The article reviews the prevalence of cardiovascular diseases (CVD) related risk factors and the level of their control in Ukrainian population on the basis of information from population surveys and State Statistics Service of Ukraine. Factors having major impact on CVD development in Ukraine are hypertension, dyslipidemia, tobacco use, impaired glucose metabolism and type 2 diabetes mellitus, overweight and obesity, unhealthy diet, low level of physical activity and high level of anxiety. In 2015 the prevalence of hypertension in the Ukrainian population amounted to 29735.4 per 100 000, among the working age population – 18521.5 per 100 000, and the total number of smokers reached 6.2 million. Over past decades, some positive trends concerning Ukrainian population awareness of CVD risk factors may be noted. Tobacco use prevalence dropped from 25.6 % to 18.4 % within 2008–2015, there is a better control of hypertension, more physical activity, and more healthy nutrition. Physicians have been identified by The Ukraine national strategy for improving physical activity (2016) as the preferred source of information about physical activity and its impact on the risk of non-communicable diseases. Effective implementation of evidence-based strategies for CVD prevention require state engagement and adequate funding (budgetary allocations) in primary and secondary healthcare.
The paper describes the case of surgical treatment of hypertrophic obstructive cardiomyopathy. Extended resection of the interventricular septum, resection of three secondary (pathological) chords of the anterior leaflet of the mitral valve and mobilization of the papillary muscles of the mitral valve have been carried out using the Ferrazzi procedure. An objective improvement of echocardiography parameters and improvement of well-being with disappearance of dyspnea in moderate exercise and dizziness have been achieved after the operation.
Stent thrombosis is a dangerous life-threatening condition, which is more frequent during the first month after stent implantation. Currently, there are several possible schemes for preventing stent thrombosis with clopidogrel and stronger P2Y12 receptor inhibitors. The article describes the clinical case of stent thrombosis in a patient with clopidogrel resistance against the background of carrying the allelic variant of the gene CYP2C19*2, a «slow metabolizer of clopidogrel». Despite the recommended use of high doses of clopidogrel to improve the clinical outcome in patients with a homozygote CYP2C19*2 (*2/*2), this clinical case showed high doubtfulness of such tactics. In such cases, the use of more potent inhibitors of P2Y12 receptors is justified, since it allows improving clinical outcomes of mechanical revascularization.
The aim – to study heart structure and function according to the results of MR and ultrasound imaging, heart rate variability parameters, immune status indices in patients with myocarditis and to detect prognostic markers of unfavorable myocarditis clinical course.
Material and methods. Fifty two patients with clinically suspected acute diffuse myocarditis, sinus rhythm and heart failure with reduced LV ejection fraction (LV EF ≤ 40 %), among them 30 men and 22 women were examined. They were divided into two groups: 1st group – 27 patients with recovery of left ventricular ejection fraction (> 40 %) in 12 months, 2nd group – 25 patients without restoration of myocardial contractile function (LV EF ≤ 40 %). Within the 1st month after disease onset and after 12 months magnetic resonance imaging (MRI) of the heart, transthoracic echocardiography, Holter ECG monitoring with HRV parameters and examination of the immune status were performed.
Results. Left ventricular ejection after 12 months observation in patients of the 1st group increased by 27.8 % (P<0.01) and averaged 48.7 %, in patients of the 2nd group – by 12.4 % (P>0.05), on average to 38.5 %. Within the 1st month after myocarditis onset, myocardial edema at MRI was detected in 100 % and early contrast accumulation – in 92.3 % of patients (n=48). After 12 months of follow-up, both study groups were comparable by the results of detection of myocardial edema (18.5 and 20 %, respectively), and early contrast accumulation (22.2 and 28 %, respectively). The amount of delayed contrast accumulation zones at 12 months was significantly higher in patients in the second group – 42 (80.7 %) and 45 (86.5 %). The SDNN indicator in the 1st group increased by 18.3 % (P<0.05) for 12 months, while in the 2nd group it increased by 9.6 % (P>0.05). Number of ventricular arrhythmias and episodes of an unstable ventricular tachycardia after 12 months in patients of the 2nd group almost 2 and 2.5 times (P<0.01) respectively, exceeded the similar indicators of the 1st group. Conclusions. In patients with myocarditis, in which LV EF remained ≤ 40 % after 12 months, significantly greater amount of delayed contrast accumulation and a decrease of HRV parameters were noted, related to more frequent development of ventricular arrhythmias. Patients with myocarditis having sites with delayed MRI accumulation of contrast, had a significantly higher risk of developing episodes of unstable ventricular tachycardia after 12 months of follow-up, according to Fisher’s exact test (F=0.012, OR=6.88).
The aim – to estimate changes of the myocardial structural and functional state and intracardiac hemodynamics in patients with non-valvular permanent atrial fibrillation (PAF) under treatment with β-blockers (BB), to determine the critical value of the heart rate being a negative predictor of the echocardiographic parameters during 6 month monitoring, to identify the preference for one of the HR control strategies.
Material and methods. 30 patients were included in this study. The duration of observation was 238.3±17.0 days, it consisted in 3 visits. Titration of the BB dose lasted 67.7±10.3 days (the interval between the first and second visits). Treatment with maximal or maximal tolerable dose of BB lasted 170.6±17.7 days (the interval between the second and final visits). During the follow-up period, echocardiography was performed twice – at 2 and 3 visits.
Results. During follow-up period significant changes were revealed, i.e. increase of LV end-diastolic dimension and its index in the general group and in women; of LV end-diastolic volume in women; the increase of LV mass index in the general group and in women; basal and transverse diameters of the RV and its area in diastole; pressure in the LA; early diastolic mitral in flow velocity and its relation to early diastolic mitral annular velocity; diameters of the PA and aorta root, mitral regurgitation. Correlation analysis revealed relationship between rate of mitral annular systolic velocity and the degree of severity of mitral regurgitation with the mean daily HR value according to 24 h Holter ECG. Along with lenient heart rate control after 6 months significant increase of the the interventricular septum thickness, basal RV diameter and PA diameter was observed; fractional change of the RV area decreased. At achievement of strict heart rate control fractional change of the RV area significantly increased compared to lenient one.
Conclusions. During follow-up period in patients with PAF we observed progression of LV diastolic dysfunction, heart valve dysfunction and increase of heart chambers, more significant in women, due to pressure overload. The median daily heart rate > 91 beats/min recorded during Holter ECG is a predictor of systolic function deterioration according to the tissue Doppler. Strict heart rate control has an advantage over the lenient one to improve the myocardial structural and functional state, the size and contractility of the right heart.
The aim – to evaluate the effectiveness and safety of warfarin therapy in patients with atrial fibrillation (AF) in the anticoagulation practice, the rate of CYP2C9, CYP4F2, VKORC1 genes polymorphism and their interrelation with hemorrhagic complications among Zaporizhzhia region residents.
Material and methods. We studied 41 patients with AF (mean age – 68.2±1.2 years, men – 19, women – 22) enrolled in a 1-year out-patient observation in the anticoagulation practice of Zaporizhzhia State Medical University clinics. All patients were treated with warfarin. CYP2C9, CYP4F2, VKORC1 genes polymorphism was determined using polymerase chain reaction method.
Results. During one year hemorrhagic complications (small bleedings) arose in 22 (53.66 %) patients with AF, receiving warfarin therapy. Bleedings were significantly more frequent in the group of patients with VKORC1 gene mutation: 69.5 % vs. 37.5 %, respectively (χ2=5.331; Р<0.05). It was found that the relative risk of bleeding under warfarin treatment in patients with VKORC1 gene mutation is 1.97 (95 % CI 1.039; 3.751; Р<0.05). Conclusions. VKORC1 polymorphism is associated with increased frequency of hemorrhagic complications in patients with AF taking warfarin, indicating the relevance of a personalized approach to the warfarin dose titration using pharmacogenetic testing.