Search

BACKGROUND. In order to prevent complications of coronavirus infection (platelet hemostasis disorders, heart rate variability and QT interval dispersion, which increase the risk of thromboembolic complications and fatal arrhythmias), it is promising to study the relationship between heart rate variability and platelet hemostasis in patients with coronary artery disease (CAD) in combination with coronavirus disease (COVID-19). OBJECTIVE. The aim of the study was to investigate the impact of COVID-19 on the interdependence of changes in platelet hemostasis and heart rate variability in patients with CAD. MATERIALS AND METHODS. We examined 102 patients divided into three groups: group 1 – CAD without COVID-19 (n=32); group 2 – CAD in combination with COVID-19 (n=35); group 3 – COVID-19 without CAD (n=35). The control group included 30 conditionally healthy individuals. Changes in platelet hemostasis were studied according to laser aggregometry by the Born method and analysis of the average size of aggregates with an assessment of spontaneous aggregation and aggregation induced by adenosine diphosphate (ADP), arachidonic acid, epinephrine, collagen, ristomycin. Heart rate variability parameters and QT interval variability characteristics were determined by the results of 24-hour Holter electrocardiogram monitoring. RESULTS AND DISCUSSION. The time for spontaneous aggregation was longer in all patients compared to the control group, with the highest values observed in groups 2 and 3 (with COVID-19). In ADP aggregation, the control group showed higher results. The rate of aggregation in ADP was lowest in group 2. Collagen-induced aggregation was higher in COVID-19 cases. All groups exhibited lower values of adrenaline-induced aggregation, with the lowest values in group 3. The time of aggregation under adrenaline was shortest in group 2. Ristocetin induced greater aggregation in the control group, but the lowest rate in group 2, and the shortest time in group 1 (СAD without COVID-19). In СAD with COVID-19, an inverse relationship was observed between the parasympathetic nervous system and adrenaline-induced aggregation, as well as between sympathetic activity and ristocetin-induced aggregation. The degree of platelet aggregation induced by ADP had a direct correlation with the corrected QT interval. The rate of aggregation with ADP had an inverse correlation with the mean QT. The time of platelet aggregation activated by ristocetin had an inverse correlation with the standard deviation of QT(NN). The mode of QT had an inverse correlation with the degree of aggregation with ristocetin. CONCLUSIONS. In СAD and COVID-19, platelet hemostatic function is impaired, as confirmed by laser aggregometry data. Autonomous dysregulation and prolonged QT interval have been identified. A complex interaction between platelet hemostasis and heart rate variability is observed. Considering platelet hemostatic function, heart rate variability, and QT dispersion is crucial for treating this cohort of patients.

In order to prevent complications of coronavirus disease COVID-19 (impaired platelet hemostasis, endothelial function, heart rate variability and QT interval, which increase the risk of thromboembolic complications and cardiovascular mortality), it is promising to study the relationship between heart rate variability and platelet hemostasis in patients with coronary artery disease in combination with COVID-19. The aim of the study was to investigate the effect of COVID-19 on the interdependence of changes in platelet hemostasis and heart rate variability in patients with CHD. The clinical and instrumental results of 102 patients were analyzed, who were divided into 3 groups: group 1 - coronary heart disease (CHD) without COVID-19 (n = 32); group 2 - CHD in combination with COVID-19 (n = 35); group 3 - COVID-19 without CHD (n = 35). The control group included 30 conditionally healthy individuals. In the group of CHD + COVID-19, changes in platelet hemostasis were determined by laser aggregometry by the turbidimetric method according to Born and analysis of light transmission fluctuations (to assess the average size of aggregates) with an assessment of spontaneous and induced aggregation: adenosine diphosphate (ADP), arachidonic acid (AA), epinephrine, collagen, ristomycin. Aggregation parameters were recorded on a BIOLA LA230-2 analyzer using the AGGR program. According to the results of the study, an aggregogram was obtained with the following parameters: according to the curve. In patients with coronary heart disease with concomitant COVID-19, a wide range of disorders of the functional state of platelet hemostasis was observed, in particular, an increase in the degree, rate and time of spontaneous platelet aggregation, as well as a decrease in the degree, rate and time of platelet aggregation induced by epinephrine. At the same time, the profile of the course of CHD in combination with COVID-19, in contrast to the "isolated" course of both conditions, was characterized by a predominance of a decrease in the rate of aggregation during induction with arachidonic acid and ADP in patients of group 2. The degree of aggregation was greater in group 2 when using collagen and ristomycin. The aggregation time was shorter when using an adrenaline inducer in group 2. Patients with chronic coronary artery disease, in particular in its combination with COVID-19, showed signs of autonomic nervous system dysfunction, namely a decrease in overall HRV (by SDNN, SDАNN and SDNNi) and a decrease in the activity of the parasympathetic nervous system (by rMSSD, pNN50 and HF). The detected changes in the autonomic regulation of the heart were most pronounced among patients with associated coronary artery disease and COVID-19 in terms of HRV parameters such as SDNN and pNN50. Increases in QT interval duration and variability recorded in patients with chronic coronary artery disease and COVID-19 were most pronounced in the combination of the two nosologies and the collagen-induced aggregation time had a direct correlation with HF. There are inverse relationships between the rate of spontaneous aggregation induced by adrenaline and collagen on the one hand and the indicators characterizing the sympathetic link of the ANS on the other. A direct correlation was observed between the degree of spontaneous aggregation and ADP-induced aggregation and between the rate of spontaneous aggregation induced by adrenaline and collagen and the parasympathetic part of the ANS. The aggregation time induced by epinephrine was directly related to the integral indices of the ANS and PNS. Inverse relationships with the ANS were observed with the time of platelet aggregation induced by ristomycin. Regarding the variability of the QT interval, inverse relationships with neurogenic, myogenic and respiratory fluxmotions were observed. The standard deviation and coefficient of variation of QT were inversely related to the degree of aggregation induced by ristomycin and directly to epinephrine. The time of spontaneous aggregation, as well as that induced by ADP and collagen, was directly correlated with the QT mode and mean QT. The standard deviation and coefficient of variation of the QT interval inversely affected the time of spontaneous aggregation induced by collagen, AK and ristomycin. The rate of aggregation did not affect the variability of the QT interval. Given the established relationships of HRV parameters and QT interval variability with indicators of the functional state of platelet hemostasis, additional consideration of the characteristics of autonomic dysfunction, as well as prolongation of the QT interval with increased variability, is appropriate in the system of management of patients with coronary artery disease and concomitant coronavirus disease. There is a need for widespread use of noninvasive methods of assessing the state of the microcirculatory system and assessing platelet hemostasis in the management of patients with coronary artery disease suffering from COVID-19. Patients with chronic coronary artery disease and concomitant COVID-19, along with platelet hemostasis dysfunction, showed signs of autonomic dysregulation and increased QT interval duration and variability. Additional consideration of the characteristics of platelet hemostasis function, heart rate variability and QT interval is advisable in the management of such patients. [ABSTRACT FROM AUTHOR]

In the recently published clinical practice guidelines by the American Heart Association/American College of Cardiology, a central part has been dedicated to the revascularization, as new evidence came up increasing our knowledge on this relevant topic. Providing symptom relief, preventing major adverse cardiovascular events and improving long-term survival is ultimately the aim of coronary revascularization. Such ambitious goals should be actively pursued, as suggested thoroughly in the text, sharing the clinical decision making with the patient. Aim of this commentary is to highlight critical messages from the recent guideline, especially in complex clinical scenarios such as angiographically intermediate coronary artery stenoses, significant left main disease and multivessel disease with severe left ventricular dysfunction. [ABSTRACT FROM AUTHOR]

In this meta-analysis, we examine the advantages of invasive strategies for patients diagnosed with chronic coronary heart disease (CHD) and preserved left ventricular (LV) function, as well as those with significant LV systolic dysfunction (LV ejection fraction (EF) < 45%). Material and methods: We conducted a systematic search to identify all randomized trials directly comparing invasive strategies with optimal medical therapy (OMT) in patients diagnosed with chronic CHD. Data from these trials were pooled using a random-effects meta-analysis. The primary outcome assessed was the all-cause mortality, while secondary endpoints included cardiovascular (CV) death, stroke, myocardial infarction (MI), and unplanned revascularization. This study was designed to assess the benefits of both invasive strategies and OMT in patients with preserved LV function and in those with LV systolic dysfunction. The statistical analysis of the data was conducted using the Review Manager (RevMan) software, version 5.4.1 (The Cochrane Collaboration, 2020). Results: Twelve randomized studies enrolling 13,912 patients were included in the final analysis. Among the patients with chronic CHD and preserved LV systolic function, revascularization did not demonstrate a reduction in all-cause mortality (8.52% vs. 8.45%, p = 0.45), CV death (3.41% vs. 3.62%, p = 0.08), or the incidence of MI (9.88% vs. 10.49%, p = 0.47). However, the need for unplanned myocardial revascularization was significantly lower in the group following the initial invasive approach compared to patients undergoing OMT (14.75% vs. 25.72%, p < 0.001). In contrast, the invasive strategy emerged as the preferred treatment modality for patients with ischemic LV systolic dysfunction. This approach demonstrated lower rates of all-cause mortality (40.61% vs. 46.52%, p = 0.004), CV death (28.75% vs. 35.82%, p = 0.0004), and MI (8.19% vs. 10.8%, p = 0.03). Conclusions: In individuals diagnosed with chronic CHD and preserved LV EF, the initial invasive approach did not demonstrate a clinical advantage over OMT. Conversely, in patients with ischemic LV systolic dysfunction, myocardial revascularization was found to reduce the risks of CV events and enhance the overall outcomes. These findings hold significant clinical relevance for optimizing treatment strategies in patients with chronic CHD, contingent upon myocardial contractility status.

In this meta-analysis, we examine the advantages of invasive strategies for patients diagnosed with chronic coronary heart disease (CHD) and preserved left ventricular (LV) function, as well as those with significant LV systolic dysfunction (LV ejection fraction (EF) < 45%). Material and methods: We conducted a systematic search to identify all randomized trials directly comparing invasive strategies with optimal medical therapy (OMT) in patients diagnosed with chronic CHD. Data from these trials were pooled using a random-effects meta-analysis. The primary outcome assessed was the all-cause mortality, while secondary endpoints included cardiovascular (CV) death, stroke, myocardial infarction (MI), and unplanned revascularization. This study was designed to assess the benefits of both invasive strategies and OMT in patients with preserved LV function and in those with LV systolic dysfunction. The statistical analysis of the data was conducted using the Review Manager (RevMan) software, version 5.4.1 (The Cochrane Collaboration, 2020). Results: Twelve randomized studies enrolling 13,912 patients were included in the final analysis. Among the patients with chronic CHD and preserved LV systolic function, revascularization did not demonstrate a reduction in all-cause mortality (8.52% vs. 8.45%, p = 0.45), CV death (3.41% vs. 3.62%, p = 0.08), or the incidence of MI (9.88% vs. 10.49%, p = 0.47). However, the need for unplanned myocardial revascularization was significantly lower in the group following the initial invasive approach compared to patients undergoing OMT (14.75% vs. 25.72%, p < 0.001). In contrast, the invasive strategy emerged as the preferred treatment modality for patients with ischemic LV systolic dysfunction. This approach demonstrated lower rates of all-cause mortality (40.61% vs. 46.52%, p = 0.004), CV death (28.75% vs. 35.82%, p = 0.0004), and MI (8.19% vs. 10.8%, p = 0.03). Conclusions: In individuals diagnosed with chronic CHD and preserved LV EF, the initial invasive approach did not demonstrate a clinical advantage over OMT. Conversely, in patients with ischemic LV systolic dysfunction, myocardial revascularization was found to reduce the risks of CV events and enhance the overall outcomes. These findings hold significant clinical relevance for optimizing treatment strategies in patients with chronic CHD, contingent upon myocardial contractility status. [ABSTRACT FROM AUTHOR]

In the recently published clinical practice guidelines by the American Heart Association/American College of Cardiology, a central part has been dedicated to the revascularization, as new evidence came up increasing our knowledge on this relevant topic. Providing symptom relief, preventing major adverse cardiovascular events and improving long-term survival is ultimately the aim of coronary revascularization. Such ambitious goals should be actively pursued, as suggested thoroughly in the text, sharing the clinical decision making with the patient. Aim of this commentary is to highlight critical messages from the recent guideline, especially in complex clinical scenarios such as angiographically intermediate coronary artery stenoses, significant left main disease and multivessel disease with severe left ventricular dysfunction.

Objective: to assess how cerebral stroke (CS) in patient’s history affectы length life of patients with stable coronary heart disease (СHD), included in the СHD PROGNOSIS registry.Materials and methods. We analyzed the data of patients from CHD PROGNOSIS registry who underwent coronary angiography and confirmed CHD diagnosis (n = 541, including 432 men and 109 women) during the reference hospitalization in the National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of Russia from 01 / 01 / 2004 to 31 / 12 / 2007. The average age of men and women was 57.5 ± 0.4 and 60.9 ± 0.9 years, respectively. During reference hospitalization, we took into account CS / transient ischemic attack in anamnesis (retrospective part) and frequency of reaching endpoints (general and cardiovascular mortality, myocardial infarction and CS after 4 and 7 years of follow-up (prospective part). In case of 4-year observation, therapy response was 89 %, in case of 7-year observation – 93 %.Results. Twenty (3.7 %) patients had CS or transient ischemic attack in anamnesis at reference hospitalization, 284 (52.5 %) patients suffered myocardial infarction (p < 0.001). There were revealed differences in patients with coronary artery disease, which cannot be detected in the anamnesis by age, sex, presence of comorbid burden, arterial hypertension and diabetes mellitus, non-cardiological diseases, smoking frequency. The relative risk of death from all causes at 4- and 7-year follow-up was 3.3 and 2.4 times higher, respectively (p < 0.05). Patients with CS in anamnesis demonstrated 25 and 45 % overall mortality in 4 and 7 years, their cardiovascular mortality was 25 and 35 %, respectively. Patients without CS in medical history demonstrated 9 and 18 % overall mortality after 4 and 7 years of follow-up, cardiovascular mortality was 8 and 12 %, respectively (intergroup differences are statistically significant at p < 0.05–0.01).Conclusion. It was noted that patients with CHD and CS in anamnesis were older, percent of women among them was higher, they more often suffered from grade II–III hypertension and diabetes mellitus, had more comorbidities, but smoked less often. CS in anamnesis significantly worsened the medium-term and long-term life prognosis for patients with CHD, increasing overall and cardiovascular mortality.

In the review article are provided the approaches to the therapy for improvement of prognosis in patients with peripheral and multifocal atherosclerosis which are available now; some limitations and a real situation are designated for the antithrombotic therapy in this category of patients. According to the clinical trial COMPASS the prospects of wide use of a combination of acetylsalicylic acid and a rivaroxsaban of 2.5 mg 2 times a day in the patients with chronic coronary heart disease and/or symptom peripheral atherosclerosis are designated.

Background. Metabolic syndrome (MS) is a topical issue of 21st century, a criterion for type 2 diabetes mellitus (DM) and coronary heart disease (CHD) severity. Violations of lipid, carbohydrate exchange and hormonal state, in particular the functional state of hypothalamic pituitary and thyroid systems, underlie MS. The functional state of thyroid gland in MS becomes the object of many researches. It is proved that thyroid hormones regulate secretion of insulin. The concept of hypothyroidism­induced MS is well­known. Subclinical hypothyroidism is an independent risk factor of atherosclerosis and acute coronary syndrome for the elderly women. It is important to pay a considerable attention to the study of thyroid function in comorbid pathology. The purpose of research is to study the thyroid function in MS and in combination with chronic CHD and type 2 DM, both compensated and decompensated. Materials and methods. Three hundred nineteen patients with MS combined with chronic CHD, compensated and decompensated type 2 DM were examined. Depending on a presence or absence of the combined pathology, six groups of patients with MS were formed. The first group was represented by patients with MS without complications, second group — MS and compensated type 2 DM, third group — MS and decompensated type 2 DM, fourth group — MS in combination with chronic CHD, fifth group — MS combined with chronic CHD and compensated type 2 DM, sixth group included patients with MS, chronic CHD and decompensated type 2 DM. The levels of thyroid­stimulating hormone (TSH), cortisol, free thyroxine, antithyroglobulin and thyroid peroxidase antibodies were determined to study the thyroid functional state and to confirm of its pathogenic role in this combined pathology. Results. According to the results of research, increase of TSH level was observed in patients with MS without complications, MS with chronic CHD, MS with chronic CHD and compensated type 2 DM. These changes are specific for subclinical hypothyroidism, having regard to the normal levels of free thyroxine. The level of cortisol was increased in MS without complications, with its further decrease. In MS with chronic CHD and decompensated type 2 DM, TSH was at the level in control group that indicates normalization of thyroid function, the cortisol level was increase. Conclusions. Levels of TSH and cortisol are the markers of severity of the combined pathology of MS with CHD and type 2 DM.

Objective: to estimate a trend in the frequency of using drugs with their proven effect on disease outcome in patients with chronic coronary heart disease (CHD) in 2004–2014 within the CHD PROGNOSIS registry. Materials and methods. The investigation included data from the CHD PROGNOSIS registry on 303 patients with verified CHD during the 2004–2007 reference hospitalization at the National Research Center for Preventive Medicine, who made a control visit 4 years later, and those on 125 patients who had come following 7 years. Results. There was a low frequency of prescribing the drugs that were able to improve prognosis in patients with stable CHD prior to the 2004–2007 reference hospitalization with an increase at discharge and with a further reduction during outpatient treatment. 7.6 and 86.5% of the patients took statins; 68 and 96 % received disaggregants; 24.8 and 94 % used β-adrenoblockers (β-AB), and 19 and 83 % had angiotensin-converting enzyme (ACE) inhibitors before hospitalization and at discharge, respectively (p < 0.001). Four and seven years after discharge, there were reductions in the frequency of using statins to 67 and 70 %, disaggregants to 80 and 90 %, β-AB to 80 and 75 %, and ACE inhibitors to 66 and 65 %, respectively (p < 0.01). At the same time, the above-mentioned drugs were taken by 15 and 69 % of patients on admission and at discharge, respectively (p < 0.001), by 41 and 35 % after 4 and 7 years (p < 0.01). In 2004 to 2014, most drugs were used at low and moderate doses with a gradual increase in the share of generics. Conclusion. The therapy in patients with stable CHD was characterized by a low frequency of using the drugs with their proven effect on prognosis prior to the 2004–2007 reference hospitalization with an increase and a decrease in the frequency of their use on discharge and after 4 and 7 years. During 10 years, β-AB, ACE inhibitors/angiotensin II receptor antagonists, and statins were used mainly at low and moderate doses. Moreover, there was a gradual rise in the share of generics, in the use of statins in particular.

Copyright of International Journal of Endocrinology / Mìžnarodnij Endokrinologìčnij Žurnal is the property of Zaslavsky O.Yu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The national guidelines for treatment of chronic coronary heart disease (CHD) recommend surgical coronary aortic bypass grafting (CABG) rather than percutaneous coronary intervention (PCI) for patients with a coronary three-vessel disease. The epidemiology of three-vessel CHD and data about the application of different revascularisation strategies raise suspicion of deviation from the guidelines in the treatment of those patients. Claims data containing records of almost 10 million patients of the largest German statutory health insurance fund (Techniker Krankenkasse) were utilised to measure adherence to the guidelines for treatment of groups of patients with one-, two-, and three-vessel CHD, respectively. The impact of age, sex, and comorbidity on each patient's revascularisation procedure was investigated as well. There was no significant difference in the rate of PCI between the groups. In conclusion, the hypothesis that patients with a coronary three-vessel disease are not always treated according to the recommendations of the national guidelines could not be disproved by this study. Finally, the results of this study suggest that the best revascularisation strategy for each patient with two- and three-vessel disease should be decided upon by an interdisciplinary discussion between both cardiologists and cardiac surgeons. [ABSTRACT FROM AUTHOR]

Aim. To assess effectiveness and safety of a new rehabilitation method — interval hypoxia-hyperoxia training (IHHT) — in patients with chronic coronary heart disease (CCHD).Material and methods. This pilot study included 40 CCHD patients, Functional Class II–III (31 men and 9 women; mean age 61,7±7,7 years). The IHHT group (n=30) underwent 20 procedures (duration 40–50 minutes, 5 times a week), while the control group (n=10) underwent 20 similar placebo procedures. The REOXY device (AIMediqS.A., Luxemburg) was used for the creation of the gas mixtures with O2 content from 10% to 35–40%. At baseline and in the end of the treatment, individual hypoxia sensitivity was assessed in a 10-minute hypoxic test (HT). The IHHT procedure started with 5–7 minutes of mask inhalation of 12–11% О2, followed by 2–3 minutes of mask inhalation of 30% O2. The automatic switch between the gas mixtures followed the biological feedback principle; one procedure included 6–8 hypoxiahyperoxia cycles. Before and after the intervention phase, all participants underwent clinical and biochemical blood assay, rest ECG, submaximal treadmill test (time of the test, workload, and exercise capacity in metabolic equivalent units (MET)).Results. After the IHHT course, the main group demonstrated a significant increase in exercise capacity: test time increased by 34,1% (vs. —2,7% in controls), while exercise capacity (MET) increased by 15,8% (vs. 5,4% in controls), and the prevalence of angina attacks as the result of test termination significantly decreased. Improved exercise capacity was associated with a significant reduction in total cholesterol, plasma triglycerides, initially elevated blood pressure and resting heart rate, as well as with an elevated hypoxia tolerance threshold in the HT. In all participants, IHHT was well tolerated and free from adverse effects. Conclusion. The IHHT method increases exercise capacity in CCHDpatients, which is associated with lipid profile normalisation, blood pressure reduction, decreased number of angina attacks, and increased resistance to hypoxia.

Aim. Using the data from the CHD PROGNOSIS register, to assess the long-term survival of patients with stable coronary heart disease (CHD) confirmed by a diagnostic coronary angiography (CAG).Material and methods. The study design (retro- and prospective observational cohort study) agreed with the register principles. The study included all consecutive patients (Moscow Region residents) who were hospitalised to the State Research Centre for Preventive Medicine with a preliminary diagnosis of CHD, for a diagnostic CAG and therapeutic strategy selection (01.01.2004–31.12.2007). The total number of participants was 641 (500 men and 141 women). Vital status was ascertained in 551 patients (86%). Mean follow-up time was 3,8 years (range 0,76–6,52 years).Results. The register participants had a high prevalence of conventional risk factors and adverse clinical and anamnestic characteristics. CAGconfirmed coronary artery (CA) stenosis ≥50% was registered in 563 patients. In 24 out of 78 individuals with “intact” CA, coronary syndrome X or vasospastic angina was diagnosed; in the other 54, CHD diagnosis could not be confirmed. During the hospitalisation, balloon angioplasty was performed in 38% of the patients with known vital status. Before hospitalisation, the main drug classes with proven prognostic benefits were administered insufficiently often. During the follow-up period (mean follow-up 3,9 years), 50 patients died. All-cause mortality was 11,38±1,61 per 1000 person-years. The leading cause of death was chronic CHD (84%), which confirms high levels of cardiovascular risk in these patients. In total, fatal and non-fatal complications, including revascularisation episodes, were registered in 36%.Conclusion. The established register of stable CHD includes a typical cohort of chronic CHD patients who are referred for invasive diagnostics and treatment. Therefore, the register is expected to provide valid information on the factors determining prognosis and effectiveness of medical intervention, such as pharmacological therapy and percutaneous revascularisation.

Aim. To study the prevalence of selected parameters of subclinical atherosclerosis and their association with muscle function and muscle volume in patients with different levels of cardiovascular risk (CVR). Material and methods. The study included 20 patients (11 men and 9 women; mean age 54,5±8,5 years) with chronic coronary heart disease (CCHD; mean duration 6,4±2,3 years) in the main group (MG), as well as 20 CCHD-free people in the control group (CG). Arterial stiffness was assessed by pulse wave velocity (PWV) and calculated carotid-femoral index (CFI). Endothelial function was assessed by endothelium-dependent vasodilatation (EDVD) in the reactive hyperemia (RH) test. Common carotid artery (CCA) ultrasound was performed in order to assess intima-media thickness (IMT) of carotid arteries. All participants underwent veloergometry (VEM); exercise capacity (EC) was measured by calculated metabolic equivalents (MET). Muscle tissue volume was assessed using a bioelectrical impedance analyser. The percentage of active muscle mass (%AMM) and fat-free muscle mass (%FFM), out of the total body mass, was calculated. Results. Increased CFI values >12 m/s, as a marker of adverse prognosis, were observed in 20% CCHD patients and in 10% of controls (z=0,17; p=0,87). Vasomotor endothelial dysfunction (EDVD 0,9 mm were observed in 55% and 15%, respectively (z=2,3; p=0,02). Most patients with pathologically increased arterial stiffness and vasomotor endothelial dysfunction had low EC. In CCHD patients with low EC, CFI significantly correlated with %AMM and %FFM (r=-0,32; p

Aim. To identify the value of selected parameters and integral indices of treadmill test (TT), such as Duke Treadmill Score (DTS), Centre for Preventive Medicine index (CPMI), and modified CPMI, in the assessment of cardiovascular complication (CVC) risk among patients with chronic coronary heart disease (CCHD). Material and methods. The study included all consecutive patients with the admission diagnosis of CCHD (n=260), who underwent coronary angiography (CAG) and TT in the period from January 1st 2004 to December 31st 2007, and were permanent residents of Moscow City or Moscow Region. Primary end-point was death from all causes; non-fatal CVC included acute myocardial infarction, acute cerebrovascular accident, and revascularization (percutaneous coronary intervention or coronary artery bypass graft surgery). Results. The mean time to the development of primary end-point was 3,2 years; it total, it was registered in 71 patients (32,0 %). The incidence of primary end-point was higher in patients with ST segment depression ≥1 mm at TT, positive TT result, or chest pain development during the test. Achievement of target heart rate and TT time ≥12 minutes was associated with a better prognosis. In patients with high and intermediate risk by DTS and CPMI, the incidence of primary end-point was higher than in patients with low risk. Modified CPMI demonstrated high correlation with the primary end-point. Conclusion. The highest prognostic value in the assessment of the risk of CCHD complications was demonstrated by TT result, ST segment depression ≥1 mm, TT time, and chronotropic TT response. The role of CPMI and modified CPMI as predictors of CVC risk in CCHD patients was assessed.

The article is devoted to general principles of chronic coronary heart disease treatment, according to modern international guidelines. Information on medications improving life prognosis and/or clinical symptoms is presented.

This paper examines the indicators of microviscosity coefficients in the area of integral and annular lipids of erythrocyte membranes of peripheral blood in patients aged 35-50 and 60-75 years with chronic coronary heart disease (CHD), as well as in age-matched healthy donors. In healthy donors, microviscosity coefficients in the area of integral and annular lipids proved to be significantly higher in the older age group (60-75 years). In CHD, regardless of the age of patients, erythrocyte membranes can be characterized by both a growth and decrease in the microviscosity parameters of lipid-lipid interactions. The growth in the microviscosity coefficient is typical in lipid-protein contacts for patients aged 35-50 years; meanwhile, the patients aged 60-75 years are characterized by a decrease in the microviscosity coefficient. It is concluded that the values of erythrocyte membrane microviscosity in patients from different age groups during the development of chronic coronary heart disease reflect both the implementation of the general mechanisms of adaptive changes in cell membranes and the individual specificity determined by their lipid and protein composition. [ABSTRACT FROM AUTHOR]

Background: Several biohumoral variables, taken individually, are predictors of prognosis in patients with chronic coronary artery disease (CAD). We hypothesized that taken together, laboratory tests provide prognostic information that is additive to a complete diagnostic work-up. Methods: We prospectively examined 2370 consecutive patients with chronic CAD, as shown by a >50% coronary stenosis (in 95% of patients), previous coronary revascularization (in 31% of patients), and/or previous myocardial infarction (MI, in 54% of patients). We tested the ability of laboratory and clinical variables to predict future cardiac events (cardiac death and non-fatal MI). Results: During follow-up (median, 46 months), 147 patients (6.2%) died from cardiac causes and 81 (3.4%) experienced a non-fatal MI. Using multivariate analysis, after adjustment for clinical variables (including left ventricular ejection fraction and angiographic extent of coronary stenoses), a high-density lipopro-tein cholesterol (HDLc) concentration < 35 mg/dL (p< 0.0001), a neutrophil-to-lymphocyte ratio >2.4 (p = 0.0014), and an fT3 serum level<2.1 pg/mL with normal thyrotropin (low-T3 syndrome) (p = 0.0260) showed an independent and incremental prognostic value, and were associated with an increase in the rate of cardiac events of 86%, 57% and 41%, respectively. When these variables were added to clinical and instrumental variables, the prognostic power of the model increased significantly (global chi-square improvement: from 157.01 to 185.07,p<0.0001). Conclusion: Low HDLc, high neutrophil-to-lymphocyte ratio and low-T3 syndrome, both individually and taken together, provide prognostic information that is independent of and incremental to the main clinical and instrumental findings. [ABSTRACT FROM AUTHOR]

Copyright of Der Kardiologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the review article are provided the approaches to the therapy for improvement of prognosis in patients with peripheral and multifocal atherosclerosis which are available now; some limitations and a real situation are designated for the antithrombotic therapy in this category of patients. According to the clinical trial COMPASS the prospects of wide use of a combination of acetylsalicylic acid and a rivaroxsaban of 2.5 mg 2 times a day in the patients with chronic coronary heart disease and/or symptom peripheral atherosclerosis are designated.