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

Vaccination against a COVID-19 and predictors of COVID-19 development in patients after heart transplantation: a Russian multicenter observational study

Patients after heart transplantation (HT) have a high risk of infectious complications, including hospitalization and death due to SARS-CoV-2 infection. However, both patients with heart failure and heart recipients often face vaccination refusal due to insufficient data on its safety in this population.Aim. To evaluate the efficacy and safety of vaccination against a coronavirus disease 2019 (COVID-19) in individuals after HT.Material and methods. This retrospective analysis of a multicenter registry created on the basis of the "Database of patients after heart transplantation depending on the vaccination against a COVID-19" (№ 2022622422, Simonenko M. A., Fedotov P. A.) was performed. It included 47 indicators and blinded results of observation of 367 heart recipients who received post-transplant support from February 2020 to May 2023 and lived in 7 regions of Russia.Results. Most patients included in the study were men (80%, n=294). The mean age of patients at the time of vaccination was 53±13 years. Immunosuppression was induced in 82,3% of patients and they then received maintenance immunosuppressive therapy with calcineurin inhibitors, mycophenolic acid/ mycophenolate mofetil, or everolimus, and half of them, by the time after HT, received glucocorticosteroids. It is important to note that 67% (n=245) of the recipients included in the analysis did not have COVID-19 before HT, and another 33% (n=122) had COVID-19 after HT without being vaccinated. As of May 2023, almost half of the registry participants (47%; n=174) were vaccinated against COVID-19 using the Gam-Covid-Vac (Sputnik V) vaccine in 94% (n=164) of individuals and Sputnik Light in 6% (n=10). Before HT, immunization was carried out in only 6,5% of the studied subjects. Mild side effects such as subfebrile fever (10%), fever (4%), general weakness (11%), or headache (2%) developed in 17% (n=30) of patients within 24-48 hours after vaccination. In addition, 18% (n=32) of patients in the vaccinated group were subsequently infected with COVID-19, of which only 5 people had a moderate course. After 1,5-2 months, two patients developed post-COVID complications such as exacerbation of bronchial asthma (n=1) and post-COVID alveolitis (n=1), which were stopped by glucocorticosteroid therapy. In the absence of vaccination, the relative risk of COVID-19 compared to vaccinated patients was 2,66 (95% confidence interval: 1,88; 3,75). Vaccination against COVID-19 is associated with a 30,9% reduction in the absolute risk of COVID-19, and to prevent 1 case of COVID-19, 4 heart recipients need to be vaccinated (NNT=3,2).Conclusion. Vaccination against COVID-19 in heart recipients is safe and associated with a lower incidence of COVID-19 and a milder course of COVID-19 compared to unvaccinated patients. Predictors of COVID-19 infection in the studied sample were male sex, the use of mycophenolic acid/mycophenolate mofetil, and the induction of immunosuppression

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

A clinical case of ulcerative colitis in a patient with viral hepatitis

Purpose: to attract the attentio n of therapeutists, gastroenterologists, and infectious disease specialists to the problem of treating the combined course of inflammatory bowel diseases (IBD) and chronic viral hepatitis.Fundamentals: the rate of ulcerative colitis (UC) detection in the population tends to increase. We are accumulating experience in treating patients with IBD and concomitant diseases (oncopathology, tuberculosis, and viral hepatitis). The implementation of standards of treatment for IBD is undoubtedly difficult due to the presence of many contraindications dictated by the presence of a concomitant disease.Conclusion: timely decision on antiviral therapy in patients with a combination of IBD and HCV improves the prognosis of the disease, allows to prolong remission, prevent complications, and has an impact on performance, quality and life expectancy.</jats:p

P5543Features of treatment and outcomes in elderly patients. Results of the KRACS register

Abstract Purpose To evaluate the features of treatment and outcomes in elderly patients with acute coronary syndrome. Methods The elderly group comprised 2385 (28.9%) patients ≥75 years of the 8249 patients enrolled in the KRACS registry. Results When comparing patients of different ages, it was shown that among the elderly, dyspnoea was the most common manifestation of ACS, 9% vs 4% (p=0.015), they were less often hospitalized in “invasive” hospitals - 36% vs 49% (p=0.003), At admission, they often had the class Killip ≥ II - 36% vs 17% (p&lt;0.001), a high risk for the GRASE-68% vs 30% (p&lt;0.001). In addition, in elderly patients significantly lowered levels of Hb and increased creatinine were detected more often. Drug treatment of elderly patients was characterized by less frequent use of ticagrelor - 3% vs 21% (p&lt;0.001), LMWH or fondaparinux - 4% vs 12% (p=0.004). Thrombolytic therapy in STEMI in the elderly was more often streptokinase - 30% vs 18% (p=0.04), less often - tissue activator plasminogen - 2% vs 10% (p=0.03). The frequency of performing any invasive interventions for any type of ACS in elderly patients was significantly lower - 16.7% vs 46.3% (p&lt;0.0001), and the incidence of fatal outcomes during hospitalization for any type of ACS was significantly higher - 16, 0% vs 6.1% (p&lt;0.0001). When assessing the incidence of fatalities in different facilities, it was found that STEMI, patients ≥75 years old hospitalized in “invasive” hospitals died significantly less frequently than when they got into “non-invasive” hospitals - 15.6% vs 50.0% (p=0.013). At the same time, among patients &lt;75 years hospital mortality in “invasive” and “non-invasive” hospitals was not significantly different - 14.7% vs 9.9% (p=0.50). There was also a clear trend towards a higher incidence of deaths among elderly patients who were left without PCI, compared with those who had been intervened. In patients &lt;75 years, this trend was absent. Conclusion Thus, the results obtained indicate that elderly patients, with a higher risk and worse outcomes, receive treatment that is less consistent with the requirements of modern guidelines for the treatment of ACS. Important factors associated with better outcomes in elderly patients is their hospitalization in “invasive” hospitals and the implementation of PCI. </jats:sec