Functional Parameters Of Myocardium Research Articles

Assessment of morphological and functional parameters of myocardium in patients with coronary artery disease and overt primary hypothyroidism

Aim. To evaluate the morphological and functional parameters of the myocardium in patients with coronary artery disease (CAD) and concurrent overt primary hypothyroidism, as well as to identify possible relationships between these parameters and levels of thyroid hormones.Methods. 344 patients with CAD who had verified classes 1-3 stable angina pectoris using the clinical guidelines were recruited in a study [6]. 100 patients with CAD and concurrent primary hypothyroidism were enrolled in the study group. 244 patients with CAD were enrolled in the comparison group. Severity of stenosis in one- and/ or two- and/or three-vessel disease were measured in all patients. A comparative assessment of biochemical parameters and echocardiography was performed. A single-stage cross-sectional comparative analysis of the studied parameters was performed. The presence of any relationships of thyroid hormones with morphological and functional parameters of the myocardium were determined. The correlation analysis reported the relationships between diastolic dysfunction, left ventricular ejection fraction and thyroid-stimulating hormone levels in patients with CAD and concurrent hypothyroidism.Results. Statistically significant differences in lipid profile, glucose levels, glycated hemoglobin, and glomerular filtration rate were found. Three-vessel disease prevailed in both groups, but the prevalence of three-vessel disease was higher in the study group (CAD and hypothyroidism) than in the comparison group (p<0.01). Echocardiography assessment reported the differences in the levels of E/a (p = 0.02), E/E` (p = 0.001), and LVEF (p = 0.001) between the study groups.Conclusion. Patients with coronary artery disease and concurrent overt primary hypothyroidism demonstrated worse dyslipidemia parameters, glycemic indicators and impaired glomerular filtration rate. Three-vessel disease prevailed among patients enrolled in the study. The relationship between TSH and myocardial morphological and functional parameters was determined. Obtained data can be used for assessing the prognosis in this group of patients.

Хроническая сердечная недостаточность на фоне ревматоидного артрита: роль воспаления в изменении уровня предсердного натрийуретического пептида и показателей липидограммы

The aim of the research is the analysis of basic clinical laboratory and instrumental parameters of patients suffering from CHF with intermediate left ventricular ejection fraction (LEF), developed as a result of ischemic heart disease and arterial hypertension associated with RA compared to patients without RA; assessment of indicators of morphological and functional parameters of myocardium and possible associations with indicators of RA inflammation activity. Material and methods. The study group included 134 patients with HFFV associated with RA; the comparison group was of 122 patients with HFFV without RA. CHF functional class of patients who took part in the study according to NYHA I-II. RA was diagnosed based on X-ray and serological studies, which included determination of rheumatoid factor (RF), antibodies to cyclic citrullinated peptide (ACCP), C - reactive protein (CRP). Inflammatory process activity was assessed by DAS28 index and visual analogue pain scale (VAS). X-ray RA stage included the studied I-III patients according to Steinbrocker classofication. CHF treatment medications were compared in groups. The basic anti-inflammatory medication for RA treatment is methotrexate. Patients who did not take methotrexate due to side effects and / or individual intolerance took leflunomide at a dosage of 20 mg per day. Moreover, NSAIDs were used (enterally, parenterally, locally). Hematological, biochemical and instrumental studies were carried out. The processing was carried out in STATISTICA 10.0 program. The work presents statistically significant results. The critical level of significance when testing statistical hypotheses is p <0.05. Results. Comparative analysis revealed statistically significant differences in the levels of ESR and CRP, with a predominance of values in the study group, which naturally reflects the intensity of inflammatory process. Furthermore, statistically significant differences in the levels of creatinine and GFR were revealed. It can be due to the influence of chronic inflammation and regular intake of NSAIDs. In the group of patients with CHF on the background of RA, statistically significant decrease in hemoglobin level was found. Statistically significant predominance of TG, LDL-C concentration, as well as a decrease in HDL-C in the study group in relation to the comparison group were obtained. Statistically significant predominance of atherogenic coefficient was revealed in the study group. NT-proBNP concentration in the study groups differed significante: in the group of patients with CHF associated with RA, the level was 306.7 (225; 391) pg / ml; in the CHF group without RA - 488.7 (355; 638) (p = 0.02). A direct association of the DAS28 index and NT-proBNP was found (r = 0.04; p = 0.02). Conclusion. Patients with CHF associated with RA are reasonably recommended to increase the dosage of statins with more frequent monitoring of lipid profile. An assessment of NT-proBNP level is required for more detailed assessment of morphological and functional parameters of myocardium.

Galectin-3 - a modern biomarker for the diagnosis of left ventricular hypertrophy and chronic heart failure and control of treatment of patients with hypertension

The development of new methods for the prevention and treatment of chronic heart failure and its control is an urgent medical and social problem. In this regard, using of new biological markers of the disease may be useful for early diagnosis of the disease, predict a clinical course, monitor the effects of pharmacotherapy (personalized medicine) and play an important role in stratifying the patient's risk. In 2013, according to the recommendation of the American Heart Association, a galectin-3 was introduced into the pool of such biomarkers for prevention and treatment of chronic heart failure. Objective: to improve prediction of the course and effectiveness of the therapy for hypertension and chronic heart failure as the hypertension complication in men 40-60 years old by applying the level of galectin-3 as a biomarker. There were observed the men 40-60 years old with hypertension and chronic heart failure for the concentration of galectin-3. Also, there were observed subjects without cardiovascular pathology (n=79), the men with hypertonic disease with myocardial hypertension (n=62) and the men with chronic heart failure II-III functional class of NYHA (n=50) for the indicators of central and systemic hemodynamics. The level of galectin-3 was determined by immunoassay analysis on the equipment "Stat Fact 300". Structural and functional parameters of myocardium were assessed by an ultrasound method using the equipment "RADMIR ULTIMARA". Data statistical analysis was performed on a personal computer using standard statistical package "Statistica 10.0". All data is presented in the form of average (M) and standard deviation (± σ). It has been established that the concentration of galectin-3 significantly decreases against the background of treatment. The level of galectin-3 in the patients with the II stage of hypertonic disease with good treatment effect was close to normal values compared to those with moderate treatment effect. In terms of patients with hypertension III stage, the level of galectin-3 also decreased, indicating the possibility of therapy monitoring using this biomarker. The mathematical model of the galectin-3 influencing factors also has been determined in patients with hypertension. The boundary level of the galectin-3 has been calculated, it is counted 46.51 pg/ml. It might be assumed a moderate effect of the treatment of hypertensive patients and chronic heart failure in males.

Galectin-3 as the marker of hypertrophy and myocardial dysfunction in males with essential hypertension, carriers of polymorphic genes of angiotensin ii type 1 receptor

One of the main etiological causes of development of heart failure is essential hypertension. The diagnosis of heart failure is usually made on the basis of comprehensive analysis of medical history, sonographic and biochemical examination. Normal ejection fraction does not exclude dyspnea of cardiac origin. Objective: to determine the role of galectin-3 as a marker of structural and functional changes of the myocardium in males with essential hypertension and CHF, carriers of polymorphic AT1R genes, residents of Podillya region of Ukraine. In this contingent, the surveyed were studied сoncentrations of galectin-3 and brain natriuretic peptide (BNP), parameters of central and systemic hemodynamics in carriers of polymorphic variants of angiotensin II type 1 receptor gene (АТ1R) - individuals with no cardiovascular pathology (n=79), male patients with II-III degree essential hypertension (EH) and hypertrophy of the myocardium (n=62), and essential hypertension (n=50) complicated by chronic heart failure (CHF), residents of Podillya region of Ukraine, were studied. Genotyping of АТ1R gene was performed using polymerase chain reaction. Galectin-3 and brain natriuretic peptide levels were determined by enzyme immunoassay. Structural and functional parameters of myocardium were assessed by ultrasound using the apparatus “RADMIR ULTIMARA”. Statistical analysis of the results obtained was done on personal computer using standard statistical package Statistica 10.0. The data are represented as mean values (M) and standard deviations (±m). Carriers of C allele of angiotensin II type 1 receptor gene were found to be dominating among the males with essential hypertension and resultant myocardial hypertrophy. Concentrations of galectin-3 and brain natriuretic peptide were significantly higher in men with essential hypertension and essential hypertension associated with chronic heart failure, as compared to those with no cardiovascular diseases, as well as the carriers of C allele of angiotensin II type 1 receptor gene. It was found that concentrations of study biomarkers were higher in individuals with severe and eccentric left ventricular hypertrophy, as well as in those with decreased ejection fraction of the left ventricle. Therefore, those biomarkers can be used in complex diagnosis of left ventricular hypertrophy in essential hypertension and the development of chronic heart failure in such patients.

IMMUNOREGULATORY IMBALANCE AND FUNCTIONAL STATE OF THE HEART IN THE PATIENTS WITH DIABETES MELLITUS TYPE 2

Diabetes mellitus type 2 is one of the most important non-infectious diseases in the modern world, being an important risk factor of cardiovascular disorders. Changes in left ventricular myocardial diastolic function are observed in diabetic patients independently from other comorbidities. Etiology of the heart failure during diabetes mellitus type 2 is multifactorial, exhibiting cellular, molecular and metabolic aspects. However, its pathophysiological mechanisms are not completely understood. The aim of this study was to evaluate numbers of inflammatory T lymphocytes, i.e., T helper type 1 (Th1) and T helper type 17 (Th17) cells, and FoxP3+T regulatory lymphocytes, depending on the functional state of the heart assessed by two-dimensional echocardiography in patients with arterial hypertension and diabetes mellitus type 2. A total of twenty-five patients with a combination of arterial hypertension and diabetes mellitus type 2, and 14 patients with arterial hypertension without carbohydrate disturbances were recruited to a cross-ectional case-control study. All the patients underwent echocardiography with transthoracic access at the M-mode, B-mode and Doppler mode of imaging. We evaluated numbers of Th1 and Th17 lymphocytes by intracellular production of IL-17 and IFNγ by CD4+ lymphocytes, respectively. The numbers of FoxP3+T regulatory lymphocytes were estimated by expression of CD25 and FoxP3 transcription factor. A flow cytometry approach was used in both cases. We revealed some correlations between the numbers of Th17 lymphocytes, FoxP3+T regulatory lymphocytes and functional parameters of myocardium in patients with diabetes mellitus type 2, which were absent in patientswithout carbohydrate impairments. The numbers of FoxP3+T egulatory lymphocytes, Treg/Th17 lymphocyte ratio, and mean fluorescence intensity of IL-17 for Th17 cells was lower in patients with diabetes mellitus and diastolic dysfunction compared to the patients with diabetes free of diastolic dysfunction. Association of diastolic dysfunction with diabetes mellitus type 2 was accompanied by increase of IFNγ+Th1 lymphocyte numbers and concentrations of IL-10, IFNγ and TNFα in serum as compared to the patients with diastolic dysfunction in the absence of carbohydrate metabolism disturbances. The diabetic patients with diastolic dysfunction were characterized by hyperinsulinemia, hyperglycemia, higher index of insulin resistance, increase of waist circumference and visceral adiposity index when compared to the patients with diastolic dysfunction without diabetes. Visceral obesity and decrease of insulin sensitivity may be regarded as pathogenetically significant factors for the development of immune regulatory imbalance and diastolic dysfunction in the patients with diabetes mellitus type 2.

Polymorphism of the second type angiotensin II receptor’s gene in women with essential hypertension and the corresponding features of structural and functional parameters of myocardium

Objective. To improve the diagnosis of predisposition to Essential arterial hypertension (EH) and Chronic heart failure (CHF) in postmenopausal age’s women by determining the polymorphic genotypes of the first type angiotensin II receptor’s gene (AT1-R) and the corresponding structural and functional state of myocardium. Materials and methods. The study involved 180 women of postmenopausal age, they were residents of Podillya Region of Ukraine. 80 women without signs of cardiovascular diseases were the control group, 100 women with EH included the main study’s group. Genotyping of AT1-R was carried out using the polymerase chain reaction. The distribution of the frequencies of genotypes AT1-R was checked in accordance with the Hardy–Weinberg equilibrium law. The structural and functional parameters of myocardium were evaluated using an echocardiography. The left ventricular’s systolic function was preserved in cases where the left ventricular’s ejection fraction was more than 40 %. Mathematical processing was performed using the standard statistic package Statistica 6.0. Results. In patients with EH genotype AC was detected most often (49 %), AA and AC genotypes weer determined in 40 % and 11 % of patients (Р АА-СС ≤ 0.05, Р АС-СС ≤ 0.05) respectively. Carrying allele C of the AT1-P gene was associated with a higher probability of future occurrence of CHF in patients with EH, more significant structural disorders of myocardium and disturbances of systolic and diastolic functions of left ventricle (LV) such as pseudonormal and restrictive types. Conclusions. Allele C associates with the presence of EH and a greater probability of occurrence of CHF in postmenopausal women, residents of Podillya Region, more pronounced disturbances in the structure of myocardium, with diastolic and systolic dysfunctions of LV. Developed mathematical models help to determine approximately the structure of AT1-R according to the parameters of cardiac hemodynamics in the case of impossibility of laboratory investigation.

Analysis of correlation between the indicators of myocardial dyssynchrony and structural and functional parameters of myocardium

Посилення дисинхроніїсерця сприяєзбільшенню кінцевих систолічних та діастолічних розмірів й об'ємів, росту маси міокарда лівого шлуночка та його індексу, потоншанню стінки лівого шлуночка, росту ударного об'єму, ударного індексу, хвилинного об'єму, серцевого індексу,а також зменшення фракції викиду та ступеня вкорочення передньозаднього розміру в систолу

Evaluation of myocardial muscle functional parameters in patients with multiple sclerosis.

Structural and functional parameters of myocardium were evaluated with 2D+ Doppler echocardiography in two similar age groups of MS patients: S1: 12 subjects in 3-4 Degrees EDSS (Expanded Disability Status Scale), S2: 12 subjects in 5-7 degrees EDSS. The control group comprised 12 healthy subjects temporarily (at least 1 month) immobilized due to lower limb fractures. Investigations were performed in the supine position and 3 min after tilting to the erect position. Symptoms of organic myocardial injury which might have caused its insufficiency were not observed in any subjects. All structural parameters evaluated by this method did not differ significantly in the examined groups. Symptoms suggesting myocardial insufficiency were found in patients from group S2. Statistically significant decrease of ejection fraction (EF) and cardiac output (CO) was observed in the supine position of S2 patients as compared to S1 and the controls. These symptoms intensified in the erect position in S2 patients and they were accompanied by the decreased values of stroke volume (SV). The fact that in the majority of patients orthostatic hypotonia was not observed and that those disorders were not compensated by significant intensification of heart rate suggest to us that besides disorders resulting from autonomic nervous system dysfunction they may have been caused by secondary myocardial injury in the course of MS.