Organizational and technological algorithm of primary specialized health care at cardiovascular diseases

Aim. To develop an algorithm for primary specialized cardiovascular care with a priority of endovascular strategy. Methods. The study was conducted in 20182019 based on the Central Clinical Hospital Russian Railways-Medicine and 14 polyclinics in the regions of the Russian Federation. The subject of the study is cardiovascular surgeons (n=2), possessing the skills of endovascular care. The object of the study was patients (n=1018) attended regional polyclinics of the Russian Federation. Patients were divided into two groups: group A consisting of 673 patients with clinically significant atherosclerosis of the coronary, brachiocephalic and peripheral arteries and abdominal aortic aneurysm; group B consisting of 345 patients with chronic lower limb ischemia that does not require surgical treatment. The average age of patients in group A was 696.1 years, in group B 637.2 years. There were 467 men in group A (69.4%), and 339 in group B (98.3%). An organizational and technological algorithm was developed to improve the primary specialized cardiovascular care. The results were assessed by the presence of outcomes (heart attack, stroke, bleeding, death), the availability of endovascular care and patient survival follow up 12 and 24 months. A content analysis of scientific publications on the issue under study has been performed. Results. An organizational and technological algorithm of primary specialized cardiovascular care has been developed, including the activities of the cardiovascular surgeon, who has the skills of endovascular care and a nurse in an outpatient clinic. The implementation of the algorithm ensured continuity, 100% availability, safety and quality of cardiovascular care using endovascular technology. Outcomes are not registered in both groups. Both patient groups showed 100% one and two-year survival. Conclusion. The developed algorithm of primary specialized cardiovascular care has provided high quality healthcare.

LINE-1 retrotransposon demethylation is associated to atherosclerotic plaques destabilization

В работе проведен анализ уровня метилирования ретротранспозона LINE-1 в атеросклеротических бляшках сонных артерий, выделенных из них макрофагах и гладкомышечных клетках, а также в лейкоцитах периферической крови пациентов с клинически выраженным атеросклерозом и в лейкоцитах здоровых доноров. Выявлен сниженный уровень метилирования LINE-1 в атеросклеротических бляшках по сравнению с лейкоцитами крови пациентов, а также его связь с гистологическими признаками нестабильности атеросклеротической бляшки. We analyzed the LINE-1 methylation level in carotid atherosclerotic plaques, macrophages and smooth muscle cells isolated from plaques and in the blood leukocytes of patients with clinically significant atherosclerosis and leukocytes of healthy donors. A reduced level of LINE-1 methylation in atherosclerotic plaques was detected compared to leukocytes, as well as it was associated with the histological features of carotid plaque instability.

Left Main Percutaneous Coronary Intervention and Transcatheter Aortic Valve Replacement in a Young Male with Rheumatic Heart Disease and Porcelain Aorta

We highlight the presence of a calcified mass in the left main coronary artery without significant atherosclerosis seen in the other coronary arteries or in the peripheral large arteries. In our view, the calcified character of the obstruction and the calcification of the aortic valve are characteristic of a variant type of coronary artery disease (CAD) not associated with the same risk factors as diffuse coronary atherosclerosis, but, in this case, with rheumatic heart disease. This case report also emphasizes the interventional approach for patients with aortic valve stenosis secondary to rheumatic heart disease.

Stroke prevention - B vitamins

In a nutshellThe association between elevated Hcy, the B vitamins linked to it, and stroke incidence and severity appears strong.So far, a dozen RCTs, (almost all in patients with significant atherosclerosis), have tried to prevent stroke by reducing Hcy through various combinations of folate, B12and B6. In only one trial did this clearly succeed.