The impact of the post-procedural elevation in troponin-T level on the outcomes off percutaneous coronary intervention for patients with cardiac ischemia (based on the prospective follow-up)

Objective: to study the relationship between post-procedural levels of Troponin T (TnT) on short-term and long-term survival after percutaneous coronary intervention (PCI). The study population included 128 patients with ischemic heart disease confirmed by coronary angiography and followed up with PCI. For all patients, levels of cardiac necrosis biomarkers (TnT and CK-MB) were assessed three times (prior to PCI, 8 and 24 hours after PCI). Depending on the post-procedural TnT levels, the patients with negative TnT prior to PCI were randomized into 4 groups: no TnT elevation after PCI (n=59); any TnT elevation after PCI (n=65); TnT elevation 0,03 ng/ml after PCI (n=40); elevated ThT>0,1 ng/ml after PCI (n=25). The results were analyzed in early (up to 30 days) and extended (from half a year to 6,8 years) follow-up periods (in average 52,3+23,3 months). The prognostic value of TnT elevation after PCI was assessed against three criteria: 1) cardiac death; 2) non-fatal myocardial infarction (Ml); 3) cardiac death or non-fatal Ml. Significant TnT elevation > 0,1 ng/ml (3 times of the upper boundary value) due to PCI correlated with worsened prognosis for the patients with cardiac ischemic disease in short-term and long-term perspective. Also it was correlated with increase in cumulative frequency of cardiac death events or non-fatal Ml (24.0% versus 1.7%, p=0,0032; 36.0% versus 11.9%, p=0,023, respectively). No impact of post-procedural elevations of TnT level on short-term and long-term survival was identified.Цель исследования состояла в изучении влияния постпроцедурных уровней тропонина Т (ТнТ) на краткосрочный и долгосрочный прогноз после чрескожных коронарных вмешательств (ЧКВ). В исследование включены 128 больных с подтвержденной коронарографией (КАГ) ИБС с последующим выполнением ЧКВ. Всем пациентам трехкратно (до ЧКВ, через 8 и 24 часа после ЧКВ) определялись уровни биомаркеров некроза миокарда (ТнТ и MB-фракции креатинкиназы MB (КК-МВ). В зависимости от постпроцедурных уровней ТнТ, при отрицательном ТнТ до ЧКВ, больные были рандомизированы на 4 группы: отсутствие повышение ТнТ после ЧКВ (n=59); любое повышение ТнТ после ЧКВ (n=65); повышение ТнТ 0,03 нг/мл после ЧКВ (n=40); повышение ТнТ>0,1 нг/мл после ЧКВ (n=25). Результаты анализировались в раннем (до 30 дней) и отдаленном - от полугода до 6,8 лет (в среднем 52,3+23,3 месяца) периодах наблюдения. Оценку прогностической значимости повышения ТнТ после ЧКВ проводили в отношении 3-х критериев: 1) сердечная смерть; 2) нефатальный инфаркт миокарда (ИМ); 3) сердечная смерть или нефатальный ИМ. Значимое > 0,1 нг/мл (в 3 раза выше верхней границы) повышение ТнТ вследствие ЧКВ было сопряжено с ухудшением прогноза больных с ИБС в краткосрочной и долгосрочной перспективе. При зтом отмечалось увеличение кумулятивной частоты сердечных смертей либо нефатальных ИМ (24.0% против 1.7%, р=0,0032; 36.0% против 11.9%, р=0,023, соответственно) и риска нефатальных ИМ (24.0% против 0%, р=0,0006; 32.0% против 5.1%, р=0,003, соответственно). Не выявлено влияния постпроцедурного повышения ТнТ на краткосрочную и долгосрочную выживаемость больных ИБС

Seed morphology of some species in the family Gentianaceae

In this work, we investigated the outer and inner morphological characters of the seeds of 13 species in the family Gentianaceae. We also identified the main morphometric parameters and described the shape, coloration and sculpture of the seed surface. Some aspects of their internal structure were analyzed as well

Invasive strategy of treatment in acute coronary syndromes

The improvement of the treatment results of acute coronary syndrome has a place thanks to the introduction of the act algorithm, accessibility of invasive diagnostic and treatment methods. Among patients with ST-elevation acute coronary syndrome the primary reperfusion therapy was used in 80%, primary percutaneous coronary intervention was used in 67,5% from them. In-hospital mortality in cases of ST-elevation acute coronary syndrome was 8,8%. Among patients with non-ST-elevation acute coronary syndrome 50,9% were treated invasMy during in-hospital stay, early invasive management was used for 43,5% patients. The minimal level of in-hospital mortality among patients with no ST-elevation acute coronary syndrome registered amongst those treated invasively (1,2%).Благодаря внедрению в практику современного алгоритма лечения острого коронарного синдрома (ОКС), доступности инвазивных методов диагностики и лечения стало возможным улучшение госпитальных исходов у больных ОКС. При ОКС с подъёмами сегмента ST на ЭКГ реперфузионная терапия проведена у 80% больных, в том числе в 67,5% случаев осуществлялись первичные чрескожные вмешательства. Показатель госпитальной летальности среди больных ОКС с подъёмами ST составил 8,8%. При ОКС без стойких подъёмов сегмента ST инвазивные вмешательства проведены 50,9% больных, в том числе в 43,5% случаев они осуществлялись в ранние сроки госпитализации. Показатель госпитальной летальности был наименьшим среди больных ОКС без стойких подъёмов ST, получивших инвазивное лечение, и составил 1,2%

COMPARATIVE PROGNOSTIC VALUE OF CREATINE PHOSPHOKINASE MB AND TROPONIN T IN THE DIAGNOSTICS OF PERIPROCEDURAL MYOCARDIAL DAMAGE

Aim. To investigate the link between the levels of creatine phosphokinase MB (CKMB) or troponin T (TrT) and the prognosis in patients with coronary heart disease (CHD), periprocedural myocardial necrosis, or Type 4a myocardial infarction (MI) associated with percutaneous coronary intervention (PCI). Material and methods. The study included 124 CHD patients who underwent planned PCI. The levels of CK-MB and TrT were measured before PCI and 8 and 24 hours after the procedure. Results. After PCI, CK-MB and TrT levels were elevated in 11 (8,9%) and 24 (19,4%) patients, respectively. CK-MB or TrT elevation was less than three-fold, compared to the upper reference limit (URL), in 9 (7,3%) and 18 (14,5%) participants, respectively. In other words, probable periprocedural myocardial necrosis was not confirmed twice as often, based on CK-MB (n=9; 7,3%) vs. TrT criteria. CK-MB or TrT elevation over 3 x URL was registered in 2 (1,6%) and 6 (4,8%) participants, respectively. Therefore, probable Type 4a MI was not confirmed in 4 patients (3,3%) – three times less often, compared to TrT criteria. Over the mean follow-up period of 4,3 years, survival was non-significantly worse in patients with periprocedural CK-MB elevation of <3 or ≥3 x URL, compared to participants with similar TrT elevation (22,2% vs. 5,6% and 50,0% vs. 33,3%, respectively). The combined end-point of cardiac death and MI was also registered more often in patients with CK-MB elevation (33,3% vs. 16,7% and 50,0% vs. 33,3%, respectively), due to the differences in cardiac death rates. Conclusion. Therefore, periprocedural TrT elevation of <3 and ≥3 x URL could be a less reliable predictor of long-term cardiac mortality than similar CK-MB elevation

PERIPROCEDURAL MYOCARDIAL DAMAGE

Percutaneous coronary intervention (PCI), as a method of myocardial revascularisation, is widely and effectively used for the treatment of coronary heart disease (CHD), with immediate success rates of >90%. Depending on the diagnostic criteria, 5–30% of these patients could develop the signs of periprocedural myocardial damage (PMD) or periprocedural myocardial infarction (PMI). PMD predictors, mechanisms of PMD development, and its specific clinical features play an important role in the PMI prevention. At present, there is no universal agreement on the definition and diagnostics of periprocedural myocardial necrosis and PMI, or on their impact on the clinical outcomes. According to the results of the recent studies, which are presented in this review, the current criteria of PMI might need to be modified, due to the increasingly high sensitivity of the modern threshold levels of troponin

AGE-DEPENDENT ASPECTS OF ACUTE CORONARY HEART DISEASE INCIDENCE RATE AND MORTALITY IN MEN AND WOMEN

Aim. To study gender and age characteristics of incidence rate, mortality and lethality in acute coronary heart disease (ACHD).Material and Methods. Analysis of the ACHD (ICD-10 codes: I21.0-I22.9, I20.0, I24) morbidity, mortality and lethality, depending on sex and age was performed in the population (n=285 736; 46% men) of several city administrative districts of Voronezh, Ryazan and Khanty-Mansiysk. Morbidity, mortality and lethality were calculated on the basis of medical documentation as well as cases identified by the study protocol.Results. The ACHD morbidity and mortality in men were 1.99 and 1.79 times higher (p<0,001), respectively, than these in women. The studied parameters increase with age, reaching a maximum in 50-59 y.o., have a plateau in 60-79 y.o. and then they decrease. Morbidity and mortality in women increase with age, but reach a maximum in 70-79 y.o., being comparable with the male level, and then exceed it in ≥80 y.o. Age curve of lethality in men has J-alike shape with minimum in patients of 50-79 y.o. Women have a line age curve with minimum in patients of <50 y.o.Conclusion. The population of ACHD patients should be considered according to both the sex and age: <50, 50-79 and ≥80 y.o. Every of these population group has special epidemiological characteristics

SUDDEN CARDIAC DEATH IN PATIENTS WITH CORONARY HEART DISEASE: RESULTS OF THE RUSSIAN MULTI-CENTRE EPIDEMIOLOGICAL STUDY OF MORTALITY, MORBIDITY, AND DIAGNOSTICS AND TREATMENT QUALITY IN ACUTE CHD (RESONANCE)

The study was aimed at assessing the incidence of sudden cardiac death (SCD) in patients with coronary heart disease (CHD) and evaluating the quality of SCD diagnostics and statistical registration in medical institutions (MI). In the population of 285736 patients with CHD (76,4% aged 18 years or older; 46% men), the incidence of SCD cases registered in MIs was compared to the study algorithm-based incidence of SCD. The latter was as high as 156 per 100 000 in men and 72 per 100 000 in women, which was 2,3 and 2,8 times higher, respectively, than the MI-registered levels (р<0,001). MI-based diagnostics and/or registration missed 55,6% and 66,5% of the SCD cases in men and women with CHD, respectively. The two main explanations were inadequate diagnostic search at death cause identification (45,4%) and mistakes made at completing medical documents (55,6%). Therefore, every second SCD case in men with CHD and two-thirds of SCD cases in women with CHD are not identified by MIs, which results in under-estimation of SCD incidence

Differential beta-adrenoblocker therapy in chronic heart failure: the role of age, gender, and co-morbidity

Aim. To investigate differential beta-adrenoblocker (BAB) therapy, based on clinical and demographic characteristics of the patients, as a method to optimise the management of chronic heart failure (CHF).Material and methods. The study included 90 patients: 50 men (55,6%) and 40 women (44,4%) of mean age 64,7±1,9 years. The participants stopped taking the previously prescribed BAB and two weeks later, they were randomly divided into three groups. Group I (n=30) received bisoprolol (starting dose — 2,5 mg once a day, maximal dose — 50 mg/d). Group II (n=30) received carvedilol (initial dose — 12,5 mg/d, maximal dose — 50 mg/d). Group III (n=30) was administered nebivolol (starting and maximal doses — 2,5 mg/d and 10 mg/d, respectively). At baseline and 6 months later, all participants underwent echocardiography (EchoCG), assessing ejection fraction, diastolic dysfunction presence and type. Increased functional class (FC) of CHF was regarded as disease progression, and reduced FC — as disease regression. The levels of neuro-hormones and brain natri­uretic peptide (BNP) were also measured. Treatment effectiveness was assessed by efficacy and safety parameters in combination.Results. No inter-group differences were observed for central hemodynamics, EchoCG parameters and neuro­hormone levels. Nebivolol was particularly effective in chronic renal failure, anaemia, in elderly patients and women. In other patient groups, bisoprolol was the most effective agent. The main laboratory parameter determining BAB choice, was aldosterone, followed by pro-BNP (a=0,049). Noradrenalin levels should not be used for choosing BAB.Conclusion. Considering the fact that aldosterone, noradrenalin and pro-BNP level measurement is not a part of routine clinical practice, and could not be easily implemented into real-world clinical settings, the parameters determining BAB choice could be the patient’s age, gender, and co-morbidities

ANALYSIS OF INTERCULTURAL YOUTH BY THE EXAMPLE OF RUSSIAN AND AMERICAN INTERNET USERS

In this paper, the authors consider the problem of intercultural communication on the example of comparison of images of self-presentation of Russian and American youth who use social networks “Vkontakte” and “Facebook”. The authors, jn the basis of the idea of double contingently and unity of information, namely the communication and understanding that is used in the theory of Nicholas Luhmann, conducted the survey. In this study, by analyzing public information on personal pages of users in social networks “Vkontakte” and “Facebook”, an atterupt was wade to identify the methods and forms of constructing identity of Russian and American social media users. The article compares and assesses the information that these users post on their personal pages in social networks. In the study the authors come to the couclision that American users are more dynamic and open in communication than Russian users, however, both groups of users from Russia and from America have been trying to build a positive social image of themselves on the Internet. The article has a theoretical and applied nature, and it will be relevant for researchers studying sociology of youth and intercultural communication

Seed morphology of some species in the family Gentianaceae

In this work, we investigated the outer and inner morphological characters of the seeds of 13 species in the family Gentianaceae. We also identified the main morphometric parameters and described the shape, coloration and sculpture of the seed surface. Some aspects of their internal structure were analyzed as well