Consilium Medicum

Despite the development of modern technologies in the field of healthcare and the wide application of modern diagnostic and treatment methods, mortality from ischemic heart disease remains the leading cause of death among diseases. It is known that coronary artery bypass grafting in combination with optimal medical therapy is the gold standard for treating patients with multivessel coronary artery disease. However, for several decades now, percutaneous coronary intervention has proven to be an alternative method of myocardial revascularization for patient with multivessel coronary artery disease and low or intermediate risk. Nevertheless, despite accumulated experience in treating patients with ischemic heart disease, the choice of revascularization method for patients with complex coronary artery disease and high surgical risk (not eligible for CABG) remains debatable. In this review article, the authors described the main factors influencing the choice of myocardial revascularization strategy and demonstrated the results of clinical studies dedicated to studying this issue.

Brugada syndrome (BrS) is an inherited clinical and electrocardiographic syndrome, related to ion channelopathies and associated with an increased risk of sudden cardiac death. The cornerstone in diagnosis remains a spontaneous type 1 Brugada-pattern on the electrocardiogram (ECG), including J point elevation of ≥ 2 mm, coved-type ST segment elevation and T wave inversion in right precordial leads. Similar ECG changes, induced by antiarrhythmic therapy, should be considered as diagnostic when combined with a documented polymorphic ventricular tachycardia or ventricular fibrillation episode, arrhythmogenic syncope, nocturnal agonal breathing or a family history of sudden cardiac death or BrS. The article represents a clinical case of drug-induced type 1 Brugada-pattern in the settings of antiarrhytmic treatment using 1C class sodium channel blocker ethacizine in a female without additional BrS criteria, with negative genetic testing results and the ECG normalization after drug withdrawal.

Background. Abdominal aortic aneurysm rupture is a life threating condition, that requires emergent intervention. At the present stage endovascular aortic repair should be performed, when possible, as a first line strategy, but stent-grafts have some anatomical limitations for use, so surgical repair is still performed in urgent situations.

Aim. To evaluate the results of endovascular and surgical repair of ruptured abdominal aortic aneurysms in vascular center on the base of regional hospital.

Materials and methods. In Krasnoyarsk Regional Clinical Hospital all kinds of aortic interventions are performed, both in acute and stable pathologies. During 5 years 63 patients with acute rupture of abdominal aneurysms where transferred, 31 underwent endovascular repair, 32 – surgical repair. Clinical characteristics, initial state and time for intervention didn’t differ in endovascular and surgical groups.

Results. Technical success was 100% in both endovascular and surgical repair groups. 30-day mortality with endovascular repair was 4 (12.9%) patients, and it was statistically lower compare to surgical repair group – 11 (34%) patients (p = 0.011). Repeat interventions were performed in both groups, without statistical significance in frequency. The superiority of less invasive intervention is seen during 1 year follow up: in endovascular group 1-year survival is 74.2% vs 45.5% in the surgical group (р = 0.039).

Conclusion. In real-life practice endovascular approach demonstrate convincing advantage in 30-day mortality rate in the treatment of patients with abdominal aneurism rupture. The main reason for surgical repair performing in our hospital is the presence of juxta renal aneurysm.

Aim. To clarify the role of acyl-ghrelin in the development of protein-energy wasting of haemodialysis patients (HD).

Materials and methods. A total of 645 patients receiving treatment with programmatic bicarbonate HD for 8.4 ± 5.3 years, including 345 women and 300 men, the average age was 56.8 ± 12.8 years. Nutritional status was assessed using the method proposed by the International Society of Renal Nutrition and Metabolism (ISRNM). For the quantitative determination of acyl-ghrelin, the enzyme-linked immunosorbent assay kit “Active Ghrelin ELISA Kit” (highly sensitive method) from Sceti KK, Japan was used in this work. Reference values: 30–62 fmol/ml.

Results. The prevalence of protein-energy wasting (PEW) using the ISRNM method was 24.9% (160 patients). Reduced levels of acyl-ghrelin were detected in 352 (54.5%) patients. The average acyl-ghrelin values in patients without signs of PEW were 50.2 ± 10.3 fmol/ml, and in patients with PEW 24.9 ± 9.2 fmol/ml (p < 0.0001). Patients with reduced acyl-ghrelin levels had statistically significantly lower values of total protein, albumin, prealbumin, total cholesterol, and transferrin than patients with normal acyl-ghrelin levels (p < 0.0001, p < 0.0001, p < 0.0001, p < 0.001 and p < 0.0001, respectively). Also, patients with reduced acyl-ghrelin levels were characterized by statistically significantly lower values of BMI, skeletal muscle mass, and percentage of body fat mass (p < 0.001, p < 0.001, p < 0.001, respectively).

Conclusion. The prevalence of PEW in HD patients according to the ISRNM method was 24.9%. A reduced level of acyl-ghrelin in the blood serum may be an important pathogenetic link in the development of PEW in HD patients.

Aim. To study the change of hemoglobin (Hb) levels in the perioperative period with the intravenous administration of ferric carboxymaltose (FCM) in cardiosurgical patients.

Materials and methods. The retrospective study included data from the medical charts of 113 cardiac surgical patients who received FCM infusion in the preoperative period (Group 1). The control group (Group 2) was selected using the pseudo-randomization method from 1042 patients who did not receive FCM infusion. We analyzed the effect of FCM infusion on the levels of Hb and ferritin, the need for transfusion of erythrocyte-containing blood components, the duration of the postoperative period, mortality, and complications.

Results. After FCM infusion in Group 1, the ferritin level increased from 37.1 ± 15.4 to 588.3 ± 150.4 µg/L (p = 0.0001). In Group 1, there was a significant increase in Hb immediately after FCM infusion, as well as in the early postoperative period; in Group 2, no increase in Hb was observed. The decrease in Hb in Group 1 at the time of discharge was 10.8 ± 11.9 g/L compared to baseline Hb at admission, in Group 2 it was 19.8 ± 12.8 g/L (p < 0.001). In the postoperative period, patients of both groups received an average of 0.07 ± 0.3 units of erythrocyte-containing blood components (p = 1.0). No deaths were reported. The duration of treatment in the intensive care unit and the total duration of the postoperative period in both groups did not significantly differ. Surgical bleeding was reported in 4 (3.5%) patients in Group 1 and 1 (0.8%) patient in Group 2 (p = 0.35). The frequency of infectious complications did not differ significantly between the groups (p = 0.35).

Conclusion. A single infusion of FCM in cardiac surgery patients significantly increases Hb levels immediately after the infusion and in the early postoperative period, without affecting the risk of infectious complications and death.