Combined Coronary Heart Disease Research Articles

Геронтологические особенности влияния новой коронавирусной инфекции на показатели интерлейкинового профиля, воспаления и эндогенной интоксикации у пациентов зрелого и пожилого возраста с ишемической болезнью сердца

Background: Coronary heart disease (CHD) is considered as an independent risk factor for COVID19, however, the indicators of inflammation and endogenous intoxication in patients with CHD 3-4 weeks after recovery from COVID-19 have not been the subject of scientific research. The aim of the study: Assessment of the gerontological features of the effect of the transferred new coronavirus infection on the indicators of the interleukin profile, inflammation and endogenous intoxication of mature and elderly patients with coronary heart disease in the early stages of recovery. Materials and methods: The study included 58 mature-age patients with coronary heart disease 3-4 weeks after recovery from COVID-19 of moderate severity, who made up the comparison group. The main group of patients was represented by 62 elderly people with coronary heart disease who had suffered a new coronavirus infection and were examined in the same way as the previous group, 3-4 weeks after recovery. The level of C-reactive protein and highly sensitive C-reactive protein in the blood was studied using the Nicomed-reader express analyzer, and antistreptolysin-O was studied using an immunoturbidimetric method on the Cobas 600 analyzer (Switzerland). The blood levels of bilirubin, urea, creatinine and sialic acids were studied using the ROKI biochemical analyzer. The content of systemic cytokines was determined by the Beckton Dickinson FACS Canto 2 (USA). The level of anxiety and depression was studied on the HADS scale. Results: 3-4 weeks after recovery from COVID-19, antistreptolysin-O levels ranged from 120.9 МЕ/ml to 208.1 МЕ/ml. Significant changes among the considered parameters of inflammation and endogenous intoxication in patients with coronary heart disease in old age during recovery from a new coronavirus infection were accompanied by a change in the content of highly sensitive C-reactive protein in peripheral blood. In the early stages of recovery after COVID-19, in elderly patients with coronary heart disease, the concentration of many studied cytokines in blood plasma remained elevated compared with those aged 45-59 years. The excess of reference values in both groups was found for IL-17, TNF-α and IFN-α, and among elderly patients – for IL-3, IL-4, IL-6, IL-7, IL-17. Conclusion: Antistreptolysin-O, highly sensitive C-reactive protein, C-reactive protein can be considered markers of recovery in patients with combined coronary heart disease in the early stages after a new coronavirus infection.

Analysis of the Necessity of Stellate Ganglion Block after Anesthesia to Reduce the Risk of Cardiovascular Accidents in Coronary Heart Disease

Objective: To adjust the sympathetic nervous system through preoperative ultrasound-guided stellate ganglion block and to explore and analyze the situation and necessity of postanesthesia stellate ganglion block to reduce the risk of cardiovascular accidents in coronary heart disease. Methods: 80 patients with cardiovascular risk factors in Songshan Hospital of Chifeng were selected, and the time span would cover from October 2022 to June 2024, with 80 cases of elective surgery and combined coronary heart disease. They will be randomly divided into blocked groups and conventional groups, 40 cases each. Conventional block was performed after anesthesia in patients in the conventional group, and planetary ganglion block was performed after anesthesia in patients in the blocked group. The cardiovascular responses of patients in the two groups were observed, and the number of intraoperative cardiovascular active drugs and the occurrence of cardiovascular adverse events were recorded in patients in the two groups. Results: Analysis of the mean arterial pressure (MAP) and heart rate (HR) values of the two groups of patients at the time points before anesthesia (T0), the moment of tracheal intubation (T1), the moment of surgical skin cutting (T2), the end of the operation (T3), and the 6h postoperative period (T4) showed that the MAP and HR of the blocked group were lower than those of the conventional group at the time points of T1 to T4, and the differences in MAP and HR values of the two groups in different time points compared with the T0 time point were statistically significant (P < 0.05) and the differences in cardiovascular response (P < 0.05) were statistically significant (P < 0.05). significance (P < 0.05). The number of intraoperative cardiovascular active drugs used in the blocked group was shorter than that in the conventional group, and the incidence of cardiovascular adverse events was lower than that in the conventional group, with a statistically significant difference (P < 0.05). Conclusion: By implementing preoperative ultrasound-guided stellate ganglion block in patients with cardiovascular risk factors, the frequency and degree of coronary heart disease symptoms will be reduced, thus reducing the risk of patients, which is worth promoting.

Inclisiran Usage in Very High-Risk Patients with Dyslipidemia Resistant to Statins and Ezetimibe Therapy

Background. Complications of systemic atherosclerosis (myocardial infarction, ischemic stroke) are the main causes of mortality and disability in the modern world. The relevance of this problem is determined by its scale: the number of deaths from cardiovascular disease has gradually increased from 12.1 million in 1990 to 18.6 million in 2019 and is on the rise. Today, the standard treatment regimen for dyslipidemia includes statins and ezetimibe. For patients who do not achieve the required lipid lowering, intensification of therapy with a relatively new group of drugs – PCSK9 inhibitors – is available. The aim. To study the effectiveness of inclisiran in the complex therapy of dyslipidemia in patients with very high cardiovascular risk. Materials and methods. The study design was a series of clinical cases, the data of which are described for comparison in dynamics. On the basis of the Department of Cardiometabolic Diseases of the Ukrainian Children’s Cardiac Center, a group of 7 patients with very high cardiovascular risk who did not achieve the target lipid parameters on standard therapy with rosuvastatin and ezetimibe was selected. Results. All the patients in the study group of very high cardiovascular risk with dyslipidemia resistant to standard combination treatment who took inclisiran as part of complex lipid-lowering therapy achieved a significant reduction in total cholesterol, but more importantly, they reached the target low-density lipoprotein cholesterol values. We did not find any side effects when using inclisiran. Conclusions. The present series of clinical cases demonstrates high efficacy of inclisiran as part of complex lipid-lowering therapy in patients with very high cardiovascular risk, who have a combination of coronary heart disease and type 2 diabetes mellitus. These results suggest the possibility of wider use of inclisiran in patients with very high cardiovascular risk to reduce cardiovascular morbidity and mortality.

PATHOGENESIS OF IMMUNE DYSFUNCTION IN THE SETTING OF METABOLIK SYNDROME IN CORONARY HEAT DISEASE. QUALIFYING SCENTIFYING WORK ON THE RIGHTS OF THE MANUSCRIPT

PATHOGENESIS OF IMMUNE DYSFUNCTION IN THE SETTING OF METABOLIK SYNDROME IN CORONARY HEAT DISEASE. QUALIFYING SCENTIFYING WORK ON THE RIGHTS OF THE MANUSCRIPT

Disorders of adaptation in patients with coronary heart disease in combination with subclinical hypothyroidism

Disorders of adaptation in patients with coronary heart disease in combination with subclinical hypothyroidism

Cytokine profile in the patients with combined cardio- and ophtalmopathies

Combined cardiological and ophthalmological pathology has a high prevalence in older age groups of the population and common pathogenetic mechanisms, among which, of course, is a violation of the cytokine profile. However, the cytokine profile of the blood was practically not analyzed in elderly patients with combined ischemic heart disease with glaucoma. The aim of the study was to study the cytokine profile in patients with combined cardio- and ophthalmopathology. The study was performed at the S.N. Fedorov National Medical Research Center “MNTK Eye Microsurgery”, in two groups: patients with combined coronary heart disease with glaucoma (n = 58 people), and patients with coronary heart disease (n = 49 people), who in both cases have the same age of 60-74 years. The diagnosis of glaucoma was carried out in accordance with the criteria of the “National Glaucoma Guidelines”. Electrocardiographic, echocardiographic, radiographic, and enzyme studies were performed to diagnose coronary heart disease. The determination of cytokines in blood plasma was carried out on the device “Becton Dickinson FACS Canto 2 (USA)” using a special set of CBA (BD Biosciences, USA). Among the patients of the compared groups of the same age, significant differences in most cytokines were revealed, namely, a predominant increase in patients with combined cardio- and ophthalmopathology relative to the group with coronary heart disease. The content of IL-5, IL-12, IFNγ, TNFα in the blood plasma of patients with coronary heart disease combined with glaucoma increased with a significant difference compared to patients with coronary heart disease. However, the highest increase among the cytokines under consideration is characteristic of IL-6 and IL-17, which amounted to 23.8±1.1 pg/mL and 20.2±1.7 pg/mL in patients with combined cardio- and ophthalmopathology versus 6.3±0.3 pg/mL and 7.9±0.5 pg/mL, respectively, in patients with coronary heart disease. At the same time, the level of IL-4 and IL-10 decreased significantly to 2.2±0.2 pg/mL and 6.4±0.4 pg/mL versus 4.8±0.3 pg/mL and 11.9±0.6 pg/mL. The use of logistic regression made it possible to determine the relative risk values of the studied blood cytokines and to develop uncorrected and adjusted models, according to which the closest association with the risk of developing combined coronary heart disease with glaucoma was established for IL-6 and IL-17, with the relative risk values in the uncorrected model of 2.87 and 2.71, respectively (p < 0.001). However, in the adjusted model, the association of IL-6 with combined coronary heart disease with glaucoma increased to 2.92 (CI 2.80-3.27, p = 0.004), and IL-17 decreased to 2.64 (CI 2.51-2.85, p = 0.003). There was also a significant association of IL-4, IL-5, IL-12, IFNγ and TNFα with combined coronary heart disease with glaucoma. The study demonstrated new associations of systemic cytokines with the risk of developing combined coronary heart disease associated with glaucoma.

Clinical management and prognosis for descending necrotizing mediastinitis

Objective: To investigate the clinical characteristics, treatment experiences and prognostic factors for descending necrotizing mediastinitis (DNM). Methods: A retrospective analysis was performed on the data of 22 patients with DNM diagnosed and treated in Henan Provincial People's Hospital from January 2016 to August 2022, including 16 males and 6 females, aged 29-79 years. After admission, all patients underwent CT scanning of the maxillofacial, cervical, and thoracic regions to confirm their diagnoses. Emergency incision and drainage were performed. The neck incision was treated with continuous vacuum sealing drainage. According to the prognoses, the patients were divided into cure group and death group, and the prognostic factors were analyzed. SPSS 25.0 software was used to analyze the clinical data. Rusults: The main complaints were dysphagia (45.5%, 10/22) and dyspnea (50.0%, 11/22). Odontogenic infection accounted for 45.5% (10/22) and oropharyngeal infection accounted for 54.5% (12/22). There were 16 cases in the cured group and 6 cases in the death group, with a total mortality rate of 27.3%. The mortality rates of DNM typeⅠand typeⅡwere respectively 16.7% and 40%. Compared with the cured group, the death group had higher incidences for diabetes, coronary heart disease and septic shock (all P<0.05). There were statistically significant differences between the cure group and the death group in procalcitonin level (50.43 (137.64) ng/ml vs 2.92 (6.33) ng/ml, M(IQR), Z=3.023, P<0.05) and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score (16.10±2.40 vs 6.75±3.19, t=6.524, P<0.05). Conclution: DNM is rare, with high mortality, high incidence of septic shock, and the increased procalcitonin level and APACHE Ⅱ score combined diabetes and coronary heart disease are the poor prognostic factors for DNM. Early incision and drainage combined with continuous vacuum sealing drainage technique is a better way to treat DNM.

AFFECTIVE DISORDERS IN MEN WITH ARTERIAL HYPERTENSION IN COMBINATION WITH METABOLIC SYNDROME

Purpose. To study the features of affective disorders in men with comorbid chronic coronary heart disease with metabolic syndrome.&#x0D; Materials and methods. The study was performed with the participation of 115 male patients diagnosed with chronic coronary heart disease. Metabolic syndrome verification was carried out using the clinical recommendations of the All-Russian Scientific Society of Cardiology (2009). Identification of the presence of anxiety-depressive states and assessment of their severity was carried out using The Hospital Anxiety and Depression scale.&#x0D; Results. The study showed that among men with chronic coronary heart disease who have metabolic syndrome, the median averaged anxiety score on the Hospital Anxiety and Depression scale was significantly higher (p=0,041) compared to those without metabolic syndrome. In 17,6% of the examined patients with a combination of chronic coronary heart disease and metabolic syndrome, elevated levels of anxiety were detected. Anxiety disorders of a subclinically pronounced nature were found in 13,7% of the surveyed in this group, and clinically pronounced in 3,9%. Elevated levels of depression were detected in 17,6% of the examined patients with metabolic syndrome. At the same time, depressive disorders of both subclinically expressed and clinically expressed nature were detected with the same frequency: 7,8% vs 7,8%.&#x0D; Conclusion. Among patients with chronic coronary heart disease with a comorbid course with metabolic syndrome, the number of people with clinically pronounced anxiety and depression was higher compared to those without metabolic syndrome. In men with chronic coronary heart disease in combination with metabolic syndrome with both increased levels of anxiety and increased levels of depression, 3- and 4-component clusters of metabolic syndrome, including arterial hypertension, abdominal obesity and various dyslipidemias, were more often detected.

Характеристика деяких показників системи гемостазу у хворих на компенсоване хронічне легеневе серце бронхо-легеневого генезу та особливості їх змін в умовах коморбідності зі стабільною ішемічною хворобою серця

The purpose of the study was to research and analyze the peculiarities of changes of some hemostasis system indices and define their possible role in the formation of a vascular lesion in the patients with compensated chronic cor pulmolale of broncho-pulmonary genesis in conditions of its comorbidity with stable coronary heart disease. Materials and methods. The retrospective study and analysis of hemostasis system indices (platelet count, thrombin time, prothrombin time, antithrombin – III, plasma tolerance to heparin, plasmin lysis, fibrinogen, soluble fibrin) in 64 patients with chronic obstructive pulmonary disease and compensated chronic cor pulmonale (29 female, 35 male, mean age – 54.6 ± 2.3) were carried out. 32 patients with the isolated pathology formed the comparative group whereas 32 patients with the comorbid coronary heart disease (exertional angina, functional class II-III, postinfarction or aterosclerotic cardiosclerosis) built the main group. The obtained research results of the patients of the main and comparative groups were compared both in groups and with the indices of practically healthy individuals (n = 15) of the same gender and age. Results and discussion. The obtained results indicated the presence of a significant increase of coagulation potential (the changes of indices of platelets, fibrinogen, plasma tolerance to heparin, antithrombin – III, and soluble fibrin) and activation of fibrinolysis system (thrombin time) and, simultaneous, its more pronounced depression (plasmin lysis) and increase of prothrombin time in case of presence of comorbid coronary heart disease in the patients with chronic cor pulmonale in conditions of chronic inflammatory process. Comorbidity promoted to the formation of disbalance of systemic correlation hemocoagulation and fibrinolysis. Our results confirm to a certain extent the following ideas of scientists: there are hypercoagulation and “exhaustion of the anticoagulant system potential” in case of combination of coronary heart disease and chronic obstructive pulmonary disease; hypercoagulation together with the oxidative stress and chronic systemic inflammation are general pathogenic mechanisms of chronic obstructive pulmonary disease and cardiovascular diseases, particularly of the coronary heart disease. Conclusion. The analysis of the changes of the hemostasis system indices in patients with compensated chronic cor pulmonale of broncho-pulmonary genesis indicates the presence of an increase of coagulation potential; the most significant changes with suppression of fibrinolytic activity are typical of the patients with comorbid coronary heart disease. The peculiarities of the hemostasis system changes in the patients with compensated chronic cor pulmonale of broncho-pulmonary genesis should be considered as a marker of the increased risk of the thrombogenic vascular complications. It should be taken into account for treatment-diagnostic strategy formation

Metabolic Status in Patients with Ischemic Heart Disease and Obesity with Different Genotypes of Leptin Receptor Gene (Arg223Glu)

The purpose of the study was to assess the metabolic status, namely carbohydrate and lipid metabolism, in patients with coronary heart disease and obesity with different genotypes of the leptin receptor gene (Arg223Glu). Materials and methods. The study included 220 patients with coronary heart disease and obesity. The comparison group consisted of 113 patients with coronary heart disease with normal body weight. The control group included 35 healthy individuals. Additionally, patients with coronary heart disease and obesity were divided into subgroups depending on the genotype of the leptin receptor gene (Arg223Glu): the first subgroup included carriers of the A/A genotype (n=57), the second – G/A genotype (n=90), the third – G/G genotype (n=73). Results and discussion. The analysis of carbohydrate metabolism depending on the genotypes of the leptin receptor gene (Arg223Gln) in patients with coronary heart disease and obesity showed that carriers of the G/G genotype have more pronounced disorders of carbohydrate metabolism in the form of hyperinsulinemia and decreased tissue sensitivity to insulin while carriers of the genotypes G/A and A/A have greater resistance to glucose-metabolic disorders. Body mass index in carriers of G/G genotype had the highest value, which is 19.19% and 19.53% more than in carriers of genotypes G/A and A/A. Thus, the G/G genotype in patients with coronary heart disease and obesity was associated with body mass index. The impaired lipid metabolism in patients with coronary heart disease in combination with obesity was defined as hypertriglyceridemia, which is associated with the G/G genotype of the leptin receptor gene polymorphism (Arg223Gln). The results obtained in our work indicate the involvement of the polymorphic locus of the leptin receptor gene (Arg223Gln) in the formation of disorders of carbohydrate and lipid metabolism, which corresponds to the literature. It has been suggested that structural changes in the leptin receptor gene are associated not only with the development of obesity but also with the development of type 2 diabetes mellitus. Conclusion. The features of the combined course of coronary heart disease and obesity were identified: hyperinsulinemia and insulin resistance are associated with the G allele and G/G genotype of the polymorphic locus Arg223Gln leptin receptor gene (r=0.76, p&lt;0.05); the rearrangement of the lipid spectrum due to hypertriglyceridemia is influenced by the homogeny of the G allele of the polymorphic locus of the Arg223Gln gene of the leptin receptor gene (r=0.73, p&lt;0.05)

Внесок деяких біологічно активних речовин жирової тканини в розвиток серцево-судинних ускладнень у коморбідних пацієнтів

The contribution of some biologically active substances of adipose tissue to the development of cardiovascular complications in comorbid patients. Adipose tissue hormones — adipokines — vaspin and omentin, which control homeostasis, lipid and glucose metabolism, have attracted scientific interest in recent years. The purpose of the study was to determine the contribution of some hormones of adipose tissue, namely, vaspin and omentin, in the development of obesity in patients with coronary heart disease with concomitant obesity. Materials and methods. A comprehensive examination of 38 patients with coronary heart disease in combination with obesity (average age: 64±1.9 years), men and women in equal numbers, was conducted; the comparison group consisted of 40 patients with coronary artery disease without obesity. Control group: 20 practically healthy individuals without coronary heart disease and with normal body weight, average age 58.2±1.4 years. Conclusions: The comorbidity of coronary heart disease and obesity leads to the activation of the pro-inflammatory hormone of adipose tissue — vaspin and insufficient circulation of omentin, which leads to an increase in body weight. The development of obesity in patients with coronary heart disease depends on the dysfunction of adipose tissue, the manifestations of which are an imbalance in the levels of vaspin and omentin.

NON-INVASIVE METHODS OF DIAGNOSTICS OF GASTRO-ESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH ISCHEMIC HEART DISEASE.

The aim: To determine the diagnostic value of non-invasive methods of GERD diagnosis based on questionnaire data and a diagnostic test with a proton pump inhibitor (PPI) with Rabeprazole in patients with coronary heart disease (CHD). Materials and methods: 90 patients were under observation, namely, 68 patients with coronary heart disease with concomitant essential arterial hyperten¬sion (EAH), 6 patients with coronary artery disease + arrhythmias, and 18 - others diseases. All patients were surveyed according to the GerdQ questionnaire, followed by PPI testing with Rabeprazole, and body mass index (BMI) was calculated for all the patients. A BMI of 18.5-24.9 kg/m2 was considered as normal body weight, and a BMI > 24.9 kg/m2 was considered overweight. Results: Based on the results of the questionnaire, it was established that the most common complaints typical for GERD were noted by patients with CHD in combination with EAH. There were 48 of such patients and, depending on BMI, they were divided into 2 groups: 1st group (n=14) - patients with CHD+EAH+GERD with normal body weight and 2nd group (n=34) - overweight patients with CHD+EAH+GERD. In patients of group 1, typical symptoms of GERD prevailed (in 71.4% of patients), and in patients group 2, the distribution of typical and extra-esophageal symptoms did not differ significantly (52.9% vs. 47.1%). Among the extraesophageal manifestations, pain behind the sternum (in the projection of the esophagus) was significantly more often recorded in patients of group 1, and rhythm disturbances in patients of group 2 (43.8% and 75.0% of patients, respectively, p<0.05). The results of the GerdQ questionnaire showed a direct relationship between GERD, body weight and symptom score. Patients with GERD+normal body weight had a mean score of 6 for classic gastroesophageal reflux symptoms, while patients with GERD+increased body weight had a mean score of 7. The sensitivity of the questionnaire was 78.7%, and the specificity - 92.9%. According to the PPI test, in the 1st and 2nd groups, already in the first three days, 28.5% and 23.5% of patients noted the disappearance of heartburn and after 10 days - 85.7% and 64.7%, respectively. Over the entire period, that is, after 14 days of observation, 85.7% of patients in the 1st group and 73.5% in the 2nd group noted improvement. Conclusions: It has been established that questionnaires based on the GerdQ questionnaire followed by a PPI test with Rabeprazole in patients with coronary heart disease combined with essential arterial hypertension have a high diagnostic value and can be used for early diagnosis and effective treatment of GERD.

Efficacy of Combination Therapy in Patients with Stable Coronary Heart Disease with Comorbid Chronic Obstructive Pulmonary Disease

The objective: to analyze the quality of life (QoL) and functional status after combination therapy in patients with stable coronary heart disease (CHD) and comorbid chronic obstructive pulmonary disease (COPD). Materials and methods. The study included 60 men with stable CHD in combination with COPD. The patients were divided into two groups of 30 people, comparable according to the main indicators. Study group (1) received basic treatment with nebivolol, valsartan, eplerenone, acetylsalicylic acid, rosuvastatin for CHD and basic COPD treatment with combination of umeclidinium bromide (a long-acting cholinolytic) and vilanterol (a long-acting beta2-agonist). Patients from Group 2 in addition tj the basic treatment received L-arginine in the form of an infusion of 4.2% 100 ml solution for 10 days, followed by oral administration at a dose of 3 g per day. The duration of treatment was 6 months. Quality of life was evaluated by validated standardized non-specific questionnaire «The 36-Item Short Form Health Survey» (SF-36), a validated specific respiratory questionnaire of St. George’s Hospital – St. George’s Respiratory Questionnaire (SGRQ). The functional state of patients before and after treatment was evaluated by cardiorespiratory test, which included the distance 6-minutes walk test (6MWT) according to the standard method in combination with pulse oximetry (SpO2), calculation of desaturation level (ΔSpO2), recording of electrocardiogram and blood pressure before and after exercise. Results. After the treatment, patients in both groups noted a significant improvement in quality of life across all domains of the SF-36 questionnaire, which includes 36 questions with physical and mental components. Patients from group 2 demonstrated better results of treatment in all indicators of physical functioning, general health and vital activity than patients from group 1. The results of the quality of life evaluation according to the specific respiratory questionnaire SGRQ also showed a significant improvement in patients of both groups. In both groups, the distance of 6MWT significantly increased, the heart rate at rest and after exercise decreased, and the level of desaturation decreased. In group 2, the increase in the distance of 6MWT, the decrease of desaturation level was significantly better than in group 1. Conclusions. Rational combination treatment of patients with stable coronary heart disease (CHD) with comorbid chronic obstructive pulmonary disease (COPD) includes nebivolol, valsartan, eplerenone, acetylsalicylic acid, rosuvastatin and a combination of vilanterol and umeclidinium bromide, contributes to improving the quality of life of patients and their functional status. Addition of L-arginine to the basic combination treatment of patients with CHD and COPD increases the efficacy of therapy and improves cardiohemodynamics. Addition of L-arginine to the treatment complex contributed to the additional improvement of the physical and mental patterns of quality of life and indicators of cardiorespiratory test.

Efficacy of Combination Therapy in Patients with Stable Coronary Heart Disease with Comorbid Chronic Obstructive Pulmonary Disease

The objective: to analyze the quality of life (QoL) and functional status after combination therapy in patients with stable coronary heart disease (CHD) and comorbid chronic obstructive pulmonary disease (COPD). Materials and methods. The study included 60 men with stable CHD in combination with COPD. The patients were divided into two groups of 30 people, comparable according to the main indicators. Study group (1) received basic treatment with nebivolol, valsartan, eplerenone, acetylsalicylic acid, rosuvastatin for CHD and basic COPD treatment with combination of umeclidinium bromide (a long-acting cholinolytic) and vilanterol (a long-acting beta2-agonist). Patients from Group 2 in addition tj the basic treatment received L-arginine in the form of an infusion of 4.2% 100 ml solution for 10 days, followed by oral administration at a dose of 3 g per day. The duration of treatment was 6 months. Quality of life was evaluated by validated standardized non-specific questionnaire «The 36-Item Short Form Health Survey» (SF-36), a validated specific respiratory questionnaire of St. George’s Hospital – St. George’s Respiratory Questionnaire (SGRQ). The functional state of patients before and after treatment was evaluated by cardiorespiratory test, which included the distance 6-minutes walk test (6MWT) according to the standard method in combination with pulse oximetry (SpO2), calculation of desaturation level (ΔSpO2), recording of electrocardiogram and blood pressure before and after exercise. Results. After the treatment, patients in both groups noted a significant improvement in quality of life across all domains of the SF-36 questionnaire, which includes 36 questions with physical and mental components. Patients from group 2 demonstrated better results of treatment in all indicators of physical functioning, general health and vital activity than patients from group 1. The results of the quality of life evaluation according to the specific respiratory questionnaire SGRQ also showed a significant improvement in patients of both groups. In both groups, the distance of 6MWT significantly increased, the heart rate at rest and after exercise decreased, and the level of desaturation decreased. In group 2, the increase in the distance of 6MWT, the decrease of desaturation level was significantly better than in group 1. Conclusions. Rational combination treatment of patients with stable coronary heart disease (CHD) with comorbid chronic obstructive pulmonary disease (COPD) includes nebivolol, valsartan, eplerenone, acetylsalicylic acid, rosuvastatin and a combination of vilanterol and umeclidinium bromide, contributes to improving the quality of life of patients and their functional status. Addition of L-arginine to the basic combination treatment of patients with CHD and COPD increases the efficacy of therapy and improves cardiohemodynamics. Addition of L-arginine to the treatment complex contributed to the additional improvement of the physical and mental patterns of quality of life and indicators of cardiorespiratory test.

EFFECT OF HYPOTHYROIDISM ON MYOCARDIAL INFARCTION AND REVASCULARIZATION IN PATIENTS WITH RHEUMATOID ARTHRITIS

EFFECT OF HYPOTHYROIDISM ON MYOCARDIAL INFARCTION AND REVASCULARIZATION IN PATIENTS WITH RHEUMATOID ARTHRITIS

Bioinformatics and System Biological Approaches for the Identification of Genetic Risk Factors in the Progression of Cardiovascular Disease.

Background Cardiovascular disease (CVD) is the combination of coronary heart disease, myocardial infarction, rheumatic heart disease, and peripheral vascular disease of the heart and blood vessels. It is one of the leading deadly diseases that causes one-third of the deaths yearly in the globe. Additionally, the risk factors associated with it make the situation more complex for cardiovascular patients, which lead them towards mortality, but the genetic association between CVD and its risk factors is not clearly explored in the global literature. We addressed this issue and explored the linkage between CVD and its risk factors. Methods We developed an analytical approach to reveal the risk factors and their linkages with CVD. We used GEO microarray datasets for the CVD and other risk factors in this study. We performed several analyses including gene expression analysis, diseasome analysis, protein-protein interaction (PPI) analysis, and pathway analysis for discovering the relationship between CVD and its risk factors. We also examined the validation of our study using gold benchmark databases OMIM, dbGAP, and DisGeNET. Results We observed that the number of 32, 17, 53, 70, and 89 differentially expressed genes (DEGs) is overlapped between CVD and its risk factors of hypertension (HTN), type 2 diabetes (T2D), hypercholesterolemia (HCL), obesity, and aging, respectively. We identified 10 major hub proteins (FPR2, TNF, CXCL8, CXCL1, IL1B, VEGFA, CYBB, PTGS2, ITGAX, and CCR5), 12 significant functional pathways, and 11 gene ontological pathways that are associated with CVD. We also found the connection of CVD with its risk factors in the gold benchmark databases. Our experimental outcomes indicate a strong association of CVD with its risk factors of HTN, T2D, HCL, obesity, and aging. Conclusions Our computational approach explored the genetic association of CVD with its risk factors by identifying the significant DEGs, hub proteins, and signaling and ontological pathways. The outcomes of this study may be further used in the lab-based analysis for developing the effective treatment strategies of CVD.

Application possibilities of PCSK9 inhibitors in patients with coronary heart disease in combination with type 2 diabetes mellitus

Introduction. Coronary heart disease (CHD) combined with type 2 diabetes mellitus (DM) requires enhanced secondary prevention.The aim of the study was to evaluate the application possibilities of PCSK9 inhibitors in patients with coronary heart disease combined with type 2 diabetes.Materials and methods. The study included 77 patients with coronary heart disease divided into 2 groups: the first group without type 2 diabetes (n=39) and the second group with concomitant type 2 diabetes (n=38). Before the experiment started all patients received a combination of the maximum tolerated dose of atorvastatin and ezetimibe and did not reach the target values of low-density lipoprotein cholesterol (LDL cholesterol), after that alirocumab was added to treatment. In all patients, for 12 months, the parameters of the lipid transport system, glycated hemoglobin and the dynamics of changes in the thickness of the intima-media complex of the carotid arteries were evaluated.Results. After starting treatment with alirocumab, in the first group, LDL cholesterol targets reached 97.4 % (n=38), in the second group – 94.7 % (n=36). The LDL cholesterol level in the first group decreased from 2.27 [2.21; 2.35] to 1.15 [1.07; 1.28] mmol/l (by 49.1 %, p&lt;0.001), in the second group from 2.32 [2.27; 2.36] to 1.17 [1.12; 1.19] mmol/l (by 49.6 %, p&lt;0.001). A direct strong statistically significant correlation was revealed between the concentration of LDL cholesterol and other indicators of lipid metabolism.Conclusion. The obtained results of PCSK9 inhibitors appliance in CHD patients with very high cardiovascular risk demonstrate a decrease in LDL cholesterol by 73.9 % in the group of CHD patients and by 74.2 % in the group of CHD patients in combination with type 2 diabetes. In the first group, the target concentrations of LDL cholesterol were reached by 97.4 % of patients, in the second group – 94.7 %. The achieved hypolipidemic effect was simultaneously combined with a decrease in the thickness of the intima-media complex in the group of patients with coronary artery disease: for the right common carotid artery by 7.8 %, for the left by 10.9 %; in patients with coronary heart disease with concomitant type 2 diabetes: for the right common carotid artery by 8.3 %, for the left by 8.1 %.

Features of changes in insulin-like growth factor-1 in patients with coronary heart disease in combination with type 2 diabetes mellitus

The purpose of the study was to study the level of insulin-like growth factor-1 in the blood of patients with coronary heart disease with type 2 diabetes mellitus, in patients with coronary heart disease without type 2 diabetes mellitus and in almost healthy individuals. Materials and methods. We examined 73 patients (30 men, 43 women) with coronary heart disease aged 49 to 75 years (mean age –58.3 ± 1.8). All patients were treated in the therapeutic department of the prof. А. А. Shalimov Kharkiv Municipal Clinical Hospital No. 2. Examination of patients was performed using clinical, laboratory and instrumental methods. All patients had ischemic heart disease in the form of stable angina pectoris of I – II functional classes, I functional class was diagnosed in 27 patients, II – in 46 patients. From the group of examined patients in 36 patients the disease was accompanied by concomitant type 2 diabetes mellitus (group 1). Mild diabetes was detected in 15 people, moderate – in 21 patients. 37 patients did not have diabetes mellitus (group 2). Diagnosis of diabetes was based on the criteria of the World Diabetes Federation. The control group consisted of 20 people of the same age, who according to the results of clinical and additional studies were found to be practically healthy. Determination of insulin-like growth factor-1 and insulin levels in the blood was performed by enzyme-linked immunosorbent assay on a «Humareader photometer-analyzer». DRG kits (USA) were used to study the level of insulin-like growth factor-1. Results and discussion. It was found that patients with coronary heart disease with concomitant type 2 diabetes had higher levels in serum triglycerides (p &lt;0.05) and very low density lipoprotein cholesterol (p &lt;0.05) compared with patients with coronary heart disease without diabetes. Patients with coronary heart disease and concomitant type 2 diabetes showed a statistically significant increase in blood insulin levels compared with patients with coronary heart disease without diabetes. The results of the analysis of insulin-like growth factor-1 showed that the content of insulin-like growth factor-1 in the blood of patients with coronary heart disease and type 2 diabetes was probably lower compared with patients with coronary heart disease without diabetes and with practically healthy individuals (p &lt;0.01). At the same time, the levels of insulin-like growth factor-1 in almost healthy individuals and patients with coronary heart disease without type 2 diabetes did not differ significantly. Conclusion. In patients with coronary heart disease with type 2 diabetes the level of insulin-like growth factor-1 is probably lower than in patients with coronary heart disease without diabetes and almost healthy individuals. Given the antiapoptotic, antiatherosclerotic, anabolic properties of this growth factor, it can be argued that the development of relative insulin-like growth factor-1 deficiency in the combination of coronary heart disease with type 2 diabetes causes a significant increase in the risk of cardiovascular complications in this category of patients

Modified methods of polygepatography and peripheral arterial tonometry in the assessment of peripheral circulation regulation

Objective. The purpose of the work was to assess the application of modified ways of polyhepatography (PHG) and peripheral arterial tonometry (PAT) in the evaluation of regulation of peripheral circulation (capillary blood flow).Design and methods. We included 150 people, divided into four groups. The first group (n = 40) includes patients with stage II hypertension, moderate and high risk of cardiovascular complications. The second group (n = 40) includes patients with stable forms of coronary heart disease in combination with hypertension. The third group (n = 40) includes patients with chronic liver diseases. The fourth group (n = 30) consisted of subjects without anamnestic and objective data of pathology. All subjects underwent a comprehensive clinical and laboratory examination, an assessment of intrahepatic hemodynamics by the PGG method, an assessment of the endothelial function by the PAT method. A modified method of PAT was used to evaluate the central reaction of the peripheral blood flow regulation system (endothelium-independent vasodilation).Results. Endothelial dysfunction was found in patients with cardiovascular pathology and in patients with chronic liver diseases. A modified method of PAT showed a multidirectional reaction of peripheral blood flow to the test with local ischemia. A number of features were identified in the study groups when assessing disorders of intrahepatic microcirculation. Patients of group I had multidirectional disorders of arteriovenous inflow (45% cases, confidence interval (CI) from 27 % to 63 %) and outflow (37,5 %, CI from 22 % to 56 %) in the liver, while in patients of group II and group III, disorders of arteriovenous inflow were more common, 85 % (CI from 70 % to 95%) and 90% (82 % to 94%), respectively. Rheographic signs of bile passage disorders were more common in groups II and III. A significant negative relationship was established between endothelial dysfunction and the severity of intrahepatic microcirculation disorders (r = –0,35, p &lt; 0,001).Conclusions. Modified methods of peripheral arterial tone and PHG enable assessment of local and central mechanisms of blood flow regulation at the microvascular level in patients with hypertension, coronary heart disease and chronic liver diseases. The relationship between impaired endothelial function and intrahepatic microcirculation allows us to consider the liver as a target organ in cardiovascular pathology.

Influence of Meldonium on Blood Lipid Spectrum and Echocardiography Parameters in Patients with Coronary Heart Disease and or Withoutconcomitant Arterial Hypertension

Introduction. Coronary heart disease (CHD) is one of the main causes of high mortality, disability and reduced quality of life for patients in both Europe and Ukraine. Modern drug therapy of coronary heart disease in combination with arterial hypertension (AH) does not always achieve a satisfactory therapeutic effect. The use of meldonium, which has antioxidant properties, has a positive effect on NO release and has a lipid-lowering effect is promising for patients with AH. The aim of the study. To evaluate the influence of meldonium on lipid metabolism and echocardiography parameters in combination therapy in patients with CHD with stable angina and concomitant AH. Materials and methods. We examined 66 patients with CHD, stable angina pectoris II-III functional class, 40 of them with concomitant AH stage II-III. Patients were divided into 2 groups of 40 and 26 patients, respectively. The first group included patients with CHD and concomitant AH, the second - without pre-existing hypertension. Each of the groups was further divided into 2 subgroups: 1) Patients who were prescribed meldonium at a dose of 750.0 mg/d for 6 months in addition to the basic therapy of the underlying disease (n = 20 for CHD + AH and n = 14 for CHD without hypertension). 2) Patients who continued basic antianginal, disaggregating, hypolipidemic therapy (n = 20 for CHD + AH and n = 12 for CHD without hypertension). Serum levels of triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol were assessed. Indicators of cardiac hemodynamics were determined by echocardiography with assessment of left ventricular end systolic and diastolic volumes and diameters (LVESV, LVEDV, LVESD, LVEDD respectively), the thickness of the interventricular septum and posterior wall of the left ventricle (IVST, LVPWT respectively), pulmonary artery pressure (PAP), LV myocardial mass (LVM) and LV myocardial mass index (LVMI). Results. The use of meldonium for 6 months in patients with CHD and concomitant AH led to a decrease in the concentration of total cholesterol from 5.07 to 4.34 mmol/l and LDL from 2.07 to 1.70 mmol/l. In the group of patients without concomitant hypertension there was a decrease in the concentration of total cholesterol from 4.80 to 3.93 mmol/l, LDL from 1.62 to 1.18 mmol/l and an increase in HDL from 1.18 to 1.37 mmol/l. At 6-month administration of meldonium as a part of combination therapy of patients with CHD with concomitant AH, there is a decrease in LVM from 216.90 g to 181.50 g and LVMI from 109.10 g/m2 up to 91.20 g/m2. In patients without concomitant hypertension, a decrease in LVM from 232,20 g to 183.90 g and LVMI from 121.50 g/m2 to 96.40 g/m2 was observed. Conclusions. Our study showed that meldonium has a positive effect on lipid metabolism and echocardiography. In the group of patients with coronary heart disease and concomitant hypertension on the background of additional use of meldonium for six months, we registered a decrease in TC, LDL and AI. LVPWT, PAP, LVM and LVMI also significantly decreased. In the group of patients with coronary heart disease without concomitant hypertension, we registered a decrease in TC, LDL, AI and an increase in HDL. LVM and LVMI also decreased significantly. Therefore, we consider it appropriate to use meldonium in the complex treatment of patients with coronary heart disease with stable angina and concomitant hypertension. Keywords: coronary heart disease, arterial hypertension, meldonium, echocardiography, blood lipid spectrum.