Papers by Hamlet Hayrapetyan
DOAJ (DOAJ: Directory of Open Access Journals), Dec 1, 2021
ESC heart failure, Jun 28, 2024
European journal of preventive cardiology, Jun 1, 2024
Cardiology and cardiovascular medicine, 2024
European Heart Journal
Background Lung ultrasonography (LUS) is a relatively new method for assessing subclinical lung c... more Background Lung ultrasonography (LUS) is a relatively new method for assessing subclinical lung congestion. It has been approved to predict prognosis in heart failure; however, the importance of LUS as a prognostic marker in acute myocardial infarction is not well studied. Purpose Our goal was to assess the predictive value of LUS in patients with ST-segment elevation myocardial infarction(STEMI). Methods The study involved 140 patients in total. The primary percutaneous coronary intervention was performed on all patients. We used the 8-zone approach to perform LUS in patients with STEMI within 6 hours of admission. LUS detected lung congestion as B-lines, and the sum of the B-line from 8 chest zones was determined. The patients were divided into two groups depending on the amounts of B lines. Patients with a number of B-lines < 15 were included in Group 1 (70 patients) and patients with a B-lines ≥ 15 were included in Group 2 (70 patients). The NT-proBNP analysis was performed b...
European Heart Journal, 2021
Aims The aim of this study was to determine the contemporary use of reperfusion therapy in the E... more Aims The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI). Methods and results Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset <24 h in 196 centres across 29 countries. A total of 11 462 patients were enrolled, for whom primary percutaneous coronary intervention (PCI) (total cohort frequency: 72.2%, country frequency range 0–100%), fibrinolysis (18.8%; 0–100%), and no reperfusion therapy (9.0%; 0–75%) were performed. Corresponding in-hospital mortality rates from any cause were 3.1%, 4.4%, and 14.1% and overall mortality was 4.4% (country range 2.5–5.9%). Achievement of quality indicators for reperfusion was reported for 92.7% (region range 84.8–97.5%) for the performance of reperfusion therap...
International Journal of Cardiology, Jun 1, 2018
BACKGROUND Hospitalization is an opportunity to optimize heart failure (HF) therapy. As optimal t... more BACKGROUND Hospitalization is an opportunity to optimize heart failure (HF) therapy. As optimal treatment for hospitalized HF patients in sinus rhythm with heart rate≥70bpm is unclear, we investigated the impact of combined beta-blocker (BB) and ivabradine versus BBs alone on short and longer term mortality and rehospitalization. METHODS AND RESULTS A retrospective analysis was performed on 370 hospitalized HF patients with heart rate≥70bpm (150 BB+ivabradine, 220 BB alone) in the Optimize Heart Failure Care Program in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Russia, Ukraine, and Uzbekistan, from October 2015 to April 2016. RESULTS At 1month, 3months, 6months and 12months, there were fewer deaths, HF hospitalizations and overall hospitalizations in patients on BB+ivabradine vs BBs alone. At 12months, all-cause mortality or HF hospitalization was significantly lower with BB+ivabradine than BBs (adjusted hazard ratio [HR] 0.45 (95% confidence interval [CI] 0.32-0.64, P<0.0001). Significantly greater improvement was seen in quality of life (QOL) from admission to 12months with BB+ivabradine vs BBs alone (P=0.0001). With BB+ivabradine, significantly more patients achieved ≥50% target doses of BBs at 12months than on admission (82.0% vs 66.6%, P=0.0001), but the effect was non-significant with BBs alone. CONCLUSIONS Heart rate lowering therapy with BB+ivabradine started in hospitalized HF patients (heart rate≥70bpm) is associated with reduced overall mortality and re-hospitalization over the subsequent 12months. A prospective randomized trial is needed to confirm the advantages of this strategy.
European Heart Journal, Aug 2, 2013
European Journal of Heart Failure, Aug 1, 2012
This double-blind, randomized, parallel, placebo-controlled investigation evaluated the effects o... more This double-blind, randomized, parallel, placebo-controlled investigation evaluated the effects of cross-linked polyelectrolyte (CLP) on serum potassium and measures of congestion in patients with heart failure (HF) and chronic kidney disease (CKD). The primary endpoint was change in serum potassium over time. Exploratory endpoints included: weight, physician and patient assessment of exertional dyspnoea, effect on N-terminal pro brain natriuretic peptide (NT-proBNP) levels, New York Heart Association (NYHA) classification, 6 min walk test (6MWT), and quality of life by Kansas City Cardiomyopathy Questionnaire (KCCQ). Serum potassium was similar in CLP (n =59) and placebo (n =52) groups throughout the 8-week study. Weight loss was greater in the CLP than in the placebo group at Weeks 1 (P =0.014) and 2 (P =0.004), and this trend continued until the end of the study. After 8 weeks, by physician assessment, the percentage of patients experiencing marked or disabling dyspnoea tended to be lower in the CLP than in the placebo group (7.3% vs. 23.9%, P =0.128). Fewer patients in the CLP than in the placebo group had NT-proBNP levels &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1000 pg/mL at Week 4 (P =0.039) and Week 8 (P =0.065). The proportion of patients improving by at least one NYHA functional class over the study was higher in the CLP than in the placebo group (48.8% vs. 17.4%; P =0.002). Effects on 6MWT at Week 8 (p =0.072) and quality of life (overall KCCQ score) at Week 4 (p =0.005) and 8 (P =0.062) all favoured the CLP cohort. Four treatment-unrelated deaths occurred in the CLP group and none in the placebo group (P =0.056). In advanced, symptomatic HF with CKD, CLP is associated with beneficial clinical effects without significant serum potassium changes. NCT01265524.
Международный научно-исследовательский журнал, Aug 31, 2013
Türk kardiyoloji derneği arşivi, Mar 1, 2014
Aṛoghjapahut'yan ev bzhshkagitut'yan haykakan handes, Sep 5, 2022
In recent years, many clinical studies have lost their relevance due to changes in the modern app... more In recent years, many clinical studies have lost their relevance due to changes in the modern approach to management of patients with chronic heart failure. New clinical trials show that the division of patients with chronic heart failure into groups with reduced, mildly reduced and preserved ejection fraction does not fully reflect prognostic and clinical features of the disease, which indicates the necessity for new clinical trials in this field. In this brief review, the authors discuss recent clinical research and attempt to point the way for new research.
Türk kardiyoloji derneği arşivi, 2014
İnferiyor ST yükselmeli miyokart enfarktüslü hastalarda miyokart performans indeksiyle triküspit ... more İnferiyor ST yükselmeli miyokart enfarktüslü hastalarda miyokart performans indeksiyle triküspit halkası düzleminin sistolik yer değiştirmesinin birlikteliği, her birinin tek başına kullanımına göre daha iyi bir öngördürücü müdür?
Problems of Endocrinology
BACKGROUND. There is enough evidence of the negative impact of excess weight on the formation and... more BACKGROUND. There is enough evidence of the negative impact of excess weight on the formation and progression of res piratory pathology. Given the continuing SARS-CoV-2 pandemic, it is relevant to determine the relationship between body mass index (BMI) and the clinical features of the novel coronavirus infection (NCI).AIM. To study the effect of BMI on the course of the acute SARS-COV-2 infection and the post-covid period.MATERIALS AND METHODS. AKTIV and AKTIV 2 are multicenter non-interventional real-world registers. The АКТИВ registry (n=6396) includes non-overlapping outpatient and inpatient arms with 6 visits in each. The АКТИВ 2 registry (n=2968) collected the data of hospitalized patients and included 3 visits. All subjects were divided into 3 groups: not overweight (n=2139), overweight (n=2931) and obese (n=2666).RESULTS. A higher BMI was significantly associated with a more severe course of the infection in the form of acute kidney injury (p=0.018), cytok...
Kardiologiia, 2021
Aim To study the effect of regular drug therapy for cardiovascular and other diseases precedi... more Aim To study the effect of regular drug therapy for cardiovascular and other diseases preceding the COVID-19 infection on severity and outcome of COVID-19 based on data of the ACTIVE (Analysis of dynamics of Comorbidities in paTIents who surVived SARS-CoV-2 infEction) registry.Material and methods The ACTIVE registry was created at the initiative of the Eurasian Association of Therapists. The registry includes 5 808 male and female patients diagnosed with COVID-19 treated in a hospital or at home with a due protection of patients’ privacy (data of nasal and throat smears; antibody titer; typical CT imaging features). The register territory included 7 countries: the Russian Federation, the Republic of Armenia, the Republic of Belarus, the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Moldova, and the Republic of Uzbekistan. The registry design: a closed, multicenter registry with two nonoverlapping arms (outpatient arm and in-patient arm). The registry scheduled 6 ...
European Heart Journal, 2019
Background Four recommended self-care behaviors (low salt diet, avoidance of excessive fluid inta... more Background Four recommended self-care behaviors (low salt diet, avoidance of excessive fluid intake, weight control, and flexible diuretic regimen) play an important role in the management of heart failure (HF) patients. However, little is known about the impact of patients' adherence to these self-care behaviors on prognosis and rate of HF re-hospitalizations. The aim of our study was to analyze the impact of HF patients' adherence to maintenance of euvolaemia on all-cause mortality and HF re-hospitalizations. Methods The analysis included data from the international prospective multicenter Optimize Heart Failure Care Program which was collected over 12 months from 628 patients (mean age 62.6±12.3 years, 70% male) hospitalized with decompensated HF, NYHA II-IV (mean 2.7±0.6), mean left ventricular ejection fraction 33.8±9.4%. The underlying etiology of HF was ischemic in 64% of cases. Before discharge from the hospital all HF patients were educated in self-care skills to ma...
European Heart Journal, 2018
Strategies to optimize established heart failure therapies / Bleeding risk and oral anticoagulati... more Strategies to optimize established heart failure therapies / Bleeding risk and oral anticoagulation 19 tions Assessment, Development and Evaluation) approach was used to rate the quality of the evidence. Results: Eighteen RCTs (n=4630 patients) were included for systematic review, and 16 (n=4447 patients) for meta-analysis. In this review meta-analysis the pooled estimate showed a significant reduction in HF hospitalizations {odd ratio (OR) 0.72 [95% confidence interval (CI) 0.55-0.93], P=0.01, heterogeneity (I2)=39%} but no reduction in HF mortality [OR, 1.56, 95% CI (0.60-4.03), P=0.36, I2= 0%]. We observed a significant reduction in all-cause hospitalizations [OR 0.76, 95% CI (0.60-0.96), P=0.02, I2= 52%] and all-cause mortality showed a similar, but non-significant trend [OR 0.92, 95% CI (0.74-1.13), P=0.476, I2= 9%]. The effect on medication adherence was heterogeneous, significant improvement (P<0.05) as well as a non-significant improvement. There was also evidence to support significant improvements in HF knowledge (P<0.05), and non-significant improvements in health care costs, self-care, and composite endpoint [OR 0.97, 95% CI (0.82-1.16), P=0.74, I2= 0%]. Conclusions: According to the GRADE evaluation, we rated high quality evidence for the significant reduction of HF hospitalizations, all-cause hospitalizations, and improvement in medication adherence, and HF knowledge. The pharmacist is a vital member of a multidisciplinary team in HF management to improve clinical outcomes.
Background: Area tracking (AT,%) is a novel three-dimensional parameter of myocardial deformation... more Background: Area tracking (AT,%) is a novel three-dimensional parameter of myocardial deformation that incorporates longitudinal and circumferential shortening and delineates deformation of the endocardial surface area. The aim of this study was to evaluate the correlation between AT and left ventricular ejection fraction (LVEF) and to assess its accuracy in predicting normal LVEF (.55%) and systolic dysfunction (LVEF ,45%). Methods: 152 patients (pts) were evaluated with the use of 3-D echocardiography (Artida, Toshiba).Since 19 pts were excluded for suboptimal image quality (16) and rhythm disturbances (3), the final cohort involved 133 ptsincluding ischaemic cardiomyopathy (41%), hypertensive heart disease (30%), hypertrophic cardiomyopathy (7%), heart failurewith preserved LVEF(17%) and controls (5%). Receiver-operating characteristic (ROC) curves were constructed for AT for the proper identification of LVEF ,45% and .55%. Results: 3D LVEF ranged between 20 and 75% (mean value: 57+9%). AT highly correlated with LVEF (r=0.83, p,0.001). AT was shown to be accurate at predicting LVEF.55% with area under the curve (AUC) equating 0.96[0.93-99], p,0.05. Cutoff value was established at 236.4% with sensitivity and specificity being 90% and 89%, respectively. Similarly, AT accurately identified systolic dysfunctionwith AUC=0.99 [0.98-00], p,0.05. Cutoff values for LVEF,45% was established at-29.3% with sensitivity of 100% and specificity of 96%. Conclusions: Area tracking is a new parameter of myocardial deformation provided exclusively by 3D echocardiography. In this large range of LVEF values, it proved to be extremely accurate at predicting systolic dysfunction with high levels of sensitivity and specificity. P984 Regression of right ventricular mass in idiopathic pulmonary arterial hypertension: indicator of poor prognosis? two year follow-up study with 3D echocardiography and cardiac magnetic resonance
European Heart Journal, 2018
Coronary artery disease: diagnosis, phamacotherapy and revascularisation / Biomarkers in acute co... more Coronary artery disease: diagnosis, phamacotherapy and revascularisation / Biomarkers in acute coronary syndromes 1169 and TLR was 689.3±922.0 days in the first generation DESs and 285.4±540.5 days in the second/third generation DESs (p=0.04). Conclusion: The prevalence of late acquired PSS and the subsequent occurrence of TLR and VLST were significantly higher in lesions treated with first generation DESs. Conversely, the occurrence of TLR and VLST after the detection of late acquired PSS was relatively rare in lesions treated with second/third generation DESs. P5591 Early vascular responses after everolimus-eluting stent implantation assessed by serial observations of intracoronary optical coherence tomography in STEMI patients
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Papers by Hamlet Hayrapetyan