Cardiovascular System In Patients Research Articles

The ultrasound characteristics of the cardiovascular system in systemic lupus erythematosus in children

Background. Systemic lupus erythematosus (SLE) is one of the most typical diffuse connective tissue diseases characterized by the involvement of many organs and systems in the pathological process. Cardiac involvement in SLE is one of the most common manifestations of visceritis in both adults and children. According to various authors, the frequency of heart involvement ranges widely from 40% to 90–95%, with changes being detected in 100% of patients during autopsy. Establishing an accurate diagnosis of cardiovascular system changes in SLE is challenging yet crucial for assessing disease activity and prognosis. This has become possible with the clinical application of modern objective functional methods of examination such as echocardiography and Doppler, which have significantly increased the detection rate of even subclinical forms of heart involvement. Purpose – of the study is to examine the structural and functional state of the heart in children with systemic lupus erythematosus using echocardiography. Materials and Methods. We analyzed echocardiography and Doppler data of 32 children aged from 11 to 18 years old with systemic lupus erythematosus who were examined and treated at the Institute for the Protection of Children’s and Adolescents’ Health of the National Academy of Medical Sciences of Ukraine. There were 7 boys (21.87%) and 25 girls (78.13%) among the patients. The diagnosis was confirmed through comprehensive clinical, laboratory, and instrumental examinations. Ultrasound scanning of the heart and major vessels was performed using «Siemens SL-1» and «Logic-400» General Electric pulse-wave devices with color mapping. Results. The study revealed that the most frequent signs of systemic connective tissue dysplasia diagnosed by echocardiography were the presence of abnormal chords in the left ventricle (in 24 patients – 75%) and mitral valve prolapse (in 12 patients – 37.50%). A typical sign of the disease was lupus carditis manifested by the reduction in the left ventricular diameter systolic contraction (22 patients – 68.75%) and thickening of the left ventricular myocardium and the thickness of the interventricular membrane in 15 patients (46.88%). Left ventricular contractile function was reduced (EF < 60%) in 15 patients (46.88%). In cases with a disease duration of up to two years and grade I activity of the pathological process, an increase in contractile function was observed in 3 patients (9.38%). Grade I/II mitral insufficiency was present in 2 patients (6.25%). Grade I aortic insufficiency was found in 1 patient (3.13%). Characteristic changes in the right ventricle were also observed in patients with systemic lupus erythematosus. The most common findings included enlargement of the right ventricular cavity and the outlet tract of the right ventricle (in 15 patients – 46.88%), hyperkinesia (in 3 patients – 9,38%) and myocardial thickening. Accumulation of fluid in the pericardial cavity during echocardiography was observed in 9 patients (28.13%) as a sign of polyserositis. The amount of liquid was small. Conclusions. The study established the polymorphism of pathological changes in the cardiovascular system of patients with systemic lupus erythematosus, which dictates the necessity of conducting echocardiography and Doppler both at the initial examination and during monitoring of the pathological process and treatment quality. The high frequency of diagnosed abnormal chords may indicate a congenital predisposition of connective tissue in patients with systemic lupus erythematosus to dysplasia. Echocardiography is especially valuable for identifying valve and pericardial lesions.

Possibility of correction of the blood-heart barrier damage as a consequence of the impact of the SARS-CoV-2 virus on the cardiovascular system in patients with coronary artery disease in combination with COVID-19.

damage to the blood-heart barrier (BHB) and endothelial dysfunction is a characteristic feature of congestive (cardiopulmonary) chronic heart failure (CHF), the main cause of death in elderly people with CHF caused by new coronavirus variants (SARS-CoV-2), but the mechanism of this phenomenon remains unclear. The aim of this project is to determine the mechanism of BHB damage in coronary artery disease (CAD) with COVID-19, as well as the possibility of its correction with the use of sulodexide. The endocardial endothelium (EE) is a barrier that prevents blood leakage from the endocardium to the interstitium; however, this barrier is impaired during the course of COVID-19 in patients with CAD. Previous studies have shown that one of the pathophysiological mechanisms is the activation of matrix metalloproteinases (MMPs) in CAD with CHF. MMP-9 degrades connexins, which leads to EE dysfunction. One study [Rubens P. et al. 2021] found a juxtacrine connection of EE with the myocyte and mitochondria (Mito), but how this works is still an open question. Materials and methods. We examined 65 patients with coronary artery disease diagnosed with COVID-19. Patients were divided into two groups: Group I (n=35) - patients who had been taking sulodexide at a dose of 500 LE x 2p/day for 6 months against the background of standard therapy of coronary artery disease; Group II (n=30) - patients without sulodexide. Echocardiography and laser Doppler flowmetry were performed at baseline and 6 months later. Echocardiography at the time of inclusion in the study revealed that 30 (50%) patients in group I and 14 (47%) patients in group II had reduced left ventricular ejection fraction (LV EF) values of 40 to 50%. After 6 months of treatment with sulodexide, a tendency to improve LV systolic function and decrease in left ventricular myocardial mass index (LFMMI) was noted in patients of group I. There were no differences between the groups at the time of inclusion in the study in terms of the level of the capillary flow reserve – occlusion test (CFRo) and the capillary flow reserve – nitroglycerin test (CFRn). A repeated study of CFR revealed a significant increase in CFRo and CFRn levels only in group I. In patients of group II, no significant changes in CFRo and CFRn were found. An inverse relationship between the level of CFRo and C-reactive protein (CRP) was found in patients of group I (r=0.52, p<0.05). After 6 months of treatment, plasma CRP concentrations decreased significantly: from 17.7 [1.3; 50.1] to 5.7 [1.0; 12.0] mg/L in group I (p=0.01) and from 14.2 [1.2; 27.0] to 4.2 [1.0; 11.0] mg/L in group II (p=0.01). No significant correlations between CRP level and CFRo after 6 months of treatment were found. There were correlations of CFRo and CFRn with left ventricular systolic function, as well as inverse relationships with the size of the left and right ventricles and systolic pressure in the pulmonary artery. There was a tendency to improve systolic and diastolic left ventricular function in the first group, where sulodexide was used, and no significant changes in echocardiography were noted in the second group. At the initial examination of patients, the ratio of CFRo and CFRn had no significant differences. After 6 months of treatment, a significant increase in the ratio of CFRo and CFRn was observed only in patients taking sulodexide, and no positive dynamics of this ratio was observed in group II. The results indicate that MMP-9 activation, endothelial damage, endothelial-myocyte (E-M) uncoupling, and mitochondrial-myocyte uncoupling in heart failure in patients with CAD combined with COVID-19 were detected to a significant extent; however, treatment with sulodexide successfully mitigated the destructive changes in the heart in CAD with CHF. The results obtained are directly relevant to the range of cardiac manifestations and phenotypes arising from COVID-19 complications in people with CAD. Conclusion. The obtained results confirm the improvement of microcirculation, as well as a tendency to improve systolic function and left ventricular myocardial mass index after 6 months of sulodexide treatment in patients with coronary artery disease with preserved and moderately reduced left ventricular ejection fraction (LV EF) who have undergone COVID-19. The described effects of improving endothelial function, as well as improving the state of the blood-brain barrier due to the use of sulodexide, make it possible to recommend the use of this drug in the category of patients with CAD to reduce the negative impact of COVID-19 on the cardiovascular system.

Right-ventricle heart failure in PAH vs. HFrEF with secondary PH: Hemodynamic, ergospirometric, and organ function correlations

PurposeThe goal of the study was to identify markers of organ function used in daily routines that could potentially aid in the overall evaluation of the cardiovascular system in patients with right-ventricle heart failure due to pulmonary arterial hypertension (PAH) and left-ventricle heart failure. We analyzed correlations between parameters from right heart catheterization (RHC), cardiopulmonary exercise test (CPET), and selected laboratory parameters of thyroid, liver, kidneys function and iron homeostasis. Patients and methodsA retrospective analysis included 107 patients (mean age 57.6 ​± ​16.2; 34.6 ​% women), comprising 57 patients with PAH (mean age 54.0 ​± ​18.2; 49.1 ​% women) and 50 patients with heart failure with reduced ejection fraction (HFrEF) ​< ​40 ​% (mean age 61.6 ​± ​12.7; 18 ​% women). All patients underwent CPET. Each patient in the PAH group had RHC performed. Fifteen patients from the HFrEF group underwent RHC, which confirmed the suspicion of pulmonary hypertension (HFrEF-SPH). ResultsCPET and laboratory parameters’ analysis showed strong correlations between ventilation/carbon dioxide production (VE/VCO2) slope and NT-proBNP in HFrEF without secondary PH and HFrEF-SPH groups. In the PAH group, VE/VCO2 slope correlated with liver and thyroid function but also with morphological parameters of red-cell system.Analysis of correlations between laboratory and hemodynamic parameters revealed significant correlations between pulmonary arterial pressure, pulmonary vascular resistance (PVR) and red-cell parameters, especially strong with fT4 in the PAH group. ConclusionsIn HFrEF-SPH patients, laboratory parameters strongly correlated with pulmonary pressures and pulmonary capillary wedge pressure (PCWP).

State of the cardiovascular system in thyroid pathology

The review presents the data on cardiac damage in patients with thyroid dysfunction (hyper- and hypothyroidism). The features of cardiovascular pathology in patients with hyperthyroidism and the possibility of using certain groups of drugs (beta blockers, antiplatelet agents, anticoagulants) are described. The association of hypothyroidism (including subclinical) with atherosclerosis and diastolic arterial hypertension, an increased risk of developing ischemic heart disease and myocardial infarction, heart failure and cardiovascular mortality, regardless of gender, age and previous cardiovascular diseases, has been shown. Available facts indicate the need to determine thyroid hormones in patients with cardiovascular pathology and mandatory assessment of the state of the cardiovascular system in patients with thyroid pathology.

Myocardial remodeling in wistar rats with renal dysfunction fed a high-salt diet

BACKGROUND. Dietary adjustment is an important point in the treatment of chronic kidney disease (CKD). However, at present, the effect of a diet with a high NaCl content on the state of the cardiovascular system in patients with early stages of CKD has not been sufficiently studied.The AIM: to evaluate blood pressure levels and changes in the myocardium of Wistar rats with early stage renal dysfunction fed a high-salt diet for a long time.MATERIALS AND METHODS: The study was performed on male Wistar rats. The control group consisted of sham-operated animals (LO-group), receiving a standard diet (0.34 % NaCl), the second – rats subjected to resection of ¾ of the kidney parenchyma, receiving a standard diet (NE-group), the third – rats, subjected to ¾ NE, receiving high sodium diet (4 % NaCl, NE+HSD). After 4 months, the rats were assessed for blood pressure (BP), levels of urea, creatinine, sodium in the blood serum, daily diuresis, albumin content in the urine, myocardial mass index (IMM) and left ventricular myocardial mass index (IMLV), and a histological examination of the myocardium was performed.RESULTS: In rats with kidney dysfunction, an increase in blood pressure was detected, most pronounced in the NE+HSD group. In rats of this group, albumin excretion, connective tissue volume, arterial diameter, thickness of the adventitia and media of myocardial vessels increased relative to the indicators of rats with NE receiving a standard diet. IMLV in NE+HSD rats was higher by 16.4 %, and IMM by 10.9 % than in animals with NE on a standard diet. The groups with NE did not differ from each other in the content of urea and creatinine in the blood serum, although these indicators were higher than in LO animals. There were no differences between groups in serum sodium levels.CONCLUSION: Prolonged consumption of a diet with a high content of table salt contributes to the development of the initial stages of CKD in Wistar rats, promotes blood pressure growth and myocardial remodeling, manifested primarily in the progression of cardiomyocyte hypertrophy and myocardial fibrosis.

Alteration of circulating ACE2-network related microRNAs in patients with COVID-19

Angiotensin converting enzyme 2 (ACE2) serves as the primary receptor for the SARS-CoV-2 virus and has implications for the functioning of the cardiovascular system. Based on our previously published bioinformatic analysis, in this study we aimed to analyze the diagnostic and predictive utility of miRNAs (miR-10b-5p, miR-124-3p, miR-200b-3p, miR-26b-5p, miR-302c-5p) identified as top regulators of ACE2 network with potential to affect cardiomyocytes and cardiovascular system in patients with COVID-19. The expression of miRNAs was determined through qRT-PCR in a cohort of 79 hospitalized COVID-19 patients as well as 32 healthy volunteers. Blood samples and clinical data of COVID-19 patients were collected at admission, 7-days and 21-days after admission. We also performed SHAP analysis of clinical data and miRNAs target predictions and advanced enrichment analyses. Low expression of miR-200b-3p at the seventh day of admission is indicative of predictive value in determining the length of hospital stay and/or the likelihood of mortality, as shown in ROC curve analysis with an AUC of 0.730 and a p-value of 0.002. MiR-26b-5p expression levels in COVID-19 patients were lower at the baseline, 7 and 21-days of admission compared to the healthy controls (P < 0.0001). Similarly, miR-10b-5p expression levels were lower at the baseline and 21-days post admission (P = 0.001). The opposite situation was observed in miR-124-3p and miR-302c-5p. Enrichment analysis showed influence of analyzed miRNAs on IL-2 signaling pathway and multiple cardiovascular diseases through COVID-19-related targets. Moreover, the COVID-19-related genes regulated by miR-200b-3p were linked to T cell protein tyrosine phosphatase and the HIF-1 transcriptional activity in hypoxia. Analysis focused on COVID-19 associated genes showed that all analyzed miRNAs are strongly affecting disease pathways related to CVDs which could be explained by their strong interaction with the ACE2 network.

ДОЛГОСРОЧНЫЕ СОСУДИСТЫЕ ЭФФЕКТЫ УСИЛЕННОЙ НАРУЖНОЙ КОНТРПУЛЬСАЦИИ У ПАЦИЕНТОВ С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА, ОСЛОЖНЕННОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ

Aim. To study the long-term effect of complex therapy with the addition of enhanced external counterpulsation (EECP) on the structural and functional parameters of the cardiovascular system in patients with ischemic chronic heart failure (CHF). Material and methods. Patients with ischemic CHF NYHA class II-III (n=59; median age 64.8 [57.6; 71.2] years; 81.4% men), receiving EECP in addition to optimal medical treatment (35-hour course every 6 months; compression pressure 220-280 mmHg) had an assessment of exercise tolerance (distance in the 6-minute walk test; 6MWT), structural and functional state of large vessels and microvasculature (computer video capillaroscopy of the periungual bed, photoplethysmography, applanation tonometry), assessment of echocardiographic parameters (volume dimensions, systolic and diastolic functions of the left ventricle) at baseline, after 12, 24 and 36 months. The follow-up period was 36 months. Results. Significant stable positive dynamics of tolerance to physical activity (the distance in the 6MHT increased by 59.4%) was found. Functional parameters of the heart (LVEF from 40.6 [34.6; 43.2] to 49.2 [43.0; 52.7] %, p=0.003; NT-proBNP from 246 [167; 341] to 120 [93; 148] pg/ml), large (occlusion index by phase shift) and small (occlusion index by amplitude, percentage of perfused capillaries, percentage of capillary restoration) vessels significantly improved already in the first year of observation, while structural parameters (volume dimensions; indexed LV myocardial mass from 94.3 [79.4; 97.4] to 121 [109; 134] g/m2, p=0.010; radial augmentation index, stiffness index, occlusion index) began to change significantly by 2-3-years. Conclusion. A stable positive effect of EECP treatment in patients with ischemic heart failure on the structural and functional parameters of the heart and blood vessels has been demonstrated. At the same time, the rate of improvement in functional indicators was much faster than that of structural parameters.

Changes in the Cardiovascular System in Patients with Acute Leukemia after the Use of Polychemotherapy

Abstract: This article examines the seasonal changes in the vascular system and the problems that arise in this process in a patient with leukemic flow after polychemotherapy. Also, in the article, the results of the analysis of the cardiotoxic effects of polychemotherapy in patients with acute leukemia are cited and discussed

Dynamics of modified cardiovascular risk factors in patients with rheumatoid arthritis on the background of 5-year therapy with an interleukin 6 receptor inhibitor

The effect of an inhibitor of interleukin (IL) 6 receptors on the state of the cardiovascular system in patients with rheumatoid arthritis (RA) remains poorly understood, especially with its long-term use.The aim – to study the effect of therapy with the IL-6 receptor inhibitor tocilizumab (TCZ) on the dynamics of modifiable risk factors (RF), total cardiovascular risk (CVR), structural changes in the carotid arteries (CA) and the incidence of cardiovascular complications (CVC) in patients with rheumatoid arthritis during the 260-week follow-up period.Material and methods. The study included 37 patients with active RA (32 women and 5 men) with ineffectiveness and/or intolerance to disease modifying anti-rheumatic drugs (DMARDs); median age was 56 [48; 68] years, disease duration was 92 [49; 158] months; DAS28 (Disease Activity Score 28) – 6.2 [5.5; 6.7] points; all patients were seropositive for rheumatoid factor (RF), 86% – for antibodies to cyclic citrullinated peptide (ACCP). Patients received TCZ therapy 8 mg/kg intravenously every 4 weeks; after 192 [176; 210] weeks, 60% of patients switched to subcutaneous administration of the drug at a dose of 162 mg once a week. In 51% of patients with RA, TCZ monotherapy was performed, in 49% – combination therapy of TCZ with DMARDs. Statins were received by 17 (46%) patients, including 7 patients before and 10 after inclusion in the study. All patients underwent an assessment of traditional risk factors, the total cardiovascular risk was calculated using the mSCORE scale, atherosclerotic vascular lesions were assessed by the detection of atherosclerotic plaques (ASP) of CA. The observation period was 260.4 [251.5; 283.4] weeks.Results. After 260 weeks of TCZ therapy, RA remission was observed in 32 (86%) patients, low activity – in 5 (14%) patients. During the observation period, the frequency of modified RF and the total CVR did not change significantly, an increase in body mass index (BMI) by 11% was recorded, the number of patients with hypercholesterolemia and a reduced level of HDL cholesterol (C) decreased. In patients without statin therapy, there were no significant changes in the blood lipid spectrum. In the group of patients receiving statins, there was an increase in HDL-C by 43%, a decrease in cholesterol levels by 15%, atherogenic index (AI) by 56% (p&lt;0.01 in all cases) and associations between the dynamics of ∆cholesterol and ∆CRP (r=0.35; p=0.04), ∆LDL-C and ∆CRP (r=0.41; p=0.03). Significant structural changes in CA in RA patients by the end of 260 weeks of TCZ therapy were not identified. Initially, intima-media thickness (IMT) CA positively moderately correlated with age (r=0.7; p&lt;0.01), BMI (r=0.37; p&lt;0.01), systolic blood pressure (SBP) (r=0.62; p&lt;0.01) and weakly with lipid spectrum parameters – cholesterol (r=0.29; p&lt;0.01), LDL-C (r=0.36; p&lt;0.01). No new associations of IMT CA by the end of the observation, as well as the relationship of the IMT CA value with the indicators of RA activity and the ongoing therapy, were identified. By the end of the study, the distribution of patients by mSCORE value and CVR level did not change significantly. The incidence of CVC was 0,54 per 100 patient-years over a 260-week period of TCZ use. Conclusion. Against the background of long-term TCZ therapy in RA patients, there was no increase in CVR and significant structural changes in CA. It is necessary to dynamically monitor the blood lipid profile and CVR in RA patients receiving TCZ therapy. Statin therapy can successfully control dyslipidemia in RA patients who receive long-term TCZ.

Effectiveness of different treatment regimens of enhanced external counterpulsation in patients with stable coronary artery disease complicated by heart failure

Aim. To study the effect of various therapy regimens with enhanced external counterpulsation (EECP) on exercise tolerance, quality of life, indices of structural and functional state of cardiovascular system in patients with stable coronary artery disease (CAD) complicated by chronic heart failure (CHF).Material and methods. The study included patients with stable CAD complicated by CHF with reduced and intermediate left ventricular ejection fraction (LVEF) from the randomized EXCEL trial (NCT05913778; n=120) and additionally patients with similar inclusion and exclusion criteria (n=90) who were randomized into groups with different EECP treatment regimens for 12 months: Group 1 (n=40): course of 35 hour-long procedures; Group 2 (n=40): course of 35 hourlong procedures every 6 months; Group 3 (n=30): course of 20 hour-long procedures then constantly 1 hour per week; Group 4 (n=30): constantly 2 hours per week; Group 5 (n=30): course of 20 hour-long procedures then constantly 2 hours per week; Group 0 (placebo ; n=40): course of 35 hour-long procedures with compression pressure 80 mm Hg. All patients at baseline and after 12 months were assessed for clinical status, quality of life (MLHFQ, SF-36), NT-proBNP levels, LVEF, as well as exercise tolerance (6-minute walk test; 6MWT) initially, after 3, 6, 9 and 12 months. Correlation analysis and risk assessment of adverse events (combined endpoint — combination of cases of adverse cardiovascular events, deaths, hospitalizations for CHF, new-onset of atrial fibrillation, diabetes, decreased renal function) was performed.Results. Treatment effectiveness had positive correlation with EECP duration (r(S)=0,670; p&lt;0,001) and treatment regimen (r(S)=0,620; p&lt;0,001). The maximum effect (changes in NT-proBNP levels, LVEF, clinical status, quality of life) was noted in the combined and constant regimen groups (5, 4, 2). The increase of 6WMTdistance was 6,6% in group 0, 24,9% in group 1, 44,5% in group 2, 31,8% in group 3, 49,1% in group 4, 58,6% in group 5. The proportion of patients with an increase in 6WMT-distance &gt;20% after 12 months was 7,7%, 72,5%, 97,5%, 76,7%, 90%, 100%, respectively. Cumulative event-free survival was highest in groups 5, 4, and 2 (0,97, 0,93, and 0,86, respectively), and the risk of developing combined endpoint in these groups was minimal (0,035, 0,075, and 0,150, respectively).Conclusion. The effect of EECP treatment in patients with coronary artery disease complicated by CHF depended on the EECP hours and regimen. Alternative EECP regimens (with more treatments spread evenly over the year) in addition to optimal medical therapy may improve the management of these patients.

Intraoperative atrial rhythm changes during atrial fibrillation catheter ablation in patients with arterial hypertension and coronary artery disease

Atrial fibrillation is a rhythm disorder with an extensive etiology and not fully understood pathogenesis. Catheter ablation is an effective way to control the rhythm of atrial fibrillation. The results of catheter ablation differ in patients with various comorbidities of the cardiovascular system. Intraoperative changes in the atrial rhythm can be a criterion for the long-term effectiveness of the operation or determine the need for additional effects.Aim: To assess intraoperative changes in atrial rhythm during catheter ablation of atrial fibrillation in patients with concomitant pathology of the cardiovascular system.Methodology and research methods. The results of catheter ablation of 451 patients with paroxysmal and persistent atrial fibrillation were analyzed retrospectively for the period from 2016 to 2017. After clinical and anamnestic data analysis, 151 patients with primary isolation of the pulmonary veins were selected. Depending on the concomitant pathology of the cardiovascular system, patients were divided into 3 groups: group 1 – with idiopathic atrial fibrillation, group 2 – atrial fibrillation in combination with isolated essential arterial hypertension and group 3 – atrial fibrillation in combination with ischemic heart disease.Results. In patients with idiopathic atrial fibrillation, relief of atrial fibrillation with sinus rhythm preservation until the end of surgery was more often observed than in patients with ischemic heart disease (22% vs. 10,6%, р = 0,021). In patients with ischemic heart disease, typical atrial flutter was much more common and there was a need to perform radiofrequency ablation of the cavothricuspid isthmus in addition to isolation of the pulmonary veins (47,9% vs. 18,8% 1 Group 1, р = 0,005, and 24,7% in Group 2, р = 0,01).Conclusions. The concomitant pathology of the cardiovascular system in patients affects the dynamics of the atrial rhythm during catheter treatment of atrial fibrillation and may take into account the definition of intraoperative tactics.

Piezopulsometric analysis of the functional state of human cardiovascular system

This paper expounds how to apply in practice the developed computer method of arterial piezopulsometry, with examples, for non-invasive express analysis of the functional state and the nature of autonomic regulation of the cardiovascular system in patients of different ages and health conditions. The participation and role of the contractile component of myocytes of the left ventricle of the heart is assessed as a universal muscle effector, providing both the basic pumping function of the heart and the implementation of the autonomic regulation of heart contraction using peripheral neurohumoral mechanisms that maintain the optimal level of cardiac hemodynamics. This analysis enhances the predictive value of early non-invasive pulsometric diagnostics of the individual functional state and nature of regulation of human cardiovascular system during ontogenesis. This knowledge helps identify the risk of reducing the ability of the cardiovascular system, which has developed during its evolution, to maintain dynamic balance, self-regulation and adaptation to changing environmental conditions, which is associated with a violation of the body’s homeostasis.

How should we assess the cardiovascular system in patients presenting with bothersome nocturia? ICI-RS 2023.

The link between nocturia and cardiovascular disease (CVD) is frequently discussed in literature, yet the precise nature of this relationship remains poorly characterized. The existing literature was reviewed in order to address issues concerning the origin, diagnosis, management, and implications of the co-occurrence of CVD and nocturia. This review summarizes literature and recommendations regarding the link between CVD and nocturia discussed during a think-tank meeting held at the 2023 International Consultation on Incontinence-Research Society. Cardiovascular disorders are often underestimated contributors to nocturia, with various potential mechanisms influencing nighttime urination, such as impact on fluid retention, atrial natriuretic peptide, and glomerular filtration rate. The redistribution of fluid from leg edema in supine position can lead nocturnal polyuria (NP). Additionally, sleep disturbances due to nocturia in itself may lead to CVD through an increase in blood pressure, insulin resistance, and inflammation. Disrupted circadian rhythms (e.g., in sleep pattern and urine production) were identified as critical factors in most etiologies of nocturia, and their contribution is deemed imperative in future research and treatment approaches, particularly in the aging population. NP can be detected through a simple bladder diary and can even be used to distinguish cardiac from noncardiac causes of nocturia. For the treatment of NP, desmopressin can be effective in select patients, however, caution and close monitoring is warranted for those with CVD due to increased risk of side effects. Gaps were identified in the available evidence and clear cut recommendations were put forth for future research. It is essential to gain a deeper understanding of the mechanisms linking nocturia and CVD to develop optimal management strategies.

Diabetes and Cardiorenal Complications: A Clinical Review of Existing Therapies and Novel Combinations, Focusing on SGLT2 Inhibitors.

Type 2 diabetes mellitus (T2DM) is a set of metabolic disorders specified by hyperglycemia as a result of abnormalities in insulin secretion or sensitivity. Chronic kidney disease (CKD) and cardiovascular disease (CVD) are the widespread co-morbidities of T2DM and share risk factors for onset and progression. Despite numerous mono- and combination therapies exist, the progression of diabetes complications remains a global health concern. Treatment options for diabetic- CKD and CVD include drugs targeting hyperglycemia, hypertension, albuminuria, hyperlipidemia and the renin-angiotensin aldosterone system (RAAS). The sodium-glucose co-transporter 2 channel (SGLT2) is abundantly present in proximal tubules of the kidney and its capacity to recover glucose and sodium from the glomerular filtrate limits urinary glucose and sodium excretion. SGLT2 inhibitors (SGLT2i) reduce sodium and glucose reabsorption in the proximal and thus increase urinary glucose excretion in T2DM. SGLT2i monotherapy can improve but dual SGLT2/RAAS inhibition or SGLT2i along with other classes of drugs are more effective in protecting the kidneys and the cardiovascular system in patients with and without diabetes. Combinations such as empagliflozin and linagliptin, ertugliflozin and metolazone, dapagliflozin and sacubitril- valsartan and many more show promising results. Here, we have reviewed the ongoing and completed clinical trials, addressed current theories, and discussed necessary future research to explain the possible risks and benefits of using an SGLT2i alone and in combination with existing antidiabetic drugs and drugs acting on the cardiovascular system.

Pathophysiological concepts and screening of cardiovascular disease in dialysis patients.

Dialysis patients experience 10-20 times higher cardiovascular mortality than the general population. The high burden of both conventional and nontraditional risk factors attributable to loss of renal function can explain higher rates of cardiovascular disease (CVD) morbidity and death among dialysis patients. As renal function declines, uremic toxins accumulate in the blood and disrupt cell function, causing cardiovascular damage. Hemodialysis patients have many cardiovascular complications, including sudden cardiac death. Peritoneal dialysis puts dialysis patients with end-stage renal disease at increased risk of CVD complications and emergency hospitalization. The current standard of care in this population is based on observational data, which has a high potential for bias due to the paucity of dedicated randomized clinical trials. Furthermore, guidelines lack specific guidelines for these patients, often inferring them from non-dialysis patient trials. A crucial step in the prevention and treatment of CVD would be to gain better knowledge of the influence of these predisposing risk factors. This review highlights the current evidence regarding the influence of advanced chronic disease on the cardiovascular system in patients undergoing renal dialysis.

ВЗАИМОСВЯЗЬ ТИПА ЛИЧНОСТИ D И НАРУШЕНИЯ ФУНКЦИИ ЭНДОТЕЛИЯ У ПАЦИЕНТОВ С ОСТРЫМ ИНФАРКТОМ МИОКАРДА

Introduction. Major psychosocial risk factors for acute myocardial infarction include depression, anxiety (various anxiety syndromes and disorders), pessimistic D personality type, work and family stress, anger/hostility, lack of social support, and low socioeconomic status. There are few studies evaluating the association between psychological factors and myocardial infarction. Aim. The aim of the study was to study the relationship of personality type D with the development of endothelial dysfunction in patients with acute myocardial infarction. Material and methods. The study included 158 patients, mean age 58.2±2.5 years, who were admitted to the hospital for ST-segment elevation myocardial infarction. The diagnosis was established according to the clinical guidelines of the Russian Society of Cardiology, 2020. In addition to the traditional clinical and instrumental examination, on the 3rd–7th day after the development of myocardial infarction, patients underwent an assessment of plasma concentrations of inflammatory biomarkers and psychological testing using anxiety and depression rating scales. In the group of patients, individuals with and without personality type D were identified. Results and discussion. Personality type D was found in 29.1% of patients with acute myocardial infarction. Patients with personality type D were significantly younger, employed and married, had a higher body mass index and a significantly greater hereditary burden of arterial hypertension. In patients with personality type D, the values of pro-inflammatory markers were statistically significantly different from the comparison group, which indicates the intensity of subclinical inflammation and cytokine imbalance. Personality type D was significantly associated with total inflammation score and total endothelial dysfunction score. Significant differences were found in the ratio of patients with depressive conditions in subgroups of patients with personality type D. The values of echocardiographic parameters were also associated with the presence of personality type D. Conclusion. Personality type D was associated with impaired endothelial function in men with acute myocardial infarction, they were more likely to have depressive disorders. An adverse effect of personality type D on the cardiovascular system in patients with myocardial infarction was revealed.

A novel method for assessing cardiac function in patients with coronary heart disease based on wrist pulse analysis

BackgroundThe timely assessment of B-type natriuretic peptide (BNP) marking chronic heart failure risk in patients with coronary heart disease (CHD) helps to reduce patients’ mortality.ObjectiveTo evaluate the potential of wrist pulse signals for use in the cardiac monitoring of patients with CHD.MethodsA total of 419 patients with CHD were assigned to Group 1 (BNP < 95 pg/mL, n = 249), 2 (95 < BNP < 221 pg/mL, n = 85), and 3 (BNP > 221 pg/mL, n = 85) according to BNP levels. Wrist pulse signals were measured noninvasively. Both the time-domain method and multiscale entropy (MSE) method were used to extract pulse features. Decision tree (DT) and random forest (RF) algorithms were employed to construct models for classifying three groups, and the models’ performance metrics were compared.ResultsThe pulse features of the three groups differed significantly, suggesting different pathological states of the cardiovascular system in patients with CHD. Moreover, the RF models outperformed the DT models in performance metrics. Furthermore, the optimal RF model was that based on a dataset comprising both time-domain and MSE features, achieving accuracy, average precision, average recall, and average F1-score of 90.900%, 91.048%, 90.900%, and 90.897%, respectively.ConclusionsThe wrist pulse detection technology employed in this study is useful for assessing the cardiac function of patients with CHD.

On the possibility of non-invasive study of the peripheral mechanisms of autonomous regulation of the human cardiovascular system

The aim of this study was to evaluate the possibility of using the developed method of arterial piezopulsometry for non-invasive study of peculiarities of the functioning of peripheral mechanisms of autonomic regulation of the cardiovascular system in patients of different age and health state. Study emphasizes the importance of determining the variability of the parameters of blood pressure pulse waves as a measure of assessing the participation and role of the components of the neuroendocrine (sympatho-adrenal) efferent link in the formation of a fast and well-regulated response of systemic hemodynamics, using myocytes of the left ventricle of the heart as effectors. This paper discusses the possibility and expediency of personalized use of the arterial piezopulsometry method for pulsometric diagnostics of the functional state and nature of autonomic regulation of the functions of cardiovascular system in patients in order to be able to detect earlier pathological conditions and disorders of peripheral mechanisms that ensure adequate blood supply in humans.

Патологические изменения сердечно-сосудистой системы у больных с постковидным синдромом

Currently, there is more and more data on the possible long-term effects of the new coronavirus infection (COVID-19) on human health. In particular, there is an increased risk of complications from the cardiovascular system in patients with post-COVID-19 syndrome. A review of the literature data on the most common cardiovascular complications of post-COVID-19 syndrome, the main pathogenetic mechanisms of these diseases and some recommendations for their prevention and treatment is presented. Aim. Analysis of scientific literature data on the role of SARS-CoV-2 infection and post-COVID-19 syndrome in the development of cardiovascular pathology. Key points. Cardiovascular pathology in patients with COVID-19 is a factor that seriously aggravates the course of the disease. At the same time, coronavirus infection itself can lead to cardiovascular complications, including in the framework of the post-COVID-19 syndrome. Among the main pathogenetic mechanisms of the development of cardiovascular complications are: dysregulation of the renin-angiotensin-aldosterone system (RAAS), direct cytotoxic effect of SARS-CoV-2 on cardiomyocytes, hypercytokinemia (cytokine storm). Anticoagulants (low molecular weight heparin), antihypertensive drugs (RAAS inhibitors), and inotropic agents are recommended as therapeutic tactics in the treatment of cardiovascular complications. If necessary, mechanical stimulation of blood circulation (extracorporeal membrane oxygenation), correction of electrolyte balance and suppression of excessive formation of catecholamines are indicated. Conclusion. Coronavirus infection can lead to the development of various cardiovascular complications, including fatal ones. In order to prevent pathological changes associated with coronavirus infection, monitoring of the morphofunctional state of the cardiovascular system of patients is necessary. Key words: COVID-19, SARS-СoV-2, post-COVID-19 syndrome, diseases of the cardiovascular system, cardiovascular patology.

Diagnosis of primary aldosteronism and the algorithm of interaction between a cardiologist and an endocrinologist from the position of a cardiologist

Primary aldosteronism is one of the most common causes of secondary arterial hypertension.The probability of its detection is especially high in patients with hypertension resistant to ongoing therapy. The purpose of the review is to analyze the causes of underdiagnosis of primary aldosteronism based on the data of modern publications, discuss the main trends in approaches to identifying this pathological condition, and justify the need for closer interaction between all specialists involved in the process of providing medical care to patients of this category. The review provides data on the groups of patients in whom it is most helpful to screen primary aldosteronism, and the frequency of this screening in real practice. The advantages and disadvantages of using various criteria for the primary diagnosis of primary aldosteronism are analyzed. The need for common approaches to the methodology of examination and management of patients with suspected primary aldosteronism is discussed for general practitioners, therapists, cardiologists, organizers of laboratory services and endocrinologists. The negative consequences of long-term exposure to elevated levels of aldosterone on the cardiovascular system of patients with primary aldosteronism, their cardiovascular prognosis are analyzed. The necessity of the most thorough identification of patients with primary aldosteronism subject to surgical treatment is substantiated. Criteria for the effectiveness of drug therapy in case of non-indication or impossibility of performing surgical intervention are given.