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.
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.
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.
The aim – to determine the efficacy and to perform retrospective study of the results of balloon valvuloplasty in patients of the first year of life with isolated pulmonary artery stenosis.
Material and methods. During the period from January 1, 2007 to December 2014 the balloon valvuloplasty of the pulmonary valve was performed in 238 patients at the Ukrainian Pediatric Cardiology and Cardiac Surgery Center, among them 119 were males and 119 females. The median age of the patients was 42 (0; 365) days, the average weight – 4.60 ±1.81 kg (1.7–11.4 kg). On average, before cath: systolic pressure in the right ventricle was (92.0±24.5) mm Hg; the gradient of systolic pressure on the valve of the pulmonary artery – (69.3±24.9) mm Hg; systolic pressure in the pulmonary artery was – (22.50±8.47) mm Hg.
Results. The procedure was effective in 223 (93.7 %) of 238 patients. Early mortality after balloon valvuloplasty was absent. Complications after balloon valvuloplasty occurred in 4 patients (1.68 %). The result of balloon valvuloplasty was suboptimal in 15 (6.3 %) patients. The mean follow-up period was 5.2±2.1 y (from 2 to 9.7 y). On average: the gradient of systolic pressure at the level of the pulmonary valve decreased from 69.3±24.9 to 20.6±13.4 mm Hg; systolic pressure in the right ventricle – from 92.0±24.5 to 48.2±13.8 mm Hg; the systolic pressure in the pulmonary artery increased from 22.50±8.47 mm Hg up to 27.60±8.65 mm Hg; the level of oxygenation of arterial blood increased from 90.80±9.32 % to 94.30±5.08 %. 29 (12.2 %) patients out of 238 required the repeated cardiac surgical interventions.
Conclusions. Balloon pulmonary valvuloplasty is an effective and safe method of x-ray endovascular treatment of isolated valve stenosis of the pulmonary artery.
The aim – to determine antiarrhythmic efficacy and safety of 1C class antiarrhythmic agents ethacizin and propafenone in patients with arterial hypertension (AH) and frequent recurrences of atrial fibrillation (AF).
Material and methods. 146 patients (age 37–86 years, 68 (46.6 %) males) with AH II stage and frequent recurrences of AF were examined. Antiarrhythmic therapy was used in all patients. The patient self-assessed the frequency of AF attacks and their course. The observation period from the time of the selection of effective antiarrhythmic therapy was 6 months. The actual average observation period for patients was 8.2±0.4 months.
Results. In general, 134 (91.8 %) of the treated patients had a positive antiarrhythmic effect within 6 months of the treatment. Thus, in 48 (35.8 %) cases it was total and in 86 (64.2 %) – partial antiarrhythmic effect (Р<0.0001). Propafenone was effective in 72 (62.6 %) cases, ethacizin – in 46 (62.2 %) patients (in vagal AF – 90.3 %). An additional use of bisoprolol increased the efficacy of ethacizin to 76.2 %. The study drugs decreased the frequency of arrhythmias attacks, increasing the time between the registered symptomatic episodes of AF by 5.7 times – from 12 to 80 days (Р<0.0001). In addition, the median duration of symptomatic episodes was significantly decreased by 5.0 times – from 12 to 2 hours (Р<0.0001).
Conclusions. The study proved antiarrhythmic efficacy and safety of ethacizin and propafenone in patients with arterial hypertension and paroxysmal atrial fibrillation.
The aim – to evaluate the risk of cardiovascular mortality in clinical practice with adherence to rhythm control strategy and anticoagulation therapy in patients with non-valvular atrial fibrillation and flutter (AF–AFl).
Material and methods. In a prospective observational study with a median follow-up of 36.8 (LQ 24.9–UQ 64.6) months we examined 293 patients with non-valvular AF–AFl, mean age 60.5±10.4 years, among them 81 (27.65 %) females. The mean CHA2DS2-VASc score was 2.25±1.46. All patients underwent clinical examination and transthoracic echocardiography. Transesophageal echocardiography was performed in 263 (89.76 %) patients.
Results. Cardiovascular death occurred in 20 (6.83 %) of cases during follow-up. 140 (52.83 %) patients were referred to the rhythm control group, and 125 (47.17 %) to the rate control group. Cardiac death occurred in only 1 (0.71 %) patient in the rhythm control group, versus 15 (12 %) patients of the rate control group (P<0,001). According to survey results, 138 (47.1 %) patients were adherent to the anticoagulation therapy (ACT), and 155 (52.9 %) were not adherent to. In the adherent to ACT group, cardiovascular death occurred in 4 (2.9 %) patients, versus 16 (10.32 %) in non-adherent group (P=0.004). In the multivariant regression model, history of stroke (relative risk (RR) 11.45, 95 % CІ 2.44–53.7, P=0.002) and myocardial infarction (RR 6.6, 95 % CІ 1.7–25.4, P=0,006), adherence to ACT (RR 0.07, 95 % CІ 0.014–0.34, P=0.001) and the rhythm control strategy (RR 0.06, 95 % CІ 0.01–0.48, P=0.008), independently reduced the risk of cardiovascular death.
Conclusions. Rhythm control strategy independently of adherence to ACT recommendations reduces the risk of cardiovascular death in patients with non-valvular AF–AFl.
The aim – to determine the impact of the «no-reflow» phenomenon (NRP) after percutaneous coronary intervention (PCI) upon long-term prognosis in patients with ST elevation myocardial infarction (STEMI) and the effect of NRP on the incidence of complications of acute myocardial infarction during the acute period.
Material and methods. 105 patients with STEMI aged 36 to 85 years were studied, the mean age was 60.40±2.03 years. PCI was performed immediately after the diagnosis of STEMI, an average of 7.6±1.2 hours after the onset of the first symptoms. No-reflow was determined after the recanalization of the infarct-related artery (IRA) as the absence of optimal myocardial perfusion using the MBG (Myocardial blush grade, MBG ≤ 2) scale. Patients in whom NRP was fixed were assigned to the main group, n=18 (17.1 %), patients whose angiographic data met the criteria for successful PCI were appropriately allocated to the control group, n=87 (82.9 %). The final combined point was nonfatal repeated myocardial infarction, nonfatal stroke, cardiovascular death (CVD), and repeated hospitalization for the recurrence of the angina pectoris within one year after intervention.
Results. In the main group, postinfarction angina (OR 3.79, 95 % CI 1.08–13.42, Р<0.05), acute left and/or right ventricular failure was significantly more frequent (OR 7.98; 95 % CI 1.89–33.65, Р<0.05) and there were more cases of ventricular fibrillation (OR 12.14, 95 % CI 2.03–72.67, Р<0.05). At the end of 10.9±1.6 months it was found that the incidence of the combined endpoint in the patients of the main group is significantly higher than in the control group (OR 3.89, 95 % CI 1.36–11.24, Р<0.05). The greatest contribution to the difference between the groups at the combined endpoint was made by the discrepancy between the study groups for CVD (OR 10.38, 95 % CI 2.55–42.18, Р<0.05)
Conclusions. NRP in patients STEMI after PCI is related to the development of postinfarction angina, acute left and/or right ventricular failure, ventricular fibrillation. The strongest link was established between the development of NRP and cardiovascular mortality during the first 30 days in patients after intervention. It was not possible to establish connection between NRP and re-hospitalization for the resumption of angina pectoris, the incidence of non-fatal recurrent myocardial infarctions and non-fatal strokes.
The aim – to study the dynamics of indices of the exercise tolerance and the qualitative status of the main classes of lipoproteins together with activity of corresponding enzymes in patients after acute myocardial infarction (MI) during the first 6 months of follow-up.
Material and methods. 76 patients were included in the study (mean age 52.2±1.2 years). They received basic therapy according to the current guidelines, including emergent stenting. 41 pt (1st gr) in addition to standard medical treatment had the course of 30 cycle ergometer exercise trainings 3 times per week in individual regimen and 35 pts (2nd gr) underwent medical treatment and walking without trainings. All of them were examined on the 14–16th days of myocardial infarction and in dynamics at 2,5; 4 and 6 months. Blood biochemistry assays were performed on the 14–16th days and in 5 months after myocardial infarction.
Results. There was no difference in main clinical and anamnestic indices in patients of both groups at the first examination. Regular cycle ergometer exercise trainings led to the significant increase of the level of work capacity at the 4th month from (60.7±3.0) to (114.0±2,9) kJ (P<0.05) with better economic efficiency of heart work. The level of tolerance to physical load which was achieved by pts in the 1st gr was preserved 2 months at least after physical training stopping (112.0±3.9) kJ (P<0.05). At the same time these indexes in the 2nd gr were (59.1±3.8), (65.8±3.0) and (69.8±4.4) kJ, respectively with worse economic efficiency of heart work. At the 1st exam it was established high level of free radical oxidation of proteins, associated with oxidation of low density lipoproteins (LDL), very low density lipoproteins (VLDL), and high density lipoproteins (HDL) with higher index of their oxidative modification and blood atherogenic potential. The accomplished training program significantly decreased the content of free radical oxidation of proteins in blood serum and lipoproteins (LDL+ VLDL, HDL).
Conclusions. The efficiency of physical training program at the cycle ergometer in early period after myocardial infarction was established during 6-months follow up. Regular activities in individual regimen in addition to standard medical treatment (with emergent stenting) led to significant increasing of the level of the completed work and economic efficiency of heart work. These clinical effects may be explained by the decreasing of intensity of oxidative stress and inflammation, the improvement of qualitative status of lipoproteins. After stopping of physical trainings the achieved tolerance to physical load was preserved at least for two months.
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.