Rational Pharmacotherapy in Cardiology

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Vol 8, No 3 (2012)
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405-414 553

Aim. To evaluate the diagnostic value of heart-type fatty acid-binding protein (H-FABP) introduction to standard cardiac biomarkers in diagnostics of myocardial infarction (MI) early after clinical symptoms onset. Material and methods. Patients aged 18 years and older admitted to the hospital with acute coronary syndrome (ACS) during first 6 hours after ACS symptoms onset were enrolled into the study. At hospitalization level of biomarkers of myocardial damage (creatine phosphokinase-MB fraction - CPK-MB, troponin T) and qualitative tests on FABP were assessed in all patients. Serum troponin T concentration measured in 12 hours after the hospitalization was used to confirm diagnosis of MI. Moreover , diagnosis of MI was verified by echocardiography with the assessment of local reduction in myocardial contractility. Results. 101 patients were included into the study (27% female; aged 59.9±12.4). At the moment of hospitalization 71 (70%) patients were diagnosed with ACS with ST-segment elevation, and 30 (30%) patients - ACS without ST-segment elevation. In total, period between clinical symptoms onset and hospitalization was 3.6±1.4 hours. Analysis of diagnostic value of tests during the first 6 hours after ACS symptoms onset showed higher sensitivity of H-FABP in comparison with troponin T and CPK-MB (72.5, 56.2 and 49.5%, respectively). Specificity of these tests during the first 6 hours after onset of clinical signs of ACS was 90, 100 и 90%, respectively.  Sensitivity and specificity were 87.7 and 100.0%, respectively , when H-FABP , troponin T and CPK-MB were used in combination as a “block test” in patients hospitalized during the first 6 hours after ACS symptoms onset. Sensitivity and specificity were 74.3 и 100.0%, respectively , when “block test” was used in patients hospitalized during the first 3 hours after ACS symptoms onset; between 3 and 6 hours after ACS symptoms onset sensitivity and specificity of tests reached 100%. Conclusion. “Block test” with H-FABP , troponin T and CPK-MB early after ACS symptoms onset is more sensitive in comparison with separate use of the tests.

415-419 498

Aim. To study effect of long-term controlled physical training (CPT) of moderate intensity on diastolic function, depending on the degree of recanalization, in patients with ischemic heart disease (ICD) with left ventricle diastolic dysfunction (DD) who underwent percutaneous coronary intervention (PCI). Material and methods. Patients with ICD (n=60, all males, aged from 49 to 58 years) who had undergone PCI last 3–6 weeks were included into the study. They were randomized into two groups depending on CPT availability in the rehabilitation program. Standard clinical examination, diastolic function assessment, exercise tolerance test were performed at baseline, after 6 and 9 months. Results. The long-term CPT of moderate intensity led to diastolic function improvement in 15.6% of patients after 6 months and 28.1% - in 9 months. Improvement of diastolic function in ICD patients with complete recanalization was observed after 6 months of CPT moderate intensity. Longer period of physical rehabilitation (9 months or more) was required for patients with incomplete recanalization. The improvement of diastolic function without CPT was observed after 6 months in 2 (7.1%) patients with a relaxation type of DD and complete recanalization. Normalization of diastolic function without CPT after 9 months was observed in 10.7% of patients and 3.5% of patients showed DD progression. Conclusion. Inclusion of the long-term CPT of moderate intensity into the rehabilitation program has cardioprotective effect in ICD patients with ischemic DD undergoing PCI.

420-423 548

Aim. To study the effect of ethylmethylhydroxypyridine succinate (EMHPS) on the protein oxidative modification (POM) in patients with acute ischemic stroke. (IS) Material and methods. Patients with IS (n=80) and 20 healthy subjects matched for age and sex (control group) were included in the study. IS patients were split into 2 groups: group 1 (n=39) received EMHPS in addition to standard treatment, and group 2 (n=41) - the standard therapy only. POM was studied by optical density of dinitrophenylhydrazone in wave lengths of 356, 370, 430, 530 nm in 1, 3 and 15 days after IS in patients of the both groups and in control. Results. Significant disorders of the antioxidant system were determined in patients with IS in the range of aldehyde and ketone derivates of dinitrophenylhydrazone in comparison with patients of control group. The highest POM level was observed in patients with atherothrombotic IS: optical density indexes of neutral and alkaline aldehyde and ketone derivates in blood serum proteins were maximal in all wave lengths. Next in order of POM levels decreasing followed patients with cardioembolic and haemodynamic IS and lastly patients with lacunar IS. POM increasing tendency was observed after 3 days in all patients with IS, especially in patients with atherothrombotic IS. A positive POM trend was found in all patients of the group 1 (p<0.05) in 15 days after disease onset. Patients with lacunar IS demonstrated optical density indexes in 530 nm wave length even comparable to those in the control group (0.18±0.01 and 0.2±0.03, respectively; p>0.05). Conclusion. EMHPS inclusion in the treatment of IS patients has a positive effect on the POM changes.

424-427 460

Smoking is a major risk factor in patients with angina pectoris. Interventions that facilitate the rejection of it are an important part of the treatment. Aim. To analyze the cost effectiveness of the partial agonist of nicotinic receptors, varenicline, in patients with angina who require cardiac interventions. Material and methods. The estimation was conducted using a Markov model based on the results of clinical trials and epidemiological studies. The cost of treatment of complications were calculated on the basis of compulsory medical insurance rates for St. Petersburg in 2011. Results. The varenicline therapy in 70-year-old patients before cardiac surgery reduces hospital mortality at an extremely high cost-effectiveness (the cost of preventing one death - 148.8 thousand rubles). The cost/effectiveness ratio in the analysis for the period of survival of patients in this situation was 31.3 thousand rubles for 1 additional year of life. Life expectancy will be increased by an average of 0.147 years. Analysis for the period of survival of 50-year-old patients has shown that in patients after cardiac surgery cost-effectiveness of varenicline is extremely high (in the analysis from the perspective of the health care system the cost/effectiveness ratio was 36.0 thousand rubles for 1 additional year of life, in the analysis, taking into account the social perspective – 17.9 thousand rubles for 1 additional year of life). Increase in the life expectancy of 50 year-old patients will be 0.291 year in average. Conclusion. Varenicline therapy of patients with angina pectoris is the economy before cardiac surgery , and after their execution, and this applies not only young, but older patients. The desirability of varenicline including to federal and regional programs to reduce cardiovascular morbidity and mortality is shown.

428-432 397

Aim. To study the effect of left ventricular (LV) systolic dysfunction on cerebral hemodynamic in patients with ST segment elevation myocardial infarction (STEMI) during acute period. Material and methods. Cerebral hemodynamics ultrasound assessment was performed in the extra-and intracranial vessels in 118 patients with STEMI. Results. Significant changes in cerebral hemodynamics were found in LV systolic dysfunction with ejection fraction (LVEF) ≤40% due to hemispheric blood flow asymmetry in the middle cerebral artery (MCA) as large as 45.1±6.7% with correlation coefficient r=-0.87. Compensation of cerebral blood flow was manifested in vasoconstriction or vasodilation (resistive index 0.63-0.76 and 0.49-0.43 c.u., respectively). Conclusion. A strong relationship between LV systolic dysfunction and cerebral hemodynamic was found in patients with STEMI. It was manifested in significant contralateral hemispheric blood flow asymmetry in MCA in patients with LVEF ≤40%. Reduction in cerebral blood flow velocity activated autoregulation mechanism in the form of vasoconstriction or vasodilation.

433-440 620

Aim. To compare the dynamics of intrarenal vascular resistance (IRVR), circadian blood pressure (BP) profile and glomerular filtration rate (GFR) in patients with arterial hypertension (HT) and type 2 diabetes mellitus (DM) who achieved the target BP levels (<130/80 mmHg) due to long-term combined antihypertensive therapy with or without renin-angiotensin-aldosterone system (RAAS) inhibitors. Material and methods. Patients (n=61) with HT and DM without clinical symptoms of nephroangiopathy were included into the open randomized study , 59 of these patients completed study. Patients of Group 1 (n=41) received therapy with valsartan (n=20), 80–160 mg/day , or perindopril (n=21), 5–10 mg/day , in combination with indapamide retard, 1.5 mg/day , and amlodipine, 5–10 mg/day. Patients of Group 2 (n=18) received amlodipine (5–10 mg/day) in combination with indapamide retard (1.5 mg/day) and metoprolol succinate (50–100 mg/day). Initially and after 30–32 weeks of therapy the following examinations were performed: duplex ultrasound scanning of the main renal (MRA) and intrarenal arteries (IRA) with resistive index (RI) calculation, ambulatory BP monitoring (ABPM), GFR calculation (by Cockcroft-Gault formula). Results. The target BP levels were achieved in all patients of both groups. Patient’s baseline characteristics including age, sex, duration of disease, office BP , GFR, RI in MRA and IRA did not differ in the groups as well as decrease in office BP due to treatment. However patients of Group 2 had higher levels of systolic BP and systolic BP load at night time than these in patients of Group 1 during all period of the treatment. In patients of Group 2 RI in MRA and arcuate IRA were increased from 0.67±0.06 to 0.69±0.06 (p=0.02) and from 0.62±0.07 to 0.64±0.06 (p=0.02), respectively. The increase in IRA was positively associated with systolic BP at night time in these patients (r=0.6; p=0.01). There were no significant changes of IRA in Group 1 totally. At the same time, initially high IRVR decreased in 61% of patients. GFR increased in patients of Group 2 (p=0.01), while dynamics of GFR was not found in patients of Group 1. Conclusion. Achievement of target BP levels due to antihypertensive therapy not including RAAS inhibitors resulted in increase in IRVR that associated with the lack of systolic BP reduction at night time.

441-446 815

Aim. To study the morphological and functional heart disorders in patients with different duration of antipsychotic treatment. Material and methods. Medical documents of 78 deceased schizophrenic patients treated with antipsychotic drugs were studied. The patients were split into 4 groups depending on duration of neuroleptic treatment: group 1 — <10 years, group 2 — 11-20 years; group 3 — 21-30 years, group 4 — >30 years. ECG-disorders and left ventricular morphometric data were analyzed. Сorrelation analysis of myocardium morphological changes and electrophysiological disorders was performed. Results. The dependence of morphometric myocardium changes on the treatment duration was found: increase in stromal-parenchymal ratio (from 9.9±4.1% to 80.0±10.1% in groups 1 and 4, respectively), in specific volume of atrophied cardiomyocytes (from 8.0±3.8% to 45.1±12.6% in groups 1 and 4, respectively), in specific volume of degenerative cardiomyocytes (from 5.2±3.1% to 35.2±12.1% in groups 1 and 4, respectively). Increased incidence of extrasystole detection (from 2.2% to 11.2% in groups 1 and 2, respectively), as well as left anterior fascicular block (from 1.1% to 25.9% in groups 1 and 2, respectively) and left ventricle hypertrophy (from 2.2% to 18.5% in groups 1 and 4, respectively) were found. A strong positive correlation (r=0.88–0.99) was revealed between antipsychotic treatment duration and ECG disorders, as well as between morphological myocardium state and ECG disorders. Conclusion. Awareness about the neuroleptic-depended ECG changes is necessary for early diagnosis, secondary prevention and correction of existing heart disorders due to cardiotoxic side effects of antipsychotic drugs.


447-452 712

Aim. To evaluate the influence of pipofezine, tianeptine and chlorprothixene on blood pressure (BP) level and neuropsychological performance in patients with attention deficit hyperactivity disorder (ADHD) and arterial hypertension (HT). Material and methods. Young males with ADHD and HT (n=58) were included into the study. Patients were split into three treatment groups: group 1 (n=19) received pipofezine 50 mg/day, group 2 (n=20) — tianeptine 25 mg/day , group 3 (n=19) — chlorprothixene 50 mg/day. Clinicopsychopathologic and neurophysiological findings were evaluated at baseline and after 4 weeks of treatment. BP self-monitoring, analysis of psychiatric disorders severity with Brief Psychiatric Rating Scale, electroencephalography (EEG) were performed. Results. The positive dynamics of disregulatory-motor hyperactivity , subjective-cognitive and emotional-vegetative components of ADHD was observed. The positive dynamics of neurophysiological parameters (increase in EEG frequencies index) in groups 1 and 2 (from 0.37±0.05 to 0.54±0.07 and 0.38±0.06 to 0.50±0.05, respectively , p<0.05 for both) was also found. There were no significant effects of the study drugs on BP levels in patients of all groups (p>0.05). Conclusion. Four-week usage of the study drugs in adolescents with ADHD and HT had no significant effect on BP levels. Pipofezine and tianeptine showed more pronounced improvement of clinicopsychiatric and neuropsychological performance in comparison with chlorprothixene in patients with ADHD.


453-456 497

The possibilities of antithrombotic therapy in atrial fibrillation are highlighted. The alternative antithrombotic agents, including rivaroxaban presented along with the traditional drugs (acetyl-salicylic acid, warfarin). Efficacy and safety of rivaroxaban is considered on the basis of the results of the ROCKET-AF study.

457-462 470

The problem of the "optimal pharmacotherapy" choice in patients with stable coronary artery disease is discussed. Expert’s opinions are presented concerning first-line antiischemic drugs and about current approaches to the choosing additional (adjuvant) antiischemic drugs. The practical application of optimal pharmacotherapy in patients with stable angina pectoris is also discussed.


463-468 1005

At present experimental and clinical data confirming efficacy of magnesium-containing drugs in different cardiovascular diseases are obtained. Physiological significance of magnesium is determined by its intracellular fraction. That is why it is desirable to use magnesium with the components contributing to its intracellular penetration. Magnerot deserves attention as a complex drug consisting of magnesium and orotic acid that contributes to intracellular penetration. Data of some studies on magnesium-containing drugs application in different cardiovascular diseases are presented.

469-473 623

The safety of statin therapy is considered. In particular the reasons of a complication such as myopathy are discussed in detail. The molecular mechanisms of statin myopathy , as well as its risk factors are presented. The role of coenzyme Q10 in the myopathy development and coenzyme Q10 application for the prevention of this complication are considered. 

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ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)