Diastolic Heart Function and Myocardial Electrical Instability in Patients with Q-wave Myocardial Infarction

The study included 131 male patients between the ages of 30 and 69 (51.9±9.13 years) with primary Q-wave myocardial infarction (Q-MI). All patients underwent clinical examination, including a physical examination, medical history, ECG in 12 conventional leads, echocardiography, and 24-hour ECG monitoring from the 10th to the 14th day of MI. The progression of LV diastolic dysfunction in Q-MI patients is associated with a longer history of coronary heart disease and arterial hypertension. With worsening diastolic dysfunction, a marked decrease in LV systolic function is revealed. The severe diastolic dysfunction in Q-MI patients is closely associated with myocardial electrical instability

Results of Off-Pump Coronary Artery Bypass Surgery in Patients with EuroSCORE≥5

Background: The lack of reliable data on the possibility, safety and results of OPCABG in patients with high surgical risk hinders the further wide introduction into clinical practice of such operations. In this regard, conducting a comparative evaluation of the results of OPCABG in patients with low and high surgical risk seems to us a worthwhile project. Materials and Methods: During the period between 2015 and 2017, 310 OPCABG operations were performed. Patients were divided into 2 groups depending on the EuroSCORE risk calculator value. Group 1 consisted of 130(41.9%) patients with a high surgical risk (EuroSCORE≥5), and Group 2 consisted of 180(58.1%) patients with a low surgical risk (EuroSCORE<5). Results: We could not find between the two groups significant differences in the number of mean grafts per patients (3.12 in Group 1 and 3.13 in Group 2), in operation times, or in the level of morbidity and mortality (1.5% in Group 1 and 1.2% in Group 2). All intraoperative conversions to on-pump CABG (5 cases or 3.8%) occurred in patients of Group 1 (P=0.008). Conclusion: The OPCABG operation in patients of high-risk group is a safe method and can be performed without compromising the completeness of myocardial revascularization with the same low mortality as in low-risk patients. The most common type of complication in high-risk patients is on-pump conversion, which at earlier and planned implementation is not reflected significantly at the level of hospital mortality

Dynamics of Non-Invasive Risk Factors of Sudden Cardiac Death after Myocardial Revascularization

Background: An attempt was made to study the effect of surgical myocardial revascularization on the processes of electrical myocardium instability underlying the occurrence of life-threatening ventricular arrhythmias, as well as the possibility of its non-invasive assessment by studying heart rate variability (HRV) and heart rate turbulence (HRT), as well as the duration and dispersion of the QT interval. Based only on the presence of viable myocardium, it is often impossible to predict the positive impact of revascularization on a patient’s prognosis, especially with reduced myocardial contractility. Moreover, given the well-studied relationship between myocardial remodeling and neurohormonal activation, non-invasive methods for assessing the autonomic regulation of cardiac activity can provide additional diagnostic information. Along with this, changes in these indicators and their prognostic role in patients with coronary artery disease after revascularization are subjects of discussion. Methods and Results: All patients underwent a comprehensive clinical and biochemical blood test, transthoracic echocardiography, tissue Doppler echocardiography, ultrasound examination of brachiocephalic arteries, selective coronary angio- and ventriculography, as well as Holter monitoring. Results show that a year after the coronary intervention, there was a significant positive trend in the frequency and structure of ventricular arrhythmias (VA). HRV indicators generally did not show significant dynamics. Only an increase in the values of the SDANN and low-frequency power (LFP) indices was noted, indicating a gradual increase in the activity of the sympathetic part of the autonomic nervous system. HRT indicators also did not show significant dynamics. A significant increase was found in the number of patients with no signs of impaired HRT. The average duration of the QT interval decreased significantly. There was also a tendency to shorten the corrected QT interval; however, it was insignificant. In terms of dispersion, both the QT interval and its corrected index, no significant dynamics were recorded in the general group of patients. Conclusion: Our study found that in patients with prior myocardial infarction, after revascularization, significant positive dynamics were recorded in life-threatening ventricular arrhythmias, but were unreliable for the indicators of autonomic regulation of cardiac activity, such as HRV and HRT

One-Year Results of the Use of Absorb Bioresorbable Vascular Scaffold in Patients with Different Forms of Coronary Artery Disease as Compared to a Drug-Eluting Stent

The aim of this study was to evaluate the immediate and long-term (12 months) clinical and angiographic efficacy of myocardial revascularization using Absorb GT1 Bioresorbable Vascular Scaffold (BVS) in comparison to second-generation drug-eluting stent (DES) in patients with various forms of coronary artery disease (CAD). Material and Methods: The study included 152 patients with CAD. There were 131 men and 32 women with an average age of 54.6±10.4 years. Patients' data were evaluated retrospectively from the medical records. Results: • Implantation of BVS in patients with different forms of CAD did not cause any angiographic or clinical complications, either at the hospital or at 12-month observation stages, and the results were comparable to those of the DES group. • The technique of implanting BVS and the reception of dual antiplatelet therapy are the key factors for achieving positive results in real clinical practice. • The use of BVS-frameworks contributes to improving clinical, functional and laboratory indicators, while the observed positive dynamics are comparable to similar data of the DES group. • Regardless of the type of implanted stents, the survival rate among CAD patients within 12 months after stenting was 100%, while none of the respondents during this time developed acute MI or recurrence of angina attacks

INTERNATIONAL JOURNAL OF BIOMEDICINE Diastolic Heart Function and Myocardial Electrical Instability in Patients with Q-wave Myocardial Infarction

Abstract The study included 131 male patients between the ages of 30 and 69 (51.9±9.13 years) with primary Q-wave myocardial infarction (Q-MI). All patients underwent clinical examination, including a physical examination, medical history, ECG in 12 conventional leads, echocardiography, and 24-hour ECG monitoring from the 10 th to the 14 th day of MI. The progression of left ventricular diastolic dysfunction in Q-MI patients is associated with a longer history of coronary heart disease and arterial hypertension. With worsening diastolic dysfunction, a marked decrease in LV systolic function is revealed. The severe diastolic dysfunction in Q-MI patients is closely associated with myocardial electrical instability. Key words: diastolic heart function; Q-wave myocardial infarction; 24-hour ECG monitoring; myocardial electrical instability. Abbreviations LVEDD, left ventricular end-diastolic dimension; LVESD, left ventricular end-systolic dimension; LVEDV, left ventricular end-diastolic volume; LVESV, left ventricular end-systolic volume; LAESV, left atrium end-systolic volume; IVST, interventricular septal thickness; LVPWT, left ventricular posterior wall thickness; LVM, left ventricular mass; EF, ejection fraction; PVCs, premature ventricular contractions; VA, ventricular arrhythmias; PE, peak early filling velocity; PA, peak atria1 filling velocity; EPIA, early post-infarction angina

Effects of the Presence of Left Main Coronary Artery Disease on the Results of Off-pump Coronary Artery Bypass Grafting Surgery

Background: Left main coronary artery (LMCA) disease is one of the risk factors that affect the outcomes of coronary artery bypass grafting surgery. In particular, this risk factor pertains to the conduct of conventional on-pump CABG. Very little is known about the effects of the presence of LMCA disease on the results of off-pump CABG (OPCABG) surgery. Material and Methods: In the Department of Cardiac Surgery of the Republican Specialized Center of Cardiology, during the period between April 2015 and April 2017, 270 consecutive OPCABG procedures were performed. Patients were divided into 2 groups depending on the presence or absence of LMCA disease. Group 1 consisted of 124(44.9%) patients with LMCA disease, and Group 2 consisted of 146(55.1%) patients without LMCA lesions (non-LMCA group). Results: The average number of distal anastomoses in both groups was more than 3 anastomoses/patient. The incidence of nonfatal intraoperative complications was 8.9% in Group 1 and 15.1% in Group 2 (P=0.1212). The conversion rate to on-pump CABG amounted to 3.2% (4 patients) in Group 1 and to 4.8% (7 patients)in Group 2. In the immediate postoperative period, 40(32.2%) patients of Group 1 and 45(30.8%) of Group 2 needed inotropic support until full restoration of normal hemodynamics with duration between 3.0 and 2.6 hours. The average duration of ventilation support was 6.4 hours in Group 1 and 5.6 hours in Group 2. Hospital mortality was 0.8% (1 patient) in Group 1 and 0.7% (1 patient) in Group 2 (P>0.05). Conclusion: Thus, the presence of left main stem lesion of LCA is not an additional risk factor that would complicate the performance of OPCABG surgery. The OPCABG operation in this group of patients is a safe method and can be performed without compromising the completeness of myocardial revascularization with the same low mortality as in low-risk patients

Overview of the current status of familial hypercholesterolaemia care in over 60 countries - The EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC)

Management of familial hypercholesterolaemia (FH) may vary across different settings due to factors related to population characteristics, practice, resources and/or policies. We conducted a survey among the worldwide network of EAS FHSC Lead Investigators to provide an overview of FH status in different countries

Overview of the current status of familial hypercholesterolaemia care in over 60 countries - The EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC)

Background and aims: Management of familial hypercholesterolaemia (FH) may vary across different settings due to factors related to population characteristics, practice, resources and/or policies. We conducted a survey among the worldwide network of EAS FHSC Lead Investigators to provide an overview of FH status in different countries. Methods: Lead Investigators from countries formally involved in the EAS FHSC by mid-May 2018 were invited to provide a brief report on FH status in their countries, including available information, programmes, initiatives, and management. Results: 63 countries provided reports. Data on FH prevalence are lacking in most countries. Where available, data tend to align with recent estimates, suggesting a higher frequency than that traditionally considered. Low rates of FH detection are reported across all regions. National registries and education programmes to improve FH awareness/knowledge are a recognised priority, but funding is often lacking. In most countries, diagnosis primarily relies on the Dutch Lipid Clinics Network criteria. Although available in many countries, genetic testing is not widely implemented (frequent cost issues). There are only a few national official government programmes for FH. Under-treatment is an issue. FH therapy is not universally reimbursed. PCSK9-inhibitors are available in ∼2/3 countries. Lipoprotein-apheresis is offered in ∼60% countries, although access is limited. Conclusions: FH is a recognised public health concern. Management varies widely across countries, with overall suboptimal identification and under-treatment. Efforts and initiatives to improve FH knowledge and management are underway, including development of national registries, but support, particularly from health authorities, and better funding are greatly needed