PROGNOSTIC ROLE OF EEG INDICATORS FOR CHANGES IN COGNITIVE PERFORMANCE IN PATIENTS IN THE EARLY AND LONG-TERM POSTOPERATIVE PERIODS OF CORONARY ARTERY BYPASS GRAFTING

Aim. To study the prognostic role of background EEG activity indicators recorded in patients in the preoperative period of coronary artery bypass grafting (CABG) for the development of cognitive impairment in the early and late postoperative periods.Methods. A total of 85 patients with coronary artery disease (CAD) who underwent CABG were included in the study. Before CABG (3-5 days) all neuropsychological testing and EEG studies were performed, at the 7-10th days and 1 year after CABG only neuropsychological testing. EEG predictors of early (n = 85) and long-term (n = 65) postoperative cognitive dysfunction were detected using the method of multiple linear regression.Results. EEG predictors of deterioration of cognitive status in the early postoperative period of CABG were basic higher values of theta-rhythm power in the posterior regions of the cortex of both hemispheres with closed and open eyes. Whereas higher preoperative parameters of beta2-rhythm biopotentials in the left frontal areas with eyes open and lower alpha-rhythm power in the left occipital parts of the cerebral cortex with eyes closed were associated with long-term postoperative cognitive dysfunction.Conclusion. associations of preoperative eeg indicators with deteriorations of cognitive status in the early and longterm postoperative periods of cabg were revealed. Aim. To study the prognostic role of background EEG activity indicators recorded in patients in the preoperative period of coronary artery bypass grafting (CABG) for the development of cognitive impairment in the early and late postoperative periods.Methods. A total of 85 patients with coronary artery disease (CAD) who underwent CABG were included in the study. Before CABG (3-5 days) all neuropsychological testing and EEG studies were performed, at the 7-10th days and 1 year after CABG only neuropsychological testing. EEG predictors of early (n = 85) and long-term (n = 65) postoperative cognitive dysfunction were detected using the method of multiple linear regression.Results. EEG predictors of deterioration of cognitive status in the early postoperative period of CABG were basic higher values of theta-rhythm power in the posterior regions of the cortex of both hemispheres with closed and open eyes. Whereas higher preoperative parameters of beta2-rhythm biopotentials in the left frontal areas with eyes open and lower alpha-rhythm power in the left occipital parts of the cerebral cortex with eyes closed were associated with long-term postoperative cognitive dysfunction. Conclusion. associations of preoperative eeg indicators with deteriorations of cognitive status in the early and longterm postoperative periods of cabg were revealed

THE EFFECT OF MILD COGNITIVE IMPAIRMENT ON EEG TOPOGRAPHIC CHANGES AFTER ON-PUMP CORONARY ARTERY BYPASS GRAFTING

The purpose. Previously it was shown that on-pump coronary artery bypass grafting (CABG) induced cerebral ischemia and cognitive decline. The patients with mild cognitive impairment (MCI) could be a high-risk group of CABG-associated cognitive decline. Non-invasive neuromonitoring can provide information regarding subclinical symptoms and topography of cerebral ischemia. The aim of this study was to investigate the topographic changes in electroencephalogram (EEG) spectral power in coronary artery disease (CAD) patients with or without MCI before and after on-pump CABG.Methods: 62 males with CAD were divided into two groups according to their Mini-Mental State Examination: without MCI (n = 37) and with MCI (n = 25). Clinical factors were assessed, including the severity of coronary lesions (SYNTAX score), the left ventricular ejection fraction (LVEF). Eyes-closed rest EEG was recorded from 62 channels positioned according to the International 10–20 system. Spectral EEG power was calculated for frequencies from 0.1 to 50 Hz.Results: The patients with MCI had theta-1 (4–6 Hz) power increase 7-10 days after on-pump CABG only in frontal and fronto-central clusters of right and left hemispheres as compared to the preoperative values, whereas in the groups without MCI this effect was widespread over the brain. In the beta-1 band (13–20 Hz), CABG patients with MCI had power increase in the frontal, fronto-central and fronto-temporal regions of the brain cortex. Similar power changes in patients without MCI were observed only for occipital brain clusters.Conclusions: CAD patients with MCI have demonstrated EEG signs of cortical dysfunction focused on the frontal brain areas. Cortical dysfunction in this localization can be associated with the progression of cognitive deficits, causing loss social integration in CAD patients with MCI.The purpose. Previously it was shown that on-pump coronary artery bypass grafting (CABG) induced cerebral ischemia and cognitive decline. The patients with mild cognitive impairment (MCI) could be a high-risk group of CABG-associated cognitive decline. Non-invasive neuromonitoring can provide information regarding subclinical symptoms and topography of cerebral ischemia. The aim of this study was to investigate the topographic changes in electroencephalogram (EEG) spectral power in coronary artery disease (CAD) patients with or without MCI before and after on-pump CABG.Methods: 62 males with CAD were divided into two groups according to their Mini-Mental State Examination: without MCI (n = 37) and with MCI (n = 25). Clinical factors were assessed, including the severity of coronary lesions (SYNTAX score), the left ventricular ejection fraction (LVEF). Eyes-closed rest EEG was recorded from 62 channels positioned according to the International 10–20 system. Spectral EEG power was calculated for frequencies from 0.1 to 50 Hz.Results: The patients with MCI had theta-1 (4–6 Hz) power increase 7-10 days after on-pump CABG only in frontal and fronto-central clusters of right and left hemispheres as compared to the preoperative values, whereas in the groups without MCI this effect was widespread over the brain. In the beta-1 band (13–20 Hz), CABG patients with MCI had power increase in the frontal, fronto-central and fronto-temporal regions of the brain cortex. Similar power changes in patients without MCI were observed only for occipital brain clusters. Conclusions: CAD patients with MCI have demonstrated EEG signs of cortical dysfunction focused on the frontal brain areas. Cortical dysfunction in this localization can be associated with the progression of cognitive deficits, causing loss social integration in CAD patients with MCI

Clustering of indicators of the cognitive status in cardiac surgery patients to assess the risk of postoperative decline

The aim of the study. To determine the informational value of psychometric indicators used for the integral assessment of cognitive status in cardiac patients, and to find those that would help differentiate the individual sensibility to postoperative cognitive dysfunction (POCD).Materials and methods. The clustering methods were analyzed the extended psychometric testing data in 256 cardiac surgery patients. The psychometric testing carried out 3–5 days before and on days 7–10 after surgery using the psychophysiological complex program “Status PF”.Results. The cluster analysis revealed that the most informative tests for a screening risk assessment of POCD are the testing the speed of response to visual stimuli with feedback of changes in the stimuli exposition according to the individual reaction time and the testing short-term memory (memorized words). While the analysis of postoperative psychometric indicators, the patients in a modified clustering group were characterized by a deterioration of verbal memory and a decrease of the time reaction to visual stimuli whereas that its observed acceleration in the general “stable” group.Conclusion. The clustering methods enabled the identification of cardiac surgery patients in the preoperative stage who had less cognitive reserve for recovery after surgery. The changes in the relationship of complex visual and motor response, attention, and memory indicators, which depended on the belonging to the identified clusters, suggest that the preoperative period is characterized by the dedifferentiation of cognitive functions indicating a cognitive deficit

Acute coronary syndrome in patients with prior coronary artery bypass grafting. Literature review

Invasive management of patients with ST- segment elevation acute coronary syndrome (ST-ACS) and non-ST-elevation acute coronary syndrome (NSTE-ACS) is a priority and reflected in the current guidelines for management of this category of patients with a high evidence level (class I, level of evidence A). One of the limitations in invasive strategy is prior coronary artery bypass grafting in patients with multivessel artery coronary disease. This analytical review reflects modern ideas about the features of diagnosis and management of patients with acute coronary syndrome and previous coronary artery bypass surgery, approaches to revascularization from the standpoint of efficiency and safety

Изменения в структуре когнитивных функций и тревожности у кардиохирургических пациентов в зависимости от выраженности стенозов сонных артерий

Highlights. The article revealed that severe (more than 50%) carotid artery (CA) stenosis was associated with significant slowdown of the information selection processes, and these patients were characterized by older age and tendency to an increase in trait anxiety compared to the patients without CA stenosis.It was found that the reduced attention and memory was a typical feature of the cognitive status in patients with severe CA stenosis in the early postoperative period of cardiac surgery in comparison with the patients without CA stenosis. At the same time the speed characteristics indicators of the information selection processes in these patients are positively related to state anxiety.Aim. The cardiac surgery patients were studied in order to analyze the postoperative changes in the efficiency of selection information and memory processes depending on the degree of carotid artery (CA) stenosis (including more than 50%) and the age and the role of the trait anxiety indicator assessed before surgery.Methods. The prospective study included 229 patients undergoing elected coronary artery bypass grafting (CABG) or CABG and carotid endarterectomy (CEE). Each study participant underwent clinical, instrumental and extended psychometric examination before cardiac surgery and at 7-10 days after surgery. The evaluation of the extracranial vessels state was carried out before surgery using color duplex scanning. Based on the results of assessing the extracranial vessels state, all patients were divided into three groups: no stenosis (n = 124), CA stenosis less than 50% (n = 69) and more than 50% (n = 36).Results. It was found out that the patients with CA stenoses more than 50% are characterized by a slower reaction under different conditions of visual stimuli selection and by an older age as compared with patients with no stenoses as well as patients with stenoses less than 50%. In the postoperative period of cardiac surgery in comparison with testing before surgery there was an improvement in the information selection stability (an increase in the number of processed symbols per 4 minute of the Bourdon's test (p<0.00006)) and short-term memory (p = 0.03) only in the group of patients without stenoses. The patients with stenoses of less than 50% had an increase the of the information selection stability but the short-term memory decrease (p<0.05) whereas the group with stenoses more than 50% had a decrease in both the stability of information selection and short-term memory (p<0,05). Additional factors of cognitive deficit in CA stenosis patients were trait anxiety associated with memory impairment and a history of stroke that related to a decrease in the effectiveness of a complex visual-motor reaction.Conclusion. The comprehensive analysis of the cognitive status of cardiac surgery patients with different severity of CA stenosis showed that an increase in the age and stenosis degree is the factor of the reaction time slowdown under different conditions of information selection. To differentiate groups of patients depending on the severity of stenosis in the postoperative period the testing short-term memory and stability of attention is informative. These indicators improve in the group without stenosis but decrease in the group with pronounced stenosis. The trait anxiety and the history of stroke were the additional factors of memory impairment due to CA stenosis.Основные положения. Впервые показано, что выраженный (более 50%) стеноз сонных артерий (СА) приводит к значимому замедлению формирования реакции при селекции информации и эти пациенты характеризуются старшим возрастом и тенденцией к росту личностной тревожности по сравнению с больными с отсутствием стенозов СА.Обнаружено, что отличительной особенностью когнитивного статуса пациентов с выраженными стенозами СА в раннем послеоперационном периоде кардиохирургического вмешательства служат снижение объема внимания и ухудшение памяти в сравнении с больными с отсутствием стенозов СА, при этом скоростные показатели селекции информации положительно связаны с личностной тревожностью.Цель. Проанализировать послеоперационные изменения эффективности селекции информации и памяти в зависимости от степени стеноза сонных артерий (СА) (более 50%) и возраста пациентов и выяснить роль показателя личностной тревожности, измеренного до оперативного вмешательства.Материалы и методы. В проспективное исследование включены 229 больных, перенесших изолированное коронарное шунтирование (КШ) либо КШ в сочетании с каротидной эндартерэктомией. Клиническое, инструментальное и расширенное психометрическое обследование выполнено до вмешательства и на 7-10-е сут после операции. Оценка состояния экстракраниальных сосудов проведена до операции с использованием цветного дуплексного сканирования. По результатам этой оценки сформированы три группы пациентов: отсутствие стеноза СА (n = 124), стеноз СА менее 50% (n = 69) и более 50% (n = 36).Результаты. Больные со стенозами СА более 50% отличаются от пациентов с отсутствием стенозов и стенозами менее 50% более медленной реакцией в разных условиях селекции зрительных стимулов и старшим возрастом. В послеоперационном периоде кардиохирургических вмешательств только в группе лиц без стенозов отмечено улучшение устойчивости селекции информации (увеличение количества обрабатываемых за 4 минуты символов теста корректурной пробы Бурдона; p<0,00006) и кратковременной памяти (р = 0,03) в сравнении с тестированием до операции. У пациентов со стенозами менее 50% наряду с повышением устойчивости селекции информации показатели кратковременной памяти снижались (р<0,05), а в группе со стенозами более 50% отмечено как уменьшение устойчивости селекции информации, так и кратковременной памяти (р<0,05). Дополнительными факторами когнитивного дефицита при стенозе СА выступают личностная тревожность, связанная с ухудшением памяти, и наличие ОНМК в анамнезе, ассоциированное со снижением эффективности сложной зрительно-моторной реакции.Заключение. В результате комплексного анализа когнитивного статуса кардиохирургических пациентов с разной выраженностью стенозов СА установлено, что увеличение возраста и степени стеноза служит фактором замедления формирования ответа в разных условиях селекции информации. Для дифференциации групп больных в зависимости от выраженности стеноза в послеоперационном периоде информативно тестирование кратковременной памяти и устойчивости внимания, показатель которого улучшается в группе без стеноза, но снижается в группе с выраженным стенозом

A New Chapter in the Treatment of Patients with Heart Failure. The Role of Sodium-Glucose Co-transporter Type 2 Inhibitors

Heart failure (HF) remains one of the major social and medical public health problems worldwide. Despite new advances in the treatment of patients with HF, the prognosis is still poor. According to the European Cardiology Society guidelines for the diagnosis and treatment of acute and chronic heart failure (CHF) 2021, a new class of drugs related to hypoglycemic has been confirmed to be effective in influencing the survival of patients with heart failure with low ejection fraction (HFpEF), regardless of the presence of disorders of carbohydrate metabolism. We are talking about inhibitors of the sodium-glucose co-transporter type 2 (iSGLT-2) or gliflozins. The article presents the results of the latest large clinical trials on the effective use of SGLT-2 in patients with HF, not only with low, but also with intact ejection fraction (HFpEF), for which there is no evidence base at the present stage. The review article presents the results of experimental studies that explored the potential mechanisms of action of gliflozins with an emphasis on new ones that are of fundamental importance for patients with heart failure, and also describes controversial and little-studied issues. Currently, there is no therapy that improves outcomes in patients with acute heart failure. The article presents the results of small analyzes of the use of iSGLT-2 in this category of patients, which are the basis for the hypothesis of their potentially effective and safe use in the case of acute decompensation of CHF, however, the role of gliflozins in this category of patients requires further in-depth study

Impact of preoperative mild cognitive impairment on cerebrovascular events and cognitive status in patients undergoing coronary artery bypass grafting: data from 5-year follow-up

Aim. To assess the incidence of cerebrovascular events and cognitive status in the long-term period after coronary artery bypass grafting (CABG) in patients with and without preoperative mild cognitive impairment (MCI).Material and methods. This prospective study involved 115 patients aged 45 to 69 years, who were admitted to the hospital for elective on-pump CABG. All patients underwent clinical, laboratory, ultrasound, neuroimaging and neuropsychological examination 3-5 days before and 5-7 years after CABG. Cognitive functioning was assessed using screening neuropsychological scales and neuropsychological testing with an assessment of neurodynamics, attention and short-term memory. Pre-CABG MCI was diagnosed based on the criteria by R. Petersen et al. Therefore, the patients were divided into two groups: with (n=51) and without MCI (n=64).Results. It was found that strokes and dementia during the long-term postoperative period of CABG were observed only in the group of patients with preoperative MCI (7,84%). Five-seven years after CABG, a decrease in cognitive status according to neuropsychological scales was found in all patients (p≤0,05). A decrease in neurodynamics, attention and short-term memory compared to the preoperative level was found in 47,92% of patients with preoperative MCI, without MCI — in 40,63%. Neurodynamic disorders occurred equally frequently in both groups (63,8% and 57,8% of patients, respectively). Memory impairments were more often observed in patients with MCI (55,3%) compared to those without MCI (34,4%) (OR=2,36, 95% CI, 1,09-5,12, p=0,03). According to brain multislice computed tomography in the group with preoperative MCI, the number of patients with cysts and leukoaraiosis 5-7 years after CABG was higher than in those without MCI (p≤0,05).Conclusion. In the long-term (5-7 years) postoperative period of CABG, more than 40% of patients demonstrate a decrease in cognitive status, regardless of preoperative data. At the same time, preoperative MCI is associated with adverse cerebrovascular events and dementia, accompanied by morphological brain abnormalities. Due to the revealed facts, it is necessary to optimize approaches to drug treatment and secondary prevention of cognitive decline after cardiac surgery

Three Year Prognosis of Patients with Myocardial Infarction Depending on the Body Weight Index: Data of the Kemerovo Acute Coronary Syndrome Registry

Aim. To study the effect of body mass index (BMI) on the 3-year prognosis of patients after myocardial infarction (MI).Material and methods. The study is based on data from a 3-year observation of patients with MI from the Kemerovo registry of acute coronary syndrome (n=1366). The characteristics of patients with MI, distributed by the BMI, were determined, the outcomes were analyzed, the risk factors and predictors for the vascular events and mortality were identified.Results. Obesity was detected in 32.2% people with MI (I degree – 22.3%; II – 7.7%; III – 2.3%), lack of BMI at 0.5%, normal BMI at 20.5%, overweight at 46.9%. Patients with different BMI showed a comparable incidence of recurring MI. In patients with normal BMI, when compared with patients with obesity, unstable angina pectoris (UA), heart failure (HF) and strokes developed often. In patients with normal BMI compared with obese patients, fewer deaths from all causes were recorded within 3 years after MI. A similar pattern with respect to the group with normal BMI in terms of high overall mortality was obtained among patients with overweight who had a lower UA. Patients with obesity was favorable in relation to the development of HF, strokes and overall mortality than patients with overweight. Differences in the 3-year outcomes in the group of patients with MI and underweight were not found when compared with patients with normal and overweight, however, they had a higher of strokes compared with patients with obesity. At patients with I degree obesity within 3 years after MI UA, HF, strokes were less. Patients with III degree obesity, the maximum frequency of total mortality was recorded. The development of death from all causes during the observation period in patients with MI and obesity was associated with: male, smoking, multivessel arterial diseases, non-endovascular reperfusion, acute HF with MI, history of vascular events and angina pectoris; whereas with overweight: multifocal atherosclerosis and arterial hypertension; with a deficit of BMI: non-reperfusion; with normal BMI: heredity for cardiovascular diseases, dyslipidemia and atrial fibrillation.Conclusion. 3 years after MI patients with obesity of the I degree are less likely than patients with obesity of II-III deaths from all causes are recorded; these patients are less likely than patients with normal weight to develop strokes, HF, UA. Thus, patients with MI and the presence of I degree obesity are characterized by better survival during 3 years of observation

ГОДОВАЯ ДИНАМИКА НЕЙРОФИЗИОЛОГИЧЕСКИХ ПОКАЗАТЕЛЕЙ У ПАЦИЕНТОВ, ПЕРЕНЕСШИХ КОРОНАРНОЕ ШУНТИРОВАНИЕ С ИСКУССТВЕННЫМ КРОВООБРАЩЕНИЕМ

Purpose. To study the dynamics of neurophysiological parameters in patients undergoing on-pump coronary artery bypass grafting 1 year follow-up. Materials and methods. Eighty-one patients with coronary artery disease (CAD) aged 47 to 68 years were included. All the patients underwent neuropsychological and electroencephalographic (EEG) study 3–5 days before, 7–10 days and 1 year after on-pump CABG. The cases of early and long-term postoperative cognitive dysfunction (POCD) were defined by arbitrary criterion, such as 20 % parameters decline in 20 % of tests of all neuropsychological test battery. High-resolution monopolar EEG recordings (62 channels) with closed and open eyes were made using encephalograph «NEUVO», Compumedics, USA. Artifact-free EEG fragments were divided into 2-s epochs and underwent Fourier transformation. EEG spectral power in the frequency band of 4–50 Hz were obtained. The data were log-transformed to normalize the distribution. Statistical processing was performed by using the t-test (Statistica 6.0). Results. The incidence of early POCD was 70 %, long-term POCD – 68 %, of which 51 % were patients with early POCD. The increase of low-frequency theta activity power was found at 7–10 days after CABG in the open and closed eyes, as well as alpha and beta1 activity power with eyes open. One year after CABG the power values of these rhythms decreased, but not reaching the baseline, and were higher than before surgery. Conclusion. The clinical manifestations of early and long-term POCD associated with signs of cortical dysfunction revealed by EEG dynamic changes after on-pump CABG 1 year follow-up.Цель. Изучение годовой динамики нейрофизиологических показателей у пациентов, перенесших коронарное шунтирование (КШ) с искусственным кровообращением (ИК). Материалы и методы. Обследован 81 пациент с ишемической болезнью сердца (ИБС) в возрасте от 47 до 68 лет за 3–5 дней до, на 7–10-е сутки и через 1 год после КШ в условиях ИК. Всем больным проводилось нейропсихологическое и электроэнцефалографическое (ЭЭГ) исследование. Случаи ранней и стойкой послеоперационной когнитивной дисфункции (ПОКД) были зарегистрированы на основании 20 %-ного снижения показателей в 20 % тестов из всей нейропсихологической батареи. Фоновую ЭЭГ с закрытыми и открытыми глазами регистрировали монополярно в 62 стандартных отведениях системы 10–20 с помощью энцефалографа «NEUVO», Compumedics, USA. Методом быстрого преобразования Фурье были получены значения спектральной мощности ЭЭГ в частотной полосе 4–50 Г ц. Для нормализации распределения данных показатели мощности ЭЭГ ритмов перед статистической обработкой логарифмировали. Статистическую обработку проводили с помощью t-критерия Стьюдента по программе Statistica 6.0. Результаты. Частота развития ранней ПОКД составила 70 %, а стойкой ПОКД – 68 %, из этих больных 51 % – пациенты с ранней ПОКД. На 7–10-е сутки после КШ увеличилась мощность низкочастотной тета-активности при закрытых и открытых глазах, а также альфа- и бета1-активности при открытых глазах. Через год после КШ значения мощности биопотенциалов указанных ритмов снижаются, однако, не достигая исходного уровня, остаются выше, чем до операции. Заключение. Клинические проявления ранней и стойкой ПОКД ассоциированы с признаками корковой дисфункции, выявляемыми по динамическим изменениям ЭЭГ в течение года после КШ в условиях ИК

PERSONALITY TYPE D AND THE LEVEL OF SUBCLINICAL INFLAMMATION MARKERS IN CHD PATIENTS

Aim. To study the level of biomarkers of subclinical inflammation in CHD patients with existence of absence of personality type D.Material and methods. In 62 patients with stable CHD before planned CBG operation we assessed concentrations: of matrix metalloproteases -2, -3, -9, tissue inhibitor of matrix proteases -1, -2, C-reactive protein, soluble CD40 ligand, tumor necrosis factor alpha. For further study we selected two groups: 1 group (n=27) — patients with type D and 2 group (n=35) — with non-D type. Personality type was defined with DS-14 questionnaire. Patients were asked 14 questions with 5 variants of responses to each. Counting of points was done by two scales: negative irritability and social suppression. Type D was set if 10 points and more by each of the scales. All patients underwent: general and biochemical blood tests, echocardiography, color duplex scanning of brachiocephalic arteries and coronary angiography.Results. In intergroup comparison both groups were comparable by the most anamnestic and clinical parameters. There were no any differences in the instrumental assessments data. In type D patients there was higher level of MMP-9 (resp. 53,2 pg/mL and 66,5 pg/mL; р=0,051) and sCD40L (resp. 2,8 ng/mL and 5,7 ng/mL; р=0,013) comparing with those non-D-type. The level of other biomarkers in groups did not differ, concentration of MMP-2 and TNF-α were slightly higher among type-D, of the others — among non-D-typers. There were also statistically significant negative correlations of type-D and MMP-9 and sCD40L.Conclusion. In CHD patients, examined before coronary bypass operation, presence of type D personality was not followed by the increase of subclinical inflammation markers level comparing to patients without such type. In type-D patients there was increase of platelet activation markers activation, that associates with adverse outcomes in CHD