The management of acute myocardial infarction in the Russian Federation: protocol for a study of patient pathways

Death rates from cardiovascular disease in Russia are among the highest in the world. In recent years, the Russian government has invested substantially in the healthcare system, with a particular focus on improving access to advanced technology, especially for acute myocardial infarction (AMI). This protocol describes a study to understand the management of AMI in different Russian regions, investigating the role of patient, clinical, and health system characteristic

Outpatient management of patients with peripheral artery disease by cardiologists or surgeons: influence on the prognosis and prevalence of surgical interventions

Highlights. The study shows for the first time that during the three-year follow-up of patients with diseases of the arteries of the lower extremities in the observation groups of a general surgeon and a cardiologist, adverse events (myocardial infarction, stroke, amputation, disability) and deaths occurred more often in a surgeon than a cardiologist. The study proves the correctness and real benefit of such an approach with the involvement of a cardiologist to the outpatient stage of management of a complex cohort of patients with atherosclerosis of the vessels of the lower extremities.Aim. To study the effect the outpatient observation of patients with peripheral arteries disease (PAD) by cardiologists and surgeons has on timing and prevalence of reconstructive surgery and the prognosis of patients. Methods We analyzed the data on 585 PAD patients who underwent outpatient observation from 2010 to 2017, dividing them into 2 groups. The first group (131 patients) managed by an surgeon; the second (454 patients) managed by a cardiologist. Since the groups were not comparable in terms of the initial parameters, the comparability of patients in the groups (observation by a surgeon or by a cardiologist) was achieved using pseudorandomization. The follow-up period was three years; we assessed the incidence of deaths, adverse events, and the prevalence of reconstructive operations.Results. During a three-year follow-up the 1st group, compared with the 2nd, had more deaths in general (p<0.001), death from cardiac causes (p = 0.045), from stroke (p><0.001), as well as the total number of adverse events (p><0.001) and disability (p = 0.065). Indications for reconstructive surgery on the lower extremities arteries (LEA), and operations frequency were comparatible in groups. Amputation history, taking diuretics, presence of rhythm disturbances, and management by a surgeon increased the risk of adverse outcomes. Management by a cardiologist, reconstructive LEA surgeries, female sex improved the prognosis of patients. Conclusion Observation of PAD patients by a cardiologist contributes to a higher frequency of optimal drug therapy by patients and can reduce the number of adverse events in patients and improve their survival without affecting the timing and frequency of reconstructive LEA surgeries. Keywords Peripheral atherosclerosis • Outpatient follow-up • Optimal drug therapy • Reconstructive surgery>˂ 0.001), death from cardiac causes (p = 0.045), from stroke (p˂ 0.001), as well as the total number of adverse events (p˂ 0.001) and disability (p = 0.065). Indications for reconstructive surgery on the lower extremities arteries (LEA), and operations frequency were comparatible in groups. Amputation history, taking diuretics, presence of rhythm disturbances, and management by a surgeon increased the risk of adverse outcomes. Management by a cardiologist, reconstructive LEA surgeries, female sex improved the prognosis of patients.Conclusion. Observation of PAD patients by a cardiologist contributes to a higher frequency of optimal drug therapy by patients and can reduce the number of adverse events in patients and improve their survival without affecting the timing and frequency of reconstructive LEA surgeries.Highlights. The study shows for the first time that during the three-year follow-up of patients with diseases of the arteries of the lower extremities in the observation groups of a general surgeon and a cardiologist, adverse events (myocardial infarction, stroke, amputation, disability) and deaths occurred more often in a surgeon than a cardiologist. The study proves the correctness and real benefit of such an approach with the involvement of a cardiologist to the outpatient stage of management of a complex cohort of patients with atherosclerosis of the vessels of the lower extremities.Aim. To study the effect the outpatient observation of patients with peripheral arteries disease (PAD) by cardiologists and surgeons has on timing and prevalence of reconstructive surgery and the prognosis of patients. Methods We analyzed the data on 585 PAD patients who underwent outpatient observation from 2010 to 2017, dividing them into 2 groups. The first group (131 patients) managed by an surgeon; the second (454 patients) managed by a cardiologist. Since the groups were not comparable in terms of the initial parameters, the comparability of patients in the groups (observation by a surgeon or by a cardiologist) was achieved using pseudorandomization. The follow-up period was three years; we assessed the incidence of deaths, adverse events, and the prevalence of reconstructive operations.Results. During a three-year follow-up the 1st group, compared with the 2nd, had more deaths in general (p<0.001), death from cardiac causes (p = 0.045), from stroke (p><0.001), as well as the total number of adverse events (p><0.001) and disability (p = 0.065). Indications for reconstructive surgery on the lower extremities arteries (LEA), and operations frequency were comparatible in groups. Amputation history, taking diuretics, presence of rhythm disturbances, and management by a surgeon increased the risk of adverse outcomes. Management by a cardiologist, reconstructive LEA surgeries, female sex improved the prognosis of patients. Conclusion Observation of PAD patients by a cardiologist contributes to a higher frequency of optimal drug therapy by patients and can reduce the number of adverse events in patients and improve their survival without affecting the timing and frequency of reconstructive LEA surgeries. Keywords Peripheral atherosclerosis • Outpatient follow-up • Optimal drug therapy • Reconstructive surgery>˂ 0.001), death from cardiac causes (p = 0.045), from stroke (p˂ 0.001), as well as the total number of adverse events (p˂ 0.001) and disability (p = 0.065). Indications for reconstructive surgery on the lower extremities arteries (LEA), and operations frequency were comparatible in groups. Amputation history, taking diuretics, presence of rhythm disturbances, and management by a surgeon increased the risk of adverse outcomes. Management by a cardiologist, reconstructive LEA surgeries, female sex improved the prognosis of patients.Conclusion. Observation of PAD patients by a cardiologist contributes to a higher frequency of optimal drug therapy by patients and can reduce the number of adverse events in patients and improve their survival without affecting the timing and frequency of reconstructive LEA surgeries

T Cell Response in Patients with Implanted Biological and Mechanical Prosthetic Heart Valves

The study was aimed at assessing T cell subsets of peripheral blood from recipients of long-term functioning (more than 60 months) biological and mechanical heart valve prostheses. The absolute and relative number of CD4 and CD8 T cell subsets was analyzed: naïve (N, CD45RA + CD62L + ), central memory (CM, CD45RA − CD62L + ), effector memory (EM, CD45RA − CD62L − ), and terminally differentiated CD45RA-positive effector memory (TEMRA, CD45RA + CD62L − ) in 25 persons with biological and 7 with mechanical prosthesis compared with 48 apparently healthy volunteers. The relative and absolute number of central memory and naïve CD3 + CD8 + in patients with biological prosthesis was decreased ( < 0.001). Meanwhile the number of CD45RA + CD62L − CD3 + CD8 + and CD3 + CD4 + was increased ( < 0.001). Patients with mechanical prosthesis had increased absolute and relative number of CD45RA + CD62L − CD3 + CD8 + cells ( = 0.006). Also the relative number of CD3 + CD4 + cells was reduced ( = 0.04). We assume that altered composition of T cell subsets points at development of xenograft rejection reaction against both mechanical and biological heart valve prostheses

Respiratory Muscle Strength in Patients with Coronary Heart Disease and Different Musculoskeletal Disorders

Aim. To measure respiratory muscle strength (RMS) in patients with coronary heart disease (CHD) and different musculoskeletal disorders (MSD).Material and methods. Patients were divided in four groups according to the MSD. Group I included 52 (13.4%) patients with sarcopenia, group II included 28 (7.2%) patients with osteopenia, group III included 25 (6.5%) patients with osteosarcopenia, group IV included 282 (72.9%) patients without MSD. All patients underwent the assessment of maximal expiratory (МЕР) and maximal inspiratory mouth pressures (MIP).Results. The mean RMS values were lower than the normative values, and the strength of the expiratory muscles was 1.25 times lower compared to the inspiratory muscles. Both of these parameters were within the normal range in 191 (49.3%) patients, and lower values were noted in 196 (50.7%). An isolated decrease in MIP was observed in 24.8% of patients, an isolated decrease in МЕР in 6.5%, a combined decrease in MIP and МЕР in 19.4% of patients. Comparative analysis of МЕР and MIP (depending on the MSD) did not demonstrate statistically significant differences. Lower МЕР (76.9%) and MIP (75%) values were noted mainly in the group of patients with sarcopenia. A similar pattern was notes in patients with osteosarcopenia and in patients without MSD. Normative values of RMS were observed in patients with osteopenia. Correlation analysis revealed a unidirectional relationship between RMS and the parameters of muscle function (hand grip strength, muscle area and musculoskeletal index) and a multidirectional relationship between МЕР and BMI (r -0.743, p=0.013), MIP and patient age (r -0.624, p=0.021).Conclusion. Respiratory muscle weakness was diagnosed in half of the patients with coronary heart disease. There were no statistically significant differences in RMS between patients with MSD and isolated CHD, despite lower values in the group with MSD. Correlation analysis revealed an association between RMS and muscle function

Курение и факторы сердечно -сосудистого риска

In this review the literature data of 2010–2015 years were analysed for smoking prevalence and its influence on brain, heart, blood vessels, blood and treatment effects with taking into account of age, gender, genetic factors, duration of smoking. The results of smoking stopping and its biorhytmic aspects were presented too.В обзоре проанализированы данные литературы 2010–2015 гг., отражающие распространенность курения, механизмы его влияния на мозг, сердце, кровеносные сосуды, кровь и эффекты лечения с учетом возрастных, гендерных, генетических аспектов и длительности курения. Отмечены результаты прекращения курения, их биоритмологические особенности

PERSONALITY TYPE D AND THE LEVEL OF SUBCLINICAL INFLAMMATION MARKERS IN CHD PATIENTS

Aim. To study the level of biomarkers of subclinical inflammation in CHD patients with existence of absence of personality type D.Material and methods. In 62 patients with stable CHD before planned CBG operation we assessed concentrations: of matrix metalloproteases -2, -3, -9, tissue inhibitor of matrix proteases -1, -2, C-reactive protein, soluble CD40 ligand, tumor necrosis factor alpha. For further study we selected two groups: 1 group (n=27) — patients with type D and 2 group (n=35) — with non-D type. Personality type was defined with DS-14 questionnaire. Patients were asked 14 questions with 5 variants of responses to each. Counting of points was done by two scales: negative irritability and social suppression. Type D was set if 10 points and more by each of the scales. All patients underwent: general and biochemical blood tests, echocardiography, color duplex scanning of brachiocephalic arteries and coronary angiography.Results. In intergroup comparison both groups were comparable by the most anamnestic and clinical parameters. There were no any differences in the instrumental assessments data. In type D patients there was higher level of MMP-9 (resp. 53,2 pg/mL and 66,5 pg/mL; р=0,051) and sCD40L (resp. 2,8 ng/mL and 5,7 ng/mL; р=0,013) comparing with those non-D-type. The level of other biomarkers in groups did not differ, concentration of MMP-2 and TNF-α were slightly higher among type-D, of the others — among non-D-typers. There were also statistically significant negative correlations of type-D and MMP-9 and sCD40L.Conclusion. In CHD patients, examined before coronary bypass operation, presence of type D personality was not followed by the increase of subclinical inflammation markers level comparing to patients without such type. In type-D patients there was increase of platelet activation markers activation, that associates with adverse outcomes in CHD

ПИТАНИЕ И СЕРДЕЧНО-СОСУДИСТОЕ ЗДОРОВЬЕ

Scientific information of last 5-7 years about the influence of dietand its components on cardiovascular disease development is reported in this review. The data about the role of products volume, vegetable and animal proteins, lipids, unsaturated lipid acids, glucose, vitamins, ions and other components of diet are reported. These data are correspond to the thesis: «We eat not into stomach, but into heart!»В обзоре отражены научные данные последних 5-7 лет о влиянии пищи и её компонентов на развитие сердечно-сосудистых заболеваний. Использованы сведения о значении объёма потребляемой пищи, источников белков и жиров растительного и животного происхождения, роли полиненасыщенных жирных кислот, глюкозы, витаминов, ионов. Изложены данные, соответствующие тезису: "Мы едим не в желудок, а в сердце!

Clinical and biochemical markers of coronary artery calcification progression after elective coronary artery bypass grafting

Aim. To assess the relationship of various clinical and biological markers of bone metabolism with the progression of coronary artery calcification (CAC) in patients with stable coronary artery disease (CAD) within 5 years after coronary artery bypass grafting (CABG).Material and methods. This single-center prospective observational study included 111 men with CAD who were hospitalized for elective CABG. In the preoperative period, all patients underwent duplex ultrasound of extracranial arteries (ECA) and multislice computed tomography (MSCT) to assess CAC severity using the Agatston score, as well as densitometry with determination of bone mineral density in the femoral neck, lumbar spine and T-score for them, In all participants, the following bone metabolism biomarkers were studied: calcium, phosphorus, calcitonin, osteopontin, osteocalcin, osteoprotegerin (OPG), alkaline phosphatase, parathyroid hormone. Five years after CABG, ECA duplex ultrasound, MSCT coronary angiography and bone metabolism tests were repeated. Depending on CAC progression (>100 Agatston units (AU)), patients were divided into two groups to identify significant biomarkers and clinical risk factors associated with CAC progression.Results. For 5 years after CABG, contact with 16 (14,4%) patients was not possible; however, their vital status was assessed (they were alive). Death was recorded in 4 (3,6%) cases (3 — due to myocardial infarction, 1 — due to stroke). In 18 (19,7%) cases, non-fatal endpoints were revealed: angina recurrence after CABG — 16 patients, myocardial infarction — 1 patient, emergency stenting for unstable angina — 1 patient. There were no differences in the incidence of events between the groups with and without CAC progression. According to MSCT 5 years after CABG (n=91 (81,9%)), CAC progression was detected in 60 (65,9%) patients. Multivariate analysis allowed to create a model for predicting the risk of CAC progression, which included following parameters: cathepsin K <16,75 pmol/L (p=0,003) and bone mineral density <0,95 g/cm3 according to femoral neck densitometry before CABG (p=0,016); OPG <3,58 pg/ml (p=0,016) in the postoperative period 5 years after CABG.Conclusion. Within 5 years after CABG, 65,9% of male patients with stable coronary artery disease have CAC progression, the main predictors of which are low preoperative cathepsin K level (<16,75 pmol/L) and low bone mineral density (<0,95 g/cm3) according to femoral neck densitometry, as well as a low OPG level (<3,58 pg/ml) 5 years after CABG

Непосредственные клинические результаты применения нового биологичекого опорного кольца для коррекции митральной недостаточности

Aim. To make the first clinical experience evaluation of the new biological closed support ring for mitral valve.Methods. 26 patients (16 men, 10 women, mean age 55 [49; 62] years) with dysplastic mitral insufficiency were implanted “NEORING” biological ring for the first time from March 2020 to June 2021. The etiological factor of the defect formation in all cases was the connective tissue dysplasia. The mean functional class of heart failure before surgery was 2 [2; 3] according to NYHA, the effective regurgitant orifice (ERO) was 0.4 [0.3; 0.5], vena contracta was 0.7 [0.6; 0.8]. Ten patients received rings of 28 mm diameter, ten patients – 30 mm, six patients – 32 mm.Results. No significant adverse events such as death from any causes, strokes, myocardial infarction, cardiac complications, bleeding, and return of regurgitation or failure of plastic surgery requiring reoperation, infective endocarditis after the intervention were observed. In two cases a permanent pacemaker was implanted due to sinus node dysfunction. At discharge all patients had no regurgitation (ERO 0), medium transvalvular gradient was 4.0 [3.0; 5.3] mm Hg. All the patients were assigned to NYHA functional class I heart failure after the surgery.Conclusion. New biological support ring “NEORING” (“NeoKor”, Kemerovo) use in the middle age group of patients showed high hemodynamic efficiency, the absence of specific complications in the early stages after the surgery. It is planned to expand the clinical material on the use of the biological ring, as well as to evaluate the long-term results in the format of a prospective, randomized trial and compare the new device with the existing ones.Цель. Оценка первого опыта клинического применения нового биологического замкнутого опорного кольца для митрального клапана «НЕОРИНГ» (ЗАО «НеоКор», Кемерово).Материалы и методы. С марта 2020 г. по июнь 2021 г. 26 пациентам с диспластической митральной недостаточностью впервые имплантировано биологическое кольцо «НЕОРИНГ» (16 мужчин, 10 женщин, средний возраст 55 [49; 62] лет). Во всех случаях этиологическим фактором формирования порока явилась дисплазия соединительной ткани. Средний функциональный класс сердечной недостаточности до операции составил 2 [2; 3] по классификации NYHA, эффективная площадь регургитации (ERO) – 0,4 [0,3; 0,5] см2 , vena contracta – 0,7 [0,6; 0,8] см. Десяти пациентам имплантированы кольца с диаметром 28 мм, десяти больным – с диаметром 30 мм, шести пациентам – с диаметром 32 мм.Результаты. Таких значимых неблагоприятных событий, как смерть от всех причин, инсульт, инфаркт миокарда, сердечные осложнения, кровотечения, возврат регургитации или несостоятельность пластики, требующая реоперации, инфекционный эндокардит после вмешательства, не отмечено ни в одном случае. Двум больным имплантирован постоянный водитель ритма по причине дисфункции синусового узла. На момент выписки у всех пациентов отсутствовала регургитация (ERO 0), средний трансклапанный градиент составил 4,0 [3,0; 5,3] мм рт. ст. После операции все больные были отнесены к I функциональному классу сердечной недостаточности по NYHA.Заключение. Применение нового биологического опорного кольца «НЕОРИНГ» в средней возрастной группе пациентов показало высокую гемодинамическую эффективность и отсутствие специфических осложнений в ранние сроки после операции. Планируется расширить клинический материал использования биологического кольца, провести оценку отдаленных результатов в формате проспективного рандомизированного исследования, а также сравнение нового изделия с уже существующими моделями

Three Year Prognosis of Patients with Myocardial Infarction Depending on the Body Weight Index: Data of the Kemerovo Acute Coronary Syndrome Registry

Aim. To study the effect of body mass index (BMI) on the 3-year prognosis of patients after myocardial infarction (MI).Material and methods. The study is based on data from a 3-year observation of patients with MI from the Kemerovo registry of acute coronary syndrome (n=1366). The characteristics of patients with MI, distributed by the BMI, were determined, the outcomes were analyzed, the risk factors and predictors for the vascular events and mortality were identified.Results. Obesity was detected in 32.2% people with MI (I degree – 22.3%; II – 7.7%; III – 2.3%), lack of BMI at 0.5%, normal BMI at 20.5%, overweight at 46.9%. Patients with different BMI showed a comparable incidence of recurring MI. In patients with normal BMI, when compared with patients with obesity, unstable angina pectoris (UA), heart failure (HF) and strokes developed often. In patients with normal BMI compared with obese patients, fewer deaths from all causes were recorded within 3 years after MI. A similar pattern with respect to the group with normal BMI in terms of high overall mortality was obtained among patients with overweight who had a lower UA. Patients with obesity was favorable in relation to the development of HF, strokes and overall mortality than patients with overweight. Differences in the 3-year outcomes in the group of patients with MI and underweight were not found when compared with patients with normal and overweight, however, they had a higher of strokes compared with patients with obesity. At patients with I degree obesity within 3 years after MI UA, HF, strokes were less. Patients with III degree obesity, the maximum frequency of total mortality was recorded. The development of death from all causes during the observation period in patients with MI and obesity was associated with: male, smoking, multivessel arterial diseases, non-endovascular reperfusion, acute HF with MI, history of vascular events and angina pectoris; whereas with overweight: multifocal atherosclerosis and arterial hypertension; with a deficit of BMI: non-reperfusion; with normal BMI: heredity for cardiovascular diseases, dyslipidemia and atrial fibrillation.Conclusion. 3 years after MI patients with obesity of the I degree are less likely than patients with obesity of II-III deaths from all causes are recorded; these patients are less likely than patients with normal weight to develop strokes, HF, UA. Thus, patients with MI and the presence of I degree obesity are characterized by better survival during 3 years of observation