Vol 89, No 9 (2017)


Chronic heart failure: New challenges and new perspectives

Tereshchenko S.N., Zhirov I.V.


Chronic heart failure is an important global public health problem. This is associated with extremely poor prognosis, high readmission rates, and substantial treatment costs in patients. The paper gives the main aspects of the setting-up of a specialized service to patients with heart failure.
Terapevticheskii arkhiv. 2017;89(9):4-9
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Influence of modifiable cardiovascular risk factors on antihypertensive therapy efficiency escape

Mikhailova O.O., Litvin A.Y., Rogoza A.N.


Aim. To evaluate the influence of cardiovascular risk factors on antihypertensive therapy (AHT) efficiency escape (EE). Subjects and methods. Data on 59 patients with grades 1—3 hypertension (Stages I—II) were analyzed. During chosen AHT, 24-hour blood pressure monitoring was done at baseline, 1 and 3 months after beginning the observation to identify/rule out the AHT EE phenomenon. Results. The AHT EE group (Group 1) as compared with the group that needed no therapy correction within 3 months (Group 2) was observed to have the following: elevated fasting blood glucose levels (FBGL) (5.8±0.8 vs 5.3±0.7 mmol/l; p=0.008) and higher impaired glucose tolerance (IGT) rates (8 (27.6%) vs 4 (13.3%) cases (p=0.03)); a more number of smoking patients (8 (27.6%) vs 3 (10%) cases; p=0.02); a larger number of patients with a compromised family history of cardiovascular diseases (17 (58.6%) vs 11 (36%); p=0.02). Furthermore, in Group 1 baseline average systolic blood pressure during 24 hours (SBP-24) proved to be higher than that in Group 2 (127.4±4.2 vs 122.4±6.8 mm Hg; p=0.002). Odds ratio (OR) for developing the EE phenomenon increased by 60% with a rise of 0.5 mmol in FBGL (OR, 1.60; 95% confidence interval (CI), 1.06 to 2.4; p=0.02) and by 18% with an increase of 1 mm Hg in baseline SBP-24 (OR, 1.18; 95% CI, 1.05 to 1.33; p=0.004). Multivariate analysis indicated that the independent predictors of AHT EE were a compromised family history (OR, 3.7; 95% CI, 1.1 to 12.1; p=0.03) and IGT (OR, 4.1; 95% CI, 1.02 to 16.4; p=0.04). Conclusion. AHT EE was influenced by FBGL, IGT, smoking, a compromised family history, and baseline SBP-24 level.
Terapevticheskii arkhiv. 2017;89(9):10-14
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Time course of changes in left ventricular twist in the presence of idiopathic left bundle branch block during exercise testing

Pavlyukova E.N., Kuzhel D.A., Matyushin G.V.


Aim. To investigate left ventricular (LV) deformation properties, rotation, and twist during a bicycle ergometer exercise test among patients with idiopathic left bundle branch block (LBBB). Subjects and methods. Thirty-four patients with idiopathic LBBB having a mean QRS duration of 153±24 msec were examined. A control group included 18 apparently healthy volunteers. All the patients and apparently healthy individuals underwent echocardiography to determine LV hemodynamic parameters, deformity, rotation and twist at rest and after exercise test. Results. As compared with the control, the idiopathic LBBB group at rest showed decreases in LV global longitudinal deformity (-15.6±4.7 and –18.4±3.1%, respectively; p=0.037), apical rotation (4.59±4.2° and 8.99±3.68°; p=0.0067) and twist (9.08±4.59° and 13.96±4.61°; p=0.0156), whereas there were no differences in LV ejection fraction and end-systolic and end-diastolic volumes. After exercise testing there were no augmentations in basal and apical rotation and resulting δTwist in the idiopathic LBBB group compared with the control (–2.05±8.35 and 4.66±8.49%; p=0.0463). The described changes in LV rotation and twist during exercise testing occurred in the presence of elevated pulmonary artery systolic pressure (PASP) in the LBBB group compared with the control (41.6±3.81 and 32.4±3.81 mm Hg, respectively; p=0.0201). Conclusion. Decreases in LV basal, apical and resulting twist may lead to elevated PASP in patients with idiopathic LBBB during exercise.
Terapevticheskii arkhiv. 2017;89(9):15-19
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Endothelial immune activation and functional state in patients with hypertensive disease

Ashcheulova T.V., Kovalyova O.N., Gerasimchuk N.N.


Aim. To investigate the nitric oxide (NO) system, the activity of endothelial NO synthase (e-NOS) and inducible NO synthase (i-NOS) in relation to the levels of tumor necrosis factor-α (TNF- α) and its soluble receptor type I (sTNFRI) depending on the grade of hypertensive disease (HD). Subjects and methods. A total of 317 patients, including 284 patients aged 30 to 65 years (mean age 54.7±0.58 years) with Grades 1—3 HD who had not previously received regular antihypertensive therapy and 33 apparently healthy individuals, were examined at Kharkov City Clinical Hospital Eleven. Immune activation was judged by the serum levels of the proinflammatory cytokine TNF-α in all the examinees and y those of sTNFRI, which were measured by enzyme immunoassay. To study the endothelial functional state, the level of stable end metabolites of nitric oxide, that of S-nitrosothiol and the activity of NO synthases were biochemically determined in 100 patients from this group. A control group consisted of 16 apparently healthy individuals. Results. There were increases in the circulating levels of proinflammatory cytokines (TNF-α, sTNFRI), the content of S-nitrosothiol and the activity of i-NOS. At the same time, there were decreases in the activity of e-NOS and the level of end nitric oxide metabolites, such as nitrites and nitrates. Conclusion. In patients with HD, the end metabolites of nitric oxide decrease, which indirectly shows a reduction in its vasoactive part, and the stable NO metabolite S-nitrosothiol increases. This is associated with enhanced NO oxidation under conditions of oxidative stress and endothelial dysfunction. The higher amount of S-nitrosothiol in the examinees may be associated with increased i-NOS. The immunoinflammatory activation mediated by the proinflammatory cytokines, particularly by the enhanced activity of TNF-α and sTNFRI, has been proven to play a role.
Terapevticheskii arkhiv. 2017;89(9):20-24
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Impact of hyperglycemia on the results of percutaneous coronary interventions in patients with acute ST-segment elevation myocardial infarction

Bessonov I.S., Kuznetsov V.A., Potolinskaya Y.V., Zyrianov I.P., Sapozhnikov S.S.


Aim. To investigate the impact of hyperglycemia on the results of percutaneous coronary interventions (PCIs) in patients with acute ST-segment elevation myocardial infarction (ASTEMI). Subjects and methods. A study group consisted of 511 patients with hyperglycemia (blood glucose level (BGL) ≥7.77 mmol/L) who underwent primary PCIs in the period from 2005 to 2015. A comparison group included 579 patients (BGL ≥7.77 mmol/L). Results. Assessment of the results of hospital interventions revealed that the mortality rates in patients with hyperglycemia proved to be higher than in those with normal BGL (6.5 and 2.6%, respectively; p=0.002). No differences were found in the rates of stent thrombosis (1 and 1.4%; p=0.541) and recurrent myocardial infarction (1.2 and 1.6%; p=0.591). Major adverse cardiac events, including death, recurrent infarction, and stent thrombosis, were more frequently determined in the hyperglycemic patients (7.6 and 4.3%; p=0.020). No-reflow phenomenon statistically significantly more frequently developed in the patients with hyperglycemia (6.8 and 3.3%; p=0.007). Binary logistic regression analysis showed that the presence of hyperglycemia served as an independent predictor of hospital mortality (odds ratio (OR) 2.6; 95% confidence interval (CI), 1.4 to 4.8; p=0.002). The application of a random probability sampling technique revealed that mortality remained statistically significantly higher in the hyperglycemic patients than in the normoglycemic individuals at admission (6.7 and 2.6%; р=0.011). Conclusion. PCIs in patients with ASTEMI and hyperglycemia are characterized by higher mortality rates and the risk of major adverse cardiac events. Admission hyperglycemia is an independent predictor of hospital mortality.
Terapevticheskii arkhiv. 2017;89(9):25-29
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Clinical, laboratory and instrumental criteria for myocarditis, established in comparison with myocardial biopsy: A non-invasive diagnostic algorithm

Blagova O.V., Osipova Y.V., Nedostup A.V., Kogan E.A., Sulimov V.A.


Aim. To determine the diagnostic value of different clinical, laboratory, and instrumental signs in the diagnosis of myocarditis in patients with the picture of idiopathic arrhythmias, dilated cardiomyopathy (DCM) and in a comparison group when comparing with myocardial morphological examination. Subjects and methods. A study group included 100 patients (35 women; mean age, 44.7±12.5 years) with idiopathic arrhythmias (n=20) and DCM as a syndrome (n=100). All underwent myocardial morphological examination: endomyocardial biopsy (EMB) (n=71), intraoperative biopsy (n=13), study of the explanted heart (n=6), and autopsy (n=11). A comparison group consisted of 50 patients (25 women; mean age, 53.7±11.7 years) with non-inflammatory diseases of the heart (left ventricular end-diastolic dimension <6.0 cm, ejection fraction >50%) who underwent open-heart surgery (n=47), EMB (n=2), or autopsy (n=1). The investigators also performed polymerase chain reaction for cardiotropic viral DNA in the blood and myocardium, anticardiac antibody (ACA) identification, myocardial scintigraphy (n=26), coronary angiography (n=47), magnetic resonance imaging (MRI) (n=25), and multislice computed tomography of the heart (n=45). The diagnostic value of the extended spectrum of clinical, laboratory, and instrumental markers for myocarditis was estimated. Results. Active/borderline myocarditis was diagnosed in 76% of the patients in the study group (75.5% in the arrhythmia subgroup and 76.3% in the DCM one) and in 24.3% of those in the comparison group (p<0.001). A viral genome in the myocardium was detected statistically significantly less frequently in the study group than that in the comparison one (40.2 and 65%, respectively; p<0.01): in 46.6% in the DCM subgroup and 15.8% in the arrhythmia one. An ACA set (sensitivity, specificity, and predictive value of positive and negative test results (45.7, 80, 80.4, and 45%, respectively) was of the greatest diagnostic importance in identifying myocarditis; antibodies to cardiomyocyte nuclei in a titer of 1:160—1:320 had the highest specificity (93.3%). A specificity above 70% was seen for a full medical history triad (acute onset, an association between onset and infection, a symptom duration of less than one year), systemic immune manifestations, anginas in the history and elevated anti-O-streptolysin levels, systemic blood changes, Q waves/QS complexes on ECGs, local hypokinesias, pericardial effusion, atriomegalia (in arrhythmias), angina/ischemia with intact coronary arteries, and focal perfusion defects during myocardial scintigraphy. A sensitivity higher than 50% was observed for age over 40 years (differential diagnosis with genetic forms), acute onset, a correlation with infection, and delayed contrast agent accumulation, as evidenced by MSCT/MRI. Conclusion. When the incidence of myocarditis is similar in the arrhythmia and DCM subgroups, the viral genome detection rate is statistically significantly higher in DCM. Among the non-invasive markers, an ACA set (high sensitivity and specificity) is of the greatest diagnostic value in the diagnosis of myocarditis. The diagnostic rule based on counting the number of scores has been developed, which makes it possible to individually establish the risk of myocarditis in patients with idiopathic arrhythmias and DCM for both the determination of indications for biopsy and the lack of the possibility of its performance. The risk of myocarditis is high if there are 5—7 scores; that is close to 100% if there are 8 scores or more.
Terapevticheskii arkhiv. 2017;89(9):30-40
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Factors for the development of persistent postoperative cognitive dysfunction in patients undergoing coronary artery bypass surgery under extracorporeal circulation

Trubnikova O.A., Tarasova I.V., Maleva O.V., Kagan E.S., Barbarash O.L., Barbarash L.S.


Aim. To analyze the factors contributing to the increased risk of persistent postoperative cognitive dysfunction (POCD) in patients undergoing coronary artery bypass surgery (CABS) under extracorporeal circulation (EC). Subjects and methods. 257 male patients aged 45 to 69 years with coronary heart disease (CHD) undergoing elective CABS under EC were examined. In addition to conventional clinical examination, all the patients underwent neuropsychological testing 3—5 days before, 7—14 days and 1 year after CABS. Persistent POCD was diagnosed if there was a 20% decline in cognitive domains at 1-year postoperatively versus preoperatively in 20% of the tests of an entire neuropsychological battery. Binary logistic regression analysis was applied to identify the factors supposedly increasing the risk of persistent POCD. Results. It was found that high baseline cognitive status, early POCD after CABG under EC, low adherence to the prescribed treatment regimen, as well as progressive carotid artery (CA) stenosis could predict with a high (85%) probability that persistent POCD might develop at 1 year after surgery. Conclusion. The findings are suggestive of the multifactorial origin of persistent POCD, a significant role in the development of which is played by not only the preoperative cognitive status, but also by postoperative factors, such as the degree of adherence to the prescribed treatment regimen, early POCD, and progressive CA stenosis.
Terapevticheskii arkhiv. 2017;89(9):41-47
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Role of AGTR1 A/C polymorphism in the development of atrial fibrillation

Kuskaeva A.V., Nikulina S.Y., Chernova A.A., Aksyutina N.V., Kuskaev A.P., Cherkashina I.I.


Aim. To investigate the AGTR1 A/C polymorphism associated with atrial fibrillation (AF) to form risk groups among patients who are prone to this disease. Subjects and methods. 90 probands with a confirmed diagnosis of AF and their 144 first-, second-, and third-degree relatives were examined. These families made up a study group. A control group was formed of 100 apparently healthy individuals without a history of cardiovascular diseases. Collection of medical history data and complaints, electrocardiography, electrocardiogram monitoring, as well as molecular genetic analysis, thyroid hormone tests were done in all the patients. Results. No statistically significant data on the correlation between the AGTR1 A/C polymorphism and the development of AF were obtained in any patient subgroup. The obtained results can be due to the genetic features of a Siberian population, which are dependent on climatic conditions and geographical location, and confirm that AF is a heterogeneous disease. Conclusion. There were no statistically significant differences between the patients in the study group and those in the control group. Our findings suggest the heterogeneity of AF and confirm its multifactorial nature.
Terapevticheskii arkhiv. 2017;89(9):48-52
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Comparative analysis of mortality from acute forms of ischemic heart disease during a 15-year period in the Russian Federation and the United States and the factors influencing its formation

Boytsov S.A., Samorodskaya I.V., Nikulina N.N., Yakushin S.S., Andreev E.M., Zaratyants O.V., Barbarash O.L.


Aim. To comparatively analyze the registered mortality rates from coronary heart disease (CHD) as a whole, as well as myocardial infarction (MI) and other acute forms of CHD during a 15-year period in the Russian Federation (RF, 2000—2014) and the United States of America (USA, 1999-2013). Materials and methods. Primary data were obtained from the database of the RF State Statistics Service, the World Health Organization Mortality Database, Human Mortality Database, then converted into standardized mortality rates and are presented in three age groups (30+, 30-49, and 50+ years old) in men and women separately. Results. The analysis revealed a substantial excess of the registered mortality rates from CHD in the RF versus in the USA, as well as a lower incidence of MI and a higher incidence of other acute CHD forms registered as the cause of death. It also showed considerable differences in the structure of registered types of MI as the cause of mortality. Conclusion. The differences found in the mortality rates from CHD, MI, and other acute forms of CHD in the RF and the USA can be explained by objective (the higher prevalence of cardiovascular risk factors, the higher and earlier incidence of CHD in the RF, as well as differences in the organization of medical care and, as a result, actually higher mortality rates from CHD in Russia) and subjective (differences in approaches to statistically developing a population-based mortality rate, as well as defects in filling out the medical documents and coding the causes of death) factors.
Terapevticheskii arkhiv. 2017;89(9):53-59
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Gender peculiarities of the risk of cardiovascular diseases in a population with symptoms of depression in Siberia (the WHO MONICA-psychosocial program)

Gafarov V.V., Gromova E.A., Gagulin I.V., Panov D.O., Gafarova A.V.


Aim. To identify gender differences in the prevalence of depression in an open population of individuals aged 25—64 years and to evaluate its impact on the risk of cardiovascular diseases (CVD) in the population of Siberia. Subjects and methods. A random representative sample of a 25—64-year-old Novosibirsk population (657 men and 689 women) was surveyed within the framework of the third screening of the WHO MONICA-psychosocial program in 1994. The screening program included sociodemographic data registration and depression detection. Over a 16-year study period, women had myocardial infarction (MI) in 15 cases and stroke in 35 cases and men had these conditions in 30 and 22 cases, respectively. Results. In the open 25—64-year-old population, depression was detected in 54.5% of the women and in 29% of the men; major depression was present in 11.8% of the women and 3.1% of the men (χ2=66.724; υ=2; p=0.0001). The risk of MI in the depressed patients was higher in the women (hazard ratio (HR)=2.5) than in the men (HR=2); when social parameters and age are included in the model, only a trend towards the impact of depression on the risk of MI persisted in the women (HR=3.4; p>0.05) and the men were observed to have a 1.6-fold higher risk for MI. The greatest risk of MI was seen in the men (HR=6.8) and women (HR=6.3) at the age of 55—64 years, as well as in the men who had incomplete secondary or primary education (HR=3.2); in blue-collar workers (HR=6.7), in the men who were single (HR=3.6), divorced (HR=4.5), or widowed (HR=6). The risk of stroke in the depressed patients during a 16-year study period was greater in the men (HR=5.8) than in the women (HR=4.6); after adjusting for age and social gradient, the risk of stroke in the women was higher in both the population and those who were aged 55—64 years (HR=8.5 and 6.9, respectively) than that in the men (HR=4.2 and 3.1, respectively). Among the men, the risk of stroke was higher in those who had primary education (HR=8.8), were widowed (HR=8.4) or divorced (HR=2.7). Conclusion. The women are much more susceptible to depression than are the men. The risk of MI with depression is higher in the women than in the men; at the same time, the risk of stroke is higher in the men than in the women. The picture is opposite in the older age group. The risk of CVD in the depressed men is exacerbated by a social gradient; these relationships have not been revealed in the women.
Terapevticheskii arkhiv. 2017;89(9):60-67
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Genetic determinants of hypertension in two national cohorts of Mountain Shoria

Barbarash О.L., Voevoda М.I., Artamonova G.V., Mulerova Т.А., Voropaeva Е.N., Maksimov V.N., Ogarkov М.Y.


Aim. To estimate the prevalence of the genotypes of the candidate genes ACE (I/D, rs4646994), ADRB1 (Ser49Gly, A/G, rs1801252) ADRA2B (I/D), MTHFR (C677T, Ala222Val, rs1801133), and eNOS (4b/4a) and their association with hypertension in two ethnic groups of Mountain Shoria. Subjects and methods. A clinical and epidemiological study was conducted in a population compactly living in the hard-to-reach areas of Mountain Shoria (the settlements of Orton, Ust-Kabyrza, and Sheregesh of the Kemerovo Region). A continuous method was used to survey 1178 residents from the above settlements; the sample consisted of adults (aged 18 years and older), 565 people were genotyped. Results. The prevalence of hypertension among the population of Mountain Shoria was 42.3%. The incidence of this disease among the Shorians was lower (39.9%) than that among the representatives of non-indigenous people (46.1%). The ethnically justified peculiarities of the association of ADRA2B and ACE I/D polymorphisms with hypertension were established. There were fewer patients with hypertension among ACE ID and ADRA2B DD genotype carriers in the cohort of the Shorians than in that of the non-indigenous population: 40.6% versus 58.6% and 38.3% versus 64%, respectively. Conversely, there were more hypertensive patients among the carriers of the homozygous ACE DD genotype in the native ethnic group (60%) than in the non-indigenous one (37.1%). Conclusion. Adverse prognostic ACE DD, ADRB1 AA, MTHFR TT, and eNOS 4a/4a genotypes were more frequently observed in the non-indigenous ethnic groups; the ADRA2B DD genotype was more common in the native population. Hypertension was associated with the ACE DD, МTHFR CT, and ADRB1 AA genotypes in the native ethnic group and with the ACE ID genotype in the non-indigenous population.
Terapevticheskii arkhiv. 2017;89(9):68-77
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Renal function in patients receiving long-term warfarin therapy: A five-year prospective follow-up

Zemlyanskaya O.A., Kropacheva E.S., Dobrovolsky A.B., Panchenko E.P.


Aim. To investigate the prognostic value of renal function and to estimate glomerular filtration rate (GFR) changes during a 5-year follow-up of patients receiving warfarin therapy. Subjects and methods. 200 patients (124 men, 76 women) mainly from a group at high risk for thromboembolic events (mean CHA2DS2-VASc scores, 3.25±1.89) were examined. The patients’ mean age was 62.3±9.4 years; the follow-up period was 5 years. 74% of the patients received warfarin monotherapy (international normalized ratio (INR) 2.0 to 3.0); 36% took vitamin K antagonists in combination with one or two antiplatelet agents. The CKD-EPI formula was used to estimate GFR in all the patients at baseline and throughout the investigation once a year. Results. GFR less than 70.9 ml/min/1.73 m2 was found to be a predictor of fatal and nonfatal thrombotic events. The decreased GFR was unassociated with the development of major and clinically relevant hemorrhagic complications within 5 years of warfarin therapy. The initial decline in renal function (GFR <70.9 ml/min/1.73 m2) was associated only with an increased rate of recurrent minor hemorrhagic complications. During 5-year warfarin therapy, there was a significant decrease in GFR from 97.1±24.85 to 91.9±28.9 ml/min/1.73 m2; at the same time, a rapidly progressive loss of renal function (GFR ≥3 ml/min/1.73 m2/year) was recorded in 25.9% of the patients. Discriminant analysis showed that a baseline left ventricular ejection fraction of <40% was a predictor for the rapidly progressive loss of kidney function. Conclusion. Long-term warfarin therapy achieved the therapeutic range for INR is safe in the environment of the created patronage system. The initial decrease in GFR is a predictor of thrombotic events and is unassociated with an increased risk of bleeding.
Terapevticheskii arkhiv. 2017;89(9):78-86
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Quality of life in patients with lower extremity atherosclerosis during standard treatment and therapeutic angiogenesis

Chervyakov Y.V., Vlasenko O.N.


Aim. To compare the impact of standard conservative treatment (SCT) and its combination with therapeutic angiogenesis for 3 to 5 years on quality of life in patients with Stage II (according to the classification developed by A.V. Pokrovsky-Fontaine) lower extremity atherosclerosis. Subjects and methods. 92 patients (69 men and 23 women) (mean age 65.2±7.7 years) were examined and divided into 2 groups of 46 people each. Only SCT (statins at an individually adjusted dose, antiaggregants, and graded exercise walking 3 to 5 km daily were used in Group 1; while Group 2 received SCT in combination with double injection of a plasmid-based VEGF165 gene drug (1.2 mg) into the ischemic limb muscles. The Russian version of the standard SF-36 questionnaire was applied; pain-free walking distances were measured before treatment and then every year; limb preservation and survival rates were determined in the patients. Results. It was determined that standard treatment did not significantly affect patients’ quality of life throughout the follow-up period. Addition of gene therapy leads to a significant improvement in both physical (p=0.00001) and psychological (p=0.00002) health components just in the first year of the follow-up. This is achieved through a significant (500%) increase in the average leg pain-free walking distance; p=0.007). Conclusion. The obtained result is consistently high throughout the subsequent period. There was no statistically significant difference in survival rates between the groups; limb preservation remained comparable.
Terapevticheskii arkhiv. 2017;89(9):87-92
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Chronic thromboembolic pulmonary hypertension developed in a female patient with lupus erythematosus and secondary antiphospholipid syndrome

Movsisyan G.A., Martynyuk T.V., Mershin K.V., Danilov N.M., Satybaldyeva M.A., Reshetnyak T.M., Akchurin R.S., Nasonov E.L., Chazova I.Y.


Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the potentially curable forms of pulmonary hypertension, in which pulmonary thromboendarterectomy is the gold standard treatment. However, over the last decade, great attention has been given to a combined therapeutic approach including both drug therapy and surgical treatment and the application of endovascular technologies. This clinical case demonstrates the diagnostic difficulties of CTEPH and the opportunities of a comprehensive approach to therapy for the disease with mandatory assessment of preoperative surgical and medical treatment in order to improve the patient status and to prepare for surgery.
Terapevticheskii arkhiv. 2017;89(9):93-99
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A patient with severe idiopathic pulmonary arterial hypertension: Is there a way out?

Tsareva N.A., Avdeev S.N., Neklyudova G.V.


The paper considers a clinical example of current therapy for idiopathic pulmonary arterial hypertension in a female patient with its clinical deterioration. It shows the tactics of switching from one drug (bosentan) to others (macitentan) within in the same pathogenetic therapy group (endothelin receptor antagonists). The latest pulmonary hypertension classification (Nice, 2013) is presented. The current strategies of pathogenetic therapy for pulmonary hypertension are discussed.
Terapevticheskii arkhiv. 2017;89(9):100-103
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Atrial septal aneurysm: Evolution of diagnostic and clinical judgements

Rudoy A.S., Bova A.A., Nekhaichik T.A.


The article discusses anatomical and clinical judgements on atrial septal aneurysm (ASA) as a primary cardiac structural abnormality. It presents current approaches to the classification of ASA and its echocardiographic diagnosis. Special attention is focused on the clinical significance of ASA as an isolated anomaly and concurrent with other structural abnormalities of the heart, especially from the standpoint of a risk of cardioembolic stroke.
Terapevticheskii arkhiv. 2017;89(9):104-108
pages 104-108 views

The role of integrated assessment of the indicators of external respiration function in cardiac surgical patients

Kamenskaja O.V., Klinkova A.S., Loginova I.J., Lomivorotov V.V., Ponomarev D.N., Habarov D.V., Lomivorotov V.N.


This literature review dedicated to the importance of an integrated assessment of external respiratory function in cardiovascular diseases (CVDs), including an analysis of up-to-date techniques, such as spirometry, body plethysmography, examination of the diffusing capacity of the lung, determination of O2 consumption with evaluation of the effectiveness of pulmonary ventilation. It considers the pathogenetic components of impairments in pulmonary ventilation and gas exchange, which develop in different CVDs, as well as during and after cardiac surgery. The authors analyze the results of international investigations and their own experience, which emphasize the prognostic value of lung function tests and suggest that there is a need for a comprehensive functional assessment of the respiratory system in cardiac surgical patients for their effective preoperative preparation, assessment and reduction of operational risks, and improvement of the prognosis of surgical treatment.
Terapevticheskii arkhiv. 2017;89(9):109-114
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Use of loop diuretics in heart failure: Current aspects

Kurlykina N.V., Seredenina E.M., Orlova Y.A.


Loop diuretics take the lead in the treatment of patients with symptomatic heart failure. Torasemide is the most effective and safe loop diuretic with the optimal pharmacokinetic profile, the additional properties associated with simultaneous blockade of the renin-angiotensin-aldosterone system and with the antiadrenergic effects of the drug, its positive impact on myocardial fibrosis and minimal severe potential negative effects. Sustained-release torasemide provides a more comfortable removal of excess liquid and does not deteriorate quality of life.
Terapevticheskii arkhiv. 2017;89(9):115-119
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Non-vitamin K antagonist oral anticoagulants for heart diseases

Kondratieva T.B., Popova L.V., Bokarev I.N.


Non-vitamin K antagonist oral anticoagulants (NОАСs) are highly effective drugs that prevent venous thrombosis and stroke in atrial fibrillation. Their use has difficulties that are associated with the need for laboratory control and with the influence of many factors on the activity of these medications. The emerged direct oral anticoagulants have some advantages over NOACs. Nevertheless, there are a number of pathological conditions, in which NOACs remain first-line drugs. These include prosthetic mechanical heart valves, a glomerular filtration rate less than 60 mL/min/1.73 m2, and left atrial thrombus.
Terapevticheskii arkhiv. 2017;89(9):120-127
pages 120-127 views

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