Hours Of Myocardial Infarction Research Articles

Use of metformin in patients with type 2 diabetes and acute myocardial infarction: safety and impact on glycemic control

Myocardial infarction (MI) in patients with diabetes type 2 (T2DM) occurs 1.5-3.0 times higher than in general population. Metformin is contraindicated for patients with T2DM and acute coronary syndrome due to the risk of developing lactic acidosis. Using metformin more than 48 hours of MI is a topical question, which will help to improve patient's safety. To evaluate the safety and quality of glycemic control using metformin in patients with T2DM during inpatient treatment for MIMATERIALS AND METHODS: The study included 161 patients with T2DM, who were hospitalized consecutively with acute MI with ST-elevation and underwent percutaneous coronary intervention (PCI). Average time of metformin initiation was 5th day from admission. Creatinine was assessed at admission and 48 hours after PCI. The acid-base balance and lactate were assessed at admission and on the 3rd day after the start of using metformin. Criteria for the effectiveness of glycemic control was the proportion of glycemic measurements in target range of 6.1-10.0 mmol/l during hospitalization ("hospital time in range", hTIR). hTIR >55% was considered to be a critical level. The long-term outcome was estimated at 365 days after hospitalization. Metformin was prescribed to 99 patients (61%) ("M+"group) during the hospitalization, 62 patients were in "M-"group. Use of metformin was accompanied with better glycemic control in the «M+» group compared to the «M-»: mean glycemia 9.3 ± 1.6 vs 10.3 ± 2.3 mmol/l (p=0,002), SD 2.87 ± 1.1 vs 3.26 ± 1.8 (p=0,049), hTIR 60 ± 18% vs 48 ± 23% (p<0,001). There were clinically insignificant changes in acid-base balance on the 3rd day from the start of metformin use in the "M+" group, the lactate level did not increase. Use of metformin before to hospitalization with MI was not associated with an increased risk of developing acute kidney injury (AKI): RR 0.85 (0.37-1.96), p=0,691. Use of metformin in patients with T2DM and acute MI is associated with better glycemic control. Carrying out angiography in patients, treated with metformin before the hospitalization, is not accompanied by an increased risk of developing AKI. Appointment of metformin in 3-7 days after angiography does not lead to an increase level of lactate and significant deviations in acid-base balance.

К ВОПРОСУ ОБ ОСОБЕННОСТЯХ КАЧЕСТВА ЖИЗНИ МУЖЧИН МОЛОЖЕ 60 ЛЕТ С НАРУШЕНИЯМИ МОЧЕИСПУСКАНИЯ В ОСТРЫЙ И ПОДОСТРЫЙ ПЕРИОДЫ ИНФАРКТА МИОКАРДА

Relevance. Changes in the quality of life associated with heart failure (HF) in young and mid-dle-aged men with urological pathology and myocardial infarction (MI) are not well under-stood. Aim. To evaluate changes in the quality of life (QL) indicator associated with heart failure (HF) in men under 60 years old with MI and acute urinary retention (AUR) to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with type I MI. Patients are divided into two age-comparable groups: I - the study group, with AUR - 22 patients; II - control, without it - 633 patients. A comparative analysis of the QL indicator associated with HF (HFQL) (V. Ironosov) was performed in the selected groups in the first 48 hours (I) and at the end of the third week (II) of MI. The changes and correlations (C. Spearmen) of HFQL with clinical features, metabolic parameters, central and peripheral hemodynamics were studied. Results. HFQL in patients with AUR (85.7±15.6%) was worse than in the control group (59.4±20.1%; р˂0.0001) in the first hours of MI. At the end of the third week of the disease, no differences between the groups were observed (24.3±11.9 and 18.6±11.9%, respectively; p = 0.06). A positive (72 and 69%) dynamics of HFQL were obtained from the first hours to the end of the subacute MI period in both patient groups (р˂0.0001). In the study group, signifi-cant correlations of HFQL with the size of the left heart chambers, parameters of left ventricle systolic and diastolic function, peripheral hemodynamic, and lipid metabolism parameters were revealed. In the control group, more correlations were found, but their strength was less. Conclusions. The quality of life associated with HF is worse in patients with AUR during the first hours of MI. Dilatation of the left heart chambers, left ventricle systolic and diastolic dys-function, no history of arterial hypertension, and hypocholesterolemia were the most associat-ed with quality of life in the study group. The assessment of HF-related quality of life is use-ful as an adjunct to the examination of patients with MI, starting from the first hours of the disease, for early identification of risk groups for adverse events and chronic HF formation.

Abstract P3078: Stress-induced Early Recruitment Of Neutrophils To The Infarcted Hearts Influence Cardiac Outcomes.

Myocardial infarction (MI)-induced heart failure is one of the leading causes of death in the modern world. This is in part due to abnormal cardiac remodeling, instigated by a large influx of neutrophils immediately following MI. These activated neutrophils in the heart release a plethora of proteolytic enzymes and exacerbate tissue injury leading to cardiac failure and death. The role of neutrophils during MI is complex with the intensity and duration of their residency dictating the ensuing remodeling process. We have previously shown that the recruitment of neutrophils to heart post-MI is mirrored by an increased proliferation of progenitors (granulopoiesis) in the bone marrow (BM). However, the increase in the number of neutrophils at the infarct begins much earlier (&lt; 6 hours post MI) than the peak granulopoiesis (24 hours post-MI) in the BM. These finding suggest that sources other than granulopoiesis may contribute heavily to the initial neutrophil burden of the heart. One such source is the marginated pool. In the circulation, the marginated pool of neutrophils represents the same size as that of the circulating pool. We hypothesize that “ demargination of neutrophils from the vascular wall contribute to the neutrophil burden of the heart particularly during the early hours after MI ”. To test this hypothesis, we created a mouse model of MI by permanent ligation of the left anterior descending coronary artery and studied the impact of early recruitment of neutrophil to ischemic heart. We found that the initial wave of neutrophils recruited to the ischemic heart were exclusively sourced from the vasculature and not granulopoiesis in the BM/ Spleen. The neutrophils that were recruited to the heart exhibit distinct hallmarks of demargination including decreased F-actin, CD62L and increased Adam17 expression. This early recruitment of neutrophils was orchestrated by catecholamine stress as strategies aimed at inhibition of catecholamine biosynthesis or blockade of β adrenergic receptors (β-AR) significantly reduced neutrophil burden and improved cardiac function. Interestingly, this protective effect was lost when neutrophil recruitment was suppressed over a longer period. In conclusion we show that while short-term blockade of β-AR signaling suppresses the early neutrophil swarming, suppression beyond the reparative phase (&gt; 3 days post-MI) adversely impact the cardiac function. Together these data suggest that catecholamine stress induced-demargination constitute the major source of neutrophils during the early hours of MI. Understanding the precise signaling mechanisms that drive demargination and optimizing the right dose/duration of a specific β-AR blocker may help suppress the initial onslaught of neutrophils without compromising their overall beneficial function during the reparative phase of inflammation.

LIPID METABOLISM STATE IN MEN UNDER 60 YEARS OLD WITH METABOLIC SYNDROME DURING MYOCARDIAL INFARCTION

Abstract: Relevance. The lipid metabolism changes during myocardial infarction (MI) in men with metabolic syndrome (MS) may be important for the MI complications development. Aim. To evaluate the lipid metabolism changes in acute and subacute MI periods and their role in the MI complications development in men under 60 years old with MS to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with MI and MS. The patients were divided into two age-comparable groups: I - study group, with MS - 95 patients; II - control, without it - 571 patients. A comparative analysis of the lipid metabolism parameters and their dynamics in acute and subacute MI periods in selected groups, analysis of their influence on the risk of MI complications were performed. Results. It was found that in the first hours of MI in the study group, higher levels of triglycerides (3.19 ± 2.34 mmol/l) were noted compared to the control group (2.44 ± 1.75 mmol/l; p=0.02). The dynamics of lipid metabolism at the end of the third week of MI, significant multidirectional changes in all parameters with more pronounced atherogenic changes in the study group were revealed. The risk of MI complications was associated with levels of triglycerides (TG) ˂5.2 (p=0.02), high density (HDL) ≥0.9 (p=0.04) and very low-density lipoproteins (VLDL) ˂0.9 (p=0.04) (mmol/l) of the first hours of MI. Conclusions. The presence of MS impairs lipid metabolism in both acute and the subacute MI periods. In the study group, there is an increase in the levels of atherogenic lipids and their indices during the observation period. MI complications are associated with levels TG ˂5.2; HDL ≥0.9 and VLDL ˂0.9 (mmol/l) during the first hours of MI. It is expedient to use them in predictive modeling.

Mechanical Circulatory Support in Myocardial Infarction Complicated by Cardiogenic Shock: Impact of Sex and Timing

Sex differences in presentation, treatment, and outcomes persist in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS). Sex-based outcomes of patients with AMICS undergoing percutaneous coronary intervention (PCI) with percutaneous left ventricular assist device (pLVAD) support are poorly defined. From January 2017 to August 2019, consecutive patients undergoing PCI who received Impella support within 48 ​hours of myocardial infarction were enrolled in the prospective RECOVER III postmarket registry. In-hospital survival and predictors of mortality were compared by sex. A total of 358 patients (276 men and 82 women) were included. Women had lower baseline mean arterial pressure and shorter duration of pLVAD support compared with men. In-hospital adverse events were similar in women and men, including mortality (54% versus 46%, P = .25), major bleeding (11% versus 10%, P = .83), and vascular complications requiring surgery (8.5% versus 4%, P = .10). Women had better survival with pre-PCI versus post-PCI pLVAD implantation (59% versus 34%, P = .03), whereas survival in men was similar regardless of pre- versus post-PCI pLVAD support (56% versus 50%, P = .39). The number of inotrope/vasopressor use pre-pLVAD was the strongest predictor of mortality in women (OR 3.03, P = .01) but not in men (OR 1.18, P = .25). Survival of patients with AMICS treated with PCI and Impella support was 52% at hospital discharge and was similar for women and men. Women with AMICS may derive greater benefit from early pLVAD support prior to escalation of inotrope/vasopressors and had no evidence of increased risk of access-related complications. - In RECOVER III, survival of patients with AMICS treated with PCI and Impella support was 52% at hospital discharge and was similar for women and men. - The strongest predictor of mortality in women was the number of pre-Impella inotropes/vasopressors used. - Women with AMICS may derive greater benefit from early pLVAD support prior to escalation of inotrope/vasopressors compared to men. - Impella was not associated with excess bleeding or vascular complications in women.

Meta-Analysis of Nonrandomized Studies to Assess the Optimal Timing of Coronary Artery Bypass Grafting After Acute Myocardial Infarction

The optimal timing of coronary artery bypass grafting (CABG) in patients after an acute myocardial infarction (MI) is unknown. We performed a systematic review and meta-analysis of studies comparing mortality rates in patients who underwent CABG at different time intervals after acute MI. Bias assessments were completed for each study, and summary of proportions of all-cause mortality were calculated based on CABG at various time intervals after MI. A total of 22 retrospective studies, which included a total of 137,373 patients were identified. The average proportion of patients who died when CABG was performed within 6hours of MI was 12.7%, within 6 to 24hours of MI was 10.9%, within 1day of MI was 9.8%, any time after 1day of MI was 3.0%, within 7days of MI was 5.9%, and any time after 7days of MI was 2.7%. Interstudy heterogeneity, assessed using I2 values, showed significant heterogeneity in death rates within subgroups. Only 1 study accounted for immortal time bias, and there was a serious risk of selection bias in all other studies. Confounding was found to be a serious risk for bias in 55% of studies because of a lack of accounting for type of MI, MI severity, or other verified cardiac risk factors. The current publications comparing timing of CABG after MI is at serious risk of bias because of patient selection and confounding, with heterogeneity in both study populations and intervention time intervals.

CHANGES IN BASIC BLOOD SERUM ELECTROLYTES IN MEN UNDER 60 YEARS OLD WITH MYOCARDIAL INFARCTION, COMPLICATED BY ACUTE KIDNEY INJURY

Abstract. Relevance. Acute kidney injury during myocardial infarction worsens the prognosis. At the same time, changes in electrolyte metabolism have been studied only in cases of severe lesions. And most of the data were obtained for patients over 60 years old. Aim. To evaluate the features of changes in serum potassium, sodium, calcium, and chlorides in men under 60 years old with myocardial infarction complicated by acute kidney injury to improve prevention and outcomes. Material and methods. The study included men 19-60 years old with type I myocardial infarction. The patients were divided into two age-comparable groups: I - study group, with acute kidney injury - 25 patients; II - control, without it - 168 patients. A comparative analysis of serum sodium, potassium, calcium and chloride concentration in the first 48 hours (1) and at the end of the third week of the disease (2), their dynamics, analysis of their impact on the risk of acute kidney injury (ANOVA) were performed. Results. The study group differed from the control in high levels of sodium (143.3 ± 3.4 and 140.3 ± 4.5 (mmol/l); respectively; p = 0.004) and chlorides (104.6 ± 2.7 and 102.8 ± 3.5 (mmol/l); p = 0.047) at the end of the third week of the disease. The concentrations of the studied electrolytes increased at the second observation point in both groups of patients. The main markers of the acute kidney injury risk development in the first hours of myocardial infarction were: potassium levels &lt; 4.75 mmol/l (absolute risk: 17.2%; p = 0.003), sodium ≥ 140 mmol/l (absolute risk: 18.2%; relative - 3.64; p = 0.01), chlorides ≥ 104 mmol/l (absolute risk: 22.6%; relative - 3.67; p = 0.02). Conclusions. Men under 60 years old with acute kidney injury in myocardial infarction are characterized by low levels of potassium (&lt;4.75 mmol/l) as well as higher levels of sodium (≥140 mmol/l) and chloride (≥104 mmol/l) serum in the first hours of IM. The listed above values should be used in the formation of the high-risk groups for the acute kidney injury development, as well as for prognostic modeling.

Oncostatin M is associated with adverse left ventricular remodeling in patients with ST-segment elevation myocardial infarction

Abstract Introduction The development of adverse left ventricular remodeling (LVR) after myocardial infarction (MI) remains a significant problem despite current achievements in invasive and pharmacological treatment. A large number of biomarkers are known that reflect various processes and pathophysiological mechanisms of the pathogenesis of MI and the development of adverse cardiovascular events in the post-infarction period. Oncostatin M (OSM) is a cytokine of the interleukin-6 family that is involved in the pathophysiology of cardiovascular diseases and takes part in processes of inflammation, tissue regeneration, cell development and growth. Purpose To assess the dynamics of serum levels of OSM and its association with the development of adverse left ventricular remodeling in the long-term post-infarction period in patients with acute primary myocardial infarction with ST-segment elevation (STEMI). Methods Subjects were 21 patients (59.2±8.1 y.o.) with STEMI, who underwent percutaneous coronary intervention during the first 24 h of the onset of MI. The serum level of OSM and echocardiography with 2D speckle tracking imaging were assessed at days 1 and 6 months after STEMI. The criterion of adverse LVR is an increased of end-diastolic (EDV) or/and end-systolic (ESV) volume more than 20% from admission to 6 month period. Results A significant increase of the serum levels of OSM during the first 24 hours of MI was detected [46.9 (18.9; 75.7)] pg/ml. A decrease of the OSM levels in 6 months after STEMI was revealed [13.1 (6.9; 19.6)] pg/ml (p&amp;lt;0.0005). Correlation analysis showed strong positive association between the values of OSM with Troponin I (R=0.797 p=0.0001) and Nt-proBNP (R=0,713 p=0.0013). The relationship between OSM and Troponin I persisted in the long-term post-infarction period (R=0.751, p=0.0005). An inverse correlation between the OSM, measured at admission to hospital and the left ventricular ejection fraction at day 7 after MI was found (R=−0.63, p=0.023). Logistic regression analysis showed that the values of OSM at day 1 of the MI were associated with development of adverse LVR in the long term after STEMI. OSM level of more than 18.4 pg/ml at a time of admission was associated with the increased of ESV in 6 months after STEMI by more than 20% (p&amp;lt;0.05). Conclusions Our study showed the serum levels of OSM statistically significantly decreased in 6 months after STEMI. The content of OSM was positive associated with Troponin I and Nt-proBNP. Elevated levels of OSM were associated with an increase of ESV in 6 months after STEMI. The serum levels of OSM can be used to predict of adverse remodeling in patients undergoing STEMI. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Science

Changes in the level of cardiomarkers in the development of acute myocardial infarction on the background of chemotherapy of a patient with tongue cancer

Cancer is one of the leading causes of death and disability worldwide. Timely diagnosis and the introduction of new effective treatments, including intensive radiation and chemotherapy regimens, have significantly improved survival forecasts in recent years. At the same time, the use of these types of treatment increases the risk of complications, one of which includes chemotoxic cardiopathies. In this regard, timely detection and treatment of complications from the cardiovascular system in patients receiving chemotherapy courses in combination with surgical methods of treatment is important. This paper presents an assessment of the significance of the use of cardiomarkers in the early diagnosis of acute myocardial infarction that developed during chemotherapy in a patient with tongue cancer with a complicated cardiac history. Patient M., 45 years old, was admitted for surgical treatment for cancer of the tongue St. IVA, T4aN1M0, cl. gr. 2. Planned laboratory and instrumental studies were performed. Contraindications for surgical treatment were not identified. A preoperative course of chemotherapy was performed, against the background of which the patient's condition worsened with symptoms of acute cardiopathy. A second ECG was urgently performed, as a result of which an increase in the ST segment in III, aVF was established, as well as a study of the concentration of cardiomarkers: highly sensitive troponin I, N-terminal propeptide of natriuretic hormone, creatine phosphokinase MB, myoglobin, the dynamics of changes in the level of which indicated the development of acute coronary syndrome. The complex application of diagnostic procedures, including the determination of the level of cardiomarkers, made it possible to timely diagnose the development of acute type 1 myocardial infarction in a patient with tongue cancer on the background of chemotherapy. When analyzing the entire array of clinical and laboratory data, the leading initiating factor that played a decisive role in the development of myocardial infarction in this case was, in our opinion, a preoperative course of polychemotherapy with paclitaxel and carboplatin, which have cardiotoxicity. Thus, the category of patients with an initial unfavorable background, due to a common malignant process and the presence of a history of cardiodisfunction, requires more careful preparation for preoperative courses of polychemotherapy, including cardiotropic therapy with mandatory monitoring of the level of the main cardiomarkers. The most significant changes were in the levels of creatine phosphokinase MB, troponin I, and myoglobin, which were recorded in the first hours of myocardial infarction. An association was found between an increase in troponin I concentration and an increase in the ST segment of the electrocardiogram.

Changes in the level of cardiomarkers in the development of acute myocardial infarction on the background of chemotherapy of a patient with tongue cancer

Cancer is one of the leading causes of death and disability worldwide. Timely diagnosis and the introduction of new effective treatments, including intensive radiation and chemotherapy regimens, have significantly improved survival forecasts in recent years. At the same time, the use of these types of treatment increases the risk of complications, one of which includes chemotoxic cardiopathies. In this regard, timely detection and treatment of complications from the cardiovascular system in patients receiving chemotherapy courses in combination with surgical methods of treatment is important. This paper presents an assessment of the significance of the use of cardiomarkers in the early diagnosis of acute myocardial infarction that developed during chemotherapy in a patient with tongue cancer with a complicated cardiac history. Patient M., 45 years old, was admitted for surgical treatment for cancer of the tongue St. IVA, T4aN1M0, cl. gr. 2. Planned laboratory and instrumental studies were performed. Contraindications for surgical treatment were not identified. A preoperative course of chemotherapy was performed, against the background of which the patient's condition worsened with symptoms of acute cardiopathy. A second ECG was urgently performed, as a result of which an increase in the ST segment in III, aVF was established, as well as a study of the concentration of cardiomarkers: highly sensitive troponin I, N-terminal propeptide of natriuretic hormone, creatine phosphokinase MB, myoglobin, the dynamics of changes in the level of which indicated the development of acute coronary syndrome. The complex application of diagnostic procedures, including the determination of the level of cardiomarkers, made it possible to timely diagnose the development of acute type 1 myocardial infarction in a patient with tongue cancer on the background of chemotherapy. When analyzing the entire array of clinical and laboratory data, the leading initiating factor that played a decisive role in the development of myocardial infarction in this case was, in our opinion, a preoperative course of polychemotherapy with paclitaxel and carboplatin, which have cardiotoxicity. Thus, the category of patients with an initial unfavorable background, due to a common malignant process and the presence of a history of cardiodisfunction, requires more careful preparation for preoperative courses of polychemotherapy, including cardiotropic therapy with mandatory monitoring of the level of the main cardiomarkers. The most significant changes were in the levels of creatine phosphokinase MB, troponin I, and myoglobin, which were recorded in the first hours of myocardial infarction. An association was found between an increase in troponin I concentration and an increase in the ST segment of the electrocardiogram.

ОСОБЕННОСТИ ПЕРИФЕРИЧЕСКОЙ ГЕМОДИНАМИКИ У МУЖЧИН МОЛОДОГО И СРЕДНЕГО ВОЗРАСТА С РЕЦИДИВИРУЮЩИМ ТЕЧЕНИЕМ ИНФАРКТА МИОКАРДА

Relevance. Hemodynamics changes in recidivating myocardial infarction and early postinfarction angina are not well understood. In recent years, the frequency of these complications has been increasing. Aim. To evaluate peripheral hemodynamics changes in men under 60 years old with recurrent myocardial infarction and early postinfarction angina to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with recurrent myocardial infarction - 102 patients; II - control, without it - 541 patients. A comparative assessment of hemodynamics changes in first 48 hours (1) and the end of third week disease (2), also risk analysis of recurrent ischemia and poor outcome in selected groups were performed. Results. The study group was distinguished by a high level of total peripheral resistance1 (2055.5±965.2 (dyn×sec×cm-5)) from the control (2055.5± 965.2 (dyn×sec×cm-5); p=0.02). In both groups, a decrease in the values of all indicators was noted (p&lt;0.05). A more pronounced decrease in total peripheral resistance was found in the study group, and in the parameters of blood pressure and heart rate - in the control group. The values of total peripheral resistance1 ≥1600 dyne×sec×cm-5 were the markers of the risk of ischemia recurrence. Predictors of poor outcome are blood pressure levels1 (systolic &lt;97; diastolic &lt;70; mean &lt;93.3 (mm Hg)); total peripheral resistance1 &lt;1746.2 dyne×sec×cm-5 and heart rate (˃92 per min). Conclusions. Patients with recurrent ischemia are characterized by higher levels of total peripheral resistance in the first hours of myocardial infarction. For both groups, a decrease in all studied indicators is determined. The above values of hemodynamic parameters should be used in the formation of groups with a high risk of early recurrence of ischemia and an unfavorable outcome, as well as for prognostic modeling of these complications.

ELECTROLYTIC EXCHANGE FEATURES DURING MYOCARDIAL INFARCTION WITH RECURRENT EPISODES OF ISCHEMIA IN MEN UNDER 60 YEARS OLD

Relevance. Recurrent myocardial infarction and early postinfarction angina negatively effects on the prognosis of myocardial infarction. Aim. To evaluate myocardial infarction sodium, potassium, chlorides, calcium metabolism, features in men under 60 years old with recurrent myocardial infarction and early postinfarction angina to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with recurrent myocardial infarction - 110 patients; II - control, without it - 555 patients. A comparative analysis of blood serum electrolyte levels, their dynamics from the first hours to the end of the third week of myocardial infarction in the selected groups were performed. Their impact on the risk of recurrent ischemia and unfavorable outcome was assessed. Results. In the study group, in the first hours of the disease, the levels of chloride were higher (103.7±5.5 and 101.7±4.7 (mmol/l); p=0.002), and total calcium at the end of the third week of myocardial infarction (2.3±0.2 mmol/l) - lower than in the control (2.46±0.16; p=0.001). With an unfavorable outcome in the study group, the sodium level was lower in the first hours of the disease (138.7±4.9 and 142.7±6.6 (mmol/l); p=0.049). Moreover, the risk of its development was associated with sodium levels ≥148.0 mmol/l (absolute risk: 100.0%; relative - 13.8; p&lt;0.0001) and potassium levels ≥5.3 mmol/l (absolute: 71,4%; relative - 12.4; p&lt;0.0001). The risk of developing recurrent episodes of ischemia in the examined increased at chloride levels ≥104.7 mmol/l (absolute: 28.4%; relative: 3.1; p=0.0001) and sodium ≥139.0 mmol/l (absolute: 19.5%; relative: 1.7; p=0.03) in the first hours of myocardial infarction and calcium (&lt;2.4 mmol/l) at the end of the third week of the disease (absolute: 31.0%; relative: 4.9; p=0.003). Conclusions. The listed combinations of levels of basic electrolytes in blood serum are markers of recurrence of ischemia in myocardial infarction and poor outcome. They should be used to identify risk groups with the necessary preventive measures and for predictive modeling.

Factors affecting the prognosis of patient with ST elevation myocardial infarction and massive thrombosis of infart related coronaty artery

Abstract Funding Acknowledgements Type of funding sources: None. Manual thrombaspiration (MT) is aimed at achieving optimal myocardial perfusion and improving prognosis in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary interventions. Purpose. To study the factors influencing the prognosis of the disease in patients with STEMI and massive thrombosis of an infarction-associated artery, who underwent percutaneous coronary intervention in combination with MT. Materials and methods. 2-year dynamic follow-up of two groups of patients with STEMI: 175 patients undergoing percutaneous coronary intervention with MT and 175 patients with percutaneous coronary intervention without MT. Results. As a result of the logistic regression analysis by a step-by-step method of including factors (107 indicators in total) that affect the likelihood of developing major adverse coronary event (MACE), the parameters independently influencing the risk of their development were: age of patients over 65 years old (OR 1.9), history of coronary heart disease and MI (OR 3.35), diabetes mellitus (OR 2.54), ischemia time more than 180 minutes (OR 5.43), multivessel coronary artery disease (OR 2.16), absence of myocardial perfusion - MBG grade 0 (OR 39 , 82), the ratio of neutrophils to lymphocytes is more than 3 (OR 11.05). In addition, it was found that with LV ejection fraction at discharge ≤ 42%, the risk of developing BCCS after 48 months. follow-up in both groups was 17.7 times higher (p = 0.00001, OR: 17.7 CI 95%), and in patients in the MTA (+) group with LV EDV of more than 160 ml at discharge from the hospital, the risk of developing MACE after 48 months observation was 7.9 times higher (p = 0.006). Conclusion. A retrospective analysis of the data obtained showed that all patients with STEMI and massive thrombosis of an infarction-associated coronary artery who died of cardiac causes had predictors of unfavorable outcome, most of which were determined already in the first hours of myocardial infarction.

Myocardial gene expression in patients with myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. Myocardial infarction (MI) and following heart failure (HF) have various clinical scenarios. However, despite the clinical heterogeneity, the management of MI lacks effective personalized approaches. The response to ischemic injury in the infarct zone and remote myocardium has a definite spatio-temporal sequence and underlies the mechanism of adverse cardiac remodeling. Understanding its myocardial biology remains unclear due to insufficiency of heart tissue molecular and genetic analysis. Although animal models play an important role in data accumulation, they failure to reflect all the compounds of response to ischemic injury and following HF syndrome. Purpose. The purpose of the study was to investigate myocardial expression profile in the infarct zone in comparison to remote myocardium in patients with MI. Methods. The study included 4 patients with fatal MI type 1. All patients died within 48 hours of MI. The post-mortem examination was performed according to country policy. In each case, we obtained myocardial samples from the infarct zone and remote myocardium. Genome-wide gene-level expression was assessed by microarray analysis. We used transcriptome analysis software to analyze and visualize global expression patterns of genes. The analysis included normalization process. Differentially expressed genes (DEGs) were defined as gene-level fold change &amp;lt;-2 or &amp;gt;2 and adjusted P-value of &amp;lt;0.05. Results. We studied expression of 21448 genes. A total of 1785 DEGs, including 1692 up-regulated genes and 93 down-regulated genes in the infarct zone, were identified (Figure 1). According to the fold change, the first 10 up-regulated genes were TNFSF10 (TRAIL), SUCLA2, NAE1, PDCL3, OSBPL5, FCGR2C, SELE, CEP63, ST3GAL3, C4orf3. Fold changes for TNFSF10 (TRAIL), SUCLA2, and NAE1 were 19.83 (p = 0.049), 10.68 (p = 0.048), and 10.24 (p = 0.008), respectively. These 3 up-regulated genes were enriched in apoptotic signaling pathways, immune response, angiogenesis, inflammation, tricarboxylic acid cycle, and protein binding. Conclusions. We performed myocardial transcriptomic analysis in patients with MI. DEG analysis clearly distinguishes the infarct zone and remote myocardium. Genes overexpressed in the infarct zone included TNFSF10 (TRAIL), SUCLA2, NAE1. TNFSF10 (TRAIL) regulates vasodilation, angiogenesis, and inflammation. TNFSF10 (TRAIL) regulated effects could be both protective and harmful in ischemic heart disease. The enzyme encoded by SUCLA2 is active in tissues that require a large amount of energy, such as those of the heart, brain, and muscle. Overexpression of NAE1 causes apoptosis through deregulation of NEDD8 conjugation. It is known that the protein encoded by NAE1 binds to the beta-amyloid precursor protein, and it is thought to play a role in the pathogenesis of Alzheimer"s disease. Thus, our pilot study emphasized the potential of translational approach and identified targets to consider for precision diagnostics and therapeutics. Abstract Figure. С1: infarct zone; C2: remote myocardium

CORONARY ARTERIES DAMAGE FEATURES IN IN YOUNG AND MIDDLE-AGED MEN WITH MYOCARDIAL INFARCTION AND RECURRENT EPISODES OF ISCHEMIA

Relevance. Recurrent ischemic events (RIS) adversely affect the duration of treatment and the prognosis of myocardial infarction (MI). Aim. To evaluate the coronary arteries condition in men under 60 years old (y.o.) with RIS and MI to improve understanding of the mechanisms of development and prevention. Material and methods. The study included men 19-60 years old with type I of MI. Patients were divided into two age-comparable groups: I - study group, with RIS (early postinfarction angina pectoris and / or recurrent MI) - 26 patients; II - control, without them - 114 patients. A comparative assessment of angiographic data in the selected groups was performed. Results. Patients in the study group had a greater (15.5%) than in the control (7.9%; p = 0.01) history of coronary artery bypass surgery, the degree of infarction-related artery stenosis (96.9 ± 7.7 and 92.3 ± 10.8%, respectively; p = 0.02). The magnitude of the narrowing of the coronary artery was associated with the coefficient of atherogenicity (r = 0.87; p &lt;0.05), end-systolic (r = 0.53; p &lt;0.05) and diastolic (r = 0.6; p &lt;0, 05) left ventricle (LV) sizes, glomerular filtration rate (r = -0.5; p &lt;0.05) in the first hours of MI, creatinine in the first hours (r = 0.47; p &lt;0, 05) and at the end of the third MI week (r = 0.65; p &lt;0.05). Conclusions. In men under 60 y.о. with RIS during MI, the most pronounced association with a history of coronary artery bypass surgery and a greater lumen narrowing of the infarct-associated artery, which, in turn, increased with impaired renal function and lipid metabolism, and was also associated with LV dilatation.

THE PULMONARY CIRCULATION PECULIARITIES IN YOUNG AND MIDDLE-AGED MEN WITH MYOCARDIAL INFARCTION AND RECURRENT EPISODES OF ISCHEMIA

Relevance. The pulmonary hypertension (PH) and heart failure (HF) development during myocardial infarction (MI) in men with recurrent ischemic events (RIE) has not been adequately studied. Aim. To evaluate changes in pulmonary circulation parameters (PCP) in men under 60 years old (y.o.) in acute and subacute MI periods with RIS to improve understanding of PH and HF developmental options and to search for possible ways to improve prevention. Material and methods. The study included men aged 19-60 years old with type I of MI. Patients are divided into two age-comparable groups: I - the study group, with RIS - 110 patients; II - control, without it - 555 patients. A comparative assessment of PCP in the first 48 hours and the end of the subacute period of MI in these groups was performed. Results. In the first hours of MI the higher values of total pulmonary resistance (TPR) and mean pulmonary artery pressure (MPAP) were noted in the study group. When considering their dynamics at the end of the third MI week the MPAP decreased in both groups (I: by 8.7%; p˂0.0001; II: by 15.0%; p˂0.0001). TPR decreased in both groups (I: by 30.6%; II: by 29.6%; p˂0.0001) too. The heart rate - I: by 6.2%; p=0.03; II: 8.4%; p˂0.0001). At the end of the third MI week, MPAP remained elevated in the study group (I: 30.6 ± 12.7; II: 27.2 ± 7.7; p = 0.03).

ОСОБЕННОСТИ КЛИНИЧЕСКОГО ТЕЧЕНИЯ ИНФАРКТА МИОКАРДА С ОСТРЫМ ПОВРЕЖДЕНИЕМ ПОЧЕК У МУЖЧИН МОЛОЖЕ 60 ЛЕТ

Relevance. Acute kidneys injury (AKI) negatively affects the prognosis of myocardial infarction (MI). Aim. To evaluate MI clinical features (CF) in men under 60 years old (y.o.) with AKI during MI to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with type I MI. Patients are divided into two age-comparable groups: I - the study group, with ACI - 25 patients; II - control, without it - 486 patients. A comparative assessment of the MI CF frequency in selected groups were performed. Results. In patients of the study group more often than in the control group, a combination of MI complications (64.0 and 36.9%; respectively; p = 0.009), psychic disorders (20.0 and 6.9%; p = 0.01), chronic heart failure (CHF) of the second functional class and above (NYHA) at the end of the eighth MI week (72.0 and 43.2%; p = 0.005), with a predominance of newly diagnosed CHF forms (36.0 and 28.0%; p = 0.006). In the study group, less often than in the control group, pulmonary hypertension was noted in the first 48 hours of MI (44.0 and 66.0%; p = 0.02) and at the end of the third MI week (38.1 and 60.3%; p = 0.04). Conclusions. There were no specific clinical signs of AKI in men under 60 y.o. with MI. At the same time, the study group has the worst prognosis during the observation period in terms of the frequency of MI complications combinations and CHF, which requires the start of prophylactic therapy from the moment of AKI verification.

THE STRUCTURAL AND FUNCTIONAL MYOCARDIAL STATE PECULIARITIES IN MEN UNDER 60 YEARS OLD WITH MYOCARDIAL INFARCTION AND CHRONIC INFLAMMATORY PULMONARY DISEASES

Relevance. The development of chronic heart failure in chronic inflammatory pulmonary disease (CIPD) after myocardial infarction (MI) remains insufficiently studied. Aim. To evaluate changes in intracardiac hemodynamic parameters in men under 60 years old with CIPD in the acute and subacute MI periods to clarify their significance in the development of chronic heart failure. Material and methods. The study included men aged 19-60 years old with type I MI. Patients are divided into two age-comparable groups: I - the study group, with CIPD - 166 patients; II - control, without it - 490 patients. A comparative assessment of intracardiac hemodynamic in selected groups was performed in first 48 hours (1) and the end of third MI week (2). Results. There was a left ventricle (LV) large dilatation in the study group, as in the first hours of MI (end-systolic volume index (ESVI1) 43.5±21.5 and 36.6±20.7 (ml/m2); p=0.001 ), and at the end of the third week of MI (ESVI2 35.6±16.9 and 32.2±18.4 (ml/m2); p=0.03). There was a left atrium (LA) dilatation (I (1): 40.3±5.3; I (2): 40.9±5.2 (mm) and II (1): 40.7±5.1; II (2): 40.4±5.2 (mm); p≥0.05), right ventricle (RV) dilatation in the first hours of MI (28.3±6.7 and 25.2±6.7 (mm); p = 0.01). There was a significant decrease in the LV ejection fraction in the study group compared to the control at both measurement points (1: 42.6±13.4 and 47.8±13.3 (%), respectively; p=0.0004; 2: 54.9±11.5 and 57.2±12.6 (%); p=0.04). When assessing the dynamics over the observation period, an expansion of the LP was noted in the study group (by 1.4%), in contrast to its decrease in the control group (by 0.6%; p˂0.0001). Also revealed: negative dynamics of the ratio of the velocity of late and early LV filling in the study group (decrease by 6.0%) in comparison with the control (increase by 5.8%; p˂0.0001). Conclusions. Thus, in CIPD, we observed more pronounced dilatation of the RV and LV, systolic and diastolic LV dysfunction in the acute and subacute MI periods. This confirms the negative value of CIPD for the prognosis of MI.

THE PULMONARY CIRCULATION IN MEN UNDER 60 YEARS OLD WITH MYOCARDIAL INFARCTION AND CHRONIC INFLAMMATORY PULMONARY DISEASE

Relevance. Formation of pulmonary hypertension (PH) in myocardial infarction (MI) and chronic inflammatory pulmonary diseases (CIPD) remains poorly understood. Aim. To evaluate changes in pulmonary circulation indicators (PCI) in men under 60 years old (y.o) with CIPD that in acute and subacute MI periods to improve understanding of developmental options and prevention. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with CIPD - 142 patients; II - control, without it - 424 patients. A comparative assessment of PCI in the first 48 hours and the end of the subacute period of MI in these groups was performed. Results. In the first hours of MI, higher values of total pulmonary resistance (TPR) (I: 572.4 ± 276.0; II: 505.3 ± 286.6 (dyn×sec×cm-5)) were noted in the study group. When considering their dynamics at the end of the third week of MI, the mean pressure in the pulmonary artery decreased in both groups (I: 18.3%; p˂0.0001; II: 11.2%; p˂0.0001). TPR decreased in both groups (I: 36.1%; II: 24.4%) and heart rate also decreased (I: 11.0%; II: 5.3%; p˂0,0001 for all indicators). Conclusions. The study group is distinguished by more pronounced disorders of pulmonary circulation in the first hours of MI, which confirms the feasibility of their assessment and study of indicators of the severity of CIPD as additional markers of a negative prognosis of PH.

Annexin V Levels as an Indicator of Myocardial Cell Death after Myocardial Infarction

Background:Myocardial ischemia is associated with apoptosis of cardiomyocyte and because of apoptotic cell death is characterized by externalization of Phosphatidylserine on the cell membrane, so it is amenable to targeting by Annexin V. Objective: To compare plasma concentrations of Annexin V in patients who had an early infarct with patients without infarction. And to analyze the plasma concentration of Annexin V in relationship to cardiovascular risk factors. Patients and Methods: A Case-control study of 100 patients (case) who are diagnosed with Myocardial Infarction (MI) and admitted to the coronary care unit of Baqubah Teaching Hospital and another 100 patients homogenous in terms of age and gender and who attended the hospital for other cause than myocardial infarction is selected as the control group during a period between the first of April and the first of July 2019. A special questionnaire used to collect the required information, an early morning blood sample is taken to measure the level of Annexin V by ELISA, Student’s t-test, ANOVA test and Chi_square test to find an association and differences between variables. Results: The results showed that The mean Annexin V level is significantly higher in cases (10.48155ng/ml) than control (1.28803ng/ml) with p-value =0.001 and a sample taken within 24 hours after MI is significantly higher in the mean level of Annexin V then the sample taken after 24 hours of MI. Conclusion: Generally, the measurement of Annexin V level has provided a good diagnostic test to evaluate myocardial infarction. Keywords: Myocardial infarction, Annexin V, Phosphatidylserine, Apoptosis