Имплантируемые кардиовертеры-дефибрилляторы для первичной и вторичной профилактики внезапной сердечной смерти: анализ клинико-анамнестического статуса пациентов по данным кузбасского регистра

Aim. To study clinical and anamnestic data of patients with implantable cardioverterdefibrillators (ICD) for primary or secondary prevention of sudden cardiac death (SCD) based on the data from the Kuzbass ICD registry.Methods. Retrospective analysis of demographic, clinical and anamnestic data from the “Kuzbass Registry of Patients with Implanted Cardioverter-Defibrillator”, which includes 286 patients admitted at the Kuzbass Cardiology Center in 2015–2019, was carried out.Results. The age of patients included in the registry was 59 (53; 66) years, 239 (83.6%) were men; all patients were diagnosed with heart failure. ICD for primary prevention of SCD was prescribed in 171 (63.6%) patients (group 1) and for secondary prevention in 98 (36.4%) patients (group 2). The groups were comparable in age, sex, main nosology (coronary artery disease), left ventricular ejection fraction (31.4 (26; 35) and 30 (10; 68)%, p = 0.389). Compared with the group 2, the group 1 had fewer working patients, higher incidence of heart defects, severe heart failure, higher incidence of paroxysmal supraventricular tachycardia (68.7% versus 44.8%, p = 0.001), and higher rates of revascularization (48, 9% and 31.7%, respectively, p = 0.006). Before ICD implantation for heart failure, 210 (73.4%) patients were receiving renin angiotensin aldosterone system inhibitors, 259 (90.6%) – beta-blockers, 167 (58.4%) – mineralocorticoid receptor antagonists. There were no differences in prescribed treatment between the groups. Only 137 (47.9%) patients, 86 (47.3%) patients in the group 1 and 51 (49.0%) patients in the group 2 received triple neurohormonal blockade. Remote monitoring was used only within the framework of research programs.Conclusion. The primary cohort of patients with ICD is the primary SCD prevention group. Regardless of the type of SCD prevention, the underlying disease is coronary artery disease. Current guidelines for optimal drug therapy and myocardial revascularization are not always followed prior to ICD implantation. The creation of registries of patients with ICD is an effective way to identify existing problems in ICD patient selection and to optimize follow-up and treatment.Цель. Изучение клинико-анамнестических особенностей пациентов с имплантируемыми кардиовертерами-дефибрилляторами (ИКД) для первичной или вторичной профилактики внезапной сердечной смерти (ВСС) на основе данных кузбасского регистра.Материалы и методы. Проведен ретроспективный анализ демографических, клинико-анамнестических данных кузбасского регистра пациентов с имплантированным кардиовертером-дефибриллятором, включавшего 286 больных, госпитализированных в Кузбасский клинический кардиологический диспансер имени академика Л.С. Барбараша с 2015 по 2019 г.Результаты. Возраст включенных в регистр лиц составил 59 (53; 66) лет, 239 (83,6%) – мужчины, у всех больных диагностирована хроническая сердечная недостаточность. ИКД установлен 171 (63,6%) больному с целью первичной профилактики ВСС (группа 1) и 98 (36,4%) пациентам для вторичной профилактики состояния (группа 2). Группы не различались по возрасту, полу, основной нозологии (ишемическая болезнь сердца), фракции выброса левого желудочка (31,4 (26; 35) и 30 (10; 68) % соответственно, p = 0,389). По сравнению с группой 2 в группе 1 было меньше работающих пациентов, чаще встречались пороки сердца, тяжелая сердечная недостаточность, чаще регистрировались пароксизмы неустойчивой ЖТ (68,7 против 44,8%, p = 0,001) и чаще проводилась реваскуляризация миокарда (48,9 и 31,7% соответственно, p = 0,006). До имплантации кардиовертера-дефибриллятора по поводу сердечной недостаточности 210 (73,4%) больных получали блокаторы ренин-ангиотензин-альдостероновой системы, 259 (90,6%) – бета-адреноблокаторы, 167 (58,4%) – антагонисты минералокортикоидных рецепторов. Различий в назначаемой терапии между сравниваемыми группами не выявлено. Трехкомпонентную нейрогуморальную блокаду получали всего 137 (47,9%) пациентов: 86 (47,3%) больных группы 1 и 51 (49,0%) группы 2. Системы удаленного наблюдения использованы ограниченно, только в рамках научных программ.Заключение. Основную когорту пациентов с ИКД составляет группа первичной профилактики ВСС. Независимо от вида профилактики ВСС основным заболеванием является ИБС. До имплантации устройства не всегда выполняются действующие рекомендации по назначению оптимальной медикаментозной терапии и реваскуляризации миокарда. Создание регистров больных с ИКД позволит выявить существующие проблемы по отбору пациентов на ИКД, оптимизировать их последующее наблюдение и лечение.

Диагностика и лечение тампонады сердца

Highlights. Current and emerging approaches in diagnosis and treatment strategies in cardiac tamponade are discussed. Particular attention is focused on the choice between pericardiocentesis or open surgical drainage as live-saving approaches to treat pericardial effusion in patients with urgent conditions.The article provides a systematic review of the literature on current and emerging approaches in the diagnosis and treatment of cardiac tamponade. We explored the decision-making process in diagnosis and treatment of pericardial decompression in pericardial effusion to provide clinicians with additional support in the assessment of high-risk patients requiring immediate intervention and those patients who should be transferred to specialized clinics and/or can be safely delayed for pericardiocentesis. The complex issues of choosing between pericardiocentesis or open surgical drainage of pericardial effusion to save the lives of patients with urgent conditions are considered. In addition, the practical aspects of manipulations and technologies for monitoring their implementation are highlighted.Основные положения. Представленный обзор литературы посвящен современным взглядам на диагностику и тактику лечения тампонады сердца. Рассмотрены сложные вопросы выбора перикардиоцентеза и хирургического дренирования перикардиального выпота для спасения жизни пациентов в ургентных состояниях.В обзоре систематизированы современные данные о методах диагностики и лечения тампонады сердца. Рассмотрены возможности пошаговой системы принятия решения о декомпрессии перикарда при перикардиальном выпоте для предоставления клиницистам дополнительной информации при отборе пациентов с высоким риском, требующим немедленного вмешательства, и больных, которых следует перевести в специализированное учреждение и/или которым возможно отсрочить выполнение перикардиоцентеза. Проанализированы вопросы выбора перикардиоцентеза и хирургического дренирования перикардиального выпота для оказания помощи пациентам в неотложных состояниях. Освещены практические аспекты выполнения манипуляций и технологии их контроля

Характеристика морфологічних змін клітин печінки, міокарду та шлунку в щурів за умов застосування карбамазепіну й тіотриазоліну.

We investigated the histological changes in rats after new complex drug administration. Seventy male white rats were used for this experiment. During 90 days they received carbamazepin and thyotriazolin compound. Compound were administered orally via gavage. We observed damaging action of high dose carbamazepin on hepar, myocardium and stomach. Our data suggest that thyotriazolin reduce toxic effect of carbamazepin on hepar, myocardium and stomach.В исследованиях на белых крысах с помощью гистологического анализа изучено действие новых комбинированных таблеток карбамазепина с тиотриазолином при длительном 90-дневном введении на морфофункциональное состояние клеток печени, миокарда желудка. Установлено, что длительное введение животным высоких доз карбамазепина вызывало ряд структурно-функциональных сдвигов со стороны гепато-билиарного аппарата,в элементах проводящей системы сердца наблюдались признаки внутриклеточного отека, обнаружен дозозависимый катаральный гастрит. Тиотриазолин уменьшал или нивелировал кардио-, гастро- и гепатотоксическое действие высоких доз карбамазепина.У дослідженнях на білих щурах за допомогою гістологічного аналізу вивчена дія нових комбінованих таблеток карбамазепіну з тіотриазоліном при тривалому 90-денному введенні на морфофункціональний стан клітин печінки, міокарда, шлунка. Встановлено, що тривале введення тваринам високих доз карбамазепіну викликало ряд структурно-функціональних порушень з боку гепато-біліар­ного апарата, в елементах провідної системи серця, спостерігалися ознаки внутрішньоклітинного набряку, виявлений дозозалежний катаральний гастрит. Тіотриазолін зменшував або нівелював кардіо-, гастро- і гепатотоксичну дію високих доз карбамазепіну

Антибіотики: вікові аспекти нефротоксичності

Age-specific aspects of nephrotoxicity with antibiotic therapy, its main pathophysiological mechanisms, methods of diagnosis, prevention and correction of nephropathy have been analyzed in a brief review.В кратком обзоре проанализированы возрастные аспекты нефротоксичности при антибиотикотерапии, основные ее патофизиологические механизмы, способы диагностики, профилактики и коррекции нефропатии.У короткому огляді проаналізовані вікові аспекти нефротоксичності при антибіотикотерапії, головні її патофізіологічні механізми, способи діагностики, профілактики та корекції нефропатії

Features of in-hospital clinical course of pulmonary embolism in patients of different age groups

Aim. To study the clinical course and management of patients with pulmonary embolism (PE) of various age groups hospitalized in a cardiology hospital.Material and methods. This prospective single-center study in the period from 2016 to 2018 included 154 patients with PE verified by computed tomography. Statistical processing was conducted using the MedCalcVersion 16.2.1 software package (Softwa, Belgium).Results. In all groups, female patients dominated, but the highest number of women (70,7%) belonged to the group of senile patients, while in the group <60 years, only half of patients with PE were women. Comorbid cardiovascular disease and deep vein thrombosis was diagnosed in eldest patients significantly more often than in those <60 years of age. The highest prevalence of cancer and recurrent PE were identified in the group of elderly patients. Thrombolytic therapy was performed most often in patients 60-75 years old, since these patients had a high risk of 30-day mortality according to Pulmonary Embolism Severity Index, but did not have severe comorbidities, as patients older than 75 years. An increase of right atrium size was found in the group of elderly and senile patients in comparison with patients <60 years. The highest pulmonary artery systolic and diastolic pressure was observed in the patients older than 75 years.Conclusion. In the Kemerovo Oblast, PE most often develops in patients aged 60-75 years and is characterized by a more severe clinical course compared with patients younger than 60 years. Patients over the 60 years of age have severe cardiovascular comorbidity status, atrial fibrillation/flutter and recurrent PE. Surgical treatment for senile patients is limited due to the high risk of postoperative complications, which specifies high mortality. Patients <60 years of age are a third of all patients hospitalized with PE. They have a low risk of mortality, but have an unfavorable course of the hospital period

Risk factors associated with the development of death events during the first year of follow-up after pulmonary thromboembolism

Purpose: to identify the factors associated with the development of death events during the year follow-up after hospitalization for pulmonary embolism (PE). Materials and methods: 93 patients with PE discharged to the outpatient stage of observation were studied. 45 (61,6%) patients were female with an average age of 66 years. The examination of patients at the stage of inclusion in the study consisted of standard methods of examination for this pathology. The diagnosis was confirmed by multislice computed tomography. Follow-up was 12 months. Statistical analysis was performed using the MedCalc Version 16.2.1. Results: during the one-year follow-up period 62 (66,7%) patients with PE were alive but 11 patients (11,8%) died, and no information was obtained about 20 patients. The causes of death were as follows: the development of recurrent PE – 4 (36,4%) patients, cancer – 3 patients (27,3%), stroke – 2 (18,1%), one patient (9,1%) died due to severe heart failure and one – myocardial infarction. A comparative analysis in the groups of alive patients (n = 62) and patients with a fatal events (n = 11) showed that the dead patients were older (78 (68; 81) vs. 65 (49; 75) years; p = 0,003), had a higher PESI score (119,0 (99,7; 137,2) vs. 88,0 (68,0; 108,0); p = 0,016) and were less compliant to prolonged anticoagulant therapy during the one year of observation (45,5% of patients (n = 5) vs. 82,3% ( = 51); p = 0,015). The ROC curve determined that a high risk of death during the one year after PE is associated with age over 70 years (p = 0,0001) and more than 95 points by PESI in the hospital period (p = 0,0001). Conclusion: The death events were developed in 11,8% of cases in patients with pulmonary embolism during the first year of follow-up. The death outcomes were significantly associated with elderly age, intermediate and high risk by PESI in the hospital period and low compliance to anticoagulant therapy extended during the year after pulmonary embolism

Antiarrhythmic drug therapy after atrial fibrillation ablation: data of the ESC-EHRA registry

Aim. Catheter ablation (CA) is an effective approach for rhythm control in atrial fibrillation (AF), however antiarrhythmic therapy (AAT) remains important. There is a lack of data about long-term AAT use after CA. This study evaluates AAT after CA for AF.Material and methods. In 2012-2016, EURObservational Research Programme of Atrial Fibrillation Ablation Long-Term (EORP AFA L-T) registry was conducted, which included 476 Russian patients (57,1% — men; mean age — 57,1±8,7 years). The follow-up after CA was 12 months (available in 81,9% of patients). The use of AAT was evaluated prior to hospitalization, during hospitalization for CA, as well as at 3, 6 and 12 months of follow-up.Results. Prior to CA, 439 (92,2%) patients received AAT During CA, 459 (96,4%) patients were treated with AAT. After CA, AAT was used by 463 (97,3%), 370 (94,8%), and 307 (78,7%) patients at 3, 6 and 12 months of follow-up, respectively. There was no arrhythmia recurrence in 187 (47,9%) subjects. Among these patients, 40 (21,4%) received class IC or III AAT. The peak of AAT use was found for class IC agents within 3 months after CA (P<0,05), while for other drugs this trend was not observed. There were no factors associated with AAT usage in patients without arrhythmia recurrence after CA. A positive correlation of arrhythmia non-recurrence with a minimum number of previously used antiarrhythmic agents was revealed (RR=0,85; 95% CI 0,73-0,98; P=0,03).Conclusion. The frequency of AAT use after AF ablation is significantly reduced. However, there is a cohort of patients without documented arrhythmia recurrence still receiving AAT, which requires special attention of physicians. There were no clinical predictors of continued AAT in subjects without arrhythmia recurrence