Chronic Cardiovascular Pathology Research Articles

Analysis of the Risk of COVID-19 in the Post-Vaccination Period Based on the Results of a Multicenter Study — a Survey of Medical Workers

Background. One of the vulnerable categories of the population during the COVID-19 pandemic has become employees of medical and educational institutions. Timely and properly organized prevention, based on anti-epidemic measures based on vaccination, is necessary not only to reduce the incidence of the disease, but primarily to reduce the severity in case of its occurrence, reduce the risk of hospitalization. Understanding the effectiveness of preventing SARS-CoV-2 infections among healthcare workers is a critical component of occupational health and safety policy and strategy.
 Aim — analysis of the incidence of COVID-19 after vaccination among medical staff and teaching staff of medical higher educational institutions.
 Methods. In the period from January to March 2022, a cross-sectional retrospective single-stage online study was conducted (anonymous questionnaires posted on the Anketologist platform). The survey was completed by 6032 respondents (82% efficiency). According to the criteria, 2114 respondents were excluded from the study. The analysis was carried out according to the questionnaires of 3918 respondents, including an assessment of the incidence after vaccination (n = 3668 respondents).
 Results. Fell ill after a double vaccination for 5 months — 663 (16.9%). Unvaccinated respondents reported that within 5 months. prior to the survey, 116 (46.4%) had a laboratory-confirmed new coronavirus infection. Lack of vaccination increased the risk of SARS-CoV-2 (OR 1.78 ± 0.14; 95% CI: 1.34–2.36). Efficiency within 5 months post-vaccination period was 55.5% (95% CI: 42.2–57.7%) for Sputnik V; 71.9% (95% CI: 68.1–85.4%) — Sputnik Light. It was found that gender and age were not a risk factor for the onset of the disease in the post-vaccination period. The presence of a history of previous COVID-19 increased the risk of disease in the post-vaccination period in individuals under 35 years of age (OR 2.323 ± 0.102; 95% CI: 1.903–2.836), aged 36–64 years (OR 2.547 ± 0.086; 95% CI: 2.150–3.016), older than 65 years (OR 1.323 ± 0.280; 95% CI: 0.764–2.290). Respondents with a history of a combination of chronic cardiovascular pathology and past COVID-19 had a higher risk of getting sick in the post-vaccination period (OR 1.338 ± 0.160; 95% CI: 0.977–1.832).
 Conclusion. According to the questionnaire, an important factor affecting the risk of COVID-19 in the post-vaccination period is the presence of SARS-CoV-2 before vaccination, which can increase the chance of developing the disease in the presence of other risk factors (chronic pathology, age, smoking, alcohol consumption).

ESR Essentials: ten steps to cardiac MR-practice recommendations by ESCR.

The growing clinical role of cardiovascular MR in risk assessment, diagnosis, and treatment planning highlights the necessity for radiologists to achieve expertise in this modality, advancing precision medicine and healthcare efficiency. • Cardiovascular MR is essential in diagnosing and monitoring many acute and chronic cardiovascular pathologies. • Features such as technical expertise, quality assurance, patient safety, and optimized tailored imaging protocols, among others, are essential for a successful cardiovascular MR program. • Ongoing technological advances will push rapid multi-parametric cardiovascular MR, thus improving accessibility, patient comfort, and cost-effectiveness. • Cardiovascular MR is essential in diagnosing and monitoring a wide array of cardiovascular pathologies (Level of Evidence: High). • A successful cardiovascular MR program depends on standardization (Level of Evidence: Low). • Future developments will increase the efficiency and accessibility of cardiovascular MR (Level of Evidence: Low).

How to improve long-term results of patients with atrial fibrillation of non-valvular ethiology after embolism to main arteries of the limbs

BACKGROUND: In patients with atrial fibrillation, systemic thromboembolic complications dramatically worsen the long-term prognosis. There is currently no generally accepted treatment tactics for patients with atrial fibrillation of non-valvular ethiology after embolism to main arteries of the limbs. Objective: evaluate the efficacy of our approach for patients with atrial fibrillationof non-valvular ethiology who survived an embolism to main arteries of the limbs and acute limb ischemia.
 MATERIALS AND METHODS: For the period from 1991 to 2022, in the Department of Vascular Surgery of our institution, emergency care due to embolism and acute limb ischemia was provided to 1816 patients. In 1425 (78.5%) patients, the main disease that led to arterial embolism was non-valvular atrial fibrillation. In the long-term period after discharge from our clinic, it was possible to trace the fate of 216 patients and determine the cause of death for 106 patients. The main causes of death in the long-term period were the decompensation of chronic diseases of the cardiovascular system in 73,6% of patients and the recurrence of systemic thromboembolic complications in 21.7%. Since 2012, at our department an integrated approach has been developed and implemented. It included a set of measures aimed at compensating for chronic cardiovascular pathology and preventing the recurrence of systemic thromboembolic complications. The whole set of measures all patients underwent during their current hospitalization after the elimination of life-threatening complications associated with acute limb ischemia and the stabilization of their general condition. They formed the main group (n = 50). The control group (n = 166) consisted of patients after embolism and acute limb ischemia discharged before 2012. Their cardiac pathology was treated after discharge from our department on an outpatient basis in a polyclinic at their place of residence. The overall comparative survival rate was analyzed. The survival function was evaluated using the Kaplan – Meyer method.
 RESULTS: In the control group, long-term survival was low, and the median life expectancy was 24 months after discharge. In the main group, long-term survival improved significantly, and the median survival period was not reached during the observation time set. The differences in overall survival estimated using the likelihood ratio test were statistically significant (p = 0.001). When evaluating the groups, the risk of death in the main group was 2.2 times lower than in the control group for each month of follow-up (p = 0.003).
 CONCLUSION: the set of measures implemented in our clinic over the last decade for patients with atrial fibrillation of non-valvular ethiology hospitalized with arterial embolism and acute limb ischemia has proved its efficacy and significantly (p = 0.003) improved the survival rate of patients with long-term follow-up after discharge from our department.

Blockchain technology in Cardiovascular Medicine: a glance to the future? Results from a social media survey and future perspectives.

The leverage of digital facilities in medicine for disease diagnosis, monitoring, and medical history recording has become increasingly pivotal. However, the advancement of these technologies poses a significant challenge regarding data privacy, given the highly sensitive nature of medical information. In this context, the application of Blockchain technology, a digital system where information is stored in blocks and each block is linked to the one before, has the potential to enhance existing technologies through its exceptional security and transparency. This paradigm is of particular importance in cardiovascular medicine, where the prevalence of chronic conditions leads to the need for secure remote monitoring, secure data storage and secure medical history updating. Indeed, digital support for chronic cardiovascular pathologies is getting more and more crucial. This paper lays its rationale in three primary aims: 1) to scrutinize the existing literature for tangible applications of blockchain technology in the field of cardiology; 2) to report results from a survey aimed at gauging the reception of blockchain technology within the cardiovascular community, conducted on social media; 3) to conceptualize a web application tailored specifically to cardiovascular care based on blockchain technology. We believe that Blockchain technology may contribute to a breakthrough in healthcare digitalization, especially in the field of cardiology; in this context, we hope that the present work may be inspiring for physicians and healthcare stakeholders.

ОСОБЕННОСТИ КОМОРБИДНОСТИ И ТЕЧЕНИЯ СЕПСИСА У ОНКОГЕМАТОЛОГИЧЕСКИХ БОЛЬНЫХ

The study aims to analyze the features of comorbidity and the nature of the course of sepsis in on- cohematological patients. A comparative analysis of the clinical examination and observation data of 25 patients with lymphoproliferative diseases (multiple myeloma and lymphomas) was carried out. The patients were divided into four groups as follows: the first group included patients who had received cytostatic therapy with sepsis complications, while the third group comprised those without complications; the second and fourth groups included patients with autologous hematopoietic stem cell transplantation after the course of cytostatic therapy with and without sepsis complications, respectively. The statistical analysis of the data obtained was carried out with the nonparametric Mann–Whitney test, the χ2 test and Fisher’s exact test were used in the analysis of qualitative indicators with p < 0.05. There were pronounced stages of chronic cardiovascular pathology in groups with sepsis complications, including those with fatal outcomes, which demonstrated the critical importance of vascular disruption as an underlying disease in the development, course, and outcomes of sepsis. In the study of biomarkers reflecting the activity of inflammation and cellular damage, the level of C-reactive protein in both groups with sepsis statistically significantly differed from that of groups without sepsis, while the level of lactate dehydrogenase showed statisti cally significant differences between the first and the corresponding third comparison group. A dramatic increase in the level of lactate dehydrogenase was detected in both groups with transplantation of autologous hematopoietic stem cells with and without sepsis complications. That corresponds to the literature data and is associated with an increase in the level of cell lysis following transplantation. There were no statistically significant differences in the level of thrombocytopenia (a typical marker value) between groups with sepsis and groups without sepsis. The earch for markers of risk and the severe course of sepsis require further research.

Current State of Pediatric Cardio-Oncology: A Review.

The landscape of pediatric oncology has dramatically changed over the course of the past several decades with five-year survival rates surpassing 80%. Anthracycline therapy has been the cornerstone of many chemotherapy regimens for pediatric patients since its introduction in the 1960s, and recent improved survival has been in large part due to advancements in chemotherapy, refinement of supportive care treatments, and development of novel therapeutics such as small molecule inhibitors, chimeric antigen receptor T-cell therapy, and immune checkpoint inhibitors. Unfortunately, many cancer-targeted therapies can lead to acute and chronic cardiovascular pathologies. The range of cardiotoxicity can vary but includes symptomatic or asymptotic heart failure, arrhythmias, coronary artery disease, valvar disease, pericardial disease, hypertension, and peripheral vascular disease. There is lack of data guiding primary prevention and treatment strategies in the pediatric population, which leads to substantial practice variability. Several important future research directions have been identified, including as they relate to cardiac disease, prevention strategies, management of cardiovascular risk factors, risk prediction, early detection, and the role of genetic susceptibility in development of cardiotoxicity. Continued collaborative research will be key in advancing the field. The ideal model for pediatric cardio-oncology is a proactive partnership between pediatric cardiologists and oncologists in order to better understand, treat, and ideally prevent cardiac disease in pediatric oncology patients.

Clinical and pathomorphological analysis of deaths from COVID-19 in 2020

The aim of the work – to conduct clinical and pathomorphological analysis of deaths from COVID-19 in 2020. Materials and methods. We analyzed 41 case histories and results of pathological-anatomical examination of patients who were died of COVID-19 during 2020. Results. The lethal outcome of COVID-19 disease was recorded at day 22 (16; 27) of the disease. Among the dead, there is a high percentage of men (73.2 %), early old age and middle old age patients (75.6 %) with comorbid pathology (92.7 %). Early lung damage with COVID-19 in the deceased was determined by pronounced interstitial and interstitial-alveolar edema, the presence of erythrocyte stasis in the pulmonary microvessels, blood clots and hypoperfusion leukocyte stasis, as well as the presence of erythrocytes in the alveoli. Bilateral polysegmental subtotal viral pneumonia in 90.2 % of dead patients was characterized by significant edema and thickening of the alveolar walls with their moderate infiltration by lymphocytes, focal peribronchial and perivascular inflammatory polymorphonuclear infiltration, multiple and small exfoliated alveolar epithelium (87.8 %), as well as metaplasia of a few alveolocytes preserved on the luminal surface of the alveoli (82.9 %). Every tenth person who died of COVID-19 had signs of secondary bacterial microflora. In 85.4 % of patients who died on day 22–27 of the disease focal or sublobar pneumofibrosis was diagnosed. In those who died due to COVID-19, multiorgan failure was characterized by focal necrosis of the renal tubular epithelium (73.2 %), focal lymphocytic-leukocyte infiltration (12.2 %) and renal microvascular thrombosis (17.1 %), focal centro-lobular necrosis (90.2 %) and focal lymphocytic-leukocyte infiltration of lobes (7.3 %) of the liver. Thrombotic complications were confirmed in 22.0 % of deceased patients: ischemic cerebral infarction, transmural myocardial infarction, pulmonary embolism, deep vein thrombosis of the lower extremities under the pathology. These thrombotic complications were not diagnosed during life in all patients. The majority of deaths due to COVID-19 had morphological signs of chronic cardiovascular pathology. Ischemic heart disease and hypertension during the life of patients were not diagnosed in all cases. Conclusions. Early lung damage in COVID-19 in the deceased was determined by pronounced interstitial-alveolar edema, blood clots and leukocyte stasis in microvessels, less often – the presence of “hyaline membranes”. In 90.2 % of the dead patients bilateral polysegmental subtotal pneumonia with edema and lymphocytic infiltration of the pulmonary interstitium, inflammatory peribronchial and perivascular focal polymorphonuclear infiltrates, foci of atelectasis and dyscryphaseses was found. In 9.7 % of patients bilateral subtotal viral-bacterial fibrinous-purulent bronchopneumonia developed. In those who died on the 22nd–27th day of the disease focal pneumofibrosis was determined. Pathomorphologically, thrombotic complications, which were not diagnosed in all patients during their lifetime, were confirmed in 22.0 % of deceased patients. Most deaths from COVID-19 had morphological signs of chronic cardiovascular disease.

Microcirculation Disorders in Patients with Severe COVID-19

Impaired microcirculation due to endothelial dysfunction in COVID-19 is considered to be the most important link in the pathogenesis of this disease. However, due to the complexity of its instrumental assessment in critically ill patients, the data available in the literature on specific manifestations of endothelial dysfunction are very contradictory.The objective: to determine the most characteristic capillaroscopic signs of microvascular disorders and to assess the state of microcirculation regulation in patients with severe COVID-19.Subjects and Methods. When admitted to the intensive care unit, 60 patients with COVID-19 and 12 patients with chronic cardiovascular pathology without COVID-19 (Comparison Group) were examined. All patients underwent microscopy of the microcirculatory bed of finger nail bed; the following parameters were assessed: diameters of the venous, arterial and transitional parts of capillaries, height of capillary loops, density of capillaries per 1 mm of the length of the perivascular zone, the average linear velocity of capillary blood flow (LVCBF), and thickness of the perivascular zone. The presence of avascular zones, the number of capillaries in the visualized field with circulating aggregates in the lumen, and the shape of capillaries were taken into account. In addition, an occlusion test using laser Doppler flowmetry was performed in 32 patients with COVID-19. The maximum post-occlusive increase in blood flow at the moment of cuff deflation was assessed, as well as changes in the mean value of post-occlusive blood flow relative to the baseline within 3 minutes after cuff deflation.Results. In 53 (88.3%) patients with COVID-19, abnormalities corresponding to chronic microcirculatory changes in the form of predominance of pathological capillary forms were detected. Microaggregates in the lumen of capillaries and decreased linear velocity of blood flow were revealed in 100% of cases. When comparing groups of patients with different outcomes, statistically significant differences were revealed between the LVCBF parameters (in the survivors - 354.35 ± 44.78 pm/sec, in the deceased - 278.4 ± 26.59 pm/sec), as well as between the values of the perivascular zones thickness (95.35 ± 15.96 microns versus 159.93 ± 19.90 microns). The results of the post-occlusion test revealed a significant difference between the groups in terms of the maximum post-occlusion gain (39.42 ± 3.85 BPU in the group with a favorable outcome, 27.69 ± 3.19 BPU in the group with an unfavorable outcome, 47.23 ± 1.78 BPU in the control group). In both groups, there was no increase in this parameter relative to the initial blood flow. At the same time, in the control group, the average index of post-occlusive blood flow was higher than the initial level.Conclusions. Acute microcirculation disorders with decreased linear velocity of capillary blood flow, circulation of aggregates, increased thickness of the perivascular zone were detected in all patients with severe COVID-19 but especially in those with unfavorable outcomes. Vascular tone regulation disorders were manifested by the absence of reactive hyperemia in response to acute ischemia, as well as a decrease in maximal flow-induced increase. These changes fit into the concept of endothelial dysfunction. Signs of chronic microcirculation disorders in most patients increase the risk of severe COVID-19.

Past, present, and future of mortality risk scores in the contemporary cardiac intensive care unit.

Risk stratification dates to the dawn of the cardiac intensive care unit (CICU). As the CICU has evolved from a dedicated unit caring for patients with acute myocardial infarction to a complex healthcare environment encompassing a broad array of acute and chronic cardiovascular pathology, an expanding array of risk scores are available that can be applied to CICU patients. Most of these scores were designed for use either in patients with a specific acute cardiovascular diagnosis or unselected critically ill patients, and risk scores developed in other populations often underperform in the CICU. More recently, risk scores have been developed specific to the CICU population, demonstrating improved performance. All existing risk scores have relevant limitations, both in terms of performance and applicability to patient care. Risk scores have been predominantly developed to predict short-term mortality, either by quantifying severity of illness or by incorporating other risk factors for mortality. It is essential to distinguish mortality risk attributable to severity of illness, which may be modifiable through intervention, from mortality risk attributable to non-modifiable risk factors. This review discusses established risk scores applicable to the CICU population, details how risk score performance is characterized, describes how new risk scores can be developed, explains how the information provided by risk scores can be used in clinical practice, and highlights how novel risk stratification approaches can be developed.

ASYMPTOMATIC HYPERURICEMIA AS A POTENTIAL METABOLIC RISK FACTOR FOR CORONARY ARTERY CALCIFICATION IN PATIENTS WITH ATRIAL FIBRILLATION OR HEART FAILURE

Purpose: To assess the role of asymptomatic hyperuricemia for the presence and severity of coronary arterial calcium (CAC) in adults with different cardiovascular (CV) pathology and its association with conventional CV risk factors. Material/Methods: Adults (n=81) of both genders were divided into controls: with moderate- to high risk without known CVD; AF-group: CVD-patients with paroxysmal or persistent atrial fibrillation in sinus rhythm, HF–group: heart failure subjects with preserved ejection fraction. A structured interview was performed at admittance for evaluation of the classical CVD risk factors. CAC score (CACS) was determined by multislice computed tomography. Routine laboratory parameters, including uric acid (UA), were extracted from medical documentation. Descriptive statistics, Mann-Whitney U-test, one-way ANOVA, chi-square test, Spearman's correlation, and multiple linear regression analysis were applied. The predictive power of serum UA was evaluated using receiver operating characteristic (ROC) analysis. Statistical significance was considered at p<0.05. Results: Serum UA was significantly higher in subjects with CACS=1-99AU (p=0.030), and with CACS≥100AU (p=0.067) vs. patients without CACS. Within the UA tertiles, highest CACS was found in the tertile with highest serum UA. UA revealed positive relation with CACS (r=0.35, p=0.002), age (r=0.25, p=0.027), body mass index (0.27, p=0.017), waist circumference (r=0.44, p<0.0001), triglycerides (r=0.29, p=0.001), and creatinine (r=0.54, p<0.0001). Multiple linear regression analysis revealed significant association between UA as dependent variable and waist circumference (β=0.63, p=0.061), serum triglycerides (β=0.37, p=0.028), creatinine levels (β=0.45, p<0.0001). Conclusions: Asymptomatic hyperuricaemia could be an important metabolic factor negatively affecting the chronic cardio-vascular pathology besides the conventional risk factors.

АВТОМАТИЧЕСКИЙ ПЛАЗМАФЕРЕЗ У ПАЦИЕНТОВ С COVID-19-АССОЦИИРОВАННОЙ ПНЕВМОНИЕЙ. ПЕРВЫЙ ОПЫТ ПРИМЕНЕНИЯ

Objective. To determine the possibility of using automatic plasmapheresis in patients with COVID-19- associated bilateral polysegmental pneumonia. Methods. The treatment of three patients with COVID-19-associated pneumonia with application of the Autopheresis-C™ automatic plasmapheresis machine (the USA) has been analyzed. The patients’ age was 47. 49 and 55 years. The patients’ case histories included factors aggravating the course of pneumonia (diabetes mellitus, chronic cardiovascular pathology with heart failure, obesity). The condition of all patients was severe. The effectiveness estimation of the given technique was carried out 6 hours after the manipulation and included a general clinical blood test, a biochemical blood test, hemodynamic parameters, and objective data. Results. After the first application of automatic plasmapheresis, all patients occurred a decrease in temperature and the level of respiratory failure, which was accompanied by an increase in hemoglobin saturation; a decrease in the severity of dyspnea was also reported, which was the reason for the changing patient position from prone to supine. All patients had a blood pressure reduction. Positive changes in the hemodynamic situation were the basis for reducing the dosage of antihypertensive drugs. Along with this, in the course of manipulation, a gradual decrease in the severity of tachycardia was noted in all patients: a reduction of heart rate was recorded. On the second day after the manipulation, the main blood parameters (leukocytosis, c-reactive protein) decreased. The observed positive effects contributed to the early transfer (by 10-15 days) of patients from the intensive care unit to the general somatic departments. Conclusion. The early inclusion of automatic plasmapheresis in the complex therapy of patients with COVID-19- associated bilateral polysegmental pneumonia leads to the stabilization of hemodynamic parameters, decline of the severity of respiratory failure, which made it possible to avoid the mechanical ventilation. What this paper adds For the first time, the clinical effectiveness of the method of automatic plasmapheresis in the framework of the complex therapy of COVID-19- associated polysegmental pneumonia is shown, which is expressed in a decrease in the manifestations of functional and metabolic disorders of vital systems for maintaining homeostasis. It was found that the inclusion of this technology in the complex therapy contributed to the stabilization of respiratory and hemodynamic parameters, which made it possible to avoid the mechanical ventilation.

Pentacyanoferrate(II) complex of pyridine-4- and pyrazine-2-hydroxamic acid as source of HNO: investigation of anti-tubercular and vasodilation activities.

A pharmacophore design approach, based on the coordination chemistry of an intimate molecular hybrid of active metabolites of pro-drugs, known to release active species upon enzymatic oxidative activation, is devised. This is exemplified by combining two anti-mycobacterial drugs: pyrazinamide (first line) and delamanid (third line) whose active metabolites are pyrazinoic acid (PyzCOOH) and likely nitroxyl (HNO (or NO.)), respectively. Aiming to generate those active species, a hybrid compound was envisaged by coordination of pyrazine-2-hydroxamic acid (PyzCONHOH) witha Na3[FeII(CN)5]moiety. The corresponding pentacyanoferrate(II) complex Na4[FeII(CN)5(PyzCONHO-)] was synthesized and characterized by several spectroscopic techniques, cyclic voltammetry, and DFT calculations. Chemical oxidation of this complex with H2O2 was shown to induce the release of the metabolite PyzCOOH, without the need of the Mycobacterium tuberculosis (Mtb) pyrazinamidase enzyme (PncA). Control experiments show that both H2O2- and N-coordinated pyrazine FeII species are required, ruling out a direct hydrolysis of the hydroxamic acid or an alternative oxidative route through chelation of ametal center by a hydroxamic group. The release of HNO was observed using EPR spectroscopy in the presence of a spin trapping agent. The devised iron metal complex of pyrazine-2-hydroxamic acid wasfound inactive against an actively growing/non-resistant Mtb strain; however, itshowed a strong dose-dependent and reversible vasodilatory activity with mostly lesser toxic effects than the reference drug sodium nitroprussiate, unveiling thus a potential indication for acute or chronic cardiovascular pathology. This is a priori a further indirect evidence of HNO release from this metal complex, standing as a possible pharmacophore model for an alternative vasodilator drug.

Management of patients with acute respiratory infections and chronic cardiovascular pathology. Clinical guidelines 2020

Management of patients with acute respiratory infections and chronic cardiovascular pathology. Clinical guidelines 2020

Left atrial strain: a multi-modality, multi-vendor comparison study

Left atrial (LA) strain is a prognostic biomarker with utility across a spectrum of acute and chronic cardiovascular pathologies. There are limited data on intervendor differences and no data on intermodality differences for LA strain. We sought to compare the intervendor and intermodality differences between transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) derived LA strain. We hypothesized that various components of atrial strain would show good intervendor and intermodality correlation but that there would be systematic differences between vendors and modalities. We evaluated 54 subjects (43 patients with a clinical indication for CMR and 11 healthy volunteers) in a study comparing TTE- and CMR-derived LA reservoir strain (ƐR), conduit strain (ƐCD), and contractile strain (ƐCT). The LA strain components were evaluated using four dedicated types of post-processing software. We evaluated the correlation and systematic bias between modalities and within each modality. Intervendor and intermodality correlation was: ƐR [intraclass correlation coefficient (ICC 0.64-0.90)], ƐCD (ICC 0.62-0.89), and ƐCT (ICC 0.58-0.77). There was evidence of systematic bias between vendors and modalities with mean differences ranging from (3.1-12.2%) for ƐR, ƐCD (1.6-8.6%), and ƐCT (0.3-3.6%). Reproducibility analysis revealed intraobserver coefficient of variance (COV) of 6.5-14.6% and interobserver COV of 9.9-18.7%. Vendor derived ƐR, ƐCD, and ƐCT demonstrates modest to excellent intervendor and intermodality correlation depending on strain component examined. There are systematic differences in measurements depending on modality and vendor. These differences may be addressed by future studies, which, examine calibration of LA geometry/higher frame rate imaging, semi-quantitative approaches, and improvements in reproducibility.

Chromogastroduodenoscopy in Diagnostics of Ulcerative Lesions in Patients with Cardiovascular Pathology in Anemia

Rationale. Standard esophagogastroduodenoscopy does not always detect ‘plain’ defects of mucosa with fibrin in comorbid patients with anemia. It is known that irrigation of gastric mucosa with methylene blue solution makes the relief more distinct. Objective: to improve imaging of acute plain ulcers at anematized mucosa of stomach and duodenum using chromogastroduodenoscopy with methylene blue solution. Methods. Chromogastroduodenoscopy with 0.25% and 0.5% methylene blue solution was used in 28 patients (aged 53–86; 17 (60.7 %) women, 11 (39.3 %) men) hospitalized for acute and chronic cardiovascular pathology in anemia. The endoscopic examination was carried out in reanimation or intensive care units. The exclusion criterion was the patient’s refusal to participate in the study. The key outcome was identification of mucosa defects (erosion, ulcer). Results. Chromastroduodenoscopy with methylene blue allowed correct diagnosing of 5 patients (17.8 %) in which pathological processes could not be verified without contrasting. Improved visualization of mucosal defects during contrasting was obtained due to the following: – the colorant spreading over the surface of the mucous accumulates in folds and grooves, erosions, ulcers, thereby showing the configuration; – in stomach methylene blue does not color normal mucosa, but colors fibrin in the base of the defect. And in duodenum it colors mucosa and fibrin in the base of the ulcerative defect, while the edges of the defect are colored unevenly and are visualized as a rim during the imaging. No side effects were identified in the course of chromogastroduodenoscopy with methylene blue. Conclusion. Chromogastroduodenoscopy with methylene blue is of great practical importance, being an informative and simple method.

PREOPERATIVE MANAGEMENT OF PATIENTS WITH CARDIOVASCULAR DISEASES FOR ELECTIVE CANCER SURGERY

Significant progress in the diagnosis and treatment of cancer resulted in a marked improvement in the survival of these patients. Declining mortality in acute cardiovascular diseases is accompanied by an increase in the proportion of patients with chronic cardiovascular pathology. Both trends resulted in a growing cohort of patients with concomitant oncology and cardiovascular disease, given rise to cardiooncology, a rapidly growing field. Cardio-oncology incudes a variety of clinical issues, particularly preoperative assessment of patients for cancer surgery. However, this section has been recently neglected in the recent guidelines. This review focuses on the preoperative management of patients with cardiovascular diseases for elective cancer surgeries. It reports the existing algorithm of assessing the risk of cardiac events in non-cardiac surgeries relatively to cancer patients. Current international and national guidelines were published in 2014 and, therefore, do not contain the latest evidences. Thus, this review summarizes all recent data and provides a modified and simplified preoperative management strategy for cancer patients. In particular, surgical risk assessment should be comprehensive, taking into account the complexity of the surgical procedures and the severity of comorbidity. The review discusses specific risk assessment scales proposed for different groups of cancer patients (for example, the ThRCRI scale in surgeries for non-small cell lung cancer). In addition, it contains various options for assessing the functional status of patients (stress tests, including spiroergometry, DASI index, assessment tables). Current recommendations on additional screening and preventive treatment of patients are summarized and addressed to the healthcare specialists and researchers studying perioperative risk assessment in cancer surgery.

Genetic risk factors of cytolysis syndrome in the treatment of recrudescence of chronic cardiovascular diseases

Aim . To assess the clinical, biochemical, and genetic risk factors for the development of hepatocyte cytolysis syndrome in patients with a combination of fatty liver disease and recrudescence of chronic cardiovascular pathology. Material and methods . The study included 74 patients with chronic cardiovascular disease (coronary heart disease, chronic heart failure, hypertension) treated in the cardiology department of the Central Clinical Hospital of the Siberian Branch of Russian Academy of Sciences with a normal baseline transaminase level (AST and ALT); 12 of them have increasing of transaminase level on 10-12 days. All patients underwent therapeutic and diagnostic procedures in accordance with the medical standards in Russian Federation. Genotyping of polymorphic loci of the genes of the cytochrome P450 family was carried out using real-time polymerase chain reaction (PCR). Results . There was no significant correlation between cytolysis syndrome and phenotypic characteristics: gender, age, body mass index. A positive correlation of fatty liver disease with abdominal obesity and body mass index was confirmed. There was no significant correlation between cytolysis syndrome and clinical and biochemical risk factors: comorbidity and lipid profile. The presence of minor minor allele of cytochrome P-450 — CYP2C9, CYP2D6, CYP2C19 genes in a patient with fatty liver disease increases the risk of cytolysis syndrome during CVD therapy. Conclusion . Pharmacogenetic testing of polymorphic variants of cytochrome P-450 — CYP2C9, CYP2D6, CYP2C19 genes is advisable to recommend to patients with cardiovascular diseases and high-risk of liver disorders for a personalized approach to therapy.

Психоэмоциональный и вегетативный статус стоматологических больных на фоне кардиоваскулярной патологии

Subject. Studying the psychoemotional and vegetative status of dental patients on the background of cardiovascular pathology. Goal. Evaluation of the dynamics of the clinical state, the author's medical-diagnostic protocol and the effectiveness of specific premedication in the performance of surgical intervention in patients with purulent-inflammatory diseases of the maxillofacial region with cardiovascular pathology. Methodology. 63 patients with HBV HBV on the background of cardiovascular pathol-ogy at the age of over 30 years were subjected to clinical, laboratory and instrumental examinations, including using the Spielberg-Khanin, Korach, and Lusher methods, as-sessing the condition of SAD, periodontal tissue, and hygiene and caries intensity, the conditions of the salivary glands, the regional lymph nodes, the temporomandibular joint, the muscles of the head and neck were assessed, as well as electro-one-tonometry, aimed intraoral contact radiography, orthopantom graphy, computed tomography. Results. In patients with chronic cardiovascular pathology, the level of dental anxiety is almost 2 times higher than in the patients of the control group, they revealed a high level of personal and reactive anxiety, determined the presence of psychoemotional stress in patients with HBV CHO in the background of chronic obscheomatic pathology in contrast from the control group. In all patients with HBV CHO in the background of chronic heart disease, the level of blood pressure before premedication was higher: in patients with AH an average of 15 mm Hg. in patients with ischemic heart disease - by 11 mm Hg. Art. , than their "working" BP, in comparison with the control group, where a low level of anxiety and normal values of blood pressure and Ps were determined. Af-ter premedication, improvements were noted. Conclusions. Patients with HBV CHO in the background of chronic cardiovascular pa-thology have complicated psychoemotional and vegetative status, need complex dental and additional specialized examination. Dental treatment of such patients requires indi-vidual premedication.

Cardiovascular disease and resuscitated septic shock lead to the downregulation of the H2S-producing enzyme cystathionine-\u03b3-lyase in the porcine coronary artery

BackgroundDownregulation of the hydrogen sulfide (H2S)-producing enzymes cystathionine-γ-lyase (CSE), cystathionine-β-synthase (CBS), and/or 3-mercaptopyruvate sulfurtransferase (3-MST) is associated with chronic cardiovascular pathologies. Nevertheless, equivocal data are available on both the expression and function of these enzymes in coronary arteries (CA). We recently reported that atherosclerotic pigs subjected to sepsis developed impaired cardiac function, which coincided with decreased myocardial CSE expression and increased nitrotyrosine formation. To define the endogenous source(s) of H2S in the CA, we studied the expression of CBS, CSE, or 3-MST in the CA of pigs subjected to septic shock with/without pre-existing cardiovascular co-morbidity.MethodsAnesthetized and instrumented FBM "familial hypercholesterolemia Bretoncelles Meishan" pigs with high-fat diet-induced hypercholesterolemia and atherosclerosis were subjected to polymicrobial septic shock, or sham procedure, and subsequent intensive care therapy for 24 h. Young German domestic pigs were used as naïve controls. CSE, CBS, 3-MST, HO-1, eNOS, and nitrotyrosine expression was quantified by immunohistochemistry of formalin-fixed paraffin sections.ResultsFBM pigs, in the absence of septic shock, showed decreased CSE expression in the media. This decrease became more pronounced after sepsis. The expression pattern of HO-1 resembled the pattern of CSE expression. CBS protein was not detected in the media of any of the CA examined but was localized to the adventitia and only in the atheromatous plaques containing foam cells of the CA, in regions that also displayed abundant nitrotyrosine formation. The CBS expression in the adventitia was not associated with nitrotyrosine formation. 3-MST expression was not found in any of the CA samples.ConclusionsWe hypothesize that (i) the reduced CSE expression in FBM pigs may contribute to their cardiovascular disease phenotype and moreover (ii) the further decrease in CA CSE expression in sepsis may contribute to the sepsis-associated cardiac dysfunction.

Immunomodulation by dietary long chain omega-3 fatty acids and the potential for adverse health outcomes

Recommendations to consume fish for prevention of cardiovascular disease (CVD), along with the U.S. Food and Drug Administration-approved generally recognized as safe (GRAS) status for long chain omega-3 fatty acids, may have had the unanticipated consequence of encouraging long-chain omega-3 (ω-3) fatty acid [(eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)] supplementation and fortification practices. While there is evidence supporting a protective role for EPA/DHA supplementation in reducing sudden cardiac events, the safety and efficacy of supplementation with LCω-3PUFA in the context of other disease outcomes is unclear. Recent studies of bacterial, viral, and fungal infections in animal models of infectious disease demonstrate that LCω-3PUFA intake dampens immunity and alters pathogen clearance and can result in reduced survival. The same physiological properties of EPA/DHA that are responsible for the amelioration of inflammation associated with chronic cardiovascular pathology or autoimmune states, may impair pathogen clearance during acute infections by decreasing host resistance or interfere with tumor surveillance resulting in adverse health outcomes. Recent observations that high serum LCω-3PUFA levels are associated with higher risk of prostate cancer and atrial fibrillation raise concern for adverse outcomes. Given the widespread use of supplements and fortification of common food items with LCω-3PUFA, this review focuses on the immunomodulatory effects of the dietary LCω-3PUFAs, EPA and DHA, the mechanistic basis for potential negative health outcomes, and calls for biomarker development and validation as rational first steps towards setting recommended dietary intake levels.