Dyslipidemia in liver transplant recipients
E. Grigorenko, A. Shalimova, O. Rummo, N. Mitkovskaya
Liver transplant is known to be the only radical treatment for patients with end-stage liver diseases. It is known that cardiovascular diseases rank third among patients, who underwent liver transplant. Due to the current generally accepted policy of aggressive treatment of hypercholesterolemia, mortality from cardiovascular diseases has been significantly reduced in general population. Statin therapy has also demonstrated a decreasing effect on mortality among patients with chronic liver failure. Recently published research results have shown the increasing occurrence of non-communicable diseases among liver recipients, including diseases that determine cardiovascular mortality (arterial hypertension, chronic coronary syndrome, chronic heart failure, chronic kidney failure). This evidence demonstrates that in post-operative period doctors should do their best to identify not only traditional risk factors of acute transplant rejection, but also pay attention to cardiovascular risks and their timely treatment. Based on the data about a number of differences in the incidence of cardiovascular risk factors and on the specifics of confirmation and treatment of chronic coronary heart disease in liver transplant recipients in comparison with the general population, we believe that in transplant centers it is necessary to develop a specialized algorithm of dispensary follow-up of recipients (checklist) for adequate prevention of diseases of the circulatory system.
2021 Том 5, №2
Angina without obstructive lesion coronary arteries (part 1). Pathophysiological aspects of development
S.Р. Solovey
Angina pectoris is one of the most common symptoms of ischemic heart disease (IHD). Coronary angiography in a significant part of patients with angina pectoris and signs of myocardial ischemia does not reveal obstructive atherosclerotic changes in the coronary arteries. Independent or additional mechanisms of ischemia can be microvascular dysfunction and epicardial coronary vasospasm. The clinical form of ischemic heart disease, which is based on ischemia caused by dysfunction of the coronary vessels in the absence of obstructive changes, has recently received the definition of INOCA (Ischaemia with No Obstructive Coronary Artery Disease). The concept of INOCA comprises two types of angina pectoris – microvascular and vasospastic. The underlying INOCA coronary vasomotor disorders have both different pathophysiological mechanisms and localization in the vascular system of the coronary circulation itself. Clinically the most important vasomotor disorders are epicardial and microvascular vasospasm, impaired microvascular vasodilation. The article provides a brief overview of the mechanisms of regulation of coronary blood flow under physiological conditions and vascular dysfunction in non-obstructive atherosclerotic lesions.
2021 Том 5, №2
Independent predictors and prognosis of long-term myocardial infarction in patients with unstable angina after coronary artery stenting
Miadzvedzeva Alena, Gelis Ludmila, Polonetsky Oleg, Russkikh Iryna
Objective. to develop independent predictors for predicting long-term myocardial infarction (MI) in patients (pts) with unstable angina (UA) after coronary artery stenting (PCI) based on the results of a seven-year follow-up. Materials and Methods. The study involved 165 pts with UA and coronary artery stenting (PCI). PCI was performed in 3.2±1.6 days after admission to the in-patient department. Drug-coated stents (Xience V and Biomatrix) were used, the average number of stents was 2.1±0.8 per person, the average length of the stented area was 43.12±25.6 mm, and the average diameter of the implanted stents was 3.12±0.5 mm. All patients were assessed for troponin I, myeloperoxidase, and C-reactive protein levels; coagulation hemostasis was assessed; and a thrombin generation test was performed. The aggregatogram was performed on the analyzer Multiplate (ASPI-test, ADP-test). The patients underwent echocardiography, coronary angiography. Double antithrombotic therapy with clopidogrel 75 mg and acetylsalicylic acid 75 mg was prescribed for 12 months. The follow-up period was 7.0±1.6 years.
2021 Том 5, №1
Unstable angina pectoris or unstable coronary syndromes?
N.P. Mitkovskaya, O.V. Laskina, Patrick Teefy
Unstable angina pectoris (UA) is a variant of acute coronary syndrome without ST segment elevation (NSTEACS), which is characterized by the absence of biochemical criteria for myocardial damage, a change in the clinical picture of angina pectoris (an increase in the functional class of angina pectoris, the appearance of resting angina and a high probability of transformation of the process into myocardial infarction (MI)). UA and the developed MI without ST segment elevation (NSTEMI) are not accompanied by the appearance of a pathological Q wave and are characterized by a general complex pathogenesis associated with progressive atherosclerosis, a non-occlusive thrombus in the area of erosion or rupture of an atherosclerotic plaque, vasospasm, coronary microcirculatory dysfunction or other causes of imbalance between oxygen intake and oxygen consumption resulting in myocardial ischemia, and are distinguished by increased levels of myocardial necrosis in the blood in case of NSTEMI. It is difficult to differentiate UA and NSTEMI in the first hours of the development of the process when a decision is made on reperfusion technologies and drug therapy without laboratory, and in some cases, additional examination with visualization of the probable new loss of viable myocardium, therefore, the diagnosis and management of these two clinical conditions are usually considered in the same clinical recommendations. The article discusses various mechanisms of the development of myocardial ischemia, diagnostic and therapeutic invasive and non-invasive technologies that improve the prognosis of patients with UA.
2020 Том 4, №2
COVID-19 coronavirus infection (overview of international research data)
N.P. Mitkovskaya, I.A. Karpov, G.P. Arutyunov, Ye.A. Grigorenko, D.Yu. Ruzanov, T.V. Statkevich, Е.I. Tarlovskaya
COVID-19 coronavirus infection is a previously unknown acute respiratory viral infection caused by the zooanthroponous RNA-containing SARS-CoV-2 virus, first reported and described in December 2019 in the Chinese city of Wuhan. On 30 January 2020, WHO declared an international emergency and upgraded the risk assessment for COVID-19 at the global level from high to very high. The epidemic was recognized as a pandemic, in which the simultaneous infection of many people with the virus in a number of countries led to overloaded healthcare systems, an avalanche of hospitalizations and deaths.
2020 Том 4, №1
Nosocomial pneumonia: modern approaches to diagnosis and treatment
Zh.V. Antanovich
Nosocomial pneumonia (NP) is the second most common nosocomial infection and the main cause of death from nosocomial infections in critically ill patients. Most cases of NP are caused by aerobic gramnegative bacteria (P. aeruginosa, E. coli, K. pneumoniae, Acinetobacter spp.) and gram-positive cocci (S. aureus). From a practical point of view, in order to prescribe adequate initial antibacterial therapy (ABT) it is advisable to stratify patients depending on timing of the NP development and presence of risk factors (RF) for multidrug-resistant (MDR) pathogens. MDR pathogens are more often excreted in patients with severe chronic diseases and RF for the development of NP. Diagnostic criteria and Clinical Pulmonary Infection Score (CPIS) are used to diagnose NP and determine its severity. The outcome of treatment of patient with NP depends on the doctor’s level of knowledge and the most rapid administration of an adequate initial empiric ABT, presented in guidelines, taking into account local data on pathogens prevailing in the department and their resistance.
2019 Том 3, №2
Chronic coronary syndromes: a review of the recommendations of the ESC-2019
A.S. Rudoy
The review summarizes the key points and main evidence of the updated modern recommendations of the European Society of Cardiology in 2019, which influenced the principles of management and treatment of patients with chronic coronary syndromes. The new concept and recognition of the importance of the multifactorial causes of angina pectoris and myocardial ischemia represents an important evolution in understanding the pathogenesis and treatment of coronary artery disease.
2019 Том 3, №2
Personalized medicine and its role in type 2 diabetes prevention
V.V. Salukhov, B.V. Romashevskiy
Personalized medicine (PM) is a safe and effective way to prevent and treat type 2 diabetes mellitus (T2DM). The basic strategy of PM is to adapt various prevention and treatment methods to individual characteristics of patients, including their genome sequence, microbiome composition, life, case history and dietary preferences. The article highlights the prospects of personalized methods application for T2DM prevention based on the results of research in the field of genomics, metabolomics, intestinal microbiome technologies, pharmacogenetics and pharmacogenomics. The potential and advantages of mobile applications and technologies for large amounts of data assessment (“Big Data”) in the PM structure are demonstrated. The findings on the role of pharmacogenetics and pharmacogenomics in the selection of effective and safe drugs for T2DM treatment are presented. In conclusion, it was noted, that it would be feasible to conduct population –based studies confirming the effectiveness, profitability and advantages of PM compared to traditional T2DM prevention and treatment methods.
2019 Том 3, №2
WPW syndrome in childhood: unsolved problems
E.V. Zasim, V.V. Strogiy
This review presents current data on the causes, pathogenesis of development from the standpoint of electrophysiology of the cardiac conduction system of the WPW syndrome, and also discusses the methods of diagnosis and treatment of this syndrome in childhood. Particular attention is paid to the role of anatomical and physiological features, the development of the autonomic nervous system and the formation of the cardiac conduction system in children. The role of connective tissue dysplasia and the presence of an inflammatory process in the cardiac system are considered among the possible causes of WPW syndrome today. A comparative characteristic of antiarrhythmic therapy in children for the prevention of tachycardia attacks is provided, and some indications for radiofrequency ablation and its effectiveness in children with this pathology are presented.
2019 Том 3, №1
Complex problems of antithrombotic therapy for acute coronary syndrome in patients with atrial fibrillation
A.S. Rudoy, Yu.S. Lysyy
The choice of anticoagulant, the number of antiplatelet agents and the duration of antithrombotic therapy in patients with acute coronary syndrome with indications for oral anticoagulants, in particular for atrial fibrillation, remain complex and ambiguous. On the one hand, the development of acute coronary syndrome requires the appointment of dual antiplatelet therapy, on the other, the combined use of anticoagulant and antiaggregants significantly increases hemorrhagic risks. There is a clinical situation, when you need a clear knowledge of the strategy and choice of antithrombotic drugs, in particular the knowledge about the balance between the risk of developing stent thrombosis, thromboembolic and hemorrhagic complications. In the presented review, the data concerning the regime of antithrombotic therapy are systematized in various types of acute coronary syndrome in patients with atrial fibrillation, depending on the choice of treatment tactics (pharmaco-invasive or conservative).
2019 Том 3, №1
Dysglycemia of critical conditions
O.N. Isachkina, L.I. Danilova
Dysglycemia develops in the form of hyperglycemia, hypoglycemia and marked glucose variability in critically ill adults whether they are known to have premorbid diabetes or not. Patients with such glucose dysregulation have increased morbidity and mortality. Substantial data obtained over the past decade provide evidence that quality glucose management in these individuals improves clinical outcomes. Multicentre trials did not confirm the benefits of tight control of blood glucose. The general consensus now is that excessive hyperglycemia (>10 mmol/L) and severe hypoglycemia (<2.2 mmol/L) should be avoided in critically ill adults. This review describes the epidemiology, pathophysiology and management of dysglycemia in critically ill patients.
2018 Том 2, №2
Topical issues of managing patients with hypertensive crises
V.N. Khirmanov
Doctors of different specialties often see patients with hypertensive crises, the need to provide urgent care for these rather diverse pathological conditions and to manage such patients in the future. This article presents current data, mainly expert advice, on how to choose the proper treatment tactics in patients with hypertensive crises.
2018 Том 2, №2
Acute heart failure: epidemiology, risk factors, prognosis, diagnosis, treatment and prevention
N.P. Mitkovskaya
Acute heart failure (AHF) is a clinical syndrome, which complicates the course of numerous cardiovascular diseases; it appears suddenly or is characterized by rapid or steadily progressing exacerbation of HF symptoms, which require immediate hospitalization and specialized care. In spite of great contribution of health care and financial expenses connected with AHF and chronic heart failure (CHF), a lot of issues still remain unresolved in the field of diagnosis, drug therapy, prognosis and prevention of this syndrome. A high incidence of comorbid pathology is revealed, which to a great extent determines the occurrence, development and prognosis of AHF. Detection of malignant neoplasms in patients with the previously diagnosed HF has become very frequent, and specialists express concern regarding diagnosis of cancer in patients with HF.
Some clinical and laboratory cardiovascular, noncardial, patient-conditioned or iatrogenic indices are independent predictors of the outcome in AH. To assess the risk of unfavorable outcomes in case of hospitalization, it is necessary to develop and implement into practical health care risk scores based on generally accessible indices, which will make it possible to define with a high degree of accuracy the risk of hospital lethality of the patient.
Each hospitalization in case of AHF is connected with deterioration of the heart function, which is never restored to the initial condition after the discharge from the hospital and is accompanied by progressing HF. The average survival of patients with HF decreases in proportion to the number of hospitalizations, therefore, for prevention of AHF episodes it is necessary to fully arrest the congestive conditions in the hospital, to educate patients with CHF, to patiently titrate oral medications to the maximally tolerated effective doses, to thoroughly monitor patients after the discharge from the hospital in order to reveal and correct decompensation as early as possible. It is useful to develop a modern and effective model of monitoring the course of the disease, capable of improving the efficiency of medical care, the quality of life and prognosis of patients – telemedical monitoring.
After the hospitalization of the patient with AHF it is necessary to assess the clinical status for the identification of life-threatening syndromes which require specific organizational tactics: acute coronary syndrome; hemodynamic “catastrophe”, respiratory failure, life-threatening tachi- or bradyarrythmia. Practical health care faces a set of tasks, which call for continuous improvement and assistance of scientists: improvement of the quality of life for patients with HF, decrease in mortality, reduction of the number and duration of rehospitalizations; refinement and creation of new diagnostic and therapeutic technologies, prompt selection of patients, who can be helped by nondrug therapy (invasive ventilation, temporary assist circulation) and in the future – resynchronization therapy or heart transplantation, optimization of drug therapy of CHF and of diseases, which triggered AHF, after the stabilization of the condition and before the discharge from the hospital.
2018 Том 2, №1
Cardiogenic Shock in Acute Myocardial Infarction - Losses and Achievements
N.P. Mitkovskaya
The most severe manifestation of acute cardiac failure - cardiogenic shock (CS)-occurs in 5-7% of patients and is accompanied by unfavorable outcome in 40-60% of cases, thus remaining the main cause of death among patients admitted to hospital with acute myocardial infarction. The North- American register INTERMACS, created for analyzing the effectiveness of application of various systems for rendering assistance to patients with severe cardiac failure, including the systems of artificial circulatory support, classifies cardiogenic shock as INTEMACS1.
2017 Том 1, №1