Arrhythmic Mitral Valve Prolapse: New Menaces of the Known Disease

Mitral  valve prolapse  (MVP) has  long  been  the subject  of intense  discussions regarding the prognosis and  follow-up tactics.  In most  cases,  this condition has a benign prognosis. However, recent autopsy and follow-up studies have shown risks of developing  sudden cardiac death (SCD) in some subgroups of patients who have this clinical phenomenon. The proposed  literature review uses the population  of patients with MVP with the highest probability  of developing  life-threatening ventricular tachyarrhythmias. Patients with the presence of a complex  of changes, including  bicuspid  MVP, negative T waves in the inferior and lateral leads on a standard  12-lead electrocardiogram (ECG), and a special anatomical  phenomenon called mitral annular  disjunction  (MAD), are at high  risk of developing  ventricular  ectopias  and VSS.  A reflection  of the high  risk of SCD  in such patients  is the increase of ventricular ectopy according to Holter monitoring. The presence of a bicuspid  MVP and the MAD  phenomenon, which is a separation  of the line of attachment  of the posterior mitral leaflet from the basal inferior wall segment  towards  the atrial wall, determines the presence of a special form of MVP,  the so-called  arrhythmogenic MVP.  Hence,  in most cases MVP has a benign  prognosis. However, patients with the aforementioned ar- rhythmic  MVP  signs  must  be given  particular  attention  and  annual  follow-up including  ECG  control,  Holter  monitoring and  echocardiographic examination of the heart to reduce the risk of ventricular tachyarrhythmias and SCD development

SAFETY OF AMIODARONE USAGE IN PATIENTS WITH WOLFF-PARKINSON-WHITE SYNDROME AND ATRIAL FIBRILLATION

Amiodarone is one of the basic antiarrhytmic drugs for atrial fibrillation treatment. However application of amiodarone in patients with atrial fibrillation and Wolff-Parkinson-White syndrome can induce ventricular fibrillation. Amiodarone usage in these patients should be accompanied by readiness for performance of resuscitation. This is confirmed by clinical case presentation

PROGNOSTIC VALUE OF PATHOLOGIC Q-WAVE AND TIME OF ITS APPEARANCE IN PATIENTS WITH MYOCARDIAL INFARCTION: COMPARISON STUDY

Aim. To evaluate short- and long-term prognosis of myocardial infarction (MI) depending on occurrence of pathologic Q-wave on ECG and time of its appearance.Material and methods. 616 patients with initial ST-elevated MI were included into the study — 254 women and 362 men, aged 62.1±11.2. All patients were split up three groups depending on occurrence of pathologic Q-wave on ECG and time of its appearance. First group consisted of 311 patients with early Q-wave (during first 6 hours from onset of MI symptoms). Second group consisted of 120 patients with late Q-wave (from 6 to 24 hours from onset of MI symptoms). Third group consisted of 185 patients with non-Q-wave MI.Results. The hospital lethality in the patients with early Q-wave was significantly higher than this in patients of the second and the third groups. However, we didn’t reveal significant differences between patients with late Q-wave and patients without Q-wave on ECG. The incidences of cardiac death (sudden death and fatal MI), non-fatal MI and hospitalization because of unstable angina was assessed during next two years. During the follow-up period patients of three groups had similar incidences of the non-fatal MI and hospitalization because of unstable angina. However, incidence of cardiac death was significantly higher in early Q-wave group in comparison with non-Q-wave group.Conclusion. Occurrence of pathologic Q-wave on ECG and time of its appearance should be taken into account to assessed short- and long-term prognosis of MI

THE PREVALENCE AND CLINICAL SIGNIFICANCE OF CARDIAC ARRHYTHMIAS

Arrhythmias are one of the most complex, insufficiently studied, and therefore one of the most urgent problems of modern cardiology. A wide spectrum of clinical manifestations of cardiac rhythm disorders (CRDs), their detection both in various diseases and in healthy people, necessitate the study of their prevalence in populations. In the majority of conducted epidemiological studies a single recording of electrocardiogram (ECG) was used. This is the most usable method for examination of large populations but a little informative for detecting arrhythmias. The small frequency of CRDs detected during ECG recording is due to the short duration of its registration. An increase in the duration of ECG recording (ECG recording for 2 minutes, continuous recording of 100 cardiocycles) leads to an increase in arrhythmias frequency. With a wide introduction in the practice of ECG monitoring by Holter as well as the use of individual recorders of electrocardiogram ("handheld ECG recording") data appeared indicating a much higher frequency of CRDs. Data obtained in numerous studies on the prevalence of arrhythmias are very contradictory and depend both on the characteristics of populations and on methodological approaches, which requires further epidemiological studies. At the same time, the main initiating point of such researches is the clinical significance of certain CRDs. However, if the clinical significance of ventricular tachyarrhythmias and atrial fibrillation does not currently cause any doubt, the clinical significance of extrasystoles is highly controversial, despite the high their prevalence, including this in prognostically unfavorable groups of patients. In recent years, the results of a number of studies have been published that allow to think about the adverse effects of both supraventricular and ventricular extrasystoles of the course of certain cardiovascular diseases. Very heterogeneous results of the performed studies, as well as data about the high clinical significance of individual CRDs, make further epidemiological studies in this field extremely urgent

The relationship of arrhythmias with structural and functional heart changes according to the echocardiography data in the adult population of the Arctic

Aim. To study the relationship of arrhythmias, registered by the electrocardiography (ECG) and ECG Holter monitoring, with the changes of the heart and disorders of its function detected by echocardiography in the adult population of the Arctic, living in unfavorable environmental conditions.Material and methods. Patients (n=348) of both sexes, aged 20 years and older, were randomly selected and examined. All participants were carried out ECG recording in 12 standard leads, Holter monitoring and transthoracic echocardiography.Results. Statistically significant associations between certain types of arrhythmias and echocardiographic changes were observed. There were revealed correlations of medium strength: between atrial fibrillation (AF), registered by ECG and dilatation of the left (r=0.3215) and right (r=0.3275) atrium; between AF, registered by Holter monitoring, and left ventricular (LV) systolic dysfunction (r=0.3216); between premature ventricular contractions, registered by Holter monitoring, and LV hypertrophy (r=0.3332).Conclusion. The аassociation between arrhythmias and structural and functional changes of the heart in individuals living in adverse climatic conditions were confirmed

DIAGNOSTICS AND TREATMENT OF MITRAL VALVE PROLAPSE

The mitral valve prolapse (MVP) is one of the most inconsistent diagnose. In the most cases patients with MVP have the good long-term prognosis, and therapy is aimed at reduction in psychovegetative dysfunction. Careful follow-up and timely cardiosurgical correction should be performed, if necessary, in patients with classical MPV. The choice method in these cases is the mitral valve plasty

ROLE OF SYNTAX SCORE SCALE IN THE STRATIFICATION OF THE NOSOCOMIAL RISK OF CARDIOVASCULAR COMPLICATIONS AND LETHALITY IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION

The lethality of patients with acute myocardial infarction with ST-segment elevation (STEMI) depends on many factors. In conditions of timely transportation of the patient to the center of percutaneous coronary intervention one of these factors is the severity of the coronary bed lesion. In clinical practice, the most common method of assessing such lesions is the SYNTAX Score scale.Aim. To study the impact of the assessment by angiographic SYNTAX Score scale on in-hospital complications and lethality in patients with STEMI.Material and methods. The single-center observational retrospective study was performed. The medical data of 816 cases of treatment of patients with STEMI in the first 6 hours from the onset of symptoms were analyzed. All patients underwent reperfusion therapy (primary percutaneous coronary intervention or pharmacoinvasive strategy (FIS)) with assessment of the SYNTAX Score index prior to intervention. The main group (SYNTAX Score ≤22 points) and the comparison group (SYNTAX Score index >22 points) were comparable in terms of clinical characteristics and time delays.Results. An increase in the SYNTAX Score more than 22 points was an independent predictor of hospital complications and lethality (4.9% for SYNTAX Score ≤22 points and 21.9% – for >22 points). The group with a high SYNTAX index was older, had a higher proportion of smokers (46.8% vs 36.1%, p=0.015) and patients with myocardial infarction history (38.5% vs 20.6%, p<0.001), fewer patients to whom the FIS was applied (33.3% vs 45.7%; p=0.017). Nevertheless, in multivariate analysis, the initial clinical data of patients influenced the hospital prognosis, first of all in patients with SYNTAX Score ≤22 points. The group with a more severe lesion of the coronary bed was represented by patients with frequent development of pulmonary edema, cardiogenic shock and ventricular fibrillation. Cardiac complications in this group of patients were less dependent on the initial characteristics. Strong SYNTAX Score correlations were found with left ventricular ejection fraction (r=-0.156, p<0.001), the number of implanted stents (r=0.226, p<0.001), and with complications and lethality. The frequency of hemorrhagic complications did not depend on the severity of the coronary bed lesion.Conclusion. The use of the SYNTAX Score scale in clinical practice is scientifically grounded and advisable. Stratification of high-risk patients with STEMI during primary angiography based on the SYNTAX Score scale has a high prognostic value