Репозиторий Университета

© 2018 GEOTAR Media. All rights reserved. Aim: to value the significance of various predictors of sudden cardiac death (SCD) and clarify the selection criteria for implantation of cardioverter-defibrillators in patients with cardiomyopathies [dilated (DCM), arrhythmogenic right ventricular (ARVC), left ventricular noncompaction (LVNC)]. Material and methods. 220 patients with DCM syndrome were observed, 151 men, average age 47.5±12.5 years [mean left ventricular end-diastolic dimension (LV EDD) 6.5 [6.0, 7.1] cm, LV EF 30.3±10.1%], 50 patients with ARVC (definite diagnosis in 26 patients, probable in 13, possible in 11), 20 men, average age 38.1±14.6 years and 108 patients with a definite diagnosis of LVNC, 63 men, average age 45.4±14.8 years [mean LV ejection fraction (LF EV) 38.4±14.4%, LV EDD 5.9±0.8 cm]. The average follow-up periods were 16 [6, 37], 13.5 [4, 34] and 14 [3, 5, 36.0] months accordingly. The decision to implant the ICD / CRT-D was taken individually. The endpoints of the study were overall mortality, SCD, death + transplantation, appropriate defibrillators shocks and the "shocks + SCD". Results. The overall mortality in DCM, ARVC, and LVNC was 19.1%, 14.0% and 14.8%. It was mainly determined by terminal heart failure; SCD was recorded in 2.7%, 4.0% and 2.8%. Cardioverter-defibrillators were implanted in 66 (30%) patients with DCM (37 ICD, 29 CRT-D, 93.9% as the primary prevention of SCD), in 13 (26%) patients with ARVC (only ICD, primary prevention in 32,1%) and in 33 (30,6%) patients with LVNC (24 ICD, 9 CRTD, primary prevention in 88,1%). The frequency of appropriate shocks was 18.2% (15.0% in the primary prevention group and 50.0% in the secondary group) in patients with DCM syndrome, 69.2% (33.3% and 80.0% %) in ARVC, and 27.2% in LVNC (22.2% and 50.0%). The primary (genetic) nature of DCM (RR 1.58, OR 10.93), stable VT (RR 18, OR 26.5), and unstable VT (RR 1.43), a low QRS voltage (RR 1.75, OR 1.98), absence of LV hypertrophy signs on the ECG (RR 1.37, OR 2.56) were identified as criteria for selection for the implantation of a defibrillators in patients with DCM syndrome. In the patients with ARVC, these were a stable VT/VF and syncope (RR 4.75, OR 19), male sex (RR 1.25, OR 2), the low QRS voltage (RR 2.2, OR 10.5), chronic heart failure (OR 2.4, OR 8.0), the size of RV 2.85 cm (RR 1.55, OR 3.5), LV EDD> 5.5 cm (RR 2.1, OR 16, 7). In patients with LVNC the criteria were a stable VT/ VF, the presence of myocarditis (RR 3.3, OR 6.3), more than 500 PVBs per day (RR 3.3, OR 4.9), the low QRS voltage (RR 1,1, ОR 1,1), the follow up more than one year (RR 1,5, ОR 1,8). EF is not a statistically significant predictor of appropriate defibrillators shocks. Conclusions. In patients with various cardiomyopathies, which are accompanied by a high risk of SCD, the implantation of a cardioverter-defibrillators is an effective method of preventing SCD, including primary prevention. Due to adequate use of cardioverter-defibrillators in patients with DCM, ARVC and LVNC implanted in view of conventional and additional indications established in the study, mortality is determined primarily not by SCD, but terminal heart failure. Isolated myocarditis as the cause of DCM syndrome is not accompanied by a high risk of SCD, but its adherence to genetic cardiomyopathy determines the high risk of SCD.

© 2018 by the authors; licensee Modestum Ltd., UK. Objective: Prolongation of the QT interval in patients with coronary heart disease (CAD) is a risk factor of polymorphic ventricular tachycardia (PVT) and as consequence, the sudden death. Drug-drug interactions (DDI) on metabolic rate involving cytochrome P-450 (CYP) is the one of the major cause of Long QT Syndrome (LQTS). The aim of the present study was to improve the safety of combined pharmacotherapy when using drugs that affect the QT interval. Method and Results: Medication occurrence of potential dangerous combination of medicines that are affected on QT interval duration in patients with CAD are researched (outpatient medical records (patient history) analysis). Clinical relevance of DDI, which are associated with changes in CYP enzyme activity, categorized by drugs.com Medication Guide. Finding potential dangerous combination of medicines that are affected on QT interval duration were administered to patients with CAD in 3.6% cases in outpatient clinical practice. The most often prescribed combination of drugs is amiodarone and torasemide (13.3% evidence of all concomitant administration that are leading to QT prolongation). The potential mechanism of Amiodarone and Torasemide interaction on metabolic rate that are leading to QT prolongation are competitive substrates CYP 2C8 and a result of inhibited CYP 2C9 by amiodarone. Conclusion: Ability to predict the prolongation of the QT interval caused by DDI on metabolic rate make possible to improve the safety concomitant administration to patients with CAD.