Monocyte response in myocardial infarction in patients with type 2 diabetes

Aim. To reveal the features of monocyte response in myocardial infarction (MI) in pa­­tients with type 2 diabetes (T2D).Material and methods. The study included 121 patients with MI and T2D as follows: 76 — with target glycated hemoglobin (HbA1c), 45 — with elevated HbA1c values. In addition to the standard examination, all patients underwent a blood test for HbA1c on day 1 of MI, while on days 1, 3, 5, and 12±1, monocyte subpopulations were assessed by flow cytometry.Results. Patients with target HbA1c were older than patients with elevated HbA1c levels. In the group with target HbA1c, the number of CD16(+) monocytes on the 1st day of MI was significantly higher: 61,38 (39,2; 100,08) cells/µl vs 35,7 (28,98; 40,33) cells/µl, p=0,03; on the 3rd day of MI, the number of "intermediate" CD14(+)CD16(+) monocytes was higher: 74,82 (71,78; 83,2) cells/µl vs 25,90 (14,04; 57,12) cells/µl, p=0,03, while the CD16(-) to CD16(+) monocyte ratio on the 3rd day of MI was lower: 8,32 (6 ,87; 10,03) vs 10,81 (8,90; 21,10), p=0,04. At the same time, in the group of patients with target HbA1c values, the level of CD16(+) monocytes on the 3rd day of MI was significantly higher in patients aged <71 years compared with patients ≥71 years: 104,55 (63,64; 149,7) cells/µl vs 55,20 (36,92; 76,59) cells/µl, p=0,03.Conclusion. In patients with T2D and target HbA1c values, compared with patients with elevated HbA1c, the inflammatory response in MI is associated with higher levels of CD16(+) monocytes on days 1 and 3 of MI, which is more typical for people aged <71 years

Прогностические факторы неблагоприятного исхода при тромбоэмболии легочной артерии у больных ишемической болезнью сердца

Summary. Patients with ischemic heart disease (IHD) have a high risk of the death during the first year after an episode of pulmonary embolism (PE). This study involved 71 patients with IHD and PE. Data of medical history, clinical manifestations and laboratory findings were analyzed. Factors predictive for poor outcome in patients with IHD and PE were age > 65 yrs, concomitant chronic obstructive pulmonary disease, malignancies, seizures and severe hypertension as clinical manifestations of PE, the left ventricle ejection fraction < 45 %, pulmonary artery systolic pressure > 50 mmHg, diameter of the pulmonary artery > 28 mm.Резюме. У больных ишемической болезнью сердца (ИБС) после эпизода тромбоэмболии легочной артерии (ТЭЛА) сохраняется высокий риск летального исхода в течение одного года. В исследование был включен 71 пациент с ИБС в сочетании с ТЭЛА. Были проанализированы анамнестические данные, клинические проявления, данные инструментального исследования у этих пациентов. Выявлены следующие предикторы неблагоприятного исхода при ТЭЛА у больных ИБС: возраст > 65 лет, сопутствующие хроническая обструктивная болезнь легких и новообразования, клиническая манифестация ТЭЛА в виде синкопального состояния и тяжелой артериальной гипотензии, фракция левого желудочка < 45 %, систолическое давление в легочной артерии > 50 мм рт. ст. и диаметр легочной артерии > 28 мм

Оценка функционального состояния митохондрий мононуклеарных лейкоцитов методом проточной цитометрии у пациентов с хронической сердечной недостаточностью под влиянием убидекаренона

Aim. To evaluate the functional state of mitochondria isolated from peripheral blood mononuclear leukocytes using flow cytometry in patients with chronic heart failure receiving ubidecarenone (coenzyme Q).Materials and methods. The study included 53 patients with chronic heart failure who had experienced myocardial infarction. The patients were divided into two groups: group 1 received optimally chosen standard therapy, while group 2 received optimally chosen standard therapy and ubidecarenone (“Kudevite”). The mitochondrial membrane potential was evaluated by flow cytometry using propidium iodide and 3,3′-dihexyloxacarbocyanine iodide (DiOC6(3)). The levels of coenzyme Q were determined using high-performance liquid chromatography with ultraviolet (UV) detection.Results. A direct correlation was established between the coenzyme Q levels in the blood plasma and the percentage of DiOC6(3)-positive cells (R = 0.39; р < 0.05) in the patients with chronic heart failure. In group 1, no significant differences in the coenzyme Q levels and the percentage of DiOC6(3)-positive and DiOC6(3)-negative cells before and after the therapy were observed. In group 2, a significant increase in the proportion of DiOC6(3)-positive cells and a significant decrease in the percentage of DiOC6(3)-negative cells were revealed.Conclusion. The increase in the functional activity of mitochondria in the patients with chronic heart failure receiving ubidecarenone was identified. Flow cytometry can be used to evaluate the functional state of mitochondria and observe the efficiency of the selected therapy. Цель – оценить функциональное состояние митохондрий мононуклеарных лейкоцитов периферической крови с применением метода проточной цитометрии у пациентов с хронической сердечной недостаточностью на фоне приема препарата убидекаренона (коэнзима Q).Материалы и методы. В исследование включены 53 пациента с хронической сердечной недостаточностью после перенесенного инфаркта миокарда. Пациенты были распределены в две группы: первая группа получала только оптимально подобранную стандартную терапию, вторая группа – дополнительно к оптимально подобранной медикаментозной терапии получала препарат убидекаренона («Кудевита»). Оценка митохондриального мембранного потенциала проводилась методом проточной цитометрии с применением йодистого пропидия и йодид 3,3’-дигексилоксакарбоцианина (DiOC6(3)). Определение содержания коэнзима Q в крови проводилось методом высокоэффективной жидкостной хроматографии с ультрафиолетовой детекцией.Результаты. Выявлена прямая корреляционная зависимость между содержанием коэнзима Q в плазме крови и процентом DiOC-позитивных клеток (R = 0,39; р < 0,05) у пациентов с хронической сердечной недостаточностью. В группе пациентов, получавших только оптимально подобранную стандартную терапию, не выявлено статистически значимых различий в содержании коэнзима Q и процентном содержании DiOC-позитивных и DiOC-негативных клеток до начала и после терапии. В группе пациентов, получавших дополнительно препарат убидекаренона, после терапии наблюдалось статистически значимое увеличение доли DiOC-позитивных клеток и уменьшение доли DiOC-негативных клеток.Заключение. Установлено повышение функциональной активности митохондрий у пациентов с хронической сердечной недостаточностью на фоне терапии препаратом убидекаренона. Метод проточной цитометрии может быть использован для оценки функционального состояния митохондрий и контроля эффективности применяемой терапии

A RARE CASE OF MYOCARDIAL INFARCTION IN CORONARY ARTERIES ECTASIA

A rare case is described, of myocardial infarction developed in a young male with rare pathology of coronary arteries — multiple ectasies

Association between biomarkers and progression of post-infarction myocardial remodelling

Aim. To study the association between the levels of inflammation and myocardial remodelling biomarkers and the progression of post-infarction left ventricular (LV) remodelling, based on the cardiac magnetic resonance tomography data. Material and methods. The study included 60 patients with ST segment elevation myocardial infarction, who underwent the standard examination, measurement of serum biomarker levels, and cardiac magnetic resonance tomography, in order to assess the progression of myocardial remodelling. Results. Progressing post-infarction myocardial remodelling was observed in 28,3% of the patients. There was an association between the levels of matrix metalloproteinase (MMP) 1 precursor, MMP-9, tissue inhibitor of MMP-1, N-terminal pro-brain natriuretic peptide (N-proBNP), interleukin-6 (IL-6), end-systolic and enddiastolic volume indices,LV ejection fraction, and damaged myocardial mass index. Conclusion. The study emphasised the important role of the increased levels of MMP and their tissue inhibitor, N-proBNP, and IL-6 in the process of structural and functional post-infarctionLV remodelling

VENTRICULAR EXTRASYSTOLIA IN PATIENTS WITH NON-ST ELEVATION ACUTE CORONARY SYNDROME: ASSESSING THE RISK OF LIFE-THREATENING VENTRICULAR ARRHYTHMIAS (CLINICO-EXPERIMENTAL STUDY)

The study aimed to assess the risk of life-threatening ventricular arrhythmias (LTVA) in patients with non-ST elevation acute coronary syndrome (ACS) and ventricular extrasystolia (VE) developing in the first 24 hours of ACS. In 46 dogs, VE with early, postponed post-depolarisation, re-entry and ischemic mechanisms was modelled. In total, 168 patients with non-ST elevation ACS and Class II-V Lawn VE were examined. All patients underwent general clinical examination as well as the assessment of late ventricular potentials (LVP), QT interval dispersion (QTd), and heart rate turbulence (HRT). In the experimental study, persistent ventricular tachycardia and/or ventricular fibrillation developed in 100%, 75%, and 85,71% of the animals with early post-depolarisation, re-entry and ischemic VE mechanisms, respectively. In the clinical study, LTVA was observed in 13,76 % of ACS patients, including 69,32 % with arrhythmia development in the first 3 days. Positive predictive value for LVP, QTd>80 ms and pathologic HRT was no more than 42%. LTVA risk could be assessed by the formula: LTVAR = А ÷ В, where LTVAR is LTVA risk in units, A – linear deviation of corrected pre-ectopic interval (ms) for at least 20 ventricular extrasystoles, calculated separately for left and right VE, and B – analysed ventricular extrasystole number (per hour). LTVAR<0,5 could be a marker of high LTVA risk, with positive predictive value of 96,34%, in non-ST elevation ACS patients with VE

Laboratory medicine in modern teaching clinical physicians

At the end of the last century and, especially, in the first two decades of the 21st century, a significant technological breakthrough took place in clinical laboratory diagnostics in Russia. The transition from manual techniques to high-tech and high-performance automated systems has changed the potential of laboratory medicine. The laboratory has become a high-tech, rapidly developing branch of medical organizations. Following the changes in technology, the range of diagnostic tests began to alter, while the list of laboratory tests available grew. These dynamics are growing every year. Simple routine techniques, practiced for all patients, are complemented by more specific tests. The place of conventional routine tests has been determined by many years of practical experience, while modern analyzers allow the use of tests with a high evidence value of recommendations, which, in the context of evidence-based medicine, enable the clinician to conduct a personalized diagnostic search. At the same time, in order to use all the possibilities of laboratory medicine, the discipline Clinical Laboratory Diagnostics should be included in educational programs at different stages of a doctor's training