Course Of Acute Myocardial Infarction Research Articles

Gender Features of the Course of Acute Myocardial Infarction Depending on the Functional State of the Kidneys

Gender Features of the Course of Acute Myocardial Infarction Depending on the Functional State of the Kidneys

Bioinformatics analysis of the role of cuproptosis gene in acute myocardial infarction.

Immune infiltration plays a vital role in the course of acute myocardial infarction (AMI). Cuproptosis is a new type of programmed cell death discovered recently. Currently, there is no study on the mechanism of cuproptosis gene regulating immune infiltration in AMI. Therefore, by integrating cuproptosis-related genes and GEO database-related microarray data, this study analyzed the association between cuproptosis genes and immune infiltration and built a risk model. The GSE59867 was used to extract cuproptosis gene expression profile. The R limma package was used to analyze the differentially expressed genes associated with AMI-Cuproptosis. The risk model was constructed according to AMI-cuproptosis differentially expressed genes. Prediction of AMI-cuproptosis-related gene drugs through Coremine Medical database. The upstream miRNAs were predicted using miRWalk, TargetScan, and miRDB libraries, and a miRNA-mRNA network was constructed. Cuproptosis-related genes (DLST, LIAS, DBT, ATP7A, LIPT1, PDHB, GCSH, DLD, DLAT) were down-regulated in AMI patients. One (ATP7B) gene was up-regulated in AMI patients (P<0.05). These 10 Cuproptosis-related genes were significantly associated with immune cell infiltration. Based on these 10 differential genes, the AMI risk prediction model was constructed, and the AUC value was 0.825, among which the abnormal expression of DLST was a risk factor for AMI. Additionally, we also predicted DLAT upstream miRNAs and associated drug targets, finding that 9 miRNAs were upstream of DLST. DLST is a potential cuproptosis gene associated with AMI, but its specific mechanism remains unclear and requires further investigation in future studies.

The Impact of a Modified Anaesthetic Protocol on Animal Survival and the Characteristics of Ventricular Arrhythmias in the Course of Acute Myocardial Infarction in a Domestic Pig Model.

Acute myocardial infarction (MI) is one of the most common causes of death in humans in highly developed countries. Among its most frequent complications affecting the patient's prognosis are cardiac arrhythmias: ventricular tachycardia (VT) and ventricular fibrillation (VF). The study aimed to characterise arrhythmias in 19 pigs subjected to experimentally induced MI obtained by occlusion of the proximal left anterior descending (LAD) coronary artery using an angioplasty balloon. The anaesthetic protocol was modified to reduce mortality by including procedures stabilising haemodynamic disorders which develop during episodes of ischaemia and arrhythmia. During 30 min of experimentally induced ischaemia, the heart rhythm was recorded using a 12-lead ECG. The time, frequency, and type of arrhythmias were analysed. Ventricular arrhythmias were found in 94.74% of the treated pigs. The most common were ventricular premature complexes, reported in 88.89% of pigs with arrhythmia. Ventricular tachycardia was recorded in 66.67% and ventricular fibrillation in 50% of pigs with arrhythmias. Myocardial infarction due to proximal LAD occlusion is characterised by a high incidence of ventricular arrhythmias, especially VT and VF. Because of the high survival rate, this MI porcine model may serve as a model for research on acute ischaemic ventricular arrhythmias in humans. Additionally, it reduces the total number of animals required for testing while yielding meaningful results, which is in line with the 3R principle.

DYNAMICS OF ADROPIN AND IRISIN BIOMARKERS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AND TYPE 2 DIABETES MELLITUS

summary. A pressing concern of modern medicine is the search for new biomarkers that can influence the development and course of acute myocardial infarction (AMI) in patents with type 2 diabetes mellitus (DM). The aim – To examine the dynamics of adropin and irisin serum levels in diabetic patients with or without AMI complications. Materials and Methods. In total, 134 AMI patients were enrolled. Among 60 examined AMI patients (group I), 41 patients were identified without early cardiovascular (CV) complications of AMI and 19 patients – with complicated AMI. Among 74 AMI patients with type 2 DM (group II), there were 48 patients without early AMI complications and 26 patients with early AMI complications. The control group consisted of 20 otherwise healthy persons. Serum levels of adropin and irisin were measured by enzyme-linked immunosorbent assay. Results. The adropin and irisin serum levels on day 1 of treatment was low in both nondiabetic (I) and diabetic patients (II) compared with those in the control group (p&lt;0.05). On the 10th day of treatment, the levels of adropin in group II patients without early AMI complications were reduced by 13.91 % compared with those in group I (p&lt;0.05). Group II with the presence of early AMI complications showed a reduction of 17.34 % in adropin levels on day 10 compared with group II (p&lt;0.05). On day 10 of treatment, the irisin levels in group II without early AMI complications were reduced by 18.94 % compared with those in group I (p&lt;0.05). In group II with the presence of early AMI complications on the 10th day, the irisin levels were reduced by 23.87 % compared with those in group I (p&lt;0.05). Conclusions. The concentrations of adropin and irisin were significantly low in group II on day 1 and 10 of hospital stay. In the dynamics of treatment on day 10, the levels of adropin and irisin remained low in group II with early CV complications of AMI.

Gender characteristics of the course and treatment of acute myocardial infarction

Background and Aims : The aim of the study was to study the gender characteristics of the course of acute myocardial infarction (MI).Methods: The study included 372 patients aged 31 to 93 yrs (64.5 ± 12.3 years) with a diagnosis of MI, who were divided into 2 groups (gr.) by gender: Gr.1 - 140 (37.6%) , women, gr. 2 - 232 (62.4%) men.Results: The average age of women is 70.77 ± 11.7 yrs, of men - 60.52 ± 11.5. In women, MI was significantly more likely to develop against the background of arterial hypertension (p <0.044), diabetes mellitus (p <0.002) and obesity (p <0.043), and the prevalence of smoking was higher in the male (p <0.001). The GRACE in women is higher than in men (p <0.007). The most common complication of MI in both groups was acute heart failure (HF), which was recorded in 53.7% of women and 55.5% of men (RR 0.96; 95% CI 0.75– 1.23; p> 0.05). The frequency of deaths was statistically significantly higher in women; they were more often registered as hospitalized (11.4% versus 6.4%; RR 1.79; 95% CI 0.94–3.43; p <0.05), so and post-hospital mortality (9.2% versus 6.4%; RR 1.44; 95% CI 0.68–3.02; p> 0.05).Conclusions: The most significant risk factors for the development of MI in women are diabetes mellitus, arterial hypertension and obesity. The course of myocardial infarction in women is associated with the development of severe heart failure, and the immediate prognosis and outcome of myocardial infarction in women is more unfavorable than in men. Background and Aims : The aim of the study was to study the gender characteristics of the course of acute myocardial infarction (MI). Methods: The study included 372 patients aged 31 to 93 yrs (64.5 ± 12.3 years) with a diagnosis of MI, who were divided into 2 groups (gr.) by gender: Gr.1 - 140 (37.6%) , women, gr. 2 - 232 (62.4%) men. Results: The average age of women is 70.77 ± 11.7 yrs, of men - 60.52 ± 11.5. In women, MI was significantly more likely to develop against the background of arterial hypertension (p <0.044), diabetes mellitus (p <0.002) and obesity (p <0.043), and the prevalence of smoking was higher in the male (p <0.001). The GRACE in women is higher than in men (p <0.007). The most common complication of MI in both groups was acute heart failure (HF), which was recorded in 53.7% of women and 55.5% of men (RR 0.96; 95% CI 0.75– 1.23; p> 0.05). The frequency of deaths was statistically significantly higher in women; they were more often registered as hospitalized (11.4% versus 6.4%; RR 1.79; 95% CI 0.94–3.43; p <0.05), so and post-hospital mortality (9.2% versus 6.4%; RR 1.44; 95% CI 0.68–3.02; p> 0.05). Conclusions: The most significant risk factors for the development of MI in women are diabetes mellitus, arterial hypertension and obesity. The course of myocardial infarction in women is associated with the development of severe heart failure, and the immediate prognosis and outcome of myocardial infarction in women is more unfavorable than in men.

The state of platelet and plasma hemostasis as a predictor of coronary blood flow in patients with acute myocardial infarction.

Aim To study the relationship of the platelet function and plasma homeostasis with the blood flow in the infarct-related artery (IRA) and with the course of acute myocardial infarction (AMI).Material and methods This study included 93 patients with AMI (75 patients with ST-elevation AMI and 18 patients without ST segment elevation). 63 patients had TIMI 0-1 blood flow in the IRA and 30 patients had TIMI 2-3. Rotational thromboelastometry, impedance aggregometry, the endothelium-dependent vasodilation (EDVD) test, and the thrombodynamics test were performed for all patients. The primary clinical endpoint included the totality of in-hospital complications of AMI, and the secondary endpoint included the totality of out-of-hospital complications of AMI. Major bleedings (BARC 3-5) and minor bleedings (BARC 1-2) were evaluated separately.Results Patients with IRA TIMI 0-1 flow were characterized by a shorter blood clotting time (BCT), larger thrombus size and density, more intense platelet aggregation induced by arachidonic acid and ADP, and lower values of the EDVD test. It was found that the parameters of platelet aggregation induced by arachidonic acid (AUC Asa) in combination with BCT allowed assessment of the severity of IRA blood flow disorder (sensitivity 76 %, specificity 71 %) in patients with AMI, regardless of the presence of ST segment elevation on the ECG. In addition, the incidence of the primary endpoint was greater in patients with IRA TIMI 0-1 flow (41.3% and 16.7%, respectively; p=0.015). In patients with TIMI 2-3 flow in the long-term period of the disease, the incidence of minor bleedings was significantly higher (8.5% and 30.4 %, respectively; p=0.045).Conclusion Compared to patients with preserved blood flow, patients with AMI and IRA TIMI 0-1 flow are characterized by endothelial dysfunction and more intense processes of thrombogenesis and platelet aggregation. It has been shown for the first time that the combination of two simple criteria for assessing hemostasis (AUC Asa; BCT) allows assessment of the degree of IRA blood flow disorder in patients with AMI.

CORRECTION OF INSULIN RESISTANCE IN OBESE PATIENTS WITH MYOCARDIAL INFARCTION AND COMORBID METABOLIC SYNDROME

Objective. Insulin resistance (IR) is playing an essential role in the development of cardiovascular disease and has an adverse prognostic effect on the course of acute myocardial infarction (AMI) as a result of direct proatherogenic effects of IR and an adverse effect on myocardial contractility. The aim of the study was to evaluate the insulin resistance effects of multimodality therapy with dapagliflozin (Forxiga) and L-arginine/L-carnitine combination in overweight and obese patients with myocardial infarction.&#x0D; The aim of the study: to evaluate the insulin resistance effects of multimodality therapy with dapagliflozin (Forxiga) and L-arginine/L-carnitine combination in overweight and obese patients with myocardial infarction.&#x0D; Methods. The study enrolled 85 males with acute myocardial infarction with ST segment elevation; among these, there were 24 overweight patients (BMI within 25–29.9 kg/m2) and 36 patients with obesity (BMI &gt;30 kg/m2). Normal body weight (BMI within 18–24.9 kg/m2) was documented in 25 study patients. The age of study subjects in the groups was 58.62±7.02 years on average. All patients were receiving standard of care treatment according to the protocols of the MoH of Ukraine [8]. Depending on the treatment program used, all patients were divided into three groups: Group 1 enrolled 25 patients who were receiving standard of care per-protocol treatment; Group 2 (test group) enrolled 28 patients where standard of care per-protocol treatment of MI was appended with L-arginine/L-carnitine combination (“TIVOR-L” by Yuria-Pharm Ltd.; marketing authorization No. UA/15067/01/01) as intravenous infusions for seven days at 100.0 ml once a day; Group 3 (test group) enrolled 32 patients who received dapagliflozin (10 mg/day) in addition to combination therapy (per-protocol treatment + L-arginine/L-carnitine combination). Control group enrolled 20 virtually healthy volunteers without cardiovascular disease.&#x0D; The presence of IR was assessed using HOMA-IR index. The severity of IR was determined based on the magnitude of the IR factor according to F. Caro. The patients were considered to have IR if the following criteria were met: HOMA &gt; 2.77 and Caro index &lt; 0.33; i.e. the higher the HOMA index and the lower the Caro index, the lower was the tissue sensitivity to insulin and the greater was the IR.&#x0D; Statistical analysis of study findings was performed using Statistica 10.0 package of statistical software and Microsoft Excel 2019.&#x0D; Results. Overweight and obese patients with MI + MS develop carbohydrate metabolism disorders, which are manifested by hyperglycemia, increased HOMA index and decreased Caro index. Insulin resistance is the main cause of the above disorders. The severity of insulin resistance was increasing in the presence of excessive body and obesity, as suggested by a significant reduction in Caro index. It is the presence of IR and carbohydrate metabolism disorders that contributed to the development of systolic-diastolic dysfunction of the myocardium in patients with ACS (MI).&#x0D; Conclusions. At baseline, overweight and obese patients with myocardial infarction develop a pronounced insulin resistance with carbohydrate metabolism disorders and reduced systolic-diastolic function of the heart. Multi-modality treatment with inclusion of L-carnitine/L-arginine combination and dapagliflozin in overweight and obese patients with myocardial infarction facilitated restoration of tissue sensitivity to insulin and improved carbohydrate metabolism and systolic-diastolic function of the heart in such comorbid patients.

Роль біомаркерів NT-proBNP та ST2 у стратифікації ризику ускладнень у пацієнтів з гострим інфарктом міокарда та ожирінням

Мета роботи – з’ясувати діагностичну цінність показників NT-proBNP (N-кінцевий фрагмент попередника мозкового натрійуретичного пептиду) та ST2 (стимулювальний фактор росту, що експресується геном 2) і визначити їх прогностичне значення щодо виникнення серцево-судинних ускладнень (ССУ) у пацієнтів з гострим інфарктом міокарда (ГІМ) з елевацією сегмента ST за наявності ожиріння.Матеріали і методи. Усі пацієнти були розподілені на три групи залежно від маси тіла: І групу становили 52 пацієнти з нормальною масою тіла (середній вік (60,83±11,94) року); ІІ групу – 51 пацієнт з надлишковою масою тіла (середній вік (62,04±8,55) року); ІІІ групу – 55 пацієнтів з ожирінням І–ІІІ ступеня (середній вік (60,96±11,31) року). Для детальнішого дослідження було відібрано 60 пацієнтів, у яких додатково визначали концентрацію NT-proBNP та ST2 у сироватці крові імуноферментним методом за допомогою тест-систем виробництва Biomedica і Presage ST2 assay при госпіталізації і на 10-ту добу захворювання.Результати та обговорення. Залежно від перебігу захворювання впродовж стаціонарного лікування вибірку із загальної групи ретельно обстежених пацієнтів (n=60) було розподілено на дві групи: А (n=22) – особи, в яких перебіг захворювання ускладнився появою серцево-судинних подій, Б (n=38) – пацієнти, у яких ГІМ був без ускладнень. При госпіталізації середні показники NT-proBNP були незначно вищими в пацієнтів із ССУ (група А) (612,8 [489,5; 860,4] пг/мл) порівняно з пацієнтами без ССУ (група Б) (598,6 [326,6; 913,1] пг/мл, р&gt;0,05). При повторному визначенні біомаркера NT-proBNP в обох групах пацієнтів спостерігали суттєве його зниження (р&lt;0,01) незалежно від перебігу ГІМ: на 44,52 % – у групі А та 68,24 % – у групі Б. Однак рівні NT-proBNP у пацієнтів групи А на 10-ту добу спостереження статистично значуще переважали відповідні показники осіб групи Б (р&lt;0,05). При госпіталізації середні показники ST2 були статистично значуще вищими в пацієнтів із виявленими ССУ (61,1 [44,8; 133,6] нг/мл – група А) порівняно з пацієнтами без ускладнень (40,8 [33,1; 64,3] нг/мл – група Б, p&lt;0,05). При повторному визначенні біомаркера ST2 в обох групах пацієнтів спостерігали значне (p&lt;0,001) його зниження: відповідно до 23,7 [18,8; 28,3] нг/мл і 24 [19,7; 28,7] нг/мл, без статистично значущої різниці між групами.Висновки. Біомаркер ST2 можна розглядати як предиктор виникнення ССУ в пацієнтів із ГІМ з елевацією сегмента ST у ранній післяінфарктний період. Значення NT-proBNP у пацієнтів, в яких виникали ускладнення в ранній післяінфарктний період, залишаються на 10-ту добу спостереження статистично значуще вищими порівняно з відповідними в пацієнтів, у яких небажані події не виникали. Наявність ожиріння погіршує перебіг ГІМ з елевацією сегмента ST: у таких пацієнтів вищі значення біомаркерів ремоделювання міокарда NT-proBNP та ST2 (у дебюті захворювання) і частіше виникають ускладнення в ранній післяінфарктний період (у групі з ускладненнями ожиріння відзначали статистично значуще частіше, ніж серед осіб групи без ускладнень, р=0,02).

Dynamics of carbohydrate metabolism in patients with acute myocardial infarction with concomitant type 2 diabetes mellitus during 6 months of follow-up

Annotation. Hyperglycemia complicates the course of acute myocardial infarction (AMI) and is associated with its unfavorable prognosis. The aim of the study was to analyze the dynamics of carbohydrate metabolism in patients with acute myocardial infarction with concomitant type 2 diabetes mellitus during 6 months of follow-up. The study involved 120 patients: group 1 – patients with AMI with diabetes mellitus (DM) type 2 (n=70), group 2 – patients with AMI (n=50) and 20 people who made up the control group. All patients underwent general instrumental and clinical examinations. Statistical processing of the results was performed using the software package “Statistica 6.0” (USA) with calculation: M ± m, probability and level of reliability (p) for comparison of samples. The analysis of independent samples that were not subject to Gaussian distribution laws was performed using the Mann-Whitney U-test. The correlation coefficient (r) was used to estimate the degree of correlation between the samples. The average fasting glucose level in patients of group 1 was 17.48±6.78 mmol / l; 2nd – 5.57±0.84 mmol / l; in the control group – 4.64±0.67 mmol / l; (p1-2 &lt;0.00001, p1-3 &lt;0.00001, p2-3 &lt;0.0001). The mean insulin level in patients of group 1 was 36.19±3.5 μIU / ml; 2nd – 16.08±5.08 μOD / ml; in the control group – 8.77±0.52 μOD / ml (p1-2 &lt;0.00001, p1-3 &lt;0.00001, p2-3 &lt;0.001). The average level of glycosylated hemoglobin in patients of group 1 was 8.58±0.95 μmol of fructose / gHb; 2nd – 5.6±0.2 μmol fructose / gHb, in the control group – 5.4±0.33 μmol fructose / gHb (p1-2 &lt;0.00001, p1-3 &lt;0.00001, p2- 3&lt;0.05). The value of the HOMA index in patients of the 1st group was equal to – 30.39±13.33; 2nd – 3.89±1.39, in the control group – 1.81±0.27 (p1-2 &lt;0.00001, p1-3 &lt;0.00001, p2-3 &lt;0.05). When re-measured after 6 months, these indicators were significantly lower, significantly higher levels of carbohydrate metabolism in patients with type 2 DM. Thus, the carbohydrate profile in patients with acute myocardial infarction was significantly higher in the presence of concomitant type 2 diabetes mellitus, indicating the presence of insulin resistance, hyperinsulinemia and stress hyperglycemia on the background of a coronary event. After 6 months, the above indicators in both groups were significantly lower, there was a direct relationship with the presence of type 2 diabetes mellitus and its degree.

​Circulating Cytokines in Myocardial Infarction Are Associated With Coronary Blood Flow.

BackgroundThe level of systemic inflammation correlates with the severity of the clinical course of acute myocardial infarction (AMI). It has been shown that circulating cytokines and endothelial dysfunction play an important role in the process of clot formation. The aim of our study was to assess the concentration of various circulating cytokines, endothelial function and blood clotting in AMI patients depending on the blood flow through the infarction-related artery (IRA).MethodsWe included 75 patients with AMI. 58 presented with ST-elevation myocardial infarction (STEMI) and 17 had non-ST-elevation myocardial infarction (non-STEMI). A flow-mediated dilation test (FMD test), thrombodynamics and rotational thromboelastometry as well as assessment of 14 serum cytokines using xMAP technology were performed.FindingsNon-STEMI-patients were characterized by higher levels of MDC, MIP-1β, TNF-α. Moreover, we observed that patients with impaired blood flow through the IRA (TIMI flow 0-1) had higher average and initial clot growth rates, earlier onset of spontaneous clots, C-reactive protein (CRP) and IL-10 compared to patients with preserved blood flow through the IRA (TIMI flow 2-3). Patients with TIMI 2-3 blood flow had higher level of IP-10. IL-10 correlated with CRP and pro-inflammatory cytokines levels, initial clot growth rate and clot lysis time in TIMI 0-1 patients. All these differences were statistically significant.InterpretationWe demonstrated that concentrations of the inflammatory cytokines correlate not only with the form of myocardial infarction (STEMI or non-STEMI), but also with the blood flow through the infarct-related artery. Inflammatory response, functional state of endothelium, and clot formation are closely linked with each other. A combination of these parameters affects the patency of the infarct-related artery.

Characteristics of the acute myocardial infarction course in patients with type 2 diabetes mellitus before and after reperfusion therapy

Introduction. Scientific research is currently being done to diagnose and manage comorbid conditions in patients. The importance of studying the pathophysiological mechanisms of acute myocardial infarction (AMI) in patients with type 2 diabetes mellitus (DM) has been proven. The purpose of the study: to conduct a retrospective analysis before and after reperfusion therapy by evaluating the features of the AMI course in patients with type 2 DM. Material and methods. The study was conducted from January 10, 2020 to January 12, 2021. In total, 74 STEMI patients with or without type 2 DM, aged 59.42±7.66 years were examined at the Intensive Care Unit of the Government Institution “L. T. Malaya National Therapy Institute of the National Academy of Medical Sciences of Ukraine” and the Kharkiv Railway Clinical Hospital No. 1 of the branch “Center of Healthcare” of Public Joint Stock Company “Ukrainian Railway”. Serum levels of insulin, adropin, irisin, fatty acid binding protein 4 (FABP4) and C1q/TNF-related protein (CTRP3) were detected by enzyme-linked immunosorbent assay. Analysis and processing of the findings obtained after examinations were carried out using the computer program IBM SPPS software, version 27.0 (IBM Inc., USA, 2020). Results and discussion. Before the treatment, patients with AMI and type 2 DM had significantly higher values of end-systolic size (ESS) by 5.56%, left atrium (LA) by 10.53%, left ventricular myocardial mass index (LVMMI) by 6.87% and lower values of systolic blood pressure (SBP) by 11.76%, atherogenic index (AI) by 5.80%, glucose by 25.71%, insulin by 39.92%, irisin by 15.34%, FABP4 by 19.76% compared to the values of these indicators 14 days after medicamentous therapy (p&lt;0.05). Patients with AMI and type 2 DM had significantly higher values of adropin by 46.10%, irisin by 20.11%, CTRP3 by 28.78% and lower values of SBP by 17.65%, diastolic blood pressure by 12.38%, heart rate (HR) by 13.73%, pulse by 10.87%, body mass index by 5.57%, weight by 9.52%, glucose by 26.67%, insulin by 40, 75%, total cholesterol by 10.04%, very low-density lipoproteins by 24.75%, low-density lipoproteins by 8.52%, triglycerides by 27.06%, AI by 10.55%, FABP4 by 37.04% before treatment as compared to the values of these indicators 14 days after percutaneous coronary intervention (PCI) (p&lt;0.05). Comparing the studied indicators between subgroups after medicamentous treatment and PCI, a significant decrease in HR by 8.33%, ESS by 4.11%, LA by 9.52%, LVMMI by 5.53%, FABP4 by 21.53% and an increase in the levels of adropin by 36.99%, irisin by 41.88%, CTRP3 by 30.25%, high-density lipoproteins (HDL) by 10.28% were identified (p&lt;0.05). Conclusions. When compared PCI advantages due to the absence of a tendency to the left heart dilatation over the medicamentous therapy, improvements of energy and adipokine metabolism have been observed amid increased levels of adropin, irisin and CTRP3 and decreased levels of FABP4 in patients with AMI and type 2 DM. It should be noted that there has been a significant improvement in the state of energy and adipokine profiles under the conditions of performing PCI.

PREVALENCE, CLINICAL AND FUNCTIONAL CHARACTERISTICS OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION COMPLICATED BY ACUTE HEART FAILURE.

The aim: The study was designed to establish the prevalence of acute heart failure in patients with acute myocardial infarction, to determine the sex-age characteristics of acute myocardial infarction course in case of complications by acute heart failure of high classes (Killip III and Killip IV). Materials and methods: We analyzed medical records of inpatients of the myocardial infarction department of the municipal non-profit enterprise Vinnytsia Regional Center for Cardiovascular Pathology in 2019. The survey covered 828 medical records of patients with acute myocardial infarction, average age (64.6 ± 0.38), including 569 (64.7%) males and 311 (35.3%) females. Results: 129 (15.6%) patients with acute myocardial infarction were diagnosed high-class acute heart failure. Patients with high-class acute heart failure were statistically significantly elderly individuals of the average age (69.0 ± 1.3), (p <0.001), including 53.7% of males, and 46.3% (p <0.001) female patients. Patients with acute myocardial infarction complicated by acute heart failure were hospitalized within 2 hours of symptoms` onset with statistically significantly higher probability (p = 0.004). Patients with acute myocardial infarction complicated by acute high-class heart failure were statistically significantly more likely diagnosed with concomitant hypertension, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease than individuals with uncomplicated acute myocardial infarction. Acute myocardial infarction patients` mortality was 3.4%, while the one in patients with acute heart failure was 38% (p <0.001). Conclusions: Patients with complicated myocardial infarction are characterized by statistically significantly higher comorbidity and increased lethality.

Features of energy and adipokine metabolism in patients with acute myocardial infarction and type 2 diabetes after percutaneous coronary intervention

Annotation. The study of energy and adipokine metabolism indicators for the development and course of acute myocardial infarction (AMI) with comorbidity remains relevant. The aim of the study was to determine the content of energy and adipokine metabolism in patients with myocardial infarction and ST-segment elevation depending on the presence and absence of type 2 diabetes mellitus (DM) after percutaneous coronary intervention (PCI). The study involved examination of 60 patients with AMI (Group 1) and 74 patients with AMI and type 2 diabetes (Group 2). Each group was divided into 2 subgroups according to coronary artery (CA) stenting. The control group included 20 healthy individuals. Adropin, irisin, fatty acid binding protein 4 (FABP 4), C1q / TNF-associated protein 3 (CTRP 3) were determined by enzyme-linked immunosorbent assay. All patients underwent coronary angiography. Statistical processing of the results of the study was carried out using the software package “IBM SPPS Statistics 27.0”. There was a decrease in the content of adropin, irisin and CTRP 3 and an increase in the concentration of FABP 4 on day 1 in Groups 1 and 2 compared with the control group (p˂0.05). In Groups 1 and 2 on day 14 there was an increase in the concentration of adropin by 23.87% and 41.43%, irisin by 56.59% and 11.11%, CTRP3 by 11.59% and 20.01% compared to day 1 (p&lt;0.05). The level of FABP 4 in Groups 1 and 2 decreased by 19.69% and 26.61% compared to day 1 (p &lt;0.05). In Group 1, an inverse correlation was found between Syntax Score (SS) and adropin (r= -0.432, p=0.01), irisin (r= -0.478, p&lt;0.01), CTRP 3 (r= - 0.473, p&lt;0.01) and a positive correlation between SS and FABP 4 (r= 0.436, p&lt;0.05). In Group 2, there was an inverse relationship between SS and adropin (r= -0.452, p&lt;0.05), irisin (r= -0.458, p&lt;0.05), CTRP 3 (r= -0.437, p&lt;0.05) and the direct relationship between SS and FABP 4 (FABP 4 (r= 0.418, p&lt;0.05). Thus, the peculiarities of the content of energy and adipokine metabolism indicators in patients with AMI with existing and absent type 2 diabetes before and after primary CA stenting were studied.

Вплив реперфузійної терапії на рівні ендотеліальної синтази оксиду азоту у пацієнтів з гострим інфарктом міокарда та цукровим діабетом 2-го типу

The purpose of the study was to investigate the effect of reperfusion therapy on the levels of endothelial nitric oxide synthase in patients with acute myocardial infarction and concomitant type 2 diabetes mellitus. Materials and methods. The study involved patients with acute myocardial infarction, who were divided into groups depending on the presence of type 2 diabetes mellitus and the therapy performed for them: group 1 – 58 patients with acute myocardial infarction and diabetes mellitus who underwent percutaneous coronary intervention; group 2 – 15 patients with acute myocardial infarction and diabetes mellitus who underwent exclusively conservative treatment; group 3 – 40 patients with acute myocardial infarction without diabetes who underwent percutaneous coronary intervention; group 4 – 17 patients with acute myocardial infarction without diabetes, who underwent exclusively conservative treatment. Results and discussion. According to the obtained results, in patients with concomitant type 2 diabetes mellitus, significantly lower levels of endothelial nitric oxide synthase were revealed, compared with patients without disturbances in carbohydrate metabolism, which indicates deeper impairments of endothelial function against the background of hyperglycemia and insulin resistance. Analysis of the effect of reperfusion therapy showed a statistically significant increase in the level of endothelial nitric oxide synthase both in the group of patients with concomitant disorders of carbohydrate metabolism and without them, which indicates an improvement in the processes of endothelium-dependent dilation, regardless of the presence or absence of type 2 diabetes mellitus. The obtained results testify to the positive effect of percutaneous coronary intervention at the level of eNOS, which, in our opinion, will help to improve the vasodilating properties of vascular endothelium and prevent a complicated course of acute myocardial infarction. Conclusion. The patients with acute myocardial infarction and concomitant type 2 diabetes mellitus have significantly lower levels of endothelial nitric oxide synthase levels than patients without type 2 diabetes mellitus that indicates deep violations of endothelial function against background of metabolic changes associated with insulin resistance and hyperglycemia. Reperfusion therapy accelerates its restoration regardless of the presence or absence of type 2 diabetes mellitus

Association between the osmotic fragility of erythrocytes and the course of acute myocardial infarction

Aim. To investigate the relationship between the osmotic fragility of erythrocytes and the course of acute myocardial infarction (MI).Methods. An analysis of the osmotic fragility of erythrocytes was conducted using beta-blocker-based osmotic fragility test in sixty-two patients within the first 6 hours after onset of MI symptoms.Results. The results revealed that the patients with increased erythrocyte osmotic fragility experienced more complications after acute MI, such as left ventricular failure and cardiac arrhythmias (ventricular extrasystoles and ventricular tachycardia) (p = 0.026). Moreover, these patients exhibited greater myocardial injury - the concentration of biomarkers of myocardial necrosis, such as creatine phosphokinase, creatine phosphokinase MB and Troponin I was increased - p = 0.009, p = 0.032 and p = 0.001, respectively. In addition to that, the patients with high osmotic fragility had a larger number of hypokinetic and akinetic segments, high impaired myocardial contractility index, and low ejection fraction. The impaired myocardial contractility index was significantly higher in patients with increased erythrocyte osmotic fragility (1.5 (1.22; 1.75) vs 1.12 (1.0; 1.56), U = 157.5, p = 0.032).Conclusion. Increased erythrocyte osmotic fragility in patients was associated with greater myocardial injury, manifesting through the higher concentration of biomarkers of myocardial necrosis in blood, as well as higher number of hypokinetic segments.

Reactive Hyperglycaemia Connected with Low Glycated Haemoglobin – Risk Factor for Cardiovascular Adverse Events

Introduction: Concomitance of glucose metabolism disturbances and ischemic heart disease is well known and connected to several times higher incidence of cardiovascular events resulted from atherosclerosis. Aim of this study was to assess impact of reactive hyperglycaemia accompanying chronic and not always optimally treated hyperglycaemia assessed with glycated haemoglobin level on cardiovascular prognosis among patient hospitalised in the course of acute myocardial infarction. Methods: 92 patients diagnosed with ST – segment elevation myocardial infarction (STEMI) qualified to primary percutaneous coronary intervention (pPCI) was included in the study. Study population was divided into subgroups, depending glucose level on admission (reactive hyperglycaemia) and HbA1c concentration: subgroup A (HbA1c &lt;6.5%, Glc&lt;7.8 mmol/l: n = 37; 40,2%), subgroup B (HbA1c &lt;6.5%, Glc ≥.,8 mmol/l: n = 27; 29,3%), subgroup C (HbA1c ≥6.5%, Glc ≥7.8 mmol/l: n = 20; 21,7%) and subgroup D (HbA1c ≥6.5% Glc&lt;7.8 mmol/l: n = 8; 8.7%). Level of myocardium damage was assessed on the basis of concentration of myocardial necrosis enzymes: creatine kinase (CK) and creatine kinase MB fraction (CK-MB) in the 0 and 90th minute and thereafter 8, 16, 24 and 48 hours after hospital admission and also echocardiographic examination. Prognosis in long and short term observation was assessed by major adverse cardiovascular events (MACE) such as death, myocardial infarction, stroke, heart failure requiring hospitalisation and repeated revascularisation and level of glucose metabolism disturbances in intrahospital phase, 4 months and 4 years follow up observation. Results: Results in study population revealed significant change of average value of creatine kinase (p&lt;0,001) and its MB fraction (p&lt;0,001) during first 48 hours of hospitalisation in particular subgroups of patients. Mean values of CK and CK-MB assessed in subsequent hours of hospitalisation (1,5, 8, 16 and 48 hours) were significantly higher in subgroup B (CKp=0,034 and CK-MB p=0,01, respectively). It means that area under curve was significantly higher for subgroup B. In 4 months and 4 year follow up observation, statistically significant difference in frequency of MACE in particular subgroups of patients has been shown (p=0,016; p=0,01). Conclusions: Patients with STEMI undergoing pPCI, who were diagnosed with disturbed carbohydrate metabolism, have inferior clinical outcomes in long term follow up observation. Noticeable difference was observed particularly in subgroup B (HbA1c &lt;6.5%, Glc ≥7.8 mmol/l).

Прогнозирование осложненного течения острого инфаркта миокарда у больных хронической обструктивной болезнью легких

Прогнозирование осложненного течения острого инфаркта миокарда у больных хронической обструктивной болезнью легких

&lt;p&gt;Screening and Identification of Potential Hub Genes in Myocardial Infarction Through Bioinformatics Analysis&lt;/p&gt;

BackgroundMyocardial infarction (MI) is a common cause of death worldwide. It is characterized by coronary artery occlusion that causes ischemia and hypoxia of myocardial cells, leading to irreversible myocardial damage.Materials and MethodsTo explore potential targets for treatment of MI, we reorganized and analyzed two microarray datasets (GSE4648 and GSE775). The GEO2R tool was used to screen for differentially expressed genes (DEGs) between infarcted and normal myocardium. We used the Database for Annotation, Visualization and Integrated Discovery (DAVID) to perform Gene Ontology functional annotation analysis (GO analysis) and the Kyoto Encyclopedia of Genes and Genomes for pathway enrichment analysis (KEGG analysis). We examined protein–protein interactions to characterize the relationship between differentially expressed genes, and we screened potential hub genes according to the degree of connection. PCR and Western blotting were used to identify the core genes.ResultsAt different times of infarction, a total of 35 genes showed upregulation at all times; however, none of the genes showed downregulation at all 3 times. Similarly, 10 hub genes with high degrees of connectivity were identified. In vivo and in vitro experiments suggested that expression levels of MMP-9 increased at various times after myocardial infarction and that expression increased in a variety of cells simultaneously.ConclusionExpression levels of MMP-9 increase throughout the course of acute myocardial infarction, and this expression has both positive and negative sides. Further studies are needed to explore the role of MMP-9 in MI treatment. The potential values of Il6, Spp1, Ptgs2, Serpine1, Plaur, Cxcl5, Lgals3, Serpinb2, and Cd14 are also worth exploring.

ACUTE MYOCARDIAL INFARCTION REDUCES SURVIVAL IN PATIENTS WITH LEFT VENTRICULAR ASSIST DEVICES—ANALYSIS FROM THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITY STATE INPATIENT DATABASES

Left ventricular assist device (LVAD) has been increasingly utilized in the past decade for patients with end stage heart failure. The clinical course of acute myocardial infarction (AMI) after LVAD remains unclear. LVAD provides complete hemodynamic support irrespective of cardiac rhythm or

Влияние синдрома обструктивного апноэ сна на течение острого инфаркта миокарда с подъемом сегмента ST после чрескожного коронарного вмешательства

Влияние синдрома обструктивного апноэ сна на течение острого инфаркта миокарда с подъемом сегмента ST после чрескожного коронарного вмешательства