Structural-electrical remodeling of myocardium in neurological deficits in patients with ischemic stroke: is there a connection?

Abstract Funding Acknowledgements Type of funding sources: None. Theoretical and clinical questions of the correlation between structural-electrical remodeling of the heart and the severity of neurological deficits at stroke have not been developed or remain controversial so far.  Available data in the literature suggests the key role of structural myocardial disorders mainly in hemorrhagic stroke, and cardiocerebral syndrome is considered only from the standpoint of cardioembolic stroke. The aim of the study.  To study the peculiarities of structural-electrical remodeling of myocardium with severity of neurological deficit in patients with ischemic stroke. Materials and methods.  111 patients with ischemic stroke in the left hemisphere and 75 patients in the right brain hemisphere were examined. The average age was 56.7 ± 5.58 years. All subjects underwent an ultrasound examination of the heart using the ALOKA SSD 5000 apparatus (Japan) and the QT dispersion using the Polyspectro-8EX apparatus (Russia). Duration of QT dispersion interval more than 50 ms was considered pathological. Research results.  Structural remodeling of the heart in patients with ischemic stroke was manifested by the prevalence of high values of the finite-systolic volume of the left ventricle in comparison with patients without stroke (45.8 ± 21.0 vs. 37.7 ± 16.9 ml; p &amp;lt; 0.05), and the finite-diastolic volume of the left ventricle (114.3 ± 38.5 vs. 100.9 ± 35.3 ml; p &amp;lt; 0.05), mainly in the right hemispheric localization of the stroke. Hypertrophy of the ventricular septum (11.3 ± 2.1 and 11.1 ± 2.2) and the posterior wall of the left ventricle (10.4 ± 1.8 and 10.3 ± 2.1 mm) was observed irrespective of the localization of the stroke, which was higher in comparison with patients without stroke (9.4 ± 1.5 mm). Violations of repolarization processes and their severity were characterized by higher values of duration of the corrected QT interval in patients with structural changes of myocardium in comparison with the patients without structural remodeling (0,46 ± 0,03 and 0,44 ± 0,02 sec; p = 0,025).  The conjugation of the severity of the neurological deficit (7 and more points on the NIHSS scale) was associated with the terminal-systolic size of the LV (p = 0.025) and myocardial hypertrophy (11.3 ± 1.86 vs. 10.96 ± 1.8 mm; p = 0.04) in comparison with patients with a neurological deficit of less than 7 points (31.7 ± 3.6 vs. 30.68 ± 3.86 mm; p &amp;lt; 0.025).  The severity of the neurological deficit according to the Goldstein criteria correlated with higher values of the corrected (56.0 ± 23.93 vs. 41.6 ± 23.3 ms.; p = 0.043) and normalized QT (17.5 ± 6.533 vs. 12.8 ± 6.7 ms.; p = 0.019) values in comparison with the lower neurological deficit. A similar relationship was revealed by the Brott criteria. Conclusions.  Thus, the direct connection between structural-electrical remodeling of the heart and neurological deficit revealed in the course of the study reflects the cardiocerebral relationships in ischemic stroke. </jats:sec

Electric myocardial inhomogeneity and stroke: connection and specifics

Abstract Funding Acknowledgements Type of funding sources: None. Background. The inconsistency of the literature data on the influence of different hemispheric localization of Cerebrovascular accident (CVA) on the development of cardiac arrhythmias suggests the expediency of further study of the so-called "zones" of the cerebral cortex associated with electrical instability of the myocardium.  It is known that dispersion of QT interval and fragmented myocardial activity belong to the markers of electrical instability of the heart and are associated with arrhythmogenesis.  The aim of the study.  To study the severity of abnormalities of the parameters of electrical instability of myocardium in right and left hemispheric stroke localization in patients with hypertension. Material and methods. 111 patients with left hemispheric localization of ischemic stroke and 75 patients with right hemispheric stroke were examined. Hemorrhagic stroke was observed in 17 patients in the left hemisphere and in 13 patients in the right hemisphere. The average age was 58,2 ± 7,48 years. For all strokes, men prevailed (64% vs. 36%). For the first day of the stroke, all patients were evaluated for QT dispersion and fragmented myocardial activity on the device "Polyspectro-8EX" (Russia).  Research results.  Evaluation of the parameters of electrical instability of myocardium in patients with stroke revealed more pronounced disorders in hemorrhagic stroke of left hemispheric localization (Table 1). In ischemic stroke, the severity of electrophysiological parameters, reflecting the instability of the myocardium depending on the hemispheric localization, indicates the absence of differences.  Conclusions.  1.The most pronounced disturbances in the parameters of electrical stability of the myocardium is observed in hemorrhagic stroke.  2.The severity of myocardial electrical instability in ischemic stroke is not associated with the localization of the focus. </jats:sec

Spontaneous platelet aggregation in patients with chronic heart failure with arterial hypertension

Abstract Funding Acknowledgements Type of funding sources: None. Aim of study. To study spontaneous platelet aggregation in patients with arterial hypertension with different functional classes (FC) of CHF with preserved systolic function not taking antiplatelet therapy. Material and Methods 51 patients with AH with different types of CHF, mean age 55.4 ± 5.9 years, with preserved left ventricular systolic function according to ECHO-CS were studied. The patients were divided into 4 groups depending on FC of CHF: Group 1 - 0 FC of CHF (n = 11), Group 2 - 1 FC of CHF (n = 13), Group 3 - 2 FC of CHF (n = 14), and Group 4 - 3 FC of CHF (n = 13). Spontaneous platelet aggregation was determined on a KFK-2MP photoelectrocolorimeter (Russia). Results. During the study, the spontaneous platelet aggregation was 1.08 ± 0.31 in patients with CHF class 0 (1 gr), and 1.22 ± 0.25 in patients with CHF class 1, with no statistical difference in comparison with 1 gr (p = 0.233). In group 3 (2FC CHF), spontaneous platelet aggregation was 1.33 ± 0.27, with a statistically significant difference with spontaneous platelet aggregation in patients with type 0 (p = 0.042), but with group 2 (1FC CHF), no statistically significant difference was found (p = 0.281). Spontaneous platelet aggregation in group 4 (3FC CHF) was 1,62 + 0,32, with statistically significant difference in comparison with all groups, so with group 1 - p &amp;lt; 0,001, with group 2 - p = 0,016 and with group 3 - p = 0,017. Conclusion. Patients with arterial hypertension with preserved systolic function showed an increase in spontaneous platelet aggregation with increasing functional class of CHF, and the most significant increase in platelet aggregation was seen in patients with class 3 CHF. </jats:sec

Relationship of myocardial fibrosis markers with cardiac structural and functional parameters in patients with post-myocardial

Abstract Funding Acknowledgements Type of funding sources: None. Background. In recent years much attention has been paid to cardiac remodelling processes. Many studies provide convincing evidence for the role of aldosterone and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) in the processes of structural changes in the heart and vessels, which is of particular importance in cardiovascular remodeling in patients with hypertension, acute myocardial infarction, postinfarction cardiosclerosis and chronic heart failure. Aim of the study. To investigate the association of myocardial fibrosis markers (TIMP-1 and aldosterone) with cardiac structural and functional parameters. Methods and materials. We examined 40 patients with an average age of 56.4 ± 4.8 years who had had myocardial infarction more than 1 year before (mean 2.2 ± 0.8 years before). Plasma aldosterone concentration was determined using enzyme immunoassay using a DRG (Germany) EIA-4128 reagent kit. The reference values are 40-310 pg/ml. Tissue inhibitor of matrix metalloproteinase-1 concentrations were measured using DSL kits (USA). The reference values were 92-116 ng/ml. All patients underwent echocardiography to assess the structural and functional parameters of the heart. Correlation analysis with Pearson or Spearman correlation coefficient calculation was used to determine the relationships between quantitative parameters. Differences were considered statistically significant if the probability of their absolutely random nature did not exceed 5% (p &amp;lt; 0.05). Results. During the study, TIMP-1 concentration had a direct statistically significant medium correlation with LV end-diastolic size (r = 0.39, p = 0.012). The analysis also revealed significant correlations of TIMP-1 concentration with LV end-diastolic size (r = 0.33, p = 0.037), with LV end-systolic volume (r = 0.41, p = 0.009), with LV myocardial mass (r = 0.48, p = 0.008), with LV ejection fraction (r=-0.36, p = 0.024). No statistically significant correlations were found with other structural and functional left ventricular indices during the study. Statistical correlation analysis of the relationship between plasma concentration of aldosterone and structural-functional parameters of the left ventricle (according to the results of echocardiography), statistically significant correlations with ejection fraction (r = 0.39, p = 0.035), LV myocardial mass (r = 0.60, p = 0.001), LV myocardial mass index (r = 0.51, p = 0.004), LV interventricular septal thickness (r = 0.45, p = 0.007) were found. No statistically significant correlations with plasma aldosterone concentration were found with the other left ventricular structural and functional indices during the study. Conclusions. The concentrations of aldosterone and tissue inhibitor of matrix metalloproteinase-1 have links with many structural and functional parameters of the heart, which confirms their importance in the structural rearrangement (remodelling) of the cardiovascular system in patients after myocardial infarction. </jats:sec

Relationship of myocardial fibrosis markers with glomerular filtration rate in patients with arterial hypertension

Abstract Funding Acknowledgements Type of funding sources: None. Background. Renal damage in arterial hypertension is considered among the typical damage variants of target organs such as heart, blood vessels and brain. One of the complications of arterial hypertension is nephrosclerosis. Developing quite gradually, arterial hypertension kidney damage goes unnoticed for a long time because clinically it does not cause the patient any discomfort. The most accessible and objective way to assess renal function is to calculate glomerular filtration rate (GFR). Tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) is a protein that is a natural inhibitor of metalloproteinases and forms complexes with matrix metalloproteinase-1 and other metalloproteinases, irreversibly inhibiting their activity. Many studies have demonstrated that TIMP-1 can be considered a serum marker of myocardial and vascular fibrosis Aim of the study. To assess the relationship between GFR and plasma TIMP-1 concentration in patients with arterial hypertension. Materials and Methods. 144 patients (87 men, 67 women) with arterial hypertension with preserved systolic function were examined, mean age was 52.45 ± 4.81 years, duration of AH was 4.82 ± 2.63 years. Calculation of GFR was carried out using the MDRD formula. Tissue matrix metalloproteinase-1 inhibitor concentrations were measured with DSL kit (USA). The reference values were 92-116 ng/ml. The patients were divided into 3 groups depending on GFR: group 1 - GFR over 90 ml/min/1.73m2 (n = 59), group 2 - GFR 60-90 ml/min/1.73m2 (n = 63), group 3 - GFR under 60 ml/min/1.73m2 (n = 22). Results. The highest level of TIMP-1 (481.9 ± 106.4 ng/ml) was found in Group 3 patients (GFR &amp;lt;60 ml/min/1.73m2). The level of TIMP-1 in Group 3 was statistically significantly higher than in patients of Group 1 (p &amp;lt; 0.0001) and Group 2 (p &amp;lt; 0.0001). In group 2 (GFR 60-90 ml/min/1.73m2) the level of TIMP-1 (330.5 ± 108.3 ng/ml) was higher than in group 1 (297.6 ± 104.9 ng/ml), but the difference was not statistically significant (p = 0.091). The correlation analysis revealed a negative association of plasma TIMP-1 level and GFR in patients with arterial hypertension, i.e. the higher TIMP-1, the lower glomerular filtration rate (r=-0.37, p = 0.0001). Conclusions. The increased concentration of TIMP-1 in the blood of patients with arterial hypertension is evidence of increasing fibrosis in the heart and vessels, leading to the emergence and progression of renal dysfunction. </jats:sec

Left ventricle structure and function relations with the levels of plasma markers of fibrosis in hypertensive patients with NonSTEMI

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. The myocardial fibrosis lies in the basis of left ventricle remodelling in patients with hypertension. Cardiomyocites hypertrophy, fibroblasts proliferation, enlargement of interstitial collagen volume and their ratio disorders may increase severity of stroke and myocardial infarction. Purpose. The purpose of the study is to evaluate relations between the plasma levels of myocardium fibrosis markers and left ventricle remodelling, systolic and diastolic function in hypertensive patients with NonSTEMI. Methods. Were examined 138 hypertensive patients (both men and women) with NonSTEMI. The mean age of patients was 51.2 (11.2) years. Patients with arrhythmias and conduction abnormalities, diabetes mellitus and autoimmune diseases were excluded form the study. In all patients was performed ECG in 12 standard leads; EchoCG (according to ASE/EACVI 2015 recommendations); evaluation plasma levels of tissue inhibitor of metalloproteinases-1 (TIMP-1) and insulin-like growth factor 1 (IGF-1). HF NYHA functional class was determined by performing 6MWT. Statistical significance was defined at the level of methods for p &amp;lt; 0,05. Results. The averaged levels for plasma markers of myocardium fibrosis were: TIMP-1 - 322.0 (250.0; 483.5) ng/mL; IGF-1 - 160.0 (141.0; 175.0) ng/mL. Results of correlative analysis revealed relations between IGF-1 and ILV mass (R=-0.59; p &amp;lt; 0.001), and weak correlation between IGF-1 and E/e" averaged (R=-0.19; p = 0.027) (Picture 1). These negative correlations may be explained by the growth in both fibroblasts and collagen production in myocardium. Also there were positive correlations between TIMP-1 and ILV mass (R = 0.63; p &amp;lt; 0.001) and TIMP-1 and E/e" average (R = 0.37; p &amp;lt; 0.001) (Picture 1) which may be due to an increase of myocardial stiffness as the result of fibrosis activity. The results of the comparison of TIMP-1 and ICF-1 plasma levels, structural and functional parameters of the LV in groups of patients with different types of LV geometry can be seen in Table 1. Conclusion. Thus, the results of the study show that plasma markers of fibrosis  was significantly higher in patients with concentric and eccentric LV hypertrophy which may reflects the higher levels of myocardium stiffness. Abstract Table 1.  Abstract Figure. Picture 1. </jats:sec