Acute coronary syndrome in young patients: clinical features and risk factors

Aim. To study the clinical features and risk factors (RF) associated with the development of acute coronary syndrome (ACS) in young patients.Material and methods. The study included 474 patients with ACS. Depending on age, patients were divided into 2 groups. The first group consisted of 299 patients of young age (25-44 years), the comparison group consisted of 175 patients of mean and old age (45-74 years). Clinical and anamnestic data, parameters of general clinical and biochemical tests, electrocardiography, echocardiography and coronary angiography were determined in all patients, and polymorphisms in FII G20210-A, FV G1691-A, MTHFR C677-T genes were determined in 116 patients. The control group consisted of 53 healthy volunteers.Results. ACS in patients <45 years old is most common in men. The number of women with ACS increases as elder patient is. The incidence of myocardial infarction (MI) and unstable angina, ST-elevated MI and non ST-segment elevation MI, Q-wave and non-Q-wave MI had no differences between patients of the younger and older age groups. In younger patients, anterior localization of myocardial infarction was more common, in mean and old patients — posterior. Complications of MI in young patients were less common than in the comparison group. In patients of mean and old ages, acute coronary event was preceded by a clinic of angina, in young patients most often it was the debut of coronary artery disease. It was revealed that single-vessel coronary lesion is more characteristic for young patients, for the elderly patients — two-vessel and multi-vessel. Pathology of the anterior descending coronary artery prevailed in both groups of patients. Most patients in both groups underwent myocardial revascularization. MI as a result of coronary artery thrombosis happened more often in young patients. The most significant RF associated with the ACS development were: increased total cholesterol and low density lipoproteins, decreased high density lipoproteins, increased body mass index, smoking, polymorphism of MTHFR-homozygote, hereditary tainted with smoking, aggravation in combination with F5-homozygote, hereditary tainted in combination with MTHFR-homozygote, hereditary tainted in combination with smoking and MTHFR homozygote.Conclusion. We identified clinical features and RF, mostly associated with the development of ACS in patients <45 years of age. The results can serve as additional indicators showed the risk of ACS development

Contrast-induced nephropathy in patients with acute coronary syndrome: clinical significance, diagnosis, prophylaxis

In modern medical practice, contrast-induced nephropathy (CIN) is an urgent problem in patients with acute coronary syndrome that underwent percutaneous interventions. It worsens prognosis, increases the number of cardiovascular complications and the length of hospital stay. Despite the use of modern radiocontrast agents, the incidence of CIN can increase in a certain patients up to 50%. Risk factors for CIN can be associated both with the patient and directly with the x-ray procedures. The diagnosis is mainly based on the pre- and postprocedural determination of creatinine. However, more modern biomarkers of kidney injury can be used at present, which allow diagnosing the acute kidney injury as soon as possible. A huge role is played not only by treatment, but also by the prevention of CIN, which consists in the timely identification of high-risk patients. The current study presents the main points of pathogenesis, methods for diagnosing CIN, as well as methods for its prevention and treatment in patients with acute coronary syndrome

ECONOMIC EVALUATION OF THE EFFECTIVENESS OF LOW MOLECULAR WEIGHT HEPARIN AND INTERMITTENT PNEUMATIC COMPRESSION IN WOMEN IN A CYCLE OF IN VITRO FERTILIZATION

To solve the problem of infertility in the world assisted reproductive technologies (ART) are widely used, which relate to the financial and expensive high-tech medical care. This paper shows that the conduction of therapeutic correction of excessive thrombin generation and / or hypofibrinolysis in patients in a cycle of in vitro fertilization (IVF) is economically more justified than the standard management of patients by reducing recurrent IVF

ЭКОНОМИЧЕСКАЯ ОЦЕНКА ЭФФЕКТИВНОСТИ ПРИМЕНЕНИЯ НИЗКОМОЛЕКУЛЯРНОГО ГЕПАРИНА И ПЕРЕМЕЖАЮЩЕЙ ПНЕВМАТИЧЕСКОЙ КОМПРЕССИИ У ЖЕНЩИН В ЦИКЛЕ ЭКСТРАКОРПОРАЛЬНОГО ОПЛОДОТВОРЕНИЯ

To solve the problem of infertility in the world assisted reproductive technologies (ART) are widely used, which relate to the financial and expensive high-tech medical care. This paper shows that the conduction of therapeutic correction of excessive thrombin generation and / or hypofibrinolysis in patients in a cycle of in vitro fertilization (IVF) is economically more justified than the standard management of patients by reducing recurrent IVF.Для решения проблем бесплодия в мире широко используются вспомогательные репродуктивные технологии (ВРТ), которые относятся к финансово-затратной высокотехнологичной медицинской помощи. В данной работе показано, что проведение терапевтической коррекции избыточной генерации тромбина и/или гипофибринолиза у пациенток в цикле экстракорпорального оплодотворения (ЭКО) экономически более оправдано по сравнению со стандартным ведением пациенток за счет сокращения повторных попыток ЭК

Анализ взаимосвязи параметров легочной гемодинамики с выраженностью клинических проявлений у больных хронической обструктивной болезнью легких: возможности лекарственной терапии

Objective: to assess pulmonary hemodynamics and the presence of systolic and/or diastolic dysfunction of the myocardium of the right and left ventricles in patients with COPD, depending on the risk groups (A, B, C, D); to determine the possible directions of pharmacological correction.Methods. Patients (n = 119, including 87 men, mean age - 62.5 ± 14.8 years) with COPD of risk group A (n = 21) and B (n = 98) (GOLD, 2019). In addition to the routine clinical and instrumental examinations, pulmonary and aortic pulse wave velocity was determined using MRI diagnostics.Results. The right ventricular diastolic dysfunctions (DD) were revealed in all patients with COPD (E/A TV = 0.85 ± 0,03 vs 0.97 ± 0,03; groups A and B respectively, p < 0,05). 28.6% of patients of group B had a restrictive type of transtricuspid blood flow (p < 0,05). The pulmonary blood pressure was increased: 24.3 ± 7.6 mm Hg in patients with COPD group A, 17.2 ± 6.8 mm Hg - in group B. Patients of group B had a higher pulmonary pulse wave velocity (pPWV) (B: 3.13 [2.93-3.44] ms-1 vs A: 1.97 [1.62-2.68] ms-1, p = 0.005) and stroke volume of RV (B: 33.5 [27.3-37.9] mL vs A: 29.1 [24.0-35.7] mL, p = 0.005). The correlation between pPWV and the degree of bronchial obstruction, ejection fraction and end-diastolic volume of the RV, and mean pulmonary arterial pressure (mPAP) was strong for patients of group B and moderate for patients of group A.Conclusion. Thus, patients with COPD risk group A have the borderline indicators of mPAP with DD of LV and RV. The progression of hemodynamic disorders is associated with the aggravation of of clinical symptoms and respiratory disorders, that were more pronounced in group B. This progression led to mandatory broncholytic drug correction.Целью работы явилась оценка легочной гемодинамики и наличия систолической и / или диастолической дисфункции (ДД) миокарда правого (ПЖ) и левого (ЛЖ) желудочков у больных хронической обструктивной болезнью легких (ХОБЛ) в зависимости от принадлежности к одной из групп риска (ABCD) согласно классификации Глобальной стратегии диагностики, лечения и профилактики ХОБЛ (Global Initiative for Chronic Obstructive Lung Disease — GOLD, 2019) а также определение возможных направлений медикаментозной коррекции.Материалы и методы. Обследованы больные ХОБЛ (n = 119, 87 мужчин; средний возраст - 62,5 ± 14,8 года) групп риска А (n = 21) и В (n = 98) по GOLD (2019). Помимо общепринятых клинико-инструментальных обследований, проводилось определение аортальной и легочной скорости распространения пульсовой волны (лСРПВ) с применением магнитно-резонансной томографии.Результаты. У всех больных ХОБЛ выявлены нарушения в виде ДД ПЖ (отношение максимальной скорости раннего диастолического наполнения к максимальной скорости предсердного диастолического наполнения (Е / АПЖ) у пациентов группы риска А составило 0,85 ± 0,03 vs 0,97 ± 0,03 - у пациентов группы риска В;р < 0,05). У 28,6 % больных группы риска В (р < 0,05) определялся рестриктивный тип транстрикуспидального кровотока. Легочная гипертензия у больных ХОБЛ группы риска А составила 24,3 ± 7,6 мм рт. ст., группы риска В - 17,2 ± 6,8 мм рт. ст. У пациентов группы риска В отмечены более высокие значения лСРПВ (3,13 (2,93-3,44) мс-1 vs 1,97 (1,62-2,68) мс-1 у пациентов группы риска A; р = 0,005) и ударного объема ПЖ (33,5 (27,3-37,9) мл у пациентов группы риска В vs 29,1 (24,0-35,7) мл - у пациентов группы риска А; р = 0,005). Установлена сильная корреляция показателей лСРПВ со степенью бронхиальной обструкции, фракции выброса и конечного диастолического объема ПЖ, среднего давления в легочной артерии (ДЛАср.) у больных группы В и умеренной силы корреляция - у пациентов группы риска А.Заключение. Таким образом, у больных ХОБЛ группы риска А по GOLD (2019) определяются пограничные показатели ДЛАср. с развитием ДД ПЖ и ЛЖ. Прогрессирование гемодинамических нарушений связано с утяжелением клинических проявлений и дыхательных расстройств, более выраженных у пациентов группы риска В, при этом требуется обязательная бронхолитическая медикаментозная коррекция

Long-term safety and efficacy of ravulizumab in patients with paroxysmal nocturnal hemoglobinuria: 2-year results from two pivotal phase 3 studies

10.1111/ejh.13783European Journal of Haematology1093205-21