Dyslipidemia in patients with atrial fibrillation on the background of acute coronary syndrome according to the register of the Krasnodar region

Aim. Atrial fibrillation (AF) is connected with the increased risk of stroke, mortality rate and costs for health care around the world. Earlier the predictive role of a dyslipidemia was not estimated in available literature.Material and methods. This retrospective study included 13,244 patients who consistently referred to Scientific Research Institute – Regional Clinical Hospital no. 1, Krasnodar, with acute coronary syndrome from November 20, 2015 to November 20, 2017. Primary final points were defined both as mortality from all reasons and from the cardiovascular events. Secondary final points were defined as repeated myocardial infarction. Follow up period was 12 months.Results. In the studied group ACS + AF we included 201 patients. This group of patients was divided into 3 subgroups: patients with originally developed AF episode accompanied with acute coronary syndrome, included 52 patients (Group 1), patients with constant AF form, included 96 patients (Group 2) and patients with paroxysmal or persistent atrial fibrillation registered before ACS episode, included 53 patients (Group 3). In Group 1 the level of the general cholesterol and low-density lipoproteins (LDL) was authentically higher. Among the survived and discharged patients after ACS episode there were 45 patients in Group 1, in Group 2 and 3 there were 81 and 47 patients, respectively. In 12 months the general mortality rate was comparable, however, the frequency of lethal and non-lethal myocardial infarction development was authentically higher in Group 1.Conclusions. Higher initial levels of the general cholesterol and LDL are connected with development repeated MI that does not affect the general mortality rate. However, these data are obtained in a small selection of patients and demand a further investigation

Description of rare clinical case of AA-amyloidosis with involvement in pathological process of heart and lungs

Amyloidosis is a unique group of disorders caused by the insoluble protein fibers accumulation known as amyloid fibrils in extracellular tissue and organ spaces. The involvement of different organs and tissues in amyloidosis is often the cause of missed or delayed diagnosis, and amyloidosis remains a major clinical problem as it is associated with 1/1,000 deaths in developed countries. We present a case of a 59-year-old female patient with complaints of breath shortness while talking, a sense of air lack in the horizontal position, swelling of the lower limbs, reduction of blood pressure to a minimum of 70/50 mm Hg, weight reduction by 7 kg in 6 months, dizziness. The patient was hospitalized to the Cardiology Department of Scientific Research Institute – Ochapovsky Regional Clinical Hospital no. 1 with heart failure. The electrocardiogram revealed left ventricular hypertrophy. Echocardiography showed biventricular myocardial hypertrophy with a maximum interventricular septum thickness of 16 mm, nonuniform ventricular myocardial structure and reduction of global left ventricular comparability to 38%. Computer tomography of chest organs demostrated interstitial swelling of parenchyma of both lungs. The infection during the further examination. For the final morphological verification of the diagnosis, it was necessary to perform peripheral transbronchial biopsy S 3, 4, 5 of the left lung and myocardial biopsy with specific staining on amyloid using congo red. In the lung and myocardial biopsy, the colour of the congo red is positive. An immunohistochemical study of the lung tissue and myocardial sample revealed Amyloid AA expression. This case represents a rare cause of heart failure in a woman. A feature of this observation is the rare involvement in the pathological process of both pulmonary tissue and myocardium with AA-amyloid deposition

CASE OF CORONARY ARTERY SPASM WITH FATAL OUTCOME IN THE EARLY PERIOD AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY OF THE RIGHT CORONARY ARTERY WITH IMPLANTATION OF BARE METAL STENTS

The paper presents a clinical case of coronary artery spasm after implantation of bare metal stents. The 60-year-old man was admitted to the hospital with the progression of the coronary heart disease and high angina pectoris functional class for coronary angiography. The patient had the main predisposing factor for the development of coronary artery spasm, which is 20-year smoking history. Based on the results of the coronary angiography, the decision was made to conduct endovascular treatment. The patient was discharged on the 2nd day after angioplasty with implantation of two stents in the right coronary artery. On the evening of discharge, the man developed a severe pain attack in the epigastric region and turned to the hospital. The electrocardiogram revealed ST-segment elevation in leads II, III, aVF, T-waves were negative in leads I, aVL and V3-6. Repeat coronary angiography showed the stent implantation sites were passable, there was a pronounced diffuse coronary artery spasm, which could not be eliminated by intracoronary administration of nitroglycerin.Coronary artery spasm induced by coronary angioplasty with stent placement is a rare complication that can develop at different time intervals after endovascular intervention. Based on the presented clinical case, it appears  likely that even after bare metal stents implantation, the development of endovascular dysfunction leading to coronary spasm is possible

COVID-19 after emergency coronary artery bypass grafting: features of the postoperative course and prognosis

Introduction Coronavirus disease (COVID-19) caused by SARS-CoV-2 virus identified in 2019, forces cardiology departments to quickly adapt existing clinical guidelines to the new reality, and this is particularly relevant for scheduling patients with acute coronary syndrome (ACS). The article demonstrates how COVID-19 has affected emergency cardiac surgery care.Objective To analyze the features of completed cases of emergency coronary artery bypass grafting (ECABG) and COVID-19 diagnosed during the postoperative period at the Research Institute – Ochapovsky Regional Hospital no. 1 for the period from May 1, 2020 to February 1, 2021. Material and Methods Completed cases of ECABG have been retrospectively studied. EACS was performed in 145 patients: in 79 people with unstable angina pectoris (NS), in 40 with Q-negative myocardial infarction (MI), in 14 cases with primary Q-positive MI, in 12 patients with recurrent MI. The condition for ECABG was a negative SARS-Cov-2 PCR result and the absence of viral pneumonia by CT. The patients were divided into 2 subgroups. The first one included people with ECABG that were not diagnosed with COVID-19 during postoperative follow-up in the hospital. Subgroup II had patients with ECABG and COVID-19 diagnosed during the hospitalization.Results Contingency tables showed a statistically significant interaction between group membership and mortality, 2.3% (n = 3) in subgroup 1 and 20% (n = 3) in subgroup 2, Pearson’s test χ2 = 10.6, p < 0.05. When analyzing survival rate in the EACS + COVID-19 subgroup, it is worth paying attention to the cumulative proportion of survivors, considering the severity of the course of viral pneumonia. The proportion of such patients with CT-4 by the 32nd day of hospital stay was 0.3.Conclusions Mortality rate in the postoperative course after ECABG with COVID-19 is significantly higher. In patients who underwent ECABG and died in the early and late postoperative period from COVID-19, a new coronavirus infection was diagnosed at a later date. In these cases, a considerably longer duration of CPB and a higher level of ferritin were revealed at the time of transference to the observation department. Survival rate in ECABG patients due to primary Q-negative MI is significantly lower in comparison with patients hospitalized for unstable angina

Results of dynamic follow-up for patients with myocardial infarction without obstructive lesion of coronary arteries: data of the overall register for acute coronary syndrome in Krasnodar region

Background. Myocardial infarction (MI) without obstructive lesion of coronary arteries (MINOCA) has incidence  to 14%. Despite its high prevalence,  MINOCA is paid not enough attention, therefore some patients can not receive appropriate treatment.Aim. Evaluating the long-term results of clinical observation in patients with MINOCA  in comparison with patients with obstructive damage and the subsequent revascularization of myocardium.Material and methods. On the basis of Scientific Research Institute RCH – 1 the multicenter cohort observation was organized. Patients from the register CROCS (the register of acute coronary syndrome in Krasnodar region) with the  diagnosis MI were divided into two groups: MINOCA including patients without obstructive damage of coronary arteries and MINOCA including patients with obstructive injury and the subsequent stenting a heart attack connected artery. All patients in 12 months would have control assessment during which they had objective survey; electrocardiography; daily monitoring; test of six-minute walking, echocardiography. Results. In the MINOCA group in 12 months after the acute coronary event in 21.5% cases there were tension stenocardia, in 16.2% – a painless form of myocardial ischemia was revealed, in a group of patients with MINOCA stenocardia of tension was revealed at 12.5% and 8.4% – with painless ischemia. The group of patients with MINOCA is characterized  by more reliable decrease in both parameters of heart rate variability, and turbulence of heart rate. MINOCA is followed by statistically significant increase in risk of ACS development and death within 12 months. All indicators had reliable difference.Conclusion. Patients with MINOCA are a special group, their differential characteristics demand definite diagnostic efforts

Features of the course of coronavirus infection in patients after thoracic and cardiac surgery

Objective: To study the features of the coronavirus infection course in cardiosurgical and thoracic patients to determine the factors potentially affecting the possibility of lethal outcome. To identify the predictors of fatal outcome based on the analyses of the features of the coronavirus infection course in this category of patients.Material and methods: During the analyzed period 80 patients from the departments of thoracic surgery and cardiac surgery were transferred to the infectious diseases department: 20 patients from the cardiac surgery department (CSD) – group 1; 60 patients from the thoracic surgery departments (TSD) – group 2. A control group number 3 consisting of 59 non-thoracic and non-cardiosurgical patients was also formed. According to the disease outcome the patients were divided into two groups: group 1 – fatal outcome, group 2 – recovery.Results: Out of 80 patients, lethal outcome was recorded in 25 cases: 22 patients of the thoracic profile (36% of the total number of transferred from this department) and 3 patients of the cardiosurgical profile (15% of the total number of those transferred from the cardiac surgery department). 20 out of 20 cardiac patients had been operated on the day before, 49 out of 60 thoracic patients also underwent surgery. 3 people from the group of non-operated patients transferred from departments of thoracic surgery died. Moreover, after pneumonectomy, fatal outcome was recorded in 7 out of 8 cases (87.5%).Conclusion: During the analyses of indicators it was revealed that the number of fatal outcomes in patients of the thoracic profile with COVID-19 infection is higher than of the cardiosurgical profile and in the infectious diseases department. Presumably, this is due to the fact that coronavirus infection affects the lungs to a greater extent, and in patients with a thoracic profile (in particular, those who have undergone resection interventions), the volume of the lung parenchyma is initially reduced. This is confirmed particularly by the highest percentage of fatal outcomes after pneumonectomy. Cardiosurgical patients after surgical interventions do not have a reduction in the functioning lung parenchyma, which creates an additional “reserve” for recovery. Moreover, men predominate among patients of the thoracic profile, with the survival rate lower in all groups compared to women. Patients transferred from thoracic departments showed higher rates of systemic inflammation, which indicates a more severe course of the viral infection and the possible development of complications.When analyzing the predictors of lethal outcome, the following factors were identified: male gender and, in general, a more severe course of a viral infection (low saturation, a high percentage of lung lesions on CT, more pronounced changes in laboratory screening). The studied factors are associated with a large number of fatal outcomes in thoracic and cardiac surgery patients. Among the factors that do not affect the prognosis are diabetes mellitus, stroke and myocardial infarction in history.Thus, patients diagnosed with coronavirus infection that developed after thoracic surgery had the most unfavorable prognosis. The revealed patterns are of interest for optimizing the routing of this category of patients in order to prevent coronavirus infection

Echo-cardiographic parameters for atrial fibrillation in combination with acute coronary syndrome in real clinical practice according to register of acute coronary syndrome in the Krasnodar region

Aim. To evaluate patients with acute coronary syndrome (ACS) in combination with atrial fibrillation (AF) according to the total register of ACS in the Krasnodar region of echocardiographic (EchoCG) parameters (left atrial dimension (LAD), left ventricular wall thickness (LVWT), left ventricle end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), pulmonary artery systolic pressure (PASP), as well as coronary substrate assessment according to coronary angiography (CAG) and determination of the relationship between the value of LVEF and the coronary substrate.Material and methods. From the register of the ACS in the Krasnodar region, patients were successively taken to the cardiology departments of Krasnodar regional clinical hospital № 1 for the period from November 20, 2015 to November 20, 2017 with a diagnosis of ACS, accompanied by one of the types of atrial fibrillation. This group of patients was designated as a group of ACS + AF and amounted to 119 patients. The comparison group was selected with the help of a random number generator from patients admitted to the hospital with ACS and intact sinus rhythm (SR) for the period of time from November 20, 2015 to November 20, 2017 (120). We analyzed the ECHO-CG parameters, the coronary substrate — according to the CAG.Results. When comparing the cohort of patients with ACS + AF with the cohort of patients with ACS + SR, we determined a significant (p<0,05) difference of LA size, LVEF and values of PASP. During comparing the presence of hemodynamically significant stenosis in the coronary arteries we noticed that in ACS + AF patients with LVEF <40% in significantly higher percentage of cases (p=0,0007) occurs significant hemodynamic stenosis of coronary arteries, in contrast to the group of patients with ACS + SR with LVEF <40%. In patients with EF >40% and ACS + SR we determined a significantly more frequent (p<0,001) stenosis.Conclusion. The results of the analysis are important for understanding the distinguishing characteristics of patients with ACS that occur on the background of AF, which is important for correct prediction of the course of the disease. The maintenance of the ACS register will provide information on the real clinical course of the disease, as well as improve the effectiveness of treatment in real clinical practice

Prediction of the Possibility of Hemorrhagic Syndrome during Combined Antiplatelet Therapy According to the Krasnodar Region Registry

Background. According to the literature data, acute coronary syndrome (ACS) in 2-20 % of cases is combined with atrial fibrillation (AF). According to the current guidelines of the European Society of Cardiology (ESC), patients with coexisting AF and ACS should receive dual antiplatelet therapy for the prevention of recurrent cardiovascular events and anticoagulant therapy for the prevention of thromboembolic complications. However, this combination is fraught with the development of hemorrhagic syndrome.Aim. To develop a model and software module for predicting possible bleeding in patients with ACS combined with AF taking three-component antithrombotic therapy.Materials and Methods. To build prognostic models for the development of hemorrhagic syndrome, a statistical method was used for classification trees and the neural network procedure implemented in the STATISTICA package. To build prognostic models, a sample was used consisting of 201 patients with a combination of ACS and AF with and without fatal outcome, the state of which was described by 42 quantitative and qualitative clinical indicators. The control group included 205 patients with ACS and intact sinus rhythm.Results. To identify predictors of predictive models of the possible development of hemorrhagic syndrome in patients with triple antithrombotic therapy, the Spearman correlation coefficient was used. The study of correlations allowed to reveal clinical indicators – predictors of prognostic models. After analyzing the predictive ability of the developed models, a software module was created in the Microsoft Visual C # 2015 programming environment that allows determining the possibility of hemorrhagic syndrome in patients with a combination of ACS and AF using classification trees and neural networks.Сonclusion. A classification model and a software module were developed to predict possible bleeding in patients taking three-component antithrombotic therapy. Models contain both quantitative and qualitative (categorical) clinical indicators. The current level of development of data analysis technologies opens up broad horizons for medicine in solving problems on real medical data, without translating them into scoring risk scales, including prediction of the diagnosis of the disease, stage of the disease, treatment outcome, possible complications, etc. High reliability of such systems can be provided by large volumes of medical data accumulated on servers

Predicting Methods for Analyzing Data on Fatal Outcome Possibility in the Combination of Acute Coronary Syndrome and Atrial Fibrillation According to the Krasnodar Region Registry

With the development of atrial fibrillation (AF), patients with acute coronary syndrome (ACS) are characterized by a twofold increase in the 30-day mortality compared with patients with sinus rhythm. In this regard, there is great interest in developing models of risk stratification to identify adverse outcomes in these patients with a view to more careful monitoring of patients in this group.Material and methods. For the construction of predictive models, a statistical method was used for the classification trees and, the procedure for neural networks implemented in the STATISTICA package. For the construction of prognostic models, a sample was used, consisting of 201 patients with and without fatal outcome; condition of each patient was described by 42 quantitative and qualitative clinical indices. Each patient belonged to one of 3 groups according to the type of AF: new-onset AF in ACS patient, paroxysmal AF, documented in an anamnesis before the episode of ACS and the constant or persistent form of AF.Results. To determine predictors of models predicting the possible fatal outcome of a patient, the Spearman correlation coefficient was used. Examination of the correlations for each of the 3 groups separately allowed to reveal clinical indicators for each group – predictors of predictive models with predominantly moderate correlations to the categorical variable “lethal outcome”. After analyzing the prognostic ability of the developed models, a software module was created in the Microsoft Visual C # 2015 programming environment to determine lethal outcome possibility in patients with ACS in the presence of AF using classification trees and neural networks.Conclusion. It is shown that for patients with ACS in the presence of AF, it is possible to construct mathematically based prognostic models that can reliably predict the lethal outcome possibility in patients based on actual values of clinical indices. In this case, clinical indicators can be both quantitative and qualitative (categorical), breaking patients into certain categories. Similar applications, unlike risk scales, are mathematically justified and can form the basis of systems for supporting decision-making

Specifics of acute coronary syndrome associated with atrial fibrillation in real world clinical practice (based on the registry of the Krasnodar Region)

Background: Coronary heart disease is the most common cardiovascular disorder, while atrial fibrillation (AF) is the most common heart arrhythmia.Aim: To perform a comparative analysis of the coronary substrate assessed by coronary angiography in patients with acute coronary syndrome (ACS) in combination with various AF types, as well as to analyze abnormal electrocardiographic findings and blood troponin levels in patients with ACS and AF versus ACS patients with sinus rhythm.Materials and methods: We retrospectively analyzed medical files 13,244 ACS patients entered into the total ACS registry in the Krasnodar Region from 20.11.2015 to 20.11.2017. In 1204 (9%) of them ACS was associated with AF (ACS + AF group, n = 119), the remaining 12 040 (91%) patients had sinus rhythm (ASC + SR group, n = 120).Results: Compared to the ACS + SR group, the troponin levels were significantly (р ≤ 0,05) higher in the ACS + AF group. No statistically significant differences between two groups were found for localization of hemodynamically significant coronary stenoses at coronary angiography. Only 25.0% (p = 0.1689) of patients with ACS + AF without ischemic electrocardiographic changes (ST depression or elevation) had no hemodynamically significant coronary stenoses at coronary angiography.Conclusion: AF in ACS patients is an important factor in the course of the disease and is characterized by higher blood troponin levels and significantly more frequent absence of ischemia-related electrocardiographic changes, compared to the ACS patients with sinus rhythm