Search PubMed⌕ Search

Biomedical subjects

A P Savchenko

Publications and source records attributed to A P Savchenko.

At least 19 recordsLinked to original sources
PubMed2006

[Comparative analysis of efficacy of endovascular interventions in native vascular bed and grafts in patients with ischemic heart disease after coronary artery bypass surgery].

AIM: Investigation of efficacy of endovascular interventions in native vascular bed and grafts, elucidation of factors, affecting immediate and remote prognosis after endovascular treatment. MATERIAL AND METHODS Coronary stenting was carried out in 212 patients who had previously undergone coronary bypass surgery. Stents were implanted into native vessels and grafts in 116 (native vessels group) and 96 (grafts group) patients, respectively. Frequency of angina recurrence and development of complications were assessed during hospitalization and after 1 year. Coronary angiography was repeated after 1 year in 47 and 36 patients in native vessels and grafts groups, respectively. Multifactorial analysis of predictors of complications and angina recurrence was performed with the use of logistic regression. RESULTS AND CONCLUSION: In grafts group signs of distal embolism were observed in 9 patients (9.4%), shunt thrombosis occurred in 2 of these patients. Risk factors of embolism in grafts group were complicated lesions (type C) and length of stenosis >20 mm. There was 1 non-Q wave myocardial infarction after stenting of native vascular bed (0.8%). Angina recurrence was observed after 1 year in 9 (7.8%) and 26 (27.1%), myocardial infarction developed during 1 year in 2 (1.7%) and 3 (3.1%) patients of native vessels and grafts groups, respectively. Risk factors of recurrence of clinic of ischemic heart disease (IHD) after stenting of grafts were time interval between stenting and bypass surgery >5 years and the use of stents without drug coating. More frequent recurrence of clinic of IHD in patients of grafts group was a consequence of higher level of restenosis in stented segments and more frequent progression of atherosclerosis in previously unaffected segments.

Adult↗
PubMed2005

[Possibility of coronary angiography without hospitalization].

Coronary angiography is the necessary investigation in the diagnostic complex of patients with ischemic heart disease (IHD). The use of trans-radial access makes it possible to do the angiography without hospitalization. The algorithm of coronary angiography in day-time clinic was proposed. Non-hospital angiography in 15 patients was successful. It is the first time this method has been used in this country.

Ambulatory Care↗
PubMed2004

[First results of stenting of bifurcation stenoses of the coronary arteries].

AIM: To study effectiveness of various types of coronary stenting in bifurcation stenoses. MATERIAL AND METHODS: Fifty six patients with bifurcation stenoses were divided into 2 groups: stenting of the basic and side branch of the coronary artery (CA) was made in group 1 patients (n = 27), stenting of the basic branch and balloon angioplasty of the side branch were made in group 2 (n = 29). Primary clinical and angiographic response reached 96 and 90% in groups 1 and 2, respectively. Complications were absent in group 1, occurred in 13.7% cases in group 2 (the difference was insignificant). One year after the procedure lethal outcomes were absent. The number of unfavourable clinical outcomes was higher in group 1 (25.9 and 13.7%, respectively, p = 0.4). The rate of restenoses detected angiographically was not significantly different in group 1 and 2 (33 and 26%, respectively). CONCLUSION: Stenting of bifurcation stenoses brings about good short-term and satisfactory long-term results in most of the patients. The rate of the complications was low. Two stents implantation (in basic and side branches) has no significant advantages over stenting of the basic CA and balloon angioplasty of its side branch.

Angioplasty, Balloon, Coronary↗
PubMed2002

[Long term results of endovascular treatment of ischemic heart disease in arterial hypertension patients].

AIM: To ascertain long-term prognosis after endovascular treatment of ischemic heart disease (IHD) in patients with arterial hypertension (AH). MATERIAL AND METHODS: The trial enrolled 87 IHD patients (mean age 54 +/- 8 years) who have undergone successful transluminal balloon coronary angioplasty (TBCA) or stenting. The patients were divided into two groups. Group 1 consisted of IHD patients with mild or moderate AH, group 2--of IHD patients without AH. The repeat examination was made 1-72 months (34 +/- 12) after TBCA, control coronarography was performed in 42 (48%) patients. RESULTS: The groups did not differ much by clinical and angiographic characteristics. Within 72 months the number of unfavourable clinical outcomes (UCO) in group 1 was significantly higher (68 and 19%, respectively; p = 0.02) as well as frequency of repeated TBCA (43 and 19%, respectively, p = 0.03). In both groups TBCA were repeated more frequently because of restenosis than of fresh lesions (91 and 33%, p < 0.0001; 70 and 20%, p = 0.04, respectively). The probability of no need in repeated TBCA was significantly less in group 1 than group 2 (41 and 72%, respectively; p = 0.007), the probability regressing more actively within 8 months after the intervention. CONCLUSION: Total incidence of UCO seventy two months after the endovascular treatment was higher in AH patients primarily due to repeated TBCA. Most of TBCAs were conducted within 8 months after the intervention for restenosis.

Aged↗
PubMed2002

[Changes of autologous coronary vessels and aortocoronary grafts in patients with ischemic heart disease after coronary artery bypass grafting].

AIM: 1) to assess effect of coronary lesion morphology on changes of grafts during first year after surgery; 2) to study the state of native coronary vascular bed during first year after surgery; 3) to elucidate special features of atherosclerosis in grafts and coronary arteries in remote period after surgery. MATERIAL AND METHODS: One hundred eighty seven patients with 3-vessel coronary artery disease subjected to aorto-coronary or mammary-coronary grafting. RESULTS AND CONCLUSION: Proportions of closed venous grafts were 24,2% among grafts to arteries with 50-75% stenoses, 13.1% among grafts to occluded arteries (p=0.023), and 20.1% among grafts to arteries with 75-99% stenoses. Among venous grafts to arteries with lumen diameter <1.5 mm 30.4% were occluded what was significantly more than among grafts to vessels with 1.5-2.5 mm (15.5%, p=0.003) and >2.5 mm (14.5%, p=0.004) diameter. Morphological risk factors of venous graft closure in immediate postoperative period were 50-75% stenosis and lumen diameter <1.5 mm. All mammary-coronary anastomoses were patent in 1 year, 99% of them remained patent 5 years after surgery. No relationship was found between patency of venous grafts after 5 years of follow-up and morphological characteristics (lumen diameter and percent stenosis) of bypassed arteries. During first year there was no significant differences between patients with patent and occluded grafts both in incidences of novel atherosclerotic lesions (10.4 and 10.3%, respectively, p=0.943) and proportion of closures of initially stenotic arteries (9.6 and 10.3%, respectively, p=0.085). After 5 years novel atherosclerotic lesions were found in 31.9 and 33.6% of patients with patent and occluded grafts, respectively (p=0.910). Complete occlusions of stenosed vessels proximal to anastomosis occurred more often among patients with patent than with occluded grafts (28.6 and 15.9%, respectively, p=0.047). Thus in remote postoperative period development of atherosclerosis in proximal segments of arteries with patent grafts was more 'aggressive' than in arteries with occluded grafts.

Arteriovenous Shunt, Surgical↗
PubMed2002

[Results of stenting and surgical treatment in patients with ischemic heart disease and multivessel coronary artery involvement].

Efficacy of surgical and endovascular (with the use of stents) methods of treatment was assessed in 56 patients with ischemic heart disease and double and triple vessel involvement. Coronary artery bypass grafting (CABG) was carried out in 31, implantation of stents - in 25 patients. Clinical factors used for assessment of efficacy of treatment were development of events (deaths, myocardial infarctions), presence of angina, changes of exercise capacity. In immediate postoperative period there were 2 myocardial infarctions (1 in each group, i.e. 4 and 3.2% after stenting and CABG, respectively) and no deaths. Absence of clinical effect (persistence of angina) more often occurred after stenting (12%) that after CABG (6.5%). Length of hospital stay was shorter after stenting (13-/+8 days) than after CABG (24-/+10 days). Increment of exercise tolerance was higher after stenting than after CABG (62-/+10 and 54-/+8 W, respectively). During 1 year of follow-up 1 myocardial infarction developed (after stenting). In a year after procedure angina recurred in 24 and 12.9% of patients subjected to stenting and CABG, respectively; increments of exercise tolerance were 53-/+8 and 49-/+7 W after stenting and CABG, respectively. These results are indicative of high efficacy of surgical and endovascular (with implantation of stents) treatment of multivessel coronary artery disease.

Adult↗
PubMed2000

[Association of lipoprotein(a) and apolipoprotein(a) phenotypes with coronary and carotid atherosclerosis in CHD men].

AIM: To evaluate in a case-control cross-sectional study whether lipoprotein(a) concentration and apo(a) phenotypes are associated with the presence and severity of coronary and carotid atherosclerosis. MATERIALS AND METHODS: We have examined 198 male CHD patients (mean age 53 +/- 8) years) with stenosis more than 50% at least in one main coronary artery or its major branches. Duplex scanning was performed in 168 patients to assess the degree of carotid atherosclerosis. Seventy six apparently healthy men (mean age 39 +/- 9 years) formed the control group. Lp(a) concentration was measured by ELISA, apo(a) phenotyping was performed by immunoblotting. RESULTS: Lp(a) level was significantly higher in cases compared to controls: 37 +/- 31 mg/dl vs. 18 +/- 27 mg/dl, p < 0.05. Patients had low-molecular weight apo(a) phenotypes more frequently than controls: 46% vs. 29%, p = 0.01. Patients aged 45 years and younger had low-molecular weight apo(a) phenotypes more frequently than older ones (65% vs. 42%, p < 0.05) and controls (65% vs. 29%, respectively, p = 0.001). High Lp(a) level and low-molecular weight apo(a) phenotypes correlated with presence and number of coronary occlusions. CONCLUSION: There was association between Lp(a) level, low-molecular weight apo(a) phenotypes and presence, severity, extension of carotid atherosclerosis. No differences in distribution of other CHD risk factors among all subgroups of patients were found.

Adult↗
PubMed1997

[Lipoprotein(a) as a biochemical marker of coronary atherosclerosis].

The relation between lipoprotein Lp(a) levels, other lipids and severity of coronary atherosclerosis was studied in 281 patients (241 men and 40 women aged 24 to 68 years) with suspected or diagnosed coronary heart disease. All of them underwent coronary angiography. The angiograms were evaluated according to two scores: vessel score (0 to 3 points for 0 to 3 vessels with stenoses > 50%) and stenosis score (0 to 32 points, number and severity of coronary lesions). 224 patients with verified coronary atherosclerosis were grouped according to these scores and compared with subgroup of 57 patients with intact coronary arteries. Lp(a) levels were significantly higher in patients with 1-, 2- (p < 0.05) and 3-vessel (p < 0.01) disease and stenosis score more than 10 points (p < 0.01). LDL cholesterol (LDL-C) levels were significantly higher in patients with 2- and 3-vessel disease and stenosis score more than 10 points (p < 0.05 in all cases). There was a positive correlation between Lp(a) levels and severity of coronary atherosclerosis (p < 0.05). Lp(a) contributes < 15% of total plasma cholesterol (TC). After subtraction of Lp(a)-cholesterol from TC according to modified Friedewald formula there was no any correlation between Lp(a) and LDL-C levels.

Adult↗
PubMed1995

[Predictors of coronary artery restenosis in IHD patients after transluminal balloon coronary angioplasty].

To determine clinical and angiographic predictors of restenosis after successful PTCA, we analysed the data on 63 patients (68 stenoses) who had undergone repeat coronary angiography during the first eight months after successful PTCA. The overall restenosis rate was 42.6%. Four clinical and angiographic factors were associated with high risk of restenosis. Residual stenosis > or = 25% was the strongest predictor of restenosis (p = 0.002). Among other factors presence of unstable angina, complicated lesion morphology and absence of intimal dissection had equal value of significance (p = 0.02 in all the cases).

Angioplasty, Balloon, Coronary↗
PubMed1994

[The results of catheterization and the x-ray angiographic assessment of cardiac contractility and volume in primary pulmonary hypertension].

To ascertain the role of invasive investigations in the diagnosis of primary pulmonary hypertension (PPH), 12 PPH patients underwent catheterization of the left and right heart compartments, contrast right and left ventriculography and oximetry. Compared to control values, the patients had high pressure in the pulmonary artery and right ventricle. Some of them exhibited elevated pressure in the right atrium. Pulmonary artery wedge pressure, left ventricular end-diastolic and systolic, diastolic pressure in the aorta did not differ significantly from those in the controls. Right and left ventriculography revealed an increase in the end-systolic and end-diastolic volumes of the right ventricle which diminished its stroke index and ejection fraction. The latter two were reduced in the left ventricle also. Because the procedure was well tolerated by the patients, it is recommended for PPH diagnosis and follow-up.

Adult↗
PubMed1993

[Changes in the blood lipoprotein and apolipoprotein spectrum and the state of coronary channel in patients with unstable angina pectoris: a follow-up].

The study was undertaken to examine 34 male patients with unstable angina pectoris who underwent coronary angiography (in the period of instability and at rehospitalization) and study of protein and lipid parameters in their plasma. During a follow-up (mean 33.9-2.2 months), the patients were divided into 2 groups according to the changes occurring in the coronary bed. These included: (1) patients with progressive atherosclerotic changes and (2) those with stabilization of the process. Changes in the lipid profile in patients with unstable angina were found to appear as profound atherogenic shifts in the spectrum of lipoproteins and apolipoproteins, which suggests that coronary atherosclerosis is progressive in the late period.

Adult↗
PubMed1993

[Decreased tonus of the epicardial coronary arteries in patients with dilated cardiomyopathy].

The tone of coronary artery (CA) was evaluated in 26 patients with dilated cardiomyopathy (DCMP) and 20 patients with atypical chest pain, intact CA, and normal left ventricular contractility served as controls. All the patients underwent selective polyviewed coronarography, left and right ventriculography. The configurations of the great CA were examined by a computer which calculated their mean diameter in diastole (Dd) and systole (Ds), their difference (d) and the elasticity index (EI) by the formula: d/Dsx 100%. Twelve patients with DCMP and 10 control patients had repeated left coronary contrasting after intracoronary injection of nitroglycerin, 150 mg, they authors calculated the baseline Dd (Dd1), Dd after nitroglycerin (Dd2), the degree of nitroglycerin-induced CA dilation. Ds was found to be greater than Dd in the two groups. The mean CA diameter was significantly more in DCMP patients who had lower D and EI. Intracoronary nitroglycerin injection caused a less marked increase ion the Dd of the anterior descending CA in DCMP patients. Thus, the computer-aided analysis of coronarograms and nitroglycerin test allowed one to quantitatively determined the decreases in CA in DCMP.

Biopsy↗
PubMed1993

[Left ventricular function in patients with ischemic heart disease at the moment of acute myocardial ischemia induced by transesophageal cardiac electrostimulation].

Repeat transvenous multiphase left ventriculography was performed in 14 patients with coronary stenosis diagnosed by clinical and angiographic findings. The procedure was conducted before and in the course of transesophageal pacing. The latter provoked acute myocardial ischemia responsible for a wide range of left ventricular dysfunctions which are analyzed in the paper in terms of cardiomanometry parameters, cardiocycle energetic balance, diastolic function and local motions of the camera walls.

Acute Disease↗
PubMed1993

[Left ventricular function in patients with arterial hypertension during the performance of acute drug tests with captopril and nifedipine].

An examination was made of 22 hypertensive patients with clinical and echoCG symptoms of left ventricular hypertrophy. All the patients underwent coronary angiography, transvenous multiphase left ventriculography and acute captopril (11 patients), nifedipine (11 patients) tests. A single oral 25 mg dose of captopril increased energetic efficacy of cardiocycle, restored diastolic function of the left ventricle, aroused myocardial contractility.

Adult↗
PubMed1993

[Left ventricular function in patients with arterial hypertension and myocardial hypertrophy based on the data of multiphasic ventriculography].

The study included 39 hypertensive subjects with clinical echocardiographic evidence of left ventricular hypertrophy. All the patients were subjected to coronary angiography and transvenous multiple-phase left ventriculography. Early subclinical signs of left ventricular dysfunction in hypertensive patients have been defined. They concern energetic efficacy of the cardiac cycle, left ventricular diastolic function, myocardial asynchronism. It is noted that the above dysfunction was recorded in cases where standard two-image analysis provides normal values.

Adult↗
PubMed1993

[The clinical characteristics of ischemic heart disease in patients with arterial hypertension of different origins].

To study the clinical picture of coronary heart disease with concomitant arterial hypertension of various genesis, 172 patients were examined, out of them the cause of arterial hypertension was hypertensive disease in 54, chronic pyelonephritis in 40, chronic glomerulonephritis in 37, and stenotic atherosclerosis of renal arteries in 29, endocrine disease in 12 patients. The patients were divided into 2 groups: (1) 148 with stenotic atherosclerosis of coronary arteries and (2) 24 patients with intact coronary arteries. Comparison of these patient groups revealed no clear-cut correlation between the age and the detection of exercise-induced angina, as well as the duration of arterial hypertension. There was no correlation between the detection of the anginal syndrome and ECG changes. The incidence of the anginal syndrome was 62.2% in Group 1 and 47.7% in Group 2. It was established that the detection of the anginal syndrome correlated well with the severity of left ventricular hypertrophy and values of blood pressure, despite nosological entities.

Adult↗