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Aim To study the consistency of the practice of management, selection and routing of patients at high risk of sudden cardiac death (SCD) selected for cardioverter-defibrillator implantation (CDI) with current clinical guidelines and to evaluate the quality of subsequent outpatient follow-up and treatment based on a retrospective analysis of clinical amnestic data from the Kuzbass Registry of Patients with CDI.Material and methods The study was based on the Registry of Patients with Implanted Cardioverter Defibrillator and included successive data of 28 patients hospitalized to the Kizbass Cardiological Center from 2015 through 2019. Social and clinical amnestic characteristics, indications for CVI, and concomitant drug therapy were analyzed retrospectively. Statistical analyses were performed with the Statistica 10.0 software (Statsoft, USA).Results Median age of patients was 59 (53; 66) years; 239 (83.6â%) men were included; 29 (10.1%) people were employed, CHI was performed in 182 (63.6â%) patients for prevention of SCC, and for secondary prevention in 104 (36.4â%) patients. 208 (72.7â%) patients were diagnosed with ischemic heart disease (IHD), and 145 (67.9â%) of them underwent myocardial revascularization. Noncoronarogenic diseases were found in 78 (27.3â%) patients, and most of them were diagnosed with dilated cardiomyopathy. All patients had chronic heart failure (CHF); half of them had stage IIA CHF. Median left ventricular ejection fraction was 30 (25; 36,5) % according to echocardiography using the Simpson method. Comorbidity was found in 151 (52.8â%) patients. 128 (44.8%) patients received a triple neurohormonal blockade for CHF treatment; titration to target doses was not performed in any of them. Antiarrhythmics were administered to 150 (52.4â%) patients.Conclusion According to the data from the Kuzbass Registry of CVI, the main patient cohort consisted of men of pension age with IHD and CHF. Before CVI, more than a half of them had not received an optimum drug therapy and not all of them had received target lesion revascularization. Creating and analysis of Registries of CHI patients is an effective method for identifying existing problems in patient management before CVI and for optimizing their subsequent follow-up and treatment.
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Desfibriladores Implantables , Función Ventricular Izquierda , Anciano , Muerte Súbita Cardíaca/epidemiología , Muerte Súbita Cardíaca/etiología , Muerte Súbita Cardíaca/prevención & control , Desfibriladores , Cardioversión Eléctrica , Humanos , Masculino , Estudios Retrospectivos , Factores de Riesgo , Volumen SistólicoRESUMEN
Aim To evaluate the effectiveness of the decision-making module in selecting an oral anticoagulant for patients with atrial fibrillation.Material and methods 638 patients with atrial fibrillation aged 68.2±4.5 years were evaluated. The CHA2DS2-VASc, HAS-BLED, and 2MÐСРscales, the creatinine clearance calculator, and the Morisky-Green questionnaire were used.Results 311 (48.75â%) patients had paroxysmal atrial fibrillation, 138 (21.6%) had persistent atrial fibrillation, 44 (22.7%) had long-standing persistent atrial fibrillation, and 145 (22.7â%) had permanent atrial fibrillation. Mean CHADS2VASc scale score was 4.82; ÐAS-BLED scale score was 2.9; 2MACE score was 2.28; and compliance score was 3.52. 172 (26.9â%) patients were treated with rivaroxaban; 166 (26â%), with apixaban; 84 (13.2â%), with dabigatran; 210 (32.9â%), with warfarin; and 6 (1â%), with acetylsalicylic acid.Conclusion The developed decision-making module is based on scientific justification of personalized selection of the oral anticoagulant and updates the knowledge on major issues of prescription.
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Fibrilación Atrial , Accidente Cerebrovascular , Administración Oral , Anciano , Anticoagulantes/uso terapéutico , Fibrilación Atrial/tratamiento farmacológico , Dabigatrán/uso terapéutico , Humanos , Persona de Mediana Edad , Piridonas/uso terapéutico , Rivaroxabán/uso terapéutico , Accidente Cerebrovascular/tratamiento farmacológico , Warfarina/uso terapéuticoRESUMEN
AIM: To assess advantages of integrated approach to improvement of efficiency and safety of warfarin therapy after heart valve replacement. MATERIALS AND METHODS: We included in this study 118 patients who had undergone simultaneous mitral valve replacement and maze procedure. Group 1 patients (n=37) underwent just sinus rhythm restoration, group 2 patients (n=54) underwent sinus rhythm restoration and participated in a patient education program, group 3 patients (n=27) underwent sinus rhythm restoration, participated in a patient education program, and were subjected to pharmacogenetic testing for warfarin sensitivity. In examination of patients we used clinical, demographic, and instrumental methods. Estimation of the time in the therapeutic range (TTR) of an international normalized ratio (INR) was used as a measure of warfarin therapy quality, and the Kaplan-Meier method was applied for analysis of hemorrhagic and thrombotic complications. RESULTS: TTR was 42 % in group 1, 68 % in group 2 (p=0.0327), and 82 % in group 3 (p=0.0019). Application of integrated approach was associated with absence of hemorrhagic and thrombotic complications within one year after heart valve replacement. CONCLUSION: The integrated approach comprising restoration of sinus rhythm, patient education, and pharmacogenetic testing for warfarin sensitivity was associated with improved anticoagulation control, and prevention of hemorrhagic and thrombotic complications.
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Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Anticoagulantes , Humanos , Relación Normalizada Internacional , Válvula Mitral , WarfarinaRESUMEN
UNLABELLED: The aim of the study was to estimate the efficacy and safety of dabigatran in comparison with warfarin after atrial fibrillation (AF) catheter ablation (CA). METHODS: 228 consecutive patients, having undergone AF CA, were enrolled in retrospective trial. In group I (n=170) warfarin was administered by modified interrupted scheme, in group II (n=58) dabigatran was administered by 150 mg twice a day. The main clinical efficacy and safety indicators were evaluated during the procedure and within 12 months after the procedure. RESULTS: There was no statistically significant difference between patients taking warfarin and dabigatran (p>0,1) in all of the investigated parameters, including the amount of bleeding and thromboembolic events. Side effects of mild dyspepsia were observed in the dabigatran group in 2.7% of the observations and in the warfarin group in 2.4% (p = 0,589). None of them required discontinuation of the therapy. CONCLUSION: Dabigatran can be considered as an alternative to warfarin for anticoagulation in patients undergoing AF CA.
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Fibrilación Atrial , Ablación por Catéter/métodos , Dabigatrán , Tromboembolia , Warfarina , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Fibrilación Atrial/complicaciones , Fibrilación Atrial/terapia , Dabigatrán/administración & dosificación , Dabigatrán/efectos adversos , Monitoreo de Drogas/métodos , Femenino , Hemorragia/inducido químicamente , Hemorragia/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Siberia , Tromboembolia/etiología , Tromboembolia/prevención & control , Resultado del Tratamiento , Warfarina/administración & dosificación , Warfarina/efectos adversosRESUMEN
We analyzed clinical efficacy of a strategy of sinus rhythm (SR) restoration after single stage correction of mitral valve defect and failed radiofrequency maze procedure elaborated and realized in the Research Institute for Complex Issues of Cardiovascular Diseases, and assessed its value for increase of efficacy and safety of anticoagulant therapy. First stage of this strategy--cardiosurgical treatment with maze procedure--resulted in restoration of SR in 61.8% of cases. In case of persistence of tachyarrhythmia external elelectro-impulse therapy was used in 1-1.5 months after cardiac surgery as a second stage of our strategy. Third stage--catheter radiofrequency ablation--was applied to patients with implanted biological cardiac valves. Second and third stages facilitated restoration of SR in 84.8 and 93.2% of patients, respectively, and provided 100% SR restoration in patients with biological valve prostheses. The suggested strategy allowed to withdraw anticoagulant therapy in patients with biological valves and to reduce level of hypocoagulation to lower limit of target range in patients with mechanical prostheses.
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Anticoagulantes/uso terapéutico , Fibrilación Atrial , Bioprótesis , Ablación por Catéter , Enfermedades de las Válvulas Cardíacas , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Complicaciones Posoperatorias/prevención & control , Adulto , Fibrilación Atrial/etiología , Fibrilación Atrial/terapia , Ablación por Catéter/efectos adversos , Ablación por Catéter/métodos , Femenino , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/cirugía , Recurrencia , Resultado del TratamientoRESUMEN
AIM: To evaluate diagnostic and prognostic significance of the levels of proinflammatory cytokines (IL-1, IL-6, TNF-alpha) in improvement of stratification, i.e. determination of coronary restenosis risk in patients with ischemic heart disease 18 months after coronary artery (CA) stenting. The patients were divided into two groups: group 1 consisted of 30 patients with ischemic heart disease and symptoms of anginal recurrence, 38 patients of group 2 had no recurrent coronary insufficiency. Baseline examination of 68 patients with ischemic heart disease and their examination 6-24 months (18.1 +/- 1.9 months) after CA stenting were performed. RESULTS: High activation of the proinflammatory cytokines in patients with postinfarction cardiac dysfunction and after CA stenting is associated with a high rate of recurrent angina, deterioration of myocardial perfusion, progression of atherosclerosis in CA native bed. Restenosis of CA stents in patients after endovascular myocardial revascularization significantly more frequently correlates with elevated blood levels of IL-6 by 56.8% (p = 0.031). Patients with anginal recurrence caused by stent restenosis, progression of atherosclerosis in native CA developed high expression (10.2-58.1%) of TNF-alpha (p = 0.038) 18 months after endovascular revascularization. Repeated angioplasty is associated with multiple CA affection (k = 0.56, p = 0.004) and predilation before stenting (k = 0.3; p = 0.001). CONCLUSION: Dynamics of proinflammatory cytokines (IL-1, IL-6 and TNF-alpha) is efficient to use in complex diagnosis for better stratification of CA restenosis risk in endovascular stenting of patients with coronary artery disease.
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Reestenosis Coronaria/sangre , Citocinas/sangre , Revascularización Miocárdica/métodos , Medición de Riesgo/métodos , Stents , Adulto , Angiografía Coronaria , Reestenosis Coronaria/diagnóstico por imagen , Reestenosis Coronaria/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico por imagen , Isquemia Miocárdica/cirugía , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Siberia/epidemiología , Factores de TiempoRESUMEN
Effect of 6 months treatment with carvedilol (25 mg/day) on blood levels of cytokines (interleukins 1alpha, 2, 6, 8, tumor necrosis factor alpha) and clinical symptoms of heart failure was studied in patients with cardiac dysfunction after myocardial infarction. Patients with NYHA class II heart failure, ejection fraction 50% and moderately lowered tolerance to physical exercise (n=21) initially had enhanced cytokine expression: blood content of interleukin (IL) 2 was 2.8 times, tumor necrosis factor (TNFalpha) 78%, IL-1alpha 60% above normal level. Therapy with carvedilol in this group was associated with decreases of Il-2 (-23.8%), TNFalpha (-16.7%), IL-1alpha (-12.5%) (p<0.05-0.01). This was accompanied by alleviation of clinical symptoms and improved exercise tolerance. Patients with NYHA class III heart failure (n=16) with low left ventricular ejection fraction (30+/-2.7%) and low exercise tolerance had high levels of all studied cytokines. Levels of IL-2, TNFalpha and IL-1alpha were most elevated (3.1, 2.8 and 2 times higher than normal values, respectively). Therapy with carvedilol was associated with improvement of clinical symptoms and exercise tolerance (+35%, p<0.05)), increase of ejection fraction (+15%, p<0.05), decrease of left ventricular end systolic volume (-17.5%, p<0.05), and lowering of blood levels of TNFalpha (-31%), IL-2 (-17.4%), IL-1alpha (-15.6%). However cytokine levels remained substantially elevated compared with normal values. Carvedilol was well tolerated, and did not cause negative metabolic effects or other complications.
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Antagonistas Adrenérgicos beta , Citocinas , Antagonistas Adrenérgicos beta/uso terapéutico , Citocinas/sangre , Tolerancia al Ejercicio/efectos de los fármacos , Insuficiencia Cardíaca , Humanos , Función Ventricular Izquierda/efectos de los fármacosRESUMEN
AIM: To assess influence of 2-week course therapy with atenolol, nebivolol, and verapamil on systolic and diastolic left ventricular function and mammary coronary blood flow in early period after revascularization. MATERIAL: Patients (n=113) after mammary coronary bypass grafting. METHODS: Echocardiographic characteristics of systolic and diastolic left ventricular function, and blood flow through mammary coronary grafts were measured before and after treatment with study drugs. RESULTS: In placebo treated patients isovolumic relaxation time (IVRT) and late diastolic filling phase (A) increased, while velocity characteristics of mammary-coronary blood flow decreased. Administration of atenolol, nebivolol, and verapamil was associated with significant increases of left ventricular ejection fraction, stroke volume, cardiac output, IVRT, peak diastolic velocity, flow through mammary coronary grafts and their lumen diameter, and decrease of E/A ratio. CONCLUSION: Administration of atenolol, nebivolol, and verapamil in early postoperative period after mammary coronary bypass grafting improved systolic and diastolic function of the left ventricle, and blood flow through mammary coronary grafts. None of the studied drugs had significant advantage over others.
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Puente de Arteria Coronaria , Diástole , Diástole/efectos de los fármacos , Hemodinámica , Humanos , Volumen Sistólico/efectos de los fármacos , SístoleRESUMEN
AIM: To assess antiischemic efficacy, safety and effect on myocardial perfusion of a course treatment with mildronate (as monotherapy and in combination with atenolol) in patients with postinfarction left ventricular dysfunction associated with moderate heart failure. MATERIAL AND METHODS: Patients (n=47) with postinfarction cardiosclerosis, angina, and decreased tolerance to physical exertion were divided into 2 groups. Patients of group 1 had functional class II angina and NYHA class I-II heart failure, patients of group 2 had functional class II-III angina and severe heart failure. Mildronate (0.75-1.0 g/day) was used as monotherapy in group 1 and in combination with atenolol (25-50 mg/day) in group 2. Duration of therapy was 3 weeks. RESULTS AND CONCLUSION: The use of mildronate was associated with marked antiischemic effect. Combined administration of mildronate and atenolol resulted in additional antiischemic effect without impairment of hemodynamics in patients with severe heart failure. Course use of mildronate was well tolerated. Adverse effects were registered in 4,2% of cases.
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Antagonistas Adrenérgicos beta/uso terapéutico , Atenolol/uso terapéutico , Fármacos Cardiovasculares/farmacología , Fármacos Cardiovasculares/uso terapéutico , Metilhidrazinas/uso terapéutico , Complejos Multienzimáticos/antagonistas & inhibidores , Infarto del Miocardio/complicaciones , Disfunción Ventricular Izquierda/tratamiento farmacológico , Disfunción Ventricular Izquierda/etiología , Antagonistas Adrenérgicos beta/administración & dosificación , Atenolol/administración & dosificación , Fármacos Cardiovasculares/administración & dosificación , Quimioterapia Combinada , Humanos , Masculino , Metilhidrazinas/administración & dosificación , Persona de Mediana Edad , Proteína Trifuncional MitocondrialRESUMEN
AIM: To assess efficacy of dihydropyridine calcium antagonists nifedipine and amlodipine for prevention of spasm of internal mammary artery after mammary-coronary bypass grafting. MATERIAL AND METHODS: Eighty eight men (age 56,5-/+7.2 years) subjected to mammary-coronary grafting were randomized to 3 groups. Patients of group 1 (n=35) received nifedipine (10 mg t.i.d.), patients of group 2 (n=30) received amlodipine (5 mg o.d.) and patients of group 3 (n=23) did not receive calcium antagonists. The following parameters were studied: mean linear and volume velocity of blood flow, graft lumen diameter, systolic-diastolic index. Dynamics of flow was assessed during 2 weeks after surgery. RESULTS: In nifedipine treated patients blood flow through grafts to posterior interventricular, anterior interventricular, anterior interventricular and diagonal branches rose by 61.2, 37.4, and 102.9%, respectively. In amlodipine treated patients these figures were 103.4, 113.1 and 147.1%, respectively. Treatment with nifedipine was associated with decrease of graft systolic-diastolic index by 20.2, 20.7, 19.9%, respectively, treatment with amlodipine--by 27.3, 20.6, 32.9%, respectively. Lumen diameter of grafts to posterior interventricular, anterior interventricular, anterior interventricular and diagonal branches in nifedipine treated patients increased by 9.5, 17.6, and 7.7%, respectively, in amlodipine treated patients--by 20, 22.7, and 25.9%, respectively. Moreover amlodipine was better tolerated. CONCLUSION: The first dose of nifedipine and amlodipine increased diameter of mammary-coronary grafts and blood flow through them. Augmentation of these effects which occurred during further use of nifedipine and amlodipine for 2 weeks was milder and more gradual in amlodipine treated patients.