Stable Coronary Heart Disease Research Articles

Статеві та клініко-інструментальні паралелі рівнів ліпопротеїн(а) в пацієнтів з дуже високим серцево-судинним ризиком

In recent years it has been established that elevated levels of Lp(a) are an independent genetic risk factor for the development of atherosclerotic cardiovascular diseases and aortic stenosis, however, issues of gender and age characteristics remain controversial.The aim of study was to analyze the gender characteristics of the relationship between Lp(a) levels and atherogenic changes in the lipid spectrum of the blood, clinical and instrumental characteristics, taking into account damage to the aortic valve and the results of coronary angiography in patients with stable coronary heart disease. Materials and methods. The 106 patients with chronic coronary heart disease (CAD) were examined. The average age of the subjects was 55.00±1.0 years (95% CI 51.11-58.89), among them: 78 men and 28 women.The entire cohort of patients was divided depending on the Lp(a) levels: 1group (n=58) with a Lp(a) level less than 50 mg/dl; 2 group (n=20) with Lp(a) level 50-100 mg/dl; 3 group (n=8) with Lp(a) level 101-150 mg/dl and 4 group (n=20) with Lp(a) level more than 150 mg/dl.Research methods included: 1. General clinical examination; 2. Laboratory characteristics of lipid (with determination of Lp(a)) and carbohydrate metabolism, as well as standard biochemical parameters; 3. Instrumental examination (electrocardiography, echocardiography, ultrasound peripheral vessels examination, coronary angiography); 4. Mathematical and statistical processing of the results obtained.Results and conclusions. In patients with CAD verified by clinical-instrumental and coronary angiographic criteria, it is noted that Lp(a) levels in women are on average significantly higher (P< 0.05) than in men and increase with the onset of menopause.Close correlations have not been recorded between Lp(a) in mg/dL and total cholesterol, LDL cholesterol and non-HDL cholesterol, as well as the concentrations of glucose, glycosylated hemoglobin, serum creatinine, and the concentration of thyroid-stimulating hormone (TSH).Determined that in patients with documented atherosclerotic lesions of the coronary arteries against the Lp(a) levels above 100 mg/dl, there is a greater need for coronary revascularization. A close relationship is observed between the increase in Lp(a) levels and the percentage of detection of aortic stenosis, which confirms the pathogenetic role of this lipoprotein in the formation of this acquired aortic valve disease.

Association between Plasma Interleukin-27 Levels and Cardiovascular Events in Patients Undergoing Coronary Angiography

Atherosclerotic disease, including coronary heart disease (CHD), is one of the chronic inflammatory conditions, and an imbalance between pro-inflammatory and anti-inflammatory cytokines plays a role in the process of atherosclerosis. Interleukin (IL)-27, one of the IL-12 family members, is recognized to play a dual role in regulating immune responses with both pro-inflammatory and anti-inflammatory properties. IL-27 is secreted from monocytes, T cells, and endothelial cells, and its expression is upregulated in atherosclerotic plaques. We previously reported that no significant difference was observed in plasma IL-27 levels between patients with stable CHD and those without it. However, the prognostic value of IL-27 levels has not been fully elucidated. We studied the relation of plasma IL-27 levels to cardiovascular events in 402 patients undergoing elective coronary angiography for suspected CHD. We defined cardiovascular events as cardiovascular death, myocardial infarction, unstable angina, stroke, or coronary revascularization. Of the 402 study patients, CHD was present in 209 (52%) patients. Plasma IL-27 levels were not markedly different between patients with CHD and those without it (median 0.23 vs. 0.23 ng/mL). During a follow-up of 7.6 ± 4.5 years, cardiovascular events were observed in 70 patients (17%). In comparison to the 332 patients with no event, the 70 patients who had cardiovascular events showed significantly higher IL-27 levels (median 0.29 vs. 0.22 ng/mL) and more frequently had an IL-27 level of >0.25 ng/mL (59% vs. 40%) (p < 0.01). The Kaplan–Meier analysis demonstrated a lower event-free survival rate in patients with an IL-27 level >0.25 ng/mL than in those with an IL-27 level ≤0.25 ng/mL (p < 0.02). The multivariate Cox proportional hazards regression analysis showed that IL-27 level (>0.25 ng/mL) was a significant predictor for cardiovascular events (hazard ratio: 1.82; 95%CI: 1.13–2.93, p < 0.02), independent of CHD. Thus, high IL-27 levels in plasma were related to an increased risk of further cardiovascular events in patients who underwent elective coronary angiography.

Stress Echocardiography by the ABCDE Protocol ln the Assessment of Prognosis of Stable Coronary Heart Disease.

To assess the role of clinical indicators and parameters of stress echocardiography performed according to an extended protocol as predictors for the occurrence of a composite cardiovascular endpoint (CCVEP) in IHD. The study included 186 patients (60.2% men, mean age 60.6±9.9 years) with an established (n=73; 39.2%) and suspected (60.8%) diagnosis of IHD. Stress EchoCG with adenosine triphosphate (38.2%), transesophageal pacing (15.1%), dobutamine (2.6%), and bicycle ergometry on a recumbent ergometer (44.1%) was performed. The stress EchoCG protocol included assessment of regional wall motion abnormalities (WMA), B-lines, LV contractile reserve (CTR), coronary reserve (CR), and heart rate reserve. The median follow-up period was 13 [9; 20] months. The composite CCVEP included death from cardiovascular diseases and their complications, acute coronary syndrome, and revascularization and was defined at the first of these events. Statistical analysis was performed with the Statistica 16.0 and SPSS Statistics 23.0 software packages. Differences were considered statistically significant at p<0.05. Invasive or noninvasive coronary angiography was performed in 90.3% of patients; obstructive coronary disease (stenosis ≥50%) was detected in 67.9% of cases. During the follow-up period, 58 (31.2%) patients had cardiovascular complications. The risk of developing CCVEP was associated with the pretest probability (PTP) of ischemic heart disease (odds ratio, OR, 1.05; 95% confidence interval, CI, 1.02-1.08), dyslipidemia (DLP) (OR 0.40; 95% CI 0.20-0.82), carotid atherosclerosis (OR 0.39; 95% CI 0.18-0.86), LV ejection fraction (OR 0.96; 95% CI 0.93-0.99), appearance at peak stress of new significant (2 LV segments or more) regional WMAs (OR 0.32; 95% CI 0.18-6.55), decreased LV CTR (OR 0.46; 95% CI 0.27-0.79) and CR (OR 0.33; 95% CI 0.18-0.61); p<0.05 for all. In a multivariate analysis with Cox regression, the model with clinical indicators included PTP of IHD (OR 1.04; 95% CI 1.01-1.07; p=0.01) and DLP (OR 0.14; 95% CI 0.02-1.01; p=0.05) as predictors. The model with stress EchoCG parameters included the appearance of new significant WMAs (OR 0.33, 95% CI 0.16-0.65; p=0.001) and reduced <2.0 CR (OR 0.44; 95% CI 0.24-0.82; p=0.01). A comparative analysis of Kaplan-Meier curves confirmed statistically significant differences in the dynamics of the CCVEP occurrence depending on the absence or presence of hemodynamically significant WMAs and/or reduced CR during stress EchoCG (p<0.01). Reduced LV CR and WMA during stress EchoCG in patients with suspected or confirmed IHD are significant independent predictors for the CCVEP occurrence. Among clinical indicators, PTP of IHD and DLP are of the greatest importance for prognosis.

The Use of Precision Epigenetic Methods for the Diagnosis and Care of Stable Coronary Heart Disease Reduces Healthcare Costs.

The cost of secondary prevention of coronary heart disease (CHD) is continuing to increase, with a substantial portion of this acceleration being driven by the expense of confirmatory diagnostic testing. Conceivably, newly developed precision epigenetic technologies could drive down these costs. However, at the current time, their impact on overall expense for CHD care is poorly understood. We hypothesized that the use of a newly developed, highly sensitive, and specific epigenetic test, PrecisionCHD, could decrease the costs of secondary prevention. To test this hypothesis, we constructed a budget impact analysis using a cost calculation model that examined the effects of substituting PrecisionCHD for conventional CHD diagnostic tests on the expenses of the initial evaluation and first year of care of stable CHD using a 1-year time horizon with no discounting. The model projected that for a commercial insurer with onemillion members, full adoption of PrecisionCHD as the primary method of initial CHD assessment would save approximately $113.6million dollars in the initial year. These analyses support the use of precision epigenetic methods as part of the initial diagnosis and care of stable CHD and can meaningfully reduce cost. Real-world pilots to test the reliability of these analyses are indicated.

The value of AI-based analysis of fractional flow reserve of volume computed tomographically detected coronary artery stenosis with regard to their hemodynamic relevance.

The aim of our work was to demonstrate the importance of artificial intelligence-based analysis of fractional flow reserves of computed tomographically detected coronary artery stenosis with regard to their hemodynamic relevance in patients with unclear chest pain and suspected stable coronary heart disease with a low to medium pre-test probability.The collective of our retrospective analysis includes 63 patients in whom coronary artery stenosis was detected by volume computed tomographic examination in "one beat, whole heart" mode in the period from March to October 2022. In these patients, the fractional flow reserve was also determined by computed tomography, which was modulated by the use of artificial intelligence.The calculated values of the fractional flow reserve and the degrees of stenosis determined by computed tomography showed a moderate and significant negative correlation for all three coronary vascular territories (LAD/CX/RCA) (correlation coefficient rho = 0.54/0.54/0.6; p < 0.01 respectively). In just over a third (37.6 %) of all stenoses classified as high-grade by computed tomography, the assessment of hemodynamic relevance by calculating the fractional flow reserve deviated from the severity of the stenosis diagnosed by computed tomography, while the results in the peripheral areas "no stenosis/vascular occlusion" were 100 % consistent in each case.The present results of this work illustrate that the calculation of the fractional flow reserve based on artificial intelligence as a supplement to volume computed tomography of the heart can make a decisive contribution to further therapy planning by increasing the specificity of the purely morphological method by the physiological aspect. · Calculation of fractional flow reserve is a useful addition to computed tomography of the heart.. · It provides possibility to dispense with unnecessary further diagnostics by increasing specificity.. · The combination of both procedures leads to therapy optimization for patients.. · Noblé H, Mühlbauer N, Ehling J et al. The value of AI-based analysis of fractional flow reserve of volume computed tomographically detected coronary artery stenosis with regard to their hemodynamic relevance. Fortschr Röntgenstr 2024; DOI: 10.1055/a-2271-0887.

High Perceived Stress Predicts Worse Clinical Outcomes in Patients with Stable Coronary Heart Disease

Background. High stress is associated with coronary heart disease (CHD), but the impact of perceived stress on prognosis with stable CHD remains unclear. This study investigated the impact of high perceived stress (HPS) on cardiovascular events in stable CHD patients. Methods. From March 2015 and December 2020, 2215 stable CHD patients were recruited. The Chinese version of the Perceived Stress Scale-14 (CPSS) was used, with follow-up conducted every 6 months until the occurrence of a cardiovascular event or March 31, 2022. Cardiovascular-related events were used as outcomes, including myocardial infarction, unplanned revascularization, stroke, death, or rehospitalization from angina. Patients were divided into HPS (CPSS≥31) and nonhigh perceived stress (NHPS) groups. The Kaplan-Meier survival curves were plotted, and the log-rank test compared the incidence of adverse events after adjusting for sociodemographic, lifestyle, and clinical information. Results. The recruited CHD population was 59.6 years old on average, 79.6% male, 27.2 points average CPSS, and median follow-up of 47 months. There were 523 HPS patients, with 98 (18.7%) cardiovascular events, and 1692 NHPS patients with 239 (14.1%) cardiovascular events. The log-rank analysis showed that risk of cardiovascular events with HPS was higher than NHPS (P=0.012). After adjusting for demographic, lifestyle, and clinical information, the HPS group had significantly increased risk of events within 24 months (HR 1.369, 95% CI 1.037-1.807, P=0.027), but less impact after 24 months. Conclusions. HPS predicts subsequent cardiovascular events in patients with stable CHD within 24 months. Therefore, more attention should be given to CHD patients with HPS, which may improve clinical prognosis.

Research Progress on Elderly Coronary Heart Disease with Frailty

Coronary heart disease and frailty are age-related diseases that mainly occur in middle-aged and older people. The prevalence of frailty in elderly patients with coronary heart disease is about 21%-35%. The harm of senile coronary heart disease combined with frailty is mainly manifested in the increase of sensitiveness and vulnerability, coexistence of multiple diseases, hospitalization rate, mortality, and adverse outcomes. It is essential to explore the underlying mechanisms, identify the risk factors, and evaluate the degree of frailty in a multidimensional way for personalized treatment strategies, preventing or reversing the progression of frailty and improving patients' quality of life. This article mainly studies the related research progress of stable coronary heart disease with frailty.

Therapeutic Effect of Cardiac Exercise Rehabilitation Program Based on Cardiopulmonary Exercise Test on Patients with Stable Coronary Heart Disease Complicated with Hypertension

Therapeutic Effect of Cardiac Exercise Rehabilitation Program Based on Cardiopulmonary Exercise Test on Patients with Stable Coronary Heart Disease Complicated with Hypertension

Sample size estimation for stratified cluster randomization trial with survival endpoint.

Cluster randomization trials with survival endpoint are predominantly used in drug development and clinical care research when drug treatments or interventions are delivered at a group level. Unlike conventional cluster randomization design, stratified cluster randomization design is generally considered more effective in reducing the impacts of imbalanced baseline prognostic factors and varying cluster sizes between groups when these stratification factors are adopted in the design. Failure to account for stratification and cluster size variability may lead to underpowered analysis and inaccurate sample size estimation. Apart from the sample size estimation in unstratified cluster randomization trials, there are no development of an explicit sample size formula for survival endpoint when a stratified cluster randomization design is employed. In this article, we present a closed-form sample size formula based on the stratified cluster log-rank statistics for stratified cluster randomization trials with survival endpoint. It provides an integrated solution for sample size estimation that account for cluster size variation, baseline hazard heterogeneity, and the estimated intracluster correlation coefficient based on the preliminary data. Simulation studies show that the proposed formula provides the appropriate sample size for achieving the desired statistical power under various parameter configurations. A real example of a stratified cluster randomization trial in the population with stable coronary heart disease is presented to illustrate our method.

THE VALUE OF HOLTER MONITORING AND THE LEVEL OF SYSTEMIC INFLAMMATION IN PATIENTS WITH STABLE ISCHEMIC HEART DISEASE COMBINED WITH TYPE 2 DIABETES, DEPENDING ON THE NUMBER OF AFFECTED CORONARY ARTERIES

Diabetes mellitus (DM) is one of the significant medical and social problems of modern society, which is due to high morbidity and prevalence, frequent occurrence of chronic micro- and macrovascular complications. Coronary heart disease (CHD) in patients with type 2 diabetes is 2-4 times more common than in people of the same age without diabetes [1]. In the absence of apparent signs of atherosclerosis, the risk of developing coronary artery disease in the next 10 years is 30% [2]. To date, the course and prognosis of this group of patients have not been sufficiently studied, objective clinical and diagnostic criteria for the development of complications of myocardial infarction have not been developed, and the problem of choosing pathogenetically based methods of treatment of CHD in combination with type 2 diabetes remains unresolved [3].The aim of the work was to investigate the informativeness of Holter monitoring (HM), the correlation of HM indicators, C-reactive protein (CRP) and carbohydrate metabolism in patients with stable coronary heart disease (CHD) in combination with type 2 diabetes for the prognosis of the course of this pathology, timely individual treatment and prevention occurrence of endpoints.Material and methods. The study involved 95 patients with coronary heart disease with angina pectoris functional class (FC) III and heart failure (HF FC III with a preserved left ventricular ejection fraction (LVEF); of them, 60 patients had concomitant type 2 DM in the compensation stage.Results. In patients with comorbidity (a combination CHD and type 2 diabetes), episodes of ST depression/elevation, tachycardia, and extrasystoles were more often registered in patients with multivessel lesions of CA (р&lt;0.05), according to HM; the content of CRP in blood serum increased in proportion to the severity of the course of the disease, which depended on the number of affected CA.Conclusions. The nature and severity of the course of CHD correlate with comorbid pathology and the number of CAs affected by atherosclerosis. In the case of multivessel damage, according to the data of clinical, functional and laboratory research, an aggressive progression of cardiac pathology was noted.

Network Motif Detection in the Network of Inflammatory Markers and Depression Symptoms among Patients with Stable Coronary Heart Disease: Insights from the Heart and Soul Study

Background. Network motif analysis is a technique used to explore recurrent and statistically significant subgraphs within a network. Applying a motif analysis to the complex network of inflammation and depression may yield nuanced insight into the specific interaction mechanisms between inflammatory markers and individual depression symptoms, which is our aim. Methods. This cross-sectional study is based on patients with stable coronary heart disease (CHD). A partial correlation network was initially constructed to link inflammatory markers, including C-reactive protein (CRP), Interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1), individual depression symptoms, and covariates. A network-centric approach searched all possible non-isomorphic subgraph patterns of size k = 4 in the network. Results. Although CRP, IL-6, and TNF-α displayed an insignificant association with specific depression symptoms, the motif analysis revealed various subgraph patterns of interactions between depression symptoms associated with MCP-1. Generally, MCP-1 formed a closed loop with psychomotor problems and sleep disturbances, and this configuration was connected in various forms with other symptoms, particularly cognitive (e.g., feelings of worthlessness, concentration difficulty, and suicidal ideation) and neurovegetative/somatic (e.g., appetite changes and fatigue) symptoms. Moreover, MCP-1 was frequently associated with a closed-loop triangle comprising cognitive and neurovegetative/somatic symptoms but not with mood symptoms (e.g., loss of interest and feelings of sadness). Conclusions. The findings provide insight into how MCP-1 may be involved in the pathology of depression among patients with stable CHD in a more precise manner. This study also proposes future directions for research on depression.

Association of FoxP3&lt;sup&gt;+&lt;/sup&gt; T regulatory lymphocytes with epicardial adipose tissue thickness in patients with coronary heart disease

Background. Increase ofthe epicardial adipose tissue (EAT) thickness isassociated with development of inflammation and cardiovascular complications, however, there is no data on the relationship between EAT thickening and the number of immunosuppressive regulatory T lymphocytes.The aim. To study the number of circulating T regulatory lymphocytes and nuclear translocation ofthe FoxP3 transcription factor in patients with stable coronary heart disease (CHD) depending on the epicardial adipose tissue thickness.Materials and methods. We examined 30 patients with chronic stable CHD. The EAT thickness was measured by echocardiography. Patients were divided into groups depending on the presence and absence of EAT thickening above 5 mm (groups 1 and 2, respectively). Imaging flow cytometry was used to determine the number of T regulatory lymphocytes and the level of FoxP3 nuclear translocation. The concentration of cytokines and high sensitivity C-reactive protein (hsCRP) was determined using enzyme-linked immunosorbent assay in blood serum.Results. Anthropometric indicators of obesity and the severity of atherosclerosis were comparable between groups. In group 2, there was an increase in low-density lipoprotein cholesterol concentration (p = 0.043), ratio of low-density lipoprotein cholesterol tohigh-density lipoprotein cholesterol (p = 0.017) and the concentration ofhsCRP (p = 0.044) andIL-1β (p = 0.005), adecrease in the number and relative count of Tregulatory lymphocytes (p = 0.020 andp = 0.026, respectively), aswellas thenumber of cells withFoxP3 nuclear translocation (p = 0.018) compared togroup1. According tomultiple logistic regression, the concentration ofhsCRP, IL-1β and T regulatory lymphocytes relative count in total were the predictors of EAT thickening (accuracy 80 %; sensitivity 75 %; specificity 84,6 %; AUC = 0.89).Conclusions. Thickening of epicardial adipose tissue inpatients withcoronary heart disease is associated with a decrease in the number of T regulatory lymphocytes andFoxP3 nuclear translocation inthem in presence of comparable anthropometric parameters of obesity and the severity of coronary atherosclerosis.

How is inflammation biology truly associated with depression in patients with stable coronary heart disease?: Insights from the heart and Soul study

Depression is known to be associated with inflammation among patients with established coronary heart disease (CHD), but it is unclear whether this is due to individual depression symptoms or to the broader construct of depression. We addressed this gap by using moderated non-linear factor analysis (MNLFA) to determine the extent that inflammation is associated with latent depression and/or individual symptoms in this patient group. We evaluated 1,024 outpatients with stable CHD from the baseline cross-sectional data of the Heart and Soul Study. Depression was assessed using the 9-item Patient Health Questionnaire, while inflammation was evaluated via C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and monocyte chemoattractant protein-1 (MCP-1) levels. MNLFA is based on the concept of model parameter moderation with regard to individual characteristics. Using the MNLFA approach, we simultaneously tested for differences in (1) latent depression, (2) individual depression items, and (3) the factor loading of the item on latent depression as a function of inflammatory markers, with and without covariate adjustment. Higher TNF-α levels were associated with both higher levels of a latent depression factor and greater endorsement of an individual symptom (appetite changes). Increased CRP levels were significantly associated with greater appetite changes, lower concentration difficulty, and greater fatigue. Elevated IL-6 levels were only related to greater fatigue, while increased MCP-1 levels were linked to greater sleep disturbance. After adjusting for covariates, some associations became insignificant. Inflammatory markers were not consistent predictors of factor loadings. This study represents the initial step to discussing how inflammation biology is truly related to depression among patients with established CHD.

Post-COVID syndrome: status of carbohydrate metabolism in patients with hypertension and stable ischemic heart disease

Background. Post-COVID syndrome is associated with a wide range of chronic symptoms or conditions. Coronavirus di­sease 2019 (COVID-19) causes metabolic disorders such as hyperglycemia, insulin resistance. Insulin-like growth factor 1 (IGF-1) is associated with an impaired glucose tolerance and a higher risk of developing type 2 diabetes. Currently, the study of molecules regulating carbohydrate metabolism as potential biomarkers of post-COVID syndrome and targets for therapeutic influence is relevant. The purpose of the study was to assess the level of IGF-1 and its relationship with regulation of carbohydrate metabolism, as well as the dynamics of the evaluated indicators under the influence of drug treatment in patients with hypertension and stable coronary heart disease who suffered from COVID-19. Materials and methods. Fifty-five patients who had a mild and moderate COVID-19 were included in the study; their average age was 55.87 [40; 75] years. The results of routine laboratory tests were registered and analyzed. The content of insulin and IGF-1 was assessed by enzyme immunoassay. The HOMA-IR was calculated. Results. In patients with a mode­rate COVID-19 compared to those with a mild one, a significant decrease in the level of IGF-1 (р = 0.008) was found against the background of increased reference values of glucose, insulin, and HOMA-IR (р &lt; 0.01). The influence of the degree of hypertension on the IGF-1 level was revealed (р = 0.004). An inverse relationship between IGF-1 and glucose level was noted (r = –0.28, p = 0.034). The use of meldonium contributed to a significant decrease in glucose and insulin content (p &lt; 0.001), and an increase in IGF-1. Against the background of taking meldonium, the dynamics of the shift towards a decrease in the HOMA-IR was more significant. Conclusions. An inverse relationship was found between IGF-1 and blood glucose, regardless of the level of insulin and HOMA-IR, in patients with hypertension and stable ischemic heart disease in the post-COVID period. Meldonium has been shown to improve carbohydrate metabolism by normalizing insulin levels and redu­cing the phenomena of insulin resistance as a potential drug target. Meldonium improved the clinical course of ischemic heart disease and demonstrated good tolerability and safety.

The Influence of Coronavirus Infection on the Results of Percutaneous Coronary Intervention in Patients with Coronary Artery Disease

Objective — to determine the impact of coronavirus infection incidence on the post-procedural condition of patients after percutaneous coronary intervention (PCI). Materials and methods. This single-centre study was conducted at the «Ukrainian Children’s Cardiac Center, Clinic for Adults» from June 1, 2020, to December 31, 2021. A total of 158 patients participated, of whom 78 had a history of COVID-19 infection and 80 did not, all with stable obstructive coronary artery disease (CAD). All patients underwent PCI, and their long-term outcomes were evaluated within a 6-month period. The study endpoints included repeated myocardial revascularization (defined as narrowing of the stented lumen by more than 70 % in diameter or acute stent thrombosis) and an assessment of CAD progres­sion (formation or progression of atherosclerotic plaques compared to baseline coronary angio­graphy). Results and discussion. The frequency of repeated coronary angio in the first 6 months after PCI due to tension angina or acute coronary syndrome was equal to 10 (12.8 %) patients in the COVID-19 +-group and 3 (3.8 %) cases in the COVID-19 — –group (p &lt; 0.05). According to the study data, patients with coronavirus infection tended to reach endpoints more quickly during the 6-month follow-up, in contrast to patients who did not have the incidence of COVID-19 during the same period. The frequency of repeated PCI within 6 months after the primary PCI in the group of patients with previous PCI was higher — 8 cases out of 78 patients compared to patients in the second group who did not suffer from COVID-19 in the first 6 months after the initial PCI (2 cases out of 80, c2 = 4 .0, p = 0.045). Conclusions. Patients with a mild and moderate course of coronavirus infection and existing stable coronary heart disease with atherosclerotic lesions of the coronary arteries were more likely to undergo repeat PCI within 6 months of the initial PCI. The most common causes of repeat PCI in patients with previous COVID-19 were thrombosis and restenosis of the stent, as well as progression of stenosis at a site other than the location of the previous PCI.

PAR4 Antagonism in Patients With Coronary Artery Disease Receiving Antiplatelet Therapies.

BMS-986141 is a novel potent highly selective antagonist of PAR (protease-activated receptor) type 4. PAR4 antagonism has been demonstrated to reduce thrombus formation in isolation and in combination with factor Xa inhibition in high shear conditions in healthy people. We sought to determine whether PAR4 antagonism had additive antithrombotic effects in patients with coronary artery disease who were receiving antiplatelet therapy. Forty-five patients with stable coronary heart disease and 10 healthy volunteers completed a phase 2a open-label 4-arm single-center study. Patients were allocated to 1 of 3 treatment arms for 7 days: (1) ticagrelor (90 mg BID), (2) aspirin (75 mg QD), or (3) the combination of ticagrelor and aspirin. Agonist-induced platelet aggregation, platelet activation, and ex vivo thrombus formation were measured before and 2 and 24 hours after a single oral 4-mg dose of BMS-986141 on the first study visit day in all participants. BMS-986141 demonstrated highly selective inhibition of PAR4-AP (agonist peptide)-induced platelet aggregation, P-selectin expression, and platelet-monocyte aggregate expression (P≤0.001 for all), which were unaffected by concomitant antiplatelet therapies. PAR4 antagonism reduced ex vivo thrombus area in high shear conditions in healthy volunteers (-21%; P=0.001) and in patients receiving ticagrelor alone (-28%; P=0.001), aspirin alone (-23%; P=0.018), or both in combination (-24%; P≤0.001). Plasma concentration of BMS-986141 correlated with PAR4-AP-induced platelet responses (P≤0.001 for all) and total thrombus area under high shear stress conditions (P≤0.01 for all). PAR4 antagonism has additive antithrombotic effects when used in addition to ticagrelor, aspirin, or their combination, in patients with stable coronary heart disease. URL: https://www.clinicaltrials.gov; Unique identifier: NCT05093790.

Clinical role of triggers and modulation factors of ventricular arrhythmogenesis in stable coronary artery disease

Ventricular arrhythmias are more commonly associated with coronary artery disease. However, ventricular arrhythmogenesis can be initiated by various trigger factors against its background. The substrate of arrhythmias in various nosological forms of stable coronary heart disease is heterogeneous. The patient may have stable exertional angina without severe fibrosis or have a history of myocardial infarction with significant scarring. Therefore the predictive value and prognostic significant of ventricular arrhythmias is not always unambiguous. Thus, for the successful treatment of arrhythmias as a main component of the prevention of sudden cardiac death, an individualized pathogenetic approach is the most important. The purpose of this article is to analyze and clinically interpret the results of studies, publications for 1980-2023, in which the authors describe the etiological, pathophysiological, pathomorphological characteristics of ventricular arrhythmias and their predictive value and prognostic significant for patients with stable coronary artery disease.

Варианты патогенетического лечения аспирининдуцированных гастроэнтеропатий у лиц с хронической ишемической болезнью сердца

Aim: Evaluation of Rebamipide treatment efficiency for aspirin-induced gastroduodenopathy in the patients with stable coronary heart disease (CHD). Design: Randomised controlled study. Materials and methods: In the course of the conducted research 340 CHD patients receiving long-term acetylsalicylic acid therapy in cardioprotective doses were studied. All the patients received complete clinical laboratory examination. For CHD verification there was applied selective method of coronary angiography. Gastroduodenopathy was verified by esophagogastroduodenoscopy. In both cases frequency and structure of the aforesaid events were assessed. For aspirin-induced gastroduodenopathy treatment there were applied either endogenic prostaglandin stimulant Rebamipide in combination with proton pump inhibitor (PPI) Pantoprazole (study group, n = 26) or Pantoprazole only (control group, n = 25). Prior to initiating therapy and on completion all the patients were taken blood samples for evaluation of prostaglandin E2 (PGE2) and proinflammatory cytokines (interleukine-1β Il-1β and interleukine-6 Il-6, TNF-α) levels in blood serum for verification of pathogenetic mechanisms in erosive or ulcer-bearing areas developing in gastrointestinal mucosa in association with long-term aspirin therapy. Соntrol group consisted of 26 CHD patients with no evidence of gastroduodenopathy. Statistical processing of the received data was conducted with the software program “Statistics 10.0”. Results. Aspirin-induced gastroduodenopathy was identified in 51 out of 340 (15,0%) cases. According to esophagogastroduodenoscopy data, erosions of the body and antrum of stomach were prevailing (43,1%) over all the erosive damages. CHD patients before the gastroduodenopathy treatment had significantly lower PGE2 levels in comparison with control group (p &lt; 0,01), while proinflammatory cytokines indices were higher (p &lt; 0,001). On the treatment completion 19 patients in the control group did not show endoscopic evidence of gastroduodenopathy, the laboratory findings tended to normalization. Gastric mucosa condition in the study group stabilized in all the cases, which was confirmed by statistically significant PGE2 level positive alterations (p &lt; 0,001) and also cytokine profile alterations (TNF-α: p &lt; 0,001; Il-1β and Il-6: p &lt; 0,01). Conclusion. The presented study demonstrates clinical features of aspirin-induced gastroduodenopathy development in the CHD patients and proposes possible ways of correction. Key words: aspirin-induced gastroduodenopathy, acetylsalicylic acid, prostaglandin E2, proinflammatory cytokines, rebamipide.

Psychological Distress and the Risk of Adverse Cardiovascular Outcomes in Patients With Coronary Heart Disease

BackgroundPsychological distress is a recognized risk factor in patients with coronary heart disease (CHD), but its clinical significance is unclear. ObjectivesThe purpose of this study was to determine if an index of psychological distress is independently associated with adverse outcomes and significantly contributes to risk prediction. MethodsPooled analysis of 2 prospective cohort studies of patients with stable CHD (N = 891). A psychological distress score was constructed using measures of depression, anxiety, anger, perceived stress, and post-traumatic stress disorder, measured at baseline. The study endpoint included cardiovascular death or first or recurrent nonfatal myocardial infarction or hospitalization for heart failure at 5.9 years. ResultsIn both cohorts, first and recurrent events occurred more often among those in the highest tertile of distress score than those in the lowest tertile. After combining the 2 cohorts, compared with the lowest tertile, the hazards ratio for having a distress score in the highest tertile was 2.27 (95% CI: 1.69-3.06), and for the middle tertile, it was 1.52 (95% CI: 1.10-2.08). Adjustment for demographics and clinical risk factors only slightly weakened the associations. When the distress score was added to a traditional clinical risk model, C-statistic, net reclassification index, and integrative discrimination index all significantly improved. ConclusionsAmong patients with CHD, a composite measure of psychological distress was significantly associated with an increased risk of adverse events and significantly improved risk prediction.

THE EFFECT OF PLATELET-RICH PLASMA ADMINISTRATION ON PROLIFERATION AND DIFFERENTIATION OF ENDOTHELIAL PROGENITOR CELLS IN PATIENTS WITH STABLE CORONARY HEART DISEASE

Endothelial Progenitor Cells (EPCs) are crucial precursors to endothelial cells, playing a key role in regulating blood vessel structure and maintaining homeostasis to protect against inflammation and thrombosis, contributing to stable coronary heart disease (CHD). Growth factors stimulate signal transduction during EPC proliferation and differentiation. Platelet-Rich Plasma (PRP) contains widely recognized growth factors in angiogenesis. Our research aimed to analyze PRP's effects on EPC proliferation and differentiation in stable CHD patients. Using an experimental post-test control group design, mononuclear cells (MNCs) from peripheral blood were cultured with M-199 medium, divided into PRP, Platelet Poor Plasma (PPP), and control groups, and incubated for 14 days. EPC proliferation was quantified with CD34 markers using ANOVA. After 7 days, differentiated cells were counted with von Willebrand Factor (vWF) markers using the Mann-Whitney U test.EPC proliferation significantly increased in the PRP group (1.052 ± 0.16) compared to PPP (0.762 ± 0.19) and the control (0.068 ± 0.05, p=0.000). However, EPC differentiation showed no significant increase in the PRP group compared to PPP (0.00-0.30 vs. 0.00-0.20, p = 0.565) or the control (0.00-0.30 vs. 0.00-0.00, p = 0.064). Additionally, no significant increase in EPC differentiation was observed in the PPP group compared to the control (0.00-0.20 vs. 0.00-0.00, p = 0.144). PRP significantly enhanced EPC proliferation but did not significantly enhance differentiation in the peripheral blood of stable CHD patients compared to PPP and control groups.