Clinical and biochemical markers of coronary artery calcification progression after elective coronary artery bypass grafting

Aim. To assess the relationship of various clinical and biological markers of bone metabolism with the progression of coronary artery calcification (CAC) in patients with stable coronary artery disease (CAD) within 5 years after coronary artery bypass grafting (CABG).Material and methods. This single-center prospective observational study included 111 men with CAD who were hospitalized for elective CABG. In the preoperative period, all patients underwent duplex ultrasound of extracranial arteries (ECA) and multislice computed tomography (MSCT) to assess CAC severity using the Agatston score, as well as densitometry with determination of bone mineral density in the femoral neck, lumbar spine and T-score for them, In all participants, the following bone metabolism biomarkers were studied: calcium, phosphorus, calcitonin, osteopontin, osteocalcin, osteoprotegerin (OPG), alkaline phosphatase, parathyroid hormone. Five years after CABG, ECA duplex ultrasound, MSCT coronary angiography and bone metabolism tests were repeated. Depending on CAC progression (>100 Agatston units (AU)), patients were divided into two groups to identify significant biomarkers and clinical risk factors associated with CAC progression.Results. For 5 years after CABG, contact with 16 (14,4%) patients was not possible; however, their vital status was assessed (they were alive). Death was recorded in 4 (3,6%) cases (3 — due to myocardial infarction, 1 — due to stroke). In 18 (19,7%) cases, non-fatal endpoints were revealed: angina recurrence after CABG — 16 patients, myocardial infarction — 1 patient, emergency stenting for unstable angina — 1 patient. There were no differences in the incidence of events between the groups with and without CAC progression. According to MSCT 5 years after CABG (n=91 (81,9%)), CAC progression was detected in 60 (65,9%) patients. Multivariate analysis allowed to create a model for predicting the risk of CAC progression, which included following parameters: cathepsin K <16,75 pmol/L (p=0,003) and bone mineral density <0,95 g/cm3 according to femoral neck densitometry before CABG (p=0,016); OPG <3,58 pg/ml (p=0,016) in the postoperative period 5 years after CABG.Conclusion. Within 5 years after CABG, 65,9% of male patients with stable coronary artery disease have CAC progression, the main predictors of which are low preoperative cathepsin K level (<16,75 pmol/L) and low bone mineral density (<0,95 g/cm3) according to femoral neck densitometry, as well as a low OPG level (<3,58 pg/ml) 5 years after CABG

СРАВНИТЕЛЬНЫЙ АНАЛИЗ ЭФФЕКТИВНОСТИ КОНТРОЛИРУЕМЫХ И ДОМАШНИХ ФИЗИЧЕСКИХ ТРЕНИРОВОК АМБУЛАТОРНОГО ЭТАПА РЕАБИЛИТАЦИИ ПОСЛЕ КОРОНАРНОГО ШУНТИРОВАНИЯ

The purpose. To assess the impact of the three-month supervised and home-based physical trainings in the outpatient cardiac rehabilitation program on exercise tolerance and double product in patients undergoing coronary artery bypass grafting (CABG).Material and methods: 114 male patients of working age with coronary artery disease (CAD) who have undergone CABG were examined. Patients were enrolled into three groups: Group 1 − patients undergoing supervised cycling trainings (SCT) (n = 36), Group 2 − patients undergoing home-based trainings (HBT) (n = 36) and the control group without any exercise trainings (n = 42). The following parameters were assessed: the six-minute walk test (6MWT) value, exercise tolerance (ET) and double product (DP), determined by the cycle ergometer test (CET) prior to surgery, 1, 4 months and 1 year after CABG.Results: The 6MWT value increased by 9% in the SCT group, by 6% in the HBT group, and by 1% in the control group during the outpatient cardiac rehabilitation program. ET significantly increased in all study groups according to the analysis of exercise tolerance by the CET 4 months after CABG. However, the improvement was more pronounced in patients with SCT compared to other groups. One year after CABG, this difference balanced between the study groups. DP, assessed by the CET, significantly increased in patients undergoing SCT (p = 0.01), compared to other groups. There were no significant differences found in the rate of cardiovascular events between the study groups.Conclusion: Home-based trainings are inferior to SCT in the outpatient settings, but they are safe and may improve significantly the 6MWT values compared to patients in the control group. Therefore, home-based trainings may be recommended to patients, if they cannot visit the rehabilitation center.Цель. Оценить влияние трехмесячного курса контролируемых и домашних физических тренировок (ФТ) амбулаторного этапа реабилитации на толерантность к физической нагрузке, показатель «двойного произведения» у пациентов, подвергшихся операции коронарного шунтирования (КШ). Материалы и методы. Обследовано 114 мужчин трудоспособного возраста с ишемической болезнью сердца (ИБС), перенесших КШ. Пациенты были разделены на три группы: группа пациентов с контролируемыми велотренировками (ВТ) (n=36), группа пациентов с домашними тренировками ДТ (n=36) и группа сравнения, наблюдающаяся в поликлинике по месту жительства, без ФТ (n=42). Оценивали показатели теста шестиминутной ходьбы (ТШХ), толерантность к физической нагрузке (ТФН) и двойное произведение (ДП) по результатам велоэргометрии (ВЭМ) до операции, через 1 месяц, 4 месяца и через год после КШ. Результаты. За время тренировок показатели ТШХ возросли в группе ВТ на 9%, в группе ДТ – на 6%, в группе без ФТ – на 1%. При анализе переносимости физической нагрузки по данным ВЭМ, через 4 месяца после КШ ТФН достоверно увеличилась во всех сравниваемых группах, но более выраженно это увеличение отмечалось у пациентов с ВТ в сравнении с двумя другими группами. Однако через год после КШ это преимущество утрачивалось. ДП, оцененное при ВЭМ, на фоне тренировок достоверно увеличилось только у пациентов в группе с ВТ (р=0,01). В двух других группах достоверного прироста данного показателя не отмечалось. По количеству развития сердечно-сосудистых событий сравниваемые группы не различались. Заключение. Домашние физические тренировки уступают в эффективности ВТ в условиях лечебного учреждения, однако безопасны и значимо улучшают показатели ТФН в сравнении с пациентами без ФТ, а потому могут быть рекомендованы пациентам при невозможности посещения ими реабилитационного центра

Cardiovascular Comorbidity: Patient with Coronary Artery Disease and Peripheral Artery Atherosclerosis. How to Identify and Manage the Risks of Ischemic Events?

Modern data on comorbidity in coronary artery disease (CAD) are presented in the article, as well as its frequency, dependence on the age, clinical and prognostic significance, and increasing relevance for practical health care. The positions of one of the components of cardiovascular comorbidity – multifocal atherosclerosis – are presented. The existing approaches to the detection and clinical assessment of multifocal atherosclerosis, as well as to the management of the high risk of ischemic events in such patients, are outlined. The main positions on the prevention of the risk of cardiovascular complications in patients with CAD and atherosclerosis of the peripheral arteries using a combination of the anticoagulant – rivaroxaban and the antiplatelet agent – acetylsalicylic acid, are highlighted on the basis of the results of clinical studies. Promising possibilities of using such a therapeutic approach to the management of comorbid patients in routine clinical practice are presented

Methods of teaching the educational discipline "Road Safety" for students of higher professional education organizations

Обозначена проблема удовлетворения потребностей общества в высококвалифицированных специалистах в области обеспечения безопасности жизнедеятельности, в частности, безопасности дорожного движения, что на сегодняшний день очень актуально для нашей страны. Представлена организация творческого подхода к осуществлению учебного процесса, сочетанию традиционных и новых методов обучения в связи с их влиянием на результаты подготовки специалистов. Рассмотрены вопросы методики преподавания учебной дисциплины «Безопасность дорожного движения». Дана характеристика этапам проведения занятия. Представлен примерный план занятия по теме «Основы безопасности движения». Статья адресована преподавателям, ведущим дисциплину «Безопасность дорожного движения» в системе высшего и среднего профессионального образования, а также студентам, обучающимся по данной программе.The article outlines the problem of meeting the need of society in highly qualified specialists in the field of life safety, road safety, in particular, that is very relevant for our country today. The article presents the organization of a creative approach to implement the educational process, to combine traditional and new teaching methods, due to their influence on the results of training specialists. The article deals with the issues of teaching methods of the academic discipline Road Safety. The article presents the characteristics of the stages of the lesson and an exemplary lesson plan on the topic "Fundamentals of Traffic Safety". The article is addressed to teachers who teach the discipline Road Safety in the system of higher and secondary vocational education, as well as students enrolled in this program

COMPARATIVE CHARACTERISTICS OF FUNCTIONAL CORONARY RESERVE AND MYOCARDIAL INFARCTION RISK IN PATIENTS WITH THE CARDIAC X SYNDROME AND STENOTIC CORONARY ATHEROSCLEROSIS

The aim of this research was to study the functional coronary reserve and frequency of miocardium infarction in patients with cardiologic syndrome X (CX) in comparison with patients with stenosing atherosclerosis of coronary artery (ACA). 54 patients with CX and 83 patients with ACA were examined. Coronaroventriculography,veloergometry, echo, daily ECG monitoring were conducted. It was proved that functional coronary reserve in CX patients is lower than in ACA patients. However risk of miocardial infarction development is higher in ACA patients. In the first place, functional coronary reserve depends on state of terminal sectors of coronary arterial channel both in CX and ACA patients. At the same time risk of miocardial infarction development is above all conditioned by damage of subepicardial arteries, i.e. presence of atheromas in them and relatively little depends on volume of coronary channel’s damage

The relationship of biochemical markers of bone metabolism, osteopenic syndrome and coronary atherosclerosis in men with stable coronary heart disease

Aim: To assess the levels of bone metabolism markers in patients with stable coronary artery disease according to the severity of osteoporosis, coronary atherosclerosis and coronary artery calcification. Material and Methods: 112 males with angiographically verified stable coronary artery disease with an average age of 59.8 (55; 70) years were included in the study. All the patients underwent coronary angiography, multislice computed tomography (MSCT) and densitometry. The levels of mineral metabolism markers were measured by enzyme-linked immunosorbent assay. The allocation of comparison groupswas based on the severity of coronary atherosclerosis (the Syntax Score), the degree of coronary artery calcification (the Agatston score), the presence and absence of osteopenic syndrome defined by the femoral neck T-score in accordance with the guidelines of the International Society for Clinical Densitometry (ISCD, 2007). Results: Osteopenic syndrome has been reported in 90 (80.4 %) patients: 34 (30.4 %) patients with signs of osteoporosis, and 56 (50 %) with osteopenia. A significant decrease in cathepsin K and an increase inosteocalcinhave been found in the group with radiographically verified osteopenic syndrome compared to the group with normal bone mineral density (BMD). The assessment of coronary artery disease severity reported that multivessel coronary artery disease and severe lesions were more commonly found in patients with osteopenic syndrome. Moreover, this group of patients had more pronounced calcification compared with patients with normal BMD. Patients with severe coronary atherosclerosis had the lowest cathepsin K levels. Severe coronary artery calcification was significantly associated with lower levels of cathepsin K and osteoprotegerin, elevated alkaline phosphatase and parathyroid hormone levels. Conclusion: A significant association between osteopenic syndrome and severe coronary atherosclerosis and calcification has been found in males with stable coronary artery disease. Biochemical markers of bone metabolism were more likely associated with the calcification of the existing vascular lesions than with the development of coronary atherosclerosis. The findings of the study suggest that the most significant markers are cathepsin K whichsignificantly reduced in all cases, i. e. in patients with osteopenic syndrome, severe atherosclerosis and severe coronary calcification, and osteocalcin which elevated levels are associated with decreased BMD