Vol 22, No 10 (2020)

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.

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.

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.

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.

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.

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.

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.