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WOS: 000474853700006, PubMed: 31002038, Decreased heart rate variability (HRV) is associated with increased mortality risk in various diseases. The objective of this investigation: to study HRV in patients with sickle cell anemia (SCA) and to assess the effect of pulmonary arterial hypertension (PAH) on HRV in these patients. Materials and methods. HRV registration and Doppler echocardiographic assessment of systolic pulmonary arterial pressure (PAP) was carried out in 61 stable patients with SCA and 24 healthy subjects. Results. Low frequency power (LFP) and high frequency power (HFP) were decreased in SCA patients compared to healthy subjects. Among SCA patients, PAH patients had lower LFP and HFP than patients without PAH. In SCA patients, systolic PAP showed significant negative correlation with LFP and HFP. Conclusion. HRV is significantly decreased in SCA patients, especially in those with PAH. HRV may be particularly useful in early detection of PAH patients who may have worse prognosis and higher mortality risk.

Resistance to acetylsalicylic acid (ASA) in patients with coronary artery disease is a poor predictor for the development of atherothrombotic complications. In 277 patients with coronary artery disease suffered uncomplicated coronary angioplasty with stent implantation, we was estimated arachidon-induced platelet aggregation during treatment with acetylsalicylic acid by bedside VerifyNow Assay test at 28-90 days after the intervention. It was found that 18.9% of the 144 patients receiving a combination of ASA 75 mg with 15.2 mg of magnesium hydroxide had true (laboratory) resistance to ASA. At the same time on the original enteric coated ASA 100 mg, we can found only 0.8% resistance to ASA among 129 patients. We made switch from combination of ASA 75 mg with 15.2 mg of magnesium hydroxide to original enteric coated ASA 100 mg and repeat VerifyNow Assay test at 2-4 days and found lost of resistance in 92% of 28 patients. Thus, resistance to the ASA is not constant, it depends on the form and the applied dose of ASA, and eliminating more than 92% when ASA changes from ineffective to effective form.

The polymorphic markers Ala455Val of the THBD gene and Arg353Gln of the F7 gene were tested for association with the frequency of unfavorable outcomes in patients with a history of acute ischemic heart disease. The study involved 1145 patients hospitalized in cardiology clinics of Moscow, St. Petersburg, Kazan, Chelyabinsk, Perm, Stavropol, and Rostov-on-Don because of acute ischemic heart disease. The patients were followed up for up to 62.5 months. None of the markers displayed a significant association with the time to an endpoint. The patients were then grouped by sex. In females, the frequency of unfavorable outcomes (fatal or nonfatal myocardial infarction and fatal or nonfatal stroke) was higher in carriers of allele Val of the Ala344Val polymorphic marker of the THBD gene and carriers of genotype Arg/Arg of the Arg353Gln polymorphic marker of the F7 gene, but the difference was not statistically significant. Such an increase in frequency was not observed in males. To study the combined effect of the polymorphic markers of the THBD and F7 genes, the course of ischemic heart disease was compared for two female subgroups. One included carriers of allele Val of the Ala344Val polymorphic marker of the THBD gene and genotype Arg/Arg of the Arg353Gln polymorphic marker of the F7 gene; the other subgroup included carriers of genotype Ala/Ala of the Ala455Val polymorphic marker of the THBD gene and allele Gln of the Arg353Gln polymorphic marker of the F7 gene. The frequency of unfavorable outcomes in the first subgroup was higher than in the second one. The time to an endpoin was 40.5 months (95% confidence interval (CI) 33.5–47.6) in the first subgroup and 51.6 months (95% CI 45.0–58.1) in the second subgroup (χ2 = 4.15, P = 0.042). The results made it possible to assume that the F7 and THBD genes play an important role in genetic predisposition to unfavorable outcomes in patients with a history of acute ischemic heart disease.

Association between the rates of poor outcomes in the patient cohort with acute coronary syndrome and polymorphisms G(−174)C in the IL6 gene and G(−1082)A in the IL10 gene were determined. In total, 1145 patients hospitalized for coronary artery disease to cardiological hospitals of Moscow, St. Petersburg, Kazan, Chelyabinsk, Perm, Stavropol, and Rostov-on-Don were examined. The mean observation period was 9.10 ± 5.03 months (maximal, 18 months). Analysis of the survival of the patients with acute coronary syndrome that carried allele A has demonstrated that the presence of IL10 gene polymorphism G(−1082)A is associated with more frequent poor outcomes as compared with GG genotype. The survival time to endpoint for the carriers of GA and AA genotypes was 11.68 ± 0.67 months versus 12.69 ± 0.65 months for the carriers of GG genotype in IL10 gene (χ2 = 4.13, p = 0.042). As for the IL6 gene polymorphism G(−174)C, survival rate analysis did not detect any significant association with the risk for poor outcome. However, joint analysis of these polymorphisms in both genes has demonstrated that characteristic of the patients with acute coronary syndrome that carry GG genotype of IL6 gene and GA and AA genotypes of IL10 is a higher rate of poor outcomes (time to endpoint, 11.01 ± 1.24 months) as compared with the carriers of IL6 gene CC and CG genotypes and IL10 gene GG genotype (time to endpoint, 13.28 ± 0.83 months (ξ2 = 10.23, p = 0.017). These data suggest that the genes IL6 and IL10, whose products are involved in the control of inflammatory response, play an important role by increasing the probability of poor outcomes in the patients with acute coronary syndrome.

Associations of polymorphisms of genes FGB G(−455)A and PROC C(−1654)T with the frequency of poor outcomes in patients with the history of acute coronary syndrome (ACS) were studied in the Russian population. A total of 1145 patients admitted to cardiological hospitals of Moscow, St. Petersburg, Kazan, Chelyabinsk, Perm, Stavropol, and Rostov-on-Don with ischemic heart disease exacerbation were examined. The mean follow-up time was 1.14 ± 0.33 years, and the maximum follow-up time was 3.2 years. The risk of poor outcome did not depend on the carriership of genotypes of the polymorphic G(−455)A marker in the FGB gene. However, the PROC C(−1654)T polymorphism patients with ACS history and allele T of the PROC gene had a poor outcome more often than patients homozygous for allele C. The survival time to the endpoint for carriers of the TT and CT genotypes of the PROC gene was 2.19 ± 0.18 years vs. 2.46 ± 0.16 years for carriers of the CC genotype. On the base of these results it is suggested that hemostasis-related genes play an important role in early failures in patients with ACS history.

Между хронической сердечной недостаточностью ХСН и артериальной гипертензией АГ существуют сложные взаимосвязи, которые имеют важное клиническое значение. Во-первых, как ХСН, так и АГ часто встречаются у одних и тех же категорий больных. В большинстве случаев основной причиной ХСН служит ИБС, которая встречается в анамнезе более чем у 70-80% больных с ХСН. Однако в анамнезе 60-90% больных ИБС имеются указания на АГ. АГ нередко предшествует развитию ХСН у больных с ревматическими пороками сердца. Кроме того, в 5-15% случаев АГ является единственной возможной причиной ХСН. В настоящее время различают два основных типа ХСН, в основе которых лежит дисфункция миокарда ЛЖ - ХСН, обусловленная систолической дисфункцией ЛЖ, и ХСН с сохраненной систолической функцией ЛЖ. Существование двух типов ХСН, дифференцировать которые можно лишь после эхокардиографического исследования и определения фракции выброса ЛЖ, следует учитывать при выборе b-адреноблокатора для длительной терапии АГ у больных с ХСН. Для лечения АГ у больных с ХСН, обусловленной систолической дисфункцией ЛЖ, можно использовать лишь один из пяти b-адреноблокаторов, эффективность и безопасность которых установлена в крупных рандомизированных исследованиях. При ХСН у больных с сохраненной систолической функцией ЛЖ выбор b-адреноблокаторов для лечения АГ значительно шире; тем не менее следует по возможности отдавать предпочтение липофильным b-адреноблокаторам без ВСА, кардиопротективная эффективность которых установлена в контролируемых исследованиях у больных, перенесших инфаркт миокарда.

Treatment of in-stent restenosis (ISR) with conventional percutaneous transluminal coronary angioplasty (PTCA) causes significant recurrent neointimal tissue growth in 30-85%. Therefore, laser ablation of intrastent neointimal hyperplasia before balloon dilation can be an attractive alternative. However, the long-term outcomes of such treatment have not been studied thoroughly enough. This prospective case-control study evaluated angiographic and clinical outcomes of PTCA alone and a combination of excimer laser coronary angioplasty (ELCA) and adjunct PTCA in 125 patients with ISR. ELCA was performed before balloon dilation in 67 patients, PTCA alone was performed in 58 patients. Basic demographic and clinical data were comparable in both groups. Lesions included in ELCA group were longer (17.1 ±9.9 vs 13.6 ±9.1 mm; p=0.034), more complex (36.5% type C stenoses vs 14.3%; p=0.006), and more frequently had reduced distal blood flow (TIMI

Aim To study signs of diabetic cardiomyopathy (DCM) in nondiabetic patients with controlled arterial hypertension (AH) and glycemic response during first hour of glucose tolerance test (GTT). Material and methods Patients (n = 47) with controlled AH were divided into 2 groups according to results of GTT with 75 g of glucose: patients of group 1 (n = 22) had glucose level ≤ 200 mg/dl during 1-st hour of GTT; other patients (n = 25) composed group 2. Examination of all patients included transthoracic echocardiography, ultrasound Dopplerography, tissue Doppler (TD) and 24-hour Holter ECG monitoring. Using data of these methods we calculated left ventricular (LV) mass and the following characteristics of mitral ring: E/A, TD e', TD a', TD s', TD e'/a'/. The following characteristics of heart rate variability were obtained: standard deviation of normal RR intervals (SDNN), low and high frequency (LF, HF) power, LF/HF ratio. Results Patients of group 2 had higher LV mass (229.5 ± 58.2 vs. 192.1 ± 50.6 g; p = 0.036), more pronounced changes of TD e'/a' (0.71 ± 0.25 vs. 1.06 ± 0.58; p = 0.011), lower SDNN both during day (85.4 ± 14.1 vs. 112.5 ± 31.3 ms, p = 0.007) and night (82.2 ± 22.1 vs. 105.9 ± 28.5 ms, p = 0,004) time, higher nocturnal LF/HF ratio (3.75 ± 4.02 vs. 1.72 ± 0.81, p = 0,029). Conclusion In patients with controlled arterial hypertension (AH) and glycemic response during first hour of GCT we revealed various pronounced manifestations of DCM. These data constitute a basis for further studies.

Treatment of in-stent restenosis (ISR) with conventional PTCA causes significant recurrent neointimal tissue growth in 30-85% of the cases. Therefore, laser ablation of intra-stent neointimal hyperplasia prior to balloon dilatation can be an attractive alternative. However, the long-term outcomes of such treatment have not been studied thoroughly enough. This prospective case-control study evaluated angiographic and clinical outcomes of PTCA alone and a combination of excimer laser coronary angioplasty (ELCA) and adjunct PTCA in 125 patients with ISR. ELCA was performed prior to balloon dilatation in 67 patients, PTCA alone was performed in 58 patients. Basic demographic and clinical data were comparable in both groups. Lesions included in ELCA group were longer (17.1±9.9 mm versus 13.6±9.1 mm; p=0.034), more complex (36.5% type-C stenoses versus 14.3%; p=0.006) and more frequently had reduced distal blood flow (TIMI < 3: 18.9% versus 4.8%; p=0.025) compared to lesions in PTCA group. Immediate angiographic results of PTCA and ELCA+PTCA appeared to be comparable. PTCA alone was successful in 57 patients (98.3%), ELCA+PTCA - in 66 patients (98.5%). The rates of hospital complications were comparable (3.0% in ELCA group versus 8.6% in PTCA group). The 1 year-follow-up showed that the rates of MACE were comparable in the two groups (37.3% in ELCA group versus 46.6% in PTCA group). The rates of TVR within 1 year after the intervention were also similar in ELCA and PTCA groups (32.8% versus 34.5%). The data mean that ELCA in patients with complex ISR is efficient and safe. Despite a higher complexity of lesions in ELCA group, no increase in the rate of complications was registered.

In-stent restenosis (ISR), when treated with balloon angioplasty (PTCA) alone, has an angiographic recurrence rate of 30-85%. Ablating the hypertrophic neointimal tissue prior to PTCA is an attractive alternative, however late outcomes of such treatment have not been fully determined. This multicenter case control study assessed angiographic and clinical outcomes of 137 consecutive procedures in 125 patients treated for ISR with either PTCA alone (n=58) or excimer laser assisted coronary angioplasty (ELCA, n=67). Demographics were similar. Lesions selected for ELCA compared with those selected for \PTCA were longer (17.1+/-9.9 mm vs. 13.6+/-9.1 mm; p=0,034), more complex (ACC/AHA type C: 36,5% vs. 14,3%; p=0,006), and with reduced antegrade flow (TIMI flow

Background Beta-blockers, used as an adjunctive to diuretics, digoxin and angiotensin converting enzyme inhibitors, improve survival in chronic heart failure. We report a prospectively planned economic analysis of the cost of adjunctive beta-blocker therapy in the second Cardiac Insufficiency BIsoprolol Study (CIBIS II). Methods Resource utilization data (drug therapy, number of hospital admissions, length of hospital stay, ward type) were collected prospectively in all patients in CIBIS . These data were used to determine the additional direct costs incurred, and savings made, with bisoprolol therapy. As well as the cost of the drug, additional costs related to bisoprolol therapy were added to cover the supervision of treatment initiation and titration (four outpatient clinic/office visits). Per them (hospital bed day) costings were carried out for France, Germany and the U.K. Diagnosis related group costings were performed for France and the U.K. Our analyses took the perspective of a third party payer in France and Germany and the National Health Service in the U.K. Results Overall, fewer patients were hospitalized in the bisoprolol group, there were fewer hospital admissions perpatient hospitalized, fewer hospital admissions overall, fewer days spent in hospital and fewer days spent in the most expensive type of ward. As a consequence the cost of care in the bisoprolol group was 5-10% less in all three countries, in the per them analysis, even taking into account the cost of bisoprolol and the extra initiation/up-titration visits. The cost per patient treated in the placebo and bisoprolol groups was FF35 009 vs FF31 762 in France, DM11 563 vs DM10 784 in Germany and pound 4987 vs pound 4722 in the U.K. The diagnosis related group analysis gave similar results. Interpretation Not only did bisoprolol increase survival and reduce hospital admissions in CIBIS II, it also cut the cost of care in so doing. This `win-win' situation of positive health benefits associated with cost savings is Favourable from the point of view of both the patient and health care systems. These findings add further support for the use of beta-blockers in chronic heart failure.

Aim. To assess frequency of unstable angina due to restenosis after percutaneous angioplasty of venous grafts and to elucidate risk factors of its development. Material and methods. Percutaneous interventions were successfully performed in 100 out of 106 patients with venous graft stenoses. These patients were followed up for 17+/-11 (maximum 36) months. Results. Unstable angina due to venous graft restenosis developed in 24% of patients. Patients with unstable angina compared with those without were characterized by higher frequency of hyperlipidemia (83 vs. 51%, respectively, p=0.032), lower rate of stenting (46 and 72%, respectively, p=0.032), greater residual stenosis (15+/-13 and 9+/-8%, respectively, p=0.008). At multifactorial regression analysis the following factors were significant predictors of unstable angina: hyperlipidemia (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.64-8.39), and residual stenosis after intervention (OR 1.04, 95% CI 1.01-1.07, p=0.04). In a subgroup of patients with hyperlipidemia there was a tendency to greater rate of unstable angina among patients not taking statins compared with users of statin (50 and 29%, respectively, p=0.083). Conclusion. Unstable angina developed in 1/4 of patients after balloon dilatation of venous grafts and hyperlipidemia was its most powerful predictor.