MORPHOFUNCTIONAL FEATURES OF VENTRICULAR ARRHYTHMIAS IN PATIENTS WITH POSTINFARCTION CARDIOSCLEROSIS AND ARTERIAL HYPERTENSION, DEPENDING ON THE AFFECTED CORONARY REGION

Acute and chronic perfusion disorders, the presence of hypertension are among the main risk factors for the development of electrical instability of the myocardium, in particular ventricular arrhythmias (VA), the progressive course of which increases the risk of sudden cardiac death. Changes in a number of electro- and echocardiographic indicators are recommended to be considered as predictors of the development of life-threatening arrhythmias. Purpose of the study was to study VA features, myocardial remodeling processed and lipid metabolism in patients with arterial hypertension (AH) and myocardial infarction, depending on the affected coronary region. Material and methods. The study involved 50 patients 40–80 years old with post-infarction cardiosclerosis, AH, ventricular arrhythmias episodes, of which 25 people are patients with atherosclerotic lesions of left coronary artery (LCA), 25 people are with the lesions of right coronary artery (RCA). Exclusion criteria: dilated cardiomyopathy, decompensated valvular defects, arrhythmogenic dysplasia, idiopathic ventricular tachycardia, myocarditis. Research methods: echocardiography, coronary angiography, Holter monitor (24-Hour ECG monitoring), biochemical data. Results and discussion. The tendency to the presence of more pronounced pathological changes of heart rate turbulence due to an increase of turbulence slope, dominance of the sympathetic division of the autonomic nervous system against the background of a significantly larger number of paired ventricular extrasystoles have been revealed in the group of patients with atherosclerotic lesions of LCA. That reflects organic and functional changes in the myocardium. The absence of significant changes in the duration and dispersion of the QT interval of the compared groups confirmed the low informativeness of these criteria in the prediction of the VA. The significantly lower value of interventricular septum thickness, left ventricular myocardial mass, and larger size of the right ventricle (0.15 ms) have been revealed along with the above mentioned changes in the group due to the slightly different course of the AH, myocardial remodeling processes. However, more significant changes in the lipid profile, in particular an increase in the level of total cholesterol and blood triglycerides have been registered in the group of patients with PCA. Conclusion. The more pronounced pathological shift of heart rate turbulence due to the increase of turbulence slope up to 4.4 ms/RR on the background of more paired ventricular extrasystoles has been determined in the defeat of the LCA. The significantly lower value of interventricular septum thickness, left ventricular myocardial mass, and larger size of the right ventricular have been observed in the group of patients with atherosclerotic lesions of the LCA in comparison with group of patients with lesions of the PCA

Динамика нивально-гляциальных склоновых процессов в бассейнах рек Баксан и Теберда по данным радиоуглеродного датирования погребённых почв

Radiocarbon and tree-ring dating of the soil horizons, buried in the slope and fluvioglacial deposits in Baksan and Teberda valleys, bring evidence of the reduction of the avalanche activity, stabilization of the slopes and soil formation on their surfaces. In the Baksan section three such horizons are identified, while in the Teberda section only one. The radiocarbon dates of the two thickest soil horizons in the Baksan section are 170±50 BP (1650–1890 CE) and 380±60 BP (1430–1650 CE). The dendrochronological date of the wood (after 1677) in the upper layer of the buried soil horizon in the in the Dombai section probably indicate the increase of the river runoff and debris flow activity in relation with the glacier advance in the upperstream of Ammanauz river. However it is also close to the Terskoye earth quake occurred in 1688. The radiocarbon dates of the buried soils cluster in three groups (270–290, 340–440, 1280–1440 yrs BP). It is possible that their burial is connected to the climatic (increase in precipitation, especially extreme ones) or seismic causes.В разрезе склоновых отложений р. Баксан и флювиогляциальных отложений р. Аманауз (пос. Домбай) радиоуглеродным и дендрохронологическим методами датированы горизонты погребённых почв. В разрезе «Баксан» выделяются три таких горизонта, в разрезе «Домбай» – один. Радиоуглеродный возраст двух наиболее выраженных горизонтов погребённых почв в верховьях долины р. Баксан составляет 170±50 л.н. (1650–1890 гг.) и 380±60 л.н. (1430–1650 гг.). Гибель дерева (дендрохронологическая датировка – после 1677 г.), захороненного в кровле погребённого почвенного горизонта в разрезе «Домбай», возможно, указывает на увеличение в это время объёма речного стока и селевой активности в связи с изменениями размеров ледников в верховьях р. Аманауз, однако не исключено и совпадение с Терским землетрясением 1688 г. Датировки погребённых почв в регионе объединяются в три группы: 270–290, 340–440 и 1280–1440 л.н. Возможны климатические (увеличение осадков, в том числе экстремальных) или сейсмические причины захоронения этих почвенных горизонтов

Возраст морен ледника Большой Азау в верховьях долины реки Баксан по дендрохронологическим данным

Basing on tree­ring analysis of more than 150pines growing in the Azau clearing, the minimum age of the deposits created by the Greater Azau Glacier was identified. Historical evidence, cartographic data, remote sensing materials, as well as the results of lichenometric studies and radiocarbon dating of buried soils were used as additional sources of information. We determined limits of the area covered by the glacier tongue at the end of the 19th century. It was also shown that the highest and most pronounced lateral moraine, conventionally called the «17th century moraine», was formed earlier than the end of the 15th century. Judging from the size of the maximum lichens of Rhizocarpon geographicum (120–130mm) on its surface, the age of the moraine, determined by the dendrochronological method was found to be underestimated. It may be several centuries older than the end of the 16th century. We re­examined a pine trunk buried in the sediments at the bottom of the valley which was discovered in the 1960s. Previously it was dated by radiocarbon (140±75BP[1], the calibrated date– 1650–1960 CE). According to the new data, the most probable tree­ring dates of the buried tree are 1759–1883CE, however, the second most likely dates are 1826–1950CE. Unfortunately, low statistical estimates do not allow us to confirm the reliability of the dates. The paper also discusses the controversial issue of the position of the moraine of 1849CE, which was described by H.Abich[2]. The annex to the article contains a translation of a fragment of this important paper related to the Greater Azau Glacier. Suppressions of pine growth from the moraines of the Greater Azau in the 1640s, 1710s, 1800s, 1840s, and 1860sCE are synchronous with the advances of the Bosson, Mer de Glace and Grindelwald glaciers in the Alps[3].На основе анализа дендрохронологических данных, радиоуглеродных датировок и исторических свидетельств рассмотрена история колебаний ледника Большой Азау в малый ледниковый период. Дискутируется вопрос о положении морены максимума наступания ледника в 1849г., описанного Г.Абихом. Определён минимальный возраст морен, в том числе береговой, которую ранее относили к XVII в

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Dynamics of nival and glacial slope processes in the Baksan and Teberda river basins from radiocarbon dating of buried soils

Radiocarbon and tree-ring dating of the soil horizons, buried in the slope and fluvioglacial deposits in Baksan and Teberda valleys, bring evidence of the reduction of the avalanche activity, stabilization of the slopes and soil formation on their surfaces. In the Baksan section three such horizons are identified, while in the Teberda section only one. The radiocarbon dates of the two thickest soil horizons in the Baksan section are 170±50 BP (1650–1890 CE) and 380±60 BP (1430–1650 CE). The dendrochronological date of the wood (after 1677) in the upper layer of the buried soil horizon in the in the Dombai section probably indicate the increase of the river runoff and debris flow activity in relation with the glacier advance in the upperstream of Ammanauz river. However it is also close to the Terskoye earth quake occurred in 1688. The radiocarbon dates of the buried soils cluster in three groups (270–290, 340–440, 1280–1440 yrs BP). It is possible that their burial is connected to the climatic (increase in precipitation, especially extreme ones) or seismic causes