Search

Aim. Compare the incidence of the left atrial appendage (LAA) thrombus dissolution in patients with persistent nonvalvular atrial fibrillation receiving warfarin and direct oral anticoagulants (DOAC).Materials and methods. 68 patients with persistent nonvalvular atrial fibrillation were included in a retrospective study (age was 59.7±9.8 years, 60.3% men), in whom at least one repeated transesophageal echocardiographic examination was performed after detecting a thrombus. After detecting a thrombus in the LAA, 37 (54.4%) patients started or continued taking warfarin in doses that ensure the INR maintenance at the level of 2-3, 14 (20.6%) started or continued taking dabigatran at a dose of 150 mg 2 times/day, 14 (20.6%) started or continued taking rivaroxaban 20 mg 1 time/day and 3 (4.4%) started or continued taking apixaban 5 mg 2 times/day. Repeated transesophageal echocardiographic examination was performed on average 33.3±14.2 days after the first one.Results. Dissolution of a previously identified thrombus was found in 26 (83.9%) of 31 patients receiving DOAC and in 19 (51.4%) of 37 patients receiving warfarin (p=0.011). The logistic regression analysis showed that the chances of a thrombus dissolution in LAA while taking DOAC are 14.8 times (95% confidence interval [CI] was 2.469-88.72) higher than while taking warfarin. The size and the rate at which blood is expelled from the LAA also have an independent influence on the chances of thrombus dissolution. An increase in the size of a thrombus by 1 mm reduces the chances of a thrombus dissolution by 1.136 (95% CI was 1.040-1.244) times, and an increase in the rate of blood expulsion from the LAA by 1 cm/sec increases these chances by 1.105 (95% CI was 1.003-1.219) times.Conclusion. In the present study, the incidence of the LAA thrombus dissolution in patients with persistent nonvalvular atrial fibrillation while receiving DOAC was higher than while receiving warfarin.

Aim. To study the results of thrombolytic therapy and accuracy of electrocardiographic assessment of thrombolysis efficiency in inferior myocardial infarction with and without right ventricular lesion.Material and methods. The118 patients with inferior myocardial infarction were included in this study. They received TLT in the first 12 hours of the disease. The dynamics of ST-segment in 90 minutes from the TLT start and coronary angiography data were analyzed.Results. Right ventricular myocardial infarction (RVMI) was diagnosed in 49 (41.5%) of 118 patients by echocardiography. Patients with and without RVMI did not differ in age, gender and comorbidities, but patients with RVMI were more likely to have arterial hypotension, atrioventricular block, and atrial fibrillation. All patients with RVMI had occlusion of the right coronary artery (RCA) in the proximal (34.7%) or medial segment (65.3%). Occlusion of the circumflex coronary artery was found in 20 (29.0%) patients without RVMI, and RCA occlusion - in other patients. The infarction-associated artery blood flow equal TIMI 2-3 was found in 17 (34.7%) patients with RVMI and in 46 (66.7%) patients without RVMI (p0.05). The false-positive assessment of thrombolysis efficiency was noted in patients with and without RVMI in 21 (42.9%) and 11 (15.9%) cases (p

Aim. To compare the efficacy and safety of thrombolytic therapy with recombinant non-immunogenic staphylokinase and tenecteplase in ST elevation myocardial infarction (STEMI) in real clinical practice.Material and methods. 84 patients with onset of STEMI symptoms up to 12 hours ago were included into the non-experimental study with mixed design. Recombinant non-immunogenic staphylokinase and tenecteplase were used in 38 and 46 patients, respectively. The dynamics of the ST segment on the ECG, angiographic reperfusion criteria were evaluated as well as clinical outcomes – mortality, reinfarction, stroke, bleeding and allergic reactions.Results. The ST-segment resolution by 70% after 180 min was achieved in 66% and 66% of patients in recombinant non-immunogenic staphylokinase group and in tenecteplase group, respectively (p=0.66) as well as antegrade coronary blood flow through the infarct-related artery TIMI II-III in 61% and 67% of patients, respectively (p=0.63). Mortality and the rate of reinfarction, intracranial bleeding, stroke, cardiogenic shock, left ventricle aneurism and thrombosis were similar in both groups. Large bleeding (otherwise intracranial one) and allergic reactions were not registered.Conclusion. In real clinical practice the efficacy and safety of recombinant non-immunogenic staphylokinase and tenecteplase in STEMI are similar.

Aim. To assess the efficacy of thrombolytic Fortelyzin in ST elevation myocardial infarction (STEMI) in real clinical practice.Material and methods. Fortelyzin was administered intravenously to 38 patients with STEMI with follow-up assessment of reperfusion success by ECG and angiographic criteria. Bleedings, anaphylaxis and total mortality were considered.Results. The ST-segment resolution up to 70% in 180 min was reached in 66% of patients and angiographic effect TIMI 2-3 – in 60% of patients. The major bleeding rate was 2.6%, allergic reactions – 0%, total mortality – 10.5%. Unsuccessful reperfusion was observed more frequently in patients with ECG ischemia of grade 3 and with angiographic visualization of the collateral blood flow.Conclusion. The general efficacy of Fortelyzin in real clinical practice was 73%. ECG ischemia of grade 3 and the presence of angiographic collateral blood flow predict unsuccessful reperfusion of the infarct-related artery.

Aim. To study the features of cardiac remodeling in patients with dilated cardiomyopathy (DCM) and postinfarction cardiosclerosis (PICS), that can be used for differential diagnosis of these diseases.Material and methods. Patients with DCM (27 men and 5 women; aged 43.1±2.3) and patients with PICS (62 men; aged 56.4±1.1) and chronic heart failure (CHF) were included in the study. The diagnosis of DCM was based on clinical investigation, which also includes coronary angiography. The diagnosis of DCM in 19 patients was proven by the results of postmortem investigation. The diagnosis of PICS was based on documented history of myocardial infarction, ECG and echocardiographic sings. Echocardiography was performed in all patients and 14 healthy volunteers.Results. End-systolic size (ESS) of left ventricular (LV) in patients with DCM and PICS at I (respectively 7.60±0.17 and 7.94±0.18 cm), IIA (7.66±0.28 and 8.64±0.30 cm) and IIB stages of CHF (8.26±0.28 and 8.94±0.15 cm) was significantly more than this in healthy volunteers (6.36±0.16, all p

Aim. To compare vasomotor endothelial function, aortic elastic properties and characteristics of left ventricular (LV) remodeling in patients with isolated systolic (ISHT) and sistolo-diastolic (SDHT) hypertension. Material and methods. Echocardiography , assessment of aorta elastic properties and endothelial vasomotor function were performed in 24 ISHT patients (mean age 73.6 years, mean disease duration 24.8 years) and 52 SDHT patients (mean age 58.0 years, mean disease duration 12.8 years). The age of hypertension onset did not differ significantly in patients of both groups. Results. Aorta elastic coefficient in ISHT patients was 6 times lower than this in SDHT patients (1.00 vs 6.36 mm2/mm Hg, respectively), and vasodilation coefficient (which reflects an ability of vessels to expanding in response to blood flow acceleration) less on 35% (10.9 vs 16.8 standard units, respectively). Patients of ISHT and SDHT groups did not differ in thickness of the interventricular septum (14.8 vs 14.3 mm, respectively), and LV ejection fraction (59.9 vs 60.4%, respectively). However , LV posterior wall thickness in ISHT patients was 3.0 mm less than this in SDHT patients, as well as amplitude of systolic displacement of LV fibrous ring (which reflects LV longitudinal systolic function) was 0.9 cm bigger , respectively. Conclusion. Elderly age, aorta high stiffness, asymmetric LV hypertrophy and impaired LV longitudinal systolic function are typical clinical and functional features of ISHT patients.

Aim. To compare vasomotor endothelial function, aortic elastic properties and characteristics of left ventricular (LV) remodeling in patients with isolated systolic (ISHT) and sistolo-diastolic (SDHT) hypertension. Material and methods. Echocardiography , assessment of aorta elastic properties and endothelial vasomotor function were performed in 24 ISHT patients (mean age 73.6 years, mean disease duration 24.8 years) and 52 SDHT patients (mean age 58.0 years, mean disease duration 12.8 years). The age of hypertension onset did not differ significantly in patients of both groups. Results. Aorta elastic coefficient in ISHT patients was 6 times lower than this in SDHT patients (1.00 vs 6.36 mm2/mm Hg, respectively), and vasodilation coefficient (which reflects an ability of vessels to expanding in response to blood flow acceleration) less on 35% (10.9 vs 16.8 standard units, respectively). Patients of ISHT and SDHT groups did not differ in thickness of the interventricular septum (14.8 vs 14.3 mm, respectively), and LV ejection fraction (59.9 vs 60.4%, respectively). However , LV posterior wall thickness in ISHT patients was 3.0 mm less than this in SDHT patients, as well as amplitude of systolic displacement of LV fibrous ring (which reflects LV longitudinal systolic function) was 0.9 cm bigger , respectively. Conclusion. Elderly age, aorta high stiffness, asymmetric LV hypertrophy and impaired LV longitudinal systolic function are typical clinical and functional features of ISHT patients.