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Eurasian heart journal

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No 1 (2021)
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CLINICAL GUIDELINES

6-43 2803
Abstract

Disclaimer The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

44-77 29191
Abstract

Disclaimer. The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

ORIGINAL PAPERS

78-86 402
Abstract

The aim. To evaluate the clinical outcomes and features of the state of the platelet-plasma and vascular hemostasis in patients (pts) with unstable angina and coronary artery bypass grafting (CABG) on-pump and off-pump for the correction of antithrombotic therapy and reduce the number of postoperative cardiovascular events.
Material and methods. The study included 146 pts with unstable angina (UA) with a surgical treatment strategy. CG amounted to 106 pts with CABG and a standard approach to drug maintenance. MG comprised 40 pts with CABG and a personalized approach to antithrombotic therapy.
Results. In CABG off-pump in pts with UA, an increased in platelet aggregation and activation of platelet hemostasis occurs on the 2nd day of the postoperative period, in CABG on-pump on the 5-7th day. Activation of plasma hemostasis had laboratory manifestations on the 5-7th day of the postoperative period, and is most pronounced in CABG on-pump, compared with CABG off-pump. After 1 month of control, 38,7% pts with UA and CABG were characterized by the presence of high residual platelet reactivity against the background of standard antiplatelet treatment, of which 23,6% retained activation of plasma hemostasis, which is manifested in excess of the normal level of D-dimers, as well as an increased in peak thrombin concentration and endogenous thrombin potential. Patients with UA and CABG who underwent correction of antithrombotic therapy differed from patients with a standard approach to treatment with a significantly lower number of repeated cardiovascular events over 2 years of follow-up (5% versus 22.6%).

88-93 407
Abstract

Purpose. To study the genetic aspects of increased heart rate (HR) in representatives of various ethnic groups living in Mountain Shoria.
Material and Methods. The study involved residents of the villages of Mountain Shoria aged 18 years and older. Included are 901 people – representatives of indigenous nationality (Shors), 408 people – of nonindigenous nationality. The groups did not differ by gender and age. The analysis was carried out depending on the increased level of heart rate (over 80 beats/min). Typing of polymorphic sites of the ACE (I/D, rs4340), ADRB1 (p.145A> G, Ser49Gly, rs1801252), ADRA2B (I/D, rs28365031), MTHFR (c.677C> T, Ala222Val, rs1801133) and NOS3 (VNTR, 4b/4a) was carried out using polymerase chain reaction. The association of different genotypes with heart rates above 80 beats/min was judged by the odds ratio in five inheritance models (codominant, dominant, recessive, overdominant and log-additive), and its 95% confidence interval was calculated.
Results. Ethnic features of the prevalence of increased heart rate have been established depending on the polymorphism of candidate genes involved in the pathogenesis of arterial hypertension. The respondents of the indigenous ethnic group had a high probability of developing tachycardia determined by the carriage of the C/T genotype of the MTHFR gene according to an overdominant type of inheritance [OR = 2.46]. Allele D of the ACE gene determined the tendency to the development of this pathology according to the recessive type of inheritance [OR = 1.91]. However, among young people and men, carriage of a prognostically unfavorable D/D genotype of this gene was associated with a high risk of increased heart rate [OR = 3.34] and [OR = 4.62], respectively. In a cohort of non-indigenous nationality, the heterozygous genotype I/D of the ACE gene determined the likelihood of tachycardia by an overdominant type of inheritance [OR = 2.08].
Conclusions. Most epidemiological studies show a significant difference in the contribution of the studied polymorphisms to the appearance of increased heart rate for various ethnic groups. For a small population of Mountain Shoria, genetic features of the development of tachycardia have been established. In this regard, it is advisable to take into account national characteristics when determining individual risk, and apply personalization to correction programs.

94-104 521
Abstract

Aim. To analyze the factors associated with a poor outcome of pulmonary thromboendarterectomy (PTE) and complications of the hospital postoperative period; on the basis of this analysis to optimize preoperative preparation and therapeutic support of the operation.
Materials and methods. The study included 47 patients with operable CTEPH, who underwent PTE in the Department of cardiovascular surgery of the national medical research center of cardiology from 2010 to 2018. Patients were observed during the intrahospital period, all were evaluated for clinical, instrumental, hemodynamic, and laboratory parameters. Diagnosis and treatment of complications, assessment of the relationship of factors associated with the development of these pathological conditions were carried out.
Results. A comprehensive assessment of the parameters revealed that age over 50 years, the presence of proven antiphospholipid syndrome (AFS) were independently associated with a higher frequency of adverse surgical outcomes and in-hospital complications. Older age and a history of smoking were independently associated with a greater likelihood of developing reperfusion pulmonary edema. The probability of developing transient neurological complications is independently associated with a long duration of deep hypothermic circulatory arrest (DHCA), an increased level of D-dimer. A greater age and longer duration of ventilation are independently associated with the likelihood of developing acute kidney injury (AKI). A higher level of antithrombin III and the presence of AFS were independently associated with the likelihood of developing prolonged ventilation.
Conclusion. When selecting candidates for surgery, in addition to the generally accepted clinical and instrumental parameters, it is necessary to take into account a history of Smoking, an increase in d-dimer, and the presence of AFS. Patients with this pathology need a more thorough risk assessment, correction of target levels of activated partial thromboplastin time (aPTT), activated clotting time (ACT) due to their falsely inflated indicators, and further development of standards for perioperative support. The main principle of cardiological support of the operation is the earliest possible diagnosis of all known perioperative complications and the rapid start of their treatment, which ensures the stabilization of the patient’s condition in 85% of cases in the hospital period. In the postoperative period, an early transition from ventilator to independent breathing is indicated for the prevention of associated complications, including AKI.

REVIEWS

106-117 772
Abstract

Modern scientific approaches give clinicians an advantage in using additional tools and methods for assisting in clinical assessment and expanding their capabilities for classifying patients according to risk factors for cardiovascular complications. Biomarkers are a simple tool that allows to identify and classify people with different risk degree, quickly and accurately diagnose the condition of the disease, effectively predict and control treatment. Therefore, the identification and study of biomarkers is a serious and promising approach to understanding and treating cardiovascular diseases (CVD). Among a wide range of biomarkers, the genetic and metabolic markers is of high importance. Cardio-metabolomics is a new direction in cardiovascular science that allows researchers to study changes in metabolome and metabolic networks in diseases of the cardiovascular system in order to better understand their pathophysiological mechanism. Thus, the study of metabolome can provide important information about the pathogenesis of CVDs, as well as offer the possibility of identifying new CVD biomarkers.

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ISSN 2225-1685 (Print)
ISSN 2305-0748 (Online)