Vol 92, No 9 (2020)

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COVID-19 and cardiovascular diseases

Chazova I.E., Mironova O.I.


First cases of new coronavirus infection were registered in December 2019. The COVID-19 outbreak was declared a global pandemic. COVID-19 is much more dangerous for people older than 65. It is well known that cardiovascular diseases are more affecting older patients as well. The potentially dangerous combination of the new infection and different cardiovascular diseases has become a crucial problem of cardiology in 2020.

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Original articles

Modulation of cardiac contractility in patients with chronic heart failure and atrial fibrillation

Uskach T.M., Safiullina A.A., Sapel’nikov O.V., Amanatova V.A., Nikolaeva O.A., Grishin I.R., Nazarov B.M., Tereshchenko S.N.


Aim. to evaluate the effectiveness of cardiac contractility modulation (MSS) in patients with chronic heart failure (CHF) and atrial fibrillation (AF).

Materials and methods. The following studies were performed in 40 patients with CHF and AF before implantation of the MSS device and after 2 and 6 months of follow-up: 12-channel ECG, transthoracic EchoCG, 6-minute walk test, determination of the level of Pro-natriuretic N-terminal peptide (NT-proBNP), daily ECG monitoring, and a questionnaire based on the Minnesota quality of life questionnaire for patients with CHF (MHFLQ). All patients received long-term optimal drug therapy for CHF before surgery.

Results. The results obtained indicate a statistically significant positive effect of the use of MSS in patients with CHF and AF on LV FV, the functional class of CHF, and levels of NT-proBNP regardless of the etiology of CHF.

Conclusion. The use of MSS may be promising for the treatment of heart failure in patients with CHF and AF.

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Resumption of anticoagulant therapy after major bleeding and recurrence of hemorrhagic complications in patients with atrial fibrillation with a high risk of stroke and thromboembolism (based on the results of 20 years of observation)

Mironova (Staroverova) A.I., Panchenko E.P., Kropacheva E.S., Zemlyanskaya O.A.


Aim. To analyze the frequency of resumption of anticoagulant therapy (ACT) after major and clinically significant bleeding among AF patients who received oral anticoagulants and were observed in the Department of clinical problems of atherothrombosis from 1999 to 2019 within the retro-prospective register «Regata-2», and to search for clinical factors associated with recurrence of hemorrhagic complications among patients who resumed anticoagulant therapy after a bleeding episode.

Materials and methods. In cohort study of patients with high-risk AF with absolute indications for ACT we enrolled 290 AF patients (130 women and 160 men) aged 32 to 85 years (the average age was 65.18±8.89 years). During the follow-up period, 92 patients developed hemorrhagic complications, and 73 of them resumed ACT. 35 of the 73 patients who resumed ACT developed a relapse of major/clinically significant bleeding.

Results. The frequency of resuming ACT after the first hemorrhagic complication increased over time from 75% in the period from 1999–2003 to 90% in the period 2015–2019. We were not able to establish an exact relationship between the presence of concomitant pathology and the decision to resume the ACT after bleeding. The only reliable reason for refusing to resume the ACT was the patient’s categorical reluctance. Among patients who had recurrent hemorrhagic complications, the total score on the Charleson comorbidity scale was significantly higher (4.23±2.01 vs 3.52±1.43; p=0.0425). Patients with recurrent bleeding were significantly more likely to suffer from CKD with a decrease in GFR less than 60 ml/min/1.73 sq. m, and also had a history of erosive and ulcerative lesions of the gastrointestinal tract. There was also a significant Association of recurrent bleeding with the use of proton pump inhibitors. Subgroups of patients who switched from warfarin to taking direct oral anticoagulants after the first bleeding and subsequent recurrent bleeding did not differ in basic clinical characteristics from patients without bleeding after changing the anticoagulant. According to multiple regression analysis, NSAIDs showed a tendency to develop a relapse of B/C bleeding on the background of direct oral anticoagulants in patients who underwent GO on the background of warfarin therapy (b=0.4524, p=0.0530).

Conclusion. During the 20-year follow-up, the frequency of all major and clinically significant bleeding was 2.6/100 patients-years, the frequency of first bleeding was 5.86/100 patients-years, while the frequency of repeated hemorrhagic complications was 7.06/100 patients-years. Patients with a high thromboembolic risk should receive anticoagulants, provided that the modifiable risk factors for bleeding are carefully corrected.

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The assessment of right ventricular structure and function in patients with different cardiovascular diseases using modern echocardiographic technologies and magnetic resonance imaging

Saidova M.A., Loskutova A.S., Belevskaya A.A., Stukalova O.V.


Aim. To perform comparative analysis of right ventricular (RV) structure and function in patients with various cardiovascular diseases using modern echocardiographic technologies in comparison with magnetic resonance imaging (MRI).

Materials and methods. The study included 85 patients. Group 1 consisted of 32 patients with idiopathic pulmonary hypertension (IPH) (mean age 35.9±10.2 years). Group 2 included 27 patients with arterial hypertension (AH) grade 3 (mean age 58.6±12.3 years). Group 3 consisted of 26 patients with chronic heart failure (CHF) (mean age 56.1±15.3 years). Control group included 28 healthy volunteers (mean age 38.7±10.9 years). The main method was transthoracic echocardiography (TTE) using modern technologies, such as three-dimensional echocardiography (3DE), tissue Doppler imaging (TDI), and speckle tracking echocardiography (STE). In some patients and healthy volunteers 3DE data were compared with MRI data.

Results. Patients with IPH and CHF had minimal RV ejection fraction (EF) both according to 3DE and MRI. Correlation analysis revealed close correlation between RV volumes and EF according to 3DE and MRI. Minimal values of systolic indicator S’TV according to TDI were observed in patients with CHF. In all groups, including control group, the highest values of S’TV were obtained at the level of the basal segments and the lowest values at the level of apical segments. STE revealed the same pattern as TDI. According to STE minimal RV strain was observed in IPH and CHF groups and significantly differed not only from control group, but also from AH group.

Conclusion. The lowest values of RV EF and strain were observed in IPH and CHF groups. There were no significant differences in these indicators between the groups, that dictates the need for thorough assessment of RV structure and function not only in patients with precapillary, but also with postcapillary pulmonary hypertension. The results of the study confirm good comparability of 3DE and MRI in assessing RV volumes and EF.

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Upper gastrointestinal bleeding in patients with stable coronary artery disease (registry of antithrombotic therapy “REGATТA” results)

Shakhmatova O.O., Komarov A.L., Korobkova V.V., Yarovaya E.B., Andreevskaya M.V., Shuleshova A.G., Panchenko E.P.


Introduction. Upper gastrointestinal (UGI) bleeding is a common complication of antiplatelet therapy. Data from real clinical practice that characterize the range of risk factors for UGI bleeding, prophylactic proton pump inhibitors (PPIs) therapy, bleeding frequency and their long-term effects in patients with stable coronary artery disease (CAD) are limited.

Aim. To identify predictors of UGI bleeding in patients with stable CAD, to assess the role of PPI in the prevention of bleeding and the long-term prognosis of patients after bleeding.

Materials and methods. 934 patients with stable CAD (median age 61 [53–68] years, 78.6% men) were included in the single institution prospective REGistry of Long-term AnTithrombotic TherApy (REGATTA). Atherosclerosis of peripheral arteries (APA) and abdominal aortic aneurysm (AAA) screening was performed by doctor decision, as well as esophagogastroduodenoscopy. 76% of patients received dual antiplatelet therapy for 6–12 months after elective PCI. PPIs were prescribed in 28.3% of cases.

Results. The median follow-up was 2.5 [1.1–5.1] years. The frequency of overt UGI bleeding was 1.9 per 100 patients per year. Anamnesis of peptic ulcer disease (OR 4.7; 95% CI 1.9–11.8; p=0.001), erosion of the upper gastrointestinal tract (OR 6.7; 2.7–16.6; p=0.00004 ), as well as concomitant diseases associated with a decrease in blood supply to the mucosa, such as heart failure – HF (OR 6.1; 2.3–16.0; p=0.0002), AAA (OR 9.3; 2.5–34.2; p=0.0008) and APA (OR 2.3; 0.98–5.5; p=0.05) turned out to be independent predictors of UGI bleeding. The frequency of AAA among those who underwent UGI bleeding was 19.6% (in patients without bleeding – 1.4%; p<0.001). 90.2% of patients with UGI bleeding received PPI; the frequency of UGI bleeding in patients receiving pantoprazole and omeprazole did not differ significantly. After UGI bleeding, rebleeding rate was 7.8%, thrombotic events (TE) rate – 31.4%, mortality rate – 17.7% for 30 days, 19.4% for 1 year and 35.3% for the entire observation period. The predictors of deaths were AAA (OR 92.5; 7.7–107.9; p<0.0001), APA (OR 4.2; 1.03–17.2; p=0.045) and HF (OR 34.5; 8.5–140.6; p<0.0001). The worst prognosis was expected for patients who underwent UGI bleeding and thrombotic events: 2/3 of these patients died.

Conclusion. In a prospective analysis of patients with stable CAD, we identified UGI bleeding was a significant risk factor for late thromboembolism and death, compared with patients without bleeding. Predictors of UGI bleeding and poor prognosis are factors that indicate atherothrombotic burden – abdominal aortic aneurysm, peripheral atherosclerosis and HF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04347200.

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Adherence and efficacy of long-term PAP therapy in patients with sleep-related breathing disorders associated with cardiac conduction disorders

Elfimova E.M., Mikhailova O.O., Khachatryan N.T., Litvin A.Y., Chazova I.E., Laiovich L.Y., Malkina T.A., Pevzner A.V., Golitsyn S.P.


Aim. To study the effectiveness of prolonged use of PAP therapy (positive airway pressure therapy) in eliminating sleep respiratory disorders and associated cardiac conduction disturbances.

Materials and methods. We included 21 patients who were examined at the Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology, regarding cardiac rhythm and conduction disturbances, as well as obstructive sleep apnea and who have been on PAP therapy for more than 12 months. The average age was 66.5 [63.5; 73.2] years, body mass index – 33.0 [30.2; 38.5] kg/m2, apnea-hypopnea index – 65.0 [59.0; 86.3]/h. At the time of analysis, 15 patients continued to use PAP therapy (mean time of use: 6.0 years [4.7; 9.2]) and 6 patients refused long-term use of PAP therapy, mean time to use PAP therapy until failure amounted to 2.8±2.1 years.

Results. PAP therapy lead to a persistent decrease in apnea-hypopnea index of 63.6/h to 3.7/h was (p=0.0002). 86% of patients met the criteria for adherence to PAP therapy (use >4 hours/night, more than 70% of nights). Initially, before the use of PAP therapy, all cardiac conduction disorders were during sleep and exceeded 3 seconds, with fluctuations from 3.1 to 10.6 seconds. PAP therapy appeared to be effective in all patients: no asystoles, duration of more than 3 seconds, were detected.

Conclusion. In obstructive sleep apnea patients with concomitant nighttime cardiac conduction disturbances, the long-term use of PAP therapy is effective and with good adherence.

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Contrast-induced acute kidney injury in patients with stable coronary artery disease: the most important risk factors and prevalence

Mironova O.I., Staroverov I.I., Sivakova O.A., Fomin V.V.


Aim. The aim of our study was to assess the prevalence of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD) receiving optimal medical treatment with indications to coronary angiography and intraarterial administration of contrast agents.

Materials and methods. 1023 patients with stable CAD were included in the open prospective observational cohort study. The CI-AKI was defined as a rise in serum creatinine ≥25% from baseline. The mean age of the study group was 61.7±10.1 years; 72.4% were males and 84.4% had arterial hypertension. A multiple logistic regression model of prediction of CI-AKI was created.

Results. CI-AKI developed in 132 (12.9%) of the patients. The multiple logistic regression model included gender, BMI, weight, age, heart failure, diabetes mellitus, arterial hypertension, anemia, hyperuricemia, proteinuria and baseline serum creatinine. Area under the curve for the model was 0.749 (95% confidence interval 0.703–0,795; p<0.0001). When trying to build a prognostic model, including baseline GFR and contrast volume, the model lost significance and the AUC diminished.

Conclusion. The CI-AKI remains quite a common kidney injury developing in patients with stable CAD undergoing percutaneous interventions. Several risk factors need to be assessed very carefully before any intervention requiring intraarterial contrast media administration especially in patients with comorbidities.

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The agreed experts’ position of the Eurasian Association of Therapists on tactics of management of patients with comorbid pathology infected with SARS-Cov-2

Arutiunov G.P., Tarlovskaia E.I., Koziolova N.A., Boldina M.V., Batiushin M.M., Ametov A.S., Arutiunov A.G., Belevskii A.S., Galstian G.R., Grigor’eva N.I., Dzhunusbekova G.A., Esaian A.M., Mal’chikova S.V., Mit’kovskaia N.P., Mkrtumian A.M., Orlova I.A., Petrova M.M., Rebrov A.P., Ruzanov D.I., Salukhov V.V., Sisakian A.S., Skibitskii V.V., Sugraliev A.B., Fomin I.V., Khalimov I.S., Chesnikova A.I., Shaposhnik I.I., Shestakova M.V.


The agreement of experts of the Eurasian Association of Therapists (EAT) discusses pathogenesis and treatment of COVID-19. Modern data on the characteristics of cardiovascular, kidney, respiratory damage in SARS-infected CoV-2 are presented. The tactics of managing patients initially having cardiovascular diseases, diabetes mellitus, chronic obstructive pulmonary disease, bronchial asthma, chronic kidney disease are discussed in detail. The article presents data on drug interaction of drugs.

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Decreasing cardiovascular morbidity: how to improve adherence to the treatment in the translational era

Zhirov I.V.


Cardiovascular diseases are the main drivers of the morbidity and mortality in Russian Federation. We briefly discussed the poor adherence of the patients and outlined the solutions of this problem.

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Problematic aspects of pulmonary hypertension due to left heart disease: focus on combined postcapillary and precapillary pulmonary hypertension

Aleevskaya A.M., Vyborov O.N., Gramovich V.V., Martynyuk T.V.


Рulmonary hypertension (PH) is a common complication of left heart diseases. In addition to a passive increase of pressure in the venous bed of the pulmonary circulation, leading to an increase of mean pulmonary pressure, signs of precapillary PH could be detected in some patients. Since 2013, a hemodynamic subtype of PH due to left heart diseases – combined post/precapillary PH has been identified, with a more unfavorable prognosis and high mortality.

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Hypertrophic cardiomyopathy in elderly: causes, diagnostic and treatment approaches

Chumakova O.S.


Hypertrophic cardiomyopathy is the most common inherited heart disorder with high clinical heterogeneity. Every fifth patient is older than 60 years at first diagnosis. This review discusses the possible causes for the late onset of hypertrophic cardiomyopathy, the diagnostic and treatment approaches in the elderly.

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Role of magnetic resonance imaging in patients with aortic stenosis before and after replacement of the valve

Shariya M.A., Ustyuzhanin D.V., Lepilin P.M., Imaev T.E., Komlev A.E., Belyaevskaya A.A., Ternovoy S.K.


Risk stratification among patients with aortic stenosis remains inadequate, and there is a clinical need for the correct identification of high-risk patients who would benefit from aortic valve intervention before developing left ventricular decompensation. Since the publication of the results of the PARTNER study, transcatheter aortic valve implantation (TAVI) has become the method of choice for aortic valve stenosis in inoperable patients and is a real alternative to conventional surgical replacement of the aortic valve in high-risk patients. In planning TAVI and postoperative monitoring of a patient from imaging methods, the leading role is played by echocardiography and multispiral computed tomography. However, in recent years, the interest of researchers in the use of magnetic resonance imaging in this category of patients has increased. The review article examines the potential role of magnetic resonance imaging in patients with aortic stenosis before and after TAVI.

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The achievements of the modern specific therapy of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: focus on the stimulator of soluble guanylate cyclase riociguat

Gratsianskaya S.E., Valieva Z.S., Martynyuk T.V.


Currently, treatment of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) is focused on three signaling pathways: the NO pathway, the endothelin pathway, and the prostacyclin pathway. Riociguat is the only representative of stimulators of the soluble guanylate cyclase (sGC) class that is approved for the treatment of PAH and inoperable and persistent/recurrent CTEPH. The review presents data from clinical trials showing a positive effect of riociguat on the functional and hemodynamic profile of patients with PAH and CTEPH. In recent years there has been much discussion about the possibility of optimizing therapy by switching to drugs that affect a single pathogenesis target. Thus, sGC stimulants have obvious advantages over phosphodiesterase type 5 (PDE-5) inhibitors, including the ability of riociguat to exert pharmacological effects (due to a NO-independent mechanism of action) even in conditions of reduced NO production. Switching from PDE-5 to riociguat may be safe and appropriate, according to clinical trials presented in the review. In accordance with the guidelines for the diagnosis and treatment of pulmonary hypertension of the Eurasian Association of cardiologists from 2019, this strategy is approved when PDE5 therapy is ineffective in patients with PAH FC III (WHO).

Terapevticheskii arkhiv. 2020;92(9):77-84
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Diagnostic and prognostic significance of QRS-T angle

Blinova E.V., Sakhnova T.A., Yurasova E.S.


The angle between the QRS and T vectors reflects the consistency or inconsistency of the processes of de- and repolarization of the ventricles of the heart and is considered one of the indicators of global electrical heterogeneity of myocardium. In recent years, the prognostic value of the QRS-T angle has been demonstrated in relation to total and cardiovascular mortality, both in the population and in various groups of patients. The mechanisms of this phenomenon are not completely clear. The review analyses studies published over the past five years on the relationship between the QRS-T angle and mortality, as well as coronary heart disease and heart failure. Possible mechanisms for increasing the QRS-T angle are discussed. Data are given on the use of the QRS-T angle in diagnostic and prognostic scales, including in combination with other indicators of global electrical heterogeneity of myocardium.

Terapevticheskii arkhiv. 2020;92(9):85-93
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Changes in the intestinal microbiota as a risk factor for dyslipidemia, atherosclerosis and the role of probiotics in their prevention

Oynotkinova O.S., Nikonov E.L., Demidova T.Y., Baranov A.P., Kryukov E.V., Dedov E.I., Karavashkina E.A.


The review presents an analysis of studies on the role of the intestinal microbiota and microbiome in lipid metabolism and the development of dyslipidemia, atherosclerosis and cardiovascular diseases. The role of the intestine as a metabolic organ with a multifactorial strain evolution, involved in lipid metabolism, cholesterol homeostasis and enterohepatic circulation is shown. The influence of microbial imbalance on the development of dyslipidemia and atherosclerosis is considered. Special attention is paid to preventive therapy with hypolipidemic probiotics. It is shown that the use of probiotics with hypolipidemic properties and consisting of a mixture of such strains as Lactobacillus plantarum CECT7527, CET7528 and CECT7529, mixtures of Lactobacillus acidophilus La-5, Bifidobacterium lactis BB-12, Bifidobacterium animalis lactis BB-12 contribute to reducing the level of LDL-C, CCS, TG, are safe and well tolerated, can be used as an adjuvant non-drug therapy in combination with hypolipidemic drugs for dyslipidemia, multifocal atherosclerosis.

Terapevticheskii arkhiv. 2020;92(9):94-101
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Choosing of therapy for a patient with dorsalgia

Kamchatnov P.R., Abusueva B.A., Khanmurzaeva S.B., Khanmurzaeva N.B.


Dorsalgia is one of the most common skeletal muscle syndromes. Dorsalgia often develops in patients of older age groups with polymorbidity that requires the appointment of a large number of medications. In these conditions, the choice of effective and safe therapy is a difficult problem. Discusses management of a patient suffering dorsalgia with comorbidities, the risks of complications of therapy, possible safety treatment, in particular, through the use of combination therapy.

Terapevticheskii arkhiv. 2020;92(9):102-107
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