The Influence of Low and Moderate Carotid Stenosis on Neurophysiologic Status of Patients Undergoing on-pump Coronary Artery Bypass Grafting

Background: Significant (>70%) extracranial stenosis of the internal carotid artery (ICA) is a known risk factor for brain damage in patients with coronary heart disease (CHD) undergoing coronary artery bypass grafting (CABG). There is no clear evidence of the low and moderate ICA stenoses influence on the neurophysiologic status of patients after CABG. This work was aimed at studying the influence ICA stenoses (<50%) on the dynamics of neurophysiologic status in patients undergone CABG. Methods: We examined neurophysiologic functions and electroencephalograph in CHD patients (N = 45) aged from 45 to 70 years. All patients were divided into two groups: with ICA stenosis (n = 20) and without one (n = 25). Results: It was established that the group ICA stenosis had a negative dynamics of neurophysiologic status 6 months follow-up after CABG compared with patients without stenosis. Conclusion: Our results suggest that the presence of low and moderate ICA stenosis is one of the factors affecting the neurophysiologic status of CHD patients. It has been assumed that the patients with ≤50% ICA stenoses constitute a high-risk group for cerebral complications after on-pump CABG

Early Effects of Treatment Low-Dose Atorvastatin on Markers of Insulin Resistance and Inflammation in Patients with Myocardial Infarction

Dyslipidemia is one of the primary causes of cardiovascular disease. Therefore, attention has been focused on the development of drugs that normalize lipid levels and exert an effect on markers of atherothrombosis, insulin resistance (IR), and inflammation. Atorvastatin is a drug with not only lipid-lowering potential, but it has multiple non-lipid effects. This study aimed to evaluate atorvastatin effects on lipid, adipokine, IR and inflammatory statuses in patients with myocardial infarction (MI) in an in-hospital setting. This study included 90 patients with confirmed ST-segment elevation MI, who were treated with atorvastatin 20 mg/day starting on day 1 of MI, without any dose changes. The comparison group consisted of 89 patients receiving standard anti-anginal and anti-thrombotic therapy. During the hospital stay, both groups showed a reduction in total cholesterol level and free fatty acids and increased concentrations of apolipoprotein A, especially those patients receiving atorvastatin. On day 1 of MI, patients in both groups had elevated levels of leptin by 2.9- to 3.3-fold, but the leptin levels decreased by 40.3% and were significantly lower than in patients not taking statins. The treatment with atorvastatin was associated with a decrease in C-reactive protein and interleukin-6 by 23.1% and 49.2%, respectively, compared with baseline values. In the group of patients on standard therapy, there was a decrease of interleukin-6 by 31.7%. Atorvastatin administered early on during hospitalization to patients with MI contributed to the improvement of lipid, adipokine and pro-inflammatory statuses and decreased IR

Coronary Artery Bypass Grafting in Patients with Diabetes Mellitus: A Cardiologist’s View

The review presents current data on the prevalence of diabetes in the cohort of patients undergoing coronary artery bypass grafting. The relevance of active approach to the identification of diabetes and prediabetes in patients with coronary artery disease (CAD) before coronary revascularization is reviewed. Recent information about the negative impact of diabetes on the prognosis of myocardial revascularization is reported as well as the main mechanisms responsible to the development of adverse outcomes of interventions in these patients. Target perioperative values of glycemia recommended by the leading associations of the study of diabetes have been compared. Beneficial potential of other carbohydrate metabolism markers (glycated hemoglobin, fructosamine, 1,5-anhydroglucitol) in patients with diabetes mellitus (DM) in terms of their impact on cardiovascular prognosis, including coronary intervention. The results of studies comparing different management strategies for these patients are reviewed. The significance of carbohydrate metabolism compensation during myocardial revascularization is reported; thus, a too stringent glycemic control has no benefits neither for percutaneous nor for open coronary intervention. Recent trials suggest the groups of antidiabetic drugs and evidence of their impact on the cardiovascular system. The importance of comprehensive monitoring of major risk factors in diabetic patients with coronary intervention has been proved

Randomized clinical trial of surgical vs. percutaneous vs. hybrid revascularization in multivessel coronary artery disease : residual myocardial ischemia and clinical outcomes at one year : Hybrid coronary REvascularization Versus Stenting or Surgery (HREVS)

Aim. Optimal revascularization strategy in multivessel (MV) coronary artery disease (CAD) eligible for percutaneous management (PCI) and surgery remains unresolved. We evaluated, in a randomized clinical trial, residual myocardial ischemia (RI) and clinical outcomes of MV-CAD revascularization using coronary artery bypass grafting (CABG), hybrid coronary revascularization (HCR), or MV-PCI. Methods. Consecutive MV-CAD patients (n = 155) were randomized (1 : 1 : 1) to conventional CABG (LIMA-LAD plus venous grafts) or HCR (MIDCAB LIMA-LAD followed by PCI for remaining vessels) or MV-PCI (everolimus-eluting CoCr stents) under Heart Team agreement on equal technical and clinical feasibility of each strategy. SPECT at 12 months (primary endpoint of RI that the trial was powered for; a measure of revascularization midterm efficacy and an independent predictor of long-term prognosis) preceded routine angiographic control. Results. Data are given, respectively, for the CABG, HCR, and MV-PCI arms. Incomplete revascularization rate was 8.0% vs. 7.7% vs. 5.7% (p=0.71). Hospital stay was 13.8 vs. 13.5 vs. 4.5 days (p<0.001), and sick-leave duration was 23 vs. 16 vs. 8 weeks (p<0.001). At 12 months, RI was 5 (2, 9)% vs. 5 (3, 7)% vs. 6 (3, 10)% (median; Q1, Q3) with noninferiority p values of 0.0006 (HCR vs. CABG) and 0.016 (MV-PCI vs. CABG). Rates of angiographic graft stenosis/occlusion or in-segment restenosis were 20.4% vs. 8.2% vs. 5.9% (p=0.05). Clinical target vessel/graft failure occurred in 12.0% vs. 11.5% vs. 11.3% (p=0.62). Major adverse cardiac and cerebral event (MACCE) rate was similar (12% vs. 13.4% vs. 13.2%; p=0.83). Conclusion. In this first randomized controlled study comparing CABG, HCR, and MV-PCI, residual myocardial ischemia and MACCE were similar at 12 months. There was no midterm indication of any added value of HCR. Hospital stay and sick-leave duration were shortest with MV-PCI. While longer-term follow-up is warranted, these findings may impact patient and physician choices and healthcare resources utilization. This trial is registered with NCT01699048

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Today, despite all the measures taken, cardiovascular diseases remain the main cause of temporary invalidization, disability and mortality. Obesity is a major risk factor of cardiovascular diseases and complications from them. However, not all fat depots have the same proinflammatory, paracrine and metabolic activity. Recent studies have shown that the accumulation of visceral fat, and not subcutaneous fat, is associated with an increase in cardiometabolic risk. At the same time, there is evidence that an increase in the area of visceral fat is a protective mechanism against lipotoxicity. The purpose of this review is to discuss current literature data reflecting the characteristics of the visceral, epicardial and perivascular fat depots, and also their association with cardiovascular diseases

Dysfunction of respiratory system in patients with diabetes mellitus and coronary artery disease

Aims: we aimed to estimate the main parameters characterizing respiratory pulmonary function in patients with isolated type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD), as well as with their combination. Materials and methods: the study included 198 patients divided into 3 groups: I &ndash; with isolated CAD [94 (47.5%)], II &ndash; with T2DM without the signs of CAD [64 (32.3%)], III &ndash; with combined CAD and T2DM [40 (20.2%)]. The assessment of carbohydrate and lipid metabolism, as well as the measurement of inflammatory markers were performed using unified clinical and biochemical methods. Respiratory pulmonary function and diffusion lung capacity (Dlco) were assessed using Elite Dl-220v body plethysmograph. Results: the parameters reflecting the respiratory pulmonary function and the level of gas diffusion through alveolar-capillary membrane (ACM) in patients with CAD both with and without diabetes was within the normal values. The exception was the level of residual volume, which was below the prognostic values in all the studied groups. At the same time, in diabetic patients with CAD the values of forced and slow vital lung capacity, forced expiratory volume for 1-second, as well as the level of diffusion were significantly lower as compared to the corresponding values in patients with isolated CAD and didn&rsquo;t differ in comparison with the values of diabetic patients except for the level of diffusion. It should be noted that a number of respiratory parameters had a correlation relationships with glycemic level, inflammatory markers and with the indicators characterizing dyslipidemia and myocardial dysfunction. Conclusions: in the course of the study it was found out that the diabetic patients had respiratory system dysfunction in comparison to the patients with isolated CAD. The presence of diabetes in patients with CAD worsens not only the somatic background but probably contributes to the respiratory dysfunction in the form of lower velocity and volumetric parameters, but also in the indicator showing respiratory metabolism

Inflammation of adipose tissue. Is there a place for statins to correct adiposopathy?

This review is devoted to the analysis of data on the effect of inhibitors of 3-hydroxy-3-methylglutaryl coenzymate-reductase on the endocrine function of adipose tissue in obesity. Violation of metabolism of adipose tissue, as well as the amount of fat, are a a key factor in the pathophysiology of obesity and the development of concomitant diseases. Statins are competitive inhibitors of 3-hydroxy-3-methylglutaryl-kofermenta reductase (HMG-COA reductase) that catalyze the initial stage of cholesterol biosynthesis in the liver. Therefore, traditionally, the liver is considered as the main target organ for statins. The results of studies of molecular mechanisms of action of statins on carbohydrate and lipid metabolism, adipokine and inflammatory balance in adipose tissue on the example of isolated adipocytes (in vivo) and in living organism (in vitro) are presented. Effect of statins on the action of insulin, as well as the possibility of developing pathological conditions associated with insulin resistance and the development of type 2 diabetes mellitus (DM 2). The proven clinical effects of cholesterol-lowering action of statins, allow new insights and to further explore their possible impact on other links in the development of obesity, and potentially to use them as therapeutic agents for pharmacological correction of obesity and the fight against cardiovascular diseases

Cognitive functions and patterns of brain activity in patients after simultaneous coronary and carotid artery revascularization

BackgroundOn-pump coronary artery bypass grafting (CABG) is associated with a high risk of neurological complications in patients with severe carotid stenosis. Moreover, early postoperative cognitive dysfunction (POCD) incidence remains high in patients undergoing simultaneous coronary and carotid surgery. Recent studies have shown that even moderate carotid stenosis (≥50%) is associated with postoperative cognitive decline after CABG. Data on brain health in the postoperative period of simultaneous coronary and carotid surgery are limited.ObjectivesThis study aimed to analyze early postoperative changes in the cognitive function and patterns of brain electrical activity in patients after simultaneous coronary and carotid artery revascularization.Materials and methodsBetween January 2017 and December 2020, consecutive patients were assigned to on-pump CABG with or without carotid endarterectomy (CEA) according to clinical indications. An extended neuropsychological and electroencephalographic (EEG) assessment was performed before surgery and at 7–10 days after CABG or CABG + CEA.ResultsA total of 100 patients were included [median age 59 (55; 65), 95% men, MMSE 27 (26; 28)], and among these, 46 underwent CEA. POCD was diagnosed in 29 (63.0%) patients with CABG + CEA and in 32 (59.0%) patients with isolated CABG. All patients presented with a postoperative theta power increase. However, patients with CABG + right-sided CEA demonstrated the most pronounced theta power increase compared to patients with isolated CABG.ConclusionThe findings of our study show that patients with CABG + CEA and isolated CABG have comparable POCD incidence; however, patients with CABG + right-sided CEA presented with lower brain activity

Phenotype of a modern patient with valvular heart diseases: literature review

In modern conditions, valvular heart diseases (VHD) are one of the most common pathologies among cardiovascular diseases with a dynamic change in the phenotype of patients. An increase in the prevalence of VHD is currently observed due to the active implementation of diagnostic methods in cardiology. Geographical differences in the genesis of the development of valvular heart defects are noted, and the portrait of patients also changes as a result of aging and the addition of comorbid pathology. The purpose of the literature review was to present current trends in changing phenotype of patients with VHD, to study current data on the epidemiology of valve pathology, the contribution of various cardiovascular risk factors and comorbidity of patients on the course of the disease. Current data on the number of surgical interventions performed for VHD based on Russian, European, American, Australian and other studies, data on patient survival and mortality, as well as differences in these indicators in age groups of different countries are presented. The review will be useful for doctors to understand the modern portrait of a patient with VHD, trends in cardiovascular risk factors that influence the course of the disease and prognosis in patients with VHD