Тематичний Архів | Category Archives: Original researches

E.G. Nesukay, I.I. Giresh Evaluation of the right ventricular function in patients with arterial hypertension using speckle-tracking echocardiography

The aim – to study structural and functional state of the right ventricle in patients with essential hypertension and different levels of left ventricular hypertrophy (LVH) on the basis of longitudinal right ventricular myocardium strain assessment.

Material and methods. The study involved 64 patients with arterial hypertension, average age (55.7±1.1) years. The first group consisted of 17 patients without LVH, the second group included 17 patients with mild LVH, the third group included 15 patients with moderate LVH, and the fourth group consisted of 15 patients with severe LVH. Additionally, patients with LVH were distributed according to the dilatation of the left atrium (LA) into group A – 21 patients without dilatation of the LA, and group B – 26 patients with dilated LA. In all patients we performed echocardiography and speckle tracking echocardiography with analysis of longitudinal global systolic strain of the right ventricular (RV LGSS), and its rate (RV LGSSR) and early diastolic strain rate (SR) of LV (EDSRLV). We calculated E/EDSR ratio for the assessment of LV filling pressure.

Results. Decrease of RV contractile function that was characterized by RV LGSS and RV LGSSR was observed even in patients with mild hypertrophy, being more prominent along with increase of the hypertrophy level. Average RV LGSS in group 2 was 16.8±0.4 % which appeared less compared to group 1 (19.7±0.9 %). RV LGSSR in group 2 (0.82±0.03 s–1) and group 3 (0.83±0.03 s–1) indices were less compared to group 1 (1.02±0.06 s–1). In patients with dilated LA we found decreased contractile function of RV compared to the patients without LA dilatation. RV LGSS and RV LGSSR in group B were less compared to group A.

Conclusion. Impaired RV contractility can be explained by the fact that LA dilation in arterial hypertension occurs due to diastolic dysfunction progression which in turn, influences the RV contractile function. In group with severe LVH we detected direct correlation between indicators of RV deformation and EDSRLV, as also inverse correlation between RV LGSS and E/EDSRLV, confirming influence of LV diastolic function on RV contractility.

Full article

V.I. Tseluyko, S.M. Sukhova, L.M. Yakovleva, K.Yu. Kinoshenko Factors associated with unfavorable long-term prognosis in patients with acute pulmonary embolism

The aim – to investigate the possible relation between anamnestic, instrumental, laboratory indicators and venous thromboembolism (VTE) recurrence and bleeding in patients with pulmonary embolism (PE) within 4 months after discharge from the hospital.

Material and methods. The study involved 104 patients with acute PE. Intra-hospital mortality was 13.5 % (14 patients that died were excluded from further analysis). All patients were examined by TTE, 2D STE and venous duplex ultrasound (VDU); indicators were assessed at the first day and after anticoagulant therapy. Anticoagulant therapy was prescribed by envelope method: rivaroxaban or warfarin. VTE recurrence was defined as the appearance of new signs of venous thrombosis according to the data of the VDU and/or computed tomography pulmonary angiography. The assessment of the severity of the bleeding was performed by the TIMI scale.

Results. In the group of patients with recurrent VTE, there were significantly more cases of the observe varicose veins (Р=0.02) with thrombosis localized in the proximal veins (Р=0.03), atrial fibrillation (Р=0.01) and earlier VTE (Р=0.05). Patients in this group were more likely to report hemodynamic disorders: low systolic pressure (Р=0.03), high systolic pulmonary artery pressure (Р=0.03), and segmental fraction of the apical RV segment release less than 65 %, as a sign of right ventricular dysfunction (Р=0.01). The bleedings occurred in 11.1 % of patients during anticoagulant therapy. Among them, there were significantly more patients with arterial hypertension (Р=0.03). In addition, the risk of bleeding is associated with use of drugs, such as streptokinase (Р=0.03) and warfarin (Р=0.03).

Conclusions. VTE reoccurred in 6.7 % (bleeding – 11.1 %) of patients with pulmonary embolism during anticoagulant therapy during 4.2±1.9 months after discharge from hospital. In patients with PE, VTE reoccurrence (regression analysis) is due to the presence of factors (39.6 % (Р<0.05)), such as femoral vein thrombosis (according to VDU), atrial fibrillation, varicose veins, earlier PE episodes; the value of segmental fraction of the apical RV segment release is less than 65 % based on 2D STE. According to regression analysis, the risk of bleeding occurrence is related to the presence of arterial hypertension (8.2 %, Р=0.007), the use of warfarin (8.5 %, Р=0.007) and streptokinase (7.9 %, Р=0.01).

Full article

V.M. Kovalenko, E.G. Nesukay, S.V. Cherniuk, R.M. Kirichenko Myocarditis course predicting based on complex studies of immune status and morphofunctional heart condition

The aim – complex assessment of immune status, heart rate variability, left ventricular (LV) systolic function and cardiac magnetic resonance in patients with myocarditis for the detection of prognostic markers associated with unfavourable course of the disease.

Material and methods. We examined 52 patients with clinically suspected acute diffuse myocarditis – 35 men (67.3 %) and 17 women (32.7 %). The patients underwent examination three times: within the 1st month after disease onset, after 6 and 12 months of observation. All patients at inclusion had sinus rhythm and LV ejection fraction ≤ 40 %. Control group consisted of 25 healthy individuals. Patients underwent dynamic assessment of immune state indicators, Holter ECG monitoring, echocardiography and speckle-tracking, as also cardiac magnetic resonance.

Results. Early predictors of the impaired systolic function after 12 months were: serum concentration of immunoglobulin M (OR 1.46, CI 0.71–1.65, Р<0.05), СD8+ (OR 1.72, CI 0.93–2.50, Р<0.05) and СD16+ (OR 1.89, CI 1.38–2.41, Р<0.05) lymphocytes, myocardium induced blasttransformation lymphocyte activity (OR 3.91, CI 2.41–5.89, Р<0.01), mean myocardial autoantibody titer (OR 3.53, CI 1.82–4.54, Р<0.01), SDNN (OR 2.03, CI 1.50–2.71, Р<0.05), LV end-diastolic volume index (OR 5.22, CI 3.19–7.34, Р<0.01), LV ejection fraction (OR 4.75, CI 3.30–6.84, Р<0.02), LV longitudinal global systolic strain (OR 3.71, CI 2.09–4.53, Р<0.01) obtained within the 1st month after disease onset. As a result we built prognostic model that is characterized by specificity 82.1 %, sensitivity 80.1 %, positive predictive value 81.6 %, negative predictive value 76.0 % and comprises mentioned above markers. Conclusion. Early prognostic markers that might be used during the 1st month after myocarditis onset for the assessment of persistent LV systolic dysfunction were detected that enabled creation of the mathematic model for the early predicting prolonged impairment of heart function in patients with myocarditis.

Full article

V.Yu. Zharinova, О.Yu. Galetskiy, L.A. Bodretska Diagnostic value of the level of nerve growth factor in elderly patients with ischemic heart disease and ventricular extrasystoles

The aim – to study the level of the nerve growth factor (NGF) and serum norepinephrine level in elderly patients with ischemic heart disease (ІHD) and ventricular extrasystoles.

Material and methods. 90 people were examined, including: 60 patients with IHD at the age of 60–74 years, including: 30 people with IHD: stable angina, I–III, СHF, ventricular extrasystoles III–IVb class by Lown; 30 people with IHD diagnosis: stable angina, I, СHF, without ventricular extrasystoles, control – 15 relatively healthy elderly subjects (mean age 68.2±2.7 years) and 15 healthy young subjects (mean age 23.5±2.5 years). All patients underwent echocardiography (EchoCG), Holter ECG monitoring, heart rate variability, high resolution ECG (ECG BP) with study of the late ventricular potentials; the levels of NGF and norepinephrine in serum were studied as well.

Results. In elderly patients with IHD, increase of the serum levels of norepinephrine and NGF were revealed in comparison to the group of practically healthy elderly. In IHD patients with ventricular extrasystoles, multidirectional indices of the level of NGF are noted: in 20 patients there was a significant increase in the level of NGF, in 10 – slightly increased in comparison with the IHD group without rhythm disturbances.

Conclusion. The patients with normal level of NGF showed significant increase of heart cavities, more pronounced myocardial hypertrophy and reduced left ventricular contractility compared to the group in which the level of NGF was significantly elevated. Results of heart rate variability assessment in comparison groups showed that in patients with ventricular extrasystoles and high level of NGF there was a significant increase in sympathetic activity with minor changes in the morphofunctional state of the myocardium.

Full article

U.P. Chernyaha-Royko, O.J. Zharinov, N.S. Pavlyk, S.S. Pavlyk Predictors of early recurrence of arrhythmia among patients with nonvalvular persistent atrial fibrillation and flutter after cardioversion

The aim – to compare clinical and morphofunctional characteristics of patients with nonvalvular persistent atrial fibrillation and flutter (AF and AFL) with and without early arrhythmia recurrence after cardioversion.

Material and methods. One hundred and fifty patients with documented persistent AF/AFL, who underwent successful cardioversion during hospitalization period, were involved in the prospective one-center study. Scheduled registration of ECG, continuous Holter ECG monitoring and event monitoring within 7 days were performed to identify AF/AFL recurrences. Demographic, clinical and functional characteristics, concomitant diseases, treatments were compared in groups of patients with (n=50) and without (n=100) early recurrence of atrial fibrillation after cardioversion.

Results. Isolated AF occurred more often in patients without AF/AFL recurrences (Р=0.00116); AF was more often combined with different types of AFL in patients with arrhythmia recurrent episodes (Р=0.001). Patients with AF/AFL recurrences had longer duration of arrythmia history (Р=0.00048) and also tendency towards longer duration of last AF/AFL episode (Р=0.077). Patients with AF/AFL recurrences had lower daily average and minimum heart rate, larger amount of supraventricular extrasystoles (Р=0.0001), couplets (Р=0.00002) and groups (Р=0.0001) during 24-hour Holter ECG monitoring. There were more paroxysms of atrial tachycardia (Р=0.0019) in patients with AF/AFL recurrences as well.

Conclusions. Recurrent episodes of AF/AFL during hospitalization occur in one third of the patients after successful electrical or chemical cardioversion. The 24-hour Holter monitoring of ECG and event monitoring raises possibility to detect rhythm disorder at early stages after cardioversion. Presence of AFL, detection of frequent supraventricular extrasystoles, couplets and groups and short paroxysms of atrial tachyarrhythmia could be strong predictors of AF/AFL early recurrence.

Full article

M.М. Dolzhenko, V.E. Dosenko, L.E. Lobach The recessive pattern of inheritance of аldosterone synthase gene and indicators of diastolic function of left ventricle in patient with coronary heart disease and postinfarction cardiosclerosis

The aim – was to investigate the possible association of the aldosterone synthase gene (CYP11B2) polymorphism and the recessive pattern of inheritance with left ventricular diastolic function in patients with coronary heart disease and postinfarction cardiosclerosis (PIC).

Material and methods. One hundred patients (age 57.3±8.9 years) were examined by general clinical methods. The study included patients with a history of myocardial infarction for more than 6 months and up to 2 years from the date of the event. Genetic testing was performed by polymerase chain reaction in real mode. The study material was venous blood of patients with coronary heart disease, PIC. Echocardiography was done for the evaluation of diastolic function in all patients.

Results. The E wave velocity parameters were higher among patients with TT + TC genotype compared to the data of patients with CC genotype. The wave-velocity parameters A were higher, and DT was longer in patients with CC variant of the genotype compared to the TT + TC variant of the aldosterone synthase gene polymorphism, which indicates a greater frequency of LV relaxation disturbance in patients with CC variant of polymorphism compared to TT + TC variant of the genotype. The indices of higher diastolic LV diastolic pressure, an increase in its preload (E/E´, AR) were higher in the group of patients with TT and TC, a variant of aldosterone synthase gene polymorphism. The patients with TT + TC variant of polymorphism more often encountered more severe forms of LV diastolic dysfunction (pseudonormalization, restriction) compared with the data of patients with a variant of polymorphism of the aldosterone synthase gene (P<0.0001), which indicates a more severe course of the disease in these patients. Conclusion. The risk of developing more severe forms of diastolic LV dysfunction in patients with TT + TC genotype CYP11B2 is higher, compared to the CC genotype in patients with IHD, PIC.

Full article

V.I. Tseluyko, L.M. Yakovleva, O.E. Matuzok Relationship between asymmetric dimethylarginine and clinical, laboratory, ultrasonic parameters in patients with myocardial infarction after intravenous fibrinolysis

The aim – to evaluate asymmetric dimethylarginine (ADMA) concentration and its possible relationship with clinical features, anamnesis, laboratory parameters, cardiac ultrasound in patients with ST-elevation myocardial infarction after intravenous fibrinolysis.

Material and methods. We examined 40 patients with myocardial infarction after intravenous fibrinolysis. Blood sampling was performed at admission. C-reactive protein (CRP) concentration was accessed. Quantitative determination of ADMA concentration was performed with high-performance liquid chromatography. Cardiac ultrasound was done in all patients. Fibrinolysis efficacy was evaluated according to the ECG criteria.

Results. ADMA concentration in examined patients was 0.1–4.94 mkmol/l. Patients were divided into four groups according to ADMA quartiles (increase of ADMA concentration from group I to group IV). All patients in group IV were smokers, the difference was significant in groups I and II (P=0.04). Time to fibrinolysis was significantly higher in group IV than in groups II (P=0.02) and III (P=0.04). Mean ADMA concentration was significantly higher in patients with anterior compared to patients with inferior infarction (1.79±1.5 and 0.8±0.75 mkmol/l, respectively, Р=0.02). In correlation analysis ADMA level was related to history of smoking, high-sensitive CRP and glycemia level at admission, time to fibrinolysis, heart rate on the second day of infarction, and ultrasonic parameters – end-diastolic volume (EDV), and-systolic volume and ejection fraction. Fibrinolysis was significantly less effective in patients with higher ADMA level.

Conclusion. Significant increase of ADMA level was found in presence of smoking, longer of time to fibrinolysis and in anterior localization of infarction. ADMA level increase was associated with increase of hsCRP level, younger age, EDV and admission glycemia increase, decrease of glomerular filtration rate and body mass index, increase of time to fibrinolysis (regression analysis). Fibrinolysis was significantly less effective in patients with higher ADMA level.

Full article

T.G. Slascheva, G.D. Radchenko, Yu.M. Sirenko, I.M. Martsovenko Factors associated with patient’s compliance to antihypertensive treatment

The aim – to evaluate factors related to the compliance and its changes during antihypertensive treatment.

Material and methods. We included 10 158 hypertensive patients, treated by 531 general practice physicians. Physicians administered antihypertensive therapy based on domestic generic drugs (bisoprolol, enalapril, fixed combination enalapril and hydrochlorthiazide, amlodipine) during 3 months. Every patient had four visits to the physician’s office with evaluation of the office blood pressure and heart rate, ECG patterns, compliance (by questionnaire).

Results. It was shown that 43.2 % hypertensive patients had low (< 50 % taking prescribed drugs) compliance baseline. Factors associated with poor compliance were older age, presence of coronary heart disease, myocardial infarction, stroke or heart failure, lifestyle (higher body mass index, smoking, alcohol abuse, low physical activity, low consumption of fresh fruits and vegetables, high salt consumption), low education and absence of work (or being retired). The level of blood pressure was higher in patients with baseline low compliance at all 4 visits. The target blood pressure was not achieved in 33.5 % patients with high compliance, in 39,9 % with baseline moderate compliance (P<0.001 vs high) and in 47.6 % (P<0.001 vs high and 0.005 with moderate) with low baseline compliance. In 61.7 % patients we noted improving of the compliance. Independent factors associated with final visit compliance were age (β=–0.024, Р=0.018), baseline compliance (β=0.61, P<0.001), level of systolic (β=–0.05, P<0.001) and diastolic (β=–0.04, P<0.001) blood pressure at the end of the study, presence of adverse reactions (β=–0.04, P<0,001), alcohol abuse (β=–0.03, P=0.004), physical activity (β=0.034, P=0.002), consumption of fresh vegetables and fruits (β=0.026, P=0.02). Conclusion. Administration of fixed combination of enalapril and hydrochlorthiazide and higher doses of bisoprolol and amlodipine, as well as printed recommendations for lifestyle modification were related to better compliance at the end of the study.

Full article

I.O. Zhyvylo, G.D. Radchenko, Ye.Yu. Titov, Yu.M. Sirenko Structural and functional status of the systemic circulation arteries in patients with idiopathic pulmonary arterial hypertension with different functional abilities and endpoints

The aim – to study the elastic properties of the systemic circulation arteries in patients with idiopathic pulmonary arterial hypertension (IPAH) with different functional abilities and endpoints.

Мaterial and methods. 152 patients were examined: 45 of them were with IPAH, 40 patients with pulmonary arterial hypertension associated with congenital heart disease, 32 patients with arterial hypertension (AH) and 35 healthy controls. Pulse wave velocity was measured in the arteries of muscular and elastic types, also we measured cardio-ankle vascular index (CAVI).

Results. Patients with reduced (< 330 m) functional abilities (FA) compared with patients with preserved (> 330 m) FA, have significantly higher arterial stiffness: the level of right CAVI was 8.18±0.27 vs 7.02±0.23 (Р<0.005); the level of left – 8.43±0.30 vs 7.07±0.21 (Р<0.005). Comparing groups of patients with reduced FA and with AH, CAVI measurements were higher among patients with IPAH (right side 8.18±0.27 vs 7.53±0.21, Р<0.08, left side 8.43±0.30 vs 7.39±0.20, Р<0.006). The CAVI of patients who died during the observation period was significantly higher compared to the results of surviving patients: 8.60±0.42 vs 7.01±0.20 (Р<0.001) and 8.53±0.46 vs 7.03±0.17 (Р<0.001), accordingly. Conclusions. Consequently, in addition to all known risk factors for complication and 1 year mortality among patients with IPAH, it may be possible to use CAVI as an indicator of arterial lesions of the systemic circulation.

Full article

K.M. Amosova, N.V. Shyshkina, Yu.V. Rudenko, A.B. Bezrodnyi, I.Yu. Katsitadze, S.M. Dubynska Parameters of arterial stiffness, wave reflection and ventricular-vascular coupling in patients with hypertension and heart failure with preserved and reduced left ventricular ejection fraction

The aim – to compare the relationship between brachial and central blood pressure, wave reflections parameters, pulse wave velocity and ventricular-arterial coupling in patients with hypertension and various types of heart failure (HF) with preserved or reduced left ventricular ejection fraction (LVEF), compared to patients with uncomplicated hypertension.

Material and methods. Among 180 patients with essential hypertension, 75 patients (age 57.6±10.7 years) were selected «case control» method. Patients were comparable regarding age, gender, brachial systolic blood pressure (BP), which corresponded to hypertension 1-2 degree: 25 patients with uncomplicated hypertension without HF (1st group), 25 patients with HF and LVEF ≥ 50 % (2nd group), 25 patients with HF and LVEF 30–49 % (3rd group). All patients underwent general clinical examinations, laboratory examination and determination of NT pro BNP, brachial blood pressure measurements, pulse wave analysis and measurement of the carotid-femoral pulse wave velocity (PWV) by applanation tonometry, Doppler echocardiography and calculation of the ventricular-vascular coupling parameter (Ea/Ees).

Results. Patients with HF in both groups in contrast to patients with uncomplicated hypertension had larger left atrium volume index, higher values of E/e´ and lower e´, a´, LVEF (all Р<0.05–0.01). Patients in both groups with HF were matched by e´ and E/e´ (Р>0.05). Both groups of patients with HF had lower mean brachial BP, brachial and central diastolic BP, and higher pulse pressure compared to patients with uncomplicated hypertension (Р<0.05). Patients with HF and EF < 50 %, compared with patients with HF with preserved LVEF, had higher heart rate, while all parameters of brachial and central BP didn’t differ (P>0.05). Patients with HF and EF > 50 %, compared to uncomplicated hypertension, had higher augmentation pressure (РА – 11.8±5.0 versus 8.2±6.2 mm Hg), PWV (9.4±1.9 versus 8.1±1.9 m/s) and lower pulse pressure amplification (PPA 126.5±11.4 versus 139.0±19.7 %) (all Р<0.05), in the absence of the difference in the augmentation index (AIx) (Р>0.05). Compared to patients without HF, patients with HF and EF < 50 % had lower PA (5.1±3.8 vs. 8.2±6.2 mm Hg), AIx (10.2±10.1 versus 22.6±13.9 %) (all Р<0.01), in the absence of differences in PPA and PWV (Р>0.05), which differed from patients with HF and EF > 50 % (PPA – 146.1±19.8 versus 126.5±11.4 %, and PWV – 7.8±1.7 versus 9.4±1.9 m/s, all Р<0.05). Groups of patients with HF with preserved LVEF and hypertension were comparable regarding the values ​​of Ea, Ees and Ea/Ees (Р>0.05). While patients with HF with reduced LVEF had a higher level of Ea/Ees (1.48±0.49 versus 0.65±0.15 and 0.57±0.10) because of lower level of the Ees (1.24±0.45 versus 3.17±1.18 and 3.47±0.78) compared to other two groups (all Р<0.01).

Conclusions. Patients with hypertension and HF with reduced LVEF matched by age, gender and brachial systolic blood pressure with patients with hypertension and HF with preserved LVEF had lower augmentation pressure, augmentation index and a higher level of pulse pressure amplification and lower pulse wave velocity as a result of changes of the ventricular-arterial coupling caused by the decrease of the ventricular elastance (Ees).

Full article