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Russian Journal of Cardiology

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No 3 (2017)
View or download the full issue PDF (Russian)
https://doi.org/10.15829/1560-4071-2017-3

ORIGINAL ARTICLES

6-13 2608
Abstract

Aim. To evaluate the prevalence  of comorbidities in patients  undergoing  coronary bypass grafting (CBG) in two surgery clinics of Russia.

Material and methods. Into retrospective study, done based  upon the charts data of A. N. Bakulev Scientific Center for Cardiovascular Surgery (A. N. Bakulev SCCVS) and  Research  Institute  for  Complex  Issues   of  Cardiovascular  Diseases,  1702 patients  included (1358 males, 344 females) from Bakulev SCCVS and 1159 (895 males,  264  females)  patients  from RICICD, who had  underwent  CBG, including multiple surgeries, during 2014-2015. Comparative analysis was performed  of the prevalence of comorbidity and combination pathology.

Results. The main background pathology in general group of patients was arterial hypertension   (AH) — 2322  (81,2%)  cases. In more  than  a  half  of  cases, in anamnesis there  was myocardial infarction (MI) — 1719 (60,1%), of those  in 250 (8,7%) patients  — with left ventricle aneurysm.  Lower extremities atherosclerosis was found  in 13,8%  cases. Stroke  anamnesis had  5,6%  patients.  Prior carotid endarterectomy (CEE) was found in 30 (1,0%) cases, percutaneous intervention — 190 (6,6%) patients.  The most common comorbidity in general  group was type 2 diabetes — 505 (17,6%) cases. Chronic obstructive pulmonary disease (COPD) was found in 352 (12,3%) patients,  erosions  and  ulceration  of gastro-intestinal tract (GIT) — in 10,6% cases.

Patients  of RICICD were older (62,5±7,8  vs 60,8±8,5  y.o., p=0,003),  had  AH more commonly (83,1 vs 79,8%, p=0,02), as stroke anamnesis (7,2 vs 4,5%, p=0,002), prior MI (66,8 vs 55,5%, p<0,05), prior PCI (12,9 vs 2,4%, p<0,05), COPD (13,8 vs 11,3%, p=0,044), GIT ulceration (15,2 vs 7,5%, p<0,05) in comparison to Bakulev SCCVS. Bakulev SCCVS patients had 1,5 times more prevalently the atherosclerotic lesion of lower extremities  (15,9  vs 10,6%,  p<0,05),  prior CEE was done  3,7 times  more prevalently than in RICICD (1,5 vs 0,4%, p=0,007), more commonly the combination intervention was done: CBG with valvular correction (11,3 vs 6,7%, p<0,05).

Conclusion. The prevalence of comorbidity is determined by the age of patient, as regional specifics of morbidity in population hospitalizing to one or another surgical center. 

14-19 4084
Abstract

Workgroup of the PROFILE registry: Voronina V. P., Dmitrieva N. A., Zakharova A. V., Zagrebelny A. V., Kutishenko N. P., Lerman O. V., Lukina Yu. V., Martsevich S. Yu., Tolpygina S. N.

Aim.  Based   on  the  data   of  outpatient   registry  PROFILE, with  addition  of questionnaires,  to  analyze  treatment  compliance   and  influencing  factors,   in coronary heart disease (CHD) patients.

Material and methods. 688 patients  of the PROFILE registry who had come to a primary visit in scientific department of the investigation center  at time between  1 January 2014 to 31 August 2015, were asked to complete an original compliance to clinician prescriptions (CP) questionnaire with integrated  Morisky-Green test (MG). It was filled by 479 patients  (70,1%).  In 250 of answerers there  was CCHD: 65 women (26%) and 175 men (74%). Mean age of CCHD patients was 63,6±12,5 y.o. 72,1% of them in the PROFILE registry, had higher education, 16 (6,4%) — scientific degree. Diagnosis of CHD was verified as anamnesis of myocardial infarction (MI), coronary arteriography (CAG) or exercise test in 231 (92,4%) participants.

Results. As the patients charts show, 12 patients with CCHD from 250 participants did not receive  any  medication  treatment, 15  took  medications  irregularly, and  other  223 regularly, by CP. This data  is confirmed by the results  of original questionnaires: 193 patients responded that do strictly adhere all CP on medications, and 49 (among 238) — had misused some prescriptions. By the results of 4-unit MG test, only 47 from 230 of responders were completely adherent to the treatment, and other 71 made at least one positive response, being relatively adherent. In multifactorial logistic regression, it was found that stable angina and scientific degree do increase adherence 3 times (р=0,006; OR 2,9; CI 95% [1,4;6,0]) and more than 6 times, respectively (р=0,003; OR=6,3; CI 95% [1,9;21,0]).  Also, it was shown that treatment adherence (by our original questionnaire) depends on the regularity of clinician follow-up, and office visits once per year and more do increase it more than 5 times (р=0,019, OR=5,1 CI 95% [1,3;19,9]).

Conclusion. Clinical symptoms of CHD (stable angina), scientific degree, as well as regular clinician follow-up at least once per year, are the factors increasing  overall patients adherence to CP and medication treatment compliance.

20-24 2980
Abstract

Aim. To evaluate the level of superoxide dismutase (SOD) in coronary heart disease (CHD) patients underwent coronary bypass  (CBG), and to estimate  its importance in development of post-surgery atrial fibrillation (PSAF).

Material and methods. Totally, 96 patients studied,  with CHD, admitted for CBG. Patients were selected to 2 groups: 1 group — non-PSAF (67 patients, 80,6% males, mean age 57,9±7,3  y.o.), 2 group — with first time AF in early period of CBG (29 patients,  86% males, mean age 64,0±8,4 y.o.).

Results. During study period PSAF developed  in 30,2% cases, mean on 4,9±3,8 day after surgery.  Comparing  with group  1, level of SOD was higher in group  2 patients (2589,8±1999,3 U/g vs 1572,8±1275,2 U/g, р=0,034). Patients of group 2 were  older  4 years  in average  (64,0±8,4  vs 57,9±7,3  y., р=0,048),  had  longer duration of cardiovascular pathology (86,9±76,1 months vs 44,3±38,4 m., р=0,002). Patients with PSAF had III functional class of angina (72,4% vs 47,8%, р=0,028) and III functional class of congestive  heart failure (38,0% vs 7,5%, р=0,006), they had larger left atrium (43,5±4,1 mm vs 37,9±3,4 mm, р<0,001).

After multifactorial analysis, predictive value remained  for the following: left atrium larger than 41 mm — 5,1 (95% CI, 2,1-9,8, р=0,0005), SOD more than 2948 U/g — 4,4 (95% CI, 1,1-8,9, р=0,04).

Conclusion. The study  showed  that  CBG operation  is followed by activation of oxidation stress which is followed by the decrease of SOD concentration, probably due to its consumption.  However, among patients with PSAF there is higher activity of this enzyme.

25-29 3814
Abstract

Aim. To evaluate  the  results  of the  program  for management of ischemic  heart disease registry in Altaisky kray in 2011-2015 y.

Material and methods. The system was developed and implemented in 2011 as a pilot project,  with software named  “Monitoring + [Registry of CIHD]”. The project was planned  as  retro-,  prospective  observational  cohort  study.  The registry was primarily tested on  the  bases of Regional  Clinical Hospital and  Altai Regional Cardiological Dispensary.  From the beginning of 2014, other 28 institutions were involved into  the  registry.  The  work is  being  done  continuously,  with patients admission and investigation if fulfill the registry criteria. For statistics the descriptory methods  were applied.

Results  and  discussion. From 2011  to 2015,  the  data  of 12886  patients  was entered to the registry, with the diagnosis  “ischemic heart disease”. Mean age — 65,1±9,9  y.o. Region capital citizens were 35,5% of the registry, and inhabitants of the  Region — 64,5%.  Two thirds were males.  By the  anamnesis data,  there  was significantly more  persons after  myocardial  infarction  — 7094  (p<0,01).  Hightechnology care under “Cardiovascular surgery” unit was provided to 6115 (47,4%) patients.  Medication treatment was done according  to guidelines and standards for ischemic heart  disease patients  management. With the implementation  of registry, availability of cardiovascular care for rural inhabitants improved: three times increased the volumes of outpatient stage high-technology care, and cardiosurgery increased 1,8 times. The decrease of cardiovascular mortality during last 5 years reached 18,6%.

Conclusion. A  universal  approach has  been  formulated  for a  unified base  of patients  suffering  from ischemic  heart  disease, that  makes  it to  follow-up the epidemiological situation in districts of Region by disease, to find out the risk factors and correct them. With the Registry of CIHD, it is possible to analyze the performance of cardiological care, to influence on its qualitative and quantitative parameters. The necessity  is shown, for the development  of this monitoring system in all treatmentprevention  institutions of the Region for equality in specialized  care  accessibility, including high-technology care.

30-36 1636
Abstract

Aim. To assess the level of galectin-3  in blood serum  of patients  with metabolic syndrome  (MS), including comorbidity  with coronary  heart  disease (CHD), for evaluation of its significance as fibrosis marker in MS.

Material and methods. Totally, 43 MS patients  studied  with CHD signs, and 33 patients  non-MS of comparable age,  of those  CHD was diagnosed in 17. Mean age in MS group was 62,7±10,3 y.o. at baseline,  in controls (non-MS) — 60±14,7 y.o.  Galectin-3  level was  measured  via immune-enzyme   assay   on  “Platinum ELISA”.

Results. Mean level of galectin-3 in MS group was significantly higher and reached 1,89±1,71  ng/mL, comparing  to non-MS  group  — 1,03±0,22  ng/mL (р=0,006). There were positive correlations  of galectin-3  and CHD functional class  by NYHA (r=0,346, р=0,012): in absence of CHD signs galectin-3 level was 1,05±0,26 ng/mL; in CHD of 1 functional class  (FC) — 1,06±0,18  ng/mL; 2 FC — 1,7±1,59  ng/mL; 3 FC — 2,15±1,85 ng/mL.

Conclusion. The level of fibrosis marker galectin-3 are higher in MS patients than in non-MS, and in MS+CHD is higher than in those without this pathology. Finding of high level of galectin-3  in MS and CHD patients  might witness on the severity of myocardial fibrosis, supporting prognosis. 

 

37-45 8708
Abstract

Aim. Evaluation of the prevalence of the right ventricle diastolic dysfunction (RVDD) in coronary heart disease patients (CHD), and factors associated with its diagnostics. material and methods. Totally, 691 CHD patient included (412 males) at the age 36-85  y.o. (mean  age  61,0 y.o.). Patients  were selected to 2 groups:  with saved diastolic RV function (n=478) and with RVDD (n=199). All participants  underwent echocardiography with diastolic function assessment of the left ventricle (LV) and RV in impulse-wave dopplerometry  of atrioventricular flows, spectral  tissue Doppler of the mitral and tricuspid anuli, and color-M-modal scan.

Results. The prevalence  of diastolic dysfunction of RV in CHD patients  was 29%. Most significant was the decline of velocity of tricuspid flow in group 2, being 22% lower than group 1 (p<0,0001). From the diastolic part of spectrum of tricuspid annulus there was significant decrease of the velocity of its early diastolic motion еt in RVDD t patients by 16% (Z=4,5; p<0,0001). Relation е’t /а’t  significantly decreased in group 2 (p=0,001). Relation Еt /е’t increased significantly only in group 2, by 14% (p=0,001). The  independent factors  associated with RVDD were  age  (p=0,02),  diabetes (p=0,021), clinical picture of angina III functional class (p=0,00011), decrease of LV ejection fraction (p<0,0001)  and diastolic dysfunction of LV (LVDD)  (p<0,0001  and p=0,0069 with different parameters).

Conclusion. RVDD was found in 29% CHD patients,  investigated  outpatient.  With RVDD there was association of age, diabetes, angina III class, decreased LV ejection fraction and LVDD. In RVDD assessment it is purposeful to apply complex approach with the parameters of intraventricular currents.

46-53 3765
Abstract

Aim. Younger age of the cardiac patients somehow necessitates the use of modern forms  of physical  training,  which become alternative  and  interesting  means  to provide effective rehabilitation. One such form is endurance Indoor Cycling training. In the present study attempts to determine  the impact of 1-month Indoor Cycling training on  hemodynamic  left ventricle parameters of men  with ischemic  heart disease or after myocardial infarction were made.

Material and methods. The study group consisted of 50 men under the model A of the 2nd phase  of cardiac rehabilitation (20 men of the Indoor Cycling group, IC, 20 men  rehabilitated  accordingly  to  the  recommendations  of  the  Polish  Cardiac Society — a standard group, ST and 10 people who did not participate in any cardiac rehabilitation program  — a control group, C). The average  age of all patients  was 56,60±8,25  years, the average left ventricular ejection fraction was 56%±4,00.

Results. Echocardiogram   did  not  show  significant  changes after  1-month  of training in both groups undergoing comprehensive cardiac rehabilitation. Paralleled to the preliminary study in the group of patients  who refused  to participate  in the cardiac   rehabilitation,   results   showed   a  reduction   in  all  echocardiographic parameters, including a significant decrease in the  left ventricular end  diastolic diameter (52,80 vs 50,50 mm) and volume (134,85 vs 121,88 ml; both variables at p<0,001),  as well as in the left ventricular mass (239,46 vs 208,61 g; p=0,002) and the left ventricular mass index (123,52 vs 107,61 g/m2; p=0,001).

Conclusion. No negative influence of the Indoor Cycling training on morphological parameters of the left ventricle was observed. Indoor Cycling training in the second phase  of cardiac  rehabilitation  in patients  with ischemic  heart  disease or after myocardial infarction is a safe form of therapy and therefore  may be an interesting alternative method to the classic bicycle ergometer exercise in the stage of an early cardiac rehabilitation.

54-58 2255
Abstract

Aim. To study  prognostical  significance  of vasomotor  disorder  of coronary  and brachial  arteries,   and  traditional  risk factors  in development   of  cardiovascular complications in patients with microvascular angina (MVA) and cardial syndrome X; a retrospective 12-year observation.

Material and methods. Totally, 41 patient included, with MVA (40 females/1 male), mean  age  at the moment  of inclusion 43±4,1  y.o., 15% smokers).  Endotheliumdependent vasodilation (EDV) of coronary arteries  was assessed via intracoronary acetylcholine load, EDV of brachial artery — via high-resolution ultrasound in active hyperemia test.

Results. It was found that in brachial EDV <4,7% group the risk of cardiovascular complications  (p<0,05)  is higher for 9-18  years  of observation.  Baseline  EDV of coronary arteries in the study did not influence survival rate in MVA patients.

Conclusion. Significant influence on cardiovascular  events occurring in long-term follow-up of MVA  patients,  had  the  risk factors  as  smoking  and  brachial  artery endothelial dysfunction.

59-62 2205
Abstract

Aim. To evaluate the efficacy of action of the calcium sensitizer levosimendan (LS) in patients with various grade of heart failure (HF) severity before cardiosurgery.

Material and methods. LS was applied as a part of HF treatment while preparing patients for surgery in 2-4 days. Performed dose was 0,025 — 0,1 µg/kg/min. The drug was not administered  in bolus. Preoperation group of participants  included 108 patients (62% — men, 38% — women, aged 20 — 72 years (53±13)) with CHF III-IV  FC by NYHA,  with ejection  fraction  of the  left ventricle  (LVEF)  about  in average  27±8%.Mean  level of natriuretic  B-type  peptide  was  1129  (Me 854, Q25 396, Q75 1419) pg/mL. Main etiology of chronic HF in participants  was dilation  cardiomyopathy:  noncoronary  cardiomyopathy  in 30 patients  (27,7%), ischemic cardiomyopathy  (ischemic  heart  disease, postinfarction  cardiosclerosis) in 72 patients (66,7%) and acquired valve defects  in 6 patients (5,6%). For assessment of efficacy of the drug in various grade  of HF severity, patients  were selected to subgroups according  to the level of LVEF decrease (less 20%, 21-30%, 31-40%, more 40%), and pulmonary artery pressure (PAWP) (less 40 mmHg, 40-70 mmHg, more 70 mmHg).

Results. Infusion of the drug led to statistically significant increase of LVEF comparing to the baseline (57%), decrease of PAWP (64%) and BNP concentration in 77% cases. Conclusion. The LS is an effective medication which can be applied with the aims to prepare HF patients to cardiosurgical operations. Most sensitive parameters of LS efficacy are PAWP, LVEF and BNP concentration. The highest efficacy of the drug was observed  in subgroup  with EF ≤40%, PAWP ≥40 mmHg and BNP ≥600 pg/mL. LS, applied in HF patients  before  cardiosurgery, can  be  used  for assessment of reserves  of myocardial capacity.

OPINION ON THE ISSUE

63-71 3819
Abstract

A problem of synonymy and synonyms legitimation is of big importance in practice, as multiple classifications lead to problems of organization and provision of medical care, and incorrect statistics. The article is a consensus of experts on the issue of agreement/implementation of clinical classifying of synonyms of terms listed in ICD-10, agreement on the modern clinical and morphological terms.

72-76 4052
Abstract

Ischemic heart  disease impacts  greatly the morbidity and mortality of population. The  article  focuses   on  the  specifics  of  diagnostics   and  treatment of  chronic coronary heart disease in patients of older age. Management of this kind of patients is complicated  with comorbidity, cognition decline, increased risk of side effects, reduced range of treatment options.

GUIDELINES FOR THE PRACTITIONER

77-84 2303
Abstract

Aim. To assess the  condition  of cerebral  circulation and  cognitive functions  in patients  with coronary  heart  disease (CHD), underwent  coronary  bypass  (CBG) operation  under on-pump  conditions and to evaluate the influence of citicoline on the higher brain functions at earlier and delayed periods post-surgery.

Material and methods. In the Federal center  of cardiosurgery  (Krasnoyarsk city) 66 patients studied, with diagnosis CHD. Patients selected to 2 groups. Main group (n=36) as  a medium  for cerebral  neuroprotection we used  citicoline (Ceraxon): intravenous, 1 day before surgery, 1000 mg on 200 mL of saline, and then for 7 days after  surgery,  with further  intake  of  the  drug  900  mg/daily  for  2  months.  In comparison  group (n=30) there was no neuroprotection in peri-operation period. Results. By the 12th month after surgery, cognition returned  to baseline values. In controls,  by 12 months after CBG, cognition returned  to baseline  only by the test “visual memory” of 5 words (direct remembering).

Conclusion. Neuroprotection by citicoline might be a method  for improvement of cognition  in patients  after  such  damaging  events  as  on-pump  operation,   and therefore make it to reach higher level of daily functioning of post-CBG patients.

85-90 4342
Abstract

Aim. To evaluate an additional antihypertension  efficacy and tolerability of perindopril comparing to sartans in real clinical practice.

Material and methods. The study had been designed, that included 208 patients. Main inculsion  criteria  was  arterial  hypertension   (AH) with insufficient  blood pressure (BP) control  on  treatment by angiotensine receptor  blocker  (ARB) as monotherapy, with 1 or 2 risk factors by SCORE system and on treatment by a free ARB combination with other drugs classes. In inclusion to program, instead of ARB perindopril (Prestarium  A) 10 mg was added  or its disperging  form 10 mg in the morning. Duration of program lasted  for 3 months.  The evaluation of BP decrease was done, as the target BP levels reach and treatment response.

Results. On treatment with perindopril, in 2 weeks there was statistically significant (p<0,05)  decrease of BP, and  this positive dynamics  remained  for all follow-up period. Target BP was reached in 42,4% patients. Assessment of efficacy criteria of SARA program  revealed  in all participants  BP decrease from baseline  level, with median of systolic BP decrease as 30 [25;42] mmHg, diastolic — 20 [10;20] mmHg. Target BP was reached in 42,4%.

Conclusion. Transition from non-effective  former sartans treatment to perindopril makes for successful BP control with high treatment tolerance. Such approach can be recommended for patient’s management in real clinical practice.

91-96 2083
Abstract

Aim. To assess the  dynamics  of heart  rate  variability (HRV) parameters under treatment by ivabradine in patients with stable angina after coronary bypass surgery (CBG) with test of fixed respiration tempo (FRT).

Material and methods. Totally, 26 males studied, with stable angina II-III functional class, after CBG, using hardware-software complexes.

Results. The FRT test  in postCBG patients  under  ivabradine  treatment reveals 2 main types of reaction: 1 — positive stable increase of HRV parameters during the test,  2 — U-shaped  pattern  of parameters’ dynamics: decrease in 6-second test, and increase further in 12-second test.

Conclusion. The FRT test has practical value, making physician, by the parameters as SDNN or mean rhythmogram  variation, to derive conclusions  on the adequacy of rehabilitation of patients and to correct the dosage of medication.

97-103 1109
Abstract

Aim. Under the framework of KVAZAR study, to assess antianginal and antiischemic effects of nicorandil therapy with exercise test on treadmill in chronic coronary heart disease patients (CCHD) with stable angina.

Material and methods. Randomized, double blind, placebo-control study, conducted in 2 parallel groups,  multicenter. Totally, 120 patients included, all were taking metoprolol tartrat 50 mg b.i.d. After randomization, main group was added nicorandil 10 mg b.i.d., in 2 weeks the dosage was increased to 20 mg b.i.d., control took placebo.  Duration of the  study  6 weeks.  For the  evaluation  of efficacy of nicorandil therapy 10-20 mg b.i.d., exercise  test was used,  done at randomization visit (V0) and in 6 weeks (V6).

Results. Intake of nicorandil, in 6 weeks was followed by a significant increase of the time before  the onset  of angina (p<0,0001),  time to ST depression appearance for 1 mm (p<0,005)  and time for angina attack of moderate severity development  (p<0,005).  In placebo  group,  only the  angina  onset  tolerance  parameter improved  (p<0,01),  but duration of exercise test and time for ST depression 1 mm did not change significantly. In the subgroup  of patients  having ischemic  ECG changes during exercise  test,  it was showed significant increase of these  changes in nicorandil vs placebo  (p<0,05); which confirms the anti-ischemic action of nicorandil during the day in double dosing regimen.

Conclusion. Nicorandil did statistically  significantly improve  the  parameters of exercise  tolerance  in CCHD patients  with stable  angina.  The results  of the study make it to conclude  on the additional and clinically significant impact of the drug 10-20 mg b.i.d. as an effective antianginal medication of  second-line therapy for treatment of patients with CCHD with stable angina.

CLINICAL MEDICINE NEWS

CLINICAL GUIDELINES

 
105-139 2126
Abstract

The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC).

SUPPORTING A PRACTITIONER

140-144 1667
Abstract

Acute  coronary  syndrome  (ACS) during  the  time  after  diagnosis  of oncologic disease, develops in 1,9-4,2% patients,  and not seldom in intact coronary arteries. In ACS morbidity structure  there is mostly non-ST elevation ACS (>85%). Specific factors for its development  are thrombocytopenia, incl. the one caused by chemotherapy, and radiotherapy. Patients with active oncologic process have higher risk of death during ACS treatment than patients already “cured”. Tactics of ACS in oncology remains outside current guidelines; as such patients were not included in randomized trials. Still, some studies showed efficacy of acetylsalicylic acid, double antiplatelet  therapy,  percutaneous  interventions.  However,  hemostasis  system shifts,  cardiotoxicity of chemotherapeutic agents,  radiotherapy   risks  make  the multidisciplinary approach necessary in management of ACS in this sort of patients.

145-154 3731
Abstract

High efficacy of contemporary chemical and radiation treatments made it to success in treatment of oncohematological diseases. The fundamentals of many schemes of polychemotherapy of the first line are anthracyclines. Effective treatment of the main disease in many cases is followed by a variety of cardiovascular  complications, including severe ones and fatal. It is necessary to consider the possibility not only for development  of acute cardiotoxicity, but various complications from cardiovascular system  after cessation of antitumor treatment. Algorithm of patients  preparing  for such treatment must include cardiovascular  assessment before the start of drugs, and follow-up during the treatment course. Prevention and treatment of cardiotoxicity are complicated clinical issues due to irreversible and progressing character of most disorders  of cardiovascular  system.  An important issue  is a close collaboration of cardiologist and oncologist in patient’s management. It is necessary to have longterm  dynamic  follow-up of  patients   after  chemotherapy  for  maximally early diagnostics   of cardiovascular   complications  in long-term  period  after  finishing of antitumor treatment.

REVIEW

155-159 2685
Abstract

The article focuses  on the review of the main parameters defining the standard and quality of life (LQ). An argument  for importance  provided  of LQ assessment in patients with ischemic heart disease as a task of medical and social significance. A conclusion  in  done,   that  LQ can  be  treated   as  quite  reliable  parameter  for assessment of patients condition with coronary heart disease, which can be applied for objectivity increase in clinical condition evaluation. Also, it is possible,  having revealed medical and social specifics of patients, to influence them and improve LQ.

160-164 2234
Abstract

While using the highly sensitive tests  of troponins (hs-CTn), increased levels above the  lower limit can  be  found  in most  of patients,   and  levels  more  than  99th percentile  — in about  10-15%  patients  with stable  angina.  The grade  of hs-cTn increase correlates with severity of coronary lesion and level of myocardial ischemia. Elevated  levels  of  hs-cTn  are  associated  with increased  risk  of  general   and cardiovascular mortality, as hospitalizations due to chronic heart failure.



ISSN 1560-4071 (Print)
ISSN 2618-7620 (Online)