Сlinical and hemodynamic characteristics and coronary blood flow in patients with chronic coronary artery disease and type 2 diabetes

Aim. To assess the features of clinical and hemodynamic characteristics and the severity of coronary involvement in patients with chronic coronary artery disease (CAD) with and without diabetes.Material and methods. The study included 100 patients with stable CAD, which were divided into two groups: group I (mean age, 57,9-1,04 years, male/female 35/14) — 49 patients with CAD and type 2 diabetes, II — (60,2-0,9 years, 34/17) — 51 patients without SD. Along with behavioral and biological risk factors, clinical and hemodynamic characteristics were analyzed. All patients underwent coronary angiography.Results. The presence of diabetes in patients with CAD was associated with abdominal obesity and comorbidity of somatic diseases. Among group I patients, electrocardiographic signs of left ventricular hypertrophy, conduction abnormalities, accompanied by a decrease in the left ventricular ejection fraction, impaired diastolic function, and high mean pulmonary artery pressure were significantly more often detected. In patients with CAD and type 2 diabetes, significant right coronary artery (CA) stenoses were more often recorded (39%), while in patients without diabetes, the anterior descending artery was the most susceptible to atherosclerosis. In group I, stenosis of the distal CA third was detected 1,5 times more often (p<0,001), and their diffuse multivessel lesion prevailed by 28% (73% and 45%, respectively, p<0,005). The average SYNTAX score in patients with and without diabetes was 29,2±0,8 vs 22±0,7, respectively (p<0,0005).Conclusion. In patients with CAD and diabetes, more pronounced atherosclerotic coronary involvement (diffuse multivessel CAD) was revealed, which should be taken into account when planning further treatment. The risk of adverse cardiovascular events will always be present with percutaneous coronary interventions

Immunological efficacy and tolerability of vaccination in patients with noncommunicable diseases

Aim. To study the efficacy and tolerability of Sputnik V vaccination in patients with noncommunicable diseases (NCDs) compared with healthy individuals.Material and methods. The retrospective analysis included data from 800 men and women aged 18 to 90 who were vaccinated from February to May 2021 at the National Medical Research Center for Therapy and Preventive Medicine. Sputnik V (Gam-COVID-Vac, Russia), consisting of two doses, was used as a vaccine. The mean age of the patients was 50,46±13,16 years. Patients were questioned in two stages: before vaccination and after the first dose of vaccination. The following clinical and paraclinical investigations were carried out: saturation assessment, measurement of temperature, blood pressure and heart rate at rest, pharynx examination, auscultation of the heart and respiratory organs. The blood concentration of antibodies (IgM and IgG) was determined after 21 days and 42 days. For analysis, patients were divided into three groups. The first group included healthy individuals (n=238, 29,8%), the second group — patients with one NCD (n=385, 48,1%), and the third group — patients with two or more NCDs (n=177, 22,1%).Results. The sex composition was comparable in all three groups, while the mean age differed. In the first group, the mean age was 43,93±10,80 years, while in the second and third groups — 50,51±12,55 and 59,12±12,37 years, respectively (p<0,001). Statistical analysis was performed with adjustment for age and sex. The median blood concentration of immunoglobulin G of vaccinated individuals of the cohort after 21 days was within 4,60 [2,00; 8,40]. A comparative analysis of the groups did not reveal significant differences. After 42 days, the median concentration of immunoglobulin G increased by 4 times, which is significant (p<0,001) and amounted to 16,20 [15,80; 16,40]. In the group of healthy individuals, the concentration of immunoglobulin G was significantly higher compared to groups of individuals with one, as well as two or more NCDs. Forty-two days after vaccination, the concentration of immunoglobulin M both in the cohort and in individual groups did not change significantly compared to the level after 21 days. In addition, 47%, 38% and 40% of participants from the first, second and third groups, respectively, reported some symptoms. A temperature increase on average was detected in 13% of vaccinated individuals. The largest number of persons with fever was registered in the group of healthy individuals — 19%, in the group of patients with one NCD — 14%, and in the group with two or more diseases, the temperature increase was the lowest and amounted to 3% (p<0,001). After the first dose, 18,6% of patients reported taking additional drugs as follows: first group — 23,9%, second group — 15,1%, third group — 19,2%. These are mainly analgesic, non-steroidal anti-inflammatory and antihistamine drugs.Conclusion. Vaccination with Sputnik V increases the immunoglobulin G level in the blood after 42 days by four times compared to after 21 days. This pattern is observed both in the group of healthy individuals and in patients with one, two or more chronic NCDs. Tolerability of vaccination in all groups was comparable and did not lead to visits to healthcare facilities

Thyroid status and levothyroxine natrium effectiveness in patients with dilated cardiomyopathy

Aim. To study clinical and hemodynamic parameters, in association with thyroid status (TS) markers, in patients with dilated cardiomyopathy (DCMP); to assess the effectiveness of 12-week combination of basis therapy and levothyroxine natrium (LTN) treatment. Material and methods. The study included 53 DCMP patients (39 women and 14 men), aged 22—58 years (mean age 41±2,7 years). In addition to clinical examination and hemodynamics assessment, plasma levels of triiodthyronin, thyroxin, and thyrotropin were measured in all participants. According to biochemical data, 43 patients were divided into 2 groups: Group I (n=21) with hypothyrosis (HT), and Group II (n=22) with normal TS. Group I received standard heart failure (HF) therapy and LTN. Twelve months later, the number of deaths and hospital admissions due to HF decompensation were retrospectively assessed. Results. In 39,6 % of DCMP patients, HT was observed, despite the absence of primary thyroid disease. Decreased plasma levels of thyroid hormones were associated with reduced physical stress tolerability and reduced myocardial contractility. Conclusion. The 12-week combination of basis HF therapy and LTN treatment was linked to TS normalization, improvement in clinical status and selected parameters of intracardiac hemodynamics, as well as with a significant reduction in repeat hospital admissions

HEART FAILURE AND DIABETES MELLITUS: SELECTED ISSUES OF ETIOLOGY AND PATHOGENESIS, PROGNOSIS AND TREATMENT

This review is devoted to the study of issues relating to the features of associated course of chronic heart failure (CHF) and diabetes mellitus (DM). The modern views on the epidemiology, pathogenesis of DM and CHF are systematized. The pathogenesis of diabetic cardiomyopathy is described in details. The results of the well-known studies that show the negative impact of DM on CHF prognosis are presented. The principles of CHF pathogenetic therapy in patients with DM including the role of neurohormonal modulators are analyzed. The results of multicenter studies in patients with CHF and concomitant DM type 2 show that almost all first-line drugs recommended for CHF treatment are effective in patients with DM

DISORDERS OF THE AUTONOMIC NERVOUS SYSTEM IN THE CARDIOLOGY PRACTICE: FOCUS ON THE ANALYSIS OF HEART RATE VARIABILITY

Heart rate variability (HRV) in patients with ischemic heart disease, a life-threatening heart rhythm disorders, as well as diabetes mellitus (DM) is considered. A significant association between the autonomic regulation of the cardiovascular system and death from cardiovascular causes is identified. The reactions of the autonomic nervous system (ANS) can serve as a precipitating factor of arrhythmias in patients with heart disorders. Analysis of HRV at rest is the main and informative method for determination of the ANS disorders. HRV decreases greatly in patients with acute myocardial infarction, cardiac arrhythmia, and DM, predicting a high risk of death. The leading cause of death in diabetic patients is cardiac autonomic neuropathy, with the development of "silent" ischemia and painless myocardial infarction. Autonomic regulation of the heart rate should be assessed for early diagnosis and prevention of complications in the form of sudden death

INFLUENCE OF SOMATIC COMORBIDITY ON THE COURSE OF CORONARY HEART DISEASE

Aim. To assess the life quality and clinical-laboratory parameters of the stable coronary heart disease (CHD) patients comorbid with diabetes type 2 (DM) and chronic obstructive pulmonary disease (COPD).Material and methods. Totally, 67 patients included, age 39-69 y.o. All patients were selected to 3 groups: CHD (group 1, n=21, mean age 55,4±6,8 y.o., males/ females 16/5), CHD and DM (group 2, n=21, 58,8±8,9 y.o., M/F 18/6), and CHD and COPD (group 3, n=22, 59,2±5,2 y.o., M/F 16/6). Clinical and anamnestic, as biochemical and hemodynamic parameters were evaluated, and the life quality with EQ-5D score.Results. In the CHD group with or none DM there was high rate of obesity, but in COPD group mean body mass index was lower than 29 kg/m2 . By EQ-5D, life quality decrease in CHD and DM, at most was determined by the units as “dyscomfort”, “everyday activities” and “anxiety/depression”. In CHD patients with comorbid COPD maximum was collected in the points related to “mobility”, “anxiety/ depression”. In the absence of significant dilation of the left ventricle (LV), in the patients of groups 2 and 3 there were relatively low values of ejection fraction (EF) comparing to CHD only patients. Also, in COPD and CHD patients there were signs of the left atrium overload, as the Doppler digns of pulmonary hypertension. Comorbidity of CHD and DM was followed by increased plasma urea and more significant dyslipidemia.Conclusion. Comorbid DM and COPD contribute on the worsening of CHD patients parameters with following decline in life quality, increased plasma urea and more significant dyslipidemia

DISORDERS OF THE AUTONOMIC NERVOUS SYSTEM IN THE CARDIOLOGY PRACTICE: FOCUS ON THE ANALYSIS OF HEART RATE VARIABILITY

Heart rate variability (HRV) in patients with ischemic heart disease, a life-threatening heart rhythm disorders, as well as diabetes mellitus (DM) is considered. A significant association between the autonomic regulation of the cardiovascular system and death from cardiovascular causes is identified. The reactions of the autonomic nervous system (ANS) can serve as a precipitating factor of arrhythmias in patients with heart disorders. Analysis of HRV at rest is the main and informative method for determination of the ANS disorders. HRV decreases greatly in patients with acute myocardial infarction, cardiac arrhythmia, and DM, predicting a high risk of death. The leading cause of death in diabetic patients is cardiac autonomic neuropathy, with the development of "silent" ischemia and painless myocardial infarction. Autonomic regulation of the heart rate should be assessed for early diagnosis and prevention of complications in the form of sudden death.</p

DECOMPENSATED CHRONIC HEART FAILURE COURSE IN DIABETES PATIENTS

Aim. To investigate on clinical, hemodynamic and laboratory specifics of heart failure course in diabetes mellitus type 2 (DM2) patients and non-diabetic, hospitalized due to acute decompensation of chronic heart failure (CHF).Material and methods. Totally, 134 patients included, hospitalized to cardiology. All patients were selected to 2 groups: I (CHF and DM2, n=66; age 61,8±7,2 y. o., 28 males, 38 females), and group II (CHF non-DM, n=68; 62,3±7,7 y. o., 33 males, 35 females). Symptom assessments were done, with the score of clinical state in CHF (SCSC), electrocardiography (ECG) resting in 12 leads; transthoracal echocardioscopy; laboratory blood tests; chest x-ray; 6-minute walking test.Results. Patients with CHF and DM2 were characterized by comparatively high functional class of CHF, severity of symptoms (by SCSC 13,7±2,2 versus 11,1±2,2 points, p&lt;0,05) and more prominent morphofunctional changes of the heart: significant decrease in ejection fraction of the left ventricle (LV) by 5,5% and increase of deceleration time in early diastolic filling, followed by the decrease of E/A. The specifics found was followed by disordered biochemical parameters in DM2. Anamnesis of CHF and DM2 in the cohort made it to find out an insufficient (less than 80%) control of glycemia among CHF and DM2 patients regardless long lasting course of glycemia disorder.Conclusion. Results of the conducted study demonstrate negative character of impact of DM2 on CHF course of ischemic and non-ischemic origin

Biochemical profile and prognosis of patients with heart failure and diabetes

Aim. To study clinical and hemodynamic and laboratory parameters for the 2-year prognosis of patients with chronic heart failure (CHF) and type 2 diabetes mellitus (DM).Material and methods. The study included 90 patients (61,4±8,6 years old) with NYHA class II-IV CHF related to coronary artery disease and hypertension. All patients underwent clinical examination, resting 12-lead electrocardiography, transthoracic echocardiography, and blood chemistry testing. Two-year follow-up was conducted to determine the prognosis of patients with CHF and DM.Results. CHF duration in patients with DM was 17% more, despite a comparable average age of patients. Echocardiography showed significant left ventricular dilatation and, as a result, systolic dysfunction in patients of the I group (with DM). Hypoalbuminemia was detected in both groups, but it was more pronounced in patients with CHF and DM. With comparable average creatinine concentrations, patients with CHF and DM had higher blood urea levels (13,2±2,1 µmol/L and 9,4±2,6 µmol/L, respectively). Patients of group I had significantly lower glomerular filtration rate (GFR) compared to the comparison group (by 13%). In group I, there were 42 rehospitalizations during the follow-up period, while in the comparison group — 29. Acute cerebrovascular accident was recorded in 7% and 4% of cases, respectively. Myocardial infarction (MI), including recurrent MI, was registered 50% more often in patients with DM. The mortality rate in patients of the group I was 3,5 times higher than in the comparison group.Conclusion. Features of the course of CHF depending on the presence of concomitant type 2 DM were revealed. These include the relatively early manifestation of CHF symptoms, the prevalence of patients with moderate to severe CHF and severe left ventricular systolic dysfunction. The results of a biochemical study of the blood of group I patients were characterized by hypoalbuminemia, hypertriglyceridemia, and a significant decrease in GFR. It is noted that the presence of concomitant DM aggravates the course of CHF of ischemic and nonischemic genesis, which is manifested by an increase in the frequency of repeated hospitalizations and deaths during 2-year follow-up. 8

THE INFLUENCE OF DIABETES MELLITUS ON THE COURSE AND OUTCOMES OF MYOCARDIAL INFARCTION IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTIONS

Aim. To study the clinical course and outcomes  of myocardial infarction (MI) in diabetes  mellitus patients  (DM) and  non-diabetic,  underwent percutaneous coronary intervention (PCI).Material and methods. Totally, 99 MI patients included, that underwent PCI with stenting. Patients were selected to 2 groups by absence or presence of DM: group 1 (n=49) — DM type 2; group 2 (n=50) — non-diabetic  and glucose intolerance. We studied the baseline clinical and demographic,  as laboratory and instrumental characteristics of patients, specifics of in-patient stage of treatment and outcomes in 1 year after discharge.Results.  There  was  predominance   of  women  in DM2 group  and developing MI. It was found, that DM patients  adhered  the preclinical treatment  of ischemic heart disease  in 47% cases  and about 20% DM patients  did not take  glucose  lowering medications.  In patients  from group  1  the  arterial  hypertension  was  diagnosed  significantly more commonly in comparatively lower values of the left ventricle ejection fraction. More commonly than the other complication of MI, the acute heart failure developed (14%). By the end of the 1 year, DM patients nonsignificantly more  commonly  had  recurrent   hospitalizations  for  all cardiovascular causes, as the cases  with fatal outcomes.Conclusion. The course of MI in DM has its specifics as comparatively lower values of myocardium contractility, significant lesion of coronary vessels, high number of acute period of MI complications with indefinite influence on the one-year prognosis