Author Archives: Vitali Nesukaj

Yu.I. Kuzyk, I.I. Hoshovska, B.A. Hoshovsky Primary cardiac fibroma of the right ventricle in the child: clinical and pathomorphological analysis of case

Case of cardiac fibroma of the right ventricle of the heart in a girl of 1 year 3 months age is described. Clinically, the tumor had an asymptomatic course, which was interrupted by sudden occurrence of heart failure with attacks of the paroxysmal ventricular tachycardia. Fibroma had a typical histological structure at the pathomorphology. The death of a child occurred during the surgical treatment initiated due to vital indications, being a result of cardiac failure due to cardiogenic shock. Tumors of the heart are a rare pathology in childhood, difficult for timely diagnosis and treatment.

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O.S. Sychov, A.O. Borodai, Yu.V. Zinchenko, E.S. Borodai, S.I. Deyak Left atrial thrombus and/or sludge resolution and cardioversion in patients with non-valvular atrial fibrillation – flutter at repeated transoesophageal echocardiography

The aim – to evaluate the rate of resolution of left atrial appendage (LAA) thrombus and sludge after the use of anticoagulation therapy and evaluate the safety of cardioversion in patients with residual LAA thrombus and/or sludge on repeated transoesophageal echocardiography (TOE).

Material and methods. 39 patients with LAA thrombus and/or sludge on baseline TOE were included into the prospective observational study. The mean age was 61.7±9.5 years, mean CHA2DS2-VASc score 2.85±1.3, 11 (28.2 %) were females.

Results. There were 27 patients with LAA thrombus, 22 with LAA sludge, in 10 (45.45 %) cases thrombus was accompanied with sludge. After detection of thrombus and/or sludge, anticoagulation therapy was prescribed for 51.8±10.7 days before next TOE. Warfarin was prescribed in 19 (48.72 %) cases and treatment with novel oral anticoagulants (NOAC) – in 20 (51.28 %) patients. Complete thrombus resolution was noted in 18 (66.7 %) out of 27 cases, similar in both groups: in warfarin group it was found in 4/12 (33.3 %) and in NOAC group in 5/15 (33.3 %) of cases. In all cases residual thrombi had reduced size and were immobile. Sludge resolution rate was noted in 9 (40.9 %) out of 22: in warfarin group it was found in 7/11 (63.64 %) and in NOAC group – in 6/11 (54.55 %) cases. Cardioversion was registered in 14 (56 %) of patients with residual thrombus and/or sludge, among them 7 were with residual LAA thrombus: 3 patients had spontaneous cardioversion during first 30 days of follow-up, and DCC was performed in 4 highly symptomatic patients. There were no stroke or thromboembolic events during 30 days of follow-up. All patients were highly adherent to anticoagulation therapy.

Conclusions. Residual thrombi are frequent founding at repeated TOE. It seems that cardioversion might be considered in patients with reduced and immobile thrombi, being adherent to anticoagulation therapy.

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N.M. Tereshchenko Exercise training as an integral part of cardiac rehabilitation in patients in the early post-infarction period: clinical and functional parallels

Material and methods. The study involved 91 male patients aged 33-68 (average age (52.3±1.5) years with Q-wave MI. In the first hours after MI onset, all patients had urgent coronary angiography, a stent was inserted into the culprit coronary artery and drug therapy was administered in accordance to the current protocols and guidelines. Depending on the amount of physical rehabilitation, the patients were divided into two groups: group 1 included 47 patients who underwent physical cycling course training (three times a week, a total of 30 sessions), group 2 consisted of 44 patients whose rehabilitation consisted in distance walking and remedial exercises. The examinations were carried out at discharge from the inpatient department (12–15 days). Both clinical, instrumental and biochemical tests were performed after 4, 6 and 12 months following MI.

Results. At the initial stage, the patients of either group didn’t demonstrate differences in clinical indicators or medical history data. At the first survey, the threshold power level and the cost of the work performed according to the indicator of the ratio of dual product to the level of performed work (DP/A) didn’t differ significantly. After 30 training sessions, the threshold power increased significantly (125.0 (125.0–140.0) W in group 1 at the value of DP/A 0.92 (0.76–1.17) units). In group 2, the threshold power increased to 100.0 (75.0–100.0) W, but at the level of DP/A (1.73±0.18) units. One year after MI the level of threshold power increased to 140,0 (125.0–150.0) W at low cost (1.17 (0.98–1.32) units) in group 1, while in group 2 the level of threshold power decreased and approached the data of the first survey (75,0 (75.0–100.0) W) with a significant increase of the cost of work (2.41 (1.73–3.36) units). Such dynamics of the indicators of exercise tolerance was accompanied by changes of hemodynamic indices.

Conclusions. Exercise training program increased physical tolerance with better parameters of bicycle ergometry after its interruption and preserving of the effect during one year after MI. This was accompanied by optimization of the remodeling and restoration of wall kinesis. The exercise training program contributed to improving the physical fitness in patients with late opening of the infarction-related coronary artery disease and incomplete revascularization. The effect of exercise training was short-lived and limited in multifocal lesions.

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O.A. Yepanchintseva, O.J. Zharinov, K.O. Mikhaliev, B.M. Todurov Predictors of early postoperative complications in patients with stable coronary artery disease after coronary artery bypass grafting

Material and methods. A retrospective observational single-center study included 576 consecutive pts with stable CAD (mean age 61±9 years, 491 (85.2 %) males, 85 (14.8 %) females), undergoing isolated CABG. We analyzed demographic, clinical, laboratory, echocardiographic, coronary angiographic, intra- and postoperative data, and assessed health-related quality of life. In total, EPOC were registered in 112 (19.4 %) cases. Acute kidney injury (n=55) and acute heart failure (n=49) were the most frequent major EPOC (9.5 % and 8.5 %, respectively). Two patients (0.4 %) died early after CABG.

Results. At univariate analysis, EPOC were related to the following baseline parameters: age; body mass index (BMI); heart failure NYHA class; permanent AF; severe diabetes mellitus (DM); poor kidney function (by estimated glomerular filtration rate (eGFR)); left atrium and left ventricular (LV) end-diastolic volume index; LV systolic dysfunction; LV hypertrophy; aortic and mitral valve regurgitation; three-vessel CAD. At multivariate analysis, the independent predictors of EPOC were as follows: BMI (per 5 kg/m2 increase vs < 25.0 kg/m2 as reference (r): OR 1.38 (95 % CI 1.06–1.79); Р=0.017); DM severity (per each severity category increase vs no DM (r): OR 1.75 (95 % CI 1.47–2.10); Р<0.001); eGFR (per each 30 ml/min/1.73 m2 decrease vs ≥ 90 ml/min/1.73 m2 (r): OR 2.29 (95 % CI 1.58–3.31); Р<0.001); and LV ejection fraction (EF) (< 40 % vs. 40–49 % vs. ≥ 50 % (r): OR 1.92 (95 % CI 1.49–2.49); Р<0.001). Conclusions. Multiple characteristics related to EPOC reflected comorbidity burden in the study cohort. Independent predictive value of baseline BMI, DM severity, eGFR and LV EF should be taken into account for risk stratification before CABG.

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Working group: L.G. Voronkov, K.M. Amosova, G.V. Dziak, O.J. Zharinov, V.M. Kovalenko, O.V. Korkushko, E.G. Nesukay, O.S. Sychov, Yu.S. Rudyk, O.M. Parkhomenko Guideline of the Ukrainian Association of Cardiology for the Diagnosis and Treatment of Chronic Heart Failure (2017)

Guideline on the diagnosis and treatment of chronic heart failure is an original consensus-document of the leading experts of Ukraine on chronic heart failure. Its preparation took into account the previous national consensus-document (2012), as well as principal positions of the new ESC guidelines on the diagnosis and treatment of heart failure (2016). Compared to the previous corresponding document, the 2017 national guidelines provided more detailed information about technologies of chronic heart failure management – from monitoring of efficiency and safety of therapeutic approaches to the practical issues concerning lifestyle modification and self-control of patients with chronic heart failure. Compared to previous guidelines, more attention is paid to high-technological device methods of treatment, becoming more widespread in Europe and having great potential in Ukrainian practice. A special chapter summarizes clinical approaches to decrease risk of heart failure in patients with cardiovascular diseases. The guideline is an official document of the Ukrainian Association of Cardiology, directed at improving diagnosis and treatment of chronic heart failure in our country and might be used by cardiologists, internists, family physicians, as well as teachers of high medical school.

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V.I. Berezutsky Electrocardiography in the diagnosis of arrhythmogenic right ventricular cardiomyopathy

The aim of the study was to determine the possibilities of practical application of electrocardiography (ECG) in the diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) according to the analysis of scientific publications over the past five years in journals indexed by Scopus, Web of Science and PubMed. Analysis has shown that ECG plays an increasingly important role in the diagnosis of ARVD/C. The presence of ECG changes characteristic of the disease (epsilon wave, T wave inversions, QRS complex prolongation in leads aVR and V1) allows diagnosis of ARVD/C in half of the cases without the use of ultrasound and tomography techniques. Electrophysiological disturbances in ARVD/C are registered long before the structural ones. This determines the high value of the ECG for early diagnosis of the disease. The methods of ECG analysis developed in recent years greatly expanded the possibilities of the method in differential diagnosis and prediction of the ARVD/C. The popularization of ECG-methods in diagnosis of ARVD/C among general practitioners is necessary to improve the early detection of such a dangerous disease.

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Yu.H. Kyyak, M.P. Halkevych, O.Ye. Labinska, O.Yu. Barnett Acute coronary syndrome caused by myocardial bridging: electrocardiographic and angiographic evidence

Myocardial bridging is a congenital anomaly of the coronary arteries, where a band of heart muscle tunnels through the myocardium instead of resting under epicardium, due to such conditions the artery constricts as the heart squeezes the blood to pump. The case of acute coronary syndrome without ST segment elevation is presented. The patient 44 years old was admitted to coronary care unit at emergency care hospital with suspected acute myocardial infarction. During the angiography myocardial bridging was diagnosed in the anterior interventricular branch of the left coronary artery which was the cause of retrosternal pain.

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