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

Clinical and biochemical markers of coronary artery calcification progression after elective coronary artery bypass grafting

Aim. To assess the relationship of various clinical and biological markers of bone metabolism with the progression of coronary artery calcification (CAC) in patients with stable coronary artery disease (CAD) within 5 years after coronary artery bypass grafting (CABG).Material and methods. This single-center prospective observational study included 111 men with CAD who were hospitalized for elective CABG. In the preoperative period, all patients underwent duplex ultrasound of extracranial arteries (ECA) and multislice computed tomography (MSCT) to assess CAC severity using the Agatston score, as well as densitometry with determination of bone mineral density in the femoral neck, lumbar spine and T-score for them, In all participants, the following bone metabolism biomarkers were studied: calcium, phosphorus, calcitonin, osteopontin, osteocalcin, osteoprotegerin (OPG), alkaline phosphatase, parathyroid hormone. Five years after CABG, ECA duplex ultrasound, MSCT coronary angiography and bone metabolism tests were repeated. Depending on CAC progression (>100 Agatston units (AU)), patients were divided into two groups to identify significant biomarkers and clinical risk factors associated with CAC progression.Results. For 5 years after CABG, contact with 16 (14,4%) patients was not possible; however, their vital status was assessed (they were alive). Death was recorded in 4 (3,6%) cases (3 — due to myocardial infarction, 1 — due to stroke). In 18 (19,7%) cases, non-fatal endpoints were revealed: angina recurrence after CABG — 16 patients, myocardial infarction — 1 patient, emergency stenting for unstable angina — 1 patient. There were no differences in the incidence of events between the groups with and without CAC progression. According to MSCT 5 years after CABG (n=91 (81,9%)), CAC progression was detected in 60 (65,9%) patients. Multivariate analysis allowed to create a model for predicting the risk of CAC progression, which included following parameters: cathepsin K <16,75 pmol/L (p=0,003) and bone mineral density <0,95 g/cm3 according to femoral neck densitometry before CABG (p=0,016); OPG <3,58 pg/ml (p=0,016) in the postoperative period 5 years after CABG.Conclusion. Within 5 years after CABG, 65,9% of male patients with stable coronary artery disease have CAC progression, the main predictors of which are low preoperative cathepsin K level (<16,75 pmol/L) and low bone mineral density (<0,95 g/cm3) according to femoral neck densitometry, as well as a low OPG level (<3,58 pg/ml) 5 years after CABG

Socio-economic and behavioral «portrait» of patients with myocardial infarction

Aim. To identify the specifics of socioeconomic status and behavioral patterns in patients with myocardial infarction (MI) compared with the data of regional epidemiological study participants. Material and methods. The study included participants aged 35–70 years permanently residing in the Kemerovo city or Kemerovo region. The study group consisted of patients with MI (n = 60), and the comparison group consisted of clinical and epidemiological study participants (the study was conducted by the Research Institute for Complex Issues of Cardiovascular Diseases in 2015–2020 (n = 752). After matching, the study group included 28 patients; the comparison group included 428 participants. The data were collected using a questionnaire to identify the characteristics that determine the socioeconomic and behavioral «portrait» of the participants, their health status. Food Frequency Questionnaire was used to assess how often each food item was consumed over a specified period of time. International Questionnaire on Physical Activity was used to measure health-related physical activity of the subjects. Results. All participants (with MI and from the epidemiological study) display negative behavior patterns that greatly increase the risk of experiencing cardiovascular events. However, patients with MI had a higher incidence of type 2 diabetes mellitus in the medical history (p = 0.044), prior MI, peripheral arterial disease (p = 0.001); obesity was noted less frequently (p = 0.014). Patients with MI were more likely to be prescribed antihypertensive drugs (p = 0.001), at the time of the survey they were more likely to be active (p = 0.017) and passive (p = 0.001) smokers. Alcohol consumption at the time of the survey was noted more frequently in patients with MI (p = 0.040), while the majority of respondents from the general population did not consume alcohol (p = 0.038). Patients with MI were less likely to display low physical activity at work 7 days prior to hospitalization (p = 0.001). Simultaneously, patients with MI were less likely to consume cooked and seasonal vegetables, seasonal fruits (p = 0.001). Moreover, patients with MI were more likely to incorporate fatty (p = 0.003) and low-fat dairy products (p = 0.001), lean (p = 0.013) and fatty meat (p = 0.036) in their diet. Conclusion. The established patterns of behavior in patients with MI and in the general population of the Kemerovo region do not differ significantly. A large number of people residing in Russia routinely makes unhealthy lifestyle choices, however, several «pro-atherogenic» characteristics can be identified in patients with MI

Особенности клинико-анамнестических характеристик и лечения пациентов с гипертриглицеридемией: данные кузбасского регистра дислипидемий

Aim. To study the features of clinical and anamnestic characteristics and treatment of patients with hypertriglyceridemia (HTG) using the data of the lipid control center of Kemerovo.Methods. The single-center retrospective study is based on the data of patients dynamic observation (n = 100) in the Dyslipidemia Registry of Kuzbass in 2019. A comparative analysis of clinical and anamnestic characteristics, lipidogram parameters and therapy was performed at the time when the patients were included in the study and after 6–12 months in patients with HTG (the criterion was the level of triglycerides (TG) above 1.69 mmol/L) and in patients without it. Indications for consulting a lipidologist were high cholesterol (levels of total cholesterol (TC) ˃7.5 mmol/L or low-density lipoprotein cholesterol ˃4.9 mmol/L or TG˃5 mmol/L), requirement of the high dose and/or combination therapy of lipid-lowering drugs; medical history of cardiovascular diseases and/or revascularization of vascular bed in patients under 55 years of age; suspected intolerance to lipid-lowering therapy due to the developed side effects; the issue of lipid-lowering therapy in complex clinical situations.Results. Among the patients who visited a lipidologist in 2019, mixed hypertriglyceridemia was noted in 56 (56%) of cases, while 44 (44%) patients had other lipid metabolism disorders without increased levels of TG. A distinctive feature of patients with mixed hypertriglyceridemia is the lower incidence of myocardial infarctions (p = 0.029) and lower number of coronary stents (p = 0.018) in the medical history, despite the initially higher levels of TC (p = 0.005) and TG (p = 0.000). According to the results of 6–12 months observation, a significant decrease in TC (p = 0.001) and TG (p = 0.044) levels during the lipid-lowering therapy was revealed due to the addition of fenofibrate (p = 0.000) to all groups of patients who were monitored by a lipidologist.Conclusion. The patients with dyslipidemia and HTG are a complex category of patients who require combined lipid-lowering therapy, which can only be prescribed by a lipidologist. Цель. Изучить особенности клинико-анамнестических характеристик и лечения пациентов с гипертриглицеридемией (ГТГ) по данным кемеровского липидного центра.Материалы и методы. Одноцентровое ретроспективное исследование основано на динамическом наблюдении пациентов (n = 100) в рамках регистра дислипидемий Кузбасса за 2019 г. Выполнен анализ характеристик больных, липидограммы и терапии на момент включения в исследование и через 6–12 мес. в группах пациентов с ГТГ (триглицериды, ТГ) ˃1,69 ммоль/л) и без нее. Показания для направления к липидологу: подбор высокодозовой и/или комбинированной терапии липидснижающими препаратами при общем холестерине (ОХС) ˃7,5 ммоль/л, холестерине низкой плотности ˃4,9 ммоль/л или ТГ ˃5 ммоль/л; анамнез сердечно-сосудистых заболеваний и/или реваскуляризация до 55 лет; непереносимость липидснижающей терапии; лечение в сложных клинических ситуациях.Результаты. У 56 (56%) пациентов лабораторно зарегистрирована смешанная ГТГ, тогда как у 44 (44%) отмечены другие нарушения липидного обмена. Отличительная особенность при ГТГ – меньшее число инфарктов миокарда (р = 0,029) и коронарных стентирований (р = 0,018) в анамнезе при исходно высоких значениях ОХС (р = 0,005) и ТГ (р = 0,000). По результатам 6–12 мес. наблюдения липидологом на фоне лечения отмечено значимое снижение ОХС (р = 0,001) и ТГ (р = 0,044), в том числе за счет присоединения к терапии фенофибрата (р = 0,000).Заключение. Пациенты с дислипидемиями и ГТГ – сложная коморбидная категория, нуждающаяся в комбинированной липидснижающей терапии, которая может быть эффективно назначена только в условиях специализированного приема.

Абдоминальное ожирение и 10-летний прогноз пациентов с инфарктом миокарда

Aim. To assess the relationship of abdominal obesity with left ventricular systolic function and to predict outcomes in patients with MI within 10 years.Methods. 581 medical records of patients enrolled in the Acute coronary Syndrome Registry between 2008 and 2010 were retrospectively reviewed for the period of 10 years. The following clinical endpoints were collected: all-cause mortality, cardiovascular mortality, recurrent myocardial infarction, stroke, hospitalization due to unstable angina and decompensated heart failure. Baseline left ventricular ejection fraction (LVEF) and the presence of abdominal obesity measured as waist-to-hip ratio were collected in all patients.Results. Abdominal obesity was found in 392 (67.4%) patients admitted with MI. The presence of abdominal obesity did not affect main outcomes within 10 years after the indexed event. Cardiovascular mortality was the lowest among patients with abdominal obesity., an association between abdominal obesity and low cardiovascular mortality was found in patients with intermediate LVEF using the risk stratification data based on the severity of systolic dysfunction at discharge. The highest rate of recurrent hospitalization due to unstable angina was found in patients with abdominal obesity and intermediate LVEF.Conclusion. The prevalence of abdominal obesity in MI patients was high (67%). Abdominal obesity appeared to confer protective effects on the 10-year clinical outcomes in patients with low and intermediate LVEF based on all-cause and cardiovascular mortality. The waist-to-hip ratio were significant in the generation of 10-year allcause and cardiovascular disease mortality prediction models in patients with MI.Цель. Оценить связь абдоминального ожирения (АО) и показателей систолической функции миокарда левого желудочка с прогнозом пациентов в течение 10 лет после перенесенного инфаркта миокарда (ИМ).Материалы и методы. Дизайн исследования основан на ретроспективном анализе десятилетнего наблюдения пациентов по данным регистра острого коронарного синдрома Кемерова 2008-2010 гг. (n = 581). У больных в течение 10 лет наблюдения после ИМ оценены конечные точки - смерть от всех причин, кардиоваскулярная смерть, повторный инфаркт миокарда, инсульт, госпитализация по поводу нестабильной стенокардии и декомпенсации хронической сердечной недостаточности - с учетом исходного значения фракции выброса левого желудочка (ФВ ЛЖ) и наличия АО (оценено по индексу отношения окружности талии к окружности бедер, ОТ/ОБ).Результаты. Абдоминальное ожирение, выявленное у 392 (67,4%) пациентов, госпитализированных с ИМ, не оказывало негативного влияния на основные исходы заболевания в течение 10 лет. При этом среди пациентов с АО отмечены минимальные показатели кардиоваскулярной смерти. Стратификация пациентов по тяжести систолической дисфункции, оцененной при выписке пациентов из стационара, показала связь АО с низкой частотой кардиоваскулярной смертности у пациентов с промежуточными показателями ФВ ЛЖ. Одновременно у больных с АО и промежуточными значениями ФВ ЛЖ зарегистрирован максимальный уровень повторных госпитализаций по поводу нестабильной стенокардии.Заключение. Выявлена высокая (67%) распространенность абдоминального типа ожирения у пациентов с ИМ, при этом АО оказывает протективное действие в отношении сердечно-сосудистой смертности у пациентов при промежуточном снижении систолической функции миокарда. Показатели индекса ОТ/ОБ имеют отдельное значение при формировании моделей 10-летнего прогноза общей и кардиоваскулярной смерти у пациентов после ИМ

Динамика остеопенического синдрома у пациентов с ишемической болезнью сердца после коронарного шунтирования

Aim. To determine the most significant predictors of an unfavorable progress of osteoporosis (OP) in men with coronary artery disease after coronary artery bypass grafting (CABG) according to long-term (5 years) follow-up data.Methods. The prospective study included 393 patients (men) hospitalized for CABG. All patients underwent multispiral computed tomography of the coronary and carotid arteries to assess the calcium score (CS) and determine the equivalent density of calcium deposits (EDCD), coronary angiography, and dual-energy X-ray absorptiometry. After 5 years (average 59 months) of follow-up, the prognosis (status alive/dead) was assessed in 335 patients. Mortality during follow-up in patients after CABG was 10.7% (36 patients died). 257 patients underwent repeated osteodensitometry, quantitative assessment of coronary and carotid calcification, assessment of the “end points” of bone status (osteoporotic fractures, osteoporosis).Results. During the five-year follow-up an increase in the prevalence of OP was noted from 76.1% to 90.7%, while in 43.6% of cases, the progression of OP was recorded. Fractures occurred in 39 patients (15.2%), and in 34 (13.2%) osteoporosis developed for the first time. OP progression is associated with smoking (OR 5.3, 95% CI 3.1–9.4), 30% or more carotid artery stenosis (OR 5.6, 95% CI 2.9–10.7), baseline severe (more than 400) calcification of the coronary arteries (OR 2.7 at 95% CI 1.3–9.8), low density of (EDCD less than 0.19 g/mm3 ) coronary (OR 1.7 at 95% CI 1.1–8.2) and carotid (OR 2.4, 95% CI 1.4–10.3) calcium deposits. Linear regression analysis made it possible to establish that the reliable predictors of an unfavorable course of OP are coronary CS, EDCD of the carotid arteries, and the absence of statin therapy.Conclusion. OP progression in patients in the long-term period (5 years) after CABG was noted in 43.6%. The predictors of OP progression and the complications are a high level of coronary artery calcification, a low EDCD in the carotid arteries, and 30% or more stenosis of the carotid arteries. Patients receiving statins were associated with a lower risk of osteoporosis. Цель. Определение наиболее значимых предикторов неблагоприятного течения остеопенического синдрома (ОС) у мужчин с ишемической болезнью сердца после коронарного шунтирования (КШ) по данным длительного (5 лет) наблюдения.Материалы и методы. В проспективное исследование включены 393 пациента (мужчины), госпитализированные для проведения КШ. Всем больным выполнены мультиспиральная компьютерная томография коронарных и сонных артерий для оценки кальциевого индекса и определения эквивалентной плотности кальциевых депозитов (ЭПКД), коронарография, остеоденситометрия. Через 5 лет наблюдения у 335 пациентов оценили прогноз (статус «жив/умер»). Средняя длительность периода наблюдения составила 59 мес. Летальность за время наблюдения больных после КШ составила 10,7% (n = 36). 257 пациентам повторно проведены остеоденситометрия, количественная оценка коронарного и каротидного кальциноза, а также оценка «конечных точек» костного статуса (низкоэнергетические переломы, остеопороз).Результаты. В долгосрочном пятилетнем периоде наблюдения отмечено нарастание распространенности ОС с 76,1 до 90,7%, при этом в 43,6% случаев регистрировали прогрессирование OC. У 39 (15,2%) пациентов возникли переломы, у 34 (13,2%) – впервые развился остеопороз. Прогрессирующее течение ОС ассоциируется с курением (отношение шансов (ОШ) 5,3; 95% доверительный интервал (ДИ) 3,1–9,4), стенозами сонных артерий от 30% и более (ОШ 5,6; 95% ДИ 2,9–10,7), исходно выраженным (более 400 баллов) кальцинозом коронарных артерий (ОШ 2,7; 95% ДИ 1,3–9,8), низкой плотностью (ЭПКД менее 0,19 г/мм3 ) коронарных (ОШ 1,7; 95% ДИ 1,1–8,2) и каротидных (ОШ 2,4; 95% ДИ 1,4–10,3) кальциевых депозитов. Линейный регрессионный анализ позволил установить, что достоверными предикторами неблагоприятного течения ОС являются кальциевый индекс коронарных артерий, ЭПКД сонных артерий, отсутствие терапии статинами.Заключение. Прогрессирующее течение OC у пациентов в отдаленном периоде (5 лет) КШ отмечено в 43,6% случаев. Предикторами неблагоприятного течения ОС и возникновения его осложнений выступают высокий уровень кальциноза коронарных артерий, низкая ЭПКД сонных артерий и стенозы сонных артерий от 30% и более. Также отмечено положительное воздействие регулярного приема статинов на костный статус больных

Лечение смешанной гипертриглицеридемии в условиях липидного центра (клинический случай)

Lipid metabolism disorders remain a significant medical and social problem associated with mortality, disability, morbidity and pathologies of the circulatory system. According to international and Russian epidemiological studies, hypertriglyceridemia is a common risk factor for coronary heart disease. Isolated use of non-pharmacological therapy and statin monotherapy is not effective enough, and therefore it is necessary to propagate the experience of combined treatment, supported by modern recommendations. This work shows the possibilities of effective use of combined therapy of lipid metabolism disorders (statin, ezetimibe, alirocumab, fenofibrate) in patients with mixed hypertriglyceridemia.Нарушения липидного обмена остаются значимой медико-социальной проблемой, ассоциирующейся с высокими показателями смертности, инвалидизации и заболеваемости патологиями системы кровообращения. По данным международных и российских эпидемиологических исследований, гипертриглицеридемия представляет собой распространенный фактор сердечно-сосудистого риска в отношении развития различных форм ишемической болезни сердца. Изолированное применение методов немедикаментозной коррекции и монотерапии статинами недостаточно эффективно, в связи с чем необходима трансляция опыта комбинированного лечения, активно поддерживаемого в современных рекомендациях. В настоящей работе продемонстрирован успешный случай применения комбинированной терапии нарушений липидного обмена (статин, эзетимиб, алирокумаб, фенофибрат) пациентке со смешанной формой гипертриглицеридемии

Impact of recipient-related factors on structural dysfunction of xenoaortic bioprosthetic heart valves

Olga Barbarash, Natalya Rutkovskaya, Oksana Hryachkova, Olga Gruzdeva, Evgenya Uchasova, Anastasia Ponasenko, Natalya Kondyukova, Yuri Odarenko, Leonid Barbarash Federal State Budgetary Scientific Institution Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia Objective: To analyze the influence of recipient-related metabolic factors on the rate of structural dysfunction caused by the calcification of xenoaortic bioprostheses. Materials and methods: We retrospectively analyzed clinical status, calcium–phosphorus metabolism, and nonspecific markers of inflammatory response in bioprosthetic mitral valve recipients with calcific degeneration confirmed by histological and electron microscopic studies (group 1, n=22), and in those without degeneration (group 2, n=48). Results: Patients with confirmed calcification of bioprostheses were more likely to have a severe clinical state (functional class IV in 36% in group 1 versus 15% in group 2, P=0.03) and a longer cardiopulmonary bypass period (112.8±18.8 minutes in group 1 versus 97.2±23.6 minutes in group 2, P=0.02) during primary surgery. Patients in group 1 demonstrated moderate hypovitaminosis D (median 34.0, interquartile range [21.0; 49.4] vs 40 [27.2; 54.0] pmol/L, P>0.05), osteoprotegerin deficiency (82.5 [44.2; 115.4] vs 113.5 [65.7; 191.3] pg/mL, P>0.05) and osteopontin deficiency (4.5 [3.3; 7.7] vs 5.2 [4.1; 7.2] ng/mL, P>0.05), and significantly reduced bone-specific alkaline phosphatase isoenzyme (17.1 [12.2; 21.4] vs 22.3 [15.5; 30.5] U/L, P=0.01) and interleukin-8 levels (9.74 [9.19; 10.09] pg/mL vs 13.17 [9.72; 23.1] pg/mL, P=0.045) compared with group 2, with an overall increase in serum levels of proinflammatory markers. Conclusion: Possible predictors of the rate of calcific degeneration of bioprostheses include the degree of decompensated heart failure, the duration and invasiveness of surgery, and the characteristics of calcium–phosphorus homeostasis in the recipient, defined by bone resorption and local and systemic inflammation. The results confirm the hypothesis that cell-mediated regulation of pathological calcification is caused by dysregulation of metabolic processes, which are in turn controlled by proinflammatory signals. Keywords: bioprostheses, calcium–phosphorus metabolism, inflammation, calcificatio

ROLE OF THE SERUM NGAL FOR ASSESSMENT OF HOSPITAL PROGNOSIS IN MEN WITH ST ELEVATION MYOCARDIAL INFARCTION

Aim. To evaluate clinical significance of serum NGAL in ST elevation myocardial infarction (STEMI) patients in relation with the occurrence of in-hospital period complications.Material and methods. Totally 260 men included with STEMI, hospitalized in 24 hours after the onset of clinical symptoms of the disease. The measurement of serum NGAL concentration (ng/ml, sNGAL) at 1st and 2nd day of hospitalization was done with the hard-phase immune-enzyme analysis by Hycult® biotech assay (USA), registration was done on the plain reader “UNIPLAN” (SPF “PIKON”, Russia). At the stage of in-hospital treatment we registrated endpoints — signs of coronary failure (early post infarction angina, recurrent MI), grade of acute coronary failure (Killip I-IV class), grade of chronic heart failure (by NYHA), hospital mortality.Results. Patients were selected into 2 groups depending on the endpoints occurrence at hospital stage. Adverse hospital outcome (at least one endpoint) was found in 83 (32%) patients. The level of renal damage sNGAL, measured on the 1st day did not reveal any difference between groups with adverse or benign course of MI in hospital, and on 12th day the sNGAL concentration was significantly higher in group with adverse course — 2,1 ng/ml (1,44; 2,8) vs 1,55 ng/ml (1,11; 2,3), p=0,033. Monofactor analysis showed significance for adverse outcome, the factors as 2nd type diabetes, age >60 y., the fact of glomerular filtration rate decline during hospitalization, increase of sNGAL by 12th day. By the result of multifactor analysis — increase of the age by 1 year increases the chance of adverse outcome by 14%, increase of sNGAL by 12th day of MI increases adverse outcome chance by 3,2 times. the level of sNGAL ≥1,046 ng/ml associated with complicated course of in-hospital MI period.Conclusion. The level of sNGAL, measured on 1st day of MI did not have prognostic value for the inhospital complications, however concentration of sNGAL on 12th day was associated with already occured adverse outcomes, being a marker of MI severity