Management of acute coronary syndrome in older adults (data from russian federal acute coronary syndrome registry)

The frequency of cardiovascular diseases is increasing progressively with age, and the global aging of the population poses the problem of treatment of patients of older age groups in a row with other relevant medical and socio-economic problems. Aim. In the present study was to investigate the quality of medical care for patients with acute coronary syndrome (ACS) old age and compliance of the treatment current guidelines. The data is exported from the system of the Federal register OKS. Materials and methods. Analyzed medical history 33 893 patients with ACS entered in the system registry of ACS for the period from 01.01.2016 to 31.12.2016. a comparison was made of the quality of care in patients with ACS elderly (75 years and older, n=8773) and in younger patients. Results. The results of the study showed that in patients of senile age, when compared with younger patients, comorbid conditions are significantly more often observed, as well as a significantly higher risk of hospital and 6-month death, calculated on the GRACE scale. Conclusion. Patients of senile age with ACS are almost twice less likely to undergo percutaneous coronary interventions than younger ones, which worsens the prognosis in these patients and increases mortality

May Measurement Month 2017 in Russia: hypertension treatment and control-Europe

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative by the International Society of Hypertension aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programs worldwide. The most recent publication compared data from three surveys performed in Russian population aged 25-64 showed that the prevalence of hypertension increased by approximately 20% from 2003 to 2013. This study presents screening data collected in 2017 though the MMM17 initiative in Russia. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017 in 19 Russian cities. Blood pressure measurement, the definition of hypertension, and statistical analysis followed the standard MMM protocol. The recruitment of MMM17 participants in Russia occurred in shopping malls, colleges and universities, supermarkets, business centres, parks, and squares. Russian young cardiologists as an official section of Russian Society of Cardiology was actively involved. A total of 5660 individuals were screened. After multiple imputation, 2709 (47.9%) had hypertension. Of individuals not receiving antihypertensive medication, 753 (20.3%) were hypertensive. Of individuals receiving antihypertensive medication, 1094 (55.9%) had uncontrolled BP. Comparing with the worldwide results of MMM17 screening, Russian participants had a higher proportion of hypertension, comparable antihypertensive prescription rate, and worse hypertension control. Thus, the MMM17 project appears to be an important step in evaluating hypertension burden in Russia and emphasizes the further need to improve hypertension awareness, treatment, and control

The place of intervention methods of treatment of patients with resistant hypertension in clinical practice

Every year scientific interest in studying of interventional methods of treatment of resistant hypertension steadily increases. Row of high technology device are created for performance of such procedures as well as techniques of their management are also developed. Non-pharmacological ways of treatment are described in this article, which are widely used in clinical practice: baroreflex activation therapy, radiofrequency renal denervation, and central iliac arteriovenous anastomosis

Prevention of Cardioembolic Complications in Patients with Atrial Fibrillation: Efficacy and Safety of Left Atrial Appendage Isolation and Oral Anticoagulants

Aim. To study the outcomes frequency and structure in patients with atrial fibrillation (AF) depending on the cardioembolic events preventing method: left atrial appendage (LAA) isolation, direct oral anticoagulants (DOACs) or warfarin.Material and methods. A prospective observational study included patients with AF and high risk of cardioembolic complications and without contraindications to anticoagulants. Patients who refused long-term oral anticoagulants taking underwent LAA isolation, the rest of the patients received DOACs or warfarin. The observation period was 3 years. Mortality, cardioembolic complications and major bleeding (according to GARFIELD criteria) cumulative incidence was assessed.Results. We included 245 patients: 46 patients were treated with LAA isolation, 100 with warfarin, and 99 with DOACs. Multivariate regression analysis demonstrated a statistically significant advantage of LAA occluder in terms of combined endpoint achieving frequency compared to warfarin (hazard ratio [HR] 3.10; 95% confidence interval [CI] 1.01-9.54; p=0.049), and to DOACs (HR 3.44, 95% CI 1.15-10.29; p=0.027). A similar result was obtained for all-cause mortality (HR 5.24; 95% CI 1.12-24.55; p=0.036 and HR 5.58; 95% CI 1.22-25.49; p=0.027, respectively). There were no significant differences in bleeding rates between the groups.Conclusion. This observational study demonstrates the superiority of LAA isolation as a first-line therapy over DOACs and warfarin in patients with AF and high risk of cardioembolic complications. Randomized trials are required to confirm these observations

ИННОВАЦИЯ В МЕДИКАМЕНТОЗНОМ ЛЕЧЕНИИ ПАЦИЕНТОВ С ЛЕГОЧНОЙ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ И НЕОПЕРАБЕЛЬНОЙ, ПЕРСИСТИРУЮЩЕЙ/ РЕЗИДУАЛЬНОЙ ФОРМАМИ ХРОНИЧЕСКОЙ ТРОМБОЭМБОЛИЧЕСКОЙ ЛЕГОЧНОЙ ГИПЕРТЕНЗИИ: СТИМУЛЯТОР РАСТВОРИМОЙ ГУАНИЛАТЦИКЛАЗЫ – РИОЦИГУАТ

Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are diseases, diagnosed at a late stage with functional class III or IV according to World health organization (WHO). PAH and CTEPH leads to severe right heart failureand ultimately, death. The modern researches aim at exploring the potential therapeutic targets, as at developing new drugs that can affect the previously set target. Riociguat is the first in a new class of soluble guanylatecyclase stimulators. The analysis of main researches, which reflect the evidence of riociguat efficiacy and safety in patients with PAH and inoperable, persistent/recurrent CTEPH, is presented in this rewiew.Легочная артериальная гипертензия (ЛАГ) и хроническая тромбоэмболическая легочная гипертензия (ХТЭЛГ ) являются заболеваниями, чаще всего диагностируемыми на поздней стадии, с функциональным классом (ФК) легочной гипертензии III или IV по классификации Всемирной организации здравоохранения (ВОЗ), и приводящими к тяжелой правожелудочковой недостаточности с последующим летальным исходом. Cовременные исследования направлены на изучение фундаментальных терапевтических мишеней и на создание новых лекарственных препаратов, воздействующих на ранее установленные мишени. Риоцигуат – первый представитель нового класса лекарственных препаратов-стимуляторов растворимой гуанилатциклазы (рГЦ ). В обзоре проводится анализ основных исследований, в которых оценивалась эффективность/безопасность риоцигуата у пациентов с Л АГ и неоперабельной, персистирующей/резидульной формами ХТЭЛГ

Ингаляционный оксид азота при первичной легочной гипертензии: влияние на легочную гемодинамику, газообмен и транспорт кислорода

The study assess effects of inhaled nitric oxide on pulmonary haemodynamics, gas exchange and oxygen transport in patients with primary pulmonary hypertension (PPH) and evaluates factors predicting the response to inhaled nitric oxide.Ten patients with PPH (8 females, 2 males) were observed.Oxygenation and haemodynamic variables were measures and calculated at room air and then 15 min after each sequential addition of 10, 20 and 40 ppm nitric oxide to the gas mixture. Patients were considered responders if the mean pulmonary artery pressure or pulmonary vascular resistance decreased by 20%. An electrochemical gas sensor device PrinterNOx provided continuous analysis of nitric oxide and oxidative nitric oxide products.There was a dose-dependent improvement in haemodynamic variables that was maximal at 40 ppm nitric oxide (mean pulmonary artery pressure decreased from 67±7 to 56±5 mm Hg, pulmonary vascular resistance index decreased from 1335±302 to 790±102 dyne sec/cm-5, and cardiac index increased from 2.3 to 2.7 L/min/m2, all p<0.05). There was a significant improvement in oxygen transport at 20 and 40 ppm nitric oxide (DO2 improved from 684±108 to 791±110 and 835±98, respectively, p<0.05). Five patients (50%) responded to NO. The responders differed from non-responders in such factors as distance during 6-minute walking test, pa02 and paC02 (all p≤0.01).Our data show an improvement in pulmonary haemodynamics and oxygen transport in patients with primary pulmonary hypertension.В статье изучены эффекты ингаляционного оксида азота (N0) на легочную гемодинамику, газообмен и транспорт кислорода у больных с первичной легочной гипертензией (ПЛГ) и факторы-предикторы ответа на N0. Наблюдали 10 больных (8 женщин, 2 мужчин) с ПЛГ.Параметры гемодинамики и оксигенации измерялись до начала исследования и последовательно в конце сеансов ингаляции N0 в концентрациях 10, 20, и 40 ppm (через 15 мин). Пациенты считались “ответчиками” при наличии снижения среднего давления в легочной артерии или легочного сосудистого сопротивления более чем на 20%. Для постоянного контроля N0 и N02 был использован электрохимический анализатор PrinterNOx.На фоне терапии N0 наблюдалось дозозависимое улучшение легочной гемодинамики, максимальный эффект отмечен при N0 40 ppm (среднее легочное давление снизилось с 67±7 до 56±5 л/мин/м2, легочное сосудистое сопротивление – с 335±302 до 790±102 дин-с/см-5 и сердечный индекс увеличился с 2,3 до 2,7 L/min/m2, р<0,05). При N0 20 и 40 ppm наблюдалось значимое улучшение транспорта кислорода (от 684±108 до 791 ± 110 и 835±98 соответственно, р< 0,05). Пять больных (50%) ответили на терапию N0. “Ответчики” отличались от "неответчиков" по таким показателям, как дистанция во время теста с 6-минутной ходьбой, ра02 и раС02 (р<0,01).Ингаляционный оксид азота достоверно улучшает показатели легочной гемодинамики и газообмена у больных с ПЛГ

The influence of antyhypertensive therapy of valsartan and fixed combination with hydrochlorothiazide use on pulse-wave velocity and central arterial pressure in patients with arterial hypertension of 1-2 grades in international VICTORY clinical trial

Objective - to explore influence of valsartan monotherapy use and its use in combination with hydrochlorothiazide (HCTZ) on pulse-wave velocity (PWV) and central arterial pressure (CAP) in patients with arterial hypertension (AH) of 1-2 grades in international VICTORY clinical trial. Materials and methods. The international multicenter prospective randomized clinical study VICTORY that lasted for 16 weeks included patients with 1-2 grades AH. In patients who previously received antihypertensive therapy a 7 days washout period was carried out. All patients started their therapy with 80 mg valsartan (Valsacor®, KRKA, Slovenia); in Russia the starter dose of Valsacor®, KRKA was 160 mg in previously treated patients that did not influence the study results. If after 4 weeks of treatment BP was more than 140/90 mm hg (more than 130/80 mm hg in high risk patients or in diabetes mellitus patients) the dose of valsartan was increased to 160 mg (320 mg in Russia) or diuretic in fixed combination with valsartan was added (160 mg valsartan/12.5 mg HCTZ): Valsacor® H 160 (KRKA, Slovenia). If target BP after 8 weeks of treatment was not reached valsartan dose was increased to 320 mg or fixed combination of valsartan and diuretic (160 mg/12.5 mg) was used. If target BP after 12 weeks of treatment was not reached - valsartan and diuretic 320 mg/12.5 mg were used. PWV and CAP (SphygmoCor®, AtCorMedical) were assessed at baseline and after 16 weeks of treatment. The primary endpoints were assessment of the impact of studied medications on aortic stiffness, aortic augmentation index and comparison of absolute medians of reached central and peripheral BP reduction with baseline value. Results. Of 365 patients included in the study 74 were included in PWV and CAP study subgroup. Valsartan and its combination with HCTZ were effective in CBP reduction. The mean absolute reduction of central systolic and diastolic BP after 16 weeks of treatment was 19.7±12.9 mm hg and 13.9±8.5 mm hg, respectively (

СУБТРАКЦИОННАЯ КТ-АНГИОПУЛЬМОНОГРАФИЯ В ДИАГНОСТИКЕ ХРОНИЧЕСКОЙ ТРОМБОЭМБОЛИЧЕСКОЙ ЛЕГОЧНОЙ ГИПЕРТЕНЗИИ

Purpose. To assess the state of the vascular bed and perfusion of the lungs in patients with chronic thromboembolic pulmonary hypertension (CTEPH) by the method of subtraction computed tomography (CT).Materials and methods. Between November 2015 and May 2018, 65 patients with diagnosis of CTEPH were examined. All patients were examined on a computer tomograph Aquilion ONE 640 VISION Edition (Toshiba Medical Systems) with 320 rows of detectors, slice thickness – 0,5 mm. Assessment of perfusion disorders was carried out using new software, which allows combining contrast and noncontrast images by subtraction. Were analyzed parameters of the parenchyma, blood supply and perfusion status with the calculation of indices of obstruction and perfusion disorders. The obstruction index was compared with the index of perfusion abnormalities, a 6-minute walk test, and mean pulmonary artery pressure according to the right heart catheterization data. Results. The significant correlation was found between the obstruction index and the index of perfusion disorders in patients with CTEPH (r = 0.605; p = 0.000001). Interrelations between vascular-perfusion indices (an obstruction index and an index of perfusion disorders), mean pulmonary artery pressure and distance in a 6-minute walk test were not revealed.Conclusion. Subtraction CT pulmonary angiography allows to assess the severity of vascular lesion and perfusion disorders within a single study, also determine the effectiveness of treatment in patients with CTEPH.Цель исследования: оценить состояние сосудистого русла и перфузии легких у больных хронической тромбоэмболической легочной гипертензией (ХТЭЛГ) методом субтракционной компьютерной томографии (КТ).Материал и методы. В период с ноября 2015 г. по май 2018 г. было обследовано 65 пациентов с диагнозом ХТЭЛГ. Все пациенты были обследованы на компьютер-ном томографе Aquilion ONE 640 VISION Edition (Toshiba Medical Systems) с 320 рядами детекторов, толщина томографического среза 0,5 мм. Оценка перфузионных нарушений выполнялась с помощью нового программного обеспечения, которое позволяет совмещать контрастные и бесконтрастные изображения методом субтракции. Анализировались параметры состояния паренхимы, кровоснабжения и перфузии легких с расчетом индексов обструкции и перфузионных нарушений. Индекс обструкции был сопоставлен с индексом перфузионных нарушений, тестом 6-минутной ходьбы (Т6МХ) и средним давлением в легочной артерии (ср. ДЛА) по данным катетеризации правых отделов сердца.Результаты. Между индексом обструкции и индексом перфузионных нарушений у больных ХТЭЛГ была обнаружена статистически значимая корреляция (r = 0,605; p = 0,000001). Взаимосвязей между сосудисто-перфузионными показателями (индексом обструкции и индексом перфузионных нарушений), ср.ДЛА и пройденной дистанцией в Т6МХ выявлено не было.Заключение. Использование субтракционной КТ-ангиопульмонографии позволяет оценить выраженность сосудистого поражения и перфузионных нарушений в рамках одного исследования, а также определить эффективность лечения у пациентов с ХТЭЛГ

2020 Clinical practice guidelines for Pulmonary hypertension, including chronic thromboembolic pulmonary hypertension

Russian Society of Cardiology (RSC)With the participation: Association of Cardiovascular Surgeons of Russia, Russian Respiratory Society, Federation of Anesthesiologists and Resuscitators, Association of Rheumatologists of Russia, National Congress of Radiation Diagnosticians

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700