Vol 92, No 4 (2020)

Clinical notes
Laboratory diagnostics in medicine
Kochetov A.G., Lyang O.V., Zhirova I.A., Ivoilov O.O.
Abstract

The development of clinical laboratory diagnostics is in line with the evidence-based medicine, which requires that clinical decisions have to be based on diagnostic methods with proven informativity. This creates a request for the scientific validity of the use of laboratory researches and application of probabilistic interpretation tools corresponding to the tasks. The concept of indefiniteness (analytical, biological and clinical) is at the heart of interpretation of laboratory results. The inclusion of laboratory research in clinical guidelines, the choice and appointment of this research to the patient should not be made from the position of ideas about increasing or decreasing the laboratory index in the disease, but on the basis of its scientifically proven characteristics as a laboratory biomarker – sensitivity, specificity, predictive value, as well as the relationship with certain clinical events, outcomes, risks. These characteristics are probabilistic and can be defined.

Terapevticheskii arkhiv. 2020;92(4):4-8
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Original articles
Clinical profile of patients with obstructive sleep apnea syndrome in a cardiology hospital
Elfimova E.M., Mikhailova O.O., Khachatryan N.T., Litvin A.Y., Сhazova I.E.
Abstract

Relevance. Obstructive sleep apnea syndrome (OSAS) is an important medical and social problem due to its high prevalence and impact on quality of life. The relationship between OSAS and cardiovascular pathology has been proven by many studies, which confirms the necessity for early diagnosis of OSAS and its treatment for the prevention of fatal and non-fatal events.
Aim: to study epidemiological and clinical profile of the patients referred by a cardiologist to a specialized sleep laboratory to verify the diagnosis of OSAS.
Materials and methods. Object of study – 527 patients aged 56.9±12.5 years who were hospitalized to the Myasnikov Clinical Cardiology Research Institute from 2016–2018 and had OSAS risk factors. Initially, complaints, medical history, anthropometric data were collected. As a screening survey, questionnaires were conducted using questionnaire scales. Verification of the diagnosis of OSAS and determination of the severity was carried out by cardiorespiratory or respiratory monitoring. Subsequently, 4 groups were formed depending on the presence and severity of OSAS.
Results. The prevalence of OSAS among patients in a cardiology hospital referred to a verification study was 88.6%. A comparative analysis of the groups revealed a progressive increase in the values of anthropometric indicators with increasing severity of OSAS. No differences were found between the groups by gender and daytime sleepiness on the Karolinska Sleepiness Scale. The average score on the Epworth sleepiness scale was statistically significantly lower only in the group of patients without OSAS when compared with the group with a severe degree of OSAS, and is comparable with the scores in the groups of mild and moderate degrees of OSAS. In a multivariate model of logistic regression, independent predictors of OSAS were identified as: age over 45 years, indications of loud intermittent snoring, frequent nightly urination, overweight or obesity. According to the results of assessing the incidence of various cardiovascular diseases in patients referred to the sleep laboratory, no significant differences were detected. At the same time, a significant difference was found in the frequency of obesity in patients with severe OSAS compared with other groups, as well as the frequency of type 2 diabetes mellitus or impaired glucose tolerance – when compared with groups without OSAS, and with mild OSAS. In one-factor logistic regression models, it was found that the likelihood of having a severe degree of OSAS increases with increasing both comorbidity and age.
Conclusions. High prevalence of OSAS in patients of a cardiological hospital, referred to a sleep laboratory for verification study, was confirmed. Considering the data that early diagnosis and treatment of OSAS can affect the course of both nosologies, the quality of life and prognosis of these patients, it is advisable to routinely screen and verify the diagnosis of OSAS in patients with cardiovascular diseases.

Terapevticheskii arkhiv. 2020;92(4):9-16
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Evaluation of the effectiveness of ultrasound shear elastography and liver steatometry
Tarasova O.I., Kuhareva E.I., Krasnitskaya S.K., Mazurchik N.V., Ngameni M.Y., Malinina N.A., Zykin B.I., Ogurtsov P.P.
Abstract

Detection of liver fibrosis and steatosis at early stages is a difficult task for clinical practice, due to the lack of early signs in routine radiation diagnostics.

Aim. To evaluate the efficacy of ultrasound shear elastography and ultrasound steatometry of the liver with the use of domestic ultrasonic diagnostic system Angiodin-Sono/N-Ultra.

Materials and methods. 264 people held ultrasound elastography and ultrasound steatometry. 38 patients underwent percutaneous puncture liver biopsy and subsequent pathophysiological examination.

Results. High correlation of fibrosis obtained at the Angiodin-Sono/N-Ultra and the leading ultrasonic systems with shear elastography was revealed. Cross-sectional comparative analysis of elasticity with the results of liver steatometry was conducted.

Conclusions. Results obtained in all groups correlate with the data obtained in studies on Fibroscan. When working with system Angiodin we got a simultaneous comparative analysis of elasticity with the results of liver steatosis. Results appear to be much more stable and compact than those obtained in studies on the Fibroscan. A new diagnostic criterion was revealed – the phenomenon of independence of fibrosis and steatosis indices.

Terapevticheskii arkhiv. 2020;92(4):17-22
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Adiponectin gene expression in local fat depots in patients with coronary heart disease depending on the degree of coronary lesion
Belik E.V., Gruzdeva O.V., Akbasheva O.E., Dyleva Y.A., Borodkina D.A., Sinitsky M.Y., Sotnikov A.V., Kozyrin K.A., Brel N.K., Naumov D.Y., Shilov A.A., Bychkova E.E., Karetnikova V.N., Barbarash O.L.
Abstract

Aim. To determine the dependence of adiponectin gene expression by subcutaneous, epicardial and perivascular adipocytes on the degree of coronary lesion in coronary heart disease.

Materials and methods. 84 patients with coronary artery disease were examined. Of these, 39 people showed a moderate degree of atherosclerotic lesion of the coronary bed (less than or equal to 22 points) on the SYNTAX Score scale, 20 – severe (22–31 points), and 25 – extremely severe (more than 32 points). Upon admission to the hospital, all patients underwent an echocardiographic study (Echocardiography, Acuson, Germany) with the calculation of the ejection fraction (EF) of the left ventricle (LV) to assess its systolic function. During a planned surgical intervention (coronary bypass surgery, CABG), adipocytes of subcutaneous, epicardial (EAT) and perivascular adipose tissue (PVAT) were taken. Adiponectin gene expression was evaluated by polymerase chain reaction (real-time PCR) using TaqMan probes. Statistical analysis was performed using Statistica 9.0.

Results. The maximum level of adiponectin expression was detected in adipocytes of PVAT, and the minimum – EAT. With an increase in the degree of atherosclerotic lesion of the coronary bed, the expression of the adiponectin gene in adipocytes of local depots significantly decreases r=-0.82; p=0.023. Moreover, the low level of gene expression in EAT correlated with a decrease in LV EF by r=0.73; p=0.03. In adipocytes of subcutaneous and especially PVAT, gene expression was the highest in patients with a moderate degree of coronary lesion.

Conclusions. Low adiponectin gene expression in EAT is associated with an increase in the degree of atherosclerotic lesion of the coronary bed and a decrease in LV EF.

Terapevticheskii arkhiv. 2020;92(4):23-29
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Myocardial perfusion single-photon emission computer tomography and coronary angiography results in patients with different pretest probability of ischemic heart disease
Ansheles A.A., Sergienko I.V., Denisenko-Kankiya E.I., Sergienko V.B.
Abstract

Aim. To study the relationship between pretest probability (PTP) of ischemic heart disease (IHD), calculated according to the recommendations of the European Society of Cardiology (ESC) of 2013 and 2019, with the perfusion of the left ventricle of the myocardium according to the single-photon emission tomography (SPECT) and the results of the invasive coronary angiography (CAG).

Material and methods. The study included 220 patients with a preliminary diagnosis of ischemic heart disease and planned invasive CAG. All patients underwent rest-stress perfusion myocardial SPECT within 1 month prior to or after CAG, standard quantitative parameters of left ventricular perfusion were assessed. Retrospectively clinical data was analyzed and PTP of IHD was assessed according to ESC recommendations for 2013 and 2019.

Results. Invasive CAG revealed obstructive lesion of one or more coromary arteries in 204 of the 220 patients (92.7%). In a retrospective analysis, taking into account gender, age and nature of the complaints, as recommended by ESC in 2013, PTP was rated as low (<15%) in 13 patients (5.9%), as intermediate (15–85%) – in 207 patients (94.1%). Following the comprehensive survey (SPECT and CAG) 8 patients with low PTP (61.5%) underwent coronary revascularization. Among patients with intermediate PTP significant transient ischemia according to SPECT was detected in 31 (15.0%), initial – at 107 (51.7%). According CAG among patients with intermediate PTP obstructive lesion was found in 192 (92.7%), 113 patients (58.8%) underwent revascularization. According to ESC recommendations of 2019, PTP was rated as low (<15%) in 117 patients (53.2%), including 5–14% – in 98 (44.5%). According to a survey (SPECT and CAG) 68 of them (58.1%) underwent revascularization.

Conclusion. PTP measurements proposed by ESC can not be applied to patients of the Russian population with suspected ischemic heart disease without significant corrections. 2013 ESC recommendations with higher PTP values for all categories of patients reflect Russian population better, while 2019 recommendations mistakenly attribute patients to low PTP in at least 58% of cases. These results are preliminary and will be expanded in subsequent studies with more detailed analysis of PTP in included patients with suspected IHD.

Terapevticheskii arkhiv. 2020;92(4):30-36
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Clinical characteristics and quality assessment of the treatment of patients with chronic heart failure with diabetes mellitus
Lazareva N.V., Oshchepkova E.V., Orlovsky A.A., Tereschenko S.N.
Abstract

Aim. A study of the clinical and instrumental characteristics and quality of treatment of patients with chronic heart failure (CHF) with diabetes mellitus.

Materials and methods. The study was conducted by using the CHF register method, which is a computer program with remote access, which allows on-line data collection on patients who have been examined and treated in primary care and in hospitals. The study included 8272 patients with CHF II–IV FC (functional class) (New York Heart Association – NYHA); among them 62% of patients were treated in hospital.

Results. The study showed that the frequency of diabetes was 21%. The main causes of CHF in diabetic patients are coronary artery disease, myocardial infarction (in anamnesis) and hypertension. These patients are more often diagnosed with III and IV CHF FC according to (NYHA) and retained LV (left ventricular) ejection fraction. The reduced ejection fraction was observed in 6.8% of cases, and the frequency of the “intermediate” LV was significantly higher than among patients with CHF and with diabetes and accounted for 18.9%. At patients with CHF with diabetes in comparison with patients with CHF without diabetes, atherosclerosis of the peripheral arteries, stroke (in anamnesis) and chronic kidney disease of stage III and IV were significantly more common.

Conclusion.Under the treatment, patients with CHF with diabetes have higher levels of SBP (systolic blood pressure), lipids and glucose in the blood plasma, indicating a lack of quality of treatment and, accordingly, the doctors are not optimally performing the clinical guidelines on treating this category of patients.

Terapevticheskii arkhiv. 2020;92(4):37-44
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Comparison of myocardial contrast stress-echocardiography and standard stress-echocardiography in detecting myocardial ischemia in patients with different severity of coronary artery stenoses
Atabaeva L.S., Saidova M.A., Shitov V.N., Staroverov I.I.
Abstract

Aim. To compare diagnostic value between standard stress-echocardiography and myocardial contrast stress echocardiography in detection of myocardial ischemia in patients with different severity of coronary artery stenoses.

Materials and methods. Myocardial contrast stress-echocardiography and standard stress-echocardiography were performed in 38 patients with coronary artery stenoses over 50% by angiography. Of all lesions 39 were intermediate (50–75%) and 33 – over 75% stenoses. Fractional flow reserve (FFR) was measured in 12 coronary arteries. During myocardial contrast stress-echocardiography wall motion and myocardial perfusion was assessed.

Results. Adequate visualisation increased from 81.6% in unenhanced segments to 96.1% in contrast-enhanced segments. The sensitivity, specificity, and diagnostic accuracy of standard stress-echocardiography and myocardial contrast stress-echocardiography in intermediate (50–75%) coronary stenoses were 44%, 83%, 56% and 56%, 94% и 64% respectively compare to angiography. Taking into account the 12 arteries with evaluated FFR, these parameters increased to 52%, 93% и 65% in standard stress-echocardiography and to 68%, 100% and 75% in myocardial contrast stress-echocardiography. In coronary stenoses over 75% the sensitivity, specificity, and diagnostic accuracy of standard stress-echocardiography and myocardial contrast stress-echocardiography were 78%, 88%, 80% and 86%, 100%, 92% respectively

Conclusion. Use of contrast-enhanced stress-echorardiography significantly increased the diagnostic value of this method by improving endocardial border visualization and possibilities of myocardial perfusion assessment.

Terapevticheskii arkhiv. 2020;92(4):45-50
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Characterisation of circulating microRNA-21 levels in patients with hypertrophic cardiomyopathy
Gudkova A.Y., Davidova V.G., Bezhanishvili T.G., Pyko S.A., Zarayskiy M.I.
Abstract

Aim. To study the levels of circulating microRNA-21 in patients with hypertrophic cardiomyopathy (HCM) of different ages.

Materials and methods. The study included 49 patients with HCM. The proportion of females was 55.1%, males – 44.9%. The average age was 50 [32; 65] (from 19 to 86 years). The control group for microRNA-21 included 44 healthy individuals, respectively, matched by the age and sex with the studied patients. Patients was made in accordance with the recommendations of the European society of cardiology. Plasma microRNA expression was determined by PCR with reverse transcription and real-time detection of results. The relative level of gene expression was calculated in accordance with the standard procedure 2-ÄCt.

Results. Septal wall thickness at end diastole has a significant negative correlation with age in patients with HCM (r=-0.56; р<0.001). PWTd (posterior wall thickness at end diastole) has a significant positive correlation with age in patients with HCM (r=0.67, р<0.001).

The level of circulating microRNA-21 in plasma is higher in patients with HCM compared to healthy individuals (5.28 [2.64; 13.96] and 0.84 [0.55; 1.23], respectively; p<0.001). Significantly higher levels of microRNA-21 were found in young patients aged from 19 to 45 years with the symptomatic course of HCM (36.76 [5.66; 42.22]) compared to patients with asymptomatic course <45 years of age (2.81 [1.45; 5.28]; p<0.002) and symptomatic patients ³45 years (3.88 [2.16; 8.63]; p<0.002).) The calculated risk of SCD was significantly higher in young symptomatic patients with HCM (6.01 [3.64; 9.67]) compared to patients with asymptomatic course <45 years (2.41 [1.21; 3.89]; p<0.001) and symptomatic patients ³45 years (2.56 [1.67; 4.41]; p<0.001).

Conclusion. The level of circulating microRNA-21 is significantly in patients with HCM compared to control group. The maximum level of circulating microRNA-21 was detected in patients with symptomatic course of HCM at the age of 45 years.

Terapevticheskii arkhiv. 2020;92(4):51-56
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Clinical efficacy of mechanical bacterial lysate in the prevention of infectious exacerbations of chronic obstructive pulmonary disease
Avdeev S.N., Nuralieva G.S., Gainitdinova V.V., Baimakanova G.E., So A.K., Merzhoeva Z.M.
Abstract

Aim. To evaluate the efficacy of mechanical bacterial lysate on the prevention of infectious exacerbations of chronic obstructive pulmonary disease in patients with frequent exacerbations.

Materials and methods. The study included patients (n=60) with frequent exacerbations of COPD (groups C and D according to the GOLD classification). All COPD patients were divided into two groups by blind method. The first group (n=30) received conventional therapy for COPD plus MBL (the course included 3 cycles of 10 days’ therapy with 20-day intervals between them). The second group of patients (control, n=30) received conventional therapy for COPD without MBL.We evaluated the severity of symptoms, frequency of recurrence of COPD exacerbations, readmissions, need for emergency care and changes in basic therapy of COPD. Evaluations were done on 10 days, 1, 3 and 6 months from the start of the study.

Results. Adding of MBL to the therapy list of COPD resulted in a significant decrease of biomarkers of systemic inflammation and sputum purulence during compared to the control group. After 6 months of observation MBL group demonstrated statistically significant improvement of respiratory function, decrease in frequency of COPD exacerbations, needs for emergency medical service, reduced changes in basic therapy and hospitalization for exacerbation of COPD. Therapy with MBL showed a high degree of safety and low incidence of adverse events.

Conclusion. The results of the study indicate that MBL may be used for the prevention of severe infectious exacerbations of COPD.

Terapevticheskii arkhiv. 2020;92(4):57-63
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Comparison of clinical-metabolic efficacy of pre- and probiotics in the conducted optimized protocols of eradication therapy of Helicobacter pylori infection
Butorova L.I., Ardatskaya M.D., Osadchuk M.A., Kadnikova N.G., Lukianova E.I., Plavnik R.G., Sayutina E.V., Topchiy T.B., Tuayeva E.M.
Abstract

Low patient compliance due to the development of adverse events in the form of antibiotic-associated diarrhea (AAD) is considered as the main reason for the failure of the eradication of optimized anti-Helicobacter therapy regimens. A key mechanism for the development of AAD is to reduce the number and species diversity of bacteria that form butyric acid.

Aim. The purpose of this study was to study the comparative effect on the clinical effectiveness of eradication therapy (ET) of Helicobacter pylori infection and metabolic changes in the colon microbiota of additional inclusion in the optimized treatment regimen of the combined prebiotic Zakofalk® (inulin + butyrate) with probiotics (lacto- and bifidobacteria in an amount of at least 1017 СFU).

Materials and methods. 120 patients with chronic gastroduodenal diseases and infected H. pylori were еxamined. A comparative analysis of the effect of a combined prebiotic and lacto-bifid-containing probiotics on improving the effectiveness of the optimized ET scheme and improving its tolerability, as well as on the quantitative and qualitative content of short-chain fatty acids (SFA) in feces. The success of eradication was controlled by a 13C urease breath test.

Results. According to the results of the study in randomized groups of patients, an excellent percentage of eradication (95%) was achieved in patients who performed ET with the addition of the prebiotic Zakofalk®. In the same group of patients, there was an increase in the absolute content of SFA and a significant increase in the concentration of butyric acid. In the group of patients who received ET with the addition of probiotics, an acceptable level of eradication was achieved (85.7%), but no changes in SFA were found indicating an increase in the number or activity of the butyrate-producing flora. Patients who performed ET without the addition of pre-probiotics did not achieve the «target» percentage of successful eradication (83.3%), and a significant quantitative decrease in SFA was found with a significant decrease in the proportion of butyric acid.

Conclusion. The inclusion of Zakofalk® in the ET scheme, in comparison with probiotics, significantly increases the probability of successful eradication, more effectively restores the metabolic potential of the microbiota, and prevents the development of AAD.

Terapevticheskii arkhiv. 2020;92(4):64-69
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Consensuns
Delayed coronary obstruction of the left main artery after transcatheter aortic valve replacement
Komlev A.E., Lepilin P.M., Kurilina E.V., Romakina V.V., Imaev T.E.
Abstract

Coronary arteries’ obstruction associated with transcatheter aortic valve implantation (TAVI) may occur either during the procedure or after it. In the latter coronary obstruction can be further divided into early (<7 days after procedure) or delayed one (>7 days). Delayed coronary obstruction (DCO) is referred as a rare but devastating complication after TAVI and is associated with the extremely high mortality. This case demonstrates the objective difficulties of timely diagnostics of DCO. Since the results of non-invasive methods are indetermined in most cases, the authors conclude that even low-specific clinical symptoms must be interpreted as the definite rationale for the implementation of invasive diagnostic and treatment strategy.

Terapevticheskii arkhiv. 2020;92(4):70-75
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The study of myocardial perfusion by cardiac volumetric computed tomography, combined with adenosine triphosphate test, in a patient with painless myocardial ischemia and atherosclerosis of the coronary arteries
Soboleva G.N., Gaman S.A., Ternovoy S.K., Karpov Y.A., Minasyan A.A., Shariya M.A., Shitov V.N., Mironov V.M.
Abstract

The presented clinical observation demonstrates the diagnostic capabilities of cardiac volumetric computed tomography (CT) with a pharmacological test by a vasodilator adenosine triphosphate (ATP) in the simultaneous assessment of coronary anatomy and changes in left ventricular myocardial perfusion (LV) in a patient with painless myocardial ischemia and coronary atherosclerosis. A 68-year-old patient with coronary heart disease (CHD) and atherosclerotic changes in the coronary arteries underwent cardiac volumetric CT in combination with a ATP pharmacological test. The study was performed on a Aquilion ONE 640 Vision Edition computer tomograph (Toshiba, Japan). Assessment of LV myocardial perfusion was carried out in comparison with other clinical, laboratory and instrumental examination methods. The results of clinical and instrumental examination of a patient with a low pre-test probability of coronary heart disease are presented. From the standpoint of modern recommendations on stable coronary heart disease, false-negative results of single-photon emission computed tomography of the heart and stress-echocardiography are discussed. Clinical observation demonstrates the feasibility of diagnosing LV myocardial ischemia by cardiac volumetric CT combined with ATP pharmacological test, confirmed by an invasive determination of the fractional flow reserve. The given clinical example represents the advantage of cardiac volumetric CT, combined with the ATP pharmacological test, as a method for visualizing LV myocardial perfusion in detecting myocardial ischemia.

Terapevticheskii arkhiv. 2020;92(4):76-79
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Typical errors pulmonary artery verification on the example of a clinical case
Vasiltseva O.Y., Vorozhtsova I.N., Bukhovets I.L., Gulyaev V.M., Vitt K.N., Karpov R.S.
Abstract

The difficulties of verification of pulmonary embolism (PE) are well known and have not been overcome to date, despite significant progress in approaches to managing patients with this pathology over the past 10–15 years. Due to the nonspecific clinical picture, cases of a long and difficult journey to this diagnosis are not exclusive. In large studies have shown that the most frequent symptom of pulmonary embolism – shortness of breath. However, it is not always associated with doctors of different specialties with the need to exclude this diagnosis, purposefully collect anamnesis, identify risk factors. Modern low-dose oral contraceptives are considered quite prosperous in terms of the development of thrombotic complications and cause a slight (10–20%) increase in fibrinogen concentration, factors VII, VIII and X, as well as a decrease in the content of active protein S by 10–20%. But in the case of the presence of diseases and conditions that increase the risk of venous embolism, this effect may be sufficient for the realization of life-threatening pulmonary embolism. In this regard, it is important to provide a combined effect on the prognosis of the pathology of the patients and the chosen method of contraception.

Terapevticheskii arkhiv. 2020;92(4):80-83
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Original articles
The «obesity paradox» and its degree of proof
Miklisanskaya S.V., Mazur N.A., Solomasova L.V., Chigineva V.V.
Abstract

The article gives a critical assessment of the so-called «obesity paradox». Methodological errors that occur in the organization of studies that studied the «obesity paradox» and the formation of comparison groups are highlighted. There are also examples of the disappearance of the «obesity paradox» when taking into account additional risk factors. The organization of prospective studies or more careful consideration of all currently known risk factors for cardiovascular diseases (CVD) will significantly improve the results of the study of the effect of overweight and obesity on mortality in patients with CVD. Thus, despite the biological possibility of the existence of a positive effect of adipose tissue in CVD, the presence of a large number of errors identified in the analysis of the work of researchers «obesity paradox» require to reconsider the existence of this phenomenon, it should be taken into account the possibility that the «obesity paradox» may be a consequence of improper design studies to investigate this phenomenon.

Terapevticheskii arkhiv. 2020;92(4):84-90
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Blood pressure variability in hemodialysis patients: prognostic significance and treatment possibilities
Tokareva A.S., Borovkova N.Y.
Abstract

A present review is devoted to the current state of the problem of blood pressure variability (BPV) in hemodialysis patients. The BPV classification and clinical significance of BPV metrics are discussed. The results of cohort and randomized studies on the high BPV influence on outcomes in hemodialysis patients, as well as on the possibilities of antihypertensive drugs in the treatment of high BPV in dialysis patients, are presented.

Terapevticheskii arkhiv. 2020;92(4):91-97
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Rebamipide using in gastroesophageal reflux disease treatment
Ivashkin V.T., Trukhmanov A.S., Gonik M.I.
Abstract

Rebamipide is a mucoprotective drug which was developed in Japan in 1990. The therapeutic effect of rebamipide based on the induction of cyclooxygenase-2 and increasing level of prostaglandins, inhibition of oxygen free radicals production, epidermal growth factor stimulation, vascular endothelial growth factor, nitric oxide, and decreasing of lipid peroxidation and neutrophils migration. The combination of proton pump inhibitors and rebamipide is more effective in relieving of gastroesophageal reflux disease symptoms and reducing recurrence rate of disease. Using rebamipide in the treatment of gastroesophageal reflux disease is justified because this drug has a unique mechanism of action, which eliminating the main stages of pathogenesis of the disease.

Terapevticheskii arkhiv. 2020;92(4):98-104
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The myocardial infarction size measuring using modern methods
Shigotarova E.A., Galimskaja V.A., Golubeva A.V., Oleynikov V.E.
Abstract

An accurate quantitative assessment of myocardium necrosis area and the viable zone (stunned and hibernating) in patients with myocardial infarction is crucial for the preoperative patient selection and predicting the cardiac surgery effectiveness. Currently, researchers and clinicians are most interested in the problem of determining the viable myocardium zone. However, only the necrosis zone area directly correlates with the patient’s prognosis and determines the heart pathological remodeling processes. In the distant period, the data obtained can be used to predict the post-infarction period course or for analysis the relationship of the necrosis zone with arrhythmogenesis, and a number of other indicators. Thus, the necrosis zone and the viable myocardium zone are two parameters that need to be monitored in dynamics in all patients after myocardial infarction. The most accurate and reproducible method for determining the necrosis area is contrast magnetic resonance imaging of the heart, however, this technique is still inaccessible in most hospitals. In this regard, it remains relevant to estimate the necrotic myocardium area by ubiquitous non-invasive methods such as electrocardiography and echocardiography.

Terapevticheskii arkhiv. 2020;92(4):105-110
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Perspectives of cell therapy for myocardial infarction and heart failure based on cardiosphere cells
Dergilev K.V., Vasilets I.D., Tsokolaeva Z.I., Zubkova E.S., Parfenova E.V.
Abstract

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. In recent years, researchers are attracted to the use of cell therapy based on stem cell and progenitor cells, which has been a promising strategy for cardiac repair after injury. However, conducted research using intracoronary or intramyocardial transplantation of various types of stem/progenitor cells as a cell suspension showed modest efficiency. This is due to the low degree of integration and cell survival after transplantation. To overcome these limitations, the concept of the use of multicellular spheroids modeling the natural microenvironment of cells has been proposed, which allows maintaining their viability and therapeutic properties. It is of great interest to use so-called cardial spheroids (cardiospheres) – spontaneously forming three-dimensional structures under low-adhesive conditions, consisting of a heterogeneous population of myocardial progenitor cells and extracellular matrix proteins. This review presents data on methods for creating cardiospheres, directed regulation of their properties and reparative potential, as well as the results of preclinical and clinical studies on their use for the treatment of heart diseases.

Terapevticheskii arkhiv. 2020;92(4):111-120
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The molecular marker of the preconditioning phenomenon HIF1α is a new pathway for early detection of visceral hypoxic conditions
Cherkashin D.V., Lyubimov A.V.
Abstract

Improvement and development of technologies for laboratory and instrumental examination of patients in recent years have greatly facilitated the diagnosis of ischemic myocardial damage. However, a decrease in the rating of cardiovascular diseases is not expected in the short term. This is due to an increase in the life expectancy of the population, general aging of the population and improving diagnostic capabilities and the provision of medical care. The time for verification of the diagnosis of ischemic disease, simplified the decision on treatment tactics were significantly reduced by introduction of X-ray contrast visualization examination methods such as angiography, quantitative and qualitative laboratory tests, development of diagnostic criteria based on the results of ultrasound and electrophysiological examination methods. Unfortunately, all these techniques are secondary in nature and are applied, when organ damage is for the most part already irreversible. Full restoration of organs is possible only if the patient is successfully evacuated to the hospital and there are specialists of the appropriate level of experiebce, X-ray surgical equipment with suitable supplies or pharmacological agents, usefull for quickly restoration the patency of the great vessels and normal blood flow. A large number of studies appear on the phenomenon of preconditioning at the present stage of development of fundamental medical science. The purpose of this article is to reveal the possibilities of using molecular markers of the phenomenon of preconditioning in the framework of the early detection of hypoxic conditions, the assessment of their diagnostic use in the clinic and the prevention of hypoxia-associated diseases.

Terapevticheskii arkhiv. 2020;92(4):121-126
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Safety and clinical-cost effectiveness of percutaneous coronary interventions with overnight hospitalization
Basinkevich A.B., Matchin Y.G., Ageev F.T.
Abstract

New methods and treatment plans for patients with chronic coronary artery disease after endovascular interventions are currently introduced into clinical practice. It allows reducing hospital stay down to 24 hour, with discharge the next morning. This approach is called «overnight stay». Using a similar strategy increases the availability of various types of endovascular interventions, shorter «waiting lists», and cut the cost of treatment due to a reduced hospital stay.

Terapevticheskii arkhiv. 2020;92(4):127-134
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