From bench to bedside

Background Spontaneous progression of severe congestive heart failure is structurally characterized by cellular degeneration and multiple foci of myocardial cell death. The cardiac muscle isoform of troponin I is uniquely expressed in the adult human myocardium, and an increase in its circulating levels is highly indicative of myocardial injury. Accordingly, we addressed the usefulness of cardiac troponin I as a sensitive and specific molecular marker of congestive heart failure in patients with severely reduced left ventricular performance. Methods and Results A new generation single-step immunoenzymoluminometric assay with high analytical sensitivity was used to assess cardiac troponin I in patients with severe congestive heart failure, healthy blood donors, and hospitalized control subjects without known cardiac disease. The cardiac troponin I concentration (mean±SEM) was 72.1±15.8 pg/mL in heart failure patients and 20.4±3.2 and 36.5±5.5 pg/mL in healthy and hospitalized control subjects, respectively...

Circulating Cardiac Troponin I in Severe Congestive Heart Failure

A review of scientific literature data on clinical and epidemiological characterization of viral hepatitis B, C and Epstein-Barr viral infection is presented. Scopus, Web of Science, MedLine, The Cochrane Library, PubMed, CyberLeninka, RSCI databases were used to find the necessary literature. It was shown that Epstein-Barr virus along with hepatitis B and C viruses plays a significant role in the development of virus-mediated autoimmune liver diseases, as well as other organs (intestine, heart, kidneys, thyroid gland, etc.). The similarity of these nosologies is also evident in the nature of the course of the disease: the presence of a primary infection in a manifest or latent form, with possible subsequent chronization of the process and its periodic reactivation. Wide distribution of pathogens in the human population determines the possibility of mixed infections with Epstein-Barr virus and hepatitis B and C viruses, however, this problem has not been adequately described in the scientific literature. The review suggests that the role of Epstein-Barr virus in the development of liver diseases and extrahepatic pathology should not be ignored, and the combination of this pathogen with hepatitis B and C viruses required further in-depth studies.

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[The role of Epstein-Barr viral infection and hepatitis B and C in liver pathology.]

Aim. To estimate the effect of anemia of chronic diseases on the processes of cardiovascular system remodeling in patients with dilated cardiomyopathy and ischemic cardiomyopathy. Methods. The study included 27 patients with dilated cardiomyopathy with anemia, 19 with dilated cardiomyopathy without anemia, 11 with ischemic cardiomyopathy with anemia, 34 with ischemic cardiomyopathy without anemia, and 30 healthy individuals. In these comparison groups, peripheral blood, mean corpuscular hemoglobin and mean cell hemoglobin concentration, reticulocytes, serum iron and ferritin were examined. Electrocardiography, echocardiography, scintigraphy and coronary angiography were performed. Results. In all groups identical signs of chronic heart failure class 3 and 4 were found to be predominant, which was confirmed by a significant decrease of blood pressure, stroke volume, ejection fraction, increase of end systolic and diastolic volumes and sizes, as well as left and right atrial size. Patients with dilated and ischemic cardiomyopathy with anemia had decreased hemoglobin, number of erythrocytes and platelets, positive correlation between hemoglobin and serum iron (r=0.49, p=0.000), red blood cells and ferritin (r=0.61, p=0.000), negative correlation between hemoglobin and ferritin (r=-0.51, p=0.02). In ischemic cardiomyopathy with anemia positive correlation was found between hemoglobin and serum iron (r=0.54, p=0.000), erythrocytes and ferritin (r=0.49, p=0.03), negative correlation - between hemoglobin and ferritin (r=0.54, p=0.03). Conclusion. In patients with dilated and ischemic cardiomyopathy no significant effect of anemia of chronic diseases on heart remodeling processes was revealed.

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Anemia of chronic diseases in patients with dilated and ischemic cardiomyopathy

Aim. To study the structure and incidence of the in-hospital anticoagulants prescription in patients at high risk of thromboembolic events (TEE) and to evaluate clinical characteristics of anticoagulated patients (by the example of the University Clinical Hospital (UCH) №1 of I.M. Sechenov First Moscow State Medical University (FMSMU). Material and methods. The cross-sectional retrospective study held in UCH №1 of the FMSMU, enrolled 677 patients with atrial fibrillation (AF) for whom the prevention of TEE was indicated. Results. Of 677 analyzed cases (women 70%, men 30%) only 61% of the patients received appropriate anticoagulant therapy. Warfarin was prescribed in 73% of the cases, of them unsatisfactory international normalized ratio (INR) control (time in therapeutic range less than 60%) was revealed in 79%. 8.45% of the vitamin K antagonist treated patients developed hemorrhagic complications. 16% of the patients received novel oral anticoagulants (dabigatran – 14%, rivaroxaban – 2%). Bleeding was fixed in 4.2% of the dabigatran treated patients and in 14.3% - in case of rivaroxaban therapy. Conclusion. More than a third of non-valvular AF patients receive inadequate antithrombotic therapy in routine clinical practice. 75% of the anticoagulated patients are prescribed the vitamin K antagonists (typically warfarin) as a traditional anticoagulant. At that, only in 21.7% of the patients receiving vitamin K antagonists, this therapy may be considered adequate. Low incidence rate of the novel oral anticoagulants prescription despite the advantages of such treatment also calls attention.

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Anticoagulant therapy in everyday clinical practice: data of the retrospective cross-sectional study

Indirect comparisons of new oral anticoagulants are performed with focus on their safety. Apixaban, an oral inhibitor of Xa factor, nowadays can be considered as a drug with very good safety profile according to randomized trials results and performed indirect comparisons.

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Comparative efficacy and safety of new oral anticoagulants

1Факультетская терапевтическая клиника им. В.Н. Виноградова ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова»; 2кафедра патологической анатомии ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова»; 3ФГБНУ «Российский научный центр хирургии им. акад. Б.В. Петровского», Москва, Россия; 4лаборатории молекулярно-генетических методов ФГБУ «Научный центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова», Москва, Россия; 5лаборатория иммуногистохимии ФГБУ «Федеральный научный центр трансплантологии и искусственных органов им. акад. В.И. Шумакова», Москва, Россия

Significance of different non-invasive markers in diagnosis of latent myocarditis in comparison with biopsy data

Aim. To evaluate the 5-year results of renal denervation (RDN) in patients with resistant arterial hypertension (AH). Materials and methods. The study included 14 patients to whom, during the 2011-2013 period RDN has been completed. Before and after the intervention, office blood pressure, quality of life indicators according to the EQ-5D questionnaire, mass index bodies, indicators of kidney function were duly assessed. Results. Five years after RDN, office BP decreased from 165/110 to 139/95 mm Hg. Art. (p<0.05), with the average number of of drugs decreased from 4.6 to 3.1. 12 months after the RDA, the quality of Life, based on the questionnaire EQ-5D has increased from 60 to 80 points, by the fifth year the indicator fell to 74 points. Body mass index during 5 years decreased from 33.8 ± 3.5 to 30.9 ± 3.0 kg/m2. Mean plasma creatinine initially and after 5 years remained within the normal range, the mean the GFR score after 5 years being decreased by 9.5 ml/min/1.73 m2. Conclusion. RDN can be regarded as effective and safe method of additional treatment of patients with resistant hypertension.

https://ter-arkhiv.ru/0040-3660/article/download/32995/pdf

Renal denervation with a resistant arterial hypertension: the results of a five-year follow-up.

Ambiguous data about comparability regarding clinical outcomes for prehospital thrombolysis, coupled with timely coronary angiography, and primary percutaneous coronary intervention (PCI) in the early after acute ST-segment elevation myocardial infarction (STEMI), there are now. In the STREAM trial 1892 patients with STEMI diagnosed within 3 hours after onset of symptoms, and whom it was impossible to perform primary PCI within 1 h after the first medical contact, were randomly assigned into two treatment groups: a) primary PCI b) prehospital thrombolytic therapy with bolus tenecteplase (dose decreased by half in patients aged ≥75 years) in combination with clopidogrel and enoxaparin followed by admission to the hospital, where it was possible to perform PCI. Emergency coronary angiography performed if thrombolysis failed. Coronary angiography and PCI of the infarct-related artery were performed in the period from 6 to 24 hours after randomization and thrombolytic therapy in the case of an effective thrombolysis. Primary endpoints include a composite of death, shock, congestive heart failure, or reinfarction up to 30 days. The primary endpoint occurred in 116 of 939 patients (12.4 %) of the thrombolysis group and in 135 of 943 patients (14.3%) of the primary PCI group (relative risk in the group thrombolysis 0.86, 95% confidence interval 0.68-1.09, p=0.21). Emergency angiography was required in 36.3% of patients in the thrombolysis, and the remaining patients, coronary angiography and PCI were performed at a mean of 17 hours after randomization and thrombolytic therapy. Thrombolysis group had more intracranial hemorrhages than primary PCI group (1.0% vs 0.2%, p=0.04; after correction protocol and dose reduction by half of tenecteplase in patients ≥75 years: 0.5% vs. 0.3%, p=0.45). The rate of non- intracranial bleeding in two treatment groups did not differ. Prehospital thrombolysis followed by coronary angiography and timely PCI provide effective reperfusion in patients in the early stages of STEMI that was not possible to carry out primary PCI within 1 h after the first medical contact. Nevertheless, fibrinolysis was associated with a slight increase in the risk of intracranial bleeding.

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Thrombolysis or primary pci for myocardial infarction with st-segment elevation? the stream trial (strategic reperfusion early after myocardial infarction)

V. A. Sulimov

Papers

Anticoagulant therapy in everyday clinical practice: data of the retrospective cross-sectional study

Comparative efficacy and safety of new oral anticoagulants

Significance of different non-invasive markers in diagnosis of latent myocarditis in comparison with biopsy data

Renal denervation with a resistant arterial hypertension: the results of a five-year follow-up.

Thrombolysis or primary pci for myocardial infarction with st-segment elevation? the stream trial (strategic reperfusion early after myocardial infarction)