Vol 22, No 10 (2020)


Overweight, metabolic syndrome and the course of COVID-19

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Consilium Medicum. 2020;22(10):9-11
pages 9-11 views

Cardiological practice in the "postCOVID" world

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Consilium Medicum. 2020;22(10):12-14
pages 12-14 views

Gardiotoxicity of chloroquine and hydroxychloroquine in the treatment of COVID-19 infection

Leonova M.V.


The cardiotoxicity of aminoquinolines presents as QT interval prolongation and life-threatening ventricular arrhythmia, torsade de pointes (TdP). A scientific review of studies and meta-analyzes on the rate and risk of cardiotoxicity of aminoquinolines (chloroquine and hydroxychloroquine) is presented. The mechanism of development of QT syndrome during the use of aminoquinolines is associated with inhibition of the hERG gene open potassium channels 1A and 1A/1B, which are involved in the repolarization process, as well as inhibition of potassium, calcium and If-channels of the heart, which leads to an impaired conduction and bradycardia. In 3 systematic review of data (1962-2018) of analysis of cardiotoxic side effects of chloroquine, hydroxychloroquine, mefloquine in the treatment of malaria and connective tissue diseases, isolated cases of death due to QT interval prolongation/TdP arrhythmia were revealed, however, data on the rate of detecting QT interval prolongation was not enough. In the face of the COVID-19 novel coronavirus pandemic emergency, aminoquinolines are being repurposed by the Food and Drug Administration - FDA (repurposing) to treat severe acute respiratory syndrome in hospitalized patients. Chloroquine and hydroxychloroquine were intended to be administered in short courses with QT monitoring. However, the first data of clinical trials have revealed an increased risk for hospital mortality in patients with COVID-19. In the first systematic review of studies in COVID-19 (14 clinical trials, n=1515), a clinically significant QT interval prolongation (QT>500 ms or change of more than 60 ms) in 10% of patients receiving chloroquine/hydroxychloroquine, and isolated cases of fatal arrhythmia was revealed. Subsequent studies showed that the incidence of QT interval prolongation during the use of chloroquine/hydroxychloroquine ranges from 10 to 23%, with isolated cases of ventricular arrhythmia TdP, but there is a significant increase in mortality (relative risk - RR 1.3-1.50) and sudden cardiac arrest (RR 1.91), especially in combination with azithromycin (RR>2.0). The FDA and the World Health Organization have limited the use of drugs for COVID-19. Perspectives for further treatment of COVID-19 infection are associated with remdesivir and favipiravir.
Consilium Medicum. 2020;22(10):15-21
pages 15-21 views

Clinical case of successful use of non-invasive ventilation in a patient with a new coronavirus infection

Litvin A.Y., Elfimova E.M., Mikhailova O.O., Alekseeva T.A., Sivakova O.A., Danilov N.M., Pevzner D.V., Dulaev L.O., Zyuryaev I.T., Gaman S.A.


The new coronavirus disease COVID-19 (SARS-CoV-2) is a challenge both in terms of optimal patient management and the protection of the medical personnel. We present a clinical case of a 49-year-old patient with bilateral polysegmental pneumonia (COVID-19), complicated by acute respiratory distress syndrome and a cytokine storm, in whom the chosen treatment tactics using non-invasive ventilation allowed avoidance of intubation together with organization of sufficient protection for medical personnel.
Consilium Medicum. 2020;22(10):23-28
pages 23-28 views

Experience of using a professional tonometer for in-line blood pressure screening in patients in hospital

Valuev V.E., Butenko A.V.


Aim. Evaluation of the possible advantages of measuring blood pressure (BP) with a professional tonometer for in-line screening of blood pressure, pulse, arrhythmia (oscillometric method) in a hospital over measuring blood pressure using the auscultation method. Methods and outcomes. 2503 blood pressure measurements by the oscillometric method in 165 patients were analyzed. Of these, 136 people were > 20-21 years old with a history of arterial hypertension - AH (1st group) and 29 people were young persons (18-20 years old) with no history of AH (2nd group). Results. Only 13,3% of participants had never measured BP; 24,1% of the 2nd group required antihypertensive therapy following the results of this study. The percentage of patients' awareness of their BP levels among those who measured BP by the auscultation method and by the oscillometric method was 10 and 100%, correspondently. In the course of the study, heart rhythm alterations were revealed in 9,5% of patients when using the oscillometric method. The measurement of BP in all patients in the department by one desk nurse requires 2 times less time when using the oscillometric method compared to the auscultation method. Conclusions. When measuring BP by the oscillometric method, regardless of patients’ age and gender, their awareness of the level of AH increases. Given a modern character of measurement and submitting data to the medical records in inpatients patients for accurate and quick correction of AH, detection of cardiac arrhythmias, it is preferable to choose a professional tonometer based on the oscillometric method for in-line specification of BP, pulse, arrhythmia. With regular BP monitoring, there is a correction of behavioral risk factors and adherence to antihypertensive therapy are corrected.
Consilium Medicum. 2020;22(10):30-32
pages 30-32 views

Difficulties in diagnosis and variants of the clinical course of hypertrophic cardiomyopathy in elderly patients

Krylova N.S., Maslova M.Y., Poteshkina N.G., Kovalevskaya E.A., Selivanova G.B.


Hypertrophic cardiomyopathy (HCM) is a genetically determined disease with a morphological abnormality of myocardial contractile proteins, manifested by asymmetric left ventricular myocardial hypertrophy. Currently, there is evidence that the HCM incidence rate in the population can be up to 1:200, as opposed to the traditionally quoted 1:500. In early works on HCM, this disease has been mostly perceived as a pathology of young and middle age with a high risk of sudden cardiac death. Now it is generally accepted that patients with HCM are likely to reach the old or even geriatric age subject to the benign course of the disease. Comorbidity in such patients contributes to the clinical aspect of the disease. The article deals with problem areas of HCM diagnostics in elderly patients with an emphasis on differential diagnosis of HCM and left ventricular hypertrophy as part of hypertension. It contains a discussion of differential diagnosis of ischemic heart disease in HCM. The authors also focus on the specifics of the course of HCM in old age patients and present factors affecting the prognosis for this group of patients.
Consilium Medicum. 2020;22(10):34-38
pages 34-38 views

Dynamic monitoring of cardiovascular diseases in patients with diabetes mellitus according to mobile medical center (Diamodule) in the regions of Russia

Zheleznyakova A.V., Vikulova O.K., Serkov A.A., Alferova P.A., Shestakova M.V., Dedov I.I.


Background. Diabetes mellitus (DM) is a powerful factor in the development and progression of cardiovascular diseases (CVD), it produces poor prognosis, including disability and premature mortality in this category of patients. Aim. To carry out dynamic monitoring of the prevalence of CVD in adult DM patients with type 1 and type 2 (coronary heart disease, myocardial infarction, cerebrovascular diseases and arterial hypertension) based on a comprehensive examination in a mobile medical center (Diamodule) with repeated visits to the regions in 2019 compared to data of the Federal Program "Diabetes mellitus" (2005-2006). Materials and methods. The object of the study: adult patients with DM1 and DM2 (>18 years old) who underwent examination in Diamodule (n=1480): 882 patients were in 2005/2006 (337 with DM1 and 545 with DM2) and 598 were in 2019 (275 with DM1 and 323 with DM2). Examination at the medical center includes: assessment of anthropometric data (height, weight, body mass index), biochemical data of blood lipids and creatinine levels with calculation of glomerular filtration rate, measurement of glycated hemoglobin (HbAn,), blood pressure, ECG, cardiologist’s consultation with an assessment of the anamnesis data, laboratory data, ECG. Results. Over the past 13-14 year period in both types of DM, the prevalence of coronary heart disease significantly decreased: in DM1 by 4,42% by 2 times (p=0,037), in DM2 by 18,34% by 2,7 times (p<0,001); myocardial infarction in DM1 by 1,97% by 1,9 times (p=0,172), in DM2 by 3,28% by 1,5 times (p=0,1); cerebrovascular diseases in DM1 by 2,17% by 3 times (p=0,074), in DM2 by 1,45% by 1,2 times (p=0,44). There was an improvement in the diagnosis of arterial hypertension compared to 2005/2006: in DM1 by 6,4% from 44,5 to 51% (p=0,115), in DM2 by 3,6% from 86,8 to 90,4% (p=0,096). It was revealed that the incidence of CVD with active screening in Diamodule is higher than the recorded data on referral compared with the data of the DM register. DM1 patients in the 2019 were significantly older (39 vs 38 years), with a shorter DM duration (18 vs 25 years), with a better HbA1C level (8,7 vs 9,1%). DM2 patients in the 2019 were significantly older (66 vs 58 years), differed in age of diabetes onset (52 vs 51 years), longer duration of DM2 (14 vs 7 years), lower glomerular filtration rate (54 vs 90,6 ml/min/1,73 m2), they had better level of total cholesterol (4,6 vs 5,1 mmol/L), triglycerides (1,3 vs 2,1 mmol/L), while they did not differ in the level of HbA1C and body mass index. Conclusions. The analysis showed a significant decrease in the prevalence of CVD in DM patients compared with the data obtained in the period 2005-2006, this is the result of CVD prevention programs and improving the quality of medical care for this category of patients.
Consilium Medicum. 2020;22(10):39-44
pages 39-44 views

Pharmacoeconomic analysis of the use of dapagliflozin in patients with NYHA class II-IV chronic heart failure with reduced left ventricular ejection fraction <40% in the Russian Federation

Nedogoda S.V., Tereshhenko S.N., Zhirov I.V., Salasyuk A.S., Villevalde S.V., Barykina I.N., Lutova V.O., Popova E.A.


Aim. To evaluate the economic efficiency of using dapagliflozin in patients with chronic heart failure with a reduced left ventricular ejection fraction <40% NYHA II-IV in the Russian Federation Methods. Conducted a cost-benefit analysis/cost-minimization analysis and budget impact analysis. The calculation of costs was carried out in a global model adapted to the health care system of the Russian Federation by using Russian cost indicators and indicators of disease characteristics. Results. The addition of dapagliflozin to standard care compared to standard care only will provide an additional 0.356 LYGs (life years gained) and 0.306 QALYs (quality adjusted life years) for each patient during 10 years of therapy, which will lead to an additional cost of 33.32%. The incremental cost of 1 added year of life with dapagliflozin will amount to 460 943 rubles per patient, 1 year of life adjusted for quality - 537 230 rubles, which does not exceed the value of one GDP per capita in 2019 (749 813 rubles). Thus intensification of CHF therapy with dapagliflozin is economically viable. At the same time, the use of dapagliflozin for 10 years in 1000 target patients will avoid 128 hospitalizations and 23 urgent outpatient visits for CHF, as well as prevent 47 CV deaths. The NNT (number need to treat) index for the compared strategies for hospitalization for CHF is only 8 people. Intensification of standard therapy for CHF with dapagliflozin in comparison with valsartan/sacubitril will reduce the costs of the healthcare system by 29 417 rubles per patient for one year of therapy and 73 167 rubles per patient over 3 years of therapy with comparable efficiency.
Consilium Medicum. 2020;22(10):45-51
pages 45-51 views

Insulin resistance: focus on the pathogenesis of cardiomyopathy

Shishkova V.N., Martynov A.I.


Insulin resistance is the main link of pathogenesis of a lot of diseases, including cardiovascular diseases which are the leading cause of morbidity and mortality worldwide. The combination of insulin resistance - associated disorders, such as obesity, type 2 diabetes mellitus, arterial hypertension and hypertriglyceridemia, refers to metabolic syndrome. The increase in the number of patients with metabolic syndrome is due to a prevalence of unhealthy lifestyle and inappropriate dietary pattern in the modern world, and is also partially associated with the trend of population aging in most developed countries. In this regard, it is necessary to emphasize the relevance of the link between insulin resistance and the development of a specific complication - metabolic cardiomyopathy. Given that the triggering event in pathogenesis of this cardiomyopathy is alterations in substrate balance with following accumulation of lipotoxic metabolites in cardiomyocytes, the term “lipotoxic cardiomyopathy” has been proposed. This cardiomyodystrophy is associated with myocardial hypertrophy and diastolic dysfunction, which thereafter result into chronic heart failure with a preserved ejection fraction. Although the link between the lipotoxic cardiomyodystrophy and insulin resistance-associated disorders is quite close, till now all therapeutic strategies involving only complex therapy with antidiabetic and lipid-lowering drugs have not led to a decrease in the risk for cardiomyopathy. There is a need in searching for effective therapeutic strategies to reduce the incidence of both lipotoxic cardiomyodystrophy and associated chronic heart failure.
Consilium Medicum. 2020;22(10):52-54
pages 52-54 views

Hypolipidemic therapy: evidence-based effectiveness and new perspectives

Kudina E.V., Samkova I.A., Larina V.N.


Background. Hyperlipidemia is one of the most important risk factors for the onset and progression of cardiovascular diseases. Currently, several classes of drugs are used in lipid-lowering therapy, which have proven their effectiveness over the past decades. However, in a number of patients there is an intolerance to these drugs or it is not possible to achieve the target levels of the lipid spectrum against the background of the use of maximum doses and combination therapy. This dictates the need to create new lipid-lowering drugs. Aim. To present data on the proven efficacy of widely used drugs in the treatment of hyperlipidemia and the prospects for therapy of this pathology. Materials and methods. We analysed literature sources, included European and Russian guidelines in the last 10 years. Results. The article presents the results of multicenter international randomized clinical trials that studied the efficacy and safety of the main classes of lipid-lowering drugs, both in the form of mono- and combination therapy. The indications for the administration of fibrates, ezetimibe omega-3-fats and PCSK9 inhibitors, depending on clinical situations, are discussed. Information on the mechanisms of action of new lipid-lowering drugs - bempedoic acid and inclisiran is presented. The results of clinical trials studying the efficacy and safety of these drugs are presented. Conclusion. Achieving the target levels of lipid metabolism in patients with cardiovascular diseases is an important link in the program to reduce the risk of development and progression of cardiovascular diseases. At the moment, statins remain the main drugs for the treatment of hyperlipidemia. But in some patients, in order to achieve the goal, the appointment of a combination therapy is required, in which both the long-used fibrates, ezetimibe, omega-3-fats, and the most recent drugs: PCSK9 inhibitors, bempedoic acid and inclisiran can be used.
Consilium Medicum. 2020;22(10):55-60
pages 55-60 views

Heart failure and contrast-induced acute kidney injury in patients with coronary artery disease

Mironova O.I., Sivakova O.A., Deev A.D., Fomin V.V.


Aim. To assess the influence of heart failure on the risk of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD) with indications to diagnostic procedures requiring intra-arterial administration of contrast media. Materials and methods. 1023 patients, who were receiving optimal medical therapy and had indications to coronary angiography and possible coronary angioplasty, with stable CAD were included in the study. We conducted an observational open prospective cohort study, which was registered in clinicaltrials.gov with ID NCT04014153. CI-AKI was defined as 25% or more increase of baseline serum creatinine, or more than 0.5 mg/dl and was assessed 48 hours after contrast media administration. The primary endpoint was the CI-AKI development according to KDIGO criteria. Most of the patients, included in the study, were males aged 66.3±10 years with arterial hypertension and overweight (BMI 29.14±5 kg/m2). Results. The study included 1023 patients, 76 suffered from heart failure. The rate of CI-AKI in this group was 13.2% (10 patients). The rate of CI-AKI using the absolute creatinine rise definition was 4% cases (3 cases). Conclusion. Female patients suffering from heart failure with higher levels of serum creatinine and low glomerular filtration rate need more attention, less amount of contrast and adequate preventive measures before contrast media administration in order to lower the risk of CI-AKI development.
Consilium Medicum. 2020;22(10):61-63
pages 61-63 views

Features of endovascular closure of secondary atrial septal defect in older patients

Kovalchuk I.A., Rafaeli I.R., Azarov A.V., Semitko S.P., Ioseliani D.G.


Aim. Secondary atrial septal defect (ASD II) is one of the most common congenital heart defects. While all the issues of endovascular correction of this disease in children and young patients have been practically resolved, many issues still remain debatable regarding the treatment of adult patients. In the proposed work, the author analyzes the main information’s discussed in the literature concerning this issue, such as the expediency and tactics of treatment of adult patients with ASD II, depending on its anatomical forms, the status of intracardiac and pulmonary-arterial hemodynamics, the presence of concomitant diseases. Materials and methods. The article presents a literature review based on the results of searching of publications in Russian and international bibliographic databases (PubMed, eLIBRARY, Medscape, etc.). Results. Analysis of the literature data in most cases indicates the feasibility and high efficiency of endovascular closure of hemodynamically significant ASD II in elderly patients. The analysis of dynamic observations in the long term after endovascular treatment, reveals a decrease in MPAP as well as the size of the right heart. At the same time, compliance with certain rules makes the intervention quite safe, regardless of the age of patients and, to a certain extent, the severity of symptoms. In the literature, it is particularly emphasized that when determining the management tactics of adult patients with ASD II in order to prevent possible complications, should be objectively evaluated and taken into account such factors that determine their initial state as: the presence of high MPAP, volume overload of the right heart, and vice versa, underloading of the left heart, the conditions of the heart valves, the presence of arterial hypertension, existence of heart rhythm disorders, ischemic heart disease and left ventricle dysfunction. Conclusion. Modern medical literature convincingly proves that with the right selection of patients, transcatheter closure is a safe, highly effective method of correction of ASD II, accompanied by real economic effect and it should be considered a standard in the treatment of middle-aged and elderly patients. At the same time, studies on long-term results show that the positive functional effect does not have age restrictions.
Consilium Medicum. 2020;22(10):64-68
pages 64-68 views

Adherence to drug therapy in patients with chronic coronary heart disease after percutaneous coronary interventions

Gapon L.I., Samoilova E.P., Bessonov I.S., Gultyaeva E.P., Berdinsky S.G.


Background. Poor patient adherence to drug therapy (DT) for stable coronary heart disease (CHD) is an equally important component that affects treatment outcomes. Aim. To assess adherence to DT in patients with stable coronary heart disease in patients after percutaneous coronary interventions (PCI), compare with patients who received only DT. Materials and methods. The study included 150 patients with CHD (group 1) who underwent PCI surgery at the Tyumen cardiology research center. The comparison group (group 2) consisted of 150 patients with stable CHD, receiving only DT. All patients were diagnosed with CHD and underwent coronary angiography in the anamnesis. The follow-up period was 30.8 months in both groups (8 months to 69 months). The groups of patients were comparable in the main indicators: sex, age, total cholesterol level, presence of concomitant arterial hypertension and diabetes mellitus, functional class (FC) of angina pectoris and heart failure, hemodynamically significant lesion of the main coronary arteries and arteries of the second order, the type of blood circulation and the number of affected vessels at the time of inclusion in the study. Patients of both groups were comparable in conservative therapy. Statistical analysis of the results was carried out using the statistical software package SPSS. Results. In the PCI group, FC of angina pectoris was higher, while in the MT group, III FC was more often registered. This reflects the positive effect of PCI on exercise tolerance. When analyzing regularly taken medications, it was determined that patients who underwent PCI were more likely to use all groups of drugs. On a face-to-face visit, biochemical blood tests for cholesterol spectrum were carried out. Attention is drawn to the low turnout of patients in the DT group compared to the PCI group. The target level of low-density lipoprotein (LDL) was not achieved in both groups, but due to greater adherence to statins in the PCI group, LDL was 0.7 mmol lower than in the DT group. Conclusion. PCI surgery in patients with CHD can not only improve the quality of stress angina pectoris, but also significantly increase adherence to the treatment of the main groups of drugs (statins and antiplatelets) that affect the prognosis.
Consilium Medicum. 2020;22(10):69-71
pages 69-71 views

Serum creatinine level changes and contrast-induced acute kidney injury in patients with stable coronary artery disease

Mironova O.l., Fomin V.V.


Aim. The aim of our study was to assess the influence of different risk factors on the risk of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD). Materials and methods. Patients, who were receiving optimal medical therapy and had indications to coronary angiography and possible coronary angioplasty, with stable CAD were included in the study. We conducted an observational open prospective cohort study, which was registered in clinicaltrials.gov with ID NCT04014153. Results. We included 1023 patients with chronic CAD. Most of the patients, included in the study, were males aged 61.7±10.1 years with arterial hypertension and overweight. The rate of CI-AKI in this group was 12.9% (132 patients). The rate of CI-AKI using the absolute creatinine rise definition was 1.8% cases (18 cases). A logistic regression model was created, where baseline creatinine, baseline glomerular filtration rate and delta between baseline creatinine and creatinine level after contrast media administration were the most statistically significant risk factors. The AUC was 0.984 (95% CI 0.969-0.999; p<0.0001). Conclusion. The most significant risk factors in the logistic regression model created were baseline creatinine, baseline glomerular filtration rate and delta between baseline creatinine and creatinine level after contrast media administration were the most statistically significant risk factors.
Consilium Medicum. 2020;22(10):72-75
pages 72-75 views

The role of potassium and magnesium for prevention and treatment of cardiovascular disease

Pogozheva A.V.


The article provides data on foods rich in potassium and magnesium as well as causes and consequences of their insufficient intake. It shows a high prevalence of their deficiency among the Russia population. The article considers the role of potassium and magnesium in the prevention and treatment of cardiovascular diseases. Ways to increase potassium and magnesium in your diet include the use of special diets, potassium- and magnesium-rich foods. It discusses selection criteria and advantages of using drugs which contain both potassium and magnesium to improve the mineral status of the population.
Consilium Medicum. 2020;22(10):76-79
pages 76-79 views

Skin reactions to cardiac drugs: a clinical case

Nevozinskaia Z.A., Piruzian A.L., Korsunskaia I.M.


Drug-induced photodermatitis is an important problem in a doctor's practice. This is due to the fact that a number of drugs widely used in medicine can cause the development of photodermatitis - antibiotics and sulfonamides, non-steroidal anti-inflammatory drugs, antineoplastic drugs, diuretics, antihypertensive and antiarrhythmic drugs, antidiabetic and psychiatric drugs, tretinoin and isotretinoin, as well as some others. Drug-induced photodermatitis proceeds as phototoxic reactions. In this situation, medicinal substances in the skin can act as a photosensitizer. The pathological mechanism of development of phototoxic reactions involves both an accumulation in the skin of a substance that possess effect of a photosensitizer and the simultaneous effect of solar radiation on the skin. The photosensitizer causes rashes by increasing skin sensitivity to visible or ultraviolet part of the spectrum. This article describes the case of a 64-year-old patient who developed photodermatitis while taking amiodarone for a long time.
Consilium Medicum. 2020;22(10):80-82
pages 80-82 views

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