FEATURES OF CORONARY ATHEROSCLEROSIS IN PATIENTS WITH COMBINATION STABLE ANGINA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Features of coronary atherosclerosis were estimated in patients with a combination of stable angina and chronic obstructive pulmonary disease (COPD) who underwent coronary artery bypass graft surgery (CABG). More severe coronary lesions in group with combination of coronary artery disease (CAD) and COPD were revealed. Number of hemodynamically significant stenoses weakly correlated with the severity of COPD. In patients with combination CAD and COPD total number of stenoses and the number of hemodynamically significant stenoses was higher than in the control group. As well extended stenoses were more common in patients with COPD. At the same time, there were no differences in the number of critical stenoses and occlusions between groups

Improved functionalization of oleic acid-coated iron oxide nanoparticles for biomedical applications

Superparamagnetic iron oxide nanoparticles can providemultiple benefits for biomedical applications in aqueous environments such asmagnetic separation or magnetic resonance imaging. To increase the colloidal stability and allow subsequent reactions, the introduction of hydrophilic functional groups onto the particles’ surface is essential. During this process, the original coating is exchanged by preferably covalently bonded ligands such as trialkoxysilanes. The duration of the silane exchange reaction, which commonly takes more than 24 h, is an important drawback for this approach. In this paper, we present a novel method, which introduces ultrasonication as an energy source to dramatically accelerate this process, resulting in high-quality waterdispersible nanoparticles around 10 nmin size. To prove the generic character, different functional groups were introduced on the surface including polyethylene glycol chains, carboxylic acid, amine, and thiol groups. Their colloidal stability in various aqueous buffer solutions as well as human plasma and serum was investigated to allow implementation in biomedical and sensing applications.status: publishe

Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial

Aims  The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results  Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77–0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77–0.99; P = 0.032) and Type 2 (0.77, 0.61–0.97; P = 0.025), but not Type 4 MI. Conclusion  After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.For complete list of authors see http://dx.doi.org/10.1093/eurheartj/ehz299</p

Effect of alirocumab on mortality after acute coronary syndromes. An analysis of the ODYSSEY OUTCOMES randomized clinical trial

Background: Previous trials of PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitors demonstrated reductions in major adverse cardiovascular events, but not death. We assessed the effects of alirocumab on death after index acute coronary syndrome. Methods: ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) was a double-blind, randomized comparison of alirocumab or placebo in 18 924 patients who had an ACS 1 to 12 months previously and elevated atherogenic lipoproteins despite intensive statin therapy. Alirocumab dose was blindly titrated to target achieved low-density lipoprotein cholesterol (LDL-C) between 25 and 50 mg/dL. We examined the effects of treatment on all-cause death and its components, cardiovascular and noncardiovascular death, with log-rank testing. Joint semiparametric models tested associations between nonfatal cardiovascular events and cardiovascular or noncardiovascular death. Results: Median follow-up was 2.8 years. Death occurred in 334 (3.5%) and 392 (4.1%) patients, respectively, in the alirocumab and placebo groups (hazard ratio [HR], 0.85; 95% CI, 0.73 to 0.98; P=0.03, nominal P value). This resulted from nonsignificantly fewer cardiovascular (240 [2.5%] vs 271 [2.9%]; HR, 0.88; 95% CI, 0.74 to 1.05; P=0.15) and noncardiovascular (94 [1.0%] vs 121 [1.3%]; HR, 0.77; 95% CI, 0.59 to 1.01; P=0.06) deaths with alirocumab. In a prespecified analysis of 8242 patients eligible for ≥3 years follow-up, alirocumab reduced death (HR, 0.78; 95% CI, 0.65 to 0.94; P=0.01). Patients with nonfatal cardiovascular events were at increased risk for cardiovascular and noncardiovascular deaths (P<0.0001 for the associations). Alirocumab reduced total nonfatal cardiovascular events (P<0.001) and thereby may have attenuated the number of cardiovascular and noncardiovascular deaths. A post hoc analysis found that, compared to patients with lower LDL-C, patients with baseline LDL-C ≥100 mg/dL (2.59 mmol/L) had a greater absolute risk of death and a larger mortality benefit from alirocumab (HR, 0.71; 95% CI, 0.56 to 0.90; Pinteraction=0.007). In the alirocumab group, all-cause death declined wit h achieved LDL-C at 4 months of treatment, to a level of approximately 30 mg/dL (adjusted P=0.017 for linear trend). Conclusions: Alirocumab added to intensive statin therapy has the potential to reduce death after acute coronary syndrome, particularly if treatment is maintained for ≥3 years, if baseline LDL-C is ≥100 mg/dL, or if achieved LDL-C is low. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01663402

Atrial fibrillation after heart transplantation

Arrhythmias in heart transplant recipients remain an important but under-studied issue in transplant medicine. One of the most common arrhythmias, atrial fibrillation can cause cardioembolic complications in transplant recipients, in the same way as in general population and, accordingly, affect the quality of life and the prognosis. This review discusses epidemiology, classification, mechanisms of development, and therapy of atrial fibrillation after heart transplantation

PERIOPERATIVE COMPLICATIONS IN PATIENTS WITH STABLE ANGINA PECTORIS AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE UNDERGOING CORONARY ARTERY BYPASS GRAFTING SURGERY

Perioperative complications of coronary artery bypass grafting were estimated depending on the presence of chronic obstructive pulmonary disease (COPD) as co-morbidity. A higher incidence of paroxysmal atrial fibrillation and pneumonia in patients with COPD was revealed compared with the control group. There were no differences of perioperative myocardial damage and life-threatening ventricular arrhythmias. In general, the postoperative period in patients with coronary artery disease (CAD) and COPD is characterized by more severe and the high incidence of complications

Criteria for diagnosis of humoral rejection using the method of 2D-speckle-tracking echocardiography

Aim: to identify predictors of humoral rejection at different stages using non-invasive methods of 2D-speckletracking echocardiography, to determine the correlation with immunological changes.Materials and methods. The study was conducted on the basis of Regional Clinic Hospital of Krasnodar from 2010 to 2017. The analysis of 181 heart recipients was performed. 5 groups were allocated due to the crisis of humoral rejection and the identified antibodies to donor leukocyte antigens (HLA antibodies): group 1 (n = 10) – DSA and humoral rejection, group 2 (n = 7), patients with non-DSA and humoral rejection, group 3 (n = 17) – patients with antibodies to HLA, no humoral rejection, group 4 (n = 11), humoral crisis of rejection, with no identified HLA antibodies, group 5 (n = 87) – patients do not have antibodies to HLA and signs of both humoral and cellular rejection according to EMB. Recipients were carried out endomyocardial biopsy, immunological study, 2D-speckle-tracking echocardiography, statistical methods.Results. The diagnostic criteria for a humoral rejection is greater than 1 degree are global peak systolic strain or strain rate of left ventricle (GLPSLV) – 9.94 ± 1.37% (the sensitivity was 86.2%, specificity – 90.4%); radial systolic strain (RadSLV) of 19.36 ± 3.66% (sensitivity was 75.8%, specificity – 84.5%); circumferential systolic strain (CiRSLV) – 17.83 ± 4.79% (sensitivity was 78.6%, specificity – 84.4%); the twisting of the left ventricle (twist) – 8.90 ± 1.85% (sensitivity – 66.7%, specificity – 94.2%), p &lt; 0.001. When considering indicators GLPSLV and longitudinal peak strain of the right ventricle (GLPSRV) in the diagnosis of humoral rejection sensitivity increases to 91.9%, specificity increases to 94.6%, p &lt; 0.001.Conclusion. GLPSLV has greater sensitivity at the stage of subclinical changes. It is more significantly reduced with increasing degree of rejection associated with episodes of rejection in comparison with other parameters and deformation mechanics. The interrelation between histological and immunological changes and impaired myocardial deformation. The proposed diagnostic algorithm will predict humoral rejection

THE ROLE OF SPECKLE-TRACKING ECHOCARDIOGRAPHY TECHNIQUE AT THE STAGE OF SUBCLINICAL HEART TRANSPLANT REJECTION

Aim. To identify new predictors of heart transplant rejection by using speckle-tracking echocardiography technique. Materials and methods. 117 recipients were included into research. The follow-up period in S.V. Ochapovsky Region Clinical Hospital No 1 was from March 2010 to April 2015. The groups were allocated based on results of the retrospective analysis of biopsies: group 1 (n = 68), recipients without signs of cellular and humoral rejection (AMR0 ACR0); group 2 (n = 28), recipients with ACR1; group 3 (n = 16), patients with ACR2; group 4 (n = 5), patients with chronic rejection. The analysis of the results was carried out with endomyocardial biopsy, coronary angiography, transthoracic echocardiography (TTE), tissue Doppler imaging, speckle-tracking echocardiography. Results. Early complications include infections and rejection of heart transplant. Cellular rejection is diagnosed in 70% of cases, humoral rejection in 30% of cases. The disease of coronary arteries is a kind of late complications. It was diagnosed in 13.7%. Fraction rejection sensitivity was 63%, specificity was 97% in recipients with ACR1 while carrying out TTE for the purpose of identification of early diagnostic criterion of rejection; recipients with ACR2 had 75% and 96%, respectively. While carrying out PW sensitivity and specificity Е/А in recipients with ACR1 were 83% and 53%, respectively; recipients with ACR2 had 85% and 52%, respectively. While carrying out PW-TDI sensitivity and specificity Е in recipients with ACR1 were 83% and 58%, respectively; recipients with ACR2 had 88% and 60%, respectively. The assessment of myocardial deformation of the left ventricle is as follows: global peak systolic strain in recipients without rejection (GLPS LV) – (–17.54 ± 3.71%), р = 0.0012; recipients with (ACR1, AMR1) had GLPS LV (–10.52 ± 1.8%), p = 0.0012; recipients with ACR2 had (–6.44 ± 1.8%), p = 0.002; recipients with chronic rejection had (–9.43 ± 1.8%), p = 0.002. The STE GLPS LV parameter (–10.52 ± 1.8%), p = 0.0012, which estimates longitudinal function of myocardium can be considered as early diagnostic criterion of myocardium rejection. The correlation coefficient between CD 3, CD 20, CD 68 and parameter GLPS LV% for groups ACR1-ACR2 was 0.54, 0.86 and 0.26, respectively. Conclusions. The parameters of deformation and cardiac mechanics being estimated by means of speckle-tracking echocardiography can be used as diagnostic monitoring of recipients with rejection of heart transplant