Vol 78, No 2 (2023)
- Year: 2023
- Published: 24.05.2023
- Articles: 8
- URL: https://vestnikramn.spr-journal.ru/jour/issue/view/91
- DOI: https://doi.org/10.15690/vramn.782
Full Issue
CARDIOLOGY AND CARDIOVASCULAR SURGERY: CURRENT ISSUES
Association of Calcium Index and Myocardial Blood Flow in Non-Obstructive Atherosclerotic Lesion of the Coronary Arteries
Abstract
Background. Over the past few years, scientific data have demonstrated that patients with non-obstructive coronary artery disease can have high risk for adverse cardiovascular events (ACE) despite the absence of severe coronary obstruction. From this point of view, some patients require special monitoring and treatment; we have to find new methods for stratification of the risk of ACE. Aims — to study the association of coronary artery calcification (CCA) with indicators of myocardial blood flow (MBF) and myocardial flow reserve (MFR) in patients with non-obstructive coronary artery disease (CAD). Methods. The study included patients (n = 52) with non-obstructive CAD (< 50%), identified by CCTA. All patients received dynamic myocardial SPECT according to the two-day “rest-stress” protocol with the radiopharmaceutical agent 99mTc-methoxy-isobutyl-isotnitrile and the pharmacological stress-test (adenosine triphosphate 160 mcg/kg/min) to determine quantitative indicators of MBF and MFR. Depending on the calcium index (CI), three groups of patients were formed: 1 — without CCA (CI = 0 Agatston units), 19 patients; 2 — Mild CCA (CI = 1–100 Agatston units), 21 patients; 3 — Moderate CCA (CI = 101–400 Agatston units), 12 patients. Results. The study included 52 patients (age 55.0 ± 9.8 years, 36 men). The groups differed statistically significantly (p < 0.05) in terms of quantitative scintigraphic parameters: stress-MBF, MFR and ΔMBF. When analyzing the groups in pairs, it was found that stress-MBF and ΔMBF were significantly lower in the group with moderate CCA compared to the group without CCA, and MFR was lower in the group with moderate CCA compared to the groups without CCA and with mild CCA. Correlation analysis revealed significant relationships between CI and scintigraphic parameters: stress-MBF (ρ = –0.46; p = 0.003), MFR (ρ = –0.48; p = 0.001), ΔMBF (ρ = –0.48; p = 0.0008), SSS (ρ = 0.34; p = 0.02) and SDS (ρ = 0.28; p = 0.046). Conclusions. Even with non-obstructive CAD, identified by CCTA, there is a decrease in MBF and MFR inversely proportional to the level of CI, which can be considered as an early marker of impaired vasodilation reserve of the vascular wall, which develops in atherosclerosis of the coronary artery.
85-95
Autoimmune and Autoinflammatory Genesis of Myocarditis and Pericarditis
Abstract
Myocarditis and pericarditis are common pathologies in the general population, which pose significant challenges to practitioners for both diagnosis and treatment due to the unique characteristics of diagnosis verification and lack of clear understanding of the diseases’ pathogenesis. This publication discusses the primary mechanisms of inflammatory diseases’ development of the myocardium and pericardium based on innate and acquired immunity disorders, including data from our research confirming the autoimmune and autoinflammatory nature of these diseases. The paper presents the main clinical manifestations and laboratory markers that enable differential diagnosis between autoimmune and autoinflammatory heart diseases. Additionally, it provides an evidence-based approach to the effectiveness of various anti-inflammatory and immunosuppressive drugs in different types and stages of inflammatory diseases of the myocardium and pericardium.
96-105
Interventional approaches in atrial fibrillation
Abstract
One of the most common heart rhythm disorders today is atrial fibrillation (AF). Worldwide, there are about 33 million people suffering from AF. In Europe, this number is more than 6 million, in Russia — about 2.5 million people. Initially, the main method of treatment was drug therapy. However, with the development of modern technologies, possible mechanisms for the development and maintenance of AF have a crucial importance. In connection with the emergence of new theories, there are also new methods of surgical and/or interventional treatment of AF. The article provides a comprehensive analysis of the current state of interventional treatment of patients with various forms of atrial fibrillation.
106-113
Minimally Invasive Surgery for Septal Defects Inchild: Literature Review
Abstract
Nowadays a minimally invasive approach is a rapidly evolving strategy in particular in the field of congenital heart surgery. The main advantage of minimally invasive approaches is less trauma to a patient which positively effects early postoperative period and recovery after surgery. Own to continuous technological progress and growing experience minimally invasive approaches become widely used in cardiac surgery as well as in treatments of congenital heart defects. This review highlights the main problems and their potential solutions in using minimally invasive approaches in surgical treatment of atrial septal defect, ventricular septal defect, partial atrioventricular canal, partial anomalous pulmonary venous drainage. We describe specific considerations of cardiopulmonary bypass, operative techniques and results of minimally invasive approanes.
114-119
Personalization of Anticoagulant Therapy with Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Chronic Kidney Disease Based on Pharmacogenetic Testing
Abstract
Background. Polymorphic variants of the genes encoding these isoenzymes and carrier proteins involved in the pharmacokinetics of direct oral anticoagulants (DOAC) may alter their function and, therefore, hypothetically may increase the risk of bleeding associated with the use of DOAC. Aims — to study the possible relationship between the presence of polymorphic variants of ABCB1 (rs2032582, rs1045642, rs1128503), CYP3A5 (rs776746) and CYP3A4 (rs35599367) genes on the residual equilibrium concentration (Cmin,ss /D) of apixaban, CYP3A isoenzyme activity and bleeding development in patients with AF and CKD C3–C4 stages. Methods. The study included 142 patients with AF combined with chronic CKD stages C3 and C4, receiving apixaban therapy, aged 58 to 99 years (median age 84 years). Pharmacogenetic, pharmacokinetic testing and assessment of CYP3A isoenzyme group activity were performed. Results. Plasma concentration of apixaban depended on the stage of CKD: a higher level of Cmin,ss /D was observed in patients with CKD stage C4 compared to patients with CKD stage C3a and with CKD stage C3b. When studying the effect of rs1045642 (C3435T) polymorphism of ABCB1 gene on apixaban pharmacokinetics, it was found that carriers of homozygous TT genotype had lower median apixaban concentration in blood compared to carriers of CC and TC genotypes (p = 0.027 and 0.034 respectively). For rs2032582 polymorphism of ABCB1 gene, we recorded that patients with GG genotype had higher Cmin,ss /D level of apixaban compared to GT genotype carriers (p = 0.037). CYP3A metabolic activity was statistically significantly lower (p = 0.036) in the group with a history of bleeding compared with that in patients in the group without a history of bleeding (0.8 (0.5; 1.3) and 1.2 (0.7; 2.1); p = 0.036). CYP3A metabolic activity did not differ between patients with different CYP3A5 (rs776746) and CYP3A4 (rs35599367) polymorphism genotypes. For the rs1045642 polymorphic variant, there were fewer carriers of the heterozygous TC genotype (16 (45.7%) patients) among patients with bleeding during the follow-up period compared to patients with no bleeding (43 (53.1%) patients; p = 0.024). Conclusions. The results of the study indicate the presence of an association between genome-wide changes (polymorphic variants of the ABCB1 (rs1045642) and CYP3A5 (rs776746) gene and the presence of apixaban-associated bleeding in patients with AF and CKD stages 3–4. Mechanisms of such an association require further study.
120-131
Cardiovascular and oncological diseases — focus on modifiable risk factors and modern pathogenetic aspects
Abstract
Currently, in modern medicine, there has been a sharp increase in interest in the combined pathology of cardiovascular diseases (CVD) with other nosologies, such as diabetes mellitus, chronic kidney disease, and oncopathology. Over the past decades, there have been large positive shifts in survival in this cohort of patients. An integral specialty of cardio-oncology is rapidly developing, which is aimed at improving the results of treatment of oncological patients. Due to increased life expectancy and improved long-term prognosis in cancer patients, in particular, the adverse effects of anticancer therapy have attracted great attention from researchers. The causal relationship between cancer and CVD can be partly explained by a common profile of modifiable and non-modifiable risk factors. There is also strong evidence that a systemic inflammatory response is a common pathophysiological determinant of cancer and CVD. General risk factors for development and progression, as well as pathogenetic mechanisms, contribute to high mortality rates. Increasing knowledge of pathophysiological mechanisms will help elucidate the general molecular aspects of carcinogenesis and cardiovascular disease. This review presents general modifiable risk factors and current pathogenetic aspects of cardiovascular and oncological diseases.
132-140
Tissue-Engineered Constructions for the Needs of Cardiovascular Surgery: Possibilities of Personalization and Prospects for Use (Problem Article)
Abstract
In the market for products for the needs of cardiovascular surgery, there is still no effective vascular prosthesis with a diameter of less than 4 mm, despite the continuous increase in the incidence of atherosclerosis and the increase in the number of surgical operations to restore blood flow in the affected arteries. At the same time, vascular tissue engineering has diverse methodological approaches for the development of effective functionally active small-diameter vascular prostheses suitable for adaptive growth and regeneration in situ. An important aspect is the possibility of personalizing the created prostheses not only by taking into account the individual anatomy of the patient’s vascular bed, but also by using autologous components to create such a prosthesis, which can be obtained directly from the recipient. The presented problematic article reflects the main results on the creation of biodegradable vascular prostheses of small diameter, obtained at the Research Institute of the Research institute for complex issues of cardiovascular diseases (Kemerovo). The functionality of the prostheses was provided both through the incorporation of biologically active components with proangiogenic potential for the purpose of complete remodeling in situ, and the formation of cell-populated vascular prostheses using autologous cells and proteins from patients with coronary heart disease. In the future, these vascular prostheses can cover the clinical need for elective and emergency cardiovascular surgery, neuro- and microsurgery, and military field vascular surgery.
141-150
Efficacy of catheter treatment of atrial fibrillation in patients with myocarditis depending on the adrenoreaction of the body (a prospective single-center study)
Abstract
Background. Worldwide, research continues into various factors that may influence the success of catheter treatment of atrial fibrillation. In this regard, the influence of the state of the sympathoadrenal system of the body has not been studied enough. Aims — to evaluate the effectiveness of interventional treatment of atrial fibrillation (AF) in patients with and without myocarditis, depending on the level of beta-adrenergic responsiveness of the organism. Materials and methods. The study sample included 40 patients. Of these, 27 (67.5%) are men. The age in the sample was 49 (44; 55) years. The study included 25 (62.5%) patients with paroxysmal AF, 10 (25.0%) with persistent and 5 (12.5%) with long-term persistent. All patients underwent surgical treatment of AF using radiofrequency (RFA) or cryoablation (CBA). Endomyocardial biopsy was performed in 18 patients to verify the diagnosis. Beta-adrenergic responsiveness (beta-ARM) was assessed in dynamics 3 days after surgery, 3 months and 12 months. The follow-up period for patients was 12 months. Results. All patients underwent surgical treatment of AF, in 7 cases (17.5%) CBA of the pulmonary veins was performed, in 33 (82.5%) cases RFA was performed. According to the biopsy results, signs of myocarditis were detected in 9 patients (22.5%). Focal myocarditis was found in 7 patients, diffuse — in 2. The effectiveness of catheter treatment in general was 72.5%, for CBA — 71.5%, for RFA — 73.5%. Beta-ARM before ablation was 19.16% [12.46; 27.46], 3 days after ablation — 24.43% [15.38; 33.65], after 3 months was 20.27% [9.90; 27.71], in 4 patients after 12 months, beta-ARM was 32.5% [20.0; 43.2]. The dynamics and influence of beta-ARM on the effectiveness of interventional treatment of AF in patients with early and late relapses, the presence of myocarditis was assessed. Conclusions. The results obtained showed no effect of the level of beta-ARM on the effectiveness of RFA and CBA in patients with and without myocarditis. Beta-ARM showed no association with the development of early arrhythmia recurrences after ablation. No statistically significant differences were found when comparing beta-ARM levels in patients with and without diagnosed myocarditis.
151-159