Research Institute for Complex Problems of Cardiovascular Diseases

Kemerovo, Russia

Research Institute for Complex Problems of Cardiovascular Diseases

Kemerovo, Russia
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Tarasov R.S.,Research Institute for Complex Problems of Cardiovascular Diseases | Ganyukov V.I.,Research Institute for Complex Problems of Cardiovascular Diseases | Protopopov A.V.,Regional Clinical Hospital | Barbarash O.L.,Research Institute for Complex Problems of Cardiovascular Diseases | Barbarash L.S.,Research Institute for Complex Problems of Cardiovascular Diseases
Kardiologiya | Year: 2017

Lack of evidence base on the use of 2-nd generation drug covered stents in patients with ST-elevation myocardial infarction (STEMI) with multivessel lesions in coronary vascular bed makes it important to conduct studies of new devices in a framework of multivessel stenting in primary percutaneous coronary intervention (PPCI) and staged revascularization. Controversial data on outcomes of the strategy of multiple revascularization in STEMI might be related to the use of previous generation coronary stents in this category of patients. Aim of this study was assessment of one year outcomes of multivessel stenting in a framework of PPCI and staged revascularization (8.6±4.2 days between stages) with the use of 2-nd generation drug covered stents. We showed that both multivessel stenting and staged revascularuzation might be effective options of revascularization in STEMI with the use of 2-nd generation drug covered stents and maintenance of limited time interval between PCI on infarct related artery and PCI on other coronary vessels with significant stenotic lesions. This strategy was associated with low rate of adverse cardiovascular events.


Sumin A.N.,Research Institute for Complex Problems of Cardiovascular Diseases | Korok E.V.,Research Institute for Complex Problems of Cardiovascular Diseases | Sinkov M.A.,Research Institute for Complex Problems of Cardiovascular Diseases | Nagirnyak O.A.,Research Institute for Complex Problems of Cardiovascular Diseases | Barbarash L.S.,Research Institute for Complex Problems of Cardiovascular Diseases
Kardiologiya | Year: 2017

Aim: to study rates and possible causes of detecting «clean» coronary arteries at elective coronary angiography. Material and methods. Medical records of 711 patients who had undergone elective coronary angiography (ECAG) between 01/04 and 31/05 2014 were retrospectively reviewed. Four groups were distinguished: group 1 - patients with normal coronary arteries (n=234), group 2 - patients with coronary artery stenoses (CAS) <60% (n=94), group 3 - patients with 60-69% CAS (n=22), group 4 - patients with CASa70% (n=361). Results. Most patients were men (p<0.001), except group 1, where women prevailed (p<0.05). Patients in groups 3 and 4 were older than in groups 1 and 2 (p=0.019). Symptoms of angina were less likely to be found in group 1 (p<0.001). History of myocardial infarction (Ml) prevailed in group 4 (p<0.001). Arrhythmias were detected more frequently in group 1 (p<0.001); there were less diabetics in this group (p=0.010). Group 1 contained more patients examined before cardiac valve surgery (p < 0.001). Typical angina was more often found in group 4, whereas atypical angina - in group 1 (p< 0.001). Cardialgia prevailed in groups 1 and 2 (p< 0.001). Holter ECG monitoring was used more frequently in group 1 (p< 0.001). Symptoms of latent coronary insufficiency were mainly reported in group 1 (p=0.006). The pretest probability of ischemic heart disease (IHD) was higher in groups 2 and 4 compared to group 1 (p<0.001). Conclusion. Among patients who had undergone ECAG 32.9% had no CAS. Younger females without history of Ml and diabetes as well as patients with atypical angina or cardialgia prevailed in this group. This group of patients had the lowest pretest probability of IHD (58%). Patients without CAS were more often scheduled for EGAG before valvular heart surgery and because of cardiac arrhythmias.


Pomeshkina S.A.,Research Institute for Complex Problems of Cardiovascular Diseases | Loktionova E.B.,Research Institute for Complex Problems of Cardiovascular Diseases | Arkhipova N.V.,Research Institute for Complex Problems of Cardiovascular Diseases | Barbarash O.L.,Research Institute for Complex Problems of Cardiovascular Diseases
Kardiologiya | Year: 2017

Aim: to assess efficacy of home-based exercise training (HBET) at outpatient stage of cardiac rehabilitation and its impact on adherence to treatment in patients after coronary artery bypass grafting (CABG). Material and methods. In 1 month after CABG 112 male patients (after completion of rehabilitation program in the sanatorium) were distributed to 3 groups with comparable demographic, clinical, and functional parameters: group 1 - patients fulfilling supervised cycling training program (SCTP), group 2 - patients subjected to home-based exercise training (HBET) with defined walking sessions (WS), and the control group of usual care without exercise training. Patients were examined 1, 4 months and 1 year after CABG. Results. Three months SCTP was most efficient relative to improvement of exercise tolerance (ET), modification of cardiovascular risk factors (smoking, obesity, dyslipidemia), and of adherence to medical therapy. Lowest ET and worst adherence to medical and non-medical therapies were found in the group of usual care without exercise training. The intermediate position was occupied by patients subjected to HBET and WS. Effects of 3 months of HBET diminished by 1 year of follow-up. Conclusion. HBET of moderate intensity appeared to be safe, easily workable and affordable training program for patients after CABG. However, it was less effective, compared with SCTP. Moreover, effects of this rehabilitation program were transitory.


Maksimov S.A.,Research Institute for Complex Problems of Cardiovascular Diseases | Tabakaev M.V.,Research Institute for Complex Problems of Cardiovascular Diseases | Artamonova G.V.,Research Institute for Complex Problems of Cardiovascular Diseases
Profilakticheskaya Meditsina | Year: 2016

Objective - to analyze the impact of socioeconomic features on the population-based risk of coronary heart disease (CHD) due to cardiovascular risk factors (CVRFs). Subject and methods. This investigation was conducted within the multicenter epidemiological study ESSE-RF in the Kemerovo Region. It was concerned with a random population sample of 1628 men and women aged 25-64 years. CVRFs, such as lifestyle, a number of diseases, and biochemical indicators of dyslipidemia, were considered as CVRs. Among the socioeconomic indicators, marital status, education, employment/unemployment, and income were considered. The load of SVRFs, which was composed of the ratio of their prevalence in the study subpopulations to that in the entire population, as well as the contribution of these CVRFs to the incidence of CHD, was calculated to assess the populationbased risk of CHD caused by SVRFs. Results. The differences in the spread of CVRFs in the socioeconomic cohorts of the population determine distinctions in the population-based risk of CHD. The additional risk for CHD due to CVRFs increases up to 3.0% in married men and decreases to -0.9% in single men; it increases up to 10.3% in unemployed one. The additional risk for CHD caused by CVRFs reduces to 4.5% in women having higher education in relation to the regional values and does to -2.2% in employed women. Conclusion. This investigation suggests that there are distinctions in the population-based risk of CHD due to CVRFs in the socioeconomic cohorts of the population. The higher spread of a number of CVRFs among married or unemployed men determines the increased additional risk of CHD. The low spread of CVRs and accordingly the low additional risk of CHD caused by these SVRFs are observed in women with higher education and in those who are employed.


PubMed | Kemerovo State Medical Academy and Research Institute for Complex Problems of Cardiovascular Diseases
Type: Journal Article | Journal: Terapevticheskii arkhiv | Year: 2016

To evaluate the prognostic impact of chronic kidney disease (CKD) during hospital stay in patients with ST-segment elevation myocardial infarction (STEMI) and to specify factors showing a negative impact of CKD.954 patients with STEMI were examined. The diagnosis of CKD was verified in 338 (35.4%). In all the patients, glomerular filtration rate (GFR) was calculated using the CKD-EPI formula with regard to serum creatinine levels on admission and before discharge (on days 10--12). In the patients who had undergone X-ray contrast intervention, serum creatinine levels were additionally determined on days 2--3 of this procedure in order to identify contrast-induced nephropathy (CIN). Cardiovascular events were assessed in the hospital period.Endovascular interventions into the coronary vessels were made much more rarely in the patients with CHD; but CIN cases were twice more commonly recorded. Nonfatal cardiovascular events were 1.5 times more frequently observed in the CKD patients in the hospital period. The odds of fatal outcomes in both the total sample of STEMI patients and in those with CKD increased by 3.5 and 3.1 times, respectively, in the over 60 age group and by 7.9 and 5.8 times in the presence of Killip Classes II--IV clinically relevant acute heart failure (AHF). In the total sample, the independent predictors for a fatal outcome were a decreased admission GFR less than 60 ml/min/1.73 m(2), CIN, and Killip II--IV AHF. The hospital nonfatal complications were also associated with a decreased admission GFR less than 60 ml/min/1.73 m(2).The independent predictor of a poor hospital period of STEMI, including fatal outcomes, was a decreased admission GFR less than 60 ml/min/1.73 m(2); the presence of CKD was of no independent value.


PubMed | Kemerovo State Medical Academy, Siberian State Medical University and Research Institute for Complex Problems of Cardiovascular Diseases
Type: Journal Article | Journal: Terapevticheskii arkhiv | Year: 2016

To determine the concentration of the stimulating growth factor ST2 and its relationship to the clinical course of myocardial infarction (MI) over time during hospitalization.Eighty-eight MI patients whose mean age was 598.36 years were examined. On days 1 and 12 of MI, the serum levels of ST2 and N-terminal pro-brain natriuretic peptide (NT-proBNP) were determined by ELISA. A control group consisted of 30 people.On day 1 of hospitalization for MI, the concentrations of ST2 and NT-proBNP were higher 2.4 and 4.5 times, respectively, than those in the controls; by day 12, there was a statistically significant decrease in the level of ST2 while that of NT-proBNP was unchanged. During hospitalization, the investigators recorded MI complications, according to which the patients were divided into favorable and unfavorable MI groups. On day 1 of hospitalization, the level of ST2 in the patients with unfavorable MI was twice higher than in those with favorable MI and 3.7 times higher than in the control group. On day 12, both favorable and unfavorable MI groups showed a reduction in the level of the marker. On day 1 of MI, the concentration of NT-proBNP in the patients with a poor prognosis was 6.8 times greater than in the controls and 1.8 times more than in the patients with a good prognosis. On day 12, NT-proBNP levels remained elevated in both groups. Logistic regression analysis revealed that the determination of ST2 in combination with NT-proBNP increased their diagnostic significance (odds ratio, 1.92; 95% CI, 1.7-3.2; area under characteristic curve, 0.89; p=0.004).The level of ST2 was a more sensitive indicator of hospitalization for MI than that of NT-proBNP. The combined use of ST2 and NT-proBNP was found to have a high diagnostic sensitivity and specificity.


PubMed | Kemerovo State Medical Academy and Research Institute for Complex Problems of Cardiovascular Diseases
Type: Journal Article | Journal: Terapevticheskii arkhiv | Year: 2016

To comparatively assess formulas for estimating glomerular filtration rate (GFR) in the prediction of poor outcomes in patients with type 2 diabetes mellitus (DM) within one year after myocardial infarction (MI).The investigators examined 89 patients with ST-segment elevation myocardial infarction (STEMI) within 24 hours after the onset of clinical symptoms of the disease. All the patients underwent standard laboratory and instrumental tests. GFR was calculated using the Modified of Diet in Renal Diseases (MDRD) formulas in terms of serum creatinine levels, the Hoek equation: GFR [ml/min/1.73 m2] = (80.35/cystatin C [mg/l]) - 4.3 (CKD-EPI), as well as from cystatin C levels, and the creatinine clearance rate was determined using the Cockcroft and Gault formula (ml/min). During a year after STEMI, the investigators recorded cardiovascular events (CVEs), such as death, recurrent MI, progressive angina pectoris, emergency coronary revascularization, and decompensated chronic heart failure (CHF). The examinees were divided into two groups: 1) 70 (78.6%) patients with MI and no DM; 2) 19 (21.3%) patients with MI and DM.Comparative analysis revealed a tendency towards a difference in the detection rate of GFR <60 ml/min/1.73 m2 calculated using the Hoek formula from cystatin C levels: 42.1% in Group 2 and 21.4% in Group 1 (=0.067). There were no great differences in the GFR estimated using other formulas. Logistic regression analysis was carried out to determine the most sensitive formula for estimating GFR to assess the risk of CVEs in the patients within a year after MI concurrent with and without type 2 DM. A univariate analysis showed that GFR calculations using the CKD-EPI (odds ratio (OR), 13.5; p=0.046) and MDRD (OR, 6.5; =0.040) formulas and creatinine clearance estimation (OR, 2.4; p=0.025) were most sensitive in selecting MI patients without DM and with poor outcomes. This analysis revealed that GFR estimates using the Hoek formula from cystatin C levels (OR, 6.15; p=0.018) were most sensitive for patients with MI concurrent with type 2 DM. In both models, multivariate analysis included none of the analyzed indicators.To estimate cardiovascular risk in the long-term post-infarction period, the CKD-EPI formula in the patients without type 2 DM and the Hoek formula from cystatin C levels were noted to be of the greatest prognostic value in patients with DM.


Kruchkov D.V.,Research Institute for Complex Problems of Cardiovascular Diseases | Artamonova G.V.,Research Institute for Complex Problems of Cardiovascular Diseases
Kardiologiya | Year: 2016

The purpose of this study was to explore the long-Term survival of patients after myocardial infarction (Ml) and to elucidate main medical and social factors affecting survival. Material and methods. In 2006 we included into this study 791 consecutive patients with Ml. Duration of follow-up was 8.5 years. Survival was analyzed by construction of life tables and calculation of Kaplan-Meier estimates. Results. During follow-up 446 patients died. Leading was cardiovascular death (88.2%). Other causes were cancer (7.1%), internal diseases (4.1%), and external causes (0.6%). Risk of death was the highest during first year. One, three, and five-year survival was 74.9, 62.2 and 53.8%, respectively. Main medical and social factors that reduced long-Term survival were: old age, lack of work, no percutaneous coronary intervention during initial hospitalization, recurrent myocardial infarction, and male sex among working age patients.


Sumin A.N.,Research Institute for Complex Problems of Cardiovascular Diseases | Raih O.I.,Research Institute for Complex Problems of Cardiovascular Diseases
Kardiologiya | Year: 2016

Aim of the study was to examine relationship between behavioral type D and adherence to therapy in cardiological patients. Material and methods. Patients (n=308, 63 [20.5%] women and 245 [79.5%] men, mean age 59±4 years) with stable ischemic heart disease and arterial hypertension were divided into 2 groups: with (n = 84) and without (n = 224) type D. Psychological status was assessed using type D scale-14 (DS-14) questionnaire, adherence to treatment - with the help of S.V. Davydov method and the Morisky-Green test. Results. Patients with compared with those without type D personality more often had indicators of lower adherence to treatment (48 vs 39%, p < 0.05). Indicators of higher adherence were found more often in the group without type D personality (11 vs 19%, p< 0.003). Indicators of lower compliance were independently associated with type D personality (odds ratio 3.21, p=0.02). Conclusion. Patients with type D personality have lower adherence to therapy. This can be a link between type D behavior and unfavorable prognosis in patients with cardiovascular diseases.


PubMed | Tomsk State University, Research Institute of Medical Genetics and Research Institute for Complex Problems of Cardiovascular Diseases
Type: Comparative Study | Journal: PloS one | Year: 2015

Epigenetic mechanisms of gene regulation in context of cardiovascular diseases are of considerable interest. So far, our current knowledge of the DNA methylation profiles for atherosclerosis affected and healthy human vascular tissues is still limited. Using the Illumina Infinium Human Methylation27 BeadChip, we performed a genome-wide analysis of DNA methylation in right coronary artery in the area of advanced atherosclerotic plaques, atherosclerotic-resistant internal mammary arteries, and great saphenous veins obtained from same patients with coronary heart disease. The resulting DNA methylation patterns were markedly different between all the vascular tissues. The genes hypomethylated in athero-prone arteries to compare with atherosclerotic-resistant arteries were predominately involved in regulation of inflammation and immune processes, as well as development. The great saphenous veins exhibited an increase of the DNA methylation age in comparison to the internal mammary arteries. Gene ontology analysis for genes harboring hypermethylated CpG-sites in veins revealed the enrichment for biological processes associated with the development. Four CpG-sites located within the MIR10B gene sequence and about 1 kb upstream of the HOXD4 gene were also confirmed as hypomethylated in the independent dataset of the right coronary arteries in the area of advanced atherosclerotic plaques in comparison with the other vascular tissues. The DNA methylation differences observed in vascular tissues of patients with coronary heart disease can provide new insights into the mechanisms underlying the development of pathology and explanation for the difference in graft patency after coronary artery bypass grafting surgery.

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