Serum levels of NT- pro ANP, BNP, NT-pro BNP and function of the left atrium in patients with heart failure and preserved ejection fraction after myocardial infarction

The objective of our study was to evaluate the levels of natriuretic peptides in patients (pts) with heart failure with preserved ejection fraction (HFpEF) in 12 month after ST elevation myocardial infarction (STEMI) with a focus on the function of left atrium (LA) and left ventricular (LV) filling pressure. 55 pts were included in the study. 6-minute walk test was performed. Echo exam was performed by the diagnostic system VIVID 7. BNP in whole blood was determined using the Triage ® Meter BNP test. The serum levels of NT-pro BNP, NT-pro ANP («Biomedica», Austria) were determined in blood samples by enzyme-linked immune-sorbent assay (ELISA). LA volume index were differences (16.03±3.39 ml/m2; 25.36±8.26 ml/m2; 29.41±9.46 ml/m2 accordingly I, II, III class) depending on severity of HF. Well as E/E’ ratio were differences (7.5±1.4; 9.8±5.1; 13.5±7.6 accordingly I, II, III class) depending on severity of HF. The LA volume index correlated with levels of NT-pro ANP (R=0.29; p=0.04), levels of NT-pro BNP (R=0.37; p=0.01), levels of BNP (R=0.51; p=0.0001). The LV filling pressure correlated with levels of NT-pro ANP (R=0.45; p=0.002), levels of NT-pro BNP (R=0.49; p=0.001), levels of BNP (R=0.37; p=0.01)

Histopathologic, Immunohistochemical Features and Profile of Viral Antigens in Patients with Myocarditis

We studied medical records and endomyocardial biopsies of patients with morphological confirmed lymphocytic myocarditis. The patients were divided into two groups: 1 - patients with arrhythmias; group 2 - patients with predominance syndrome heart failure. Morphological verification of myocarditis was based on World Heart Federation Consensus definition of Inflammatory Cardiomyopathy, 1997. Immunohistological study was performed to identify antigens of cardiotrophic viruses. We revealed some features in topic and character of morphological changes in depending on clinical scenario of myocarditis. In patients with chronic heart failure due to myocarditis revealed a high incidence of expression of LMP-antigen Epstein-Barr virus, the lack of expression of adenovirus antigens. Arrhythmic presentation of myocarditis was characterized by a high frequency of expression of enteroviral VP-1 antigen and the type 1 antigen herpes virus. We were not detected expression of the VP-2 antigen parvovirus B19. As a result the most severe inflammatory changes and interstitial fibrosis of intraventricular septum, widespread damage of myocytes the severe myocardial remodeling was found in patients with presentation of myocarditis by chronic heart failure. Interstitial fibrosis of the outflow tracts of the right ventricle, the low activity of inflammation and mild fibrotic changes were feature of arrhythmic scenario of myocarditis.</jats:p

Oncology disease in patients with acute myocardial infarction with nonobstructive coronary atherosclerosis

The aim of this study was to evaluate the cancer incidence among patients with myocardia

Intraobserver reproducibility of parameters of standard and 2D speckle tracking echocardiography, dynamics of global longitudinal strain I in patients with acute primary anterior STEMI

The aim of this study was to assess the intraobserver reproducibility of parameters of standard and 2 dimensional speckle tracking echocardiography, dynamics of global longitudinal strain in patients with acute primary anterior STEMI. The study included 24 patients, mean age 58.46±10.2. Echocardiography with 2D speckle tracking imaging was performed on the 1st (T1), 7th (T2), 14th days (T3) after STEMI («Vivid E9»). Analysis of echocardiographic images was performed offline at the different periods by the two independent observers (EchoPac) – experienced and inexperienced. In order to assess the agreement between standard and 2D speckle tracking echocardiography, a correlation analysis (Pearson correlation, Spearman’s rank correlation coefficient) and Bland-Altman analysis were undertaken. The 23 patients had urgent reperfusion therapy, 6 patients underwent primary PCI, 16 patients – PCI after successful fibrinolysis (68%). GLS and WMSI had the best intraobsever reproducibility. Dynamics of EDV LV, ESV LV, EF LV was without significant differences. Nevertheless, it was found positive dynamic of GLS: – 12.65±3.53 (T1), -13.61±3.81 (T2), –14.27±4.1 (T3), p<0.05. GLS reduced 11.35% (p=0.0048) from T1 to T3. The best intraobserver reproducibility of parameters of 2 D speckle-tracking and standard echocardiography was revealed in GLS and WMSI. The modern management of STEMI patients limits adverse postinfarction remodeling and preserves of global left ventricular contractility detected by the EF LV. However, GLS had the positive dynamics and improved to the 14th day

Long-term clinical results of autologous bone marrow CD 133+ cell transplantation in patients with ST-elevation myocardial infarction

The aim of the study was investigate the long-term results of autologous bone marrow CD 133+ cell transplantation in patients with primary ST-Elevation Myocardial Infarction (STEMI). Methods and results: From 2006 to 2007, 26 patients with primary STEMI were included in an open randomized study. Patients were randomized to two groups: 1st - included patients underwent PCI and transplantation of autologous bone marrow CD 133+ cell (n = 10); 2nd - patients with only PCI (n = 16). Follow-up study was performed 7.70±0.42 years after STEMI and consisted in physical examination, 6-min walking test, Echo exam. Total and cardiovascular mortality in group 1 was lower (20% (n = 2) vs. 44% (n = 7), p = 0.1 and 22% (n = 2) vs. 25% (n = 4), (p=0.53), respectively). Analysis of cardiac volumetric parameters shows significant differences between groups: EDV of 100.7 ± 50.2 mL vs. 144.40±42.7 mL, ESV of 56.3 ± 37.8 mL vs. 89.7 ± 38.7 mL in 1st and 2nd groups, respectively. Data of the study showed positive effects of autologous bone marrow CD 133+ cell transplantation on the long-term survival of patients and structural status of the heart

Macrophage activation and polarization in post-infarction cardiac remodeling

Adverse cardiac remodeling leads to impaired ventricular function and heart failure, remaining a major cause of mortality and morbidity in patients with acute myocardial infarction. It have been shown that, even if all the recommended therapies for ST-segment elevation myocardial infarction are performed, one third of patients undergoes progressive cardiac remodeling that represents morphological basis for following heart failure. The need to extend our knowledge about factors leading to different clinical scenarios of myocardial infarction and following complications has resulted in a research of immuno-inflammatory pathways and molecular activities as the basis for post-infarction remodeling. Recently, macrophages (cells of the innate immune system) have become a subject of scientific interest under both normal and pathological conditions. Macrophages, besides their role in host protection and tissue homeostasis, play an important role in pathophysiological processes induced by myocardial infarction. In this article we summarize data about the function of monocytes and macrophages plasticity in myocardial infarction and outline potential role of these cells as effective targets to control processes of inflammation, cardiac remodeling and healing following acute coronary event

The role of viruses, inflammation and myocardial macrophages in the development of idiopathic arrhythmia

We studied viral antigens, inflammation, and macrophages in the endomyocardial biopsies of patients with idiopathic arrhythmias. Immunohistological study was performed to identify the antigens of cardiotropic viruses and the types of lymphocytes and macrophages. We observed the presence of viral antigens in the myocardium of patients with and without histological criteria of myocarditis. Heart failure and ventricular arrhythmias were associated with small focal infiltration of the myocardium with macrophages. The presence of viral antigens in the myocardium was associated with fewer number of myocardial M2 macrophages. Severity of myocardial interstitial fibrosis correlated with small-focal infiltration of M2 macrophages

НЕКОТОРЫЕ АСПЕКТЫ АОРТОКОРОНАРНОГО ШУНТИРОВАНИЯ ПРИ ИНФАРКТЕ МИОКАРДА БЕЗ ПОДЪЕМА ST

HighlightsThe frequency of coronary artery bypass grafting in patients with non-ST-elevation myocardial infarction (NonSTEMI) in the Research Institute of Cardiology “Tomsk National Research Medical Center of the Russian Academy of Sciences” is equal to 10%, hospital mortality is 4.3%, which corresponds to the literature data. Patients with NonSTEMI who undergo coronary artery bypass grafting in cardiac surgery centers in Tomsk, Kemerovo and Chelyabinsk do not differ in main clinical and anamnestic characteristics. Patients with NonSTEMI who undergo CABG in cardiac surgery centers in Leipzig and Kiel (Germany), have a higher surgical risk compared with patients in Russian centers, while they are operated on much earlier than in Russian centers, and there are no statistically significant differences in hospital mortality between clinics. AbstractAim. To perform a comparative analysis of clinical and anamnestic characteristics and treatment outcomes in NonSTEMI patients who underwent CABG in 2020 at the Research Institute of Cardiology “Tomsk National Research Medical Center of the Russian Academy of Sciences” and in other domestic and foreign clinics.Methods. The retrospective study involved 23 NonSTEMI patients/ The patients clinical and anamnestic characteristics after CABG and the main outcome of treatment were analyzed. The obtained results were compared with the data of 4 other cardiac surgery clinics that were found in the literature.Results. The frequency of CABG in NonSTEMI patients is 10%, which corresponds to the literature data. The mean age of these patients was 64.8±8.4 years, LVEF – 55.5±9.2%, the risk according to the GRACE score – 4.9±5.6%, according to the EuroSCORE – 7.3±2.1%. There were no patients with cardiogenic shock or dialysis. The duration of hospitalization prior to surgery was 7.4±5.3 days. The hospital mortality was 4.3%. The clinical and anamnestic characteristics of NonSTEMI patients who underwent CABG surgery in the clinics of Tomsk, Kemerovo (n = 66), Chelyabinsk (n = 101), Leipzig (n = 758) and Kiel (n = 461) were compared. The characteristics of patients of the Russian clinics did not differ. It was found that in Russian clinics these patients were younger, and had less severe complications of the disease, and less severe comorbid diseases in comparison with patients of the German clinics. In particular, in the Russian clinics, CABG was not performed in patients with cardiogenic shock, unlike in the German clinics. At the same time, the German clinics conduct surgery on NonSTEMI patients much earlier than in the Russian clinics: only 10–20% of patients are operated on in the Russian clinics in the first 3 days of the disease, whereas in Leipzig – 42% of patients, and in Kiel almost all patients – on the first day of the disease; there were no statistically significant differences in hospital mortality between clinics.Conclusion. According to the results of the analysis, clinical and anamnestic characteristics of NonSTEMI patients who undergo CABG in Russian cardiac surgery centers (Tomsk, Kemerovo and Chelyabinsk) do not differ. Compared with the patients of the German cardiac surgery centers of Leipzig and Kiel, Russian patients have a lower surgical risk, they are operated on much later, there were no statistically significant differences in hospital mortality between clinics.Основные положенияЧастота выполнения аортокоронарного шунтирования при инфаркте миокарда без подъема сегмента ST в НИИ кардиологии Томского НИМЦ составляет 10%, госпитальная летальность – 4,3%, что соответствует данным литературы. По основным клинико-анамнестическим характеристикам больные инфарктом миокарда без подъема сегмента ST, получаемые аортокоронарное шунтирование в кардиохирургических центрах Томска, Кемерова и Челябинска, не различаются. Пациенты с инфарктом миокарда без подъема сегмента ST, которым АКШ проводят в кардиохирургических центрах Лейпцига и Киля (Германия), по сравнению с пациентами российских центров, имеют более высокий операционный риск, при этом их оперируют значительно раньше, чем в российских центрах, без статистически значимого различия в госпитальной летальности между клиниками. АбстрактЦель. Сравнительный анализ клинико-анамнестических характеристик и основных результатов лечения больных инфарктом миокарда без подъема сегмента ST (NonSTEMI), которым выполнили аортокоронарное шунтирование (АКШ) в 2020 г. в НИИ кардиологии Томского НИМЦ и других российских и зарубежных клиниках.Материалы и методы. Ретроспективно проанализированы клинико-анамнестические характеристики 23 больных NonSTEMI с выполненным АКШ. Проведено сравнение полученных результатов анализа с данными четырех других кардиохирургических клиник, представленными в литературе.Результаты. Частота выполнения АКШ при NonSTEMI в НИИ кардиологии Томского НИМЦ составляет 10%, что соответствует данным литературы. Средний возраст этих пациентов составил 64,8±8,4 года, фракция выброса левого желудочка – 55,5±9,2%, риск по шкале GRACE – 4,9±5,6%, по шкале EuroSCORE – 7,3±2,1%. Пациентов с кардиогенным шоком и на заместительной почечной терапии не было. Время от госпитализации до АКШ составило 7,4±5,3 дня. Госпитальная летальность зарегистрирована на уровне 4,3%. Проведено сравнение клинико-анамнестических характеристик больных NonSTEMI, которым выполнено АКШ в клиниках Томска (n = 23), Кемерова (n = 66), Челябинска (n = 101), Лейпцига (n = 758) и Киля (n = 461). Характеристики больных между российскими центрами не различаются. По сравнению с немецкими в российских клиниках больные более молодого возраста, с менее тяжелыми осложнениями и сопутствующей патологией. В частности, в российских кардиохирургических центрах, в отличие от немецких, не оперируют больных в состоянии кардиогенного шока. Кроме того, в немецких клиниках больных NonSTEMI оперируют значительно раньше: если в российских центрах в первые 3 дня заболевания вмешательству подвергаются только 10–20% пациентов, то в Лейпциге – 42%, при этом в Киле практически всех больных оперируют в первые сутки заболевания, без статистически значимого различия в госпитальной летальности между учреждениями.Заключение. По основным клинико-анамнестическим характеристикам больные NonSTEMI, подвергшиеся АКШ в российских кардиохирургических центрах (Томск, Кемерово и Челябинск), не различаются. По сравнению с пациентами немецких кардиохирургических центров (Лейпциг и Киль), российские пациенты имеют более низкий операционный риск, при этом им выполняют вмешательство значительно позже, без статистически значимого различия в госпитальной летальности между клиниками

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure &lt; 100 mmHg (n = 1127), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation