Saratov JOURNAL of Medical and Scientific Research

Furman N. V.

Saratov Scientific Research Institute of Cardiology, Senior Research Assistant, Candidate of Medical Science

Age and age-dependent predictors for the risk assessment in elderly and senile patients with chronic heart failure

Year: 2020, volume 16 Issue: №1 Pages: 172-176
Heading: Тhematic supplement Article type: Original article
Authors: Malinova L.I., Lipatova Т.Е., Zhuk A.A., Dolotovskaya P.V., Furman N.V., Denisova T.P.
Organization: Saratov State Medical University
Summary:

Objective: to assess the presence and nature of age-dependent changes in the predictors used for risk stratification of patients with chronic heart failure (CHF). Material and Methods. We perform an analysis of predictive models of CHF, including a comparative assessment of predictors and age of patients. At the second stage, age-dependent changes in the most commonly predictors of CHF were characterized. The study included hospitalized patients with CHF (36-94 years, n=2764). Results. We analyzed 275 prognostic models based on results of large studies (n=36062±5814). The mean age of the patients involved was 68.9±7.6 years. The major predictors included the patient's age and/or potentially age-dependent parameters: hemoglobin, creatinine, RDW, LVEF, SBP and NT-proBNP. In the study sample all of these parameters correlated with the age of the patients with the maximum correlation strength of "NT-proBNP — age" (R=0.57; p<0.05) and "hemoglobin level — age" (-0.57; p<0.05). Conclusion. The prevalence of mature and elderly patients in the populations of studies used to develop the majority of risk instruments for heart failure is revealed. The age-dependent nature of the predictors used in the risk of heart failure is established (hemoglobin, creatinine, RDW, LVEF, SBP and NT-proBNP). The simultaneous use of age and age-dependent parameters as predictors when creating risk-assessment tools may be considered as one of the reasons for the unsatisfactory quality of risk stratification in CHF, including elderly and senile patients.

AttachmentSize
2020-01-1_172-176.pdf389.36 KB

Comorbidity in patients with acute coronary syndrome in real (everyday) clinical practice

Year: 2019, volume 15 Issue: №3 Pages: 821-825
Heading: Cardiology Article type: Original article
Authors: Furman N.V., Dolotovskaya P.V., Malinova L.I., Reshetko O.V.
Organization: Saratov State Medical University
Summary:

The purpose of the study was to assess prevalence of comorbidity in the population of patients with acute coronary syndrome in Saratov region. Material and Methods. Inpatient and outpatient records of 484 patients with acute coronary syndrome (ACS) were analysed (64% of them residents of Saratov). Cases of cardiac and non-cardiac comorbidity were evaluated, Charlson Comorbidity Index (CCI) was calculated. Results. Only 20.5% of patients were without cardiac or non-cardiac comorbidity. Comorbid non-cardiac diseases were observed in 37.5% of patients (the most common diseases of the digestive system — 43% of all cases of non-cardiac comorbidity). Comorbid cardiovascular diseases were detected in 76.9% of patients, among the most common ones were arterial hypertension (88.4% of all cases of non-cardiac comorbidity) and documented hypercholesterolemia 42.2%). A correlation was found between the CCI and an unfavorable hospital outcome (0.227, P<0.0001). Conclusion. Patients with ACS in the vast majority of cases have at least one concomitant disease (cardiovascular or non- cardiac) that can significantly affect their prognosis. To determine individual prognosis for ACS patients with concomitant diseases, it is advisable to calculate the Charlson comorbidity index.

AttachmentSize
2019_03-1_821-825.pdf293.79 KB

Platelet functional pools under pharmacological suppression of aggregation in ST segment elevation myocardial infarction

Year: 2019, volume 15 Issue: №3 Pages: 779-783
Heading: Cardiology Article type: Original article
Authors: Malinova L.I., Dolotovskaya P.V., Furman N.V., Puchinyan N.F., Lipatova Т.Е.
Organization: Saratov State Medical University
Summary:

The purpose of the study is to investigate clinical significance of peripheral pool platelets functional heterogeneity, assessed with combination of collagen and ADP, under pharmacological suppression of platelet aggregation in acute coronary syndrome. Material and Methods. The study involved 374 patients with acute coronary syndrome (ACS). Functional activity of platelets (FAT) was studied on the first, the 7th and 30th days after ACS manifestation in the whole blood by impedance and luminescent aggregometry. The functional heterogeneity of platelets was studied using our own method with an estimate of AAk (functional subpopulation of platelets aggregation (cluster II)), ASk (the functional subpopulation of platelets secretion (cluster II)) and ДА (a parameter of platelets functional heterogeneity). The follow-up period was 24 months after ACS manifestation. Results. In the study sample ADP- and collagen-induced platelet aggregation remained almost constant during the whole observation period. It was established that in patients treated with double antiplatelet therapy parameters of functional platelet heterogeneity statistically significantly decreased by the seventh day of observation: ЛАк 2(0; 3)vs 1 (0; 2) Ohm, p=0,049; AS 0.26 (0.15; 0.47) vs 0.19 (0; 0.26) nmol, p=0.07. The excess of ЛАР measured on the second day after ACS manifestation, a threshold of 2 Ohms, was associated with a significant increase in the 30-day risk of rethrombotic events (HR 1.8; Cl 1.2; 3.1). Conclusion. The dynamics of platelet functional heterogeneity was revealed in patients with acute coronary syndrome treated with double antiplatelet therapy. A high degree of platelet functional heterogeneity in patients with acute coronary syndrome was associated with a significant increase in the 30-day risk of rethrombotic events.

AttachmentSize
2019_03-1_779-783.pdf562.29 KB

Tentative analytic biomarker panel of maladaptive myocardial remodeling (systematic review)

Year: 2019, volume 15 Issue: №3 Pages: 773-779
Heading: Cardiology Article type: Review
Authors: Malinova L.I., Denisova Т.Р., Furman N.V., Dolotovskaya P.V., Puchinyan N.Ph., Povarova T.V.
Organization: Saratov Road Clinical Hospital, Saratov State Medical University
Summary:

The purpose is to design a tentative analytical panel of biomarkers (BM) of maladaptive myocardial remodeling/extracellular myocardial matrix dysfunction. eLibrary.ru and PubMed were used for data extraction. Reproducibility of the obtained data was calculated, as well as the intragroup correlations of BM maladaptive myocardial remodeling/extracellular myocardial matrix dysfunction with the clinical phenotype of heart failure (HF) — т. The tentative BM panel design was carried out using the ranking method (R). Analysis included data from 5085 publications. The highest reproducibility was traced in nautriuretic peptides ((3 0.91 and 0.89) and cardiac troponins ((3 0.84), while the highest correlation ratios of BM and the clinical phenotype of CH were detected in natriuretic peptides and ST2 (т 0.81; 0.77 and 0.71). PIIINP and decorin did not reveal any significant correlation with the HF clinical phenotype. A rank of >0.5 was identified in galectin-3, GDF-15, and osteopontin. A set of biomarkers with a proven participation in the pathogenesis of heart failure, which potentially has the greatest diagnostic and prognostic value was designed, i. e. a tentative analytical panel of biomarkers of maladaptive myocardial remodeling/extracellular myocardial matrix dysfunction: NT-proBNP, BNP, cardiac rf-troponins, ST2, GDF-15, galectin-3 and osteopontin.

AttachmentSize
2019_03-1_773-779.pdf342.44 KB

Prognostic value of level of brain natriuretic peptide in patients with acute coronary syndrome without symptoms of heart failure

Year: 2017, volume 13 Issue: №1 Pages: 041-046
Heading: Internal Diseases Article type: Original article
Authors: Furman N.V., Puchinyan N.F., Dolotovskaya P.V., Dovgalevsky la.P., Panina A.V.
Organization: Saratov Institute of Cardiology, Russia
Summary:

Purpose of the study: to evaluate the prognostic value of brain natriuretic peptide (BNP) as a predictor of cardiovascular events in patients with acute coronary syndrome (ACS) within one year after hospitalization. Material and Methods. The study included 201 patients, including 150 men and 51 women, who were treated in the emergency department of cardiology with ACS including 96 patients without symptoms of CHF and/or AHF. Results. All patients were divided into groups depending on the presence signs of heart failure of CHF and/or AHF at the time of admission: patients with no signs of heart failure were divided into 2 groups: those with BNP levels >101 pg/mL (group 1; n=37) and <100 pg/mL (group 2; n=59); the third group consisted of patients with symptomatic HF (n=105). In patients without clinical signs of CHF and/or AHF with elevated level of the BNP at the time of hospitalization was observed significantly increased risk of unstable angina during the year compared to patients with normal levels (OR 2.83 [95% Cl: 1.1—7.24], p=0.04). In patients without clinical signs of CHF and/or AHF with elevated BNP levels at the time of hospitalization compared to patients with AHF and/or CHF, had no statistically significant differences in the long-term prognosis. Conclusion. Patients with ACS in the absence of CHF and/or AHF but with elevated levels of BNP at admission should be attributed to the group of high risk for cardiovascular complications. Increasing the level of BNP in ACS patients at admission has an adverse value for long-term outcome and can be used as an additional risk marker.

AttachmentSize
2017_01_041-046.pdf291.86 KB

Pharmacoepidemiological analysis of the drugs used for secondary prevention of brain infarction on dispensary stage

Year: 2014, volume 10 Issue: №1 Pages: 189-195
Heading: Parmacology Article type: Original article
Authors: Miheyeva N.V., Reshetko O.V., Furman N.V.
Organization: Saratov Institute of Cardiology, Russia, Saratov State Medical University
Summary:

Aim. The secondary prevention of cerebral infarction on dispensary stage to current clinical guidelines was analyzed. Adherence of patients to prescribe medications was evaluated. Material and methods. 106 patients of hospital neurologic department with brain infarction were included in prospective pharmacoepidemiological study of the drugs used for secondary prevention of brain infarction on dispensary stage since 1 January 2009 to 31 December 2009. Duration of outpatient observation was 3 years. Results. All of the patients were of 64,9 ± 10,3 years old. Hypertension was diagnosed in 102 of them (96.2%), atrial fibrillation — in 33 (31.1%) patients. 39 (36.8%) patients died during 3 years after discharge from the hospital. ACE inhibitors/angiotensin II receptor antagonist were prescribed for 83 (78.3%) patients, antiplatelet- 76 (71,7%), statins — 16 (15,1%) patients in discharge from hospital. Warfarin was prescribed only for 1 (3.05%) patient with atrial fibrillation and ischemic stroke.consumption of drugs with evidence efficiency were diminished already after one year of observation in outpatient clinics. Conclusion.Therapy for secondary stroke prevention is not fully comply with current clinical guidelines

Keywords: -
AttachmentSize
2014_01-01_189-195.pdf484.69 KB

Features of pharmacotherapy and clinical course of atrial fibrillation in patients with type 2 diabetes in real clinical practice. Saratov Journal of Medical Scientific

Year: 2014, volume 10 Issue: №1 Pages: 178-185
Heading: Parmacology Article type: Original article
Authors: Graifer l.V., Reshetko O.V., Furman N.V., Dolotovskaya P.V.
Organization: Saratov Institute of Cardiology, Russia, Saratov State Medical University
Summary:

The aim of the study was to investigate the clinical status of patients with atrial fibrillation (AF) and diabetes mellitus (DM) type 2 and to identify differences in the treatment of AF, conducted in the cardiology departments of multidisci-plinary teaching hospitals of the Saratov city. Materials and methods. A comparative retrospective analysis of 1041 pharmacoepidemiological solid history of patients with AF who were hospitalized in emergency, and in the planning department of cardiology of 2 multidisciplinary teaching hospitals of the Saratov city consecutively in a calendar year on the AF, recorded on an electrocardiogram. Results. Among all patients with AF, patients with DM accounted for 20.2%. Among them were women, they were younger, they developed fibrillation at a younger age, they differed more severe structural heart disease, among which was significantly greater with myocardial infarction, nearly all had symptoms of heart failure. Patients with DM performed less frequently cardioversion, and to monitor heart rate often preferred a combination of beta-blockers and digoxin. 100% of patients with DM had a higher risk of thromboembolic complications (91.9% without diabetes) in both groups, oral anticoagulants (OAC) prescribed often enough. Conclusion. DM was diagnosed in every fifth patient with AF, especially among women and patients with persistent AF and is associated with the presence of more severe organic heart disease compared with patients without DM. All patients on the background DM was a high risk of thromboembolic complications, i.e. OAC must be assigned in 100% of cases, but in the surveyed hospitals OAC were appointed only in 23% of cases.

AttachmentSize
2014_01-01_178-185.pdf275.12 KB

Leukocytosis and clinical outcomes in patients with myocardial infarction with ST-segment elevation

Year: 2013, volume 9 Issue: №4 Pages: 673-678
Heading: Сardiology Article type: Original article
Authors: Panina A.V., Dolotovskaya P.V., Puchinyan N.F., Dovgalevsky Ya.P., Furman N.V.
Organization: Saratov Institute of Cardiology, Russia
Summary:

The aim of the study is to evaluate the frequency of occurrence of leukocytosis and its prognostic value for the course and outcome of myocardial infarction with ST-segment elevation. Material and Methods. The study included 245 patients aged 61,2 years, who were on treatment at the Department of Emergency Cardiology with diagnosis of acute myocardial infarction with ST-segment elevation. Results. Leukocytosis (white blood cell levels of more than 10*109/L) was observed in 34,7% of patients. The presence of leukocytosis was associated with increased incidence of congestive heart failure class IV at Killip, ventricular fibrillation and lethal outcomes during hospitalization. There were no significant differences in the incidence of adverse events in the long-term period between the patients with leukocytosis and with normal level of white blood cells. Conclusion. Increased levels of white blood cells (more than 10*109/L) in patients with myocardial infarction with ST-segment elevation is associated with a significantly increase relative risk of cardiogenic shock (Odds ratio 5,2, 95% Cl, 1,7-15,8, p=0.001), ventricular fibrillation (Odds ratio 8,5, 95% Cl, 1,9-38,3, p=0.001) and death during hospitalization (Odds ratio 2,47, 95% Cl, 1,87-38,4, p=0,03). The level of white blood cells on admission to hospital may be used as one of the additional factors predicting the risk of patients with myocardial infarction with ST-segment elevation during hospitalization.

AttachmentSize
2013-04_673-678.pdf862.1 KB

Assessment of myocardial strain and strain rate by tissue doppler echocar-diography

Year: 2013, volume 9 Issue: №1 Pages: 50-57
Heading: Internal Diseases Article type: Review
Authors: Ekimova N.A., Katkova LA., Furman N.V.
Organization: Saratov Institute of Cardiology, Russia
Summary:

The objective of the article is to review the current data on the method of quantitative evaluation of cardiac mechanics — assessment of myocardial strain and strain rate according to the results of the tissue Doppler echocardiography and prospects of its clinical application.

AttachmentSize
2013-01_050-057.pdf422.11 KB

Paroxysmal atrioventricular nodal reentrant tachycardias: epidemiology, clinical picture, diagnostics, treatment (review)

Year: 2012, volume 8 Issue: №1 Pages: 072-080
Heading: Internal Diseases Article type: Review
Authors: Morozov I.A., FurmanN.V., Rakovskaya I.M., Oleynik G.S., Korobkov E.A.
Organization: Saratov Institute of Cardiology, Russia
Summary:

Nowadays paroxysmal AV nodal reentrant tachycardia (AVNRT) is one of the most widespread arrhythmias. In most cases AVRNT is a recurrent process, and it worsens the life quality of such patients, reduces their workability and increases the incidence of applying for medical help. Thus AVNRT today is of special attention among investigators. The interest of clinicians to the problem of cardiac arrhythmias is associated with permanent dissatisfaction with the results of antiarrhythmic therapy and also with the rapid development of the surgical methods of treatment, i.e. the use of radio frequency catheter ablation.

AttachmentSize
201201_072-080_.pdf310.27 KB