Влияние гиполипидемической длительной терапии на некоторые факторы риска пациентов со старым инфарктом миокарда и сахарным диабетом второго типа

Department of Chronic Heart Failure, Institute of Cardiology, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaScopul studiului. Determinarea influenţei tratamentului hipolipemiant de durată asupra unor factori de risc la bolnavii cu infarct miocardic vechi şi diabet zaharat tip 2. Material şi metode În studiu au fost incluşi 54 de pacienţi cu Q-Infarct miocardic vechi şi diabet zaharat tip 2 (vârsta medie de 58,88 ± 0,92 ani), dintre care 31 de bărbaţi şi 23 de femei. Pacienţii au fost divizaţi în 2 grupuri: I grup – pacienţi cu Q-Infarct miocardic vechi şi diabet zaharat tip 2, care au administrat tratament standard şi tratament hipolipemiant cu Lovastatină (doza medie – 33,15 mg/zi), timp de 1 an, şi al II grup – pacienţi cu Q-Infarct miocardic vechi şi diabet zaharat tip 2, care au administrat numai tratament standard. Corecţia glicemiei a fost efectuată cu Glibenclamid (doza medie – 7,7 mg/zi). La toţi pacienţii a fost efectuată lipidograma (cu determinarea colesterolului total, trigliceridelor, HDL-colesterolului, LDL-colesterolului), fibrinogenul, proteina C-reactivă şi aprecierea grosimii intima-media a arterei carotide, conform metodei propuse de Pignoli. Rezultate Pacienţii cu infarct miocardic vechi şi diabet zaharat tip 2 au valori înalte ale colesterolului total, trigliceridelor, LDLcolesterolului, proteinei C-reactive şi indicele intima-media. Administrarea tratamentului hipolipemiant de durată a redus nivelul colesterolului total cu 28,41% (p < 0,01), trigliceridelor - cu 17,96 % (p < 0,05), LDL-colesterolului - cu 31,49% (p < 0,001), proteina C-reactivă - cu 18,46% (p < 0,05), fibrinogen - cu 20,41% (p < 0,01) şi indicele intima-media - cu 13,91% (p < 0,05). Pe fundal de dietă hipolipemiantă a existat o tendinţă de majorare a nivelului proteinei C-reactive, a fibrinogenului şi indicelui intima-media, dar statistic nesemnificativ. Datele sunt prezentate în tabelul. 1. Concluzie Tratamentul hipolipemiant de durată este efectiv în reducerea factorilor de risc la bolnavii cu infarct miocardic vechi şi diabet zaharat tip 2

Исследование качества жизни у больных с хронической сердечной недостаточностью ишемического происхождения с систолической дисфункцией или с сохраненной функцией левого желудочка

Institute of Cardiology, Department of Chronic Heart Failure, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaThe aim of this study was to determine changes in quality of life in patients with chronic HF in relation to the degree of LV systolic dysfunction and NYHA functional class. The study included 337 patients with ischemic heart failure, functional class NYHA II and III. All patients included were Romanian-speaking. To determine the quality of life in the study population, three questionnaires were used (validated version in Romanian): Minnesota Living with Heart Failure Questionnaire (Minnesota LHF Q), Mac New Heart Disease HRQL questionnaire and MOS-SF-36 questionnaire, short form. It Significant differences in quality of life between groups of patients with NYHA functional class II and III were identified after the application of all three questionnaires. In groups of patients with and without LV systolic dysfunction, application of Minnesota and MacNew questionnaires did not determine significant differences between groups in quality of life indices. And, the application of the generic SF-36 questionnaire has highlighted that physical functioning and pain indices and total physical component were more favorable in patients without LV systolic dysfunction. Thus, differences of quality of life were more evident in groups of patients divided according NYHA functional class than in groups of patients with or without LV systolic dysfunction.Целью исследования было в определении качества жизни у пациентов с хронической сердечной недостаточностью (ХСН) в зависимости от степени систолической дисфункции левого желудочка и функционального класса (ФК) NYHA. В исследование было включено 337 пациентов с сердечной недостаточностью (ФК II - III NYHA) ишемического происхождения. Для определения качества жизни были использованы 3 опросника (Minnesota LHF Q, MacNew Heart Disease HRQL и MOS SF-36). Статистически достоверные различия качества жизни были определены при использовании 3 опросников в группах больных разделенных в зависимости от ФК NYHA. При использовании опросников Minnesota LHF Q и MacNew, достоверные различия качества жизни в группах с нормальной функцией ЛЖ и с систолической дисфункцией ЛЖ не были определены. При применении вопросника SF-36 было установлено, что физическое функционирование, индекс боли и общий физический компонент были более благоприятными в группе пациентов с сохраненной функцией ЛЖ. Таким образом, различия в качестве жизни были более очевидны в группе больных, разделенных в зависимости от ФК NYHA, чем в группах больных с систолической дисфункцией ЛЖ или без нее

Исследование психометрических качеств опросников Minnesota LHF Q, MacNew Heart Disease HRQL и MOS SF-36 у больных с хронической сердечной недостаточностью ишемического происхождения

Department of Chronic Heart Failure, Institute of Cardiology, State University of Medicine and Pharmacy „Nicolae Testemitanu”, Chisinau, Republic of MoldovaUntil now there have not been validated instruments that assess the quality of life in patients with cardiovascular disease in the Republic of Moldova. The 6 stages of Minnesota LHF Q, MacNew Heart Disease HRQL and MOS SF-36 questionnaires were validated, followed by a pilot study – 337 patients with ischemic chronic heart failure in II-III NYHA functional classes. To determine the psychometric qualities of the questionnaires we performed a test-retest method looking at correlations between the components of the questionnaires and quality of life indices, which were analyzed according to the age, sex, living environment, and studies. Our results demonstrated the questionnaires’ reliability and validity through the indication of linguistic validation that had been carried out successfully. Thus, it can be a methodological basis for future clinical trials in the Republic of Moldova.В настоящее время в Республике Молдова инструменты для оценки качества жизни пациентов с сердечно-сосудистой патологией не валидированы. Нами были выполнены все 6 этапов валидации трёх опросников (Minnesota LHF Q, MacNew Heart Disease HRQL и MOS SF36), с последующим проведением пилотного исследования – 337 пациентов с сердечной недостаточностью (ФК II-III NYHA) ишемического происхождения. Чтобы определить психометрические качества опросников было проведено двойное тестирование пациентов, корреляции между компонентами опросников, были проанализированы параметры качества жизни в зависимости от возраста, пола, условий жизни, наличия высшего образования. Полученные результаты продемонстрировали надежность и валидность опросников. Таким образом, проведение данной валидации составит методологическую основу для последующего проведения в нашей стране сравнимых клинических исследований в области кардиологии

Impact of non-cardiac comorbidities on hf outcomes in patients after coronary revascularization therapy

IMSP Institute of Cardiology, Republic of MoldovaIntroduction Heart failure (HF) and non-cardiac comorbidities often coexist. However, the prevalence and prognostic impact of non-cardiac comorbidities on the hospitalization rates and all-cause mortality according to the two phenotypes of HF remain inadequately studied Purpose To analyze the impact of 15 non-cardiac comorbidities on hospitalization rate and all-cause mortality and their interaction with EF Material and methods A 48 months prospective observational study enrolled 166 patients. They underwent coronary artery bypass grafting, percutaneous coronary angioplasty and previously where admitted to the cardiac rehabilitation department and correlated to the association of noncardiac comorbidities in particular EF phenotypes. HFmrEF defined as EF from 40-49% and HFpEF as EF ≥ 50%. Results HFmrEF patients had a similar clinical profile to that of HFpEF patients in terms of age, body mass index and blood pressure (p<0,001). The HFmrEF and HFpEF groups had similar re-hospitalization rates and all-cause mortality (p<0,001). From non-cardiac comorbidities, a greater impact on hospital re-admission was seen through obstructive bronchopulmonary diseases, thyroid gland diseases and ischemic stroke (the results a presented in the next table) Conclusions Non-cardiac comorbidities contribute both to mortality and to hospital re-admissions, thus, we determined the importance of including the management of comorbidities as a part of heart failure treatment in both patient categories