteries more frequently occurred in women and those in coronary and lower limb arteries in men (p < 0.05). Most risk factors (except smoking) are more frequently inherent in women in association with the enhanced frequency of three-vessel lesions affecting coronary arteries.

[Quality of life of patients after coronary bypass surgery: effect of age and personality type D].

AIM: To study effect of age and presence of personality type D on quality of life (QL) of patients in one year after coronary bypass surgery (CBS). MATERIAL AND METHODS: Assessment of QL before and after surgery was carried out in 408 patients. Two groups were formed: patients younger than 60 years (n=233) and older than 60 years (n=175). Quality of life and presence of personality type D was assessed by questionnaires SF-36 and DS-14, respectively. RESULTS: In a year after CBS improvement of physical and psychological components of QL (p<0.05) was noted in both groups. Personality type D was more frequent among patients older than 60 years (p<0.01). Patients with personality type D had worse parameters of irrespective of age (p<0.01). Personality type D correlated directly with age QL (p=0.003) and inversely with parameters of QL (p<0.01). Presence of personality type D was an independent predictor of low level of physical (together with index of atherogenecity prior to surgery) and psychological components of QL at multiple logistic regression analysis. CONCLUSION: Assessment of personality traits of patients before CBS can be helpful for targeted measures aimed at improvement of QL what is especially important for older age groups.

[Factors influencing life quality improvement in patients of different age one year after coronary artery bypass surgery].

The study was aimed at examining the factors having an impact on changes in the quality of life (QL) parameters a year after coronary artery bypass surgery (CABG) in different age groups. 408 patients aged 31-79 years had their QL assessed by means of the SF-36 questionnaire before and one year after elective CABG. Additionally, the patients were tested for the presence of type D personality before and one year after CABG by means of the DS-14 questionnaire. The groups were comparable in terms of previous carotid endarterectomy, peripheral arterial and aortic reconstruction number (p > 0.05). One year after CABG the improved QL (p < 0.01) was reported whereas type D patients had significantly poorer psychological test results (p < 0.01). One year after CABG type D personality and high Euroscore had an independent impact on the QL improvement while previous carotid endartectomies resulted in a significantly improved psychological health component. Thus, along with the detection and treatment of non-coronary lesions the personality type assessment and focused behavioral interventions can contribute to the QL improvement in long-term CABG period.

[Factors affecting results of coronary bypass surgery in elderly patients].

Study aim was to compare rates of perioperative complications of coronary bypass surgery in patients of various age groups and to analyze factors associated with their appearance. We retrospectively studied 2411 case histories of patients subjected to coronary artery bypass surgery between January 2006 and December 2009. According to their age at surgery patients were divided in 4 groups: <60 years (n=1555, mean age 53+/-6 years), 60-64 years (n=379, mean age 61+/-3 years), 65-69 years (n=335, mean age 67+/-2 years), >70 years (n=142, mean age 71+/-3 years). In older age groups hospital mortality and total number of complications were greater than in patients aged <60 years. Hospital mortality and rates of postoperative complications did not significantly differ between groups of patients aged 60-64, 65-69, and more or equal 70 years. Besides age the following factors were independently associated with hospital mortality: characteristics of extent of atherosclerosis (significant occlusive-stenotic lesions in arteries of lower extremities and extracranial arteries, history of stroke); lowering of left ventricular ejection fraction; and use of cardiopulmonary bypass.

[Long-term survival after reconstructive surgery on non-coronary arteries in different age groups].

The study was aimed at assessing long-term survival after reconstructive surgery on non-coronary arteries in different age groups as well as the confounding factors. 469 case histories were analyzed retrospectively. The most patients underwent coronary angiography (CA) and preventive myocardial revascularization along with non-coronary artery exam. The mean follow-up period was 57.5 +/- 14.9 months. The groups were similar in terms of aspirin and statin therapy; however, older patients more often received beta-blockers and ACE inhibitors (p < 0.03). The number of patients who undergone CA increased with age (p = 0.002). Older patients had higher long-term mortality (p = 0.008) and poorer long-term survival (p = 0.001) as compared to patients below 60 years of age. The risk of death increased with age (OR 1.11; p = 0.001), in smokers (OR 2.79; p = 0.009) and in case of complications in the postoperative period (OR 4.09; p = 0.001). In turn, lower mortality was associated with CA and further preventive myocardial revascularization, if medical reasons (OR 0.15; p = 0.001). Thus, routine CA and preventive myocardial revascularization were associated with lower long-term mortality. This allows recommending an aggressive preoperative assessment to this category of patients.

[Prevalence of multifocal atherosclerosis in different age groups].

Aim of the study was to assess prevalence of lesions in several arterial beds in patients with atherosclerosis of various localization in the clinic of cardiovascular surgery. We examined 1018 patients (825 men and 193 women, aged 31-78 years, mean age 59+/-12 years) in the period of preparation to elective surgical interventions on coronary arteries or other arterial beds. All patients were divided into 4 age groups: group 1 - younger than 60 years (n=542), group 2 - 60-64 years (n=215), group 3 - 65-69 years (n=141), group 4-70 years and older (n=120). All patients were subjected to coronary angiography and Doppler ultrasound investigation (USI) of extracranial arteries. USI of arteries of lower extremities and angiography of peripheral arteries were carried out if indicated. Presence of 50% or greater stenosis was considered a criterion of involvement of an arterial vascular bed. Lesions in 2 or more beds were found in 321 patients (31.5%). Stenoses in 2 and 3 arterial beds were revealed in 24 and 3.5%, respectively, of patients in group 1, and in 31.8 and 10%, respectively, of patients in group 4 (p=0.008). Purposeful diagnostics of multifocal atherosclerosis in patients of the given category apparently should not be limited by older age groups.

[Impact of old age on risk of perioperative complications in non-coronary vascular surgery].

The objective of the study was to assess coronary arteries and the rate of perioperative complications in elderly patients undergoing non-coronary vascular surgery. 412 medical records of patients aged 60.8 +/- 8.5 years undergone non-coronary vascular surgery were analyzed retrospectively. All the patients had a coronary angiography and, if indicated, a preventive myocardial revascularization performed before a surgery. Patients who were over 70 years old had more often significant coronary stenotic lesions (64.5%) than those who were less than 60 years old (59.4%). A myocardial revascularization was significantly more often (p = 0.03) done for patients, who were less than 70 years old (32.7-36.5%), than for those aged over 70 years (14.5%). The groups did not differ in the frequency of beta-blockers, statins and ACE-inhibitors administration (p = 0.42). The groups were also similar in the rate of perioperative complications, including mortality rates. A preventive myocardial revascularization strategy in patients with significant coronary artery disease appears to be an essential stage in the treatment nondependent of the coronary artery disease clinical course. The age per se should not be a reason to refuse those patients in performing non-coronary vascular surgery.

[Quality of life in patients of different age groups with ischemic heart disease: effect of multifocal atherosclerosis].

The aim of the research was to study the quality of life for the patients of different age groups with coronary artery disease and to evaluate the factors affecting its decline. The present study included 709 patients aged 31 to 79 years examined before elective coronary artery bypass graft surgery. All patients underwent coronary angiography, echocardiography, ultrasonography of the aorta, brachiocephalic, and peripheral arteries. With age, significantly increased incidence of multifocal atherosclerosis (p = 0.01 for the trend). To study the quality of life (QL) a non-specific questionnaire SF-36 was used, according to which the reduction of QL equally in all the groups (p > 0.05) was detected. Multivariate analysis showed that the level of QL was influenced by diabetes, myocardial infarction and the presence of multifocal atherosclerosis (p < 0.05). Thus, in order to improve the QL in aged patients with multifocal atherosclerosis is reasonable to conduct of reconstructive operations at different arterial basins.

[Intraventricular filling flows in assessment of left ventricular diastolic function in the elderly]. / Vnutrizheludochkovye potoki napolneniia v otsenke diastolicheskoi funktsii levogo zheludochka u pozhilykh liudei.

AIM: To assess effect of old age on Doppler parameters of intraventricular filling flows. MATERIAL: Echocardiography with determination of velocity and time of early diastolic flow propagation, degree of its deceleration, maximal regional intraventricular flow velocity, and late diastolic interval A-Ar was carried out in healthy elderly (age 68.0+/-7.5 years, n=20) and middle aged (mean age 45.9+/-5.9 years, n=20) persons. RESULTS: Elderly compared with middle aged persons had decreased velocity (42.1+/-1.6 and 57.6+/-0.9 cm/sec, respectively, p=0.0001) and prolonged time (29.3+/-4.3 and 18.4+/-2.2 ms, respectively, p=0.02) of intraventricular early diastolic flow propagation, lower Eiv (0.64+/-0.04 and 0.92+/-0.04 ms, respectively, p=0.0001) and E(iv)/E (0.85+/-0.04 and 1.14+/-0.07, respectively, p=0.006), similar A-Ar (55.2+/-3.5 and 0.54+/-0.04 ms, respectively, p=0.78). CONCLUSION: Advanced age is associated with worsened active relaxation of the myocardium which is not accompanied by substantial changes of late diastolic left ventricular stiffness.