Electrocardiography (ECG) takes the lead in assessing the prevalence of coronary artery disease (CAD) in the population. ECG disorders, grouped in the Major (certain) and Minor (possible) categories, are prognostic markers of a high risk of cardiovascular diseases and sudden cardiac death. Unified assessing methods of ECG disorders prevalence and their associations with socio-demographic parameters have not previously been made in Russia.

Aim. To study the prevalence of ECG parameters of certain and possible coronary artery disease among population of Russia, depending on the socio-demographic characteristics — age, sex, education and place of residence (city or country).

Material and methods. We used 17504 ECGs from representative samples of population (25-64 years old), who participated in the epidemiological study “Epidemiology of cardiovascular diseases and their risk factors in the Russian Federation”. The analysis using Minnesota code was carried out among men and women of four age groups, two educational levels, among citizens and countrymen.

Results. The highest prevalence was observed in the “Certain” (5,7%) and “Possible signs of CAD” (7,1%) categories, in the “Certain” (3,8%) and “Possible myocardial ischemia” groups (4,9%), the smallest is in the “Rhythm and conduction disorder” (0,7%) and “STT changes in left ventricular hypertrophy” (0,4%) groups. It was shown that the frequency of ECG disorders increases with age, has an sharp increase after 55 years, regardless of sex. In the age dynamics of categories, STT changes and atrial fibrillation have a decrease of gender differences. All groups of ECG disorders are detected more often among men than women, except for STT changes. With an increase in the level of education, the frequency of ECG pathologies decreases, with the exception of the groups of “major” and “minor Q (QS)”, “major rhythm and conduction disorders”. The prevalence of most ECG disorders does not depend on the place of residence. However, signs of major myocardial ischemia in men are more common in country than in the city (3,9% vs. 2,7%, p<0,05).

Conclusion. The results confirm the patterns identified earlier. There is a steady association of ECG data with socio-demographic characteristics.

Aim. To assess echocardiographic data in patients with rheumatoid arthritis (RA).

Material and methods. We included to study 129 women who underwent echocardiography (EchoCG) with Vivid-E9 ultrasound scanner: 55 people with RA and 32 with RA+arterial hypertension (AH). Allowing for the fact that in 36,8% of cases RA was combined with AH, the control group in addition to 14 healthy individuals included 28 people with AH.

Results. The systolic function of the left ventricle (LV), according to the size of the ejection fraction (EF), was preserved. EchoCG diagnosed diastolic dysfunction in 18,2% of patients with RA and 28,1% with RA + AH: usually of a rigid type (16,4% and 18,7%, respectively), less commonly pseudonormal (1,8% and 9,4%, respectively). An association of age and a) wall thickness, LV myocardium mass (r=0,46 and 0,6, respectively; p<0,0001) was found among patients with RA, which is absent in the group with AH; b) data characterizing the state of heart diastolic function (r=0,2÷0,31; p=0,001 and 0,03); c) global deformation (r=0,22; p=0,03). LV hypertrophy was noted in 3,6% of individuals with RA and 34,4% with RA+AH (p=0,02). The global deformation value more than -19,6% was in 34,5% of patients with RA and 59,4% with RA+AH (p=0,03). The global deformation changes were significant only in the presence of LV hypertrophy. Valve leaflet involvement and pathological regurgitation were present in 16,4% of patients with RA and in 31,2% of patients with RA+AH (p<0,05); open foramen ovale was noted in 3,6% and 15,6%, respectively (p<0,05); cardiac dropsy — in 18,2% and 12,5%, respectively.

Conclusion. EchoCG examination in various modes and technologies determined pathological changes, such as LV hypertrophy, valve disorders, mild cardiac dropsy, open foramen ovale, diastolic dysfunction and longitudinal systolic LV dysfunction in 45,4% of patients with RA and 96,9% with RA+AH. The value of the global systolic function can be a significant addition to the formation of cardiac risk groups with early prenosological signs of heart damage.

Aim. To compare the PESI and GRACE scores in assessing the risk of hospital outcomes in patients with pulmonary embolism.

Material and methods. The study included 383 patients with pulmonary embolism (PE), hospitalized during the period of April 4, 2003 on September 18, 2014; 190 (49,6%) are men, the average age is 57,4 years±14,4 years. We considered the patient’s anamnesis, complaints, results of biochemical and instrumental tests, as well as the treatment carried out to the patients.

Results. According to the risk stratification of PESI score, 86 (22,5%) patients had a very low risk of death, 88 (22,9%) had a low risk, 94 (24,5%) had an intermediate risk, 60 (15,%) — high risk and 55 (14,4%) patients have a very high risk. The combination of three ECG signs (SI-QIII, right bundle branch block and T-wave inversion in V1-V3) was significantly more common in patients with a very high PE risk — 14,5% (p=0,025). The most reliable sign of the most echographic (echoCG) criteria was dilatation of right ventricle (RV) (p=0,009) in a group of patients with a very high PE risk. According to the GRACE scale, 112 (29,2%) patients were assigned to the low risk group, and 271 (70,8%) patients — to the high risk group. ECG signs were observed more frequently in the high risk group: SI-QIII, T-wave inversion in III, V1-V3 leads, right bundle branch block (p<0,05). Pulmonary hypertension and RV dilatation according to echoCG prevailed in the high risk group (98,4% and 85,1%, respectively), p<0,05. The minimum value of points on the GRACE score for the deceased patients was 118 points. The GRACE scale showed high predictive ability with a sensitivity of 96% and a specificity of 63% (AUC=0,811, CI 95% 0,0738-0,884). However, the PESI score had a slightly greater predictive value with a sensitivity of 100% and a specificity of 53% (AUC=0,879 compared with AUC=0,811 for the GRACE scale). Analysis of the PESI and GRACE scores showed a moderate correlation between them (r=0,668).

Conclusion. The GRACE score showed a high predictive value for adverse outcomes in PE patients with a sensitivity of 96% and a specificity of 63%. The minimum score on the GRACE score for deceased patients was 118 points.

Aim. To study the efficacy of plasmapheresis as the main type of pathogenic treatment or in combination with immunosuppressive therapy in patients with dilated cardiomyopathy (DCMP) and arrhythmias of immune-inflammatory nature.

Material and methods. The main group included 20 patients with arrhythmic myocarditis (with premature supraventricular / ventricular contraction >3000/day, n=3/8, atrial fibrillation (AF) n=9) and 14 patients with DCMP syndrome (enddiastolic volume (EDV) left ventricle (LV) 6,3±0,6 cm, ejection fraction (EF) 33,5±8,1%). The inclusion criterion was an increase of at least 2 types of anti-cardiac antibodies titers ≥ twice. Myocarditis is diagnosed using myocardial biopsy, magnetic resonance imaging, multispiral computed tomography, scintigraphy, coronary angiography. We used a course of discrete plasmapheresis. The comparison group included 26 patients with an arrhythmic myocarditis and 19 with DCMP syndrome (EDV 6,6±0,8 cm, EF 32,6±7,3%), which plasmapheresis was not used. Dynamics was assessed at 6 and 12 months.

Results. In groups of patients with arrhythmias and DCMP, a significant decrease in anti-cardiac antibodies titers was observed immediately after plasmapheresis and in control studies (p<0,05). In patients with arrhythmias, a health-promoting effect (a decrease in the number of premature contraction and a frequency of atrial fibrillation ≥75%) was observed in 65% of the main group and 58% of the comparison group. Predictor of plasmapheresis efficiency was a titer of specific antinuclear factor ≥1: 40 (sensitivity — 92,3%, specificity — 71,4%, AUC — 0,813, p<0,05). Methylprednisolone was prescribed to 45% of patients in the main group and 73% to patients in the comparison group (p>0,05) at a dose of 8 [4; 16] and 16 [10; 24] mg per day, respectively, p>0,05. In patients with DCMP in the main group, a significant increase in EF (p<0,05) (up to 41,4±8,2% and 46,3±12,7% vs 39,1±13,7% and 37,2±10,7% in the comparison group) and the distance of 6-minute walking test was obtained. A good effect (increase in EF by 10% or more) was noted in 50% of the main group and 32% of the comparison group. The predictor of plasmapheresis efficacy was systolic pressure in the pulmonary artery ≥28,5 mm Hg. (sensitivity — 100%, specificity — 71,4%, AUC — 0,893, p<0,05). In the main group, methylprednisolone was assigned to 43% of patients, in the comparison group — 89%, p<0,05. The average doses of methylprednisolone in the main group were significantly lower than in the comparison group (8 [8; 17,25] vs 16 [13; 28] mg per day, p<0,05).

Aim. To analyze congestive heart failure management in the clinical practice of the city emergency hospital in order to develop new strategies of improving health care program for patients with chronic heart failure (CHF).

Material and methods. We reviewed 343 cases of hospitalization due to CHF decompensation. 88% of patients had NYHA Class III – IV on admission. The quality of care was assessed according to criteria approved by the Ministry of Health of Russian Federation and the Society of experts in heart failure.

Results.Despite the fact that ECG and chest X-ray were performed in almost 100% of patients, echocardiography was performed only in 64% of cases, and Holter monitoringwas done in only 3%. Standard laboratory tests included determination of serum potassium and sodium concentrations in only 15% and 14% of cases. The levelsof serum lactate dehydrogenase, alkaline phosphatase and γ-glutamyl transpeptidase were estimated in less than 5% of patients. 94% of patients received beta-blockers, 93% angiotensing-converting enzyme inhibitors/angiotensin type II receptor blockers, 74% mineralocorticoid receptor antagonists and 88% diuretics. It should be noted that 48% of patients received parenteral diuretics before discharge from the hospital and were not adapted to receive oral diuretics. Only 13% of patients were evaluated for weight loss. At discharge, NYHA Class III - IV had 38% of patients.

Conclusions. Despite the improvement in the clinical condition of patients during hospitalization, we identified factors that may adversely affect the effectiveness of care for patients with CHF. At the same time frequency of readmissions is determined by the insufficient continuity of outpatient and inpatient care. Therefore, development of the automated system for obtaining, integrating, storing and processing medical information will contribute to the improvement of medical care for patients with CHF.

Aim. To describe the characteristics of patients who were invited in observational, prospective study on a value-based approach to assess the outcomes of treatment of patients with stable coronary artery disease (CAD) by percutaneous coronary intervention (PCI).

Material and methods. We analyzed the baseline characteristics of patients with stable CAD enrolled in a planned PCI with stenting at Almazov National Medical Research Center in 2017. Statistical processing of the results was carried out using Statistica 6.0 (Statsoft Russia) and Microsoft Excel 2017. All registered patients were included in the statistical analysis. Based on the initial clinical characteristics of the patients included in the study, descriptive statistical parameters were calculated. For continuous variables, the mean value and standard deviation were calculated, for the categorical variables — the frequency of characteristic occurrence.

Results. From January 1, 2017 to December 31, 2017, were performed 1740 PCI operations with stenting in 1458 patients aged 63,8±9,6 years (men — 1008 (69,1%)). At the time of admission to the hospital, the body mass index was 29,4±5,2 kg/m2, BP=132,3±15,1/79,6±8,5 mm Hg; HR=69,4±8,3 beats per minute. PCI of one coronary artery was performed in 75,6%, multivascular — in 16,6%, in chronic occlusions — in 4,6% and in bifurcation lesions — in 3,2% of patients, respectively. Type 4a myocardial infarction as a complication of PCI was registered in 2,9% of patients. The average duration of inpatient treatment was 5,5±3,4 days.

Conclusion. Patients with stable CAD who underwent PCI are a representative sample which allows the assessment of treatment outcomes, an objective assessment of the intervention and the calculation of pharmacoeconomic parameters. An observational study will help identifying the factors affecting the efficiency of surgery and getting knowledge of patients’ opinions about this method.

In clinical practice, quite often the practitioner faces difficulties in correcting arterial pressure in patients with arterial hypertension. Patients mostly for various reasons prefer to be treated with generic drugs, sometimes to the detriment of the effectiveness of treatment. The regional study conducted by us clearly showed the presence of additional possibilities of the original drug Prestans (Servier, France) in reducing blood pressure compared to equivalent dosages of generic fixed combinations.

Aim. To assess the effectiveness and safety of therapy with fixed combination of amlodipine/indapamide (Arifam) in outpatients with arterial hypertension (AH) over 55 years old.

Material and methods. We included 2217 patients in the observation — 692 (31%) men and 1521 (69%) women. Changes in the course of 3-month therapy of systolic and diastolic blood pressure (BP), the frequency of achievement of target BP levels (<140/90 mm Hg), responder rate during the clinical and ambulatory blood pressure measurement were evaluated and.

Results. With the use of Arifam fixed combination 89,81% of patients achieved target BP level by the 3rd month of treatment, 73,77% of patients achieved positive response in 2 weeks, 94,88% of patients — after 1 month. According to the selfcontrol data, the target BP level (<135/85 mm Hg) was achieved in 79,47% of patients. The number of patients with pulse BP <60 mm Hg increased after 3 months of treatment to 81,97%. Also 48 (2,17%) patients discontinued participation; 6 (0,28%) patients — due to the development of adverse events.

Conclusion. The ARBALET program has demonstrated high efficacy and tolerance of using Arifam fixed combination in outpatients over 55 years old with hypertension.

Pregnancy is a physiological condition that takes a defined period of time in a woman’s life. For nine months, the mother’s heart works under conditions of daily additional load, which is necessary to ensure placental blood flow. In this regard, structural and functional adaptation of the heart develops in a healthy woman with a normal pregnancy. A pregnant woman with some heart diseases is less likely to adapt. That leads to greater susceptibility to stress resulting in pathological changes of pregnancy. In addition, each pregnancy may develop new heart diseases, which in some cases may be relatively innocent, but in others — fatal. In this regard echocardiography (EchoCG) is a necessary procedure for assessing a woman’s health status that needs before bearing a fetus, during and after pregnancy.

Now diagnostics of a paroxysmal form of atrial fibrillation remains an important problem. The real prevalence of atrial fibrillation can be strongly underestimated, including due to its «silent» character. The existing technologies for atrial fibrillation screening including Holter-monitoring have no high sensitivity, difficult and also cannot be widely used in population. In this regard the special relevance by the mobile medical technologies which are not demanding a visit to the doctor is acquired. In this article the overview of modern technologies of screening disturbances of a heart rhythm by means of registration of the single-channel ECG by the smartphone and its subsequent analysis by means of modern mathematical algorithms is provided.

Aim. Development of a model for calculating of predicted values of key echocardiography (EchoCG) parameters in patients of different ages and staturelweight values.

Material and methods. The study included 10604 apparently healthy patients aged from 1 day to 65 years; 5726 (54%) of them are female. In addition to the general clinical study, all patients underwent EchoCG with the measurement of standard indicators as recommended by the American Society of Echocardiography. We measured body surface area (BSA) and selected a regression model, which most adequately links the values of the EchoCG parameters and staturel-weight values.

Results. All EchoCG parameters showed a significant correlation with BSA. The patients were divided into four groups to receive more homogeneous cohorts. We have identified newborns and adults. A group of children was additionally divided according to BSA, by less than 0,3 m2 and more than 0,3 m2. The calculated regression equations were reliable in both cases — before and after separation. Comparison of dispersion excesses showed a better dependence among the separated groups. The separation also significantly increased the prediction accuracy.

Conclusion. The proposed mathematical models relevantly predict the normal values of variables. The method is well suited for calculating the Z-index of main EchoCG parameters.

The current population is characterized by a high prevalence of risk factors for the development of chronic kidney disease: hypertension, diabetes, obesity, metabolic syndrome, physical inactivity, smoking. The development of severe complications and a close connection with potentially fatal cardiovascular disorders make this disease a socially and economically significant problem. Treatment of chronic kidney disease in advanced stages belong to nephrologist duties. However, the success of preventive interventions depends on the time of their onset, which makes it relevant to identify the disease. The use of nephroprotective approaches by physicians of different specialties (general practitioners, cardiologists, gerontologists, nephrologists, endocrinologists) can significantly improve the prognosis of both those at risk of developing renal dysfunction and the existing disease. The review presents data on the clinical and laboratory efficacy of angiotensin-renin blocker use, as well as the combination of angiotensin II receptor blockers with calcium antagonists. Using the combination of the angiotensin II receptor blocker irbesartan and amlodipine as an example, we demonstrated the possibilities of nephroprotective therapy in patients with renal dysfunction.

The review discusses the issue of the mutual influence of combination of atrial fibrillation (AF) and obstructive sleep apnea (OSA). In individuals with a combination of these pathologies, OSA can influence the easier realization of AF. The presence of respiratory disturbances in sleep reduces the effectiveness of all types of AF treatment (antiarrhythmic, surgical, electrical cardioversion). It is shown, that the treatment of OSA by the method of non-invasive ventilation support (CPAP-therapy) improves the results of catheter treatment of AF in the early postoperative period.

We analyzed the publications about single-photon emission computed tomography in the diagnostics of takotsubo syndrome; the dynamics of testing data are presented on a clinical example. Single-photon emission computed tomography can be used to evaluate perfusion parameters for exclusion of myocardial infarction in uncertain cases. In segments with impaired contractile function, it is possible to detect normal or reduced perfusion. During the acute phase there is a reduced accumulation of radiopharmaceuticals in myocardial segments with impaired function, which coincides with the regional distribution of neuronal activity. Pathological changes may persist for several months, and use of scintigraphy with a radiopharmaceutical may help in cases when the diagnosis was not well-timed established. The method of myocardial scintigraphy in ECG-synchronized tomography allows to simultaneously assess the perfusion and the function of the left ventricle and differentiate such disorder as takotsubo syndrome.

Text is available in electronic version doi:10.15829/1560-4071-2018-12-143-228