«СИНДРОМ ОБКРАДЫВАНИЯ» СЕЛЕЗЕНОЧНОЙ АРТЕРИЕЙ ПОСЛЕ ОРТОТОПИЧЕСКОЙ ТРАНСПЛАНТАЦИИ ПЕЧЕНИ

Splenic artery steal syndrome is one of possible arterial complications after orthotopic liver transplantation. Material includes personal experience in diagnostics and treatment of this syndrome. In each case complication was opportunely suspected basing on laboratory and ultrasound data and proved by angiography. Successful treatment was performed using different variants of splenic artery embolization. Одним из вариантов артериальных осложнений после ортотопической трансплантации печени является синдром обкрадывания селезеночной артерии. В материале представлен собственный опыт диагности- ки и лечения этого состояния. В каждом наблюдении удалось достаточно своевременно заподозрить па- тологический синдром на основании инструментальных и лабораторных данных и подтвердить диагноз при ангиографии. Успешная коррекция выполнена путем различных вариантов эмболизации селезеноч- ной артерии.

Clinical features of post-COVID-19 period. Results of the international register “Dynamic analysis of comorbidities in SARS-CoV-2 survivors (AKTIV SARS-CoV-2)”. Data from 6-month follow-up

Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period

SPLENIC ARTERY STEAL SYNDROME AFTER ORTHOTOPIC LIVER TRANSPLANTATION

Splenic artery steal syndrome is one of possible arterial complications after orthotopic liver transplantation. Material includes personal experience in diagnostics and treatment of this syndrome. In each case complication was opportunely suspected basing on laboratory and ultrasound data and proved by angiography. Successful treatment was performed using different variants of splenic artery embolization

Comparative analysis of echocardiographic and electrocardiographic data of survivors and deceased patients with COVID-19 (sub-analysis of the international register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors”)

Aim. To carry out comparative analysis of echocardiographic and electrocardiographic (ECG) data of survivors and deceased patients with COVID-19 (sub-analysis of the international register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors”).Material and methods. The study presents the results of a sub-analysis of the international AKTIV registry, which was called AKTIV CARDIO. Data were collected from 9 medical centers in the Russian Federation. AKTIV CARDIO included 973 hospitalized patients, of which 50 patients died during hospitalization.Results. Comparative analysis of echocardiographic parameters revealed that 4 parameters differed in deceased patients compared to survivors: left ventricular ejection fraction (LVEF), right ventricular end diastolic dimension (RV EDD), right atrial (RA) short axis diameter and pulmonary artery systolic pressure (PASP). RA short axis diameter was higher in deceased patients compared with survivors (38,0 [36,0; 39,0] versus 35,0 [33,0; 38,0] mm, p=0,011). RV EDD was higher in deceased patients than in survivors (3,0 [29,0; 33,0] vs 28,0 [27,0; 32,0] mm, p=0,019). LVEF was lower in deceased patients compared with survivors (55 [52; 55] vs 60 [56; 65]%, p<0,001). PASP was higher in deceased patients compared with survivors (25 [21; 35] vs 20 [19; 25] mm Hg, p=0,006). Correlation analysis found that the largest number of correlations with markers of the infection severity was observed for RA short axis diameter and RV EDD. A comparative analysis of ECG data revealed that in deceased patients, compared with survivors, atrial fibrillation (AF) (21,4% vs 6,06%, p=0,001) and supraventricular premature beats (14,3% vs 3,36%, р=0,004) occurred more often. In addition, deceased patients had longer QTc interval (440 [416; 450] vs 400 [380; 430] ms, p<0,001).Conclusion. Comparative analysis of echocardiographic data showed that deceased patients have more pronounced right heart remodeling, higher PASP and lower LVEF. Patient survival was related to RV and RA sizes. Right heart enlargement was associated with markers of infection severity. Echocardiographic parameters characterizing the right heart side can probably be independent prognostic factors in the acute COVID-19 period

International register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors” (AKTIV SARS-CoV-2): analysis of 1,000 patients

COVID-19 is a severe infection with high mortality. The concept of the disease has been shaped to a greater extent on the basis of large registers from the USA, Spain, Italy, and China. However, there is no information on the disease characteristics in Caucasian patients.Therefore, we created an international register with the estimated capacity of 5,000 patients — Dynamics Analysis of Comorbidities in SARS-CoV-2 Survivors (AKTIV SARS-CoV-2), which brought together professionals from the Russian Federation, Republic of Armenia, Republic of Kazakhstan, and Kyrgyz Republic. The article presents the first analysis of the register involving 1,003 patients. It was shown that the most significant difference of the Caucasian population was the higher effect of multimorbidity on the mortality risk vs other registers. More pronounced effect on mortality of such diseases as diabetes, obesity, hypertension, chronic kidney disease, and age over 60 years was also revealed

International register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors” (AKTIV SARS-CoV-2): analysis of predictors of short-term adverse outcomes in COVID-19

The international AKTIV register presents a detailed description of out- and inpatients with COVID-19 in the Eurasian region. It was found that hospitalized patients had more comorbidities. In addition, these patients were older and there were more men than among outpatients. Among the traditional risk factors, obesity and hypertension had a significant negative effect on prognosis, which was more significant for patients 60 years of age and older. Among comorbidities, CVDs had the maximum negative effect on prognosis, and this effect was more significant for patients 60 years of age and older. Among other comorbidities, type 2 and 1 diabetes, chronic kidney disease, chronic obstructive pulmonary disease, cancer and anemia had a negative impact on the prognosis. This effect was also more significant (with the exception of type 1 diabetes) for patients 60 years and older. The death risk in patients with COVID-19 depended on the severity and type of multimorbidity. Clusters of diseases typical for deceased patients were identified and their impact on prognosis was determined. The most unfavorable was a cluster of 4 diseases, including hypertension, coronary artery disease, heart failure, and diabetes mellitus. The data obtained should be taken into account when planning measures for prevention (vaccination priority groups), treatment and rehabilitation of COVID-19 survivors