Parameters Of Intracardiac Hemodynamics Research Articles

Enhanced echocardiographic assessment of intracardiac flow in congenital heart disease.

4D flow magnetic resonance imaging (4D flow MRI) can assess and measure the complex flow patterns of the right ventricle (RV) in congenital heart diseases, but its limited availability makes the broad application of intracardiac flow assessment challenging. Color Doppler imaging velocity reconstruction from conventional echocardiography is an emerging alternative, but its validity against 4D flow MRI needs to be established. To compare intracardiac flow parameters measured by color Doppler velocity reconstruction (DoVeR) against parameters measured from 4D flow MRI. We analyzed 20 subjects, including 7 normal RVs and 13 abnormal RVs (10 with repaired Tetralogy of Fallot, and 3 with atrial-level shunts). Intracardiac flow parameters such as relative pressure difference, vortex strength, total kinetic energy, and viscous energy loss were quantified using DoVeR and 4D flow MRI. The agreement between the two methods was determined by comparing the spatial fields and quantifying the cross-correlation and normalized difference between time-series measurements. The hemodynamic parameters obtained from DoVeR and 4D flow MRI showed similar flow characteristics and spatial distributions. The time evolutions of the parameters were also in good agreement between the two methods. The median correlation coefficient between the time-series of any parameter was between 0.87 and 0.92, and the median L2-norm deviation was between 10% to 14%. Our study shows that DoVeR is a reliable alternative to 4D flow MRI for quantifying intracardiac hemodynamic parameters in the RV.

Parameters of intra-cardiac hemodynamics in women with essential hypertension and heart failure, carriers of different polymorphic variants of the galectin-3 gene (LGALS-3, rs 2274273)

Annotation. The study aims to improve the prediction and diagnostics of cardiac remodeling, specifically left ventricular myocardial hypertrophy (LVH) in essential hypertension and the development of chronic heart failure (CHF) in carriers of polymorphic variants of the galectin-3 gene (LGALS-3, rs2274273). 180 postmenopausal women, on average aged 58.51±0.45, residents of the Podillya region of Ukraine, were examined. The main group consisted of 113 women with EH, of which 62 had EH II, and 51 had EH III with CHF II A stage. The control group included 67 women without signs of cardiovascular pathology. General clinical examination, enzyme immunoassay method for determining the level of galectin-3 in blood plasma, genotyping of the LGALS3 gene (rs2274273) using polymerase chain reaction, and ultrasound of the heart were performed. Compliance of the frequency distribution of genotypes in the studied populations to the Hardy-Weinberg equilibrium was checked using the MedCalc Software Ltd. Odds ratio calculator. https://www.medcalc.org/calc/odds_ratio.php and calculated the odds ratio (OR) of developing left ventricular myocardial hypertrophy (LVH) and chronic heart failure (CHF). OR = 1 was considered as no association, OR>1 – as a positive association (increased risk of pathology), and OR<1 – as a negative association (reduced risk of pathology). The results were considered reliable at p<0.05. Statistical processing of the obtained results was performed using the SPSS statistical program package, STATISTICA v. 10.0. The reliability of the difference in percentages of quantitative values between groups was calculated according to the χ2 criterion. In postmenopausal women, residents of the Podillya region of Ukraine, without signs of cardiovascular pathology, the following frequency distribution of galectin-3 gene genotype variants (rs2274273) was found: GA – 49.25%, GG – 40.30%, AA – 10.45%, which corresponds to the Hardy-Weinberg equilibrium. The specified ratio does not reliably differ from that in women with EH of different stages. Therefore, the galectin-3 gene polymorphism (rs2274273) is not associated with the risk of EH: OR =0.88; 95% CI 0.47 – 1.63; z statistic 0.417; χ2 =0.1744, p=0.6763. Analysis of the structural and functional parameters of the myocardium in carriers of the A allele shows more pronounced remodeling of the myocardium with eccentric LVH, a more advanced diastolic dysfunction (DD), and lower left ventricular ejection fraction than in GG homozygotes (LVEF 47.63±0.49% vs. 50.61±0.63%, p<0.05). Therefore, the GG genotype of the galectin-3 gene (rs2274273) is a marker of limited changes in the structure of the myocardium in EH.

The Role of Modi­fiable and Non-Modifiable Factors in the Development of Right and Left Ventricular Myocardial Dysfunction in High-Risk Patients

Aim To study early manifestations of left ventricular (LV) and right ventricular (RV) myocardial remodeling in high-risk patients.Material and methods Intracardiac hemodynamics was studied by equilibrium radionuclide ventriculography (ERVG) in 83 patients (mean age, 61.1±8.9 years) with preserved LV ejection fraction according to echocardiography data, a body weight index (BWI) >25 kg /m2, obesity, and type 2 diabetes mellitus (DM2). Parameters of intracardiac hemodynamics were compared in patients with different degrees of obesity and DM2 durations in age groups of younger and older than 60 years.Results All patients had both LV and RV diastolic dysfunction. The diastolic dysfunction progressed with age and DM2 duration, primarily by the restrictive type. The increase in BWI, in contrast, was associated with increases in ventricular volumetric parameters. It was noted that specifically modifiable risk factors (obesity and DM2), but not the age, mostly facilitated the impairment of RV relaxation.Conclusion The strategy of normalizing the body weight and carbohydrate metabolism is priority in combatting the development and progression of chronic heart failure in high-risk group patients.

Relationship Between Markers of the Acute Phase of Inflammation, Parameters of Blood Lipid Composition and Intracardiac Hemodynamics During Chemotherapy in Patients With Multiple Myeloma.

Aim To evaluate in a pilot study time-related changes in the clinical state, indexes of the acute phase of inflammation, parameters of blood lipid profile, intracardiac hemodynamics, and disorders of cardiac rhythm/conduction in patients who are not candidates for autologous hemopoietic stem cell transplantation, during three bortezomib-containing chemotherapy courses (VCD) followed by a correlation analysis.Material and methods This pilot study included 20 patients diagnosed with myeloma, who were not candidates for autologous hemopoietic stem cell transplantation and who had undergone three courses of VCD chemotherapy (bortezomib, cyclophosphamide and dexamethasone). In addition to mandatory examinations, measurement of blood lipid profile, transthoracic echocardiography (EchoCG), and 24-h Holter electrocardiogram (ECG) monitoring were performed for all participants before and after a specific therapy.Results Following three bortezomib-containing courses of chemotherapy, patients of the study group had significant increases in the neutrophil-lymphocyte ratio (NLR) (1.6±0.2 and 2.5±0.4; р=0.05), cholesterol concentration (4.8±1.1 and 5.6±1.1 mmol/l, р=0.05), and low-density lipoprotein concentration (2.8±0.4 and 3.5±0.8 mmol/l, р=0.02). In comparing the changes in parameters of intracardiac hemodynamics, criteria for genuine cardiotoxicity were not met, however, a tendency to emergence/progression of myocardial diastolic dysfunction was noted. No clinically significant disorders of cardiac rhythm/conduction were observed. The correlation analysis performed prior to the start of chemotherapy, showed significant strong, direct correlations between the C-protein concentration and left atrial (LA) volume (r=0.793; p=0.006), right atrial (RA) volume (r=0.857; p=0.002), left ventricular (LV) end-diastolic dimension (EDD) (r=0.589; p=0.043), and LV end-diastolic volume (EDV) (r=0.726; p=0.017). Following the specific treatment, significant, medium-power and strong correlations were found between NLR and EDV (r= -0.673; p=0.033), NLR and end systolic volume (ESV) (r= -0.710; p=0.021), respectively. Significant direct correlations were found between the bortezomib dose per one injection and the serum concentration of triglycerides following the treatment (r=0.78; p=0.05); a single bortezomib dose and parameters of intracardiac hemodynamics: LA (r=0.71; p=0.026), RA (r=0.74; p=0.014), EDD (r=0.837; p=0.003), EDV (r=0.749; p=0.013), ESV (r=0.553; p=0.049).Conclusion For the first time, a comprehensive evaluation was performed in patients with multiple myeloma, including the dynamics of blood lipid profile, intracardiac hemodynamics and disorders of cardiac rhythm/conduction during bortezomib-containing antitumor therapy, with an analysis of correlation with levels of acute inflammation phase markers. Although in the observation window for genuine cardiotoxicity, clinically significant cardiovascular complications were not detected, the found correlations may evidence a potential role of systemic inflammation activity in myocardial remodeling in the studied patient cohort.

Предиктори 5-річного виживання хворих із хронічною серцевою недостатністю зі зниженою фракцією викиду лівого шлуночка залежно від наявності в них цукрового діабету 2-го типу

The aim – to determine the predictors of 5-year survival of patients with CHF and reduced LV EF depending on the presence of type 2 diabetes mellitus.Materials and methods. 490 case histories of patients in the period from 2011 to 2018 with CHF, 40–80 years of age (median – 64 years), II–IV NYHA functional class, LVEF ≤ 40 % were analyzed. For the analysis of all patients with CHF and reduced LV EF were divided into two groups: Group I included 338 (69 %) patients without diabetes mellitus type 2, group II consisted of 152 (31 %) patients diagnosed with diabetes mellitus type 2. To measure the values ​​of the independent predictors, we calculated the value of the odds ratio (OR) with a 95 % confidence interval. To determine predictors of mortality/survival of the studied patients, was calculated the Хі-square criterion. Additionally, we calculated the estimate of the frequency difference between the groups, the odds ratio, the confidence interval for the odds ratio, the Pearson correlation coefficient r, for all the calculated characteristics we determined the probability of error of the first kind p. As a result, we formed a final table of indicators-predictors of mortality/survival of patients with CHF with reduced LV EF with and without diabetes mellitus type 2 for which there is a statistical relationship between mortality / survival and the studied indicator.Results and discussion. In patients without diabetes, many indicators are associated with the prognosis of long-term survival. These include hemodynamic parameters (heart rate, the left atrium size (LV) and indexed left ventricular (LV) volumes, LV myocardial mass index, right ventricular size (RV) and LV ejection fraction, renal function parameters (microalbuminuria (UIA), glomerular filtration rate (GFR), urea nitrogen), systemic inflammatory marker (C-reactive protein (CRP)), markers of systemic oxidative stress (myeloperoxidase, citrulline, uric acid) and antioxidant defence – SOD, as well as the N-terminal fragment of the precursor of natriuretic peptide (NT-proBNP), flow-dependent vasodilatory response (FDVR), high-density lipoprotein cholesterol (HDL), insulin and the relative content of lymphocytes in the blood. Patients with diabetes had significantly fewer such predictors: in addition to parameters of intracardiac hemodynamics and heart modeling, other significant predictors of 5-year survival were daily UIA level, CRP, SOD, HDL, insulin and the lymphocyte level.Conclusions. Quantitative predictors of poor 5-year survival prognosis among patients with CHF and reduced LV EF with and without concomitant diabetes mellitus type 2 are parameters of heart remodeling, LV systolic function-EF, UIA level, antioxidant stress marker (SOD), HDL level, blood lymphocytes and the level of circulating insulin. Patients without diabetes are characterized by a wider range of poor long-term survival predictors, which include indicators of renal nitrogen function, markers of systemic oxidative stress (myeloperoxidase, citrulline, uric acid), flow-dependent vasodilatory response and circulating NT-proBNP. The determined quantitative predictors can be used in algorithms of individual prediction of the course of CHF and reduced LV EF, which should be created separately for patients with and without concomitant diabetes mellitus type 2

Parameters of intracardiac hemodynamics in iron deficiency in patients with chronic heart failure

BACKGROUND: Iron deficiency is a common comorbidity in many patients with chronic heart failure.
 AIM: To study the parameters of intracardiac hemodynamics in the patients with chronic heart failure in the presence of iron deficiency.
 MATERIALS AND METHODS: We examined 179 patients (36 men and 143 women, mean age 71.6 7.9 years) with heart failure of functional class 2-4 (NYHA). All the patients underwent a clinical examination, a 6-minute walk test, a general blood test; the level of NT-proBNP, iron, transferrin, and ferritin in blood serum were studied; the percentage of transferrin saturation with iron was calculated. The presence of iron deficiency was assessed based on a decrease in the level of serum ferritin less than 100 g/L or ferritin ranging from 100 to 299 g/L and saturation of transferrin with iron less than 20%. All the patients underwent echocardiography in one-dimensional, two-dimensional and Doppler modes (pulse-wave, constant-wave and tissue) in standard positions according to the generally accepted technique.
 RESULTS: It was found that in the patients with chronic heart failure and iron deficiency compared with the patients without iron deficiency; the end systolic volume of the left ventricle, the size of the right ventricle and the systolic pressure in the pulmonary artery were significantly higher, and the speed of movement of the fibrous ring of the mitral and tricuspid valves and the working capacity were lower. Significant correlations were established between the concentration of iron and ferritin and the parameters of intracardiac hemodynamics.
 CONCLUSIONS: Iron deficiency in the patients with chronic heart failure without anemia contributes to an early initial decrease in cardiac contractility with an intact ejection fraction.

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 diagnostic value of brain natriuretic peptide in men with comorbid essential arterial hypertension and type 2 diabetes mellitus

The aim of the work is to investigate the diagnostic informativeness of brain natriuretic peptide (BNP) in men with left ventricular (LV) diastolic dysfunction (DD) and initial stages of chronic heart failure (CHF) in comorbid stage 2 essential hypertension (EH 2) and type 2 diabetes mellitus (T2DM).Materials and methods. We examined 211 men. 79 people without signs of cardiovascular disease were assigned to a control group. 62 patients with EH 2 and CHF no higher than NYHA functional class (FC) I were included in the 1st, and 70 men with EH 2 combined with T2DM and CHF FC I–II formed the 2nd main study group. The plasma concentration of BNP was measured by ELISA. The examination included the determination of HbA1c, blood lipid profile, echocardiography. The mathematical processing was performed using the standard statistical package Statistica 6.1.Results. Plasma levels of BNP in comorbid EH 2 and T2DM were significantly higher (102.18 ± 4.18 pg/ml) than those in patients with EH without T2DM (77.40 ± 2.85 pg/ml) and in subjects without cardiovascular diseases (21.74 ± 0.59 pg/ml) (P < 0.00001). According to the regression analysis, the level of BNP was associated with changes in parameters of intracardiac hemodynamics in patients with EH2. In patients with comorbid EH 2 and T2DM, the level of BNP was also associated with indicators of systemic hemodynamics and body weight. BNP as a marker of CHF at the recommended borderline level (35 pg/ml) in patients with EH 2 and T2DM was characterized by a sensitivity of 98.57 % and specificity of 55.32 %. The BNP borderline levels with higher specificity were determined for early diagnosis of CHF in EH 2 with T2DM and obesity comorbidities.Conclusions. BNP, as an early marker of LV DD and the initial stages of CHF at the recommended borderline level in men with comorbid EH 2 and T2DM does not have sufficiently high specificity. In these pathological conditions, the determined borderline levels of BNP can be used as indicative surrogate markers for early diagnosis of CHF during screening with the view to identify persons for further echocardiographic additional examination and in cases where echocardiography is not possible.

Features of hemodynamics in the comorbid course of essential hypertension and type 2 diabetes in men, residents of Podillia, carriers of polymorphic variants of the brain natriuretic peptide gene

Essential hypertension (EH) and type 2 diabetes (T2D) are important risk factors for the development of chronic heart failure (CHF). The early detection of CHF, especially under comorbidity, remains a challenge. To solve it in today’s conditions are used not only instrumental diagnostic methods (Echo-CG), but also the assessment of plasma levels of biomarker – brain natriuretic peptide (BNP), the expression of which is determined by the corresponding gene (locus T-381C) and may depend on its structural organization. It is proved that deregulation of the natriuretic peptide system (NP) is an important factor in the initiation and progression of myocardial dysfunction and energy imbalance, but the role of genetic preconditions for these disorders, including the peculiarities of polymorphic variants of the most physiologically significant gene is still not enough clear. The aim of the work was to investigate the presence of associations between indicators of systemic and intracardiac hemodynamic and the carrier of polymorphic variants of the BNP gene (T-381C) in men, residents of Podillia with the comorbid course of EH 2 and type 2 diabetes mellitus. We examined 132 middle-age men: 62 patients with EH 2 and chronic heart failure (CHF) 0-I functional classes (FC) according to NYHA Classification and 70 - with EH 2 combined with T2D and CHF FC I-II. Patients with EH 2 included in the first group and patients with EH 2 and T2D included in the second group of comparison. Parameters of intracardiac hemodynamics were determined on the basis of pulsed Doppler echocardiography. The genomic DNA of the BNP gene (T-381C) for the determination of its alleles was isolated by PCR. The mathematical processing was performed using the standard statistical package Statistica 10. We calculated the primary statistical indicators, identified differences between groups on statistical signs, performed correlation and discriminant analysis. The calculation of the relative risk with a 95% confidence interval was performed using an online calculator (https://medstatistic.ru/calculators/calcrisk.html). Among men living in Podillya with EH, both in the presence and absence of diabetes mellitus 2, the T381C genotype of the BNP gene (p>0.05) dominates. In the group of comorbid patients diastolic dysfunction of the left ventricle (DD LV) was diagnosed in 90% of people (n=63), while in the isolated course of EH it was found only in 43.55% (n=28). Although among homozygotes T381T BNP gene its symptoms were 100% (n=24), and among carriers of the C allele – in 84.78% (n=39) of patients. Carriers of the T381T genotype of the BNP gene dominated among persons with DD grade II: 41.66% against 10.87% of carriers of the C allele (p<0.05), while among persons with DD LV grade I there were more carriers of the C allele. Homozygous T381T genotype with EH 2 and T2D had a higher level of pulse blood pressure (p<0,01), a higher probability of developing eccentric left ventricular hypertrophy (p≤0.05) and more pronounced diastolic changes in the myocardium, as compared with carriers of the C allele and can be allocated to the priority group of observation for the organization of targeted measures aimed at preventing the development and progression of CHF.

THE EFFECT OF BETA-BLOCKERS ON A COURSE OF CHRONIC HEART FAILURE IN PATIENTS WITH A LOW TRIIODOTHYRONINE SYNDROME

The aim: The aim is to study the effect of β-ABs in patients with LT3 S on the course of HF. Materials and methods: 354 patients with HF on a background of post-infarction cardiosclerosis were included in the 2-yeared follow-up study. LT3 S was diagnosed at 89 (25.1%) patients. The levels of thyroid-stimulating hormone, free T3f and T4f, and reversible T3 were determined. The echocardioscopy was performed. Results: Patients with HF in combination with LT3 S have a heavier functional class by NYHA, greater dilatation of the left heart cavities, less myocardial contractility, a higher frequency of atrial fibrillation and re-hospitalization. The use of β-ABs in patients with HF without LT3 S leads to a likely decrease in hospitalization frequency, while in patients with LT3 S it has an opposite effect. The frequency of rehospitalization increases with an excess of β-ABs dose > 5 mg (equivalent to bisoprolol). At these patients a decrease in serum T3 level and negative dynamics of parameters of intracardiac hemodynamics are observed. Conclusions: The use of β-ABs in patients with LT3 S leads to an increase in re-hospitalization at a dose over 5.0 mg (equivalent to bisoprolol). In these patients there is a decrease in serum T3, an increase in T4 level; and the ejection fraction decrease; and heart cavities size increase.

Changes of endothelial function and intracardiac hemodynamics during implantation of different types of pacemakers

Aim. To determine the dynamics of endothelial function and intracardiac hemodynamics during implantation of different types of pacemakers. Material and methods. The study involved 61 patients, 29 of them were implanted with single-chamber pacemaker (the first group), 32 — two-chamber pacemaker (second group) with sick sinus syndrome (SSS), as well as patients with 2-3 degrees AV conduction disorder. Test with endothelium-dependent vasodilation of the brachial artery was performed using the standard technique and the velocity parameters of blood flow were determined. Parameters of intracardiac hemodynamics and left atrial (LA) function were determined. These studies were conducted in patients initially upon admission to the hospital and 2 months later implantation of pacemaker. Results. Endothelium-dependent vasodilation significantly deteriorated in patients with single-chamber pacemaker which initially was 6,1 [2,74;9,815]% and in 2 months decreased to 5,4 [2,37;7,55]% (p=0,05). There was a tendency to deterioration of left ventricular (LV) contractile function accompanied by a decrease in ejection fraction (EF) to 55,04 [49,04;68,72]%, and decrease emptying fraction of LA to 37,36 [31,67;52,85]%. There was a tendency to increase the volume index of LA which indicates an increasing overload of the volume and pressure of LA. There was a significant increase in the degree of endothelium-dependent vasodilation in patients of the second group initially compiling a 3,25 [2,15;6,61]% and then reaches 6,15 [2,75;8,97]% 2 months after surgery (p <0,04). There was no overload in the volume and pressure of LA and improved indirect signs of LV compliance parameters (growth of end-systolic dimension and volume) and decreased LV EF to 53,23 [44,1;69,95]%. In patients in the first group there was a tendency to increase peripheral resistance to 1227 [1065;1318] dyne x cm -5 x sec, accompanied by a significant decrease in blood flow rate. In the second group there was a tendency to reduce peripheral resistance to 1215 [1136;1391] dyne x cm -5 x sec and a significant increase in blood flow rate. There was a significant correlation between the systole LA dimension and total peripheral resistance in patients with VVI stimulation (r=0,78, p=0,0022), which indicates an increase in total peripheral resistance with a change in blood flow from LA to LV and a decrease in cardiac output. Conclusion. Endothelial function deteriorates with single-chamber stimulation and improves with two-chamber stimulation. These changes are based on shear stress and nitric oxide endothelium secretion the changes of which depend on the characteristics of central and peripheral hemodynamics.

ARTERIAL HYPERTENSION AND OSTEOARTHROSIS: FEATURES OF A CURRENT CIRCUMSTANCES ( LITERATURE REVIEW)

The features of the combined prophylaxis of arterial hypertension andosteoarthritis are insufficient in the literature and more over the question requires to be further elaborated in the context of correction of patient's treatment regimen.Objective. The purpose of the study is to analyze the data of scientific works on the featuresof the course of arterial hypertension in conjunction with osteoarthritis, obesity, as well astheir "early" biomarkers.Conclusions. Аfter analyzing the literature on the peculiarities of hypertension clinicalcourse, combined with OA, as well as their "early" biomarkers, we can draw the followingconclusions:First, the combination of arterial hypertension and obesity osteoarthritis significantlyaffects the anthropometric parameters, blood pressure, parameters of intracardiachemodynamics and increases the disturbance of carbohydrate metabolism.Secondly, the prescription of a standard treatment for patients with osteoarthritis ismetabolically effective at daytime and does not reduce free radical damage.Thirdly, modern literary evidence suggests a significant participation of Grelin incardiometabolic processes.Fourth, the combination of hypertension with OA leads to aggravation of each of thediseases, increases the risk of mortality from complications from the cardiovascular system.And this requires additional research and treatment selection.

Stress increases intracardiac 4D flow cardiovascular magnetic resonance -derived energetics and vorticity and relates to VO2max in Fontan patients

BackgroundWe hypothesize that dobutamine-induced stress impacts intracardiac hemodynamic parameters and that this may be linked to decreased exercise capacity in Fontan patients. Therefore, the purpose of this study was to assess the effect of pharmacologic stress on intraventricular kinetic energy (KE), viscous energy loss (EL) and vorticity from four-dimensional (4D) Flow cardiovascular magnetic resonance (CMR) imaging in Fontan patients and to study the association between stress response and exercise capacity.MethodsTen Fontan patients underwent whole-heart 4D flow CMR before and during 7.5 μg/kg/min dobutamine infusion and cardiopulmonary exercise testing (CPET) on the same day. Average ventricular KE, EL and vorticity were computed over systole, diastole and the total cardiac cycle (vorticity_volavg cycle, KEavg cycle, ELavg cycle). The relation to maximum oxygen uptake (VO2 max) from CPET was tested by Pearson’s correlation or Spearman’s rank correlation in case of non-normality of the data.ResultsDobutamine stress caused a significant 88 ± 52% increase in KE (KEavg cycle: 1.8 ± 0.5 vs 3.3 ± 0.9 mJ, P < 0.001), a significant 108 ± 49% increase in EL (ELavg cycle: 0.9 ± 0.4 vs 1.9 ± 0.9 mW, P < 0.001) and a significant 27 ± 19% increase in vorticity (vorticity_volavg cycle: 3441 ± 899 vs 4394 ± 1322 mL/s, P = 0.002). All rest-stress differences (%) were negatively correlated to VO2 max (KEavg cycle: r = − 0.83, P = 0.003; ELavg cycle: r = − 0.80, P = 0.006; vorticity_volavg cycle: r = − 0.64, P = 0.047).Conclusions4D flow CMR-derived intraventricular kinetic energy, viscous energy loss and vorticity in Fontan patients increase during pharmacologic stress and show a negative correlation with exercise capacity measured by VO2 max.

CARDIOVASCULAR REMODELING IN PATIENTS WITH HYPERTENSION WITH DIFFERENT DEGREES OF COGNITIVE IMPAIRMENT

Introduction: Recently, the concept of vascular cognitive impairment, combining all variants of cognitive decline due to cerebrovascular insufficiency, is actively being developed. This concept goes far beyond traditionally existing ideas about the problem of vascular cognitive disturbances. The aim of the study is to demonstrate the correlation between the indices of structural and functional rearrangement of the cardiovascular system and the state of intellectualmnemonic functions in patients with hypertension. Materials and methods: A comprehensive survey of 146 patients with hypertension of the II and III stage according to ESH / ESC 2013, 2017, 2018 has been performed. The study included patients with mild and moderate cognitive impairment (CI). Depending on the state of the cognitive sphere and on the basis of the results of the neuronpsychological testing, The patients were divided into 3 groups depending on the state of the cognitive sphere and on the basis of the results of the neuron-psychological testing with further comparisons of their clinical and instrumental data. Results: According to the results of our study, it has been found that an increase of the signs of cardiovascular remodeling was observed in patients with more pronounced changes in cognitive activity. The analysis of intracardiac hemodynamic parameters in patients of the studied groups revealed more significant pathological changes in patients with cognitive impairments than in patients without them. Patients with mild and moderate CI had significantly higher heart rates, left ventricular wall thickness (LV) which led to impairment of the diastolic function of LV and had already been registered in patients without cognitive dysfunction. Moreover, it increased with the appearance (mild) and growth of the degree (moderate) cognitive impairment. The average daily values of BP (SBP, DBP) in patients of all studied groups significantly exceeded the recommended norms, while in patients with moderate CI these rates were significantly higher than those in the group with mild CI (p = 0.028). In addition, the variability of systolic blood pressure was increasing simultaneously with the deterioration of cognitive function of our patients. Also, signs of remodeling were being observed during the study of the state of peripheral vessels (increase of peripheral resistance, pulsation index, linear velocity and thickening of the intima-media complex), which is the main cause of cognitive impairment and causes their appearance and reflects their degree. Conclusions: The presented study revealed a clear correlation between the degree of cognitive impairment and the degree of changes in the daily blood pressure profile, the most important of which were the average daily systolic blood pressure and systolic blood pressure variability. On the basis of the conducted research, in the future it will be possible to predict the level of the cognitive sphere involvement, depending on the state of the daily blood pressure profile, changes of the ventricle and vessels geometry, which will enable timely diagnosis of cognitive impairment and the prescription an adequate therapy.

Functional state of the myocardium and criteria for poor prognosis in mitral valve prolapse

Aim. Study of the fnctional state of left ventricular myocardium and determination of diagnostic criteria of poor prognosis of mitral valve prolapse. Methods. 151 patients (116 males and 35 females) with mitral valve prolapse (MVP) were examined. The average age was 34.8 ± 0.79 years. Division by the groups was performed depending on the severity of structural changes of the valve and width of the cusps: group 1 included 54 patients with classic form of MVP (cusp width ≥5 mm), group 2 included 55 patients with cusp width ≥3 mm, group 3 included 42 patients with MV cusp width less than 3 mm. All patients underwent complex clinical functional examination of cardiovascular system. The state of systolic and diastolic cardiac function was assessed using stationary high-tech ultrasound scanner «Philips iE-33» (Philips, Holland) according to conventional technique with determination of standard heart parameters and calculation of intracardiac hemodynamic parameters. Echocardiography was performed on admission and 12 to 18 month later. Results. The study revealed that the most prominent changes of cardiohemodynamics and unfavorable disease course were observed in 72.2 % of patients with classic form of MVP (group 1). Patients with non-classic form of MVP (group 2) also had poor prognosis in 27.8 % of cases. Diagnostic criteria of poor prognosis of MVP according to echocardiography were determined: severe mitral regurgitation (degree ≥III), mitral valve cusp thickness during diastole over 6 mm, left ventricle dilation (EDS ≥ 60 mm; ESS ≥ 36 mm), left atrial dilation (anterior posterior size of LA ≥ 40 mm, LA volume ≥ 80 ml), mitral annulus dilation (diameter of MA ≥ 35 mm). Conclusion. Differences of functional state of the myocardium of left ventricle were revealed depending on the type of mitral valve prolapse caused by the severity of connective tissue dysplasia. In classic form of MVP more severe disorders of intracardiac hemodynamics were observed as well as more severe mitral insufficiency.

Clinical and instrumental characteristics, clinical prognosis in patients with chronic heart failure and reduced left ventricular ejection fraction, depending on the presence and nature of the iron deficiency state

The aim – to compare patients with chronic heart failure and reduced left ventricular ejection fraction (LVEF) with absolute and functional iron deficiency (ID) state according to the main clinical, hemodynamic, laboratory parameters and clinical prognosis indicators. Material and methods. In January – February, 2018, 128 stable patients with chronic heart failure (111 of men and 17 of women), 18–75 years old, NYHA class II–IV, with left ventricular ejection fraction &lt; 40 % were screened. Patients were included in a clinical compensation phase. Quality of life was assessed by the Minnesota living with heart failure questionnaire (MLHFQ), physical activity was estimated by the Duke University index, functional status – by assessing the 6-minute walking test and a standardized lower limb extension test.Results. ID was observed in 61 % of patients, 65 % had absolute ID. Patients with both types of ID were in higher functional class, had a poorer quality of life and worse clinical and laboratory indices than patients without ID. Regardless of the difference in the functional and absolute ID formation mechanisms, no significant distinctions in the clinical and functional parameters, quality of life, as well as the parameters of intracardiac hemodynamics were found. Contrary to expectations, elevated levels of hepcidin were not detected in patients with functional ID compared to the absolute ID group. The reliable differences in survival/hospitalization rate between patients without ID and both groups of patients with ID allow us to recommend the screening of iron deficiency in all patients with chronic heart failure and reduced LVEF.Conclusions. ID is found in 61 % patients. Functional ID was found in 27 patients (21 %), absolute ID – in 51 patients (39.6 %). There were no differences between groups of patients with absolute and functional ID by age, functional class, LVEF, percentage of aneamic patients, 6-minute walking distance, thigh quadriceps endurance, quality of life, physical activity index, NT-proBNP, citrulline and hepcidin levels. Compared to patients with absolute ID, patients with functional ID had higher levels of hemoglobin, MCV, MCH, interleukin-6. Presence of both ID types was associated with worse survival and more frequent hospitalization.

Effect of Physical Rehabilitation on Echocardiographic Parameters in Patients with Acute Coronary Syndrome.

Echocardiographic parameters were assessed in patients with non-ST segment elevation acute coronary syndrome, who underwent emergency percutaneous coronary intervention followed by various outpatient physical cardiac rehabilitation programs. The patients underwent physical rehabilitation for 3 months under conditions of diagnostic centre in the rehabilitation unit according to the standard program including in treadmill or bicycle exercise in the exercise therapy room or with Nordic walking in the main training block. After rehabilitation course, the left ventricular mass index significantly decreased and systolic volume and left ventricular ejection fraction significantly increased in both groups. Nordic walking training for 3 months non-ST segment elevation acute coronary syndrome induced similar positive shifts in the parameters of intracardiac hemodynamics, as standard treadmill or bicycle training program, which allows considering it as an alternative cardiac rehabilitation method.

PHARMACOGENETIC FEATURES OF THERAPY OF PATIENTS WITH ATHEROSCLEROSIS

The complexity of therapy of lipid metabolism disorders is not only in comorbidity and polypragmasia, but also in predicting a genetically determined response to the treatment. The aim of our work was to study the pharmacogenetics features of pharmacotherapy of patients with non-alcoholic fatty liver disease, with various forms of IHD, and patients taking statins. We investigated 4 study groups: I — 60 patients with 2 type of diabetes and non-alcoholic fatty liver disease (APOE polymorphism); II — 187 patients with IHD (eNOS, AGTR2, CYP2D6 polymorphisms); III — 111 people with AH and CHF (polymorphisms: AGT: 704 (Met235Thr), AGT:521 (Thr174Met), AGTR1: 1166, AGTR2: 1675, CYP11B2: -344, GNB3: 825, ADD1: 1378 (Gly460Trp), NOS3: -786); IV — 62 patients taking atorvastatin (SLCO1B1*5 polymorphism). Patients with E2, E4 alleles of the APOE gene, taking essential phospholipids, improved parameters of total cholesterol, HDL, LDL, CA, AP; patients with E3 alleles had a positive dynamics of cholesterol, HDL, TG, LDL, VLDL, CA, urea. Patients having “slow” allelic variants of the gene CYP2D6*10, CYP2D6*4 had received metoprolol, had greater decrease in heart rate: 1.6 times for CYP2D6*10, 1.7 — for CYP2D6*4. Earlier debut of IHD is noted in patients with TT variants of the eNOS gene comparing the patients with GG and GT variants. Dosages of perindopril depend on AGTR2 gene polymorphisms. The prevalence of polymorphisms AGTR2: 1675, CYP11B2: -344, NOS3: -786, AGT: 704, GNB3: 825 increases with the increase in the stage of CHF. The parameters of intracardiac hemodynamics in patients with CHF are associated with AGT: 704, NOS3:-786, GNB3: 825, ADD1: 1378, AGT: 521 polymorphisms. Allele C of the SLCO1B1*5 gene is associated with an additional risk of statin-induced myopathy. So the treatment of diseases associated with atherosclerosis, needs using of a personalized approach for more effective and safe therapy.

Short- and long-term outcomes in patients after ST-elevation myocardial infarction with urgent percutaneous coronary intervention

The aim – to study clinical and functional characteristics of patients with ST-segment elevation myocardial infarction (STEMI), the terms of urgent percutaneous coronary intervention (PCI), the coronary artery lesions, gender and age, the parameters of intracardiac hemodynamics depending on the time to PCI; to assess the end-points at 1 year follow-up.Material and methods. Between Feb till May 2015 we conducted a single-center prospective study and enrolled 108 patients with STEMI that underwent PCI (coronary angiography with stenting). We analyzed the terms of PCI after acute coronary syndrome symptoms onset, demographic, anamnestic, clinical, echocardiographic, angiographic data, as well as characteristics of interventions. We studied end-points, such as death, recurrent non-fatal MI, unstable angina, at 12 months follow-up after STEMI. Data on clinical outcomes were available in 100 of 108 patients (92.6 %).Results. According to the study results, half of STEMI patients underwent PCI within 3.5 hours; only 20.4 % patients – within the optimal time window (up to 2 hours); 60 % of patients – from 2 to 6 hours. Only 47 % of patients underwent complete revascularization. However, stenotic lesions ≥ 70 % were identified in 40 % of patients. Severe coronary lesions, suitable for CABG, were detected in 14 % of cases. Large LV aneurysm with intramural thrombus formation was diagnosed in 4 % of patients. Females, compared to males, were older, with the more prevalent concomitant hypertension and diabetes mellitus. Only 33 % of patients were judged as low-risk patients, according to the PAMI-II criteria. At 1 year follow-up, 3 % patients died from recurrent MI. These patients had single- or two-vessel disease, with stenting of the culprit artery. Among patients suitable for CABG, surgical revascularization was performed only in 1/3 cases.Conclusions. The registry data allow to assess the profile of STEMI patients undergoing PCI, as well as short-term (at discharge) and long-term (at 1 year follow-up) outcomes.

Results of the Ultrasound Study of Intracardial Hemodynamics in Patients with Ischemic Heart Disease in Combination with Arterial Hypertension and Complicated by Chronic Heart Failure 2A and 2B

Objective. To conduct a comprehensive study of patients with ischemic heart disease (IHD) in combination with arterial hypertension (AH) complicated by chronic heart failure (HF) 2A and 2B, by studying parameters of intracardiac hemodynamics considering the pressure in the pulmonary artery.Research results. We examined 120 patients with coronary heart disease in combination with hypertension aged 44 to 90 years old (mean age 72.29 ± 1.66), the majority were men (86.7%). All patients were divided into two groups according to the degree of heart failure: HF 2A - 54 persons, with HF 2B - 66 people. The groups were compared in age, gender, functional class of IHD, severity of AH and HF.Analysis of heart ultrasound showed the following. In IHD in combination with hypertension, complicated by HF 2A, the pressure in the pulmonary artery rises in an average to 46.46 ± 3.64 mm Hg and it increases in HF 2B to 57.00 ± 5.19 mm Hg., that corresponding to the average level of pulmonary hypertension (p&lt;0.01); at the same time, the fraction of ejection of left ventricle in the first patients decreases moderately up to 45.96 ± 2.01%, in others - to 39.93 ± 1.99% (p ˂0.01).In patients with IHD in combination with hypertension complicated by chronic heart failure the structural and functional changes are formed on the side of the left heart, accompanied by an increase in their size due to hypertrophy, formation of stagnant phenomena, regurgitation, functional state disorders by the restrictive type, progressive systolic and diastolic dysfunction, increased pressure in the pulmonary artery.Conclusions. Consideration of pulmonary hypertension, along with other parameters of intracardiac hemodynamics, is an important component in determining the degree and nature of heart failure, which requires the selection of adequate and timely therapeutic tactics.