Postinfarction Cardiosclerosis Research Articles

The level of highly sensitive C-reactive protein and mortality within a year after discharge from the hospital in patients with chronic heart failure with preserved ejection fraction

Background. In recent years, there has been a steady trend in the form of an increase in the number of polymorbid patients with chronic heart failure with preserved ejection fraction (CHFpEF) and an increase in the frequency of its decompensation, which leads to an increased risk of adverse outcomes and increased mortality rates.Objective: to study the mortality structure in patients with CHFpEF within 1 year from the moment of discharge after initial hospitalization for decompensation of heart failure, as well as the level of highly sensitive C-reactive protein (hs-CRP) and clinical and laboratory characteristics of patients depending on the outcome.Methods. The data of patients with CHFpEF were retrospectively analyzed within 1 year from the moment of discharge after hospitalization due to decompensation of heart failure (n=372; median age 72.6 [63.3; 82.8] years, women – 44.4 %, NYHA class III and IV chronic heart failure, respectively, had 79.3 % and 15.9 % of patients). The concentration of hs-CRP in serum was determined in all patients during the first 24 hours after admission to the hospital.Results. During the follow-up, 65 deaths were registered (17.5 % of the included patients), of which 56 (86.2 % of all deaths) were caused by cardiovascular and cerebrovascular events – acute myocardial infarction (30 cases, 46.2 %), postinfarction cardiosclerosis (11 cases, 16.9 %), ischemic stroke (10 cases, 15.4 %), and rupture of an aortic aneurysm (1 case, 1.5 %). The level of hs-CRP compared with the surviving patients (4.84 [3.78; 5.88] mg/l) was statistically significantly higher both in the group of deaths from cardiovascular causes (5.22 [4.53; 6.21] mg/l, p=0.029) and in the group of deaths from all causes (5.33[4.49; 6.19] mg/l, p=0.020). A comparative analysis of patient characteristics revealed that patients who died from cardiovascular causes, compared with survivors, had a statistically significantly lower body mass index (p=0.046), higher total cholesterol (p=0.002), and aspartate aminotransferase (p=0.025). When comparing patients who died from all causes with patients without a fatal outcome, statistically significant differences in similar indicators were obtained.Conclusion. In patients with CHFpEF, both cardiovascular mortality and all-cause mortality within 1 year after hospitalization for decompensation of heart failure may be associated with sluggish inflammation, as well as an initially lower body mass index, higher total cholesterol and indirect signs of more pronounced myocardial damage.

Pharmacological test with nitroglycerin in combination with perfusion SPECT with <sup>99m</sup>Tc-Technetril in assessing the viability of ischemic myocardium in patients after acute infarction

Aim. To evaluate the possibility of using nitroglycerin sublingually in combination with 99mTc-Technetril cardiac perfusion single-photon emission computed tomography (SPECT) as a test for detecting viable myocardium. Material and methods. 28 male patients with coronary heart disease (CHD) and postinfarction cardiosclerosis were examined. Group 1 included 10 patients with CHD without signs of acute myocardial infarction (AMI). Group 2 comprised 18 patients with CHD, postinfarction cardiosclerosis (PICS). The control group consisted of patients who were subsequently rejected a diagnosis of CHD. Patients took 2 tablets (1 mg) of nitroglycerin sublingually, and then, at the peak of the drug’s action (after 3–5 minutes), they were intravenously administered 370 MBq of 99mTc-Technetril (by Diamed, Russia). Myocardial SPECT with 99mTc-Technetril was performed 1 hour after RFP injection. The next day, myocardial SPECT with 99mTc-Technetril was repeated at rest. Results. When taking tableted nitroglycerin at a dose of 1 mg sublingually, its maximum plasma concentration is on average 0.26 ± 0.04 microcgram/l. It is reached by 110–150 s, then maintained within 10 % of the maximum for 7-9 minutes. Nitroglycerin leads to improvement in global and local contractility and increased LV pumping function in CHD patients. This is most pronounced in individuals with a higher class of angina pectoris after AMI and major changes in intracardiac hemodynamics initially. The nitroglycerin test in combination with 99mTc-Technetril SPECT-CT allowed to identify myocardial areas with improved blood flow and increased EFLV after CABG. Conclusion. The nitroglycerin test in combination with 99mTc-Technetril SPECT-CT is effective for detecting viable myocardium in patients with coronary atherosclerosis and CHD, safe and relatively simple due to the sublingual route of nitroglycerin intake.

Значение лучевых методов в диагностике ишемической болезни сердца у конкретного пациента

Purpose: Demonstrate a clinical observation in which to establish a diagnosis it was necessary to use eight methods for diagnosing coronary pathology, four of which are radiation. Material and methods: To establish a diagnosis in a cardiac patient with suspected coronary heart disease (CHD), post-infarction cardiosclerosis, echocardiography (ECG), Holter monitoring (HM), bicycle ergometry (VE), X-ray computed tomography (X-ray computed tomography) to determine calcification of the coronary arteries, single-photon selective computer tomography (SPECT), magnetic resonance computed tomography (MRI), positron emission computed tomography (PET), coronary angiography (CAG). Results: The sequential use of eight diagnostic methods, four from radiation, was established when observing cardiosclerosis with coronary heart disease, cardiosclerosis in the 4, 5, 10, and 11 segments of the heart, complicated by a left ventricular aneurysm in the lower and lateral walls with minor ischemia at the height of physical activity. The need to use SPECT/CT in the complex diagnosis of coronary heart disease consists of using hybrid tomography and sequentially performing two studies in one diagnostic procedure (X-ray computed tomography and SPECT with 99m Tc-technetril) it seems possible to obtain 26 study indicators (with X-ray computed tomography – 4 indicators assessing calcification of the coronary arteries, with SPECT – 11 indicators of perfusion and 11 indicators of myocardial function). Conclusion: A clinical observation of the diagnosis of coronary artery disease with post-infarction cardiosclerosis and left ventricular aneurysm was demonstrated in which eight diagnostic technologies were used (ECG, CM, VE, CT, SPECT, MRI, PET, and CAG), four of which relate to radiation diagnostics (X-ray CT, SPECT, PET, and KAG). A feature of sequential hybrid tomography (X-ray CT and SPECT with 99mTc-technitrile) is that this technology allows you to obtain 26 research indicators.

Early Detection and Control of Risk Factors for Cardiovascular Diseases in the Aral Region: Experience of Uzbekistan.

To analyze the results of screening of the population older than 40 years for early detection of risk factors for cardiovascular diseases in real clinical practice of family clinics in the Aral Sea region. The results of screening of the population older than 40 years were analyzed for a total of 2,430 respondents from family clinics of the district (Republic of Uzbekistan, Republic of Karakalpakstan, Ellikkala district) according to the modified WHO PEN protocol. 1,020 of the respondents with blood pressure ≥140/90 mm Hg were included in the study (mean age, 57.68±8.06 years; women, 61.4%; men, 38.6%). Additionally, the following parameters were determined: salt-taste threshold using the R. Henkin method, echocardiography, ultrasonography of the brachiocephalic arteries, blood lipid spectrum, microalbuminuria, serum creatinine and uric acid. Statistical data are presented as mean±SD. The prevalence of signs in the study group was assessed using the Pearson's chi-square test, and the Pearson correlation coefficient was used. Among the patients with elevated blood pressure included in the study, 24 (2.4%) were younger than 40 years, 847 (81%) were 40-65 years old, and 169 (16.6%) were older than 65 years. Low cardiovascular risk was twice more common among women compared to men: 11.3% vs. 5.6% (χ²=8.990; p=0.003); almost 75% fewer patients with ischemic heart disease, 7.4% vs. 28.9% (χ²=14.939; p=0.0001); however, the incidence of type 2 diabetes mellitus was twice higher, 13.7% vs. 7.4% (χ²=9.205; p=0.002); the female group had significantly fewer cases of postinfarction cardiosclerosis (PICS) (χ²=5.313; p=0.021). Among women, there were no tobacco users or regular alcohol drinkers whereas among men these risk factors were identified in 59.4% (χ²=178.848; p=0.0001) and 35% (χ²=82.238; p=0.0001), respectively. 85.6% of the respondents had a high salt-taste threshold, 96% had left ventricular hypertrophy, 76% had microalbuminuria, 21% had proteinuria, and 92% of both men and women had a common carotid artery intima-media thickening >0.9 mm. The study showed a broad prevalence of cardiovascular risk factors in the population of hypertensive patients in the Aral region, a high salt-taste threshold, and significant damages to target organs, which differed from other regions of Uzbekistan. Among hypertensive men, there was a significant prevalence of tobacco and alcohol use, and a significantly more frequent detection of ischemic heart disease, PICS and hyperuricemia compared to women; in the female population, the prevalence of type 2 diabetes mellitus was significantly greater.

Significance of depression and androgen deficiency in development of myocardial infarction in young males

In the recent years, close attention has been paid to the study of depression in general medical practice, in particular, among patients with myocardial infarction (MI). Two large groups of factors, which presumably cause such a relationship, are discussed. The first group includes direct pathophysiological factors, the second – indirect, "behavioral" reactions modifying other risk factors for coronary artery disease and reduce patient adherence to prescribed therapy. The age of patients in the observed populations, as well as the predominant type of MI in patients, may have a certain influence on the results of studies. Besides, today, no unambiguous view has been formed on the question of the relationship between the androgenic status of men and the development of coronary artery disease. Among the articles analyzing the effect of androgen levels on the course of coronary heart disease, most of the studies are devoted to androgen content in the blood serum among men with stable angina, while there are relatively few studies evaluating androgen status in acute myocardial infarction and postinfarction cardiosclerosis. On the one hand, it is assumed that age-related androgen deficiency in middle-aged men with coronary heart disease may be a compensatory response to a severe general disease and can contribute to better long-term results of myocardial revascularization in them. On the other hand, it was found that men with coronary heart disease and age-related hypogonadism are characterized by more pronounced manifestations of myocardial ischemia, dysfunction of the autonomic nervous system, and more severe atherosclerosis of the coronary arteries. A review of the latest evidence is presented, summarizing clinical data on the impact of depression and androgen deficiency in the development of myocardial infarction in young men.

Prevention of Pacemaker Malfunctions in Patients With Bradyarrhythmia: Results of a Single-Center Follow-up

Objective: To evaluate results of surgical treatment in patients with bradyarrhythmia and risk factors for pacemaker (PM) malfunctions using improved preventive measures.Materials and methods: Our study consisted of two stages. At stage I, we retrospectively analyzed histories and outpatient medical records of 948 patients with various forms of bradiarrhythmias who underwent surgery in the clinic between 2006 and 2021 to identify PM malfunctions that occurred both in the early and late postoperative periods. Based on the data on the most common types of PM malfunctions and possible risk factors for their development, preventive measures were improved in this cohort of patients and were further used at stage II (pilot) to select patients for surgery.During stage II (pilot), 188 patients were operated on between 2019 and 2021: risk factors for malfunctions were identified in 72 (38.3%) cases at the preoperative stage. All the patients underwent surgery with the proposed and improved preventive measures. Follow­up was during the hospital stay and in 6 and 12 months.Results: At stage I (retrospective analysis), 78 (8.23%) patients had signs of PM malfunction. The most common malfunctions were endocardial electrode displacement (30.8%), increased stimulation threshold (25.6%), a change in the endocardial electrode impedance (17.9%), and impaired sensitivity (10.3%). In addition, premature battery depletion and PM syndrome were present in 9% and 6.4% of the patients, respectively.The correlation analysis revealed that the most common findings associated with malfunctions were enlarged right chambers of the heart due to valvular defects and dilated cardiomyopathy, myocardial remodeling caused by chemotherapy and radiation therapy, postinfarction cardiosclerosis in the electrode implantation area, untimely and inadequate PM programming, as well as increased levels of blood uric acid, urea, and creatinine, and prolonged and uncontrolled use of steroid drugs and bronchodilators.At stage II, there were no PM malfunctions requiring changes in the pacing parameters during the hospitalization period. Six months postsurgery, 1 (1.4%) patient had an increase in impedance (to 2843 ohms) caused by the uncontrolled intake of high doses of corticosteroids due to decompensation of chronic obstructive pulmonary disease. After correction of the corticosteroids dose, the ventricular electrode impedance returned to the normal level. Twelve months postsurgery, 2 (2.8%) patients had a decrease in impedance to 215 and 143 ohms, respectively, caused by the ventricular electrode displacement. After correcting the electrode position, normal pacing parameters were restored. No cardiac complications due to malfunctions were observed. Morphofunctional parameters of the heart did not significantly differ when compared with preoperative ones.Conclusions: Surgical treatment of patients with bradyarrhythmia and risk factors for PM malfunctions who underwent surgery with the proposed preventive measures demonstrated high efficiency in reducing the number of malfunctions and cardiac complications associated with inadequate stimulation in the long­term follow­up.

A 5-year single-center experience in heart transplantation in Rostov oblast

Objective: to evaluate the outcomes of heart transplants performed at Rostov Regional Clinical Hospital within five years.Materials and methods. Between 2017 and 2022, 29 orthotopic heart transplants (HT) were performed in our clinic. Heart failure was caused by postinfarction cardiosclerosis (21 cases, 72.4%) and dilated cardiomyopathy (8 cases, 27.6%). Among the recipients, 27 (93.1%) were men and 2 (6.9%) were women. Mean age was 53.14 ± 8.7 years (34 to 67 years). All patients received quadruple-drug immunosuppressive therapy, including induction with monoclonal antibodies; calcineurin inhibitor, mycophenolic acid, and corticosteroid were used after HT.Results. In-hospital mortality was 10.34% (n = 3). The causes of death were multiple organ failure and infectious and septic complications. After discharge, 4 (13.8%) recipients died over 5 years. Rejection reaction with the development of graft dysfunction (3 recipients, 75%), infectious and septic complications (1 recipient, 25%) were the causes of death in the long-term period. The survival rate was analyzed according to the Kaplan–Meier estimate. One-year survival was 80.9%. Three-year survival rate corresponded to the 5-year survival rate – 70.56%. Five-year survival of patients surviving the first year after HT was 86.1%. Maximum follow-up period was 64 months.Conclusion. HT continues to be the gold standard for patients with end-stage heart failure. Five-year HT experience in our center has shown a survival rate that is comparable to that of the International Society for Heart and Lung Transplantation (ISHLT).

Assessment of disturbed functions in patients with chronic heart failure using International classification of functioning ICF categories

BACKGROUND: The evaluation of impaired functions in patients with cardiac diseases is traditionally based on the clinical signs of the disease and instrumental hemodynamic parameters, without affecting all other disorders that occur with this pathology. The International classification of functioning is based on the functioning of the patient in his/her environment; therefore, a consistent assessment of the entire complex of impaired functions of the patient is appropriate, allowing for a more accurate formulation of the goals of rehabilitation and controlling the main stages of rehabilitation.
 AIM: To evaluate the International classification of functioning for assessing all impaired functions in patients with chronic heart failure.
 MATERIALS AND METHODS: The study included 68 patients with decompensated chronic heart failure. The analyzed sample included patients with chronic heart failure stages 2B and 3 (NYHA classes IIIIV). The average patient age was 63.9 years, and the average disease duration was approximately 7 years. The sample was predominantly men (66.5%). The etiology of chronic heart failure was represented by uncontrolled arterial hypertension (92%), post-infarction cardiosclerosis (74%), ischemic cardiomyopathy (25%), and chronic obstructive pulmonary disease (12%). Radiation diagnostic methods were used to confirm the severity of cardiac decompensation. The study assessed impaired functions in accordance with the domains of the International classification of functioning, mainly in functions of the cardiovascular system.
 RESULTS: In this study, 68 patients had decompensated chronic heart failure stages 2B and 3 (NYHA classes IIIIV). Group 1 included 40 patients, and group 2 included 28 patients. The instrumental examination revealed a more pronounced decrease in left-ventricular ejection fraction in group 1 compared with group 2 (42.84.4 and 49.25.6, respectively), showing a significant difference (p 0.05). Other hemodynamic parameters did not differ significantly in the groups. In the analysis of a basic set of the International classification of functioning domains for patients with chronic heart failure, the following domains turned out to be the most significant: heart function (b410), forced myocardial contraction (b4102); heart rate (b4100); blood supply to the heart (b4103); blood pressure functions (b420): increase (b4200), decrease (b4201), maintenance (b4202); functions of the respiratory system (b440) including the respiratory rate (b4400); additional functions and sensations from the cardiovascular and respiratory systems (b450-469); exercise tolerance functions (b455); water balance (b5450), including water retention (b45500), characterizing the presence of edematous syndrome; and muscle strength functions (b730). The indicated domains were also supplemented with Section d (activity and participation) walking long distances (d4501) and doing housework (d640); and Domain e (environmental factors), i.e., help from the next of kin (e310).
 CONCLUSIONS: A set of domains of the International classification of functioning for patients with decompensated heart failure has been developed and proposed, which makes it possible to more effectively identify the key problems of people with disability and more objectively form a plan for complex rehabilitation, which largely determines the prognosis in these patients.

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

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

THE BENEFITS OF DUPLEX SCANNING OF EXTRACRANIAL CAROTID PATHOLOGIES FOR RISK STRATIFICATION OF ISCHEMIC STROKE

Abstract Introduction: Recent retrospective cohort study demonstrated the benefit of duplex scanning in the examination of the extracranial carotid artery pathologies for preventing cerebrovascular disorders. The aim of this study: was to evaluate the clinical and demographical characteristics and outcome in patients treated at National Scientific Center of Surgery, after detecting extracranial carotid artery stenosis ≥70%. Material and methods: A retrospective cohort study was conducted; 204 patients were included. Results: The most significant risk factors were: ischemic heart diseases – 95.6%, arterial hypertension – 80.1%, chronic heart failure – 83.8%, cholesterol level above the norm of 5.2 mmol/L-39.2%; 30.4% of patients had a history of postinfarction cardiosclerosis. There were a significant statistically difference between the prevalence of extracranial carotid artery stenosis depending on the risk factors (blood cholesterol levels, a clinical history of chronic heart failure, and acute cerebrovascular diseases p=0.048, p=0.003, p=0.048 respectively (p>0.05)). Conclusion: In summary, we conclude that surgery should be considered, and duplex ultrasound plays a crucial role in assessing the severity of carotid stenosis in atherothrombotic stroke patients with severe external carotid stenosis. These data indicate that physicians, should be aware of the usefulness of carotid duplex ultrasound scanning in stratifying the risk of cerebral and cardiovascular diseases based on various aspects.

Effects of combination antihypertensive therapy on intracardiac hemodynamics and blood vessels in patients with coronary heart disease, post-infarction cardiosclerosis and arterial hypertension

The aim of the work is to assess the effectiveness of prescribing a fixed-dose combination of amlodipine with the ACE inhibitor lisinopril or with the angiotensin 2 receptor blocker valsartan in patients with coronary artery disease, acute coronary syndrome with hypertensive disease regarding the impact on the structural and functional parameters of the heart and extracranial branches of the brachiocephalic arteries. Materials and methods. General clinical examination of 108 patients with postinfarction cardiosclerosis and hypertension was done within 12 months. The patients were allocated to two groups. Patients in the first group (n = 50) were assigned a fixed-dose combination of lisinopril and amlodipine (20 mg and 5 mg, respectively), and patients in the second group (n = 58) received a fixed-dose combination of valsartan with amlodipine (160 mg and 5 mg, respectively). The patients were monitored for 12 months, including general clinical examinations, measurements of office blood pressure (BP), 24-hour BP monitoring, echo-dopplerographic examination of the heart and brachiocephalic arteries, determination of the composite endpoint. Statistical analysis of the obtained data was performed using Microsoft Excel, IBM SPSS Statistics v.23. Results. A significant difference in echocardiographic data has been proved (p < 0.05) regarding left ventricle (LV) dimensions in both study groups. A significant decrease in the E/A ratio and an insignificant decrease in E/E’ (p > 0.05) have been found in the first group. When analyzing the indicators of diastolic function in the second group, a highly significant (p < 0.05) decrease in E/A, E/E’, IO of the LA has been revealed; data analysis on the morphofunctional state indicators of the extracranial arteries has shown a CIM reduction and a decrease in PSV and RI. Conclusions. Prescriptions of the fixed-dose combination of amlodipine with the ACE inhibitor lisinopril was more effective in terms of the LV measurements (p < 0.05) and LV diastolic function as evidenced by decreased E/A, E/E’ and IO of the LA (p < 0.05) as compared to the data in the group of amlodipine with the angiotensin 2 receptor blocker valsartan. Both fixed-dose combinations were effective in reducing the CIM thickness, decreasing PSV and RI when analyzing the morphofunctional state findings of the extracranial arteries.

Prognostic significance of NT-proBNP and sST2 biomarkers in patients with post-myocardial infarction heart failure after a coronavirus infection

Aim. To determine the prognostic significance of N-terminal pro-brain natriuretic peptide (NT-proBNP) and soluble ST2 (sST2) in patients with post-myocardial infarction heart failure after a coronavirus disease 2019 (COVID-19)Material and methods. Three following groups were formed: in patients of group I (main), who underwent inpatient treatment for COVID-19, the cause of heart failure (HF) was prior Q-wave myocardial infarction; in patients of group II (comparison) without COVID-19, the cause of HF was prior Q-wave myocardial infarction; Group III (comparison) — patients with HF of ischemic origin without postinfarction cardiosclerosis and COVID-19. Statistical processing was carried out using the software package IBM SPSS Statistics Version 26.0.Results. The patients of all three groups included in the present study were comparable. After 6 months in group I, HF course worsening was recorded. In patients of groups I and II, an increase in NYHA HF class from 2 to 3 and 4 was recorded, in contrast to patients of group III, among whom the number of patients with class 3 HF decreased by 25% due to compensation to class 2. Patients of the studied groups, who had elevated serum levels of NT-proBNP and sST2, had more pronounced structural and functional myocardial disorders than patients with normal levels of these biomarkers. Using analysis of adverse cardiovascular events, such as recurrent myocardial infarction, cerebrovascular accident, hospitalization due to coronary artery disease, decompensated HF, which required hospitalization, a predictive model was developed using a neural network. There were following most important factors of the developed model: age, level of NT-proBNP and sST2, lung involvement according to computed tomography.Conclusion. Modern biomarkers NT-proBNP and sST2 have sufficient predictive value to determine the risk of adverse events in HF.

Analysis of the S100B protein level in patients with acute coronary syndrome associated with anxiety and depressive symptoms

Background. Acute coronary syndromes are often associated with the onset or aggravation of anxiety and depressive disorders, delirium, cerebral ischemia up to the development of a stroke.Aim: To study the level of brain-specific protein S100B in blood plasma in patients with acute coronary syndrome (ACS) associated with anxiety-depressive disorders (ADD).Material and Methods. The study included 81 patients with ACS and the presence of anxiety and depression. Patients were surveyed using the Hospital Anxiety and Depression Scale, the Beck Depression Inventory, and the Sheehan Patient-Rated Anxiety Scale. All patients underwent blood sampling to study the level of S100B protein.Results. Patients included in the study were diagnosed with clinical anxiety and subclinical depression. In 35 patients (43%), the S100B protein level varied from 0 to 90 ng/l, and in 46 patients (57%), its level was above 90 ng/l. According to correlation analysis in patients, positive correlations were found between a high level of S100B protein in the blood serum and clinical indicators (diabetes mellitus, obesity, smoking, arterial hypertension, postinfarction cardiosclerosis, a history of cerebral stroke), levels of anxiety and depression, as well as negative correlations between high level of S100B protein in blood serum and glomerular filtration rate, left ventricular ejection fraction.Conclusions. An increase in the level of S100B protein was observed in comorbid patients with clinically pronounced anxiety and depressive symptoms. It is possible that higher values of glial protein S100B in the blood at admission in patients with ACS may predict a more severe course of cardiovascular disease and a worse neurological prognosis, but it requires further study.

Right ventricular visualization at SPECT perfusion imaging before and after revascularization in patients with postinfarction cardiosclerosis

Aim. To evaluate the intersystemic (between the myocardium of the left coronary artery system and the right coronary artery system redistribution mechanisms of perfusion in the myocardium after revascularization in patients with coronary artery disease with focal cardiosclerosis using gated single photon emission computed tomography. Сardiosclerosis foci were initially identified by magnetic resonance imaging. Material and Methods. The study included 17 patients with coronary artery disease with multivessel coronary disease and large-focal cardiosclerosis according to the results of magnetic resonance imaging with contrast; the diagnosis of left ventricular aneurysm was established in 14 patients, the focal subendocardial cardiosclerosis was diagnosed in 3 patients. For various reasons, all patients underwent myocardial revascularization without the left ventricle reconstruction (coronary artery bypass grafting in 10 patients, percutaneous coronary intervention in 7 patients). Magnetic resonance imaging was used as the gold standard for focal cardiosclerosis before revascularization. All patients before and after revascularization underwent gated single photon emission computed tomography with MIBI scan. During the initial analysis of peaks on the profile slices of coronal and transversal midsections passing along the lateral walls of the left and right ventricles, we did not notice a clear visualization of in 8 patients (group 1), while an increased MIBI scan accumulation in the right ventricle myocardium was clearly visualized in 9 patients (group 2). Based on the peaks height of profile curves, we compared changes in the maxima of radiopharmaceutical accumulation before and after revascularization in the lateral walls of the left ventricle and right ventricle. All studies were performed using the original Cardiac Functional Imaging medical program in order to obtain quantitative information about the myocardial function of both the left ventricle, and also the right ventricle. This program made it possible to highlight the right ventricle area even in the case of its weak visualization through the initial formation of parametric images, where the right ventricle area was visualized. Results. When comparing the revascularization results of the two groups, we noted that the left ventricle ejection fraction increased significantly only in patients without initial visualization of the right ventricular myocardium. Left ventricle ejection fraction did not change after revascularization in patients with initially increased accumulation of the radiopharmaceutical in the right ventricle. Globally, only an improvement in the diastolic function of the left and right ventricles was noted in the latter group of patients. In addition, an increase in the right ventricular uptake level was noted for patients with focal cardiosclerosis and the initially increased uptake in the right ventricle after the maximum possible complete myocardial revascularization, which may indicate a redistribution of perfusion in favor of a more intact right ventricular myocardium. Conclusions. 1. In patients without signs of increased visualization of the right ventricle (group 1) after revascularization, we revealed a statistically significant increase in the left ventricle ejection fraction (p-value=0.024), a decrease in the end-systolic volume (p-value=0.024), an increase in the motion in segments corresponding to the peri-infarct scar zone (p-value=0.016), and a change in systolic thickening in the segment of the basal parts of the anterolateral wall (p-value=0.046). 2. Initially increased visualization of the right ventricle in patients with extensive focal cardiosclerosis in the myocardium of the left ventricle suggests the absence of the left ventricle ejection fraction increase after myocardial revascularization. 3. An increase in the visualization of the right ventricle after complete myocardial revascularization indicates an intersystemic redistribution of perfusion in favor of the preserved myocardium of this part of the heart.

THE COURSE OF CHRONIC HEART FAILURE IN PERSONS WITH POST-INFARCTION CARDIOSCLEROSIS WITH ARTERIAL HYPERTENSION AND TYPE 2 DIABETES MELLITUS AND OBESITY ACCORDING TO A NUMBER OF MET

Objective: To investigate the effect of lipid metabolism, biomarkers of fractalkin and clusterin inflammation on the development and progression of chronic heart failure (CHF) in patients with post-infarction cardiosclerosis, type 2 diabetes and obesity. Design and method: A retrospective analysis of a comprehensive examination of 67 patients with postinfarction cardiosclerosis with concomitant type 2 diabetes and obesity. All patients were divided into 3 groups depending on the functional class (FC) of CHF: 1 group (n = 22) - patients with CHF II FC; Group 2 (n = 23) - patients with CHF III FC; Group 3 (n = 22) - patients with CHF IV FC. All patients were examined clinically, they underwent instrumental, biochemical and hormonal examinations. Results: With the progression of CHF from FC II to FC III there is a deterioration of lipid metabolism: a significant increase in cholesterol levels by 5.5%, TG – by 15.7%, LDL cholesterol – by 74.4%, VLDL cholesterol – by 15.9%, reduction of HDL cholesterol by 27.6% (p<0,05). An analysis of the fractal equation showing that ailing on CHF is advised by FC; and the level of clusterine - on the contrary decreases. Classical changes in patients with postinfarction cardiosclerosis with CHF and concomitant type 2 diabetes mellitus and obesity, which are the formation of atherogenic lipid metabolism disorders associated with body weight, as well as changes in the latest indicators such as fractalkin and clusterin, indicating the role of these molecules in the progression of CHF. Conclusions: Due to the progression of chronic heart failure in patients with postinfarction cardiosclerosis and AH concomitant type 2 diabetes and obesity, an increase in all fractions of lipoproteins at stage III functional class was diagnosed, and then their decrease, which may indicate a deterioration in this category of patients, due to the progression of metabolic shifts, stagnation, dysfunction of the main parenchymal organs. Increased circulatory levels of fractalkin and decreased clusterin content in patients with postinfarction cardiosclerosis with concomitant type 2 diabetes mellitus and obesity is accompanied by an increase in the functional class of chronic heart failure.

PREVENTION OF CARDIOVASCULAR COMPLICATIONS IN PATIENTS WITH RHYTHM DISTURBANCES AND PSYCHO-EMOTIONAL DISORDERS

Today, cardiac rhythm disturbances are quite common in the adult population. The correct tactics of outpatient management as well as timely diagnostics of heart rhythm disturbances considerably reduces the percentage of patients suffering from complications of heart rhythm disturbances, improves quality of life of patients and reduces risks of lethal outcome. The aim of our study was to detect psycho-emotional disorders among outpatients with heart rhythm disturbances who had myocardial infarction. 62 patients diagnosed with coronary heart disease (CHD), postinfarction cardiosclerosis (PICD) and various types of rhythm disturbances were studied in Samarkand 3rd family polyclinic. The mean age of the patients was 62.8±12.1 years. During the study we have established the relationship between the progression of signs of rhythm disturbances and psycho-emotional status of the patients based on the HADS score interpretation. Conclusions: thus, our study proves that all patients, in particular myocardial infarction patients, should be tested with Hospital Anxiety and Depression Scale - HADS already in the outpatient phase for early detection of psychoemotional disorders to reduce cardiovascular complications, as well as to provide timely targeted care already in the primary care.

Transformative Effect of COVID-19 Pandemic on Magnetic Resonance Imaging Services in One Tertiary Cardiovascular Center.

The aim of study was to investigate the transformative effect of the COVID-19 pandemic on magnetic resonance imaging (MRI) services in one tertiary cardiovascular center. The retrospective observational cohort study analyzed data of MRI studies (n = 8137) performed from 1 January 2019 to 1 June 2022. A total of 987 patients underwent contrast-enhanced cardiac MRI (CE-CMR). Referrals, clinical characteristics, diagnosis, gender, age, past COVID-19, MRI study protocols, and MRI data were analyzed. The annual absolute numbers and rates of CE-CMR procedures in our center significantly increased from 2019 to 2022 (p-value < 0.05). The increasing temporal trends were observed in hypertrophic cardiomyopathy (HCMP) and myocardial fibrosis (p-value < 0.05). The CE-CMR findings of myocarditis, acute myocardial infarction, ischemic cardiomyopathy, HCMP, postinfarction cardiosclerosis, and focal myocardial fibrosis prevailed in men compared with the corresponding values in women during the pandemic (p-value < 0.05). The frequency of myocardial fibrosis occurrence increased from ~67% in 2019 to ~84% in 2022 (p-value < 0.05). The COVID-19 pandemic increased the need for MRI and CE-CMR. Patients with a history of COVID-19 had persistent and newly occurring symptoms of myocardial damage, suggesting chronic cardiac involvement consistent with long COVID-19 requiring continuous follow-up.

Changes in the biomechanics of contractility of the myocardium of the left ventricle: results of prospective follow-up

As a result of a two-year prospective study, the differences between intraventricular and interventricular dyssynchrony in patients with arterial hypertension, atherosclerotic and postinfarction cardiosclerosis were determined according to the data of echocardiography in the standard mode and in the mode of tissue myocardial dopplerography.

Evaluation of the neutrophil-leukocyte index in patients with cardiac disorders and new coronavirus infection

Background: The neutrophil-leukocyte index (NLI) is an independent predictor of an unfavorable outcome in stable ischemic heart disease, as well as of mortality in patients with acute coronary syndromes and uncontrolled heart failure. A number of studies have shown the informative value of NLI for the prediction of severe course of COVID-19. NLI variability in COVID-19 with comorbid baseline physical diseases and cardiovascular disorders in particular, has not been studied.&#x0D; Aim: To evaluate the clinical value of NLI in hospitalized patients with COVID-19 depending on their concomitant cardiac disorders.&#x0D; Materials and methods: In this retrospective quantitative study we have analyzed the data from medical files of the patients with the diagnosis of new coronavirus infection confirmed by polymerase chain reaction, treated in a specialized in-patient department of infectious diseases in 2020 to 2022. Previously diagnosed cardiac disorders were defined as any past history of these disorders. The results of instrumental and laboratory work-up were assessed before treatment.&#x0D; Results: The analysis included 226 patients with median age of 50.0 (Q1Q3: 42.063.0) years, with 81.4% (n = 184) of them being men. Ninety four (41.6%) patients had no previously diagnosed cardiovascular disorders. Arterial hypertension by the time of admittance was present in 132 (58.4%), ischemic heart disease, in 77 (34.1%), atherosclerotic and/or post-infarct cardiosclerosis, in 82 (36.3%), and chronic heart failure, in 77 (34.1%) of the patients.&#x0D; In the total study group (n = 226) the median NLI was 2.6 (1.574.47). The larger was the volume of the lung involvement (assessed by computed tomography at admittance), the higher was NLI (p = 0.009, Kruskal-Wallis test). There was an association between the NLI value and the degree of respiratory failure (p 0.001, Kruskal-Wallis test). Median NLI in the patients with cardiac disorders (irrespective of their nosology) was significantly higher than that in the patients without any history of cardiovascular problems: 3.30 (2.095.42) versus 1.95 (1.423.62) (p 0.001, Mann-Whitney U-test). We found significant difference in the NLI values for each type of cardiac disorders, compared to that in the patients without history of cardiovascular disorders, including for the patients with arterial hypertension (p 0.001, Kruskal-Wallis test), ischemic heart disease (p 0.001, Mann-Whitney U-test), atherosclerotic cardiosclerosis (p = 0.001, Mann-Whitney U-test), and chronic heart failure (p = 0.040, Kruskal-Wallis test).&#x0D; Conclusion: We have confirmed the contribution of cardiovascular disorders to the course of COVID-19 and the clinical value of NLI as a convenient laboratory marker of the severity of infectious disease.

Can a referral diagnosis code for duplex ultrasound "predict" carotid artery stenosis?

Aim. To evaluate the detection rate of carotid artery stenosis (CAS) based on the diagnosis code according to the International Clas­sification of Diseases of 10th revision (ICD-10), used in appointment card for carotid duplex ultrasound.Material and methods. To conduct this study, the Duplex-2013 registry database was used, which sequentially included 2548 patients. When referring to carotid duplex ultrasound, all patients indicated the ICD-10 diagnosis code as the main reason for seeking medical help. The study assessed the presence and severity of CAS, the probability of CAS, taking into account age, sex, and referral diagnosis according to ICD-10.Results. According to the results of a univariate analysis, the following referral diagnoses were associated with the identification of CAS by two criteria (stenosis ≥20 and ≥50%): generalized/peripheral atherosclerosis (GPA) — odds ratio (OR), 6,54; 95% confidence interval (CI): 2,71-18,89 (p&lt;0,001) and OR, 11,91; 95% CI: 6,17-22,75 (p&lt;0,001), postinfarction cardiosclerosis — OR, 5,63; 95% CI: 2,62-13,6 (p&lt;0,001) and OR, 3,08; 95% CI: 1,39-6,28 (p=0,004), CAS — OR, 3,26; 95% CI: 2,08-5,27 (p&lt;0,001) and OR, 2,29; 95% CI: 1,25-3,96 (p=0,006) and hypertension, OR, 2,2; 95% CI: 1,87-2,58 (p&lt;0,0001) and OR, 1,45; 95% CI: 1,07-1,97 (p=0,02). Taking into account age and sex, the probability of CAS detection (&gt;20%) is associated with HTN — OR, 1,43; 95% CI: 1,19-1,71 (p&lt;0,001), postinfarction cardiosclerosis — OR, 2,89; 95% CI: 1,20-6,94 (p=0,01) and GPA — OR, 4,52; 95% CI: 1,65-12,35 (p=0,003); CAS &gt;50% — acute myocardial infarction — OR, 8,45; 95% CI: 1,32-53,97 (p=0,02) and GPA — OR, 9,82; 95% CI: 4,81-20,04 (p&lt;0,001).Conclusion. Certain groups of referral diagnoses (ICD-10 codes) are associated with a higher probability of CAS. The obtained data needs to be refined in order to optimize routing and referral for carotid duplex ultrasound.