A L Krylov

Russian Academy of Medical Sciences, Moskva, Moscow, Russia

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Publications (30)8.61 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: In order to assess comparative efficacy of pharmacoinvasive strategy of myocardial reperfusion and primary angioplasty in ST elevation acute myocardial infarction 289 patients were randomized at prehospital stage within first 6 hours of the disease into 2 groups: primary angioplasty (group 1), and prehospital thrombolysis with subsequent rescue or delayed angioplasty depending on efficacy of thrombolysis. We analyzed clinical and anamnestic characteristics of patients, efficacy of reperfusion measures, dimensions of myocardial necrosis, and clinical course of the disease. Pharmacoinvasive myocardial reperfusion with prehospital thrombolysis compared with primary coronary angioplasty decreased time of myocardial ischemia (224.65 +/- 71 vs. 278 +/- 184 min, p < 0.03), increased rate of achievement of TIMI grade 3 flow after percutaneous coronary intervention (80.5% vs. 71.4%, p = 0.002) and more effectively preserved left ventricular ejection fraction (60.0 +/- 14.9% vs. 54.9 +/- 12.3%, p < 0.01). Prehospital thrombolysis before coronary angioplasty compared with primary angioplasty was associated with lower rate of development of no-reflow syndrome (1.4% vs. 11.6%, p < 0.003).
    Kardiologiia 01/2013; 53(10):10-5. · 0.25 Impact Factor
  • A L Krylov, L N Maslov
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    ABSTRACT: The article deals with a review of clinical studies carried out within the time period from 2003 to 2007. The review contains the data concerning restenoses of sirolimus- and paclitaxel-eluting stents, suggesting that the stents with an antiproliferative coating substantially diminished the acuity of the problem regarding restenoses but did not solve the problem completely. The incidence rate of restenoses remains high in patients with diabetes mellitus as well as in those with bifurcation stenoses, acute and chronic occlusions of coronary arteries. Analysing the published data the authors made a conclusion that during angioplasty of acute and chronic occlusions of coronary arteries preference should be given to sirolimus-eluting stents since they are most effective in prevention of restenoses inside stents in such lesions. Analysing the findings of clinical trials of drug-eluting stents showed efficiency and safety of such stents in treatment of in-stent restenoses. Patients with diabetes mellitus are exceptions to this rule, being poor candidates for drug-eluting stents, since the latter proved to exhibit low efficacy in these patients.
    Angiologii͡a i sosudistai͡a khirurgii͡a = Angiology and vascular surgery 02/2008; 14(2):45-51.
  • L N Maslov, A L Krylov
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    ABSTRACT: The authors herein analysed the findings obtained in randomized studies carried out to compare the efficacy of percutaneous transluminal coronary angioplasty (hereinafter referred to as PTCA) and thrombolytic therapy for acute myocardial infarction (AMI). Some studies employed thrombolytic therapy with streptokinase, while others used plasminogen tissue activators as thrombolytic agents. Primary PTCA as compared with thrombolysis was noted to decrease the total lethality rate, lowering mortality related to cardiogenic shock, decreasing lethality amongst elderly and aged patients, decreasing the prevalence of stroke and secondary infarctions, as well as the incidence of repeat revascularizations. The obtained findings demonstrated that primary PTCA still remains a better means of management of patients with AMI as compared with thrombolytic therapy, irrespective of the thrombolytic agent used. The long-term forecasts in primary PTCA and coronary artery bypass are similar, with the average hospital stay in PTCA being, however, shorter as compared with that in coronary artery bypass and thrombolytic therapy. Hence, the authors came to a conclusion that primary PTCA is a more efficient method of management of AIM patients than thrombolytic therapy or coronary artery bypass. We also analysed the findings of randomized studies aimed at comparing the efficacy of primary balloon dilatation and stenting of the infarction-associated coronary artery, and came to a conclusion that primary stenting makes it possible to more efficiently, than balloon angioplasty, revascularize the infarction-affected myocardium, since stenting decreases the incidence rate of relapsing secondary revascularizations as compared with primary balloon dilatation. However, stenting possesses no advantages over angioplasty as regards the influence on the incidence rate of lethal outcomes and secondary myocardial infarctions. Using the syrolimus-containing stents may improve the long-term prognosis in patients presenting with AMI. Preliminary administration of absiximab was observed to decrease the lethality rate amongst the patients subjected to primary angioplasty during the first 30 days following the development of AMI, exerting however no influence on the lethality rate during one year after the onset of AMI. Intravenous administration of beta-adrenoblockers as compared with primary angioplasty improves survival in AMI patients. Aspirin treatment before and after primary angioplasty appears to improve the remote prognosis following PTCA as compared with the patients having received no aspirin. We believe that beta-adrenoblockers and aspirin should be used in management of patients having undergone angioplasty of the infarction-associated coronary artery.
    Angiologii͡a i sosudistai͡a khirurgii͡a = Angiology and vascular surgery 02/2008; 14(1):131-41.
  • L N Maslov, A L Krylov
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    ABSTRACT: The present review summarises the data obtained by analysing the publications dedicated to using paclitaxel-eluting stents in management of coronary heart disease. The stents containing paclitaxel (taxol) proved to have high clinical efficacy in both single and multiple stenoses of the coronary arteries. The feasibility of using taxol-eluting stents in patients suffering from diabetes mellitus and in patients diagnosed with chronic coronary occlusion does not admit of any doubt. However, the rate of restenoses development following implantation of the paclitaxel-eluting stents is higher than that after using the syrolimus-releasing stents. Unsolved as yet remains the issue concerning the efficacy of the paclitaxel-eluting stents intended for treatment of restenoses inside the stent, as well as concerning the feasibility of using these stents for stenting the main trunk of the left coronary artery.
    Angiologii͡a i sosudistai͡a khirurgii͡a = Angiology and vascular surgery 02/2007; 13(3):53-60.
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    ABSTRACT: The effects of intracoronary infusion of bone marrow mononuclears (BMM) on myocardial contractility after myocardial infarction (MI) was studied in 16 post-infarction patients. The intracoronary infusion of autologic BMM during the subacute period of MI did not have a significant effect on myocardial contractility, the functional class of chronic heart failure, physical tolerance, and quality of life evaluated three and six months after the transplantation. Intracoronary BMM transplantation did not provoke ventricular tachycardia or ventricular fibrillation. BMM transplantation into an infarcted myocardium did not exacerbate coronary heart disease in post-infarction patients.
    Klinicheskaia meditsina 02/2006; 84(9):31-5.
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    ABSTRACT: Autologous bone marrow mononuclear cells were transplanted by intracoronary infusion to patients with myocardial infarction after recovery of coronary perfusion. Controls received traditional therapy alone. Echocardiography was carried out before and 3 and 6 months after cell therapy. Cell transplantation did not appreciably improved left-ventricular contractility in comparison with the control group. In none patient cell therapy provoked malignant ventricular arrhythmias. Intracoronary infusion of bone marrow mononuclear cells in patients with myocardial infarction did not improve cardiac contractility and did not aggravate the course of the disease.
    Bulletin of Experimental Biology and Medicine 02/2006; 141(1):124-8. · 0.34 Impact Factor
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    ABSTRACT: To study efficacy and safety of transplantation of bone marrow autologous mononuclear cells (BMAMC) in patients with acute myocardial infarction; to examine BMAMC distribution in the human body after intracoronary introduction. The open controlled trial investigated 26 AMI patients (16 entered the study group and 10 were controls). Cell cardiomyoplasty with BMAMC was performed by intracoronary injection of the cells after stenting the coronary artery supplying blood to the infarction zone on AMI day 7-21. BMAMC were isolated by gradient centrifugation. Distribution of mononuclear cells was studied with radionuclear indication of the cells 99m-Tc-HMPAO. All the patients were examined with Tl-199 perfusion scintigraphy of the heart 2 weeks and 6 months after the treatment, echocardiography, 24-h ECG monitoring, 6-min walk test. All the patients were followed up for 6 months. Two patients (one in each group) developed recurrent myocardial infarction 3 months after the first. Radionuclide investigations revealed fixation of labelled mononuclear cells in the heart both in initial hours after the treatment and 24 hours after it. As shown by myocardial scintigraphy, intracoronary administration of the cells with short-term arterial occlusion was followed by much greater number of labeled cells. By follow-up month 6, in the study group, left ventricular ejection fraction increased more: 12.7 +/- 3.2% versus 10.4 +/- 2.5% in the control group (p = 0.09); moreover, a stable defect of myocardial perfusion reduced more (by 29 +/- 24% against 20 +/- 18%, respectively, p = 0.1). Malignant arrhythmia, complications during and after bone marrow aspiration, intracoronary administration of cell suspension were not registered. Intracoronary administration of BMAMC in AMI patients is safe and provides their transfer and fixation in the myocardium. BMAMC transplantation has a positive effect on recovery of perfusion and contractile function of left ventricular myocardium in AMI patients.
    Terapevticheskii arkhiv 02/2006; 78(8):47-52. · 0.15 Impact Factor
  • European Journal of Heart Failure Supplements 01/2006; 5(1):96-96.
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    ABSTRACT: A randomized controlled study included 44 patients with acute myocardial infarction. It was found that intracoronary injection of bone marrow mononuclear cells is safe, ensures fixation of the injected cells in the myocardium, reduces blood levels of IL-1beta and TNF-alpha, increases the content insulin-like growth factor, and does not provoke malignant arrhythmias.
    Bulletin of Experimental Biology and Medicine 12/2005; 140(5):640-3. · 0.34 Impact Factor
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    ABSTRACT: The purpose of the study was to investigate the character of clinical and functional manifestations of ischemic cardiac dysfunction in patients with idiopathic coronary microangiopathy, and their correlation with insulin level, as a possible diagnostic criterion of coronary heart disease (CHD). The subjects were 115 men, including 35 individuals (mean age 41.8 +/- 1.2 years) with microvascular form (MVF) of coronary artery lesion, 60 patients with CHD with postinfarction cardiosclerosis (PICS), and 20 healthy individuals. Patients with glucose tolerance disorder, diabetes mellitus, arterial hypertension, and other severe pathology were not included in the study. The diagnostic tests included selective coronaroventriculography with right ventricle endomyocardium biopsy, and myocardial perfusion scintigraphy. Parameters of coronary, intracardial and system hemodynamics were evaluated; insulin and glucose serum levels were measured at rest and during stress-tests with physical exercise. Endocardial biopsy in MVF patients found plastic insufficiency of the endothelium of hemocapillars, prearteriols and cardiomyocytes. Alterations in the parameters of metabolism, intracardial and system hemodynamics, and physical exercise tolerance were found to be comparable in MVF and PICS patients. Insulin level at rest in both groups was equal to that in the control group. At threshold physical load during veloergometry insulin levels in MVF and PICS patients demonstrated comparable elevation (222.8% and 201%, respectively; p < 0.05-0.01). Glucose concentrations in patients with microangiopathy decreased by 28% (p < 0.05), while in patients with CHD it increased significantly by 27.3% (p < 0.05). The study shows that structural and functional lesion of hemocapillar endothelium underlies cardiac syndrome X It results in perfusion ability impairment, chronic hypoxia, impairment of myocardial contractility under the conditions of physical activity. Hyperinsulinemia, manifesting when ischemia is induced, is not caused by insulinresistence. Probably, it presents and adaptive and compensatory reaction to increase of myocardial glucose requirement, and may be one of early CHD markers.
    Klinicheskaia meditsina 02/2005; 83(6):43-7.
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    ABSTRACT: Coronary artery stenting was carried out in 18 patients with angina recurrence 29.3+/-7.6 after coronary artery bypass grafting. Paired bicycle exercise tests, (199)Tl single photon emission tomography and graft angiography were used in evaluation of patients. Occlusions of 1 or 2 venous grafts were found in 38.9%, stenoses of both previously bypassed and native arteries in 27.8% of patients. Implantation of stents in grafts and/or native coronary arteries was associated with 2.7 fold decrease of angina frequency, 3 fold decrease of nitroglycerine consumption, 72.5% increase of exercise tolerance. The use of statins resulted in obvious lowering of total and low density lipoprotein cholesterol.
    Kardiologiia 02/2005; 45(1):57-62. · 0.25 Impact Factor
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    ABSTRACT: To elucidate the role of evaluation of coronary reserve in coronary sinus by transesophageal doppler for assessment of efficacy of various revascularization interventions. Patients with isolated stenoses of either left anterior descending or circumflex coronary artery subjected to stenting (n=14) and with two vessel disease subjected to bypass surgery (n=20). Dipyridamole was used as a stress agent. Coronary reserve was calculated as ratio of peak hyperemic to baseline antegrade coronary sinus blood flow velocity (CR(P)) and as ratio of hyperemic to baseline antegrade coronary sinus volume blood flow (CR(VBF)). In patients with atherosclerotic lesions in the system of left coronary artery normalization of CR(P) after stenting of single vessel stenoses and of CR(VBF) after bypass surgery in two vessel disease were markers of efficacy of revascularization with sensitivity 75 and 71%, respectively.
    Kardiologiia 02/2005; 45(9):16-22. · 0.25 Impact Factor
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    ABSTRACT: Attempts of mechanical coronary artery recanalization (angioplasty) were undertaken in 52 patients with acute myocardial infarction and cardiogenic shock. In 28 patients (53.9%) recanalization was successful while in 24 it was not (in-hospital mortality 39.3 and 87.5%, respectively, p<0.001). Overall 11 and 21 patients died among those with (n=28) and without (n=24) successful recanalization, respectively. Among patients with successful recanalization survivors compared with nonsurvivors had shorter time from onset of myocardial infarction to recanalization (11.44+/-2.86 vs 16.8+/-3.4 hours, respectively). No serious complications occurred during invasive interventions.
    Kardiologiia 01/2005; 45(1):4-8. · 0.25 Impact Factor
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    ABSTRACT: To evaluate the diagnostic importance of thallium-199 myocardial perfusion single-photon emission computed tomography (SPECT) in the recognition of coronary restenoses and stenoses de novo of varying sites after endovascular treatment of coronary artery disease (CAD). Myocardial perfusion scintigraphy was used to examine forty-six patients presenting with CAD before, 2-3 weeks, 3-6 months and 1-2 years after balloon dilatation and/or stenting of the coronary arteries (CA). The presence, character and magnitude of perfusion defects were estimated. The coronary angioplasty resulted in a 76% decrease of the mean size of transient ischemic zones. The reversible defects of thallium accumulation coexisted after operation with incomplete myocardial revasculization in patients with hemodynamically significant multivessel lesions. In the long-term follow up (3-6 months and 1-2 years after endovascular treatment), aggravation of coronary insufficiency in patients with incomplete revascularization proceeded mainly due to an increase in the size of the areas marked by persistent disturbance of coronary microcirculation determined not only by acute necrotic myocardial infarction but also by transformation of transient ischemic zones to the new stable perfusion defects. As compared to the early times, the patients with verified restenoses and stenoses de novo showed in the later period (3-6 months after coronary angioplasty) a significant increase in the mean size of the transient ischemic zones, exceeding the preoperative level. In six of the eleven patients, the appearance of the new stable defects was marked after 1-2 years in the area of blood supply to the recanalized CA. Meanwhile the condition of myocardial perfusion in the group of patients without restenoses did not undergo any noticeable changes. Myocardial perfusion scintigraphy using thallium-199 chloride allows to objectively evaluate over time the results of endovascular treatment of CAD. Also, there is every probability of success of predicting restenoses and stenoses de novo.
    Angiologii͡a i sosudistai͡a khirurgii͡a = Angiology and vascular surgery 02/2003; 9(4):48-57.
  • Kardiologiia 02/2002; 42(9):26-9. · 0.25 Impact Factor
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    ABSTRACT: Twenty two patients with congestive cardiac failure treated surgically by dynamic cardiomyoplasty (CMP) with m. latissimus dorsi were examined. Myocardial perfusion was assessed with (199)TlCl scintigraphy combined with dipyridamole stress-test. In order to obtain direct evidence of myocardial perfusion from muscular flap we also injected a bolus of (99m)Tc into a. thoracodorsalis, with simultaneous blood sampling from coronary sinus. Haemodynamic parameters were assessed using radionuclide angiography. In a year of follow-up all the patients were assigned to one of two groups: eleven patients demonstrated improvement in clinical status (first group) and in another group comprising eleven persons no positive effect or deterioration were obvious (second group). The patients of the first group before operation revealed two times less persistent defect size than patients of the second group. Analysis of integral index of persistent defect revealed more expressive differences between groups. Before the surgical treatment the patients with improvement in clinical status after cardiomyoplasty demonstrated greater size of reversible defect in comparison with patients of the second group. In the second group coronary fraction of thallium accumulation was 1.4 times higher in comparison to the first group, as the result of myocardial hypertrophy in patients with bad prognosis. There were no significant differences between the two groups in Il/m level before cardiomyoplasty. Before the surgical treatment the patients with improvement in clinical status after cardiomyoplasty demonstrated greater ejection fraction in comparison with patients of the second group. Cardiomyoplasty led to a decrease in the mean size of reversible defects due to indirect revascularisation. This hypothesis was testified to by the fact that in patients after cardiomyoplasty nuclide appeared in coronary sinus at 10-12th seconds after injection into artery thoracodorsalis through anastomoses between the latissimus dorsi muscle and the myocardium. The time of appearance of the second wave of rise gamma-counting in blood samples from coronary sinus reflects the repeated entry of radiopharmaceutical in myocardium after recirculation.
    Nuclear medicine review. Central & Eastern Europe: journal of Bulgarian, Czech, Macedonian, Polish, Romanian, Russian, Slovak, Yugoslav societies of nuclear medicine and Ukrainian Society of Radiology 02/2000; 3(1):21-7.
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    ABSTRACT: Thirty-five cardiomyoplasty procedures were performed in five patients with dilated and 30 patients with ischemic cardiomyopathies. Russian-made cardiomyostimulators (CMS) were implanted in these patients. Twenty-one patients underwent a one-step procedure using a left thoracotomy for cardiomyoplasty, while in 14 patients, a two-step procedure that included a mid-line sternotomy was carried out. During the average follow-up period of 9 +/- 2.1 months, studies were carried out that showed in survivors improved clinical functional status and decreased heart failure symptoms. Evidence of revascularization of the ischemic myocardium from the latissimus dorsi muscle (LDM) wrap was obtained by angiography and radioactive scintigraphy. In five patients, the CMS had to be removed due to complications, and in all these patients, their clinical functional status deteriorated following the cessation of cardiomyostimulation.
    Journal of Cardiac Surgery 10/1995; 10(5):573-9. · 1.35 Impact Factor
  • Terapevticheskii arkhiv 02/1995; 67(6):5-8. · 0.15 Impact Factor
  • Nuclear Medicine Communications - NUCL MED COMMUN. 01/1994; 15(4):232-233.
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    ABSTRACT: Myocardial perfusion and left ventricular (LV) diastolic filling were studied in 67 patients with mild to moderate hypertension and left ventricular hypertrophy (LVH). The control group consisted of 28 subjects with no cardiac pathology. LV mass assessed by M-mode echocardiography was obtained in all patients. LV diastolic filling was estimated by pulsed Doppler echocardiography before and after intravenous administration of verapamil (0.145 mg/kg) and contrast ventricular angiography during intracoronary administration of verapamil (1 to 1.5 mg). Myocardial perfusion was estimated by technetium-99m scintigraphy with albumin microspheres and thallium-199 scintigraphy in combination with intravenous dipyridamole. Coronary artery disease was excluded in 42 patients by coronary angiography. Pulsed Doppler echocardiography demonstrated an inverse correlation between the LV mass index and the ratio of peak early to peak atrial velocity (r = -65, P less than .001). Twelve of 20 patients experienced transient "normalization" of LV diastolic filling during intravenous administration of verapamil. In addition, 6 of 22 patients with LVH had an increase in end-diastolic volume owing to enhanced segment relaxation of the injected artery during intracoronary administration of verapamil. Myocardial perfusion defects assessed by scintigraphy with albumin microspheres were observed in 8 of 13 patients but in no controls. According to 199T scintigraphy data, myocardial perfusion defects were more common in patients with LVH (P less than .05). Thus, essential hypertension combined with LVH appears to result in severe cardiac dysfunction, which is probably associated with changes in small vessel walls.
    American Journal of Hypertension 07/1992; 5(6 Pt 2):190S-194S. · 3.67 Impact Factor