Acute Kidney Injury after Transcatheter Aortic Valve Implantation

Aim. The aim of the study was to evaluate the incidence and predictors of acute kidney injury (AKI) associated with transcatheter aortic valve implantation (TAVI).Material and methods. 50 patients (39 women, 11 men) aged 76 (71; 80) years who underwent TAVI were examined. One day after TAVI, blood creatinine level was determined by the Jaffe method and troponin I by a highly sensitive method (hs-cTnI). Acute kidney injury (AKI) was diagnosed according to the KDIGO criteria (2012). The following hospital complications were evaluated: cases of cardiac death, intraoperative myocardial infarction (MI), stroke and transient ischemic attack, permanent pacemaker implantation, recurrent paroxysms of atrial fibrillation.Results. History of MI had 22% of patients, percutaneous coronary intervention – 38%, hypertension – 98%, chronic kidney disease – 48%, diabetes mellitus – 24%, class II NYHA of chronic heart failure (CHF) – 52%, NYHA class III – 46%, NYHA class IV – 2%. The risk of operational mortality according to EuroSCORE II was 6.3±5.4%. AKI after TAVI was registered in 6 (12%) patients (1 grade AKI – 8%, 2 grade – 2%, 3 grade – 2%). Parameters associated with AKI after TAVI were higher CHF NYHA class (p=0,020), high hs-cTnI level (p=0,013), intraoperative MI (p=0.035). The predictor of AKI after TAVI was high hs-cTnI level (odds ratio 4.0, 95% confidence interval 1.0-16.1). Among patients with AKI after TAVI in compare with patients without AKI, the cumulative frequency of cardiac death, MI, strokes and transient ischemic attacks, implantation of a permanent pacemaker, the proportion of people with paroxysmal atrial fibrillation during the hospital stay was 5,8 times higher (66.7% vs 11.4% respectively, p=0.001).Conclusion. AKI after TAVI was present in 12% of patients. The predictor for AKI development was an increase in hs-cTnI level after TAVI implantation. The hospital prognosis after TAVI is worse in patients with postoperative AKI

USE OF FIXED COMBINATIONS OF RAMIPRIL AND HYDROCHLOROTHIAZIDE IN PATIENTS WITH ARTERIAL HYPERTENSION AND HIGH OR VERY HIGH CARDIOVASCULAR RISK (OPTIMIST 2 STUDY): RESULTS OF THE NONCOMPARATIVE STUDY

Aim. To evaluate efficacy and safety of treatment with fixed combination of ramipril and hydrochlorothiazide in patients with arterial hypertension (HT) 2-3 degree and high or very high cardiovascular risk in clinical practice. Material and methods. Patients with HT 2-3 degree and high or very high cardiovascular risk who had not reached target blood pressure (BP) levels with previous therapy (n=427) were included in open-label non-comparative multicenter phase IV study. Patients were treated with fixed combination of ramipril and hydrochlorothiazide during 8 weeks. The drug dose was increased and/or amlodipine was added in case of insufficient antihypertensive effect. Achievement of the target BP level (<130/80 mmHg) and therapy safety were assessed. Results. 420 patients (98.4%) completed the study. After 8 weeks 273 (65%) patients had a two-component therapy (fixed combination of ramipril and hydrochlorothiazide), 147 (35%) patients — triple therapy (ramipril, hydrochlorothiazide and amlodipine). The target BP level was achieved in 408 (97.14%) patients and it was not reached in 12 (2.86%) patients. 7 patients were dropped out from the study: 4 — because of adverse events (dry cough), 3 — due to violation of study protocol. Both patients and doctors considered fixed ramipril and hydrochlorothiazide combination as effective and well tolerable one.  Conclusion. Ramipril and hydrochlorothiazide fixed combination provides an achievement of the target BP level in the most of HT patients

Assessment of the psycho-emotional state of patients after COVID-19-associated pneumonia in relationship with laboratory indicators

The aim. To study peculiarities and association of psychological and laboratory indicators in patients with cardiovascular diseases (CVD) who underwent COVID-19 to clarify the factors affecting the possibility of developing delayed psychological and cardiovascular adverse events.Methods. The study enrolled 350 patients with COVID-19. Group 1 consisted of 92 patients without CVD, Group 2 – of 258 patients with CVD. Indicators of laboratory and psychological parameters were assessed according to the data of psychological questionnaire using GAD-7 (General Anxiety Disorder-7), PHQ-9 (Patient Health Questionnaire-9), PSS (Perceived Stress Scale) screening scales and SF-36. Parameters of complete blood count and biochemical blood tests were measured during hospitalization and three months after discharge from the monohospital.Results. After three months, in the general group of patients, signs of anxiety and depression were detected in more than 30 % of the examined patients, signs of stress – in 10.4 %. In the group with CVD, psycho-emotional disorders were identified in 1/4 of the patients, and severe stress – in 8 % of those included in the study. In addition, it was registered that the indicators of erythrocyte sedimentation rate, fibrinogen, high-sensitivity C-reactive protein (CRP), homocysteine and IL-6 remained at a higher level in the second group.Correlation analysis showed that the psychological component of health is interconnected with the level of neutrophils (p = 0.044) and fibrinogen (p = 0.050); the physical component of health is correlated with the level of erythrocytes (p = 0.030), hemoglobin (p = 0.015), CRP (p = 0.002), creatine phosphokinase (p = 0.036) and glucose (p = 0.017). Regression analysis revealed that in patients with CVD three months after hospitalization, an increased glucose index contributes to deterioration, and increased hematocrit and mean hemoglobin concentration improve the quality of life of patients.Conclusion. Laboratory markers that maintain the duration of a prolonged vascular reaction, violation of the rheological and metabolic properties of blood, determine the nature of the development of both psychological and cardiovascular complications

ГЕНДЕРНЫЕ ОСОБЕННОСТИ И ТАКТИКА ЛЕЧЕНИЯ ОСТРОГО КОРОНАРНОГО СИНДРОМА БЕЗ ПОДЪЕМА СЕГМЕНТА ST У ЖЕНЩИНЫ МОЛОДОГО ВОЗРАСТА

Acute coronary syndrome in young women is of particular interest for today’s research. There are some data on the different effects of major risk factors among the sex groups, driven by the presence of specific risk factors in the female population. The clinical case reports different clinical course of atherosclerosis in men and women, presented with non-stenotic coronary atherosclerosis with hormonal imbalance and classical risk factors of complicated CAD.Острый коронарный синдром у женщин молодого возраста становится актуальной проблемой. Известны данные о разнонаправленных влияниях основных факторов риска в зависимости от пола и с учетом реализации специфических факторов риска женской популяции. Приводится случай из практики, демонстрирующий иное клиническое течение атеросклероза коронарных артерий у мужчин и женщин: выявление нестенозирующей формы коронарного атеросклероза на фоне нарушения гормонального статуса и «классических» факторов риска осложненного течения ИБС

Clinical cases non-compact myocardium. Diagnostics, tactics

The article describes a clinical case of non-compact form of a non-isolated myocardium. The diagnosis is made in the performance of transthoracic echocardiography. Echocardiography has sufficiently high information in the recognition of a non-compact myocardium of the left ventricle and for the differential diagnosis with other cardiomyopathies, so you can use it as a base the most accessible, acceptable method in the case of non-compact myocardium cardiomyopathy.В статье приводится описание клинических случаев неизолированной формы некомпактного миокарда. Диагноз поставлен при выполнении трансторакальной эхокардиографии. Эхокардиография обладает достаточно высокой информативностью в распознавании некомпактного миокарда левого желудочка и для проведения дифференциальной диагностики с другими кардиомиопатиями, что позволяет использовать ее в качестве основного наиболее доступного и приемлемого метода в случае кардиомиопатии некомпактного миокарда

Biochemical parameters associated with endothelial dysfunction in patients with arterial hypertension and ischemic heart disease

With the purpose to study the characteristic of biochemical parameters related to endothelial dysfunction, a survey of 121 people aged between 40 and 70 years. The control group without arterial hypertension (AH) and coronary heart disease (CHD) accounted for 18 people, a group with AH - 56 people, the group with the combination of CHD and AH - 47. A comparative evaluation of vasomotor function of endothelium and endothelial dysfunction characterizing the biochemical parameters as endothelin-1, nitrites blood plasma, ADP-induced platelet aggregation, lipid peroxidation and antioxidant defense in blood platelets from patients with AH and with combined AH and CHD. In patients with AH and accession of CHD was identified by negative dynamics of markers of ED, in the form of reduced levels of nitrite, the increase of endothelin-1 and platelet aggregation (AT), induced by the large doses of inducer. The studied group was predominantly at one stage or another oxidative stress is caused by an imbalance of antioxidant protection (AOP) and the processes of lipid peroxidation (LPO) in platelets, in patients with AH was dominated by activation of the LPO. In patients with in combination AH with CHD had a complete depletion of the AOP and a decrease in the activity of LPO in platelets and significantly higher values AT.С целью изучения особенностей биохимических показателей, связанных с дисфункцией эндотелия, проведено обследование 121 человека в возрасте от 40 до 70 лет. Контрольную группу без артериальной гипертонии (АГ) и ишемической болезни сердца (ИБС) составили 18 человек, группу с АГ - 56 человек, группу с сочетанием АГ и ИБС - 47 человек. В работе проведена сравнительная оценка сосудодвигательной функции эндотелия и таких характеризующих эндотелиальную дисфункцию биохимических показателей как эндотелин-1, нитриты плазмы крови, АДФ-индуцированная агрегация тромбоцитов, перекисное окисление липидов и антиоксидантная защита в тромбоцитах у пациентов с АГ и сочетанием АГ и ИБС. У пациентов АГ по мере присоединения ИБС была выявлена отрицательная динамика маркеров ЭД, в виде снижение уровня нитритов, повышения эндотелина-1 и агрегации тромбоцитов (АТ), индуцированной большими дозами индуктора. Исследуемые группы находились преимущественно на той или иной стадии окислительного стресса, обусловленного дисбалансом антиоксидантной защиты (АОЗ) и процессов перекисного окисления липидов (ПОЛ) в тромбоцитах, у больных АГ преобладала активация ПОЛ. У больных АГ в сочетании с ИБС наблюдалось полное истощение АОЗ и снижение активности ПОЛ в тромбоцитах и более высокие значения АТ

Features parameters of the lipid profile and inflammatory vascular respons in patients with stable and unstable angina

169 patients (male and temale aged 60,12 ± 10,7 years) with coronary artery disease (CAD), stable and unstable angina (SA/UA) were examined. According to the selective coronary angiography, a group of patients with significant and insignificant (neighboring) coronary stenosis (SCS and ICS) was selected. CAD patients with SA and UA in the general group do not differ in the level of atherogenic parameters of lipid profile, but in UA group the level of MMP-9 and TIMP-1 is significantly higher, which may indicate an elevated level of the local inflammatory respond and increased threat of thrombogenic complications in unstable plaques. In CAD patients with UA in SCS group a significant excess of atherogenic parameters of lipid profile (total cholesterol, LDL cholesterol, trygliceride) compared to patients without SCS was noted. Equal elevation of inflammatory markers (hs-CRP, TNF-alpha and endothelin-1) in both groups regardless severity of coronary syndrome may cause thrombosis in case of unstable CAD. Patients with unstable CAD regardless of the severity of coronary stenosis may have increased level of MMP-9 and TIMP-1. According to logistic regression data, CD 40, MMP-9 and TIMP-1 levels can be isolated as differential signs of unstable angina flow.Обследовано 169 пациентов (мужского и женского пола) в возрасте 60,12±10,7 лет с ишемической болезнью сердца (ИБС), разделенных в 2 основные группы: 1-я пациенты со стабильной (СС) и 2-я пациенты с нестабильной стенокардией (НС). Согласно данным селективной коронарной ангиографии, в каждой основной группе пациентов выделены подгруппы со значимым и незначимым коронарным стенозом (ЗКС и НЗКС). Пациенты со СС и НС стенокардией в основных группах не различались по уровню атерогенных параметров липидного спектра и основных маркеров воспалительной сосудистой реакции, однако в группе с нестабильной стенокардией был зарегистрирован достоверно повышенный уровень ММП-9 и ТИМП-1, что свидетельствует о наличии повышенного уровня маркеров локального воспалительного ответа. У пациентов ИБС с нестабильной стенокардией в группах независимо от степени коронарного стеноза зарегистрировано превышение референсных знамений атерогенных параметров липидов (ОХС, ТГ, ХС ЛПНП) и равноценно повышенные уровни маркеров сосудистого воспаления вч-СРБ, ФИО- и эндотелина-1, что может обусловливать при нестабильном течении стенокардии равнозначную вероятность нежелательных сердечно-сосудистых событий. Согласно данным логистической регрессии, уровни CD 40, ММП-9 и ТИМП-1 можно использовать для верификации нестабильного течения стенокардии

The study of the dynamics of clinical and laboratory-instrumental parameters in hypertensive patients with obesity who underwent COVID-19-associated pneumonia

BACKGROUND: According  to the results of the ESSE-RF study, the frequency of obesity in the population  reached 29.7%. Obesity is one of the main risk factors for the development of cardiovascular diseases. Features of the course of COVID-19 in patients with obesity is a very urgent problem.AIM: The aim of the study was a comparative investigation of clinical and laboratory-instrumental parameters in AH patients with or without obesity who had COVID-19 associated pneumonia, to identify the role of obesity as a potential predictor of post-COVID cardiovascular complications 3 months after discharge from the hospital.MATERIALS AND METHODS: Materials and methods. The study included 174 patients with COVID-19-associated pneumonia. Group 1 included 78 patients with AH without obesity, group 2 — 96 patients with AH and obesity. All patients were tested with a blood sample at the time of admission and 3 months after discharge from the hospital. We assessed parameters of general blood test, biochemistry, hemostasis, inflammation biomarkers — concentration of C-reactive protein (CRP), highly sensitive CRP (hs-CRP), homocysteine, IL-6, etc. All patients initially underwent computed tomography  of the chest. In both groups, 24-hour blood pressure monitoring was performed using BPLaB device, according to the standard protocol; echocardiography using  an expert class ultrasound diagnostic  system Vivid S70. The study is registered with the Clinical Trials.gov database Identifier: NCT04501822.RESULTS: Results. The biomarker that significantly distinguished the both groups of patients, as well as subgroups according to the degree of obesity was the concentration of maxCRP and hs-CRP, which was significantly higher in group 2. In addition, the registered maximum values of MPO, NT-proBNP, IL-1,6, TNA-α and NRL parameters in group 2 of patients with 2–3 degrees of obesity, may indicate the highest probability of developing  delayed adverse cardiovascular complications  in this group of patients. Mean systolic blood pressure, variability of systolic and diastolic blood pressure, and heart rate at night were significantly  higher in AH patients with obesity. Numerous correlations of obesity with laboratory and instrumental parameters have been registered, which may indicate an increased likelihood of delayed unwanted cardiovascular complications in this particular group of patients. Multiple regression showed that obesity is an independent predictor of an increase in LDH, hs-CRP and right atrium.CONCLUSION: Dynamic control of the studied parameters in patients with AH and OB registered an increased concentration of CRP at the initial stage and 3 months after treatment, with a general trend towards a decrease in the increased initial structural parameters of ECHO CG. The logistic regression method showed that the presence of OB in patients with AH is an independent factor causing increased levels of immune inflammation (CRP), a marker of tissue destruction (LDH), and load on the right atrium

Comparative analysis of prospective study data of biochemical parameters of blood serum in patients with ischemic heart disease with the presence and absence of type 2 diabetes

Purpose: to conduct a prospective comparative analysis of laboratory parameters of the lipid profile, markers of the inflammatory response and functional activity of the endothelium in groups of patients with ischemic heart disease and coronary heart disease in combination with diabetes under condition of absence of significant lesion of coronary arteries. Determine a set of laboratory parameters that determine the likelihood of developing cardiovascular complications. Materials. According to the data of selective coronary angiography, patients without significant coronary stenosis were identified. Group 1 - patients with IHD (n = 29), 2nd group - CHD with type 2 diabetes mellitus (DM), (n = 39). The study of laboratory parameters of blood serum was performed against the background of standard therapy before and after 12 ± 2.4 months of follow-up. Results. In both groups, the excess of the reference values of the parameters of the lipid profile and the markers of vascular inflammation was revealed. In the 2nd group the levels of total cholesterol, LDL, Apo-B, high-sensitivity C-reactive protein, homocysteine, interleukin 1 beta are significantly higher than in the 1st group. Prospective observation with standard therapy demonstrated the presence of negative dynamics of the lipid spectrum, the preservation of a prolonged response to the activation of the inflammatory reaction, which was indicated by interleukin 1β, homocysteine, matrix metalloproteinase 9 and the persistence of disorganization of the endothelin system in both groups of patients. Conclusion: The results of the study indicate the preservation of a prolonged inflammatory response in the endothelium in both the 1 st and 2 nd group of patients, which can become a provoking factor for the destabilization of the atherosclerotic process. The increased risk of atherothrombosis in both groups of patients requires a strict control of the effectiveness of the therapy in the conditions of real clinical practice.Цель: провести сравнительный анализ лабораторных параметров липидного профиля, маркеров воспалительной реакции и функциональной активности эндотелия в группах больных ИБС и ИБС в сочетании с СД при условии отсутствия значимого поражения коронарных артерий по данным коронароангиографии. Выделить комплекс лабораторных параметров, определяющих вероятность развития сердечно-сосудистых осложнений. Материалы: Согласно данным селективной коронарной ангиографии выделены пациенты без значимого коронарного стеноза. 1-я группа - больные ИБС (n=29), 2-я группа - ИБС с сахарным диабетом типа 2 (СД), (n=39). Исследование лабораторных параметров сыворотки крови проводилось на фоне стандартной терапии до и через 12±2,4 месяцев наблюдения. Результаты: В обеих группах выявлено превышение референсных значений параметров липидного профиля и маркеров сосудистого воспаления. Во 2-ой группе достоверно выше уровни общего холестерина, ЛПНП, Апо-В, высокочувствительного С-реактивный белка, гомоцистеина, интерлейкина 1 β по сравнению с 1-ой группой. Проспективное наблюдение на фоне стандартной терапии продемонстрировало наличие негативной динамики липидного спектра, сохранение пролонгированного ответа активации воспалительной реакции, индикатором которой явились интерлейкин 1 β, гомоцистеин, матриксная металлопротеиназа 9 и сохранение дезорганизации эндотелиновой системы в обеих группах больных. Заключение: Результаты исследования свидетельствует о сохранении как в 1-ой, так и во 2-ой группе пациентов пролонгированного воспалительного ответа в эндотелии, что может стать провоцирующим фактором для дестабилизации атеросклеротического процесса. Повышенный риск развития атеротромбоза в обеих группах пациентов требует жесткого контроля эффективности проводимой терапии в условиях реальной клинической практики