CLARIFY (The prospeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) is a large multicenter project in the patients with a stable coronary artery disease (CAD). Within 5 years (2009–2014) 32,703 patients with confirmed diagnosis of CAD from 45 countries worldwide took part in the registry. Study results have demonstrated the significant differences between the current international standards of management and real-life clinical practice. Despite the fact that Ukrainian doctors actively used the complete list of the medicinal products recommended in the stable CAD (ASA, statins, BBs, ivabradine, ACE inhibitors), the control of therapy efficacy was very low and not only relative to the symptoms (after 5-year follow-up, angina attacks were persistent in 74 % of patients versus 16.9 % of the European patients). It should be noted that the clinical status of patients enrolled in Ukraine was more severe compared with the general group: 24.1 % of patients with the severe angina (ІІІ FC), in Europe – 2.2 %, in the world population – 1.6 %. Rate of the myocardial revascularization (surgical, endovascular) was very low in Ukraine as for 5-year study – only 5.9 %. As a result, our patients had 2-fold need in the hospitalization, 2-fold rate of fatal MI and acute cerebrovascular accidents (stroke + TIA) and 3-fold rate of the unstable angina. Control of such main risk factors of CAD, as BP levels < 140/90 mm Hg, LDL cholesterol levels < 1.8 mmol/L, HR < 70 beats per minute was insufficient both in the Ukrainian and global populations. During the study both Ukrainian and European patients have not demonstrated the dynamics in life style modification (majority of subjects continued sedentary lifestyle, were overweight, had signs of the abdominal obesity and smoked). Taking into consideration the results of the CLARIFY study, significant optimization of management of patients with stable CAD is still necessary.
Clinical pharmacology – is the science about drugs and their clinical use, directed at improving efficiency and safety of clinical applying of drugs. The main sections of clinical pharmacology are pharmacodynamics – the study of the cumulative effect of the drug substance and its mechanisms of action, and pharmacokinetics – the study of routes of administration, distribution, biotransformation and excretion of drugs from the body. In addition, clinical pharmacologists study the side effects/reactions, especially the action of drugs, depending on gender, age, interactions of drugs, the effect of food on the pharmacokinetics of drugs, etc. Pharmacogenetics is an important part of clinical pharmacology, studying inherited genetic differences in drug metabolic pathways, which may affect individual responses to drugs. New direction of clinical pharmacology is pharmacoeconomics searching for new, evidence-based approaches to optimize drug therapy in terms of efficacy and economic aspects.
The article reviews contemporary data focused on the incidence of myocarditis, characteristics of the different diagnostic approaches, problems related to differential diagnosis and to the evolution of diagnostic criteria. Despite that endomyocardial biopsy remains the «gold standard» of the diagnosis its use in real clinical practice is strictly limited. The last decade is characterized by the rapid development of non-invasive imaging techniques capable to detect myocardial inflammation, such as cardiac MRI with T1 and T2 mapping, positron-emission computer tomography as also contemporary echocardiographic techniques, such as speckle-tracking. Also we demonstrate our own experience with evaluation of the gender features of myocarditis clinical manifestations and assessment of their sensitivity and specificity for the diagnosis.
Transcatheter aortic valve implantation (TAVI) procedure is an alternative option for high surgical risk patients with symptomatic aortic stenosis. Despite the relatively great experience and widely introduction of TAVI procedure in developed countries, in Ukraine it was performed only in selected cases. At the same time, the need for its routine administration, according to the statistical data, is significant. The inclusion of TAVI procedure into medical care of patients with symptomatic severe aortic stenosis of high surgical risk, who are not candidates for surgical treatment, will extend and improve quality of life of these patients.
The aim of the study was to evaluate the effectiveness of the out-patient and in-patient diagnosis and care of pulmonary artery thromboembolism and their conformity to the international and national guidelines. Two hundred and forty five cases of patients with acute or relapsing pulmonary embolism (PE), or chronic post-embolic pulmonary hypertension (CPEPH) were analyzed. Overall mortality rate was 3.6 %. Diagnosis discordance rate was 13.87 %. Major complaint, dyspnea, was registered in 231 patients, while 14 patients (5.7 %) had no complaints. Among 25 CPEPH cases an episode of acute pulmonary TE was documented in 21 patients (84,0 %). Concomitant thrombophlebitis was diagnosed in 202 patients (82.4 %). The other underlying causes of PE were distributed as follows: diabetes mellitus, 30–32 weeks pregnancy or neoplasm – 4.89 %, surgery – 2.0 %, trauma – 3.7 %, pathological delivery – 1.6 %, atrial fibrillation – 3.3 %, acute phlebitis – 5.3 %. In one case the cause of PE was liposaction. PE was similarly often observed in men (49.18 %) and in women (50.9 %). Mean age of patients was 53.3±0.9 years. In most cases PE was diagnosed in overweight patients: mean body mass index was 29.4±0.4 kg/m2. Mean duration of the disease was 25.2±4.3 days. Concomitant pleurisy was revealed in 24, pericarditis – in 13, pulmonary infarction – in 24, hemophthysis – in 3 patients. Blood fibrinogen was 5.0±0.1 g/l; activated partial tromboplastin time – 60.07±5.06 sec. Mean pulmonary artery pressure during echocardiography was 61.2±1.5 mm Hg, during angiopulmonography – 61.9±1.5 mm Hg. Vena cava filter was placed in 136 (55.5 %), thrombolysis – in 52.7 %, embolectomy – in 4.9 % patients. Therapeutic interventions decreased pulmonary artery pressure from 61.2±1.5 to 47.8±1.5 mm Hg. Further long-term out-patient management is required.
Ukraine took part in EUROASPIRE IV during period of 2012–2013. There were interviewed 643 patients with cardiovascular diseases (471 men and 172 women), age 59.81±9.83 years. The results showed that the European recommendations on secondary prevention of coronary artery disease (CAD) in everyday clinical practice are insufficiently implemented in Ukraine. So, the problem of smoking in Ukraine is more significant than in the European countries-participants: considerable part of CAD patients are permanent smokers who refuse from smoking cessation after an index event (24 %). Prevalence of overweight appeared equally high (81 %), however the Ukrainian patients were considerably less motivated to reduce it. Physical activity both in Ukraine and in Europe was extremely low in more than a half of patients. The Ukrainian patients with CAD were more informed than in Europe about blood cholesterol and glucose, however their levels exceeded such for Europeans, and target values were not achieved in most of the patients. Hypertension in Ukraine appeared better diagnosed, however worse controlled, as compared to Europe. Medical therapy of the Ukrainian patients was insufficient for achievement of target values of main factors of cardiovascular risk. This may be related to less effective dosages of medications, insufficient usage of the combined therapy in CAD patients in Ukraine.
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Morphofunctional reorganization of myocardium in chronic ischemic heart disease were studied based on clinical (postmortem examination and intraoperative tissue samplings) and experimental data (modeling of acute and recurrent coronary insufficiency with vasopressin). General histological, histochemical tests, polarization and electron microscopy were used. It was determined that disease process in myocardium induced and maintained by circulatory hypoxia, implemented with active participation of intramural (sympathetic) innervation involving all cellular elements of fabric district producing wide range of biologically active neurohumoral and immunological factors. They provide interaction potentiating effect on cells secreting. Integral result of these processes was a progressive myocardium interstitial fibrotization and reducing its contractile function, which determine the morphological and clinical patterns of ischemic cardiomyopathy.
The International Registry CLARIFY (The prospeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) is a prospective project involving long-term, for 5 years, monitoring of patients with chronic coronary artery disease (CAD). The project is conceived to get more information about the patients with stable coronary artery disease, as the attention has been focused lately on the diagnosis and treatment of patients with acute forms of the disease. It is intended also to explore the differences between the actual clinical practice and current recommendations based on evidence data. The CLARIFY study included 33,438 patients from 45 countries in Europe, America, Africa and Asia, Australia and the Middle East. In Ukraine, the study included 777 patients from the outpatient practice of 52 physicians. Men predominate (˜80 %) among patients with stable coronary artery disease both in Ukraine and general CLARIFY population. 41 % of Ukrainian population had a positive family history of CAD, 78 % – arterial hypertension, 18 % – diabetes mellitus. Ukrainians are notable for significantly higher body mass index (median 29.1 vs 27.2 kg/m2, P
Contradictory position towards target level of blood pressure in patients with diabetes mellitus in the 2012 European recommendations on prevention of cardiovascular diseases (lower than 140/80 mm Hg) and
Ukrainian guidelines and clinical protocol (130/<80 mm Hg), as well as appearance of new Ukrainian clinical guidelines and clinical protocol on management of type 2 diabetes mellitus induced author to review current
scientific evidence. Based on analysis, it has been concluded that the optimal level of blood pressure for prevention of cardiovascular complications in patients with diabetes mellitus is 130–135/<80 mm Hg.