Lipid metabolism in non-alcoholic fatty liver disease in patients with different body weights in mid-mountain conditions

Aim. To study the peculiarities of lipid metabolism disorders in non-alcoholic fatty liver disease in lean and obese patients in medium altitude conditions. Materials and methods. The study was carried out within the framework of the project Etiopathogenetic features and rates of development of non-alcoholic fatty liver disease (NAFLD) in the conditions of Kyrgyzstan (№ of state registration MHN/TZ-2020-3). An open comparative study of patients with two forms of NAFLD: fatty liver and non-alcoholic steatohepatitis (n=236) living in low mountains (Bishkek, altitude above sea level 750800 m; n=111) and middle mountains (At-Bashy district , Naryn region, height above sea level 20462300 m; n=125) Kyrgyzstan. The average age of the patients was 55.70.95 years. Given that genetic factors may play a role in the development of NAFLD, we analyzed a population represented only by ethnic Kyrgyz. Patients in each group were divided into lean (BMI23) and obese (BMI23) groups. To determine physical activity, a physical activity questionnaire was used, which was compiled on the basis of the materials of the International Physical Activity Prevalence Study www.ipaq.ki.se. Physical examination included measurement of anthropometric parameters (height, body weight, waist circumference), calculation of body mass index (BMI), skeletal muscle mass index (SMM), percentage of body fat. According to the grades of the WHO, the degree of obesity was assessed by BMI for Asians. Blood samples were taken for research in the morning on an empty stomach after at least 12 hours of fasting. The following indicators were determined: glucose, lipid spectrum (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides), alanine aminotransferase (ALT), aspartate aminotransferase (AST) levels. The BARD scale was used as a predictor for assessing the development of liver fibrosis in patients with NAFLD. The scoring system included three variables: BMI, AST/ALT, and the presence of DM 2. The diagnosis of NAFLD made on the basis of history, laboratory tests, ultrasound examination of the liver, and exclusion of other liver diseases. The results were analyzed using the SPSS 16.0 statistical software package for Windows. A p-value0.05 was considered statistically significant at the 95% confidence level. Results. It was found that the inhabitants of the middle mountains with NAFLD are represented by a lower BMI relative to the inhabitants of the low mountains. In women, the levels of SMM and the percentage of fat are significantly and statistically significantly correlated (r=-0.971; p0.001), while in men these two indicators are not related. Men showed a trend towards higher percentages of fat, regardless of body weight and region of residence. For women, this indicator was within acceptable limits and did not exceed 31%. There was found a statistically significant difference in total cholesterol levels between low and middle mountain people in the group of obese patients (p0.001) suffering from NAFLD. Statistically significant low ALT indices were revealed in the group of obese patients living in mid-mountain conditions. Conclusion. Taken together, our results suggest that chronic mid-mountain hypoxia may slow down the course of overweight-induced NAFLD

Role of T-786c Endothelial Gene Polymorphism of No - Synthase in the Development of Acute Contrast-induced Nephropathy in Patients with Coronary Heart Disease

Contrast-induced nephropathy (CIN) is the third considerable cause of acute kidney injury (AKI) and makes up almost 10% of all acute kidney failure (AKF) cases.Objective. To study the role of polymorphism of eNOS-gene in the development of acute contrast-induced nephropathy (CIN) in case of coronary heart disease.Materials and methods. The prospective study was conducted in the National Cardiology and Therapy Center named after academician Mirsaid Mirahimov from 2015 to 2018. A total of 184 patients with coronary heart disease (CHD) aged 33-70 years (average age 55.2 ± 8.5 years) were examined to determine possible associative relationships between eNOS gene polymorphism (T786C) and the development of acute CIN. Of these, the group without CIN was 152, and with the CIN there were 32 patients who underwent coronary angiographic examination (CAG). Radiopaque contrast agents Ultravist (Iopromide) and Omnipack (Iohexol) were used. CIN was defined as an increase in serum creatinine (Scr) concentration by more than 25% from the initial level or by more than 0.5 mg/dL (44.2 μmol/L) and a decrease in glomerular filtration rate (GFR) after administration of an iodinated contrast agent within 48-72 hours in the absence of other reasons. A molecular genetic study was conducted to determine the T-786C polymorphism of the eNOS gene.Results. The genotype frequency of the TT gene in the group with CIN was 87.5%, and in the group without CIN 69.7%, the reliability was p <0.05. But the connection of acute CIN with the genotypes of TS and SS was not observed in both of the groups.Conclusions. TT genotype T-786C polymorphism of the eNOS gene is a risk factor for the development of acute contrast-induced in patients with coronary heart disease

PLACE OF VOLUMETRIC LOAD IN ASSESSMENT OF DIASTOLIC RESERVE OF THE LEFT VENTRICLE AND IN PREDICTION OF HEART FAILURE DEVELOPMENT FOR MYOCARDIAL INFARCTION PATIENTS

Aim. To study the role of volumetric load in assessment of diastolic reserve of the left ventricle (LV) and to reveal informative predictors of transmitral diastolic flow for heart failure development in myocardial infarction patients without systolic LV dysfunction.Material and methods. Totally, 40 males studied with primary Q-wave myocardial infarction without clinical signs of heart failure with the baseline LV ejection fraction 50-55%. Statistical analysis was performed via Excel 5.0. Standard methods of variational statistics were applied: mean values, standard deviation. Significance of differences was assessed with t-criteria by Student.Results. In patients with myocardial infarction at volume load there were 2 types of transmitral diastolic flow. 1 group — patients, who had ipsidirectional changes of transmitral diastolic flow, as the healthy: significantly increased Е and А (p<0,05), not changed Е/А, shortened IVRT of LV and Tdec (p<0,002). 2 group — patients, who at the load did not develop increase of Е (p>0,05), had significantly increased А by 12% (p<0,002) and hence decreased Е/А (p<0,05), and significantly prolonged IVRT of LV and Tdec (p<0,05); changes did not return to baseline by 5 minutes of recovery period.Conclusion. 1) load test of VDLT is safe and informative method for DR of LV estimation and for revealing of high risk congestive HF in MI. 2) in patients with decreased DR of LV in VL there is decrease of E, significant increase of A, decrease of E/A and prolongation of IVRT and Tdec, during postinfarction period in 27,3% cases congestive HF does develop. 3) in patients with MI and remaining DR of LV during postinfarction period the congestive HF does not develop

Left ventricular remodeling in patients with right ventricular myocardial infarction

Aim. To study left ventricular (LV) remodeling, interventricular and intraventricular asynchrony in isolated inferior LV myocardial infarction (MI) or combined inferior LV MI with right ventricular (RV) MI.Material and methods. 57 patients with inferior LV MI with or without RV MI (n=57) were included in a 6-month prospective study. The patients were divided into 2 groups: Group 1 - patients with inferior LV MI (n=30); Group 2 - patients with inferior LV MI in combination with RV MI (n=27). Electrocardiography and echocardiography were performed in all patients at admission, on days 3, 30 and 180 after MI.Results. Significant signs of diastolic dysfunction (RV end-diastolic area 29.21±2.0 cm2) were found in group 2 on the third day after MI. A significant increase in the LV volume indices and diastolic sphericity index (from 0.54±0.02 to 0.59±0.03 units) and an increase in interventricular asynchrony (from 37.4±4.2 to 44.6±4.2 ms) were found in group 2 in 30 days after MI. Increasing tendency towards intraventricular and interventricular asynchrony, despite the absence of pathological LV remodeling, occurred in group 2 in 6 months after MI.Conclusion. Patients with RV MI have more pronounced maladaptive LV remodeling, intraventricular and interventricular asynchrony and greater LV diastolic dysfunction.</p

Reperfusion therapies and in-hospital outcomes for ST-elevation myocardial infarction in Europe: The ACVC-EAPCI EORP STEMI Registry of the European Society of Cardiology

Aims: The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI). Methods and results: Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset <24 h in 196 centres across 29 countries. A total of 11 462 patients were enrolled, for whom primary percutaneous coronary intervention (PCI) (total cohort frequency: 72.2%, country frequency range 0-100%), fibrinolysis (18.8%; 0-100%), and no reperfusion therapy (9.0%; 0-75%) were performed. Corresponding in-hospital mortality rates from any cause were 3.1%, 4.4%, and 14.1% and overall mortality was 4.4% (country range 2.5-5.9%). Achievement of quality indicators for reperfusion was reported for 92.7% (region range 84.8-97.5%) for the performance of reperfusion therapy of all patients with STEMI <12 h and 54.4% (region range 37.1-70.1%) for timely reperfusion. Conclusions: The use of reperfusion therapy for STEMI in the ESC member and affiliated countries was high. Primary PCI was the most frequently used treatment and associated total in-hospital mortality was below 5%. However, there was geographic variation in the use of primary PCI, which was associated with differences in in-hospital mortality