Тематичний Архів | Category Archives: Original researches

A.V. Maksymenko, Yu.L. Kuzmenko, M.P. Radchenko, A.A. Dovhaliuk, O.R. Vitovska Balloon pulmonary valvuloplasty of valvular stenosis in patients of the first year of life

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.

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V.P. Ivanov, Т.D. Danilevych Antiarrhythmic efficacy and safety of 1C class antiarrhythmic agents ethacizin and propafenone in patients with arterial hypertension and frequent recurrences of atrial fibrillation

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.

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O.S. Sychov, A.O. Borodai, E.S. Borodai Rhythm control, adherence to anticoagulation therapy and risk of cardiovascular death in patients with non-valvular atrial fibrillation–flutter

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.

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V.І. Tseluyko, M.M. Doloh, O.A. Leonenko Influence of the phenomenon of no-reflow after percutaneous coronary intervention on long-term prognosis in patients with ST elevation acute myocardial infarction (results of a prospective study)

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.

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I.E. Malynovska, O.B. Kuchmenko, V.O. Shumakov, N.M. Tereshchenko, L.S. Mkhitaryan, I.N. Ievstratova, N.M. Vasylynchuk, T.F. Drobotko Clinical and biochemical peculiarities at the different stages of cardiac rehabilitation in patients after myocardial infarction

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.

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V.M. Kovalenko, E.G. Nesukay, S.V. Fedkiv, S.V. Cherniuk, R.M. Kirichenko Changes of the cardiac structure and function parameters and arrhythmias in patients with myocarditis during 12-month follow-up

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).

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O.S. Sychov, P.B. Romaniuk, A.O. Borodai, V.H. Hurianov The heart rate influence on the myocardial structural and functional state and intracardiac hemodynamics in patients with non-valvular permanent atrial fibrillation

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.

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М.Yu. Коlesnyk, O.M. Kamyshnyi, Ya.М. Mykhailovskyi The interrelation of CYP2C9, CYP4F2, VKORC1 genes polymorphism and hemorrhagic complications of warfarin therapy in patients with atrial fibrillation: a single-center one-year study

The aim – to evaluate the effectiveness and safety of warfarin therapy in patients with atrial fibrillation (AF) in the anticoagulation practice, the rate of CYP2C9, CYP4F2, VKORC1 genes polymorphism and their interrelation with hemorrhagic complications among Zaporizhzhia region residents.

Material and methods. We studied 41 patients with AF (mean age – 68.2±1.2 years, men – 19, women – 22) enrolled in a 1-year out-patient observation in the anticoagulation practice of Zaporizhzhia State Medical University clinics. All patients were treated with warfarin. CYP2C9, CYP4F2, VKORC1 genes polymorphism was determined using polymerase chain reaction method.

Results. During one year hemorrhagic complications (small bleedings) arose in 22 (53.66 %) patients with AF, receiving warfarin therapy. Bleedings were significantly more frequent in the group of patients with VKORC1 gene mutation: 69.5 % vs. 37.5 %, respectively (χ2=5.331; Р<0.05). It was found that the relative risk of bleeding under warfarin treatment in patients with VKORC1 gene mutation is 1.97 (95 % CI 1.039; 3.751; Р<0.05). Conclusions. VKORC1 polymorphism is associated with increased frequency of hemorrhagic complications in patients with AF taking warfarin, indicating the relevance of a personalized approach to the warfarin dose titration using pharmacogenetic testing.

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O.S. Sychov, A.O. Borodai, E.S. Borodai Factors influencing the risk of ischemic stroke in patients with non-valvular atrial fibrillation-flutter

The aim – to evaluate clinical and echocardiographic predictors of ischemic stroke 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 months we examined 293 patients with non-valvular AF-AFl with a mean age 60.5±10.4 years, 81 (27.65 %) patients were females. Mean CHA2DS2-VASc score was 2.25±1.46. All patients underwent clinical examination and transthoracic echocardiography. Transesophageal echocardiography was performed in 263 (89.8 %) patients.

Results. Ischemic stroke (IS) occurred in 32 (10.92 %) cases: non-fatal IS – in 26 (8.87 %) cases, fatal IS – in 6 (2.05 %) cases. Onset of IS was associated with left atrial (LA) volume index ≥ 49 ml/m2 (Р=0,011), left atrial appendage spontaneous echo contrast (SEC) 3–4+ (Р<0.001), interventricular septum thickness (IVS) ≥ 1.7 cm (Р=0.02) and class EHRAm III–IV (Р<0,001). SEIL scale (SEC 3–4 + – 1 point, EHRAm III–IV – 1 point, IVS thickness ≥ 1.7 cm – 1 point, LA index ≥ 49 ml/m2 – 1 point) was an independent predictor of occurrence of IS, relative risk (RR) 2.38 (95 % CI 1.68–3.37), Р<0.001, independent of CHA2DS2-VASc, RR 1.28 (95 % CI 1.0–1.62), Р=0.045. Conclusions. SEIL scale may be used for assessment the risk of ischemic stroke In patients with AF-AFl independent of CHA2DS2-VASc scale.

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O.A. Yepanchintseva, O.J. Zharinov, K.O. Mikhaliev, B.M. Todurov Left ventricular dysfunction before planned surgical revascularization. Features of the «grey area»

The aim – to study the clinical characteristics of patients with stable coronary heart disease (CHD) and heart failure (HF) with mid-range left ventricular (LV) ejection fraction (EF) (40–49 %; HFmrEF), undergoing the planned coronary artery bypass grafting (CABG) in the real-life clinical practice settings.

Material and methods. We conducted a cross-sectional one-center study and consecutively enrolled 622 patients with stable CHD (mean age 61±9 yr, 526 (84.6 %) males and 96 (15.4 %) females), undergoing planned CABG. We analyzed demographic, clinical, laboratory, echocardiographic and coronary angiographic data. The population of enrolled patients was stratified into three groups according to the LVEF degree: group 1 (LVEF ≥ 50 %; 350 (56.3 %)); group 2 (LVEF 40–49 %; 11 (18.5 %)); and group 3 (LVEF < 40 %; 157 (25.2 %)). Results. The set of parameters in group 2, having intermediate values when compared to groups 1 and 3, were: the frequency of baseline aldosterone antagonists administration; the frequency of patients without mitral and tricuspid regurgitation; the frequency of patients with moderate or severe mitral regurgitation; mean systolic pulmonary artery pressure; the frequency of patients with LV aneurysm, detected by coronary ventriculography. Conclusion. The population of patients with CHD and HFmrEF, undergoing CABG in the real-life clinical practice settings, is associated with clinical heterogeneity. Further studies are warranted, aimed to determine the predictors of favorable and unfavorable dynamics of LVEF in this category of patients in the post-CABG period.

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