Author Archives: Vitali Nesukaj

G.M. Solovyan, Т.V. Mikhalieva Wide QRS complex tachycardia: differential diagnosis and emergency therapy

The lecture is devoted to a serious problem in clinical practice – diagnosis and treatment of wide QRS complex tachycardia, requiring an individual approach. The main principles of the detection of different types of wide QRS complex tachycardia and their electrophysiological mechanisms are considered. The article deals with etiology of wide QRS complex tachycardia, as well as clinical and electrocardiographic criteria for differential diagnosis between ventricular tachycardia and supraventricular tachycardia with aberrant conduction. Key aspects of wide QRS complex tachycardia are discussed, and the ECG examples of certain forms of wide QRS complex tachycardia are presented. The principles of emergency care and long-term therapy for narrow and wide QRS complex tachycardia are considered. Information regarding antiarrhythmic drugs usage and general principles of catheter treatment of tachycardia is provided.

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О.А. Yepanchintseva, О.J. Zharinov, B.М. Тоdurov Surgical myocardial revascularization in stable ischemic heart disease. Quo vadis?

The article reviews contemporary data on role of the coronary artery bypass grafting (CABG) in patients with stable ischemic heart disease. The principles of pre-surgery risk assessment and choice between CABG and percutaneous coronary intervention are provided. Based on the results of the controlled studies, the indications for CABG were established in guidelines. The evaluation of the myocardial viability and coronary reserve may improve patient selection for revascularization procedures. Evidence base regarding predictors of early postoperative complications and results of the long-term observation of patients after CABG is provided. Possible intermediate ctiteria of revascularization efficiency are changes of left ventricular pump function and quality of life parameters. A special attention is devoted to the perspectives of new surgical technologies to improve CABG results.

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V.Р. Chyzhova Influence of intermittent hypoxia training on microcirculatory system, glucose homeostasis and lipids in prediabetes patients 60 years age and over

The aim – to understand effects of intermittent hypoxia training (IHT) in prediabetes patients 60 years age and over on microcirculatory system, glucose homeostasis and lipids.

Material and methods. A total of 82 subjects of different age were included into this analysis. All of them underwent glucose tolerance test (GTT). After GTT 19 prediabetes people 60 years age and over continued investigation with determination of plasma glucose, insulin and cortizol. Insulin sensitivity was evaluated by homeostasis model assessment of insulin resistance (HOMA-ІR). Lipid profile, endothelial function and microcirculatory system were studied before and after IHT in prediabetes patients 60 years age and over.

Results. It was shown that IНT promotes the normalization of carbohydrate metabolism in the elderly prediabetes people. Favorable changes were observed after the IHT course: the percentage of people with pre-diabetic disorders decreased from 100 % to 42.1 % (Р<0.01). One month after the IHT, an increase in the normalizing effect on the carbohydrate metabolism was noted: a statistically significant decrease in the fasting glucose from 5.8±0.2 to 5.5±0.2 mmol/l (Р<0.05), after 2 hours GTT – from 8.5±0.2 to 7.0±0.4 mmol/l (Р<0.01). Pre-diabetic disorders were detected in 15.8 % of the subjects (Р<0.001) after 1 month of IHT. In prediabetes subjects after course use of IHT there was statistically significant decrease in total cholesterol and cholesterol of low density lipoproteins. Conclusions. The use of IHT is promising for correction of prediabetes disorders in the elderly, which reduces not only the risk of developing type 2 diabetes but also prevents cardiovascular complications.

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O.V. Petyunina, M.P. Kopytsya Аssociations of vascular endothelial growth factor-A with hemodynamic data in patients after ST-elevation myocardial infarction

The aim – to research associations between vascular endothelial growth factor-A (VEGF-A) level and left ventricular remodeling after ST elevation myocardial infarction (MI).

Material and methods. 62 patients with MI, 51 (82.3 %) male and 11 (17.7 %) female at average age 58.63±8.90 years were enrolled into the study. VEGF-A level was determined on the 7th day of MI by enzyme-linked immunoassay. Anxiety level was assessed by Taylor questionnaire during the period of 10–14 days before MI. After 6-month observation 47 patients were assessed.

Results. In patients with MI in comparison with the control group significant rise of serum VEGF-A level was observed, showing positive correlation with creatine kinase level. The level of VEGF-A below median 160 pg/ml in comparison with its level above the median 160 pg/ml was associated with higher frequency of MI in men (Р=0.023), anxiety before MI (Р=0.019), end diastolic diameter (EDD), end systolic diameter (ESD), end diastolic volume (EDV) increase in acute phase, EDD, ESD, EDV, left ventricular myocardial mass, Е/А, lower exercise tolerance after 6-month observation. This processes indicates unfavorable role of low VEGF-A levels and protective – of high VEG-A levels for intracardiac hemodynamic after myocardial infarction. The level of VEGF-A ≤ 201.86 pg/ml with sensitivity 57.9 % and specificity 85.7 % (AUC 0.711; 95 % CI 0.513–0.908; Р=0.036) have prognostic significance for adverse remodeling development.

Conclusions. VEGF-A level – important indicator to estimate the extent of myocardial injury and pathologic remodeling development.

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