Concomitant Ischemic Heart Disease Research Articles

Tactics for Treating Thoracic Aortic Aneurysms using Hybrid and Endovascular Techniques in Patients with Concomitant Coronary Heart Disease

The presence of ischemic heart disease (IHD) in patients with aortic dissection increases the risk of intraoperative and postoperative complications during aortic repair. Researches on the effect of IHD on the treatment outcomes of patients with type B aortic dissection have not been carried out often. Only single publications based on relatively small statistical material are devoted to this problem in the literature. The cohort of patients with aortic dissection and IHD is extremely complex, and surgical correction of this comorbid condition is still a controversial topic. The aim. To analyze the impact of IHD with prior correction of coronary artery lesions on the results of hybrid and endovascular treatment of patients with thoracic aortic aneurysms. Materials and methods. From 2017 to 2023, on the basis of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, 245 patients with thoracic aortic aneurysm were treated using hybrid and endovascular techniques. Of these, 14 (5.7%) patients with coronary malperfusion underwent previous cor-rection of IHD either alone or in combination with prosthetics of the aortic valve, ascending aorta and arch of the aorta, initial section of the descending aorta (elephant trunk) with a good outcome. The comparison group included 30 (12.2%) patients who underwent endovascular or hybrid correction of the descending thoracic aorta without coronary pathology. Results. In the experimental group, 5 complications (42.9%) were detected (3 in the intraoperative period and 2 in the postoperative period). The frequency of complications of a similar nature in patients without concomitant IHD (com-parison group) was 13.3%. Endoleak type 1 was also dominant in this group. In most cases, it was eliminated by balloon dilatation of the stent graft. Only in 1 case, Endoleak type 1b was the reason for re-intervention with placement of an additional stent after 6 months. Conclusions. Studies show that the presence of even corrected IHD complicates the course of endovascular and hy-brid surgical treatment of thoracic aortic aneurysms, as evidenced by significantly higher rates of postoperative compli-cations, longer length of stay in the intensive care unit, as well as time on mechanical ventilation. Preliminary myocardial revascularization in patients with IHD should be one of the main conditions for the endovas-cular treatment of aortic aneurysms, taking into account the specifics of performing such operations and the possibility of fatal complications with hemodynamically significant narrowing of the coronary arteries.

Opportunities of metabolic treatment in paroxysmal atrial fibrillation patients with obesity, arterial hypertension and/or ischemic heart disease

This article provides the experience of examination and treatment of paroxysmal atrial fibrillation patients with concomitant obesity, arterial hypertension and/or ischemic heart disease, who were prescribed levocarnitine in addition to traditional therapy. The addition of levocarnitine in management of atrial fibrillation was found to be capable of reducing the atrial fibrillation burden after cardioversion and improve the functional state of the patients.

Circulating in the blood desquamated endotheliocytes at the cardiovascular diseases. Preliminary communication

Introduction and aim. We previously found that diabetic angiopathy is accompanied by an increase in the level of desquamated endothelial cells (CECs) circulating in the blood, commensurate with its severity. In this study, we set ourselves the aim of analyzing the level of CECs in patients with cardiovascular pathology and their relationship with the level of blood pressure and routine clinical indicators. Material and methods. The object of clinical observation were patients with stage II hypertension, who were receiving outpatient treatment. Among them, 23 men (62.3±13.2 ys) and 39 women (65.1±10.6 ys). Concomitant ischemic heart disease was diagnosed in 16 men (70±10%) and 28 women (72±7%). The main subject of the study was blood pressure and the level of CECs. In addition, routine general blood analysis and determined metabolic parameters were performed. Results. Using the method of cluster analysis, the sample was divided into 4 homogeneous groups, different from each other. It was found that in 18 patients of the first cluster, the youngest in the sample, the minimum level of hypertension for the sample occurs against the background of unchanged CECs levels and other registered parameters, instead, it is accompanied by moderate increased creatininemia and a significantly increased rate of erythrocyte sedimentation and a reduced level of hemoglobin and color index. In 18 patients of the second cluster, moderately elevated levels of terminally and markedly changed CECs were found in combination with minimally expressed signs of hyperchromic anemia. In the third cluster (n=16), the levels of terminally and markedly changed CECs are significantly increased in combination with a reduced level of urea and LP index against the background of moderate hyperchromic anemia. Finally, in 10 patients of the fourth cluster, the oldest in the sample, with maximally expressed hypertension, it is accompanied by maximally elevated levels of all three types of СEСs against the background of moderate hyperchromic anemia. Conclusion. Desquamated plasma endothelial cells can be one of the criteria for the severity of hypertonic disease.

Consensus on Stroke Prevention in Atrial Fibrillation and Utilization of NOACs in the Real-World Setting in India

Atrial fibrillation (AF) is the most frequent cardiac arrhythmia. Prevention of stroke and systemic thromboembolism remainsthe cornerstone of the management of AF. Even today, there are unresolved knowledge gaps in AF pathophysiology, screeningand therapeutic strategies and stroke prevention. The modified DELPHI method was used to develop the best practicerecommendations for the management of AF in a real-world setting with the participation of 500 cardiologists across India.The experts concurred that the decision to initiate antithrombotic treatment in patients with transient AF could be based onthe duration of transient AF, the co-existence of the risk factor for stroke and echocardiographic abnormalities impact thedecision. The decision to initiate anticoagulant therapy in device-detected atrial high-rate episodes (AHRE) can be decidedbased on the duration of AHRE, the burden of AHRE and the individual’s risk of stroke and thromboembolism. The benefitof early anticoagulation should be balanced with the risk of intracerebral hemorrhage (ICH), especially in elderly patientsand in severe strokes. Apixaban is the preferred drug in patients with concomitant ischemic heart disease (IHD), patientswith a history of gastrointestinal (GI) bleeding, patients with underlying malignancy, elderly patients with AF, patients withcomorbid diseases and patients with hepatic disease or renal disease. Apixaban was considered to be an affordable noveloral anticoagulant (NOAC) for Indian patients for primary and secondary stroke prophylaxis in AF patients

PREVALENCE OF NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) USE IN PATIENTS WITH HYPERTENSIVE CRISIS

Objective: One of the known risk factors for hypertensive crisis (HTN-C) is non-steroidal anti-inflammatory drugs (NSAIDs) which their adverse effects can lead to end-organ damage such as gastrointestinal and cardiovascular issues. Data on the correlation between NSAIDs and HTN-C are limited. In this study, we determined the prevalence of NSAID use among patients with HTN-C. Design and method: This cross-sectional study was conducted among patients primarily diagnosed with HTN-C referred to Alzahra hospital, Shiraz, Iran from April 2015 to April 2020. Demographic data, as well as information regarding the past medical and drug history and laboratory findings, were gathered -retrospectively. The history of NSAID use was also asked specifically. The collected data were analyzed by SPSS and the P-value less than .05 was considered significant. Results: A total of 257 patients with a mean age of 59.73 were enrolled in the study. Among them 62.6% were female and 137 patients (53.33%) used NSAIDs. Of all the patients 197 (76.7%), 71 (27.6%), and 46 (17.9%) suffered from concomitant hypertension (HTN), diabetes mellitus (DM), and ischemic heart disease (IHD) respectively. A significant relation was found between having each of the comorbidities and NSAIDs use among HTN-C patients (P-value <.0001). NSAIDs use was also significantly higher in older age (P-value <.0001) and female gender (P-value <.02). A high rate of NSAID use was seen among HTN-C patients with a positive significant correlation to concomitant diseases, older age, and female gender. Conclusions: The Results of our study indicate that NSAIDs are frequently used among those with HTN-C and considering the adverse effects of these medication our results further highlight the importance of monitoring and limiting NSAID use.

Osteopontin in patients with chronic obstructive pulmonary disease and coronary heart disease

Background: Osteopontin is a protein expressed by various cell types, such as endothelial and epithelial cells, osteoclasts, hepatocytes, smooth muscle cells, activated macrophages, and T-cells. Cardiomyocytes, heart fibroblasts, endothelial cells of coronary arteries express osteopontin in response to hypoxia, inflammation, toxic factors, mechanical strain, and other stimuli.
 Aim: To study osteopontin levels in patients with chronic obstructive pulmonary disease (COPD) depending on concomitant ischemic heart disease (IHD), to identify an association between osteopontin levels with severity of COPD and functional lung test parameters.
 Materials and methods: This open-label, prospective, non-randomized comparative study with parallel groups included 99 patients with COPD grades AD by GOLD, with 49 of them having confirmed comorbid stable IHD. Serum osteopontin levels were measured by immunoenzyme assay (Human Osteopontin Platinum ELISA; Bender MedSystems, Austria). The data is given as medians and quartiles (Me [Q1; Q3]). In all patients we performed functional lung tests with bronchodilation, a 6-minute walking test, BODE index assessment, as well as CAT and mMRC questionnaires were used.
 Results: In the patients with COPD and IHD, the osteopontin levels were higher than in the patients with COPD without IHD (85.55 [46.86; 110.91] vs 55.43 [20.76; 89.64] ng/mL, respectively; p = 0.027). Osteopontin levels in the patients with all COPD grades and IHD were higher than in those without IHD, but the difference was significant only in GOLD grade B patients (91.28 [73.04; 110.91] vs 37.81 [22.54; 82.95] ng/mL, respectively, р = 0.028) and GOLD grade D patients (80.79 [34.65; 111.11] vs 37.46 [13.32; 109.5] ng/mL, respectively, р = 0.027).
 Conclusion: A significant increase of osteopontin levels in comorbid patients with COPD and stable IHD found in this study has not been previously known. It is necessary to perform further studies to identify a threshold level of osteopontin predictive of the risk of COPD exacerbations or cardiovascular events. This would help to improve medical treatment of COPD patients, as well as to identify the risk groups.

Prevalence of ventricular extrasystoles among smokers and individuals with risk factors for cardiovascular diseases

Abstract Funding Acknowledgements Type of funding sources: None. Main funding source(s): no. The purpose of the work to establish the prevalence of life-threatening arrhythmias and the risk of sudden death among people with a high and very high risk of cardiovascular diseases. Materials and methods During the period 2007-2013 years, we examined 4,214 patients, ages 35 to 85 years, who underwent Holter heart rhythm monitoring. Patients were divided into 4 groups. The 1st group: patients with coronary heart disease (stable angina), but without concomitant risk factors for cardiovascular diseases, such as smoking and obesity. The 2nd group - people who smoke 5 or more cigarettes per day for more than 2 years. The 3rd group - obese people without concomitant ischemic heart disease and arterial hypertension. The 4th group - people with obesity and hypertension. The control group included 149 practically healthy people. The groups were identical in age and sex. The highest prevalence of ventricular extrasystoles was recorded in group 2 (among smokers) and was 44,8% (p<0.01), and 9,02% of people from this group had class V ventricular extrasystoles according to V. Lown and M. Wolf classification, and the result was higher among people with stable angina, where this figure was 7,69%. The lowest prevalence of this arrhythmia was found among people with stable angina and was 30,34%. This can be explained by patients being more thoroughly supervised by doctors and medicine intake. Another reason was that groups 2-4 included people with only risk factors, and group 1 - people with the disease. Among obese people with and without hypertension, the prevalence of this arrhythmia was almost the same – 35,1% and 36,7%, respectively, and was not significantly different from the control group (33,6%). The next step was to determine the prevalence of polytopic (supraventricular + ventricular extrasystole) and ectopic foci among these individuals. And again, smokers had the highest prevalence of polytopic extrasystoles, which was 69,57%. Among people with stable angina, this figure was 55% (p<0.01). In people with obesity, which were included in the 3rd and 4th groups, polytopy was observed in less than half of the patients – 47,83% and 43,48%, respectively. Therefore, analyzing the data presented above, we can say that people who smoke tobacco have higher prevalence of both individual ventricular arrhythmia and ventricular and supraventricular extrasystoles than healthy individuals and people with obesity and hypertension. There is no significant difference in the prevalence of ventricular extrasystoles in individuals with only obesity or plus hypertension.

Management of Critical Limb Ischemia Prognostic Factors

Introduction: Critical limb ischemia (CLI) represents the most severe form of Peripheral artery disease (PAD). Its prevalence is estimated to be between 0.5% and 2.3% of the population over 40 years old. Despite its importance, epidemiological studies on CLI remain patchy. In Morocco, few studies have been carried out on this subject, and we have no epidemiological data on the morbimortality of chronic critical ischemia of the lower limbs on a national scale. Objective: The objective of our study was to evaluate the results of surgical treatment of critical limb ischemia and to identify the factors associated with the medium-term evolution. Methods: We conducted a retrospective cohort study of all patients admitted to the vascular surgery department of the Hassan II University Hospital for the management of critical ischemia of the lower limbs, who underwent revascularization surgery between 01/01/2013 and 31/12/2019. Patients who underwent a major amputation of the affected limb and those for whom the revascularization procedure was a revision were subsequently excluded. The follow-up period was 2 years and the events of major interest were the occurrence of a major limb amputation and 30-day mortality. Results: The cohort included 232 patients with critical ischemia. The mean age was 62 years with a clear male predominance of 84.5%. The most common comorbidities were diabetes (65.8%), active smoking (42.5%), and hypertension (31.2%). The majority of patients (62%) benefited from endovascular procedures. The primary technical success was 94.1%, the major amputation rate was 19.7%, and the 30-day mortality was 4.3%. In multivariate analysis, factors independently associated with a high postoperative complication rate were preoperative hyperglycemia, concomitant ischemic heart disease, female sex, young age, and intensive care unit stay. Conclusion: Our study highlights several risk factors for the occurrence of postoperative complications of CLI. These results .....

Evaluation of the effects of ethylmethylhydroxypyridine succinate on cognitive function and clinical-functional status of patients with chronic obstructive pulmonary disease and ischemic heart disease

Objective — to assess the effects of ethylmethylhydroxypyridine succinate on cognitive function and clinical and functional status of patients with chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD). Materials and methods. The study was conducted among outpatients at the clinic of the GI «L.T.Mala National Therapy Institute of NAMS of Ukraine». Examinations involved 67 patients with mean age 61.64±9.17 years. Among them, 27 were patients with COPD and IHD combination, 22 patients with isolated COPD, and 18 patients with isolated IHD. According to the study design, during telephone contact 6 months after the start of observation, all patients were administered the drug ethylmethylhydroxypyridine succinate 500 mg per day for 3 months. The evaluation of its effects on cognitive function in patients with COPD and IHD was carried at visit‑2 (after 12 months from the start of observation). All patients underwent general clinical examination, anthropometric measurements, calculation of body mass index, and spirometry before taking ethylmethylhydroxypyridine succinate (at visit‑1) and after three months of taking the drug (visit‑2). To verify the degree of dyspnea intensity, the following scales were used: five‑point scale Mediсal Research Council Dyspnea Scale in Fletcher’s modification (mMRC) and modified 10‑point Borg scale (Borg, 1982). Questionnaire САТ (COPD Assessment Test) was used to assess COPD effects on the well‑being and everyday life of the patient. Physical load tolerance was evaluated based on the 6‑minute walk test. To assess the cognitive status of patients, the Hospital Anxiety and Depression Scale scale (HADS), Generalized Anxiety Disorder test (GAD‑7), and Montreal Cognitive Assessment were used. Results. In patients with COPD, both with concomitant IHD and without it, the manifestations of shortness of breath decreased and the tolerability of physical exertion improved against the background of administration ethylmethylhydroxypyridine succinate 500 mg per day for three months. Patients with isolated IHD demonstrated improved cognitive function and reduced depressive symptoms. The anxiety decrease was observed in patients with IHD with or without concomitant COPD. Conclusions. Ethylmethylhydroxypyridine succinate can be recommended to improve cognitive function in patients with COPD and IHD.

The predictive role of fully revascularized coronary artery disease in patients undergoing transaortic valve implantation

In the modern days and the era of the rapid development of medical technology, the introduction of innovative invasive methods of treatment is gradually displacing traditional conventional surgery. In 2002 was performed the fi rst transcatheter implantation of an aortic valve. Over the next twenty years, with the advancement of technology and the accumulation of experience in clinical centers, transcatheter aortic valve implantation has become the standard in adult and high-risk patients with high-grade Ao stenosis. In a large percentage of cases enrolled under the transcatheter aortic valve protocol a concomitant ischemic heart disease is detected or known. Globally, there is no signifi cant difference in overall mortality on the thirtieth day after TAVI in patients with ischemic heart disease. However, the overall mortality was signifi cantly higher in one – year follow - up of patients after transcatheter aortic valve implantation with underlying coronary pathology. We conducted a study comparing the number of late and early adverse events in patients with concomitant fully revascularized ischemic heart disease and those with insignifi cant coronary atherosclerosis. Based on the data collected, analyzed and summarized in our clinical center, fully revascularized ischemic heart disease does not increase the percentage of major adverse events after transcatheter aortic valve implantation. It can be considered when assessing the risk of transcatheter aortic implantation, as part of the individual approach for each case.

PO-705-04 CHARACTERISTICS OF PROTON BEAM ABLATION LESIONS COMPARED TO ISCHEMIA RELATED INFARCT ON MAGNETIC RESONANCE IMAGING

Proton beam ablation (PBA) is proving its efficacy as a non-invasive modality for ablation of ventricular arrhythmias (VA). Patients with VA often have concomitant ischemic heart disease secondary to coronary artery disease.

Patient-Specific Cardiac Magnetic Resonance Feature Tracking Approach for Scar Detection in Concomitant Ischemic and Non-Ischemic Heart Disease

This study investigated a patient-specific approach of using cardiac magnetic resonance (CMR) feature tracking for scar detection in a heterogenous patient group with chronic ischemic and non-ischemic heart disease. CMR exams of 89 patients with concomitant chronic ischemic and non-ischemic heart disease (IHD+) as well as 65 patients with ischemic scars only (IHD) were retrospectively evaluated. In all patients, global (GCS) and segmental circumferential strain (SCS) was derived from native cine images using a dedicated software (Segment CMR, Medviso). After calculation of patient-specific median GCS (GCSmedian), segmental values from GCSmedian percentage plots were correlated with corresponding myocardial segments in late gadolinium enhancement (LGE). Overall GCS ranged between -3.5% to -19.8% and average GCS was lower in IHD+ than in IHD (p <0.05). In IHD, 19% of all myocardial segments were infarcted, in IHD+ 16.6%. Additionally, non-ischemic LGE was present in 6.7% of segments in IHD+. Correlation of GCSmedian percentage plots with corresponding LGE showed that presence of ischemic scar tissue in a myocardial segment was very likely below a cut-off of 39.5% GCSmedian (87.5% sensitivity, 86.3% specificity, AUC 0.907, 95% CI 0.875-0.938, p < 0.05). In patient-specific GCSmedian percentage plots calculated from native cine images, ischemic scar tissue can be suspected in myocardial segments below the threshold of 40% GCSmedian (sensitivity 88%, specificity 86%), even in a heterogenous patient cohort with ischemic and non-ischemic heart disease.

Prevalence of non-steroidal anti-inflammatory drugs (NSAIDs) use in patients with hypertensive crisis.

BackgoundOne of the known risk factors for hypertensive crisis (HTN‐C) is non‐steroidal anti‐inflammatory drugs (NSAIDs) which their adverse effects can lead to end‐organ damage such as gastrointestinal and cardiovascular issues.AimsData on the correlation between NSAIDs and HTN‐C are limited. In this study, we determined the prevalence of NSAID use among patients with HTN‐C.Materials & MethodsThis cross‐sectional study was conducted among patients primarily diagnosed with HTN‐C referred to Alzahra hospital, Shiraz, Iran from April 2015 to April 2020. Demographic data, as well as information regarding the past medical and drug history and laboratory findings, were gathered retrospectively. The history of NSAID use was also asked specifically. The collected data were analyzed by SPSS and the P‐value less than .05 was considered significant.ResultsA total of 257 patients with a mean age of 59.73 were enrolled in the study. Among them 62.6% were female and 137 patients (53.33%) used NSAIDs. Of all the patients 197 (76.7%), 71 (27.6%), and 46 (17.9%) suffered from concomitant hypertension (HTN), diabetes mellitus (DM), and ischemic heart disease (IHD) respectively. A significant relation was found between having each of the comorbidities and NSAIDs use among HTN‐C patients (P‐value <.0001). NSAIDs use was also significantly higher in older age (P‐value <.0001) and female gender (P‐value <.02). A high rate of NSAID use was seen among HTN‐C patients with a positive significant correlation to concomitant diseases, older age, and female gender.ConclusionThe Results of our study indicate that NSAIDs are frequently used among those with HTN‐C and considering the adverse effects of these medication our results further highlight the importance of monitoring and limiting NSAID use.

CHANGES IN MYOCARDIAL BIOELECTRIC ACTIVITY IN PATIENTS WITH PROGRESSIVE MYLTIPLE MYELOMA

Introduction. Long-termed oncohematological course with periods of progression and remission of multiple myeloma, an increase in the cumulative dose of cytostatic drugs usually lead to a growing risk of chemotherapy-induced cardiotoxicity in patients with high cardiac risks. The aim of this study is to investigate changes in myocardial bioelectric activity of patients with progression of multiple myeloma and concomitant ischemic heart disease. Materials and methods. 42 patients with multiple myeloma were examined. The patients were divided into groups according to presence of concomitant coronary heart disease: І (n=15) included patients with multiple myeloma without concomitant cardiovascular diseases; II (n=27) involved patients with multiple myeloma and concomitant coronary heart disease. The patients were assessed before chemotherapy. We analyzed general and biochemical blood count findings. Based on Holter electrocardiography monitoring findings, we assessed heart rate, PQ interval, corrected QT interval. Results: Grade 3 and 4 of anaemia were detected only in the group of patients with multiple myeloma and concomitant coronary heart disease, in 4 (14,80%) and in 1 (3,70%) patients, respectively. Serum creatinine level above 177 μmol / l was found in 1 (6%) patient in the group I and in 2 (7%) patients in the group II. An inverse correlation was found between creatinine levels and erythrocyte counts in patients with multiple myeloma and concomitant coronary heart disease (R=-0,58, p&lt;0,05). Rhythm disorders were found in 3 (20%) patients with multiple myeloma without cardiovascular diseases and in 8 (29.6%) patients with multiple myeloma with concomitant ischemic heart disease, conduction disorders was found in 5 (33%) patients in group I and in 14 (52%) patients in group II. Tendency in increasing the incidence of myocardial bioelectrical activity has been found out in case of concomitant coronary heart disease.

Специфічність діабетичної кардіоміопатії за наявності коморбідних серцево-судинних захворювань: клініко-ультраструктурні дослідження

Актуальність. Концепція про діабетичну кардіоміопатію вперше була запропонована С. Рублер та співавт. понад 100 років тому, але цей діагноз рідко використовується клініцистами через існування, переважно в пацієнтів із цукровим діабетом (ЦД), таких коморбідних захворювань, як ішемічна хвороба серця (ІХС) і гіпертонічна хвороба. Різноманітні механізми спричинюють патогенез діабетичної кардіоміопатії, але її специфічні ознаки досі остаточно не встановлені. Мета дослідження — з’ясувати ультраструктурні особливості ремоделювання кардіоміоцитів, характерні для діабетичної кардіоміопатії, за наявності коморбідної ІХС та артеріальної гіпертензії (АГ). Матеріали і методи. Були порівняні результати клінічного обстеження та ультраструктурного дослідження експрес-некропсій та періопераційних біопсій міокарда в 25 пацієнтів із ЦД 2-го типу за наявності супутньої АГ та ІХС. Результати. Виявлені ультраструктурні особливості гібернації кардіоміоцитів, характерні для ЦД 2-го типу, відмінні від їх гібернації за наявності ІХС та АГ. З’ясовано, що гібернація кардіоміоцитів за ЦД виникає вже на ранніх стадіях захворювання, ще до розвитку АГ та ІХС, тобто за відсутності гіпертрофії кардіоміоцитів та їх оглушеності, характерних для серцево-судинних захворювань. Висновки. Діабетична кардіоміопатія виникає в результаті дисметаболічних і мікроциркуляційних розладів, що призводить до гібернації кардіоміоцитів. Тригерами розвитку діабетичної кардіоміопатії є декомпенсація ЦД і серцево-судинні захворювання. Гіберновані кардіоміоцити гинуть шляхом апоптозу або вторинного некрозу, що обумовлює трансформацію діастолічної дисфункції лівого шлуночка в систолічну.

Genomic instability of lymphocytes in patients with lung cancer with combined ischemic heart disease

Carcinogenesis is associated with a stepwise accumulation of genetic changes induced by the action of various genotoxic environmental factors (heavy metals, polycyclic aromatic hydrocarbons, radioactive substances, and others). Comorbid pathology can make a significant contribution to the accumulation of genome damage, influence the effectiveness of treatment, and determine the overall prognosis of survival. 50 men with lung cancer were examined. The control group included 84 men without oncopath-ology of close age, living in the same area. A micronucleus assay was performed on blood lymphocytes. The analysis of binuclear lymphocytes with micronuclei, protrusions, nucleoplasmic bridges revealed a statistically significant difference between the patient groups and the control. An increase in the frequency of occurrence of these markers of cytogenetic disorders in patients with lung cancer was noted. A higher replication index was recorded in the control group. In patients with lung cancer and concomitant ischemic heart disease, differences in the frequency of mononuclear lymphocytes with micronuclei and the frequency of apoptosis were recorded as compared with patients without cardiovascular diseases.

Effect of comorbidities on ischemic stroke mortality: An analysis of the National Inpatient Sample (NIS) Database.

Background: Stroke risk has been attributed to many pathological and behavioral conditions. Various modifiable and non-modifiable risk factors have been recognized and found consistent throughout epidemiological studies. Herein, we investigate the effect of comorbidities seen with patient’s suffering from ischemic stroke and its effect on in-hospital mortality.Methods: We identified patients >18 year old in the National Inpatient Sample database with diseases of interest utilizing the tenth International Classification of Disease 10 diagnostic codes from the years 2016 to 2018. Interval data were analyzed using one-way ANOVA. Post hoc analysis was performed using Bonferroni correction methods. To determine independent predictors of in-hospital mortality, odds ratios were calculated using binary logistic regression for each comorbidity. Descriptive and numerical statistics, imputation, and logistic regression were calculated using SPSS software version 25.Results: Patients hospitalized with ischemic stroke were found to have the following comorbidities: atrial fibrillation (7.5%), carotid artery stenosis (1.1%), diabetes mellitus type 2 (11.4%), congestive heart failure (CHF) (7.5%), essential hypertension (21.2%), and ischemic heart disease (IHD) (2.3%). In-hospital mortality rates were higher in patients hospitalized with ischemic stroke and concomitant IHD (28.2%, P < 0.001). Hospital length of stay was longest in patients with concomitant CHF (5.96 days, P < 0.001). Similarly, patients with CHF accrued the greatest in-hospital costs (69,174 USD, P < 0.001).Conclusion: Patients hospitalized from ischemic stroke suffered from the coexistence of other comorbidities. Of the comorbidities studied, IHD was identified as having the most significant impact on in-hospital mortality.

Association of atrial strain ratio with invasive pulmonary hemodynamics in rheumatic mitral stenosis

Abstract Funding Acknowledgements Type of funding sources: None. Background. Symptomatic rheumatic mitral stenosis (MS) results in elevation in left atrial (LA) pressure that is passively transmitted to derange pulmonary hemodynamics and subsequently elevate right ventricular afterload. We studied associations between LA to right atrial reservoir strain ratio (LA-RAs) and invasive pulmonary hemodynamics in addition to the ratio’s ability to identify subjects with elevated pulmonary vascular resistance (PVR). Methods. Consecutive MS subjects undergoing right heart catheterization (RHC) and percutaneous transvenous mitral commissurotomy (PTMC) were enrolled. Subjects with atrial fibrillation, &amp;gt;mild mitral regurgitation, concomitant aortic valve or ischemic heart disease were excluded. LA-RAs was assessed by speckle-tracking echocardiography and stratified into high or low LA-RAs subgroups based on mean value. Correlations with invasive pulmonary hemodynamics was studied. ROC analysis was performed to identify pulmonary hypertension (PH) and PVR &amp;gt; 3 Wood Units. Results. 110 subjects were analysed (age: 32 ± 8; 72% female). LA and RA reservoir strain was feasible in 88 (80%) and 83 (75%) subjects respectively. Patients with low LA-RAs demonstrated more severe MS (0.8 ± 0.1 vs. 1.0 ± 0.2cm2), higher mean pulmonary artery (43 ± 13 vs. 33 ± 13mmHg) and capillary wedge pressure (28 ± 6 vs.23 ± 16mmHg) as compared with high LA-RAs (p &amp;lt; 0.001 for all). LA-RAs was associated with invasive PA systolic (r=-0.30;p = 0.05), diastolic (r=-0.28;p = 0.02) and mean (r=-0.33; p = 0.002) pressures, demonstrated modest ability to identify elevated PVR (AUC = 0.65;p = 0.03) and strong ability to identify PH (AUC = 0.75; p &amp;lt; 0.001). LA-RAs significantly increased after PTMC (0.43 ± 0.1 to 0.52 ± 0.1;p &amp;lt; 0.001). Conclusions. The novel atrial strain ratio is associated with measures of invasive pulmonary hemodynamics and demonstrates ability to identify PH and elevated PVR in MS.

PECULIARITIES OF CORONARY REVASCULARIZATIONS IN PATIENTS WITH DIAGNOSED LUNG CANCER AND CONCOMITANT ISCHEMIC HEART DISEASE

The object of the study: coronary revascularization in patients with malignant lung diseases and concomitant ischemic heart disease. The problem to be solved: selection of the optimal tactics for coronary bypass grafting simultaneously with lung resections. Main scientific results: an individual approach to the choice of tactics for carrying out simultaneous operations in patients with malignant lung diseases and concomitant ischemic heart disease is proposed. It has been shown that performing coronary artery bypass grafting simultaneously with lung resections, according to the proposed methods, allows minimizing surgical trauma and eliminating the influence of additional risk factors associated with cardiopulmonary bypass (CPB). The area of practical use of research results: surgical hospitals. An innovative technological product: methods for performing simultaneous coronary (artery) bypass grafting in patients with malignant lung diseases, based on the use of sternotomy, thoracotomy and mini-thoracotomy approaches. The area of application of an innovative technological product: clinical practice of performing simultaneous operations for combined pathology of the heart and lungs in medical institutions of a general surgical profile.

The role of edoxaban in preventing thromboembolic complications in patients with atrial fibrillation

Edoxaban is a selective direct factor Xa inhibitor. Edoxaban in a dose of 60 mg per day is an effective and safe option in the prevention of thromboembolic complications in patients with nonvalvular atrial fibrillation, including in combination therapy in patients after percutaneous coronary interventions. ENGAGE AF-TIMI 48 is currently the most extensive study comparing direct oral anticoagulants and warfarin in patients with atrial fibrillation, both in terms of number of participants and duration of observation. For edoxaban, an adequate approach to dose reduction has been developed in patients with alikely increase in plasma concentration due to renal impairment, low body weight or inter-drug interactions. Such dose reduction does notlead to an increase in the frequency of ischemic complications.Edoxaban is characterized by an optimal safety profile in patients with chronic moderate kidney disease, a small number of drug interactions and a convenient mode of administration. In patients with atrial fibrillation and concomitant ischemic heart disease, the use of Edoxaban is associated with a decrease in the frequency of myocardial infarctions, as well as strokes and episodes of systemic thromboembolism in comparison with warfarin. The drug can be successfully used as anticoagulant support for cardioversion and catheter ablation for atrial fibrillation.Edoxaban intake does not require routinelaboratory control. In case of unexpected situations (life-threatening bleeding, urgent surgical intervention) in patients receiving edoxaban, to assess the degree of anticoagulation should use the determination of anti-Xa activity. Clinical studies of a specific antidote of edoxaban - andexanet alfa are ongoing. Before approval of the specific antidote in severe andlife-threatening bleedings against the background of edoxaban administration, the use of prothrombin complex concentrate should be considered. Data on the effective and safe use of edoxaban in routine clinical practice have been accumulated.