Forms Of Coronary Heart Disease Research Articles

New Assessment of Overall Tolerance in the Rehabilitation of Patients in the Early Recovery Period of Ischemic Stroke

Enhanced external counterpulsation (EECP) has taken a worthy place among other methods in the complex treatment and rehabilitation of patients with cardiovascular pathology. Its use in outpatient and sanatorium-clinical practice significantly expands the prospect of treatment and improvement of prognosis in a wide range of patients with multifocal atherosclerosis. Aim. To study the effect of the EECP method in the complex medical rehabilitation of stable forms of coronary heart disease (CHD) in patients permanently residing in the resort city of Sochi. Material and methods. The study included 60 patients with CHD (FC II – 23, FC III – 29, FC IV – 8) living in the resort city of Sochi. Patients were randomized into intervention and control groups, in which there were no significant differences between clinical and anthropometric parameters. All of them received basic drug therapy, a complex of climatotherapeutic non-drug effects and attended the Coronary Club, a public health school for patients with СHD. Additional outpatient courses of EECP were conducted in the form of 35 one-hour sessions daily, 5 days a week, a full course for 7 weeks for each patient of the intervention group on basis. Initially and after the end of the rehabilitation course, the patients of both groups underwent electrocardiography (ECG), bifunctional daily ECG and blood pressure monitoring, Doppler echocardiography, ultrasound duplex scanning of brachycephalic vessels and lower limb vessels, exercise test on cycle ergometer, six-minute walking test, as well as physical activity level determination using IPAQ questionnaire and psychodiagnostic testing. Results and discussion. When comparing the data, patients in the intervention group showed a significant reduction in angina attacks and nitroglycerine use, stabilization of central haemodynamic parameters, increased exercise tolerance and improved subjective “quality of life” indicators. Conclusion. The data obtained confirm the experience accumulated in the world medical practice of the effective clinical impact of the EECP method in the treatment of patients with chronic coronary syndromes in outpatient treatment, including in conditions of humid subtropical climate. Therefore, its inclusion in the programs of complex sanatorium-resort rehabilitation of patients with stable forms of CHD is justified and promising.

Targeting Circulating lncRNA ENST00000538705.1 Relieves Acute Coronary Syndrome via Modulating ALOX15

Objective Acute coronary syndrome (ACS) is the most dangerous and deadly form of coronary heart disease. Herein, we aimed to explore ACS-specific circulating lncRNAs and their regulatory mechanisms. Methods This study collected serum samples from ACS patients and healthy controls for microarray analysis. Dysregulated circulating lncRNAs and mRNAs were determined with |log2fold − change| > 1 and p < 0.05. lncRNA-mRNA coexpression analysis was carried out. ENST00000538705.1 and ALOX15 expression was further verified in serum specimens. In human coronary artery endothelial cells (HCAECs), ENST00000538705.1 and ALOX15 were knocked out through transfecting specific siRNAs. Thereafter, proliferation and migration were investigated with CCK-8 and wound-healing assays. Myocardial infarction rat models were established and administrated with siRNAs against ENST00000538705.1 or ALOX15. Myocardial damage was investigated with H&E staining, and serum TC, LDL, and HDL levels were measured. Results Microarray analysis identified 353 dysregulated circulating lncRNAs and 441 dysregulated circulating mRNAs in ACS. Coexpression analysis indicated the interaction between ENST00000538705.1 and ALOX15. RT-qPCR confirmed the remarkable upregulation of circulating ENST00000538705.1 and ALOX15 in ACS patients. In HCAECs, ENST00000538705.1 knockdown lowered the expression of ALOX15 but ALOX15 did not alter the expression of ENST00000538705.1. Silencing ENST00000538705.1 or ALOX15 weakened the proliferation and migration of HCAECs. Additionally, knockdown of ENST00000538705.1 or ALOX15 relieved myocardial damage, decreased serum TC and LDL levels, and elevated HDL levels in myocardial infarction rats. Conclusion Collectively, our findings demonstrate that circulating ENST00000538705.1 facilitates ACS progression through modulating ALOX15, which provide potential targets for ACS treatment.

Possible pathophysiological mechanisms of cardiac troponin level elevations in blood serum and urine in arterial hypertension

The review aimed to discuss and detail the main mechanisms of myocardial cell injury and increased concentrations of cardiac specific troponin isoforms (cTnI and cTnT) in blood serum and urine in hypertension. The search and analysis of foreign and domestic literature were carried out using the MedLine, EMBASE, Scopus and eLibrary databases to achieve this goal. According to recent experimental and clinical researches using high and ultra-sensitive methods for determining cTnI and cTnT, cardiomyocytes are extremely sensitive to many damaging factors in a number of physiological and pathological conditions. The serum concentrations of cTnI and cTnT can increase at the earliest stages of cardiovascular diseases (for example, in prehypertension, latent forms of coronary heart disease, arterial hypertension) and are important for predicting subsequent complications in the form of acute and life-threatening cardiovascular diseases (myocardial infarction, stroke, heart failure, and others). Moreover, troponin molecules can be detected not only in blood serum but also in non-invasively obtained biological fluids, including urine and oral fluid, which in the future can be used as new methods for the non-invasive diagnosis of many cardiovascular diseases. Although elevated levels of cTnI and cTnT in blood serum and urine in hypertension have a fairly high diagnostic and prognostic value, the pathophysiological mechanisms of cardiac troponins level elevations in human biological fluids in this pathological condition remain unclear.

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

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

ОСОБЕННОСТИ ИЗМЕНЕНИЙ ПОКАЗАТЕЛЕЙ СИСТЕМЫ ИММУНИТЕТА У ПАЦИЕНТОВ ПРИ АТЕРОСКЛЕРОЗЕ

In patients with various forms of coronary heart disease (effort angina pectoris of tension II functional class (EAP II FC), myocardial infarction (MI)) an imbalance of immunological reactivity was revealed compared to practically healthy individuals, which was manifested by the increasing of the IL-6 concentration, IL-8, IgA, BAPNA-amidase activity, B-lymphocytes count, circulating immune complexes (CIC) and the decreasing of T-lymphocytes count, IgM and IgG concentration. It was also found that in patients with MI and EAP II FC, atherosclerosis was not limited to only one vascular region, lesions of the extracranial sections of the cerebral arteries, abdominal part of the aorta, arteries of the lower extremities were also recorded. The lesion of extracranial cerebral arteries in patients with EAP II FC was accompanied by the increase of neutrophil elastase activity, the number of СIC and the decrease of IgM concentration, IL-4, B-lymphocytes count, and in patients with MI it was accompanied by the increase of T-lymphocytes count and the decrease of B-lymphocytes count. When the abdominal aorta was affected, patients with EAP II FC had increased T-lymphocytes count, neutrophils and decreased IgM concentration, and patients with MI had increased T-lymphocytes count. The lesion of the lower extremities arteries in patients with EAP II FC was accompanied by the increase of T-lymphocytes count, sVCAM-1 adhesion molecules, the decrease of IgM concentration, BAPNA-amidase activity, and in patients with MI it was accompanied by the increasing of monocytes count, concentration of sVCAM-1 molecules and the decreasing of IL-6 concentration. At the same time, the development of multifocal atherosclerotic lesion (MFA) of peripheral arteries was accompanied only by the decrease of IgM concentration in patients with EAP II FC. The lesion of the anterior interventricular artery in patients with EAP II FC was combined with the increase of sVCAM-1 molecules concentration, and in patients with MI it was combined with the increase of IgG concentration and the decrease of IL-10 concentration. The lesion of the circumflex artery in patients with EAP II FC was combined with the increase of CIC concentration, TNF-α, and in patients with MI it was combined with increased IL-6 concentration. The lesion of the right coronary artery was not accompanied by any significant change in the immune system indicators in the studied groups of patients.

Вплив на ендотеліальну дисфункцію - нова стратегія превентивної кардіоневрології

У статті представлені матеріали наукової конференцій «Карпатські читання 2016». Доповідь С.М. Кузнєцової була присвячена можливостям корекції енергетичного обміну та ендотеліальної дисфункції у хворих на церебральний атеросклероз. Представлені функції і значення ендотелію в організмі. А також обгрунтовано показання та переваги застосування препарату Капікор у хворих із дисциркуляторною енцефалопатією. У доповіді Воронкова Л.Г. відображена важливість своєчасної корекції функції ендотелію як ключової ланки превентивної судинної медицини. Соломенчук Т.М. розповіла про можливості метаболічної терапії при різних формах ішемічної хвороби серця.

КЛИНИКО-ГЕМОДИНАМИЧЕСКАЯ ОЦЕНКА ПАЦИЕНТОВ С НЕРЕВМАТИЧЕСКОЙ НЕДОСТАТОЧНОСТЬЮ ТРЕХСТВОРЧАТОГО КЛАПАНА СЕРДЦА (ФУНКЦИОНАЛЬНОЙ) ПРИ ХРОНИЧЕСКИХ ФОРМАХ ИШЕМИЧЕСКОЙ БОЛЕЗНИ СЕРДЦА ИЛИ ДИЛАТАЦИОННОЙ КАРДИОМИОПАТИИ

Objectives: to study and compare the clinical and echocardiographic characteristics of patients with functional (secondary) tricuspid insufficiency, depending on its etiology and depending on the surgical methods used in surgical practice for its correction. Materials and methods: clinical and hemodynamic assessment of a population of patients with non-rheumatic tricuspid valve insufficiency (functional) in chronic forms of coronary heart disease (CHD) or dilated cardiomyopathy (DCMP) was performed. The study included 792 patients who underwent correction of non-rheumatic tricuspid valve insufficiency (functional) during a period 2011–2020: 642 participants with coronary artery disease, 150 participants with DCMP. Clinical and echocardiographic parameters were assessed. Results: In the analyzed patient population, in-hospital mortality after surgery in patients with CAD was significantly higher than in patients with DCMP, which can be explained by a number of factors, including the more severe nature of the pathology in patients with CAD (in the study, patients with multiple coronary arteries lesions and a high functional class of angina prevailed in the group of coronary artery disease), and a larger scale of surgical intervention. In patients with DCMP, a more significant dilatation of the right ventricular cavity and a significantly higher increase of right ventricle volumes were noted. At the same time, despite more significant remodeling of the left (LV) and right ventricles (RV), the level of systolic and mean pulmonary artery pressure did not differ significantly between patients with CAD and DCMP. There was no significant difference in the levels of dilatation and volume of the right atrium between patients with CHD and DCMP. Patients with DCMP showed more severe dilatation of the tricuspid valve annulus and the area of its orifice. However, when assessing the magnitude of the degree of severity of the functional tricuspid valve insufficiency, no significant differences were noted in almost all parameters, depending on the etiology. Despite a comparable volume of regurgitation and the degree of tricuspid valve insufficiency, patients with DCMP had a significantly more severe changed geometry of the tricuspid valve annulus. Ring plasty techniques were used in patients with more pronounced LV remodeling and severe LV systolic dysfunction. This, most likely, caused a more significant overload of the pulmonary circulation, causing a higher level of pulmonary hypertension and volume overload of the right heart. In patients with CHD, suture repair methods were more often used, and in patients with DCMP, ring methods of annuloplasty of the tricuspid valve were used more often. At the same time, regardless of the etiology, ring annuloplasty techniques were used with more severe functional insufficiency of the TV in patients with a significantly more significant decrease in right ventricular contractility. Conclusion: in the study population, hospital mortality was higher in the CHD group than in the DCMP group. In DCMP, a more pronounced dilatation of the tricuspid valve annulus and the area of its opening were observed, however, the degree of severity of the functional insufficiency of the tricuspid valve in all respects does not depend on the etiology. In patients with DCMP, there is a significantly more pronounced violation of the geometry of the tricuspid valve annulus. In patients with coronary heart disease, suture repair methods are more often used, and in patients with DCMP, ring methods of annuloplasty of the tricuspid valve are used. Both in CHD and DCMP, ring plasty of tricuspid valve were used in cases of more severe functional insufficiency in patients with a significantly more decreased contractility of the left and right ventricles.

Predictor significance of β&lt;sub&gt;2&lt;/sub&gt;-microglobulinuria in determining the risk of cardiovascular complications in patients with chronic ischemic heart disease

BACKGROUND. The relevance of identifying new biomarkers of the cardio-renal syndrome in patients with coronary heart disease is beyond doubt. It is promising to study the indicators of tubular dysfunctions as predictors of the risk of cardiovascular complications in patients without primary kidney pathology.THE AIM. Analysis of the effect of β2-microglobulinuria on the prognosis of cardiovascular complications in patients with chronic ischemic heart disease in the long-term period after myocardial revascularization.PATIENTS AND METHODS. The study included 90 patients with coronary artery disease and indications for myocardial revascularization. Coronary bypass surgery was performed in 64 people, coronary artery stenting - in 26. Clinical and anamnestic data were collected in all patients, standard laboratory and instrumental diagnostics were performed. In addition, the level of β2-microglobulin (β2-MG) in the first morning portion of urine was determined at different study dates. The endpoint was considered to be the presence of acute forms of coronary heart disease - myocardial infarction and unstable angina. Survival after 5.8 ±0.1 years after myocardial revascularization was 69 %.RESULTS. A positive linear relationship of weak strength was established between the level of diastolic blood pressure (DBP) and β2-MG of urine obtained before myocardial revascularization (r = 0.28, p = 0.03). Moreover, the Kaplan-Meyer survival analysis showed the effect of an increase in β2-MG of urine over 0.2 ng/ml on the risk of AMI in the long-term period after myocardial revascularization (p = 0.025). It was found that an increase in the concentration of β2-MG in urine determined before myocardial revascularization is a statistically significant risk factor for the development of unstable angina in the long-term period after RM (χ2-criterion = 7.17, p = 0.007).CONCLUSION. It has been shown that an increase in the concentration of β2-MG in urine, reflecting the presence of tubular dysfunctions, can be considered as a predictor of an unfavorable cardiovascular prognosis in patients in the long-term period after myocardial revascularization.

PENERAPAN PROSEDUR TERAPI RELAKSASI BENSON DAN MUROTTAL AL-QUR’AN SURAH AR-RAHMAN AYAT 1-78 TERHADAP TEKANAN DARAH PADA PASIEN HIPERTENSI PRIMER DI RSUD UNGARAN

An increase in blood pressure that is not controlled will provide some further symptoms to organs such as the brain in the form of strokes, and heart in the form of coronary heart disease and hypertrophy. Benson relaxation and murottal Al-Qur'an surah Ar-Rahman ayat 1-78 is a nonpharmacological therapy that can reduce blood pressure in patients with primary hypertension so as to prevent further symptoms of hypertension. This case study aims is to discribe the application Benson relaxation and murottal Al-Qur'an surah Ar-Rahman ayat 1-78 to the reduction in blood pressure in patients with primary hypertension at RSUD Ungaran. The method of this study is descriptive. The subjects of this case study are two Moslem patients with hypertension who have no hearing problems. The data are collected through observation and measurement by using medical tools such as sphygmomanometer and stethoscope before and after the therapy. The result of this study shows that the blood pressure in subject I decreased blood pressure from 175/90 mmHg to 140/30 mmHg, while in subject II decreased blood pressure from 160/100 mmHg to 125/80 mmHg. The results of this case study reveal that the application Benson relaxation therapy and murottal Al-Qur’an surah Ar-Rahman ayat 1-78 shows the results of a decrease in blood pressure that is quite effective in patients with primary hypertension in RSUD Ungaran. Hopefully, Ungaran hospital can make Benson relaxation and Murottal Al-Qur'Aan relaxation surah Ar-Rahman ayat 1-78 as a basis for the development of nursing and companion of pharmacological therapy.

PENERAPAN PROSEDUR TERAPI RELAKSASI BENSON DAN MUROTTAL AL-QUR’AN SURAH AR-RAHMAN AYAT 1-78 TERHADAP TEKANAN DARAH PADA PASIEN HIPERTENSI PRIMER DI RSUD UNGARAN

An increase in blood pressure that is not controlled will provide some further symptoms to organs such as the brain in the form of strokes, and heart in the form of coronary heart disease and hypertrophy. Benson relaxation and murottal Al-Qur'an surah Ar-Rahman ayat 1-78 is a nonpharmacological therapy that can reduce blood pressure in patients with primary hypertension so as to prevent further symptoms of hypertension. This case study aims is to discribe the application Benson relaxation and murottal Al-Qur'an surah Ar-Rahman ayat 1-78 to the reduction in blood pressure in patients with primary hypertension at RSUD Ungaran. The method of this study is descriptive. The subjects of this case study are two Moslem patients with hypertension who have no hearing problems. The data are collected through observation and measurement by using medical tools such as sphygmomanometer and stethoscope before and after the therapy. The result of this study shows that the blood pressure in subject I decreased blood pressure from 175/90 mmHg to 140/30 mmHg, while in subject II decreased blood pressure from 160/100 mmHg to 125/80 mmHg. The results of this case study reveal that the application Benson relaxation therapy and murottal Al-Qur’an surah Ar-Rahman ayat 1-78 shows the results of a decrease in blood pressure that is quite effective in patients with primary hypertension in RSUD Ungaran. Hopefully, Ungaran hospital can make Benson relaxation and Murottal Al-Qur'Aan relaxation surah Ar-Rahman ayat 1-78 as a basis for the development of nursing and companion of pharmacological therapy

Levels IL-4, IL-8, TNF-α in middle-aged men with stented coronary arteries after repeated myocardial revascularization

Background. It has now been established that inflammatory cytokines are involved in all the stages of the development of coronary heart disease. It has been scientifically proved that the severity of coronary heart disease directly correlates with the increase in the level of proinflammatory cytokines, while data on the role of proinflammatory interleukin IL-8 and anti-inflammatory interleukin IL-4 are contradictory.&#x0D; The aim of the study was to evaluate the levels of proinflammatory cytokines (IL-8, TNF-) and anti-inflammatory interleukin (IL-4) in patients with various forms of coronary heart disease who underwent re-stenting of the coronary arteries.&#x0D; Materials and methods. By the method of enzyme-linked immunosorbent assay, the levels of cytokines were determined in 28 patients who had previously undergone myocardial infarction with stenting of an infarct-related artery, re-admitted due to the development of acute coronary syndrome, who underwent repeated stenting of coronary arteries. The same method was performed on 24 patients who also had previously undergone myocardial infarction with stenting of the infarction-associated artery, who were admitted to the clinic for staged stenting of the coronary arteries.&#x0D; Results. In patients with chronic coronary syndrome the levels of IL-4 a do not exceed the reference values, in patients with acute coronary syndrome the levels of IL-4 there was an increase 3,700,24 and 359,8066,94 pg/ml, р 0,001. In patients with chronic coronary syndrome the levels of IL-8 a do not exceed the reference values, in patients with acute coronary syndrome the levels of IL-8 there was an increase 7,341,29 and 69,7518,25 pg/ml, р 0,001.&#x0D; Conclusions. The increase in the level of IL-4 has a compensatory character and, along with a slight increase in TNF-, can be considered as a positive factor stabilizing the course of the disease.

Medical model of the diagnosis of multifocal atherosclerosis in patients with stable ischemic heart disease

Abstract Purpose To build a model according to which it would be possible to predict the presence of multifocal atherosclerosis (MFA) in patients with stable forms of coronary heart disease. Materials and results The study included 102 patients with exertional angina, (62 men (60.8%) and 40 women (39.2%), mean age 64.2±12.7 years. A search was carried out among the parameters of the local register of patients with coronary artery disease (385 items), which had the strongest relationship and influenced the presence of MFA. These turned out to be: chronic obstructive pulmonary disease (r=0.270 at p=0.006, F-criterion 5.169 at p=0.07), chronic kidney disease (r=0.330 at p=0.001, F-criterion 12.203 at p=0.001), level of the coefficient of variation of erythrocytes (RDW-CV) (r=0.228 at p=0.004, F-criterion 2.022 at p=0.015), leukocyte count (r=0.243 at p=0.016, F-criterion 6.329 at p&amp;lt;0.001), segmented neutrophils (r=0.231 at p=0.022, F-criterion 5.900 at p&amp;lt;0.001), eosinophils (r=0.336 at p=0.02, F-criterion 1.900 at p=0.002), C-reactive protein (r=0.431 at p=0.01, F-criterion 3.40 at p=0.002) increase in liver density in the form of steatosis or fibrosis according to ultrasound scanning data (r=0.427 at p=0.042, F-criterion 5.579 at p=0.022), level blood sodium (r=0.476 at p=0.011, F-criterion 4.723 at p=0.011). The following parameters were combined into one integral model using the linear modeling method: RDW-CV, leukocyte count, segmented neutrophils, eosinophils, total blood cholesterol, increased liver density according to ultrasound scan data in the form of steatosis or fibrosis and chronic obstructive pulmonary disease. The F-criterion of the full model was 4.8, the coefficient of determination R2=0.407; R2&amp;gt;0.3, significance level p=0.02. Thus, the resulting medical and mathematical model was generally acceptable. The threshold values of indicators were determined using the method of classification trees. This model visualized that the diagnostic levels of the scale values were: cholesterol level – 6.27 mmol/L, RDW-CV – 16.0%, neutrophils – 50%, eosinophils – 6%, leukocytes – 8.9%. In addition, the decision tree. shows that in individuals with cholesterol levels less than 6.27 mmol/l, without an increase in liver density according to ultrasound data, no obstructive pulmonary disease/RDW-CV level is less than 16%, only 1 patient had MFA, versus 24 patients who had cholesterol levels less than 6, 27 mmol/l, had an increase in liver density according to ultrasound, and the level of inflammatory granulocytes: neutrophils above 70%, eosinophils above 6% against the background of the total number of leukocytes 8.9x109 (l). In individuals with a GC above 6.27 mmol/L, MFA was observed in 14 people (100%) Funding Acknowledgement Type of funding sources: None. Diagnostic model

Effect of type 2 diabetes mellitus and mutations of the cyp2c19 gene on the platelets functional activity of patients with ischemic heart heart disease

Abstract Goal To establish sensitivity to clopidogrel in carriers of various G681A alleles of the CYP2C19 gene on the basis of a comprehensive assessment of platelet hemostasis. Materials and methods We examined 120 patients with various forms of coronary heart disease (CHD), including: 60 patients with acute coronary syndrome (ACS), 60 patients with chronic coronary syndrome (CCS). All patients were treated with clopidogrel. Results Genotyping of patients revealed that 73.3% of the examined cohorts of patients with ACS and 86.4% of patients with CCS were dominated by the native genotype G/G. In the cohort of patients with ACS, the degree of spontaneous platelet aggregation (SPA) among patients with G/A-A/A genotype exceeded the control values by 4.6 times (p&amp;lt;0.001). When compared with the corresponding indicator in patients with G/G genotype, it was found that the presence of a mutated A-allele had no significant effect on the increase in SPA (OR=2,450; 95% CI: 0.462–12.982; p=0.480). The degree and rate of arachidonic acid (AA)-induced platelet aggregation was significantly lower than the control values in all subgroups, but did not differ between subgroups of patients with different polymorphisms (OR=0.625; 95% CI: 0.065–6.090; p=0.912). Studying the degree and rate of ADP-induced platelet aggregation did not reveal statistically significant changes either in comparison with the control group or in the intergroup analysis. There was also no significant association between CYP2C19 gene polymorphisms and the degree of ADP aggregation (OR=0.795; 95% CI: 0.216–2.928; p=0.983). In patients with stable CHD, despite the use of clopidogrel in all patients, the level of SPA was significantly higher than the control values and depended on the polymorphism of the CYP2C19 gene. To evaluate the effect of diabetes on the effectiveness of inhibition of platelet functional activity by clopidogrel in carriers of different allelic variants of the CYP2C19 gene, we compared the G/G and G/A-A/A genotypes. The group of isolated coronary heart disease consisted of 48 patients with G/G genotype (80%) and 12 patients with mutated A-allele (20%). Patients with pathology of carbohydrate metabolism were distributed as follows: 47 patients had G/G genotype (78%), and 13 - G/A-A/A (22%). It was found that when carrying the G/A-A/A genotype, the intergroup difference was 72.6% (57.65 [49.34; 67.8] vs. 33.4 [32.47; 37.99], p&amp;lt;0.01). The chance of encountering a high degree of ADP-induced aggregation among carriers of the A-allele of the CYP2C19 gene with diabetes was almost 17 times significantly higher than the group of patients with isolated coronary heart disease (OR=16,667 (2,273–122,218), p=0.009). Conclusion The data obtained in our study showed that the patients with CHD and concomitant diabetes mellitus who had a mutated A-allele CYP2C19 gene was less sensitive to clopidogrel, which was manifested in a higher degree of ADP-induced platelet aggregation. Funding Acknowledgement Type of funding sources: None.

Эффективность амбулаторного лечения артериальной гипертензии через призму качества жизни и гемодинамический фенотип пациентов

Актуальность. Эффективность амбулаторного лечения артериальной гипертензии (АГ) как совокупный результат — достижение целевого уровня артериального давления (АДцел) и приемлемый уровень качества жизни (КЖ) пациентов, а также влияние на него гемодинамического фенотипа, определяемого оригинальным методом количественного анализа связей параметров артериального давления (КАСПАД), не исследованы, что явилось целью данной работы. Материалы и методы. Обследованы 175 амбулаторных пациентов с АГ, средний возраст 60,0 (52,0–70,0) года, получавших длительную (3–12 лет) стандартную терапию антигипертензивными препаратами из основных групп лекарственных средств (ЛС). Оценивалось КЖ по русскоязычной версии опросника RAND-36; для определения гемодинамического фенотипа по КАСПАД использованы индивидуальные ряды величин АД (не менее 25), полученные при ежедневных домашних измерениях за 2–4 недели; проведен статистический анализ клинических и демографических признаков, их связей с КЖ и фенотипами. Результаты. Значимое ухудшение КЖ (физический компонент и общий уровень) отмечено с увеличением возраста, степени и кардиоваскулярного риска АГ, особенно при наличии хронических форм ишемической болезни сердца. КЖ у пациентов, не достигших АДцел, значимо ниже по большинству параметров, чем у достигших его лиц. Увеличение количества принимаемых ЛС сопряжено со снижением КЖ у лиц, достигших АДцел. Пациенты с гемодинамическим фенотипом D, независимо от фармакологической группы принимаемых ЛС и их количества, значимо реже достигают АДцел по сравнению с лицами с фенотипом H, а также имеют более низкое КЖ, еще более снижающееся при интенсификации медикаментозной терапии. Ингибиторы ангиотензинпревращающего фермента (ИАПФ) и блокаторы кальциевых каналов (БКК) были эффективны для достижения АДцел, в основном у пациентов с фенотипом H, но негативно влияли на КЖ: ИАПФ — при фенотипе H, БКК — при D. Бета-адреноблокаторы и диуретики существенно не влияли на КЖ. Предложена статистическая модель прогноза низкого общего уровня КЖ у пациентов с достигнутым АДцел на основе 5 клинико-демографических факторов. Выводы. Эффективность лечения АГ целесообразно оценивать по совокупности достижения АДцел и общего уровня КЖ не менее 60 баллов (по RAND-36). При назначении лечения следует учитывать гемодинамический фенотип: медикаментозную терапию всех пациентов с фенотипом D, а также лиц с фенотипом H при низком КЖ и недостигнутом АДцел необходимо дополнять комплексной реабилитацией с использованием немедикаментозных методов.

ASSOCIATION OF SERUM LACTATE LEVELS WITH CREATINE KINASE – MB AND LACTATE DEHYDROGENASE IN PATIENTS WITH MYOCARDIAL INFARCTION

Objectives: Myocardial infarction is the most common form of coronary heart disease, the commonest cause of worldwide mortality. The present biochemical markers take atleast 6 hours for elevation following an episode of myocardial infarction. There is a need for sensitive marker for early diagnosis and prognosis. Lactate, the end product of anaerobic glycolysis is found to be elevated in many critical illnesses. Thus the study was undertaken to assess the levels of serum lactate in patients with myocardial infarction and to correlate it with the frequently used enzymatic markers for the diagnosis of myocardial infarction, i.e creatine kinase – MB and lactate dehydrogenase Methods: Fifty age and sex matched controls and fty cases of myocardial infarction were included in the study. Serum creatine kinase – MB, lactate dehydrogenase and lactate were estimated in these subjects. Results:The serum lactate levels were signicantly higher among cases when compared to controls. The serum lactate levels positively correlated with serum creatine kinase – MB among cases but not with lactate dehydrogenase. Conclusions: We conclude that serum lactate is altered in patients with myocardial infarction and may be considered as a prognostic risk factor in these patients. Further studies are needed to nd the cut-off value of serum lactate for assistance in the hemodynamic management of these patients.

Attitude to the health in the open population of a medium-urbanized city of Western Siberia, association with the prevalence of CHD: gender features

The validity of the use of a subjective-objective indicator of health as a significant indicator of its association with the prevalence of coronary artery disease is shown in both domestic and foreign scientific literature. At the same time, the subjective-objective indicator of health, and first of all, the attitude to one's health, is recognized as an indicator of a lifestyle that establishes the interpretation of conventional risk factors for coronary artery disease and interest in preventive measures at the population level. Purpose: to determine the attitude towards one's health in the age range and in groups with and without coronary artery disease in an open population of a medium-urbanized city of Western Siberia in terms of gender. Material and methods. Cross–sectional studies were carried out in the framework of two cardiac screenings on unorganized subpopulations of men and women 25–64 years old in Tyumen (with responses 85.0 and 70.3 %, respectively). The isolation of various forms of coronary heart disease was carried out on the basis of standard epidemiological methods, the comparison group was defined as the absence of coronary heart disease. The attitude of the population to their health was established using a rigidly standardized WHO questionnaire MONICApsychosocial «Knowledge and attitude to the health». Results. In the open population of a moderately urbanized city of Western Siberia, with a predominance among women, a low level of attitude towards their health was established, the prevalence of low responsibility for their health in the gender aspect took place in the third, fourth and sixth decades of life. Negative attitudes towards their health among persons of both sexes were determined mainly in groups with CHD; in women, the tendency towards a decrease in responsibility for their health was more pronounced than in men. Conclusion. When planning a preventive program for the population of a medium-urbanized city of Western Siberia, taking into account the priority impact on the subjective-objective indicator of population health, the implementation of the population strategy will probably not be enough. Taking into consideration the obtained regularities of the growth of negative attitudes towards their health among women, especially in groups with the presence of coronary heart disease, along with the population strategy, it would be optimal to use a high-risk strategy.

Оцінка повздовжньої деформації лівого шлуночка і її зміни при інфаркті міокарда та ішемічній хворобі серця з обструктивним ураженням коронарних артерій

The review provides data on a new method of ultrasound diagnostics – speckle tracking echocardiography in the diagnosis of myocardial infarction and coronary heart disease with obstructive coronary artery lesions, the advantages of the global longitudinal strain (GLS) compared to the existing echocardiographic indicators of global systolic and segmental systolic function. The value of measuring GLS in coronary heart disease is the quantitative detection of wall motion abnormalities, when left ventricular ejection fraction is within normal values and visual assessment does not detect violations of regional contractility. In patients with myocardial infarction without ST-segment elevation, GLS measurement may assist in the selection of patients who need urgent reperfusion therapy. In coronary heart disease, GLS can complement the conventional assessment of wall movement; replace the need for additional non-invasive testing for some patients with suboptimal stress tests. The normal limits of the GLS for various manufacturers of ultrasound scanners and technical characteristics for the correct studying of the GLS are described. The value of the GLS gradually decreases in mild, moderate and severe forms of coronary heart disease, and is the lowest in patients with myocardial infarction with ST segment elevation. The possibilities of detecting infarct-related coronary artery using the amplitude of the segmental strain and the «bull’s eye» diagram in isolated lesions of one of the coronary arteries are described. The analysis of the strain curves is carried out, the characteristics of the strain curve in normal conditions and in ischemia are presented. The probable signs of ischemia are the phenomena of early systolic lengthening and postsystolic shortening on the curves of longitudinal deformation. The conditions when the postsystolic contraction on the strain curve is pathological are described. Key words: global longitudinal strain, myocardial infarction, ischemic heart disease, «bull’s eye», early systolic lengthening, postsystolic shortening.

Treatment of Complicated Coronary Heart Disease after Successful Prehospital Resuscitation in a Public Place

The current problem of modern medicine is the lack of public awareness about personal health, late diagnosis of diseases, untimely prehospital care and treatment of existing complications. This applies to all branches of medicine, especially cardiology and cardiac surgery. Coronary heart disease occupies one of the leading places in the structure of mortality due to cardiovascular diseases. This is mainly due to the fact that patients seek medical care with complicated forms of coronary heart disease like sudden cardiac death, cardiac arrhythmia (ventricular fibrillation, AV blockade, sinus bradycardia and tachycardia), formation of left ventricular (LV) aneurysm, LV free wall rupture and LV false aneurysm, mitral regurgitation. In such cases, all actions must be early, staged, well established, and concordant with clear algorithm.&#x0D; The aim. To demonstrate our clinical case as an example of proper logistics, rapid response and timely surgical treatment of complicated forms of coronary heart disease.&#x0D; Clinical case. Patient F., born in 1964, was admitted to the clinic on March 24, 2021 with a diagnosis of coronary heart disease: acute non-Q-wave myocardial infarction of the posterolateral LV since March 22, 2021. Clinical death with successful resuscitation at the prehospital stage (03/22/2021). Ventricular fibrillation (03/22/2021). Multivessel coronary artery disease. Mitral valve regurgitation grade II-III. Tricuspid valve regurgitation grade I-II. Pulmonary hypertension grade I. Hypertensive disease grade III, degree 3, risk 4 (very high). Heart failure II A with a moderately reduced LV ejection fraction (47%). NYHA3. Closed chest injury (03/22/2021): fracture of the ribs without displacement: ribs 4-8 on the left, ribs 4-8 on the right. He considers himself ill since March 22, 2021, when he suddenly felt severe pain in his chest and fell unconscious. According to witnesses, the man got out of the subway and fell unconscious, without breathing and pulse. Due to the presence of defibrillators at the subway station, successful resuscitation was conducted by police officers before the ambulance crew arrival. Clinical and instrumental studies were performed after hospitalization. The patient was taken to the operating room on 03/24/2021 at 5:30 PM, 50 minutes after admission to the National Amosov Institute, Kyiv. Urgent off-pump coronary artery bypass grafting of 3 coronary arteries was performed. A cardioverter-defibrillator was implanted due to the history of clinical death and the conclusion of daily ECG monitoring. The intra- and postoperative period was uneventful, the patient was discharged in satisfactory condition for rehabilitation.&#x0D; Conclusions. Our clinical experience shows that timely prehospital care, proper logistics and surgical correction of coronary heart disease not only saves but also significantly improves the quality of life of the patient in the future.

DIAGNOSIS OF ACUTE CORONARY SYNDROME IN PATIENTS WITH CONGENITAL ANOMALY OF CORONARY ARTERIES

The article highlights the issues of terminology, prevalence, diagnosis, clinical manifestations, and the therapy of patients with congenital anomalies of the coronary arteries. Special attention is paid to the current state of the problem of congenital coronary artery anomalies and their in coverage in the relevant literature. Anomalies of the coronary arteries can cause the development of acute coronary syndrome and then lead to disability of the employable population. The aim of thus study was to analyze and compare clinical manifestations in coronary artery anomalies and angiographic changes of coronary arteries in order to improve the diagnosis of acute forms of coronary heart disease, and namely, acute coronary syndrome. We underscored the clinical significance of invasive diagnosis of coronary artery abnormalities using coronary angiography. We represented detailed analysis of the clinical case of an atypical course of acute coronary syndrome, accompanied by cardiac symptoms supported with changes on the electrocardiogram. Coronary angiography revealed a myocardial muscle bridge, which compressed the trunk of the left coronary artery during the systole, thus significantly reducing coronary artery diameter and provoking an attack of chest pain. Modern diagnostic methods enable to assess not only the condition of the coronary arteries, but also the features of their topography, and, in particular, in the myocardium.

Sudden death from diseases of the system of the blood circulation in workers of enterprises of various industries of the economy of the Republic of Bashkortostan

Introduction. In Russia and abroad, there has been a clear trend towards an increase in cases of sudden death in the workplace from circulatory system diseases over the past decade. Materials and methods. During the study, the databases of the State Labor Inspectorate in the Republic of Bashkortostan for 2014-2018 were studied, including accident investigation reports, information on a special assessment of working conditions, medical examinations, forensic medical examinations, and other materials. Results. The leading cause of sudden death in the workplace in more than 90% of cases were circulatory system diseases (CSD). The maximum number of cases of sudden death from CSD was recorded in the age group of 56-60 years. Working condit ions represented the overwhelming majority of the deceased - 82.8%. In 13.7% of cases, they were drivers of transport. The vast majority of deaths occurred in the morning (from 6 to 12) and daytime (from 12 to 18). The working conditions of workers from deceased CSD in most cases (59.8%) corresponded to the permissible class (class 2); under harmful conditions (subclass 3.1-3.3), 24.9% worked. Most often, some form of acute coronary heart disease (CHD) was mentioned as the immediate cause of death (64.0%). Among acute forms of coronary heart disease in medical documents, in more than 50% of cases, code I 24.8 “Other forms of acute coronary heart disease” was established. “Acute myocardial infarction” was verified in 11.1% of patients and was the leading cause of death in men. In the group “Cerebrovascular Diseases,” “Intracerebral hemorrhage” was most often diagnosed. Conclusion. The obtained results substantiate the need to develop measures to prevent sudden death in the workplace, aimed primarily at preventing the development, progression, and early diagnosis of diseases of the circulatory system.