New perspectives of three-dimensional echocardiography in left ventricular assessment

Left ventricular (LV) functional status assessment is the main indication for echocardiograpy (BchoCG) in adult patients. Due to complicated heart anatomy and its dynamic function, M-regimen and two-dimensional BchoCG ask for some geometry assumptions on LV form and function, resulting in measurement bias. When EchoCG data are necessary for making important and costly health decisions, more precise and reproducible methods of ultrasound diagnostics are requested. Three-dimensional (3D) EchoCG has been available for years, but demanding complicated reconstructive methods (trans-esophageal EchoCG included). Recent advances in computer image processing and sensor production have made real-time transthoracic 3D EchoCG a clinically available method. At the same time, 3D data set analyzing programs become available. This combination of modern equipment and software facilitates precise analysis of TV morphology and function. Therefore, EchoCG is a method of choice in non-invasive LV assessment

Right heart remodeling in coronary heat disease: clinico-pathophysiological correlations

Aim. To study right ventricular (RV) geometry and analyze clinico-pathophysiological processes, associated with right heart remodeling in coronary heart disease (CHD) patients. Material and methods. The study included 184 CHD patients, who underwent dobutamine stress echocardiography (EchoCG). Results. In CHD patients, structural and functional abnormalities of right heart chambers were registered: RV dilatation, dysconfiguration (increased ratio of RV transversal to longitudinal size), right atrium (RA) dilatation, tricuspidal valve fibrotic annulus distention, associated with tricuspidal insufficiency, and RF systolic function decrease. Among pathogenetic factors of right heart remodeling, there were: left heart function, mitral insufficiency, RV ischemic myocardial dysfunction, interventricular septum function. Conclusion.RV function determinants and right heart remodeling mechanisms are complex and multifactorial. This study analyzed regional RV geometry in various categories of CHD patients, and pathogenesis of right heart remodeling

LEFT VENTRICULAR REMODELLING AND MITRAL VALVE REMODELLING IN CORONARY HEART DISEASE PATIENTS WITH POST-SURGERY PROGRESSION OF MITRAL REGURGITATION

The progression of ischemic mitral regurgitation (MR) after coronary arty bypass graft (CABG) surgery remains one of the most complex and still unresolved problems in the treatment of coronary heart disease (CHD).Aim. To study myocardial function, left ventricular (LV) remodelling, and mitral valve (MV) remodelling in CHD patients with MR progression after isolated CABG or CABG combined with LV reconstructive surgery.Material and methods. In total, 101 CHD patients after CABG were included in the analysis.Results. The mechanisms of MR progression after isolated CABG differ from those after CABG and LV reconstructive surgery. After the former, LV remodelling progresses both locally and globally, while after the latter, the LV remodelling progression is predominantly global. The patients with post-surgery MR progression differ from their peers without MR in terms of all key parameters of MV geometry.Conclusion. The leading mechanism of MR progression is local and global LV remodelling, which leads to papillary muscle dislocation and MV leaflet tension and restricted motion. The categories of patients with a high risk of post-surgery MR progression are defined

A rare case of successful recanalization of the anterior interventricular artery through a mammary-coronary graft in a patient 15 years after coronary artery bypass grafting

Progression of atherosclerosis in patients with coronary artery disease (CAD) who underwent surgical treatment, manifests itself in the development of dysfunction of the shunts, and in worsening of the condition of native coronary arteries. Accordingly, there is an increase in the number of patients who require repeated aggressive treatments. In cases where it is technically possible to perform repeated coronary artery bypass graft (CABG) and/or percutaneous interventions (PCI), there is no question of treatment tactics. But there are times when implementation of interventions is associated with a high risk and optimal medication therapy does not have the proper effect. In a patient with multiple lesions of the coronary arteries 15 years after CABG in connection with the progression of atherosclerosis, the occlusion of anterior interventricular artery (AIVA) is distal to the mammary-coronary anastomosis, the occlusion of the venous shunt to the right coronary artery. Effort angina (class III) is caused by myocardial ischemia in the AIVA territory. Patient underwent surgery for recanalization of AIVA through mammary-coronary shunt

Kardiointerventsionnoe lechenie bol'nykh sakharnym diabetom 2 tipa s IBS

Цель. Оценка эффективности стентирования коронарных артерий у больных ИБС и сахарным диабетом. Материалы и методы. В исследование включен 101 больной с ИБС, перенесший коронарное стентирование. Всем больным проводилось общеклиническое обследование, электрокардиография, суточное Холтеровское мониторирование ЭКГ, эхокардиография, стресс-эхокардиография с тредмилом, стресс-эхокардиография с добутамином, коронарография. Перечисленные исследования проводились до и после реваскуляризации миокарда. Результаты. при сопоставлении результатов послео- перационного обследования в зависимости от наличия или отсутствия диабета выявлено, что у больных 1-й группы степень улучшения выражена меньше, чем у больных без диабета. Заключение. Коронарное стентирование у больных ИБС и сахарным диабетом представляется эффективным методом реваскуляризации миокарда, значительно улучшающим функциональное состояние больных ИБС и сахарным диабетом

Bone marrow stem cell treatment in heart failure patients

Chronic heart failure (CHF) treatment is an important problem of modern cardiology, with only one radical, but not universally possible solution – heart transplantation. Regenerative myocardial therapy, stem cell transplantation, raises increasing interest recently, due to many researchers’ doubts on genetic therapy for coronary heart disease and CHF management

Original method of external muscular counter-pulsation in coronary heart disease patients at cardiosurgery clinic

Aim. To assess the effects of external muscular counter-pulsation (MCP) in early post-operation period among coronary heart disease (CHD) patients, who underwent coronary aortic bypass graft (CABG) surgery. Мaterial and methods. 47 CHD patients (all males, functional class of angina 3.4±0.08), after on-pump CABG, were divided into two groups. In the main group (n=29), starting at Day 1-2 after CABG, standard therapy was combined with MCP course (CardioLa device, Switzerland). Control group (n=18) was observed according to standard protocol. The methods used included echocardiography (EchoCG) and tetrapolar thoracic impedancometry at rest. Results. MCP facilitated normalization of central and peripheral hemodynamics, disturbed due to on-pump intervention. In main group, stroke volume (р<0.002), stroke index (р<0.003), minute volume (р<0.0001), cardiac index (р<0.0001) and total ejection fraction (р<0.0001) increased, according to EchoCG at rest, and total peripheral resistance decreased, according to tetrapolar thoracic impedancometry results, comparing to control group. The number of post-operation days at the hospital was significantly lower in main group, comparing with controls (р<0.0001). Conclusion. MCP is highly effective for stabilization and improvement of central and peripheral hemodynamics in early post-CABG period

Faktory riska razvitiya i puti profilaktiki kontrastindutsirovannoy nefropatii pri provedenii koronarnoy angiografii u bol'nykh sakharnym diabetom 2 tipa

Цель. Определение маркеров риска развития КИН, а также разработка эффективных мер профилактики почечной дисфункции при проведении контрастных процедур у больных СД 2. Материалы и методы. Для оценки частоты КИН и определения факторов риска ее развития при проведении КАГ был проведен ретроспективный анализ данных 151 пациента с СД 2 и 50 пациентов без диабета, подвергшихся данной процедуре в период между 2000 и 2007 годами. Резульататы. Частота КИН во всей популяции госпитализированных больных составила 34,3%. КИН значительно чаще развивалась в группе больных СД 2 по сравнению с пациентами без СД. Полученные данные подтверждают роль СД как фактора риска развития КИН. При сравнении пациентов с СД 2 с КИН и без КИН не было выявлено значимых отличий в возрасте, СКФ, исходном уровне креатинина, протеинурии, гемоглобина крови. Заключение. Контрастиндуцированная нефропатия после проведения коронарографии чаще развивается у лиц с СД 2, чем у лиц того же возраста без СД при сопоставимом исходном уровне почечной функции, дозе контрастного препарата и сходном режиме гидратации. Факторами риска развития контрастиндуцированной нефропатии у больных СД 2 являются: анемия, высокая доза контрастного препарата, сердечная недостаточность III?IV класса по NYHA, прием диуретиков в перипроцедурный период, множественное поражение коронарных сосудов, необходимость проведения серьезных интервенционных вмешательств

ROLE OF GENETIC FACTORS IN THE DEVELOPMENT OF CLOPIDOGREL RESISTANCE AMONG PATIENTS REFERRED FOR PERCUTANEOUS CORONARY INTERVENTIONS

Aim. To study the associations between genetic polymorphisms and the development of clopidogrel resistance in patients referred for percutaneous coronary interventions (PCI).Material and methods. The study included 84 patients with coronary heart disease (CHD), who underwent planned PCI. Dynamic assessment of platelet aggregation was performed using light transmission aggregometry method (two-channel laser analyser Biola-230LA). The role in the development of inadequate suppression of platelet aggregation during the standard-dose dual antiplatelet therapy (DAT) was investigated for the following genes and polymorphic alleles: CYP2C19 (rs4244285*2, rs4986893*3, rs28399504*, rs56337013*5, and rs12248560*17); CYP2C9 (rs1057910*3); CYP3A4 (rs2242480); CYP2B6 (rs3211371 (5*); CYP3A5 (rs28365083*2 and rs776746); and CYP1A2 (rs762551).Results. The two study groups demonstrated a statistically significant difference in the prevalence of CYP2C19 rs4244285 (2*) polymorphisms, with an increase in GA and AA genotypes and a reduction in the “wild” GG genotype (Χ2 =11,7; р=0,003). The GA genotype was associated with inadequate suppression of platelet aggregation in patients receiving clopidogrel (75 mg/d) and aspirin (300 mg/d; odds ratio 6,27; 95% confidence interval 1,8–21,69). No significant inter-group differences were observed for other polymorphisms (CYP2C9 (rs1057910*3); CYP3A4 (rs2242480); CYP2B6 (rs3211371 (5*)); CYP3A5 (rs28365083*2, rs776746); and CYP1A2 (rs762551)).Conclusion. The degree of platelet aggregation in patients on DAT is related to their genetic status. The assessment of genetic polymorphisms can facilitate the choice of optimal therapeutic strategies in clopidogrel-resistant patients. Patients with the CYP2C192* polymorphism are in particular need for an additional correction of the antiaggregant treatment scheme