Forms Of Coronary Heart Disease Research Articles

A multicenter, randomized, double-blind, placebo-controlled trial to evaluate the effect of Tongmai Yangxin pill on ventricular remodeling in acute anterior STEMI patients after primary PCI

BackgroundAcute ST-segment elevation myocardial infarction (STEMI) is a severe form of coronary heart disease and a leading cause of mortality and morbidity. This can mainly be ascribed to adverse ventricular remodeling (VR). However, the efficacy of existing treatment strategies for STEMI is not entirely satisfactory. Tongmai Yangxin Pill (TMYX), a patented traditional Chinese medicine (TCM), has been approved for treating various cardiovascular diseases. PurposeThe purpose was to assess the effect of TMYX on VR in acute STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Study DesignA multicenter, randomized, double-blinded, and placebo-controlled trial conducted across 11 hospitals in China. MethodA total of 270 patients with acute anterior STEMI, undergoing PPCI within 10 days of symptom onset were enrolled and randomly assigned to receive either a placebo or TMYX, in addition to guideline-directed treatments for STEMI. The primary endpoint was a change in left ventricular end-diastolic volume index (LVEDVI) at 12 weeks. ResultAmong the 270 randomized patients, 218 (TMYX: 109 and placebo: 109) were included in the per-protocol analysis. At 4 and 12 weeks, TXMY significantly improved LVEDVI than the placebo group ([-2.17(-9.24, 8.28) vs. 3.76(-2.38, 11.48), p < 0.05] and [-1.17 (-12.19, 12.88) vs. 4.46 (-2.89, 11.99), p < 0.05]). Changes in left ventricular end-diastolic volume (LVEDV) at 4 weeks were superior in the TMYX group than the placebo group (-4.37 (-17, 13.99) vs. 7.41 (-4.56, 21.79), p < 0.05). Cardiac magnetic resonance imaging (CMRI) showed that left ventricular ejection fraction (LVEF) was significantly greater in the TMYX group than in the placebo group at 4 weeks. There were no statistically significant differences between groups for left ventricular end-systolic volume (LVESV), left ventricular end-systolic volume index (LVESVI), 6 min walking distance (6MWD), and major adverse cardiac and cerebrovascular events (MACCEs) (p > 0.05). ConclusionTMYX, as an adjunctive therapy in addition to STEMI guideline-directed treatments, significantly delayed VR in patients with acute anterior STEMI undergoing PPCI within 10 days of symptom onset.

Comparative analysis of the structure of the heart and blood vessels surgeries, taking into account the clinical and functional status of patients with coronary heart disease in 2015 and 2020

Relevance. In a very short period of time, surgical treatment methods have become widespread due to the expansion of indicators for performing heart surgery in patients with severe complicated forms of coronary heart disease and the use of combined surgical operations.Aim: To study changes in the clinical and functional status of patients depending on the type of surgical intervention for coronary artery disease in different time periods in the gender aspect.Material and Methods. The study was conducted retrospectively. For comparative analysis, patients with an established diagnosis of coronary heart disease who underwent surgical treatment at the Federal Center for Cardiovascular Surgery of the of the Ministry of Healthcare of the Russian Federation (Chelyabinsk) in 2015 (n = 1017) and 2020 (n = 967) were included. Of the total number of patients in 2015, there were 771 (75.8%) men and 246 (24.2%) women, in 2020 718 (74.3%) and 249(25.7%), respectively.Results. In the structure of interventions performed, there is a decrease in the number of almost all types of surgical interventions for complications of myocardial infarction, most pronounced in relation to resection of the left ventricular aneurysm, reconstruction of the left ventricle and operations in combination with mitral valve replacement. In a large percentage of cases, patients with a history of risk factors for cardiovascular diseases are referred for coronary artery bypass surgery, regardless of gender. The majority of patients had angina pectoris of the 3rd–4th functional class. However, there is a trend towards a decrease in the proportion of people with post-infarction cardiosclerosis when referred for surgery.Conclusion. Despite the significant volume and availability of practical information, the number of patients with major cardiovascular risk factors is not decreasing.

ADHERENCE TO THE MEDITERRANEAN DIET IN PATIENTS WITH HIGH CARDIOVASCULAR RISK

Introduction. Recommendations for the use of the Mediterranean diet apply to many nosologies, which made it expedient to consider the principles of such nutrition and adherence to it for patients with high cardiovascular risk. Objectives. In order to evaluate the nature of the diet of patients with high cardiovascular risk and their adherence to the Mediterranean diet, the principles of the diet were described according to the data from the Pubmed database. Adherence to and compliance with the principles of Mediterranean diet in patients with high cardiovascular risk were determined according to the Food Questionnaire in 29 outpatients with stable chronic forms of coronary heart disease and arterial hypertension: 18 men, 11 women aged 55.72±2.59 years with excessive body weight; the results were processed by the methods of variational statistics. Results. The Mediterranean diet is recommended for patients with high cardiovascular risk, excess body weight, steatotic liver disease, inflammatory bowel diseases, autoimmune changes in the thyroid gland, dementia, chronic obstructive pulmonary diseases, and oncological processes. It is based on grains, cereals, vegetables and fruits, beans, nuts, and seeds; a small amount of meat, eggs, fish, and poultry; olive oil and moderate daily consumption of cheeses and yogurts. According to the Food Questionnaire, patients with a high cardiovascular risk are not sufficiently aware of the principles of this diet, do not fully follow the recommendations for replacing fats with extra virgin olive oil, do not consume enough fish, vegetables, fruits, nuts, whole grain pasta and hard cereals. In addition, they tend to consume meat, soft cereals, ordinary types of bread and pasta, sweets, carbonated beverages, beer, and spirits in excessive amounts or too often. Conclusions. Insufficient awareness and non-adherence to the Mediterranean diet require the activation of educational work to deepen knowledge about its principles and details.

Nutrigenomics and Gene Modulation Associated with Cardiovascular Diseases

Introduction: Cardiovascular diseases (CVD) are responsible for 31% of global mortality, most in the form of coronary heart disease (CHD) and stroke. Nutrigenomics and nutrigenetics have been tools in the prevention and treatment of cardiovascular diseases. Objective: to review the main polymorphisms related to food metabolism that can be used in the diagnosis and monitoring of cardiovascular diseases. Material and Methods: This study is qualitative and descriptive through a literature review that consulted the PubMed, Virtual Health Library, Scielo, Capes Portal and Google Scholar databases with original articles published in Portuguese and English in the period between January 2010 and September 2021. Results: 26 articles were found as potentially in accordance with the search criteria. After analyzing the abstracts, 17 articles (65.38%) were excluded and 10 (38.46%) articles were selected. Discussion: Benefits of changing the dietary pattern were found that can promote prevention and reduce the risk of cardiovascular events. Conclusion: The use of bioactive substances can contribute positively to modulating the expression of genes associated with increased cardiovascular risk.

Characteristics of the severity of the early formation of the atherosclerotic process in certain pathological forms of coronary heart disease in marine specialists in the conditions of the Arctic region

The present work aims to study lipid balance, specifi markers of atherosclerosis, morphological changes in the main arteries, as well as paired indicators, in the formation of the atherosclerotic process in some non-comorbid pathological forms (painful/silent episodes of angina pectoris) of chronic coronary artery disease occurring with affective disorders in shipboard personnel serving in the Far North. The study revealed a higher incidence of structural changes in the medial sheath of both common carotid arteries in silent angina pectoris, which are manifested in vascular bed remodeling, formation of atherosclerotic plaques, and stenotic atherosclerosis. In addition, an increase in proatherogenic activity, suppression of antiatherogenic parameters, as well as more significant changes in the paired indicators of the atherosclerotic process were observed in such patients. The exacerbation of the main pathological process in chronic coronary artery disease can be attributed to the existing polymorbidity.

ANALYSIS OF THE FREQUENCY AND STRUCTURE OF HOSPITALIZATION OF YOUNG PATIENTS IN A CARDIOLOGY HOSPITAL IN ALMATY

Objective: To study the frequency and structure of hospitalizations of young patients (up to 44 years old, WHO) at the Almaty City Cardiology Center for the period 2018–2022. Design and method: In the course of an observational, descriptive, cross-sectional study, we studied the frequency and structure of reasons for hospitalization in young patients over a five-year period. Results: During the study, it was found that during the designated period, a total of 1827 young patients were hospitalized (average age 36.7 ± 4.4 years), which amounted to 4.8% of the total number of hospitalized patients (n = 38054). Detailing by year, it should be noted that the peak of hospitalizations occurred in 2019 - 8.5%, with a significant decrease in 2020 - 4%, (which may have been due to the COVID-SARS-2 pandemic), while the minimum was recorded in 2018 - 3%. The most common cause of hospitalization (more than 30%) were acute forms of coronary heart disease, while the frequency of hospitalization with unstable angina (23.5%) prevailed over the myocardial infarction (12.2%). The third position was occupied by arterial hypertension - 9.9%. In descending order, the following nosologies followed: cardiomyopathies - 8.1% and acute myocarditis - 5.6%. The top ten most common reasons for hospitalization also included supraventricular tachycardia, atrial fibrillation/flutter, WPW syndrome. Analysis of the frequency of hospitalizations of patients with acute forms of coronary heart disease over the years demonstrated an upward trend. Among all hospitalizations of young patients with myocardial infarction, the most common was, according to the ICD-11 code (I21.0) -42.8%, then in descending order - (I21.1) -25.7%, (I21.4) -12.2%, (I22.1) -7.2%, (I22.0) -6.8% (I22.8) -2.3%. Conclusions: Thus, among all reasons for hospitalization, unstable angina, myocardial infarction and arterial hypertension occupied the three leading positions. Dynamics of the frequency of hospitalization of young patients with acute forms of coronary heart disease had an upward trend. The most common type of myocardial infarction in young people was acute transmural myocardial infarction of the left ventricle, which probably determines the severity of myocardial damage and the unfavorable prognosis in this population.

Features of coronary heart disease in a cohort of tajik patients and the condition of the vascular endothelium in its different clinical forms

Relevance. In the Republic of Tajikistan, in recent years there has been a steady increase in cardiovascular diseases. In this regard, special attention is paid to coronary heart disease with its various manifestations, which can often cause permanent disability, even death. In recent decades, there has been great interest among research scientists in studying the functioning of the endothelium in various forms of coronary heart disease, as well as in individuals with post-infarction cardiosclerosis as a complication of coronary heart disease. Despite the large number of studies in this area, the role and relationship of some sensitive markers of endothelial dysfunction with the clinical course of various forms of coronary heart disease have not yet been determined. That is why its detailed study is of unconditional clinical interest and provides the opportunity for a deep understanding of its theoretical aspects. Purpose of the study: to study risk factors for cardiovascular diseases and mark­ers of endothelial dysfunction in patients with stable angina pectoris in comparison with patients with post-infarction cardiosclerosis, i.e. previous myocardial infarction.Object and methods. Of 60 patients with various forms of coronary heart disease, whose average age was 62.6 ± 3.5 years, and 20 practically healthy individuals of the same age who made up the control group, three groups were formed: Group I (n = 20) included respondents without coronary heart disease; Group II (n = 30) included patients with stable angina pectoris of functional class II and III; Group III (n = 30) included patients who were diagnosed with post-infarction cardiosclerosis, i.e. previously suffered a myocardial infarction. Endothelial cell dysfunction was detected by determining desquamated endothelial cells, as well as by the activity of von Willebrand factor and the level of homocysteine in the blood plasma.Results. In the examined patients, risk factors for coronary heart disease in the form of arterial hypertension, physical inactivity and obesity were observed with greater frequency in persons with stable angina pectoris of functional class II, in contrast to those with functional class III. Patients with stable angina pectoris of functional class III all had chronic heart failure of varying severity (100%). Most patients had at least three risk factors for coronary heart disease. All persons with post-infarction cardiosclerosis had risk factors for coro­nary heart disease, while arterial hypertension was detected in 100%. Based on the indicators of endothelial dysfunction, it can be said that individuals in group III have a more severe functional and morphological condition (increased homocysteine levels, von Willebrand factor activity and the number of desquamated endothelial cells) compared to group II (p &lt; 0.001).Conclusion. In all forms of coronary heart disease (stable exertional angina of functional class II, III and post-infarction cardiosclerosis), the content of desquamated endothelial cells in the blood serum, the activity of von Willebrand factor and homocysteine are increased. A positive correlation was established between the level of desquamated endothelial cells and the level of homocysteine, von Willebrand factor, fibrinogen and platelets. After complex therapy of patients with various forms of coronary heart disease, the functional state of the endothelium improves (decrease in the level of desquamated endothelial cells, ho­mocysteine, von Willebrand factor).

Monitoring of infusion therapy in patients with reduced cardiac reserve during abdominal operations

Background. In the pathogenesis of many intra- and postoperative complications, the composition, volume and rate of infusion therapy (IT) play a significant role. This problem is especially relevant for patients with concomitant chronic pathology of the cardiovascular, respiratory systems and kidneys. Informative indicators for assessing the correctness of IT and early diagnosis of intraoperative complications associated with errors in its implementation are complex monitoring of functional indicators of the cardiovascular and respiratory systems. Purpose – of the study is to investigate changes in biochemical markers of heart failure and ultrasound signs of venous stasis in two modes of infusion therapy (restrictive and liberal), on the basis of a comparative study, to determine the optimal mode of perioperative IT in patients undergoing elective surgery for diseases of the abdominal cavity and have comorbid pathology in the form of coronary heart disease (CHD) and heart failure (HF). Materials and Methods. 86 patients were included in a single-center, prospective, randomized study. All patients were randomly divided into two groups depending on the mode of intraoperative IT: in the first group (n = 44) – a restrictive mode of 5–8 ml/kg/hour was applied, in the second (n = 42) – a liberal mode. Echocardiography was performed at the stages of the study. Heart contractility, central hemodynamics, and ejection fraction were evaluated. An ultrasound scan of the inferior vena cava (IVC) was performed during breathing as a non-invasive method of assessing the intravascular blood volume. The diameter of the vein during inhalation and exhalation was evaluated. Based on the respiratory change in the diameter of the IVC, the caval index is calculated, which is expressed as a percentage. An index approaching 100% indicates near-complete collapse and probable volume depletion, while an index close to 0% indicates minimal collapse and intravascular overflow. Ultrasound of the lungs was performed according to the BLUE protocol with a convex sensor in 8 zones along the front chest wall. The severity of pulmonary congestion was assessed based on the sum of B-lines: 5 and less – no congestion, 6 to 15 – slight congestion, 15 to 29 – moderate, 30 and more – significant. Results. The conducted study shows the advantage of the restrictive regimen of IT in patients with concomitant coronary artery disease and minimal signs of congestive heart failure during abdominal surgical operations. The regime with restriction of intravenous fluid administration was better, as it reduces venous congestion, reduces the amount of fluid in the interstitial space of the lungs, causes a smaller compensatory reaction of the cardiovascular system to infusion with normal values of NT-proBNP. The task of the anesthesiologist in this case is careful control of daily and cumulative water balance, adequate monitoring of indicators of the cardiovascular system, use of modern ultrasound technologies and protocols for controlling volemic status, assessment of the dynamics of biomarkers of heart failure, which will allow complex abdominal operations to be safely performed in patients with reduced cardiac reserve. Conclusions. As a result of the conducted research, it was established that: the use of a liberal regimen of infusion therapy in the perioperative period in patients with coronary heart disease and HF I, I-II FC compared to a restrictive regimen leads to a statistically significant increase in biomarkers of heart failure and ultrasound signs of volemic overload. The restrictive regimen of IT in a dose of 5–8 ml/kg/hour, in comparison with a liberal one in a dose of 12–15 ml/kg/hour, can be recognized as optimal and safe in patients with coronary heart disease and HF I, I-II FC during surgery on the organs of the abdominal cavity. The use and widespread implementation in practice of complex determination of the level of the amino-terminal prohormone of brain natriuretic peptide (NT-proBNP) NT-proBNP, non-invasive methods of ultrasound of the heart – echocardiography, ultrasound of the lungs and central vessels – assessment of the dynamic filling of the inferior vena cava (IVC) allows significantly supplement clinical information on volemic status, venous stasis, contractility of the heart and fluid retention in the interstitial space of the lungs and may be key in the prevention of cardiac complications in this category of patients.

Urgent Cardiosurgical Treatment of a Military Servant with a Moving Thrombus in the Area of the Left Ventricular Apical Aneurysm (Case Report)

Against the background of military operations, post-traumatic stress disorder, the progression of the atherosclerotic process is observed, which can lead to myocardial infarction even in young people. Left ventricular aneurysm (LVA) in military personnel is the result of untimely revascularization of an infarct-related artery, gunshot wound to the heart, chest trauma, etc. The presence of a dyskinetic area promotes formation of blood clots in the LVA cavity. LVA thrombosis is associated with an increased risk of embolism, ischemic stroke, and death.&#x0D; Case description. A 37-year-old military servant A. was urgently hospitalized to the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with a mobile thrombus in the area of LVA, size 4.5 x 3 cm, with signs of lysis and a threat of separation according to echo data. The patient was found to suffer Q-wave myocardial infarction 5 months ago; at the time of examination there was decompensation of the condition and a decrease in the left ventricular contractility to 34%. The patient underwent urgent operation: on-pump coronary artery bypass grafting, LVA resection with thrombectomy. The duration of the operation was 7 hours, the aortic cross-clamp time was 53 minutes, the perfusion time was 93 minutes, the blood loss was 500 ml. The postoperative period was uneventful. The patient was discharged on the 7th day with improvement, the ejection fraction was 40%.&#x0D; Conclusion. The lack of an opportunity to conduct timely electrocardiography and echo for military personnel with acute chest pain reduces the chances of diagnosis and treatment of myocardial infarction within the therapeutic window, which leads to the occurrence of complicated forms of coronary heart disease, namely LVA. Echo is of crucial importance in deciding on emergency cardiac surgery for thrombosed LVA.

Интракоронарное применение левокарнитина при стентировании коронарных артерий у пациентов высокого риска

The main causes of postoperative mortality associated with percutaneous coronary interventions involving the coronary artery stent insertion are perioperative myocardial infarction and acute heart failure due to inadequate protection of the myocardium against ischemia/reperfusion. The standard therapy includes beta blockers, anticoagulants, antiplatelet drugs. Two clinical cases of successful use of intravenous levocarnitine for cardioprotection in senile patients with acute forms of coronary heart disease with multivessel lesions are reported. The postoperative period went well, smooth dynamics of biomarker levels (troponin I, creatine phosphokinase, MB fraction of creatine phosphokinase) was observed, and ischemic ECG changes were relatively small. The expected results of the technique application include reduction of intraoperative and postoperative complications of ischemia/reperfusion and the increase in effectiveness of the stent insertion clinical outcomes in high-risk patients.

The Role of Angiogenesis Mediators in the Mobilization of Early and Late Endothelial Progenitor Cells from the Bone Marrow in Coronary Heart Disease

Background. A severe form of coronary heart disease (CHD) is ischemic cardiomyopathy (ICMP), the pathogenesis of which has not been fully studied. Disturbances in the mobilization of endothelial progenitor cells (EPC) due to an imbalance of angiogenesis mediators may exacerbate ischemia in ICMP. The aim — to establish the peculiarities of changes in the balance of early and late EPС and subpopulations of VEGFR2+ cells in the blood and bone marrow in relation to the content of angiogenesis mediators and the number of desquamated endothelial cells (DEK) in the blood of patients with CHD, suffering and not suffering from ICMP. Methods. A single-stage, clinical, controlled (case-control) study was conducted from March 2019 to June 2022. 52 patients with CHD who had a history of myocardial infarction were examined: 30 people suffering from ICMP and 22 people not suffering from ICMP, as well as 15 healthy donors. The content of VEGFR2+, VEGFR2+CD34+CD14+ (early EPC), VEGFR2+CD34+CD14– (late EPC), VEGFR2+CD34–CD14+, VEGFR2+CD34–CD14– cells in patients with CHD in the blood (before surgery) and bone marrow (sampling was performed at the beginning of coronary bypass) and in healthy individuals in the blood, as well as (in both groups) the content of CD45–CD146+ DEC in the blood was determined by flow cytometry. The concentration of SDF-1, VEGF-A, MCP-1, GM-CSF, G-CSF in blood plasma was measured by multiplex immunofluorescence analysis. Results. The development of CHD without cardiomyopathy was accompanied by an increase in the content of VEGFR2+CD34+CD14+ and VEGFR2+ cells (0.74 [0.46; 1.23]% and 10.00 [8.20; 11.60]%, respectively, versus 0.19 [0.13; 0.32]%, p 0.001 and 5.40 [4.30; 6.50]%, p = 0.005) and concentrations of SDF-1, MCP-1, GM-CSF (respectively 60.00 [50.00; 81.00] pg/ml; 223.0 [180.0; 297.0] pg/ml; 2.10 [1.45; 3.40] pg/ml versus 30.00 [5.00; 45.00] pg/ml, p = 0.041; 175.1 [140.0; 204.0] pg/ml, p = 0.046; 0.96 [0.46; 1.41] pg/ml, p = 0.038) in the blood relative to the norm. No such changes were observed in patients with ICMP. Regardless of the presence of ICMP, the content of VEGFR2+CD34+CD14–, VEGFR2+CD34–CD14+, VEGFR2+CD34–CD14– cells, VEGF-A, G-CSF in the blood of patients with CHD varied within physiological values, and the number of DEC exceeded the norm (7.26 [5.43; 17.94]×105/l, p = 0.039). The number of VEGFR2+ cells and their immunophenotypes in the bone marrow of patients with ICMP did not differ from the parameters in patients with CHD without cardiomyopathy. Prolonged bleeding from the venopuncture area was registered in one CHD patient without cardiomyopathy. Conclusion. The development of ICMP is associated with the absence of a compensatory response to atherogenesis in the form of increased mobilization of early EPC from the bone marrow due to the absence of a reaction associated with hyperproduction of SDF-1, MCP-1, GM-CSF, which is characteristic of CHD without cardiomyopathy. The content of EPС, VEGFR2+CD34–CD14+ and VEGFR2+CD34–CD14– cells, VEGF-A and G-CSF in the blood in СHD corresponds to physiological values, regardless of the presence of ICMP. The generation of EPC in the bone marrow in ICMP is not impaired.

FEATURES OF RELATIONS OF MELATONIN WITH THE STATE OF INTRACELLULAR REGULATORSOF THE FUNCTIONAL ACTIVITY OF WHOLE BLOOD MONONUCLEAR CELLS IN CORONARY HEART DISEASE

Introduction. Coronary heart disease (CHD), leading among the causes of death in adulthood and old age, is an urgent medical and social problem. The pathogenesis of most forms of coronary heart disease is based on stenosing atherosclerosis of the coronary arteries, which develops against the background of dyslipidemia and arterial hypertension and is accompanied by the activation of immunocompetent cells (ICCs) of the vascular wall with the development of a subclinical inflammatory reaction, as well as the production of pro-inflammatory factors such as interleukins, chemokines, growth factors and etc. In turn, ICC activity is determined by the state of their intracellular molecular cascades, which transmit signals into the cell and ensure its reactivity to various external stimuli, such as mitogens, cytokines, pathogen components, etcIt has been shown that the central nervous system plays an important role in the regulation of ICC activity due to the production of neurohumoral molecules, such as melatonin, endorphin, sero-tonin, etc., which ensure the coordination of immune responses and their control by the central nervous system. The aim of this study was to study the relationship between melatonin production and intracellular factors that regulate the pro-inflammatory activi-ty of whole blood mononuclear cells and their metabolism in patients with coronary artery disease. Material and methods. As part of the cohort study, 58 patients of both sexes with coronary artery disease aged 49 to 67 years and 20 practically healthy individuals of both sexes were examined. In accordance with the purpose of the study, the concentration of focal adhesion protein kinase (FAK), 5'AMP-activated protein kinase (AMPK), AKT1 protein kinase, signal transducers and transcription activators (STAT) was determined in nuclear cy-toplasmic lysates of whole blood mononuclear cells: STAT3, STAT5A and STAT6, c-Jun N-terminal protein kinase 1 and 2 isoforms (JNK), mitogen-activated protein kinase p38 (p38), extracellular growth kinase 1 and 2 isoforms (ERK), Janus kinase type 2 (JAK2), nuclear transcription factor NF -kB, caspase-1, cyclooxygenase-2 (COX-2), p70-S6K1 protein kinase, p53, p27, p21 proteins. In addition, the concentration of cyclic adenosine monophos-phate (cAMP) and cyclic guanosine monophosphate (cGMP) was determined in cell supernatants. Melatonin concentration was determined in blood se-rum. The material for the study was venous blood taken from the cubital vein in the morning from 6.00 to 6.15. Results. The analysis showed that in patients with coronary artery disease, in comparison with practically healthy individuals, in MNCs of whole blood, there was an increased level of protein kinases FAK, AKT, JNK, ERK, p70-S6K1, factor STAT6, protein p21, against which there was a decrease in the content of STAT3, STAT5A, JAK2, transcription factor NF-kB and caspase-1. These changes were accompanied by increased levels of cGMP and cAMP. Against this background, a decrease in the content of factors was revealed in the MNC. A high concentration of melatonin in patients with CAD was as-sociated with a decrease in the content of protein kinases AMPK, AKT, Jak2, ERK1, protein p21, caspase-1, and cAMP in MNCs, which was observed against the background of an increase in the level of protein p27 and nuclear factor NF-kB. The results of the correlation analysis indicate a different na-ture of the relationship between the level of melatonin and such factors as caspase-1, protein kinases ERK, JAK2, as well as the transcription factor NF-kB and p21 protein, depending on the characteristics of melatonin production in patients with coronary artery disease. Conclusions. In patients with coronary artery disease, melatonin exhibits a modulating effect on the energy balance of ICCs and their metabolism, helps limit pro-inflammatory activity by limiting the functional activity of MAPK/SAPK signaling pathways in MNCs.

СВЯЗЬ ВОСПАЛИТЕЛЬНЫХ МАРКЕРОВ И ТРЕВОЖНО-ДЕПРЕССИВНЫХ РАССТРОЙСТВ У ПАЦИЕНТОВ С ОСТРЫМ ИНФАРКТОМ МИОКАРДА

Abstract. Introduction. In recent years, the influence of anxiety and depressive disorders on the course of cardiovascular diseases has been increasingly discussed. The main psychosocial risk factors for the development of acute myocardial infarction include depression and anxiety (various anxiety syndromes and disorders). Currently, inflammation is considered as one of the leading links in myocardial infarction pathogenesis, course, and prognosis. Recent studies have linked the development of anxiety and depressive disorders with changes in the proinflammatory cytokine levels. Severity of immunoinflammatory reactions in patients with unstable forms of coronary heart disease is greater than in patients with a stable course of the disease. The aim of our investigation was to study the proinflammatory cytokine levels in patients with myocardial infarction depending on the presence of anxiety and depressive disorders. Materials and Methods. The study included 160 patients, averagely aged 56.2±1.4 years, who were admitted to the hospital with the ST-segment elevation myocardial infarction. The diagnosis of the said disease was set according to the generally accepted diagnostic criteria. In addition to the traditional clinical and instrumental studies, the patients of the groups under study underwent an assessment of the concentrations of inflammatory biomarkers in plasma and psychological tests using anxiety and depression rating scales, such as Zung Depression Scale and Spielberger-Khanin Anxiety Scale. Results and Discussion. Signs of depression were identified in 82 (51.25%) patients with acute myocardial infarction. Symptoms of mild depression were identified in 44 (53.7%) patients, moderate depression in 30 (36.6%) patients, and severe depression in 8 (9.7%) patients. It has been proven that the average depression score increases with the increase in the disease severity. The average score was 49.72+1.68 for personal anxiety in the group and 41.9±1.6 for reactive anxiety. As the class of infarction severity increased, a significant increase in anxiety levels was observed. An increase in the serum concentrations of CRP, IL-1β, IL-6, IL-8, and TNF-α was detected during the development of myocardial infarction, which was statistically significantly associated with the presence of anxiety-depressive disorders and some indicators of myocardial contractile function. Conclusions. Subclinical inflammation is one of the mechanisms of the negative impact of anxiety and depressive disorders on the prognosis for this category of patients. The presence of anxiety and depression symptoms is associated with higher levels of pro-inflammatory markers, i. e., CRP, IL-1β, IL-6, IL-8, and TNF-a. The degree of activation of proinflammatory markers depends on the severity of the myocardial damage signs and on the nature of complications.

Hybrid Neuro-Fuzzy Classifier for Monitoring the Effectiveness of Treatment of Diseases of the Respiratory System, Taking into Account Comorbidity

The purpose of research is to develop a hybrid neuro-fuzzy classifier for remote monitoring of the severity of community-acquired pneumonia, taking into account the risk of concomitant diseases.Methods. To assess the severity of community-acquired pneumonia and determine the effectiveness of its treatment plan, a hybrid neural network is included in the hybrid neuro-fuzzy classifier, which contains three macrolayers: PNNFNN-FNN*. The number of decisive blocks of the PNN macrolayer is equal to the number of segments allocated in the space of informative features, and the output of each PNN block produces risk and non-risk assessments of communityacquired pneumonia by severity clusters. Aggregation of decisions made over N segments of the space of informative features is carried out in the FNN layer, which has the structure of a fuzzy decision-making module. The aggregation of 2L PNN-FNN outputs occurs in the FNN* macrolayer. The same macrolayer takes into account the influence of comorbidity on the severity of community-acquired pneumonia.Results. The testing of a hybrid neuro-fuzzy classifier of the severity of community-acquired pneumonia was carried out on an experimental group of patients with community-acquired pneumonia with comorbidity in the form of coronary heart disease. Indicators of the quality of classification of the severity of pneumonia taking into account the risk of comorbid disease using the example of coronary heart disease showed that the aggregation of the classifier of the severity of community-acquired pneumonia and the classifier of the risk of comorbid disease in the form of a hybrid neuro-fuzzy classifier makes it possible to improve the quality of assessing the severity of community-acquired pneumonia by more than 10% for all quality indicators.Conclusion. A hybrid neuro-fuzzy classifier, built on different pattern recognition paradigms, makes it possible to identify clusters of disease severity and improve the quality indicators for classifying the severity of community-acquired pneumonia in the presence of comorbidity by an average of 12%.

Cardioprotection with levocarnitine intracoronary administration during percutaneous coronary interventions

Currently, the number of percutaneous coronary interventions (PCI) performed in acute and chronic forms of coronary heart disease continues to grow: every year their number reaches at least 5,000,000 worldwide, and more than 200,000 of them in Russia. The main causes of postoperative mortality are perioperative myocardial infarction and acute heart failure due to inadequate protection of the myocardium from ischemia/reperfusion under conditions of balloon expansion and stenting of the affected coronary arteries. The review presents experimental and clinical literature data on the successful use of levocarnitine for cardioprotection in patients with various forms of coronary heart disease and patients with chronic heart failure, both with intravenous administration and as part of a cardioplegic solution during heart surgery. The intracoronary route of administration of levocarnitine solution during PCI in high-risk patients (elderly and senile patients, with multivessel lesions of the coronary bed, difficulties in conducting the intervention) is substantiated. The description of two clinical cases of the use of the technique in elderly patients with acute forms of coronary heart disease with multivessel lesion is given. The postoperative period proceeded without complications with smooth dynamics of biomarkers (troponin I, total creatinephosphokinase, MB-fraction of creatinephosphokinase, lactate dehydrogenase), ischemic ECG shifts were little pronounced. The expected results of the application of the technique are a reduction in intraoperative and postoperative complications of ischemia/ reperfusion and an increase in the effectiveness of the clinical results of PCI in high-risk patients.

Central sensitization and comorbid disorders in patients with coronary heart disease

Study of central sensitization (CS), insomnia and meteosensitivity in patients with coronary heart disease (CHD) admitted for a routine examination. 67 patients (29 men and 38 women), aged 50-87 years, average age 73 [67; 85] years, with chronic forms of coronary heart disease were examined. The examination included the Russian version of the central sensitization inventory (CSI); assessment of meteosensitivity using a visual analogue scale (VAS); questionnaire for semi-quantitative assessment of subjective sleep characteristics (ASHS). Patients with the presence of CS were prescribed Anvifen 250 mg 3 times a day; in addition, patients could take the drug during the day if necessary, as well as during night or early morning awakening (without exceeding the maximum daily dose of 1500 mg). The duration of drug administration and observation of patients was 30 days. The severity of CS (before and after treatment): subclinical - in 14 and 20, mild - in 15 and 37, moderate - in 17 and 10, severe - in 14 and 0, critical - in 7 and 0 patients, respectively. The average CSI score was 40.5[30; 50] and 32.5[25; 37.3] (p=0.00001). The severity of meteosensitivity according to VAS before and after treatment was 70 [60; 80] and 25 [20; 30] points (p=0.00002). The average ASHS score for subjective sleep characteristics before and after treatment was 13 [12; 15] and 26 [25; 28] points (p=0.00001). Central nervous system, insomnia and meteosensitivity are common clinical conditions in patients with coronary artery disease. Inattention to them leads to insufficient effectiveness of specific therapy and worsening of the course of cardiovascular diseases. The GABAergic drug Anvifen effectively reduces CS, meteosensitivity and improves sleep. The CSI is a simple and informative tool for assessing cerebral dysfunction in patients with coronary artery disease and can be recommended for daily routine practice in order to optimize personalized medical care.

Peculiarities of Metabolism and Cardiac Electrical Activity in Patients with Chronic Obstructive Pulmonary Disease and Coronary Heart Disease in the Presence of Metabolically-Associated Liver Steatosis

While the development of specific steatohepatitis-associated cardiomyopathy (SHACMP) in the context of fatty liver disease has been documented, it remains unclear whether any cardiac changes occur during the initial stage of fatty liver disease, known as metabolic-associated liver steatosis (LS). Objective — to evaluate the characteristics of metabolism and electrical activity of the heart in patients with chronic obstructive pulmonary disease and chronic forms of coronary heart disease and concomitant liver steatosis. Materials and methods. 35 patients with chronic obstructive pulmonary disease, respiratory insufficiency stages I and II, coronary heart disease, atherosclerotic cardiosclerosis, and heart failure functional classes I and II, were examined. Their diagnosis and treatment were conducted in accordance with established protocols and international recommendations. Depending on the occurrence of LS, patients, matched for age, gender and lung function parameters, were divided into two groups: those suffering from it (n = 26) or not suffering from it (n = 9). Additionally, leptin level was determined, body mass index (BMI), leptin to BMI ratio, De Ritis ratio, hepatic steatosis index, glomerular filtration rate (according to MDRD) were calculated, and automatic ECG test was run. The results were processed statistically; the significance assumed at р &lt; 0.05. Results and discussion. It was established that LS was diagnosed in patients with a higher BMI and was accompanied by clear metabolic changes — higher values of leptin, leptin-to-BMI ratio, fasting blood glucose and total cholesterol levels. The criteria of LS are not only an increase in echogenicity and size of the liver, but also higher values of ALT, De Ritis ratio and hepatic steatosis index. According to the correlation analysis, the deterioration of the liver condition was accompanied by changes in the heart — tachycardia and a decrease in the angle of the QRS complex, which can be considered as signs of the development of SHACMP, characteri­zed by a prolongation of the PQ interval (р = 0.07) and a significant deviation of the angle of the QRS complex. Inflammation and endogenous intoxication are the leading mechanisms of progression of both LS and SHACMP. Conclusions. Patients with chronic obstructive pulmonary disease and chronic forms of coronary heart disease, alongside with liver steatosis, exhibit signs of steatohepatitis-associated cardiomyopathy caused by metabolic changes, inflammation and endogenous intoxication.

The promotion of sestrin2/AMPK signaling by HIF-1α overexpression enhances the damage caused by acute myocardial infarction

ObjectiveAcute myocardial infarction (AMI), is a serious form of coronary heart disease. The present study sought to investigate the impact of HIF-1α on AMI, along with its fundamental mechanism.MethodsSprague-Dawley (SD) rats were used to conduct an AMI model. 2,3,5-triphenyl-2H-tetrazolium chloride (TTC) staining was used examine the region of myocardial infract area at various time intervals. Protein expression levels were detected using western blotting. The rats were randomly divided into sham, model, negative control (NC), HIF-1α overexpression (HIF-1α-OE), and HIF-1α-OE+ si-sestrin2 groups. We examined the impact of HIF-1α overexpression on AMI rats using Haematoxylin-Eosin (H&E) staining, TTC staining, enzyme-linked immunosorbent assay (ELISA), TdT-mediated dUTP Nick-End Labeling (TUNEL) assay, and immunohistochemistry (IHC) staining.ResultsAccording to the TTC findings, the region affected by myocardial infarction reached its peak at day 14. Based on the results from the western blot analysis, the levels of HIF-1α and sestrin2 were found the minimum on day 28. Subsequently, we discovered that the overexpression of HIF-1α rescued the cardiac function parameters, improved the morphology of myocardial tissue, and mitigated inflammation. Furthermore, the overexpression of HIF-1α led to a reduction in the levels of MDA and an increase in the levels of SOD. Moreover, the overexpression of HIF-1α resulted in a decrease in cellular apoptosis. This result was confirmed by the expression levels of Bcl-2 and Bax. Nevertheless, the defensive impact of elevated HIF-1α expression was somewhat counteracted by the suppression of sestrin2. In terms of mechanism, the overexpression of HIF-1α enhanced the levels of sestrin2 and the protein adenosine monophosphate activated kinase (AMPK).ConclusionOur research suggests that the overexpression of HIF-1α may rescue the damage to myocardial tissue, and this effect is associated with the sestrin2/AMPK signaling pathway. Our study provides a novel comprehension of the protective effects of HIF-1α overexpression on AMI.

Study of the state of th vascular endothelium in various forms of coronary heart disease

Purpose of the study: to investigate changes in markers of endothelial dysfunction and hemostasis system in patients with different forms of CHD on the background of treatment and before it.Materials and methods of the study. In order to fulfill the set tasks, 60 patients with different forms of CHD: stenocardia and myocardial infarction (according to the classification of the Canadian Association of Cardiology (L. Cam-peau, 1976)), 60 patients with different forms of CHD were examined during the study. Campeau, 1976), VNOC (2004), recommendations of the European Society of Cardiology (2007)), aged from 50 to 75 years (mean age 62.6 ± 3.5 and 65.1 ± 3.6 years, respectively) and 20 practically healthy individuals (without signs of CHD), comparable in age (mean age 62.7 ± 3.7 years), who constituted the control group. For comparative analysis of the results before and after treatment the subjects were divided into three groups: Group I - control group, respondents without CHD; Group II - patients with stable angina II and III functional classes (FC); Group III - patients with postinfarction cardiosclerosis, i.e. those who had undergone Ml.Results and their discussion Several risk factors were identified in the majority of hospitalized patients. CHD of II and III FC was more often registered in women (60%); men who had undergone myocardial infarction accounted for 63.3%, the indices were statistically insignificant (p &gt;0.05). The main cardiovascular risk factors (obesity, arterial hypertension, body mass index and total cholesterol) were significantly higher (in % ratio) in patients of groups ll-lll compared to group I (p&lt;0.001), but the cholesterol content and body mass index were on average higher in group II (4.5 ± 1.0 and 33.0 ± 1.3, respectively) than in group III (4.2 ±1.1 and 30.6 ± 2.6, respectively). As for the duration of the disease, group III patients were characterized by a longer history and a higher frequency of heart failure, i.e. patients in this group had a more severe clinical status (p &gt; 0.05). It should be noted that of the total number of patients (n = 80), rural residents accounted for 46.25% and city dwellers for 53.75%.ConclusionsThe presence of a higher degree of endothelial dysfunction is observed in patients who underwent myocardial infarction, in contrast to the stable form of angina pectoris without myocardial infarction in the anamnesis. The progression and deterioration of vascular endothelium is mostly associated with the presence of hyperhomocysteinemia, and the most pronounced changes in endothelial function are determined in patients with a combination of cardiovascular risk factors. In different forms of CHD the increased content of DEK and homocysteine in blood serum, increasing in parallel with the severity of clinical course, their level correlates with the degree of endothelial dysfunction. A direct correlation between hemostasis markers (von-Willebrand factor, fibrinogen and platelets) and DEK was revealed. The greatest changes in vascular-thrombocytic and coagulation hemostasis are observed in patients with IMI than in patients with stenocardia.

Dosiahnennia kardiolohii u vyvchenni kryteriiv diahnostyky ta predyktoriv prohnozuvannia uskladnen systemy krovoobihu pid chas ishemichnoi khvoroby sertsia u poiednanni z arterialnoiu hipertenziieiu (ohliad literatury; rezultaty vlasnykh doslidzhen)

Introduction. It is generally accepted, that activation of renin-angiotensin-aldosterone system is the first step in the development of hypertension, subsequently leading to the formation of atherosclerotic lesions in blood vessels of heart, brain, kidneys, aorta, and further alteration of peripheral vessels. Some time after the onset of hypertension, left ventricle hypertension develops, inducing various forms of coronary heart disease, strokes, etc. Currently the above circumstances turned to be a global problem of cardiology and medicine. However, data on diagnostic criteria and the evaluation of these combined diseases prognostic predictors are far from complete. The aim of the study. To reflect achievements of modern cardiology in the investigation of criteria predicting complications in the blood circulatory system. Materials and methods. A review of 51 articles is supplemented with author`s own results. Results. It is estimated that arterial hypertension induce hypertrophy of the left ventricle with further cardiac remodeling, which contributes to myocardial infarction, strokes, and cardiac arrhythmias. In patients with coronary heart disease combined with hypertension, structural reorganization of myocardium is supplemented with remodeling of cardiac conducting system resulting with ventricular extrasystoles, atrial fibrillation, etc. Predictors of acute left ventricular failure and chronic heart failure have been published in the literature. Due to our observations, coronary heart disease in patients with hypertension correlates with disturbances in central hemodynamics, decreased contractile function of the left ventricle, changes in blood supply of different pulmonary zones, significant disturbances in tissue metabolism, these pathological signs leading to the development of chronic heart failure, arrhythmias and heart blockage, disorders of cerebral blood circulation. Conclusion. The obtained results make it possible the identification of diagnostic criteria and predictors of various circulatory complications in patients with the diagnosed coronary heart disease combined with hypertension. However, more observations are needed to get new insight into the pathogenic mechanisms of complications development, further specification of their predictors and creating more effective methods of their prevention. Keywords: prediction of malignant arrhythmias, atrial fibrillation, left ventricular hypertrophy.