Vol 25, No 10 (2023): Болезни сердца и сосудов

Background. Class IC antiarrhythmic drugs (IC-AADs) are recommended as first-line therapy in treatment of lone paroxysmal atrial fibrillation (AF) along with catheter ablation of pulmonary veins. Despite previous attempts to identify predictors of IC-AADs` efficacy, the choice between IC-AADs agents is still most often carried out using empirical approach.

Aim. To determine the predictors of IC-AADs ` efficacy in patients with paroxysmal AF in the absence of structural heart disease.

Materials and methods. Seventy four patients (22 men, 52 women, average age 65 [57; 70] years) were treated with IC-AADs: 26 patients were prescribed lappaconitine hydrobromide (Al) (allapinin at a dosage of 75 mg/day or allaforte 50–100 mg/day), 25 patients were prescribed propafenone (P) 450–600 mg/day, 23 patients – diethylaminopropionylethoxycarbonylaminophenothiazine hydrochloride (ethacizine, E) 150 mg/day. The average frequency of AF paroxysms was 2 [0.4; 6.25] per month. Patients were divided into 2 groups depending on the effect of AADs.

Results. Over a 12 months follow-up IC-AADs therapy was effective in 28 (37.8%) patients (Eff+ group), in the remaining 46 (62.2%) patients AF recurrences or side effects demanding AADs withdrawal were registered (Eff-group). A DC value greater or equal to 5 ms predicted the effectiveness of IC-AADs therapy with 79% sensitivity and 77% specificity (OR 12, 95% CI 3.07–49.5, p<0.0001). In the Al group the deceleration capacity (DC) value greater or equal to 5.25 ms allowed predicting therapy effectiveness with 86% sensitivity and 100% specificity (OR 7, 95% CI 1.14; 43; p=0.002). In the E group, the DC index was characterized by high sensitivity (80%) and specificity (85%) for a threshold value of 5.9 ms. In case of DC above this value, the probability of E therapy efficacy increased by 22-times (OR 22, 95% CI 1.5; 314; p=0.009). In group P, the DC medians in the Eff+ and Eff- groups did not differ significantly (p=0.821). However, at low DC values (less than 4 ms) P turned out to be the most effective compared to other two IC-AADs: its effectiveness was 50%, which was significantly higher compared to E (0%) and Al (0%) (p=0.046).

Conclusion. Estimation of the DC level before starting IC-AADs can make it easier to choose a specific drug from this group and improve treatment results: at DC above 5.2 ms, it is advisable to use Al, at DC≥6 ms – Al or E, at DC less than 4 ms – P.

The close attention of researchers is riveted to the study of socially significant multifactorial diseases and syndromes with a hereditary predisposition, which include chronic heart failure, formed as a result of atherosclerosis of the coronary arteries. The promise of genomic studies in atherosclerosis and heart failure is associated with the possibility of determining the genetic risk of developing and predicting adverse cardiovascular events before the onset of clinical signs/symptoms. From the standpoint of understanding the pathogenesis of atherosclerosis as a variant of nonspecific inflammation, which has a wave-like character, it is assumed that genes encoding pro-inflammatory cytokines influence the pathological process. The aim of the review was to analyze the results of studies available in available publications on the rs1800629 polymorphism of the tumor necrosis factor (TNF) gene in patients with atherosclerotic cardiovascular diseases. Most data indicate the presence of an increased cardiovascular risk in carriers of the A allele of the rs1800629 polymorphism of the TNF gene. It was determined that carriage of the AA genotype is associated with essential arterial hypertension and remodeling of the left ventricular myocardium. In patients with chronic heart failure with preserved and moderately reduced left ventricular ejection fraction of the AA genotype, low blood pressure and frequent occurrence of atrial fibrillation were noted. A number of papers present the results of studies of the rs1800629 polymorphism of the TNF gene and the prognostic significance of the rs1800629 polymorphism of the TNF gene in heart failure.

Background. Comorbidity in patients with chronic heart failure (CHF) makes a major impact to the course of both the underlying and concomitant diseases, significantly worsens the prognosis and increases mortality from cardiovascular diseases. Improving specialized treatment within the framework of a three-tier model of providing medical care to patients with CHF is a healthcare priority.

Aim. Analysis of the frequency of comorbid conditions in patients with CHF included in the CHF registry in the Tyumen region.

Materials and methods. The study was conducted using the CHF register method, which has been operating in the Tyumen region since January 2020. Medical data from outpatient cards and discharge reports were entered by doctors from 9 polyclinics with an attached population, 1 consultative polyclinic, hospitals, on the basis of which there are outpatient CHF rooms in the structure of polyclinics in the city of Tobolsk, Zavodoukovsk, with. Nizhnyaya Tavda, Yalutorovsk, Tyumen Region, Ural Federal District. The study included medical data of 5741 patients with CHF I–IV functional classes (FC). Gender, clinical-instrumental and laboratory data, non-cardiac and cardiac diseases according to the International Classification of Diseases of the 10th revision were entered into a single map of the CHF registry.

Results. In the study sample of patients with CHF, whose average age was 70.0±9.7 years, 2331 (40.6%) were men and 3410 (59.4%) were women. The most common cardiovascular diseases were: coronary artery disease – 55.4%, HD – 22.5% and HRT – 13.5% of cases. Among concomitant diseases of non-cardiac reasons, diabetes mellitus was most often noted – in 31.5% of cases, chronic kidney disease – in 31.1% and chronic obstructive pulmonary disease – in 10% of cases. Concomitant diseases were more common in patients with CHF of functional classes III–IV.

Conclusion. Maintaining a register of CHF and analyzing register data makes it possible to assess the required volume of medical care, plan the necessary time, material, economic and organizational resources and take into account possible difficulties in diagnosis, treatment and outpatient monitoring.

This article presents two clinical cases of endovascular aneurysm repair using fenestrated endografts manufactured by the manufacturer in patients with juxta and pararenal aortic aneurysm. The variants of endovascular approaches to the treatment of pathology were analyzed. Clinical examples show the specifics of the choice and justification for the use of endovascular treatment. The conclusion is made about the effectiveness of the method.

Aim. To evaluate the effectiveness and tolerability of antihypertensive therapy with fixed combinations of telmisartan in patients with hypertension (Htn) in the presence or absence of metabolic syndrome (MS).

Materials and methods. A total of 5985 patients were included in the study: 1879 were group 1 (Htn without metabolic disorders) and 4106 were group 2 (Htn combined with MS). The duration of follow-up was 12 weeks. Blood pressure and heart rate dynamics were evaluated in all patients, and additionally in the group of patients with MS body mass index, waist circumference and hip circumference were assessed. Tolerability was evaluated on the basis of completed questionnaires in Likert scale scores and data on adverse events.

Results. After 12 weeks of taking the combination of telmisartan and amlodipine in the hypertension group without metabolic disorders, the target level of systolic blood pressure (SBP) was <140 mmHg. reached 92% of patients, the target diastolic blood pressure (DBP) level was achieved in 96% of patients. While taking a combination of telmisartan and hydrochlorothiazide, the SBP level was <140 mmHg. was recorded in 92% of patients, target DBP<90 mmHg. was recorded in 96% of patients. After 12 weeks of taking the combination of telmisartan and amlodipine in the hypertension group in combination with MS, the target SBP level was <140 mmHg. reached 89% of patients, level <90 mmHg. 93% of patients achieved target DBP levels. During a similar period of taking the combination of telmisartan and hydrochlorothiazide, the target SBP level was <140 mmHg. reached 90% of patients, level <90 mmHg. 94% of patients achieved target DBP levels. The vast majority of physicians and patients (97–98%) evaluated the efficacy and tolerability of telmisartan-based fixed combinations as good to very good. No serious adverse events were registered.

Conclusion. During therapy with fixed combinations of telmisartan and amlodipine, telmisartan and hydrochlorthiazide a high level of achievement of target values of blood pressure was observed both in the group of patients with hypertension and in the group of patients with hypertension combined with metabolic syndrome, which is more difficult from the point of view of treatment effectiveness.