Ulyanovsk Medico-biological Journal

CLINICAL MEDICINE

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DOI 10.34014/2227-1848-2020-3-44-57

 

RESULTS OF ENDOVASCULAR MYOCARDIAL REVASCULARIZATION AND QUALITY OF LIFE IN SUCH PATIENTS AGED UNDER 40

 

F.Z. Abdullaev, F.E. Abbasov, N.M. Babaev, L.S. Shikhieva, G.A. Amrakhova

M.A. Topchubashov Scientific and Surgical Center, Baku, Azerbaijan

 

The aim of the paper is to correlate the results of endovascular myocardial revascularization (EMR) in patients under 40 years of age with acute coronary syndrome (ACS) / stable angina, primary EMRage ≤35/36–40 and stent diameter.

Materials and Methods. The authors examined 208 patients (24–40 years of age) with coronary artery disease: 157 patients (75.5 %) aged 36–40; 51 patients (24.5 %) aged ≤35. All in all, 165 (79.3 %) patients underwent EMR; 32 patients (15.4 %) underwent coronary artery bypass grafting; 11 patients (5.3 %) refused medical intervention. EMR results and the quality of life were studied in 126 patients (76.4 %) at 10–107 months of observation (62.5±2.6 months).

Results. 84 patients with ACS (50.9 %) and 81 patients with stable angina (49.1 %) underwent EMR. There were no any peri-procedural complications. The authors observed 0 % hospital and 30-day mortality. The survival rate of patients for the period up to 9 years was 99.2 %; long-term mortality was 0.8 %; the constancy of results up to 1, 2 and 3 years of follow-up was 90.5 %, 84.1 % and 81.7 %, respectively, and up to 5–9 years it was 79.4 %. An active lifestyle was verified in 74.6 % of patients; a sparing lifestyle was observed in 25.4 %; 86.5 %, of patients returned to work; transient sexual disorders were found in 28.6% of patients. 83.3 % and 27.8 % of patients kept to drug therapy and dietary regimen. 34.1 % and 23.8 % of patients kept smoking and taking power drinks; overweight and obesity were observed in 23.8 % and 19 % of patients. Recurrent myocardial infarction (MI) / angina was verified in 23 % of patients; 20.6 % of patients underwent second EMR. 23 % of patients got depressed due to recurrent myocardial infarction / angina, while 18.3 % of patients were down due to the quarantine (COVID-19); 6.3 % suffered from panic attacks, for fear of recurrent anginous pain.

Conclusion. Predictors of recurrent EMR and stability of results were: 1) ACS; 2) patients’ age (≤35); 3) history of MI, ejection fraction ≤35–40 %, diabetes; 4) stent diameter (<28 mm); 5) smoking and taking power drinks. The leading predictor was the aggressiveness of atherosclerosis and diabetes in persons under 40, causing: a) early stent dysfunction; b) native and “protected” coronary vessels damage in case of intact stents patency.

Keywords: ischemic heart disease, young patients, risk profile, semiotics of coronary arteries, endovascular myocardial revascularization, quality of life.

Conflict of interest. The authors declare no conflict of interest.

 

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Received 08 May 2020; accepted 08 August 2020.

 

Information about the authors

Abdullaev Fuad Zeynalovich, Doctor of Sciences (Medicine), Professor, Cardiac Surgeon, Chief Researcher, Department of Heart Surgery, M.A. Topchubashov Scientific and Surgical Center. AZ 1122, Azerbaijan, Baku, Sharif-zade Street, 196; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0001-9759-2871

Abbasov Fazil' Eyvaz oglu, Doctor of Sciences (Medicine), Professor, Cardiac Surgeon, Head of the Department of Heart Surgery, M.A. Topchubashov Scientific and Surgical Center. AZ 1122, Azerbaijan, Baku, Sharif-zade Street, 196; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-6867-8251

Babaev Nidzhat Maksad oglu, Junior Researcher, Cardiologist, M.A. Topchubashov Scientific and Surgical Center. AZ 1122, Azerbaijan, Baku, Sharif-zade Street, 196; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0001-9936-7109

Shikhieva Larisa Sabir gyzy, Candidate of Sciences (Medicine), Cardiologist, Senior Researcher, M.A. Topchubashov Scientific and Surgical Center. AZ 1122, Azerbaijan, Baku, Sharif-zade Street, 196; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0001-8479-989X

Amrakhova Gyunay Arastun gyzy, Cardiac Surgeon, M.A. Topchubashov Scientific and Surgical Center. AZ 1122, Azerbaijan, Baku, Sharif-zade Street, 196; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-1738-2311

 

For citation

Abdullaev F.Z., Abbasov F.E., Babaev N.M., Shikhieva L.S., Amrakhova G.A. Iskhody endovaskulyarnoy revaskulyarizatsii miokarda i posleduyushchee kachestvo zhizni u bol'nykh molozhe 40 let [Results of endovascular myocardial revascularization and quality of life in such patients aged under 40]. Ul'yanovskiy mediko-biologicheskiy zhurnal. 2020; 3: 44–57. DOI: 10.34014/2227-1848-2020-3-44-57 (in Russian).

 

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УДК 616.127-089.844:616-059

DOI 10.34014/2227-1848-2020-3-44-57

 

ИСХОДЫ ЭНДОВАСКУЛЯРНОЙ РЕВАСКУЛЯРИЗАЦИИ МИОКАРДА И ПОСЛЕДУЮЩЕЕ КАЧЕСТВО ЖИЗНИ У БОЛЬНЫХ МОЛОЖЕ 40 ЛЕТ

 

Ф.З. Абдуллаев, Ф.Э. Аббасов, Н.М. Бабаев, Л.С. Шихиева, Г.А. Амрахова

Научный центр хирургии им. М.А. Топчибашева, г. Баку, Азербайджан

 

Цель. Корреляция результатов эндоваскулярных реваскуляризаций миокарда (ЭВРМ) у больных моложе 40 лет с острым коронарным синдромом (ОКС) / стабильной стенокардией, возрастом при первичной ЭВРМ ≤35 лет / 36–40 лет и диаметром стентов.

Материалы и методы. Обследовано 208 больных ИБС в возрасте 24–40 лет: 157 (75,5 %) чел. – в возрасте 36–40 лет, 51 (24,5 %) – ≤35 лет. ЭВРМ выполнена 165 (79,3 %) больным, коронарное шунтирование – 32 (15,4 %), 11 (5,3 %) пациентов отказались от вмешательства. Исходы ЭВРМ и качество жизни изучены у 126 (76,4 %) больных на сроках 10–107 мес. (62,5±2,6 мес.) наблюдения.

Результаты. ЭВРМ выполнена 84 (50,9 %) больным ОКС и 81 (49,1 %) больному стабильной стенокардией. Перипроцедурных осложнений не выявлено. Госпитальная и 30-дневная летальность составила 0 %. Выживаемость пациентов на сроках до 9 лет – 99,2 %; отдаленная летальность – 0,8 %; сохранность результатов до 1, 2 и 3 лет наблюдения составила соответственно 90,5, 84,1 и 81,7 %, до 5–9 лет – 79,4 %. Активный образ жизни верифицирован у 74,6 % обследованных, щадящий – у 25,4 %, возврат к работе – у 86,5 %, транзиторные сексуальные нарушения – у 28,6 %. Медикаментозную терапию и диетический режим питания соблюдали 83,3 и 27,8 % пациентов. Продолжали курить и принимать энергетические напитки 34,1 и 23,8 % обследованных; избыточный вес и ожирение сохранялись у 23,8 и 19 %. Рецидив инфаркта миокарда (ИМ) / стенокардии отмечен у 23 % пациентов; повторные ЭВРМ выполнены 20,6 % больным. Депрессию из-за рецидива ИМ / стенокардии отмечали 23 % пациентов, ввиду карантина (COVID-19) – 18,3 %; 6,3 % страдали паническими атаками, боясь повторения ангинозных болей.

Выводы. Предикторами повторных ЭВРМ и стабильности результатов являются: 1) ОКС; 2) возраст ≤35 лет; 3) анамнез ИМ, фракция выброса ≤35–40 %, диабет; 4) диаметр стентов <28 мм; 5) курение и прием энергетических напитков. Ведущий предиктор – агрессивность атеросклероза и диабета у лиц не старше 40 лет, обусловливающих: а) раннюю дисфункцию стентов; б) при сохранной проходимости стентов – поражение нативных и «защищенных» коронарных сосудов.

Ключевые слова: ишемическая болезнь сердца, молодые больные, профиль риска, семиотика коронарных артерий, эндоваскулярная реваскуляризация миокарда, качество жизни.

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

 

Литература

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  2. Konishi H., Miyauchi K., Kasai T., Tsuboi Sh., Ogita M., Naito R., Katoh Y., Okai I., Tamura H., Okazaki S., Daida H. Long-term prognosis and clinical characteristics of young adults (≤40 years old) who underwent percutaneous coronary intervention. J. Cardiology. 2014; 64 (3): 171–174. DOI: http://dx.doi.org /10.1016/j.jjcc.2013.12.005.

  3. Chua Su-Kiat, Hung Huei-Fong, Shyu Kou-Gi, Cheng Jun-Jack, Chiu Chiung-Zuan, Chang Che-Ming. Acute ST-elevation Myocardial Infarction in Young Patients: 15 Years of Experience in a Single Center. Clin. Cardiol. 2010; 33 (3): 140–148. DOI: https://doi.org/10.1002/clc.20718.

  4. Meliga E., De Benedictis M., Gagnor A., Belli R., Scrocca I., Lombardi P., Conrotto F., Aranzulla T., Varbella F. Conte M.R. Long-term outcomes of percutaneous interventions with stent implantation in patients ≤40 years old. Am. J. Cardiol. 2012; 109 (12): 1717–1721. DOI: http://doi:10.1016/j.amjcard.2012.01.400.

  5. Feijo I.P., Schmidt M.M., David R.B., Martins J.M.P., Schmidt K.E., Gottscha lL. Clinical profile and outcomes of primary percutaneous coronary intervention in young patients. Rev. Bras. Cardiol. Invasiva. 2015; 23 (1): 48–51. DOI: http://dx.doi.org/10.1016/j.rbci.2015.01.006.

  6. Trzeciak P., Gierlotka M., Gasior M., Lekston A., Zembala M., Polonski L. After Acute Coronary Syndrome Treatment in Patients Aged <40 Years of Age (from the Polish Registry of Acute Coronary Syndromes). Am. J. Cardiol. 2014; 114 (2): 175–180. DOI: https://doi.org/10.1016/j.amjcard.2014.04.024.

  7. Чарышкин А.Л., Матвеева Л.В., Юдин А.Н. Оценка эффективности чрескожных коронарных вмешательств у пациентов до 40 лет с ишемической болезнью сердца. Ульяновский медико-биологический журнал. 2017; 3: 28–36. DOI: https://doi.org/10.23648/UMBJ.2017.27.7073.

  8. Han T., Wang Q., Yang H., Zhou S., Wang J., Jing J., Zhang T., Liu Y. Chen Y. Risk factors for repeat percutaneous coronary intervention in young patients (≤45 years of age) with acute coronary syndrome. Peer J. 2019; 7: e6804. DOI: https://doi.org/10.7717/peerj.6804.

  9. Cader F.A., Rahman A., Rahman M.A., Zaman Sh., Arefin M.M., Reza A.T., Matin M.A., Islam S., Afroz F., Jafor A.H. Comparison of Short-term Outcomes of Percutaneous Coronary Intervention between Young Male and Female Patients with Acute Coronary Syndrome. Bangladesh Heart Journal. 2018; 33 (1): 1–9. DOI: http://dx.doi.org/10.3329/bhj.v33i1.37015.

  10. Patted S.V., Porwal S.C., Halkati P.C., Ambar S., Prasad M.R., Metgudmath V.B., Hesarur V., Konin R.S. Comparison of Clinical profile and outcome between young (≤45yrs) male and female patients with coronary artery disease undergoing percutaneous coronary intervention, a single center study. Journal of Medical Science and Clinical Research. 2017; 05 (02): 17919–17925. DOI: https://dx.doi:10.18535 /jmscr/v5i2.117.

  11. Trzeciak P., Wozakowska-Kaplon B., Niedziela J., Gierlotka M., Hawranek M., Lekston A. Comparison of In-hospital and 12- and 36-Month Outcomes After Acute Coronary Syndrome in Men Versus Women <40 Years (from the PL-ACS Registry). Am. J. Cardiol. 2016; 118 (9): 1300–1305. DOI: http://doi.10.1016/j.amjcard.2016.07.067.

  12. Lansky A.J., Mehran R., Dangas G., Cristea E., Shirai K., Costa R., Costantini C., Tsuchiya Y., Carlier S., Mintz G., Cottin Y., Stone G., Moses J., Leon M.B. Comparison of differences in outcome after percutaneous coronary intervention in men versus women <40 years of age. Am. J. Cardiol. 2004; 93 (7): 916–919. DOI: https://doi.org/10.1016/j.amjcard.2003.12.046.

  13. Puricel S., Lehner C., Oberhänslia M., Rutz T., Togni M., Stadelmann M., Moschovitis A., Meir B., Wenaweser P., Windecker S., Stauffer J.C., Cook S. Acute coronary syndrome in patients younger than 30 years – aetiologies, baseline characteristics and long-term clinical outcome. Swiss. Med. Wkly. 2013; 143: w13816. DOI: http://doi:10.4414/smw.2013.13816.

  14. Trzeciak P., Desperak P., Ciślak A., Hawranek M., Gąsior M. Clinical characteristics, and in-hospital and long-term outcomes of stable angina treatment in patients below and over 40 years of age (from the PRESAGE registry). Kardiol. Pol. 2018; 76 (1): 186–194. DOI: https://doi.org/10.5603/kp.a2017.0200.

  15. Bienert I.R.C., Ribeiro E.E., Kajita L.J., Perin M.A., Campos C.A.H., Trentin F., Lemos P.A. Long-term prognosis in young patients with stable coronary disease: ten-year follow-up of percutaneous coronary intervention. Rev. Bras. Cardiol. Invasiva. 2012; 20 (2): 162–165. DOI: http://dx.doi.org/10.1590/S2179-83972012000200009.

  16. Mukherjee D., Hsu A., Moliterno D.J., Lincoff A.M., Goormastic M., Topol E.J. Risk factors for premature coronary artery disease and determinants of adverse out comes after revascularization in patients < or =40 years old. Am. J. Cardiol. 2003; 92 (12): 1465–1467. DOI: http://doi.org/10.1016/j.amjcard.2003.08.062.

  17. Kulik A. Quality of life after coronary artery bypass graft surgery versus percutaneous coronary intervention: what do the trials tell us? Current Opinion in Cardiology. 2017; 32 (6): 707–714. DOI: http://doi.org/10.1097/HCO.0000000000000458.

  18. Abdallah M.S., Wang K., Magnuson E.A., Osnabrugge R.L., Kappetein A.P., Morice M.C., Mohr F.A., Serruys P.W., Cohen D.J. Quality of Life After Surgery or DES in Patients With 3-Vessel or Left Main Disease. JACC. 2017; 69 (16): 2039–2049. DOI: http://dx.doi.org/10.1016/j.jacc.2017.02.031.

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Поступила в редакцию 08.05.2020; принята 08.08.2020.

 

Авторский коллектив

Абдуллаев Фуад Зейналович – доктор медицинских наук, профессор, кардиохирург, главный научный сотрудник отделения хирургии сердца, Научный центр хирургии им. М.А. Топчибашева. AZ 1122, Азербайджан, г. Баку, ул. Шариф-заде, д. 196; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0001-9759-2871

Аббасов Фазиль Эйваз оглу – доктор медицинских наук, профессор, кардиохирург, руководитель отделения хирургии сердца, Научный центр хирургии им. М.А. Топчибашева. AZ 1122, Азербайджан, г. Баку, ул. Шариф-заде, д. 196; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-6867-8251

Бабаев Ниджат Максад оглу – младший научный сотрудник, кардиолог, Научный центр хирургии им. М.А. Топчибашева. AZ 1122, Азербайджан, г. Баку, ул. Шариф-заде, д. 196; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0001-9936-7109

Шихиева Лариса Сабир гызы – кандидат медицинских наук, кардиолог, старший научный сотрудник, Научный центр хирургии им. М.А. Топчибашева. AZ 1122, Азербайджан, г. Баку, ул. Шариф-заде, д. 196; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0001-8479-989X

Амрахова Гюнай Арастун гызы – кардиохирург, Научный центр хирургии им. М.А. Топчибашева. AZ 1122, Азербайджан, г. Баку, ул. Шариф-заде, д. 196; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-1738-2311

 

Образец цитирования

Абдуллаев Ф.З., Аббасов Ф.Э., Бабаев Н.М., Шихиева Л.С., Амрахова Г.А. Исходы эндоваскулярной реваскуляризации миокарда и последующее качество жизни у больных моложе 40 лет. Ульяновский медико-биологический журнал. 2020; 3: 44–57. DOI: 10.34014/2227-1848-2020-3-44-57.

CLINICAL MEDICINE

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DOI 10.34014/2227-1848-2020-3-28-43

 

APPLICATION OF ULTRASOUND ASSESSMENT OF LEFT VENTRICULAR CARDIAC STRAIN IN CARDIOLOGY

 

A.V. Mukhametgareeva1, 2, V.V. Kashtalap1, A.N. Molchanov1, 2, A.S. Vorob'ev1, I.A. Urvantseva1, 2, V.V. Romashkin2, L.V. Kovalenko1

1 Surgut State University, Surgut, Russia;

2 District Cardiological Dispensary, Center for Diagnostics and Cardiovascular Surgery, Surgut, Russia

 

Cardiovascular diseases (CVDs) remain one of the most urgent health problems worldwide. These diseases cover a large population groups and affect all age groups regardless of gender. Heart failure (HF), as a natural complication of most CVDs, is not an exclusive disease of the elderly people. There are numerous and complex pathophysiological mechanisms that operate regardless of age and cause HF. These include traditional cardiovascular risk factors (arterial hypertension, dyslipidemia, overweight), low living standards, and problematic access to health system due to socio-economic inequalities. Special attention is currently paid to the problem of early heart failure diagnosis. So, today the medical community is discussing the possibility of using such a non-invasive technique as ultrasound to study cardiac strain.

Currently, ultrasound is an affordable and highly informative technique for early diagnosis of HF manifestations. The authors consider the issue of not only clinical, but also prognostic significance of cardiac strain indicators in patients with CVD and HF. This review highlights the main issues of cardiac strain assessment, ultrasound advantages and limitations. The authors studied publicly available literature and analyzed promising directions for ultrasound application in modern cardiology. For literary analysis, the resources of PubMed, eLibrary, CyberLeninka, MedLine, Google Scholar, and Elsevier were used.

Keywords: heart failure, echocardiography, cardiac strain, cardiovascular risk.

Conflict of interest. The authors declare no conflicts of interest.

 

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Received 20 April 2020; accepted 20 July 2020.

 

Information about the authors

Mukhametgareeva Aygul' Vil'evna, Vice Head of the Department of Functional and Ultrasound Diagnostics, Functional Diagnostics Doctor, District Cardiological Dispensary, Center for Diagnostics and Cardiovascular Surgery, Postgraduate Student, Chair of Cardiology, Medical Institute. 628412, Russia, Surgut, Lenin Ave., 69/1; Postgraduate Student, Surgut State University. 628412, Russia, Surgut, Lenin Ave., 1; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0001-7611-7430

Kashtalap Vasiliy Vasil'evich, Doctor of Sciences (Medicine), Associate Professor, Professor of the Chair of Cardiology, Medical Institute, Surgut State University. 628412, Russia, Surgut, Lenin Ave., 1; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-3729-616X

Molchanov Andrey Nikolaevich, Candidate of Sciences (Medicine), Cardiovascular Surgeon, Cardiac Surgery Department No. 1, Regional Cardiological Dispensary, Center for Diagnostics and Cardiovascular Surgery, the Khanty-Mansiysk Autonomous Okrug – Yugra. 628412, Russia, Surgut, Lenin Ave., 69/1; Associate Professor, Chair of Cardiology, Surgut State University. 628412, Russia, Surgut, Lenin Ave., 1; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0001-9419-1167

Vorob'ev Anton Sergeevich, Candidate of Sciences (Medicine), Associate Professor, Chair of Cardiology, Leading Researcher, Scientific and Educational Center, Medical Institute, Surgut State University. 628412, Russia, Surgut, Lenin Ave., 1; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-4279-7578

Urvantseva Irina Aleksandrovna, Candidate of Sciences (Medicine), Chief Physician, Regional Cardiological Dispensary, Center for Diagnostics and Cardiovascular Surgery, Khanty-Mansiysk Autonomous Okrug – Yugra. 628412, Russia, Surgut, Lenin Ave., 69/1; Head of the Chair of Cardiology, Surgut State University. 628412, Russia, Surgut, Lenin Ave., 1; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-5545-9826

Romashkin Valeriy Viktorovich, Deputy Chief Physician for Medical Affairs, Cardiovascular Surgeon, Regional Cardiological Dispensary, Center for Diagnostics and Cardiovascular Surgery, Khanty-Mansiysk Autonomous Okrug – Yugra. 628412, Russia, Surgut, Lenin Ave., 69/1; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-1611-1322

Kovalenko Lyudmila Vasil'evna, Doctor of Sciences (Medicine), Professor, Director of the Medical Institute, Head of the Chair of Pathophysiology and General Pathology, Surgut State University. 628412, Russia, Surgut, Lenin Ave., 1; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-5923-0340

 

For citation

Mukhametgareeva A.V., Kashtalap V.V., Molchanov A.N., Vorob'ev A.S., Urvantseva I.A., Romashkin V.V., Kovalenko L.V. Vozmozhnosti ispol'zovaniya ul'trazvukovoy otsenki deformatsii miokarda levogo zheludochka v kardiologii [Aplication of ultrasound assessment of left ventricular cardiac strain in cardiology]. Ul'yanovskiy mediko-biologicheskiy zhurnal. 2020; 3: 28–43. DOI: 10.34014/2227-1848-2020-3-28-43 (in Russian).

 

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УДК 616.124.2

DOI 10.34014/2227-1848-2020-3-28-43

 

ВОЗМОЖНОСТИ ИСПОЛЬЗОВАНИЯ УЛЬТРАЗВУКОВОЙ ОЦЕНКИ ДЕФОРМАЦИИ МИОКАРДА ЛЕВОГО ЖЕЛУДОЧКА В КАРДИОЛОГИИ

 

А.В. Мухаметгареева1,2, В.В. Кашталап1, А.Н. Молчанов1,2, А.С. Воробьев1, И.А. Урванцева1,2, В.В. Ромашкин2, Л.В. Коваленко1

1 БУ ВО Ханты-Мансийского автономного округа – Югры «Сургутский государственный университет», г. Сургут, Россия;

2 БУ Ханты-Мансийского автономного округа – Югры «Окружной кардиологический диспансер «Центр диагностики и сердечно-сосудистой хирургии», г. Сургут, Россия

 

Сердечно-сосудистые заболевания (ССЗ) остаются одной из наиболее актуальных проблем здравоохранения во всем мире. Они охватывают обширную группу населения и затрагивают все возрастные категории вне зависимости от пола. Сердечная недостаточность (СН), как закономерное осложнение большинства ССЗ, не является болезнью исключительно пожилых людей. Существуют многочисленные и сложные патофизиологические механизмы, которые реализуются вне зависимости от возраста и приводят к СН. Они включают традиционные факторы сердечно-сосудистого риска (артериальную гипертензию, дислипидемию, избыточную массу тела), низкий уровень жизни населения, а также неоптимальный доступ к системам здравоохранения из-за социально-экономического неравенства. Особое внимание в настоящее время уделяется проблеме ранней диагностики СН. Так, сегодня медицинское сообщество обсуждает возможность использования такой неинвазивной методики, как ультразвуковое исследование (УЗИ), в целях изучения деформации миокарда.

УЗИ в настоящее время – это доступная и высокоинформативная методика для ранней диагностики проявлений СН. Обсуждается вопрос не только клинической, но и прогностической значимости показателей деформации миокарда у больных с ССЗ и СН. В настоящем обзоре освещены основные вопросы оценки деформации миокарда, преимущества, а также ограничения использования этой методики. На основании полученных в открытых источниках литературы данных проведен анализ перспективных направлений применения этой методики в современной кардиологии. Для литературного поиска были использованы ресурсы поисковых систем PubMed, eLibrary, CyberLeninka, MedLine, Google Scholar, Elsevier.

Ключевые слова: сердечная недостаточность, эхокардиография, деформация миокарда, сердечно-сосудистый риск.

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

 

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Поступила в редакцию 20.04.2020; принята 20.07.2020.

 

Авторский коллектив

Мухаметгареева Айгуль Вильевна – исполняющая обязанности заведующего отделением функциональной и ультразвуковой диагностики стационара, врач функциональной диагностики, БУ Ханты-Мансийского автономного округа – Югры «Окружной кардиологический диспансер «Центр диагностики и сердечно-сосудистой хирургии». 628412, Россия, г. Сургут, пр. Ленина, 69/1; аспирант, БУ ВО Ханты-Мансийского автономного округа – Югры «Сургутский государственный университет». 628412, Россия, г. Сургут, пр. Ленина, 1; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0001-7611-7430

Кашталап Василий Васильевич – доктор медицинских наук, доцент, профессор кафедры кардиологии, БУ ВО Ханты-Мансийского автономного округа – Югры «Сургутский государственный университет». 628412, Россия, г. Сургут, пр. Ленина, 1; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-3729-616X

Молчанов Андрей Николаевич – кандидат медицинских наук, врач – сердечно-сосудистый хирург кардиохирургического отделения № 1, БУ Ханты-Мансийского автономного округа – Югры «Окружной кардиологический диспансер «Центр диагностики и сердечно-сосудистой хирургии». 628412, Россия, г. Сургут, пр. Ленина, 69/1; доцент кафедры кардиологии, БУ ВО Ханты-Мансийского автономного округа – Югры «Сургутский государственный университет». 628412, Россия, г. Сургут, пр. Ленина, 1; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0001-9419-1167

Воробьев Антон Сергеевич – кандидат медицинских наук, доцент кафедры кардиологии, ведущий научный сотрудник научно-образовательного центра Медицинского института, БУ ВО Ханты-Мансийского автономного округа – Югры «Сургутский государственный университет». 628412, Россия, г. Сургут, пр. Ленина, 1; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-4279-7578

Урванцева Ирина Александровна – кандидат медицинских наук, главный врач, БУ Ханты-Мансийского автономного округа – Югры «Окружной кардиологический диспансер «Центр диагностики и сердечно-сосудистой хирургии». 628412, Россия, г. Сургут, пр. Ленина, 69/1; заведующая кафедрой кардиологии, БУ ВО Ханты-Мансийского автономного округа – Югры «Сургутский государственный университет». 628412, Россия, г. Сургут, пр. Ленина, 1; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-5545-9826

Ромашкин Валерий Викторович – заместитель главного врача по медицинской части, врач – сердечно-сосудистый хирург, БУ Ханты-Мансийского автономного округа – Югры «Окружной кардиологический диспансер «Центр диагностики и сердечно-сосудистой хирургии». 628412, Россия, г. Сургут, пр. Ленина, 69/1; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-1611-1322

Коваленко Людмила Васильевна – доктор медицинских наук, профессор, директор Медицинского института, заведующая кафедрой патофизиологии и общей патологии, БУ ВО Ханты-Мансийского автономного округа – Югры «Сургутский государственный университет». 628412, Россия, г. Сургут, пр. Ленина, 1; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-5923-0340

 

Образец цитирования

Мухаметгареева А.В., Кашталап В.В., Молчанов А.Н., Воробьев А.С., Урванцева И.А., Ромашкин В.В., Коваленко Л.В. Возможности использования ультразвуковой оценки деформации миокарда левого желудочка в кардиологии. Ульяновский медико-биологический журнал. 2020; 3: 28–43. DOI: 10.34014/2227-1848-2020-3-28-43.

CLINICAL MEDICINE

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DOI: 10.34014/2227-1848-2020-3-8-20

 

MODERN OUTLOOKS ON RISK FACTORS OF CEREBRAL VENOUS THROMBOSIS

 

L.A. Belova, V.V. Mashin, A.I. Sitnikova, D.V. Belov

Ulyanovsk State University, Ulyanovsk, Russia

 

The review presents the main risk factors for cerebral venous thrombosis (CVT). It outlines current understanding of their role in the pathogenesis of venous strokes.

The purpose of the review is to systematize the CVT risk factors according to their effect on a particular component of the Virchow’s triad.

Pubmed and eLIBRARY, as well as publications and papers on the issue were considered to be the main sources. As a rule, CVT is a multifactorial disease, which is more typical for young people, more often women. However, it can also occur in children and elderly patients. Since CVT does not always have a specific onset, knowledge of risk factors can help in the early disease diagnostics. In comparison with arterial thrombosis, CVT prognosis is generally more favorable. However, the consequences of the disease remain in 15–30 % of patients. The article presents the factors influencing CVT prognosis and outcome. It is considered, that such patients require timely detection and early diagnostics, as it will increase treatment efficacy, reduce after-effects and mortality.

Keywords: cerebral venous thrombosis, risk factors, deep vein thrombosis, superficial vein thrombosis, venous stroke.

Conflict of interest. The authors declare no conflict of interest.

 

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Received 30 July 2020; accepted 20 August 2020.

 

Information about the authors

Belova Lyudmila Anatol'evna, Doctor of Sciences (Medicine), Professor, Dean of the Medical Department, Institute of Medicine, Ecology and Physical Culture named after T.Z. Biktimirov, Ulyanovsk State University. 432017, Russia, Ulyanovsk, L. Tolstoy Street, 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-9585-5604

Mashin Viktor Vladimirovich, Doctor of Sciences (Medicine), Professor, Head of the Chair of Neurology, Neurosurgery, Physiotherapy and Physical Therapy, Ulyanovsk State University. 432017, Russia, Ulyanovsk, L. Tolstoy Street, 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-0085-3727

Sitnikova Anastasiya Ivanovna, Post-graduate Student, Department of Neurology, Neurosurgery, Physiotherapy and Physical Therapy, Ulyanovsk State University. 432017, Russia, Ulyanovsk, L. Tolstoy Street, 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-4392-4225

Belov Dmitriy Vyacheslavovich, 4th-year Student, Ulyanovsk State University. 432017, Russia, Ulyanovsk, L. Tolstoy Street, 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-1766-0032

 

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Belova L.A., Mashin V.V., Sitnikova A.I., Belov D.V. Sovremennye predstavleniya o faktorakh riska tserebral'nykh venoznykh trombozov [Modern outlooks on risk factors of cerebral venous thrombosis]. Ul'yanovskiy mediko-biologicheskiy zhurnal. 2020; 3: 8–20. DOI: 10.34014/2227-1848-2020-3-8-20 (in Russian).

 

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УДК 616.8-005

DOI 10.34014/2227-1848-2020-3-8-20

 

СОВРЕМЕННЫЕ ПРЕДСТАВЛЕНИЯ О ФАКТОРАХ РИСКА ЦЕРЕБРАЛЬНЫХ ВЕНОЗНЫХ ТРОМБОЗОВ

 

Л.А. Белова, В.В. Машин, А.И. Ситникова, Д.В. Белов

ФГБОУ ВО «Ульяновский государственный университет», г. Ульяновск, Россия

 

В обзоре представлены основные факторы риска развития церебральных венозных тромбозов (ЦВТ). Обсуждаются современные представления о роли этих факторов в патогенезе венозных инсультов.

Целью данного обзора является систематизация факторов риска ЦВТ в зависимости от влияния на тот или иной компонент триады Вирхова.

В качестве источников информации использовались данные электронных библиотек Pubmed, eLIBRARY , а также публикации и статьи по данной проблеме.

ЦВТ представляет собой, как правило, мультифакторное заболевание, более характерное для лиц молодого возраста, чаще женского пола, но также встречающееся у детей и пожилых пациентов. Поскольку ЦВТ не всегда имеет специфическое начало, знание факторов риска может помочь в ранней диагностике этого заболевания. Прогноз при ЦВТ, по сравнению с артериальным тромбозом, в целом более благоприятный. Однако у 15–30 % пациентов остаются последствия данного заболевания. В статье представлены факторы, влияющие на прогноз и исход ЦВТ. Постулируется, что указанная категория пациентов требует своевременного распознавания и ранней диагностики заболевания, что будет способствовать повышению эффективности лечения, уменьшению последствий патологии и снижению летальности.

Ключевые слова: церебральный венозный тромбоз, факторы риска, тромбоз глубоких вен, тромбоз поверхностных вен, венозный инсульт.

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

 

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Поступила в редакцию 30.07.2020; принята 20.08.2020.

 

Авторский коллектив

Белова Людмила Анатольевна – доктор медицинских наук, профессор, декан медицинского факультета Института медицины, экологии и физической культуры им. Т.З. Биктимирова, ФГБОУ ВО «Ульяновский государственный университет». 432017, Россия, г. Ульяновск, ул. Л. Толстого, 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-9585-5604

Машин Виктор Владимирович – доктор медицинских наук, профессор, заведующий кафедрой неврологии, нейрохирургии, физиотерапии и лечебной физкультуры, ФГБОУ ВО «Ульяновский государственный университет». 432017, Россия, г. Ульяновск, ул. Л. Толстого, 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-0085-3727

Ситникова Анастасия Ивановна – аспирант кафедры неврологии, нейрохирургии, физиотерапии и лечебной физкультуры, ФГБОУ ВО «Ульяновский государственный университет». 432017, Россия, г. Ульяновск, ул. Л. Толстого, 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-4392-4225

Белов Дмитрий Вячеславович – студент 4 курса, ФГБОУ ВО «Ульяновский государственный университет». 432017, Россия, г. Ульяновск, ул. Л. Толстого, 42; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-1766-0032

 

Образец цитирования

Белова Л.А., Машин В.В., Ситникова А.И., Белов Д.В. Современные представления о факторах риска церебральных венозных тромбозов. Ульяновский медико-биологический журнал. 2020; 3: 8–20. DOI: 10.34014/2227-1848-2020-3-8-20.

CLINICAL MEDICINE

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DOI 10.34014/2227-1848-2020-3-21-27

 

COVID-19 PNEUMONIA: THE POINT OF VIEW OF VASCULAR SPECIALIST

 

Luca Costanzo1, Simona Antonina Grasso2, Francesco Paolo Palumbo3, Giorgio Ardita1, Luigi Di Pino4, Pier Luigi Antignani5, Leonardo Aluigi6, Enrico Arosio7, Giacomo Failla1

1 Angiology Unit, San Marco Hospital, Department of cardiovascular disease, AOU Policlinico “G. Rodolico-San Marco”, University of Catania, Catania, Italy;

2 Department of Anesthesia and Intensive Care, San Marco Hospital, AOU Policlinico “G. Rodolico-San Marco”, Catania, Italy;

3 Surgery Unit, Villa Fiorita Clinic, Prato, Italy;

4 Cardiology and Angiology, Department of cardiovascular disease, C.A.S.T., A.O.U. “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy;

5 Vascular center, Nuova Villa Claudia – Rome, Italy;

6 Angiology, Care Unit Villalba, Bologna, Italy;

7 University of Verona, Verona, Italy

 

The development of coagulopathy is emerging as one of the most significant poor prognostic features in COVID-19 pneumopathy. Thromboembolic manifestations such as pulmonary embolism and disseminated intravascular coagulation (DIC) have been reported and resulted in poor prognosis for the patient.

Starting from the evidence in the literature, the purpose of this paper is to analyze potential mechanism involved in coagulation impairment following COVID-19 infection and identify possible vascular therapeutic strategies.

D-dimer, a protein product of fibrin degradation, has been found elevated in the most severe cases and correlated to mortality. Potentially involved factors in the impairment of coagulation caused by viral infection include the dysregulated inflammatory response, platelet and endothelial dysfunction with impaired fibrinolysis. Heparin is an anticoagulant molecule that also showed anti-inflammatory properties and a potential antiviral effect. A favorable outcome was highlighted with the use of LMWH in severe patients with COVID-19 who meet the SIC criteria (sepsis-induced coagulopathy) or with markedly high D-dimer. The use of low molecular weight heparin could prevent thromboembolic complications in COVID-19 pneumopathy. However, the correct timing of prophylaxis according to the stage of COVID-19 disease and the appropriate therapeutic dosage to use in severe cases need further researches.

Keywords: COVID-19, pneumonia, thrombosis, coagulopathy, D-dimer, low molecular weight heparin.

Conflict of interest. The authors declare no conflict of interest.

Authors’ contributions: all authors contributed to the conception and design of manuscript. LC wrote the manuscript, SAG, FPP, GA, LDP, PLA, LA, EA, GF contributed by reading and improving the manuscript.

 

References

  1. Chen, Jianpu and Wang, Xiang and Zhang, Shutong and Liu, Bin and Wu, Xiaoqing and Wang, Yanfang and Wang, Xiaoqi and Yang, Ming and Sun, Jianqing and Xie, Yuanliang. Findings of Acute Pulmonary Embolism in COVID-19 Patients (3/1/2020). Available at SSRN: https://ssrn.com/abstract=3548771 or http://dx.doi.org/10.2139/ssrn.3548771.

  2. Tang N., Li D., Wang X., Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J. Thromb. Haemost. 2020; 18: 844–847.

  3. Goeijenbier M., van Wissen M., van de Weg C., Jong E., Gerdes V.E., Meijers J.C., Brandjes D.P., van Gorp E.C. Review: Viral infections and mechanisms of thrombosis and bleeding. J. Med. Virol. 2012; 84: 1680–1696.

  4. Branchford B.R., Carpenter S.L. The Role of Inflammation in Venous Thromboembolism. Front. Pediatr. 2018; 6: 142.

  5. Xu J., Lupu F., Esmon C.T. Inflammation, innate immunity and blood coagulation. Hamostaseologie. 2010; 30: 5–9.

  6. Esmon C.T., Xu J., Lupu F. Innate immunity and coagulation. J. Thromb. Haemost. 2011; 9: 182–188.

  7. Fuchs T.A., Brill A., Wagner D.D. Neutrophil extracellular trap (NET) impact on deep vein thrombosis. Arterioscler. Thromb. Vasc. Biol. 2012; 32: 1777–1783.

  8. Li J., Hara H., Wang Y., Esmon C., Cooper D.K.C., Iwase H. Evidence for the important role of inflammation in xenotransplantation. J. Inflamm. (Lond.). 2019; 16: 10.

  9. Shorr A.F., Thomas S.J., Alkins S.A. D-dimer correlates with proinflammatory cytokine levels and outcomes in critically ill patients. Chest. 2002; 121: 1262–1268.

  10. Wu Y.P., Wei R., Liu Z.H., Chen B., Lisman T., Ren D.L., Han J.J., Xia Z.L., Zhang F.S., Xu W.B., Preissner K.T., de Groot P.G. Analysis of thrombotic factors in severe acute respiratory syndrome (SARS) patients. Thromb. Haemost. 2006; 96: 100–101.

  11. Hwang D.M., Chamberlain D.W., Poutanen S.M., Low D.E., Asa S.L., Butany J. Pulmonary pathology of severe acute respiratory syndrome in Toronto. Mod. Pathol. 2005; 18: 1–10.

  12. Gralinski L.E., Baric R.S. Molecular pathology of emerging coronavirus infections. J. Pathol. 2015; 235: 185–195.

  13. Levi M. Disseminated intravascular coagulation. Crit. Care Med. 2007; 35: 2191–2195.

  14. Wiwanitkit V. Hemostatic disorders in bird flu infection. Blood Coagul. Fibrinolysis. 2008; 19: 5–6.

  15. Alquwaizani M., Buckley L., Adams C., Fanikos J. Anticoagulants: A Review of the Pharmacology, Dosing, and Complications. Curr. Emerg. Hosp. Med. Rep. 2013; 1, 83–97.

  16. Brinkhous K., Smith H., Warner E., Seegers W. The Inhibition of Blood Clotting: An Unidentified Substance Which Acts in Conjunction with Heparin to Prevent the Conversion of Prothrombin into Thrombin. Am. J. Physiol. 1939; 125: 683–687.

  17. Lindahl U., Bäckström G., Höök M., Thunberg L., Fransson L.A., Linker A. Structure of the Antithrombin-Binding Site in Heparin. Proc. Natl. Acad. Sci. USA. 1979; 76: 3198–3202.

  18. Hirsh J., Warkentin T.E., Shaughnessy S.G., Anand S.S., Halperin J.L., Raschke R., Granger C., Ohman E.M., Dalen J.E. Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. Chest. 2001; 119: 64S–94S.

  19. Zhang Y., Zhang M., Tan L., Pan N., Zhang L. The clinical use of Fondaparinux: A synthetic heparin pentasaccharide. Prog. Mol. Biol. Transl. Sci. 2019; 163: 41–53.

  20. Johnston A., Hsieh S.C., Carrier M., Kelly S.E., Bai Z., Skidmore B. A systematic review of clinical practice guidelines on the use of low molecular weight heparin and fondaparinux for the treatment and prevention of venous thromboembolism: implications for research and policy decision-making. PLoS One. 2018; 13: e0207410.

  21. Mousavi S., Moradi M., Khorshidahmad T., Motamedi M. Anti-Inflammatory Effects of Heparin and Its Derivatives: A Systematic Review. Adv. Pharmacol. Sci. 2015; 2015: 507151.

  22. Oduah E.I., Linhardt R.J., Sharfstein S.T. Heparin: Past, Present, and Future. Pharmaceuticals. 2016; 9.

  23. Thachil J. The versatile heparin in COVID-19. J. Thromb. Haemost. 2020 [Epub ahead of print].

  24. Iba T., Hashiguchi N., Nagaoka I., Tabe Y., Kadota K., Sato K. Heparins attenuated histone-mediated cytotoxicity in vitro and improved the survival in a rat model of histone-induced organ dysfunction. Intensive Care Med. Exp. 2015; 3: 36.

  25. Zhu C., Liang Y., Li X., Chen N., Ma X. Unfractionated heparin attenuates histone-mediated cytotoxicity in vitro and prevents intestinal microcirculatory dysfunction in histone-infused rats. J. Trauma Acute Care Surg. 2019; 87: 614–622.

  26. Ma J., Bai J. Protective effects of heparin on endothelial cells in sepsis. Int. J. Clin. Exp. Med. 2015; 8: 5547–5552.

  27. Shukla D., Spear P.G. Herpesviruses and heparan sulfate: an intimate relationship in aid of viral entry. J. Clin. Invest. 2001; 108: 503–510.

  28. Ghezzi S., Cooper L., Rubio A., Pagani I., Capobianchi M.R., Ippolito G. Heparin prevents Zika virus induced-cytopathic effects in human neural progenitor cells. Antiviral Res. 2017; 140: 13–17.

  29. Vicenzi E., Canducci F., Pinna D., Mancini N., Carletti S., Lazzarin A. Coronaviridae and SARS-associated coronavirus strain HSR1. Emerg. Infect. Dis. 2004; 10: 413–418.

  30. Danzi G.B., Loffi M., Galeazzi G., Gherbesi E. Acute pulmonary embolism and COVID-19 pneumonia: a random association? Eur. Heart J. 2020; Mar 30 [Epub ahead of print].

  31. Tang N., Bai H., Chen X., Gong J., Li D., Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J. Thromb. Haemost. 2020 [Epub ahead of print].

  32. Xie Y., Wang X., Yang P., Zhang S. COVID-19 Complicated by Acute Pulmonary Embolism. Radiology: Cardiothoracic Imaging. 2020; 2.

Received 25 June 2020; accepted 03 August 2020.

 

Information about the authors

Luca Costanzo, MD, San Marco Hospital, Department of cardiovascular disease, A.O.U. “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy. Via Antonello da Messina 75 – 95021 Acicastello, Catania – Italy; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-3595-3461

Simona Antonina Grasso, MD, Department of Anesthesia and Intensive Care, San Marco Hospital, AOU Policlinico “G. Rodolico-San Marco”, Catania, Italy. Via Rosso di San Secondo 17 – 95128 Catania – Italy; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0001-8930-9714

Francesco Paolo Palumbo, MD, Surgery Unit, Villa Fiorita Clinic, Prato, Italy. Viale Del Ciclope 14 – 90149 Palermo – Italy; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-3121-6579

Giorgio Ardita, MD, San Marco Hospital, Department of cardiovascular disease, A.O.U. “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy. Via Pavia 7 – 95123 Catania – Italy; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-2535-3967

Luigi Di Pino, PhD, MD, professor, Cardiology and Angiology, Department of cardiovascular disease, C.A.S.T., A.O.U. “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy. Via Ungaretti 1/R, 95014 Giarre, Catania – Italy; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-4442-7199

Pier Luigi Antignani, PhD, MD, professor, Vascular center, Nuova Villa Claudia – Rome, Italy. Via Germanico 211 – 00192 – Rome – Italy; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-3982-5275

Leonardo Aluigi, PhD, MD, professor, Angiology, Care Unit Villalba, Bologna, Italy. Via Giulietta Masina 5 40016 San Giorgio di Piano (BO) – Italy; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0001-8507-1585

Enrico Arosio, PhD, MD, professor, University of Verona, Verona, Italy. Via Porto San Pancrazio 111 – 37133 – Verona – Italy; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-6702-9727

Giacomo Failla, MD, San Marco Hospital, Department of cardiovascular disease, A.O.U. “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy. Via A Di Sangiuliano 50, Sant’Agata Li Battiati 95030 Catania, Italy; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-1327-3908

 

For citation

Luca Costanzo, Simona Antonina Grasso, Francesco Paolo Palumbo, Giorgio Ardita, Luigi Di Pino, Pier Luigi Antignani, Leonardo Aluigi, Enrico Arosio, Giacomo Failla.. COVID-19 Pneumonia: the Point of View of Vascular Specialist. Ul'yanovskiy mediko-biologicheskiy zhurnal. 2020; 3: 21–27. DOI: 10.34014/2227-1848-2020-3-21-27.

 

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УДК 616.9:578.834.1

DOI 10.34014/2227-1848-2020-3-21-27

 

ПНЕВМОНИЯ ПРИ COVID-19: ВЗГЛЯД СОСУДИСТОГО ХИРУРГА

 

Лука Костанцо1, Симона Антонина Грассо2, Франческо Паоло Палумбо3, Джорджио Ардита1, Луиджи Ди Пино4, Пьер Луиджи Антиньяни5, Леонардо Алуиджи6, Энрико Арозио7, Джакомо Файлла1

1 Отделение ангиологии больницы Сан-Марко, отделение сердечно-сосудистых заболеваний, поликлиника Родолико-Сан-Марко, Катанийский университет, г. Катания, Италия;

2 Отделение анестезии и интенсивной терапии больницы Сан-Марко, поликлиника Родолико-Сан-Марко, г. Катания, Италия;

3 Операционное отделение клиники Вилла Фиорита, г. Прато, Италия;

4 Кардиология и ангиология, отделение сердечно-сосудистых заболеваний,поликлиника Витторио Эмануэле, Катанийский университет, г. Катания, Италия;

5 Сосудистый центр, Нуова Вилла Клаудиа, г. Рим, Италия;

6 Ангиология, Медицинское отделение Виллалба, г. Болонья, Италия;

7 Университет Вероны, г. Верона, Италия

 

Одним из наиболее неблагоприятных прогностических признаков пневмопатии при COVID-19 является развитие коагулопатии. У пациентов с COVID-19 наблюдались признаки тромбоэмболии, например тромбоэмболия легочной артерии и ДВС-синдром, что негативно сказывалось на здоровье пациента.

Целью исследования является анализ потенциального механизма нарушения свертывания крови у пациентов, перенесших COVID-19, и определение возможных терапевтических стратегий.

Было обнаружено, что у пациентов с тяжелой формой заболевания уровень D-димера, белкового продукта распада фибрина, повышен и напрямую взаимосвязан со смертностью. К факторам, влияющим на нарушение коагуляции, вызванной вирусной инфекцией, относятся неуправляемый воспалительный процесс, тромбоцитарная и эндотелиальная дисфункция с нарушением фибринолиза.

Гепарин, являясь прямым антикоагулянтом, также обладает противовоспалительными свойствами и выраженным противовирусным эффектом. Благоприятный исход наблюдался при использовании низкомолекулярного гепарина у тяжелых пациентов с COVID-19 с коагулопатией, вызванной сепсисом, или высоким уровнем D-димера.

Использование низкомолекулярного гепарина может предотвратить тромбоэмболические осложнения пневмопатии у пациентов с COVID-19. Тем не менее точное время профилактики в зависимости от стадии заболевания COVID-19 и соответствующая терапевтическая дозировка, которая может быть использована в тяжелых случаях, требуют дальнейших исследований.

Ключевые слова: COVID-19, пневмония, тромбоз, коагулопатия, D-димер, низкомолекулярный гепарин.

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

 

Литература

  1. Chen, Jianpu and Wang, Xiang and Zhang, Shutong and Liu, Bin and Wu, Xiaoqing and Wang, Yanfang and Wang, Xiaoqi and Yang, Ming and Sun, Jianqing and Xie, Yuanliang. Findings of Acute Pulmonary Embolism in COVID-19 Patients (3/1/2020). Available at SSRN: https://ssrn.com/abstract=3548771 or http://dx.doi.org/10.2139/ssrn.3548771.

  2. Tang N., Li D., Wang X., Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J. Thromb. Haemost. 2020; 18: 844–847.

  3. Goeijenbier M., van Wissen M., van de Weg C., Jong E., Gerdes V.E., Meijers J.C., Brandjes D.P., van Gorp E.C. Review: Viral infections and mechanisms of thrombosis and bleeding. J. Med. Virol. 2012; 84: 1680–1696.

  4. Branchford B.R., Carpenter S.L. The Role of Inflammation in Venous Thromboembolism. Front. Pediatr. 2018; 6: 142.

  5. Xu J., Lupu F., Esmon C.T. Inflammation, innate immunity and blood coagulation. Hamostaseologie. 2010; 30: 5–9.

  6. Esmon C.T., Xu J., Lupu F. Innate immunity and coagulation. J. Thromb. Haemost. 2011; 9: 182–188.

  7. Fuchs T.A., Brill A., Wagner D.D. Neutrophil extracellular trap (NET) impact on deep vein thrombosis. Arterioscler. Thromb. Vasc. Biol. 2012; 32: 1777–1783.

  8. Li J., Hara H., Wang Y., Esmon C., Cooper D.K.C., Iwase H. Evidence for the important role of inflammation in xenotransplantation. J. Inflamm. (Lond.). 2019; 16: 10.

  9. Shorr A.F., Thomas S.J., Alkins S.A. D-dimer correlates with proinflammatory cytokine levels and outcomes in critically ill patients. Chest. 2002; 121: 1262–1268.

  10. Wu Y.P., Wei R., Liu Z.H., Chen B., Lisman T., Ren D.L., Han J.J., Xia Z.L., Zhang F.S., Xu W.B., Preissner K.T., de Groot P.G. Analysis of thrombotic factors in severe acute respiratory syndrome (SARS) patients. Thromb. Haemost. 2006; 96: 100–101.

  11. Hwang D.M., Chamberlain D.W., Poutanen S.M., Low D.E., Asa S.L., Butany J. Pulmonary pathology of severe acute respiratory syndrome in Toronto. Mod. Pathol. 2005; 18: 1–10.

  12. Gralinski L.E., Baric R.S. Molecular pathology of emerging coronavirus infections. J. Pathol. 2015; 235: 185–195.

  13. Levi M. Disseminated intravascular coagulation. Crit. Care Med. 2007; 35: 2191–2195.

  14. Wiwanitkit V. Hemostatic disorders in bird flu infection. Blood Coagul. Fibrinolysis. 2008; 19: 5–6.

  15. Alquwaizani M., Buckley L., Adams C., Fanikos J. Anticoagulants: A Review of the Pharmacology, Dosing, and Complications. Curr. Emerg. Hosp. Med. Rep. 2013; 1, 83–97.

  16. Brinkhous K., Smith H., Warner E., Seegers W. The Inhibition of Blood Clotting: An Unidentified Substance Which Acts in Conjunction with Heparin to Prevent the Conversion of Prothrombin into Thrombin. Am. J. Physiol. 1939; 125: 683–687.

  17. Lindahl U., Bäckström G., Höök M., Thunberg L., Fransson L.A., Linker A. Structure of the Antithrombin-Binding Site in Heparin. Proc. Natl. Acad. Sci. USA. 1979; 76: 3198–3202.

  18. Hirsh J., Warkentin T.E., Shaughnessy S.G., Anand S.S., Halperin J.L., Raschke R., Granger C., Ohman E.M., Dalen J.E. Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. Chest. 2001; 119: 64S–94S.

  19. Zhang Y., Zhang M., Tan L., Pan N., Zhang L. The clinical use of Fondaparinux: A synthetic heparin pentasaccharide. Prog. Mol. Biol. Transl. Sci. 2019; 163: 41–53.

  20. Johnston A., Hsieh S.C., Carrier M., Kelly S.E., Bai Z., Skidmore B. A systematic review of clinical practice guidelines on the use of low molecular weight heparin and fondaparinux for the treatment and prevention of venous thromboembolism: implications for research and policy decision-making. PLoS One. 2018; 13: e0207410.

  21. Mousavi S., Moradi M., Khorshidahmad T., Motamedi M. Anti-Inflammatory Effects of Heparin and Its Derivatives: A Systematic Review. Adv. Pharmacol. Sci. 2015; 2015: 507151.

  22. Oduah E.I., Linhardt R.J., Sharfstein S.T. Heparin: Past, Present, and Future. Pharmaceuticals. 2016; 9.

  23. Thachil J. The versatile heparin in COVID-19. J. Thromb. Haemost. 2020 [Epub ahead of print].

  24. Iba T., Hashiguchi N., Nagaoka I., Tabe Y., Kadota K., Sato K. Heparins attenuated histone-mediated cytotoxicity in vitro and improved the survival in a rat model of histone-induced organ dysfunction. Intensive Care Med. Exp. 2015; 3: 36.

  25. Zhu C., Liang Y., Li X., Chen N., Ma X. Unfractionated heparin attenuates histone-mediated cytotoxicity in vitro and prevents intestinal microcirculatory dysfunction in histone-infused rats. J. Trauma Acute Care Surg. 2019; 87: 614–622.

  26. Ma J., Bai J. Protective effects of heparin on endothelial cells in sepsis. Int. J. Clin. Exp. Med. 2015; 8: 5547–5552.

  27. Shukla D., Spear P.G. Herpesviruses and heparan sulfate: an intimate relationship in aid of viral entry. J. Clin. Invest. 2001; 108: 503–510.

  28. Ghezzi S., Cooper L., Rubio A., Pagani I., Capobianchi M.R., Ippolito G. Heparin prevents Zika virus induced-cytopathic effects in human neural progenitor cells. Antiviral Res. 2017; 140: 13–17.

  29. Vicenzi E., Canducci F., Pinna D., Mancini N., Carletti S., Lazzarin A. Coronaviridae and SARS-associated coronavirus strain HSR1. Emerg. Infect. Dis. 2004; 10: 413–418.

  30. Danzi G.B., Loffi M., Galeazzi G., Gherbesi E. Acute pulmonary embolism and COVID-19 pneumonia: a random association? Eur. Heart J. 2020; Mar 30 [Epub ahead of print].

  31. Tang N., Bai H., Chen X., Gong J., Li D., Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J. Thromb. Haemost. 2020 [Epub ahead of print].

  32. Xie Y., Wang X., Yang P., Zhang S. COVID-19 Complicated by Acute Pulmonary Embolism. Radiology: Cardiothoracic Imaging. 2020; 2.

Поступила в редакцию 25.06.2020; принята 3.08.2020.

Авторский коллектив

Лука Костанцо – доктор медицины, больница Сан-Марко, отделение сердечно-сосудистых заболеваний поликлиники Витторио Эмануэле, Катанийский университет, г. Катания, Италия. Via Antonello da Messina 75 – 95021 Acicastello, Catania – Italy; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-3595-3461

Симона Антонина Грассо – доктор медицины, отделение анестезии и интенсивной терапии больницы Сан-Марко, поликлиника Родолико-Сан-Марко, г. Катания, Италия. Via Rosso di San Secondo 17 – 95128 Catania – Italy. Viale Del Ciclope 14 – 90149 Palermo – Italy; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0001-8930-9714

Франческо Паоло Палумбо – доктор медицины, хирургическое отделение клиники Вилла Фиорита, г. Прато, Италия. Viale Del Ciclope 14 – 90149 Palermo – Italy; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-3121-6579

Джорджио Ардита – доктор медицины, больница Сан-Марко, отделение сердечно-сосудистых заболеваний поликлиники Витторио Эмануэле, Катанийский университет, г. Катания, Италия. Via Pavia 7 – 95123 Catania – Italy; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-2535-3967

Луиджи Ди Пино – доктор медицины, профессор, кардиология и ангиология, отделение сердечно-сосудистых заболеваний поликлиники Витторио Эмануэле, Катанийский университет, г. Катания, Италия. Via Ungaretti 1/R, 95014 Giarre, Catania – Italy; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-4442-7199

Пьер Луиджи Антиньяни – доктор медицины, профессор, Сосудистый центр, Нуова Вилла Клаудиа, г. Рим, Италия. Via Germanico 211 – 00192 – Rome – Italy; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-3982-5275

Леонардо Алуиджи – доктор медицины, профессор, ангиология, отделение медицинской помощи Виллалба, г. Болонья, Италия. Via Giulietta Masina 5 40016 San Giorgio di Piano (BO) – Italy; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0001-8507-1585

Энрико Аросио – доктор медицины, профессор, Веронский университет, г. Верона, Италия. Via Porto San Pancrazio 111 – 37133 – Verona – Italy; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-6702-9727

Джакомо Фаилла – доктор медицины, больница Сан-Марко, отделение сердечно-сосудистых заболеваний поликлиники Витторио Эмануэле, Катанийский университет, г. Катания, Италия. Via A Di Sangiuliano 50, Sant’Agata Li Battiati 95030 Catania, Italy; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0003-1327-3908

 

Образец цитирования

Luca Costanzo, Simona Antonina Grasso, Francesco Paolo Palumbo, Giorgio Ardita, Luigi Di Pino, Pier Luigi Antignani, Leonardo Aluigi, Enrico Arosio, Giacomo Failla. COVID-19 Pneumonia: the Point of View of Vascular Specialist. Ульяновский медико-биологический журнал. 2020; 3: 21–27. DOI: 10.34014/2227-1848-2020-3-21-27.