The work is based on an analysis of a clinical case in a patient with paroxysmal tachycardia with narrow QRS complexes, which was diagnosed as WPW phenomenon by electrocardiography. A differential electrophysiological diagnosis was performed. It was proven that tachycardia with narrow complexes was an atypical form of atrioventricular nodal reciprocal tachycardia, and the WPW phenomenon is a concomitant diagnosis. This finding allowed to perform a successful radiofrequency ablation of tachycardia without redundant applications and X-ray exposure. The obtained data allow to clarify the existing knowledge about paroxysmal tachycardia and to improve the results of diagnosis and surgical treatment of this category of patients.
The aim – to compare patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF) without anemia depending on the presence of iron deficiency (ID) according to the main clinical, hemodynamic, laboratory parameters and prognosis indicators.
Material and methods. In January – February, 2018, 95 stable patients with CHF (83 of men and 12 of women), 18–75 years old, NYHA class II–IV, with left ventricular ejection fraction < 40 % were screened. Patients were included during clinical compensation phase. Quality of life was assessed by the Minnesota living with heart failure questionnaire (MLHFQ), physical activity was estimated by the Duke University index, functional status – by assessing the 6-minute walking test and a standardized lower limb extension test. Results. ID was found in 51 out of 95 patients without anemia. Patients with ID without anemia were reliably in higher functional class, had a lower body mass index, lower systolic blood pressure, glomerular filtration rate, worse 6-minute walking test and thigh quadriceps endurance and a lower quality of life by MLHFQ. They also had lower hemoglobin, MCV, MCH, hepcidin levels and higher NT-proBNP, interleukin 6, and citrulline levels. The presence of ID, even without concomitant anemia, increased both risk of death from any cause and the combined critical event risk (death or hospitalization) during 12 and 24 months. Conclusions. Among patients with CHF and reduced LVEF without anemia, ID was observed in 54 % of patients. Patients with ID were characterized by a greater proportion of patients in NYHA class III–IV and renal dysfunction, poorer functional capacity (6-minute walking test, thigh quadriceps endurance), poorer quality of life, lower body mass index, lower systolic blood pressure and lower hemoglobin and hepcidin levels along with higher circulating interleukin 6, citrulline and NT-proBNP levels. ID without concomitant anemia was associated with worse survival and more frequent hospitalizations.
The aim – to study the possibilities of correction of renal function parameters in patients with CHF and reduced LV EF on the background of treatment with a fixed combination of meldonium with gamma buterobetaine.
Material and methods. A total of 24 patients with stable CHF and reduced left ventricular ejection fraction (EF < 40 %), II–IV NYHA classes were examined. Among them, 17 people had CHD, 5 people – dilated cardiomyopathy. All patients underwent general clinical examination, determination of levels of creatinine, blood urea nitrogen, uric acid, microalbuminuria, GFR using the formula CKD-EPI. Ultrasound diagnosis of the vasodilating function of the brachial artery endothelium was performed using a test with reactive hyperemia. Against the background of standard treatment, patients received a fixed combination of meldonium with gamma-butyrobetaine (GBB) at a dose of 2 tablets 3 times a day (every 8 h) for 4 weeks. Results. Against the background of a 4-week intake of a combination of 360 mg of meldonium and 120 mg of GBB three times a day, patients had a statistically significant improvement in creatinine and GFR. Uric acid levels in the blood plasma of patients did not significantly change. There was no significant effect on the level of heart rate and systolic blood pressure. The levels of daily MAU significantly decreased, as well as blood urea nitrogen. There was a statistically significant improvement in vasodilator function of the endothelium. Conclusions. In stable patients with CHF and reduced LV EF, addition of meldonium 360 mg with GBB 120 mg to the standard pharmacotherapy is accompanied by improvement of renal function shown by significant reduction of blood creatinine, increase of GFR, decrease of blood urea nitrogen and daily MAU. This treatment improves vasodilator endothelial function.
The aim – assessment of gender differences in the frequency of comorbidities, structural and functional state of the heart, arterial stiffness, pulse load and ventricular-arterial interaction in patients with hypertension and heart failure with preserved left ventricular ejection fraction.
Material and methods. 115 patients were diagnosed with HFpEF II A or II B stage, II or III NYHA FC, with LV EF ≥ 50 % and signs of LV diastolic dysfunction by TTE, and were divided into 2 groups by gender (group 1 – women with AH and HFpEF, and group 2 – men with hypertension and HFpEF). The control group consisted of 58 patients matched for age, gender composition, with AH 1–2 degrees, without heart failure; they were also divided into 2 groups (groups 3 and 4, respectively).
Results. The examined groups of patients did not statistically differ regarding age and, among patients with HF, men and women did not differ in frequency of II or III FC (NYHA); among men, earlier MI was noted more frequently than in women – 23 (37.1 %) vs 4 (7.5 %) (P<0.001). BMI among women with or without HF was higher (30.3±5.4 vs. 29.8±4.6 and 32.0±4.5 vs. 30.0±3.2, P<0.05), without differences in the frequency of obesity. In women, the average GFR was lower – 61.2±13.5 vs. 74.4±15.2 and 70.6±1.3 vs. 86.1±17.9 (by 13.3 % and 18 %, respectively, P<0.001) Among patients with HFpEF, the prevalence of anemia was higher in women (16 (30.2 %) vs. 7 (11.3 %), P<0.05). The distance of the 6-minute walk test was significantly less in the group of patients with HF of both genders compared with the control group (353.4±91.6 vs. 553.2±56.6 and 384.3±83.5 vs. 569.8±33.7, P<0.01), with a slightly worse result among women (by 8 %, P<0.01). In women with HF, compared with men, there were elevated rates of both arterial elastance Ea — 2.3±0.6 vs.1.9±0.4, P<0.05 (by 17.4 %), and end-systolic stiffness Ees – 3.3±1.3 vs. 3.0±1.1, P<0.05 (by 9.1 %). Despite similar values of brachial BP and central BP in women with HF, compared to men, larger PWWc-f was noted by 9.5 % (12.8±1.5 vs. 12.2±1.4, P<0.05) and AIx75 by 9.2 % (37.7±12 1 vs. 34.7±8.9, P<0.05). Conclusions. In the population of the examined patients with AH and HFpEF there is a tendency towards more pronounced diastolic LV dysfunction, severity of clinical manifestations of heart failure in women, in comparison with men, in the absence of gender differences. Women with HFpEF have a higher resistive and pulsative load on LV. Thus, in women with hypertension, there is an increased tendency to develop HFpEF compared to men.
The aim – to investigate the relationship between cognitive function and adherence to treatment; to evaluate the predictive value of adherence to treatment questionnaires in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF).
Material and methods. 124 pts with stable CHF and reduced (< 40 %) LVEF NYHA II–IV not older than 75 years were examined. Besides routine clinical examination, standard neuropsychological tests (Mini Mental State Examination – MMSE, Schulte test, the HADS scale) were used. To assess adherence to the treatment, the Moriski – Green questionnaire and the disease-specific questionnaire of heart failure department were used. Cognitive dysfunction was defined as MMSE ≤ 26 points. Results. After distribution of pts to three groups depending on their adherence to treatment, it was found that they significantly differed in MMSE and Shulte test results. The number of points regarding adherence to treatment (Moriski – Green questionnaire and the questionnaire of heart failure department) directly correlated with MMSE (P=0.038 and P=0.023, respectively). The group of patients with high compliance had significantly better cognitive tests results (MMSE and Schultze) than the group of patients with moderate/low compliance – this was equally relevant to both questionnaires. The construction of survival curves showed that Moriski – Green questionnaire had no reliable prognostic significance both in relation to death and combined critical event (mortality/hospitalization) (P=0.113 and P=0.401, respectively); At the same time, the disease-specific questionnaire of heart failure department showed value regarding the prediction of long-term survival and the onset of a combined critical event (P=0.046 and P=0.024, respectively). Conclusion: More than half of pts with CHF and reduced LVEF have low and moderate adherence to treatment, which is associated with worse cognitive tests results (MMSE and Schulte). Evidence of relationship between adherence to treatment and cognitive function evaluated using our questionnaire were comparable to those obtained by Moriski – Green questionnaire. Using disease-specific questionnaire of heart failure department had a high value in predicting long-term survival and the onset of combined critical event (death or hospitalization) in patients with CHF and reduced LVEF, while the Moriski – Green questionnaire did not demonstrate the above-mentioned predictive value.
The aim – determine the state of cognitive function in the early and late postoperative period in patients with coronary heart disease who underwent on-pump coronary artery bypass grafting.
Маterial and methods. In a retrospective observational one-center study, the data obtained from the clinical and instrumental examination of patients who underwent on-pump coronary artery bypass grafting were analyzed. The analysis group included 84 patients (51.5 %) from the total cohort of 163 patients (68 men (80.9 %) and 16 women (19.1 %), mean age 64.4±7.5 years), in which in the early postoperative period cognitive impairments were detected. Neurocognitive testing was performed 3 days prior to surgery, on the 7th day after the intervention, and 3 months after discharge from the hospital using the MMSE Mini Mental State Examination Scale and the Trial Making Test Part A and B.
Results. Patients in the surveillance group in the preoperative period at the time of passing the MMSE test scored 26.2±2.3 points. At 7 days after surgery, patients gained 23.6±2.2 points (8.2 % less than before the operation – mild cognitive impairment). 3 months after discharge from the hospital, the patients of the study group gained 24.8±2.2 points (improving the cognitive status, but failed to achieve the upward level of testing). The patients spent 32.0±5.0 seconds test for the Trial Making Test Part A series in the preoperative period and 35.6±6.8 seconds on day 7. After 3 months after the operation, the test results amounted 33.3±5.0 seconds, which didn’t differ compared to preoperative indicators. The second part of the Trial Making Test Part B showed similar results.
Conclusion. The results of the cognitive tests for patients undergoing coronary artery bypass grafting demonstrated that cognitive dysfunctions registered in the early postoperative period in 51.5 % of patients (in the form of mild cognitive impairment), significantly decreased to 16.6 % at 3 months after surgery, which is consistent with the results of international studies.
The aim – to study the effectiveness of spironolactone, eplerenone, nebivolol, moxonidine as the 4th component of therapy in patients with resistant arterial hypertension.
Material and methods. The study involved 66 patients with true resistant arterial hypertension (RAH). The average age of patients was 51.9±1.2 years, mostly men (59.1 %). In addition to standard triple-dose fixed combination antihypertensive tharepy, all patients received in turn spironolactone (45.0±3.6 mg/day), eplerenone (47.9±2.1 mg/day), nebivolol (8.9±0.6 mg/day) and moxonidine (0.5±0.1 mg/day). After completion of each stage, after 3 months of therapy, all patients have been assessed an office blood pressure measurements and ABPM.
Results. In patients with RAH, the addition standardized therapy with a triple fixed-dose combination of antihypertensive drugs, antagonists of mineralocorticoid showed better effectiveness than nebivolol and moxonidine: the target level of BP with treatment of spironolactone was achieved in 68.2 % patients, eplerenone – 65.2 %, whereas in the groups of nebivolol and moxonidine – in 53.9 % and 56.2 %, respectively. The predictors of the effectiveness of the antagonists of the mineralocorticoid receptors are increasing plasma aldosterone concentrations (β=0.653; Р=0.002) and ARR values (β=0.542; Р=0.003), while the β-blocker and imidazolin receptor agonist were more effective in older patients (β=0.425; Р=0.02) along with increase of average daily pulse (β=0.315; P=0.04) and excretion of urine metanephrines (β=0.382; Р=0.01).
Conclusoins. Spironolactone and eplerenone are drugs of choice for adding to triple fixed-dose combination in patients with RAH. They were significantly more effective than beta-blocker (nebivolol) and an imidazolin receptor agonist (moxonidine).
The aim – to investigate the acute coronary syndrome without ST segment elevation and concomitant essential hypertension clinical presentation in men and women with Helicobacter pylori infection.
Material and methods. 197 acute coronary syndrome without ST segment elevation patients (age 45–83 years) with essential arterial hypertension and dyspesia were investigated according to the current clinical protocols with total antibodies to Helicobacter pylori rate detection. The patients were divided by the groups of men and women, infected and uninfected with Helicobacter pylori. The clinical presentation of acute coronary syndromes was evaluated using the 13-item Acute coronary syndrome symptoms checklist and the dyspepsia symptoms were estimated by the Likert scale.
Results. In case of Helicobacter pylori infection compared to uninfected patients a significantly higher severity of chest pain, shoulder pain and upper back pain had been revealed, while among women the chest discomfort, sweating and palpitations significantly prevailed. The intensity of dyspeptic symptoms, especially heartburn and nausea, was significantly higher among women infected with Helicobacter pylori. A significant progression of heart failure with higher prevalence of edema and liver enlargement were revealed in men infected with Helicobacter pylori versus uninfected and in men versus women regardless of Helicobacter pylori infection factor.
Conclusions. The obtained link between the total antibodies to Helicobacter pylori titer and the patients’ age, male gender, myocardial infarction history, the prevalence of edema and liver enlargement might indicate a significant clinical course deterioration and heart failure progression in elderly male patients with acute coronary syndromes without ST segment elevation and essential hypertension in case of Helicobacter pylori infection.