Assessment of the psycho-emotional state of patients after COVID-19-associated pneumonia in relationship with laboratory indicators

The aim. To study peculiarities and association of psychological and laboratory indicators in patients with cardiovascular diseases (CVD) who underwent COVID-19 to clarify the factors affecting the possibility of developing delayed psychological and cardiovascular adverse events.Methods. The study enrolled 350 patients with COVID-19. Group 1 consisted of 92 patients without CVD, Group 2 – of 258 patients with CVD. Indicators of laboratory and psychological parameters were assessed according to the data of psychological questionnaire using GAD-7 (General Anxiety Disorder-7), PHQ-9 (Patient Health Questionnaire-9), PSS (Perceived Stress Scale) screening scales and SF-36. Parameters of complete blood count and biochemical blood tests were measured during hospitalization and three months after discharge from the monohospital.Results. After three months, in the general group of patients, signs of anxiety and depression were detected in more than 30 % of the examined patients, signs of stress – in 10.4 %. In the group with CVD, psycho-emotional disorders were identified in 1/4 of the patients, and severe stress – in 8 % of those included in the study. In addition, it was registered that the indicators of erythrocyte sedimentation rate, fibrinogen, high-sensitivity C-reactive protein (CRP), homocysteine and IL-6 remained at a higher level in the second group.Correlation analysis showed that the psychological component of health is interconnected with the level of neutrophils (p = 0.044) and fibrinogen (p = 0.050); the physical component of health is correlated with the level of erythrocytes (p = 0.030), hemoglobin (p = 0.015), CRP (p = 0.002), creatine phosphokinase (p = 0.036) and glucose (p = 0.017). Regression analysis revealed that in patients with CVD three months after hospitalization, an increased glucose index contributes to deterioration, and increased hematocrit and mean hemoglobin concentration improve the quality of life of patients.Conclusion. Laboratory markers that maintain the duration of a prolonged vascular reaction, violation of the rheological and metabolic properties of blood, determine the nature of the development of both psychological and cardiovascular complications

Fibrosis biomarkers as predictors of left atrial appendage thrombosis in patients with nonvalvular atrial fibrillation

Aim. To compare clinical, echocardiographic characteristics and blood biomarkers in patients with nonvalvular atrial fibrillation (AF) depending on the presence of left atrial appendage (LAA) thrombus and to identify independent predictors of LAA thrombosis.Material and methods. Patients with nonvalvular AF subjected to transesopha geal echocardiography before catheter ablation were divided into 2 groups comparable by sex and age: group 1 (n=45) — with LAA throm bosis; group 2 (n=97) — without LAA thrombosis. The patients underwent transthoracic and transesophageal echocardiography. In addition, the following blood biomarkers were analyzed: NT-proBNP (pg/ml), GDF-15 (pg/ml), TGF-β1 (pg/ml), PIIINP (ng/ml), high-sensitivity C-reactive protein (hsCRP) (mg/l), cystatin C (mg/l).Results. In group 1, persistent AF, coronary artery disease, heart failure were more often noted. In addition, group 1 patients had higher volume indices of both atria, left ventricular mass index and pulmonary artery systolic pressure, as well as lower left ventricular ejection fraction and blood flow velocity in the LAA. There were no differences in the groups in terms of the mean CHA2DS2VASc score, the proportion of patients taking oral anticoagulants (OAC), and the OAC spectrum. In group 1, higher levels of NT-proBNP (p=0,0001), GDF15 (p=0,0001), PIIINP (p=0,0002) were found with no differences in the levels of TGF-β1, hsCRP and cystatin C. A stepwise logistic regression revealed independent predictors of LAA thrombosis: LA volume index (ml/m2) — odds ratio (OR)=1,084, 95% confidence interval (CI) 1,028-1,143 (p=0,003); GDF15 ≥933 pg/ml — OR=3,054, 95% CI, 1,260-7,403 (p=0,013); PIIINP ≥68 pg/ml — OR=5,865, 95% CI, 2,404-14,308 (p<0,001). There were following model quality parameters: AUC=0,815 (p<0,001), specificity, 74,4%, sensitivity, 72,7%.Conclusion. In patients with nonvalvular atrial fibrillation taking OAC, serum levels of fibrosis biomarkers PIIINP ≥68 pg/mL and GDF-15 ≥933 pg/mL, along with the left atrial volume index, were independent predictors of LAA thrombosis

Biochemical parameters associated with endothelial dysfunction in patients with arterial hypertension and ischemic heart disease

With the purpose to study the characteristic of biochemical parameters related to endothelial dysfunction, a survey of 121 people aged between 40 and 70 years. The control group without arterial hypertension (AH) and coronary heart disease (CHD) accounted for 18 people, a group with AH - 56 people, the group with the combination of CHD and AH - 47. A comparative evaluation of vasomotor function of endothelium and endothelial dysfunction characterizing the biochemical parameters as endothelin-1, nitrites blood plasma, ADP-induced platelet aggregation, lipid peroxidation and antioxidant defense in blood platelets from patients with AH and with combined AH and CHD. In patients with AH and accession of CHD was identified by negative dynamics of markers of ED, in the form of reduced levels of nitrite, the increase of endothelin-1 and platelet aggregation (AT), induced by the large doses of inducer. The studied group was predominantly at one stage or another oxidative stress is caused by an imbalance of antioxidant protection (AOP) and the processes of lipid peroxidation (LPO) in platelets, in patients with AH was dominated by activation of the LPO. In patients with in combination AH with CHD had a complete depletion of the AOP and a decrease in the activity of LPO in platelets and significantly higher values AT.С целью изучения особенностей биохимических показателей, связанных с дисфункцией эндотелия, проведено обследование 121 человека в возрасте от 40 до 70 лет. Контрольную группу без артериальной гипертонии (АГ) и ишемической болезни сердца (ИБС) составили 18 человек, группу с АГ - 56 человек, группу с сочетанием АГ и ИБС - 47 человек. В работе проведена сравнительная оценка сосудодвигательной функции эндотелия и таких характеризующих эндотелиальную дисфункцию биохимических показателей как эндотелин-1, нитриты плазмы крови, АДФ-индуцированная агрегация тромбоцитов, перекисное окисление липидов и антиоксидантная защита в тромбоцитах у пациентов с АГ и сочетанием АГ и ИБС. У пациентов АГ по мере присоединения ИБС была выявлена отрицательная динамика маркеров ЭД, в виде снижение уровня нитритов, повышения эндотелина-1 и агрегации тромбоцитов (АТ), индуцированной большими дозами индуктора. Исследуемые группы находились преимущественно на той или иной стадии окислительного стресса, обусловленного дисбалансом антиоксидантной защиты (АОЗ) и процессов перекисного окисления липидов (ПОЛ) в тромбоцитах, у больных АГ преобладала активация ПОЛ. У больных АГ в сочетании с ИБС наблюдалось полное истощение АОЗ и снижение активности ПОЛ в тромбоцитах и более высокие значения АТ

Cardiovascular status and echocardiographic changes in survivors of COVID-19 pneumonia three months after hospital discharge

Coronavirus disease 2019 (COVID-19) affects the function of all organs and systems. Today, studying the effect of COVID-19 on cardiovascular system, including on echocardiographic characteristics, is relevant.Aim. To study the prevalence of symptoms, cardiovascular disease and changes in echocardiographic data in persons after documented COVID-19 pneumonia 3 months after discharge from the hospital.Material and methods. The study included 106 patients after documented COVID-19 pneumonia. The patients underwent a comprehensive examination during hospitalization and 3 months±2 weeks after discharge from the hospital. The mean age of participants was 47±16 years (19-84 years); 49% of subjects were women.Results. Three months after hospital discharge, the symptoms persisted in 86% of examined patients. There were significant echocardiographic changes as follows: a decrease in LV end-diastolic, end-systolic and stroke volume (113,8±26,8 ml vs 93,5±29,4 ml; 37,7±13,0 ml vs 31,3±14,2 ml; 77,2±17,8 ml vs 62,2±18,7 ml, respectively, p<0,001 for all). The right ventricular anteroposterior dimension and the pulmonary trunk diameter decreased over time (26,0 [24,0-29,3] mm vs 25,0 [23,0-27,0] mm, p=0,004; 21,7±3,6 mm vs 18,7±2,5 mm, p<0,001), the same as the pulmonary artery systolic pressure, estimated by tricuspid regurgitation gradient (28,0 [25,0-32,25] mm Hg vs 21,5 [17,0-25,0] mm Hg). The right atrial volume (42,0 [37,0-50,0] m><0,001), the same as the pulmonary artery systolic pressure, estimated by tricuspid regurgitation gradient (28,0 [25,0-32,25] mm Hg vs 21,5 [17,0-25,0] mm Hg). The right atrial volume (42,0 [37,0-50,0] ml vs 31,0 [22,0-36,5] ml, p<0,001) a><0,001) and maximum width (36,1±4,6 mm vs 34,5±6,5 mm, p=0,023) decreased, while the right atrial maximum length increased (46,7±6,8 mm vs 48,6±7,1 mm, p=0,021).Conclusion. In survivors of COVID-19 pneumonia three months after hospital discharge, complaints persisted in 86% of cases. Cardiovascular diseases were detected in 52% of participants, including hypertension in 48,1% and coronary artery disease in 15,1%. Compared with in-hospital data, the echocardiographic characteristics improved, which was expressed mainly in a decrease in right heart load

Features parameters of the lipid profile and inflammatory vascular respons in patients with stable and unstable angina

169 patients (male and temale aged 60,12 ± 10,7 years) with coronary artery disease (CAD), stable and unstable angina (SA/UA) were examined. According to the selective coronary angiography, a group of patients with significant and insignificant (neighboring) coronary stenosis (SCS and ICS) was selected. CAD patients with SA and UA in the general group do not differ in the level of atherogenic parameters of lipid profile, but in UA group the level of MMP-9 and TIMP-1 is significantly higher, which may indicate an elevated level of the local inflammatory respond and increased threat of thrombogenic complications in unstable plaques. In CAD patients with UA in SCS group a significant excess of atherogenic parameters of lipid profile (total cholesterol, LDL cholesterol, trygliceride) compared to patients without SCS was noted. Equal elevation of inflammatory markers (hs-CRP, TNF-alpha and endothelin-1) in both groups regardless severity of coronary syndrome may cause thrombosis in case of unstable CAD. Patients with unstable CAD regardless of the severity of coronary stenosis may have increased level of MMP-9 and TIMP-1. According to logistic regression data, CD 40, MMP-9 and TIMP-1 levels can be isolated as differential signs of unstable angina flow.Обследовано 169 пациентов (мужского и женского пола) в возрасте 60,12±10,7 лет с ишемической болезнью сердца (ИБС), разделенных в 2 основные группы: 1-я пациенты со стабильной (СС) и 2-я пациенты с нестабильной стенокардией (НС). Согласно данным селективной коронарной ангиографии, в каждой основной группе пациентов выделены подгруппы со значимым и незначимым коронарным стенозом (ЗКС и НЗКС). Пациенты со СС и НС стенокардией в основных группах не различались по уровню атерогенных параметров липидного спектра и основных маркеров воспалительной сосудистой реакции, однако в группе с нестабильной стенокардией был зарегистрирован достоверно повышенный уровень ММП-9 и ТИМП-1, что свидетельствует о наличии повышенного уровня маркеров локального воспалительного ответа. У пациентов ИБС с нестабильной стенокардией в группах независимо от степени коронарного стеноза зарегистрировано превышение референсных знамений атерогенных параметров липидов (ОХС, ТГ, ХС ЛПНП) и равноценно повышенные уровни маркеров сосудистого воспаления вч-СРБ, ФИО- и эндотелина-1, что может обусловливать при нестабильном течении стенокардии равнозначную вероятность нежелательных сердечно-сосудистых событий. Согласно данным логистической регрессии, уровни CD 40, ММП-9 и ТИМП-1 можно использовать для верификации нестабильного течения стенокардии

Biochemical blood parameters in determining the elastic properties of the vascular wall in hypertensive patients with abdominal obesity

The article describes approaches that use parameters of biochemical laboratory markers as the basis for the indirect determination of the value of a functional parameter 'pulse wave velocity*, which characterizes the stiffness of the vessel wall. Using a mathematical model of an artificial neural network makes it possible to assess the degree of deviation of the resulting stiffness of the vessel wall from the standard value. An increase in this value is determined by the defeat of the vascular wall as a target organ that helps to clarify the stage of hypertension and optimize antihypertensive therapy in hypertensive patients with abdominal obesity.В статье описаны подходы, позволяющие использовать параметры биохимических лаб раторных маркеров в качестве основы для оценки величины функционального параметра «скорость распространения пульсовой волны», характеризующего жесткость сосудистой стенки. Использование математической модели искусственной нейронной сети дает возможность оценить степень отклонения полученного показателя жесткости сосудистой стенки от нормативного значения. При повышении этого значения определяется поражение сосудистой стенки как органа-мишени, что позволяет уточнить стадию артериальной гипертонии и провести оптимизацию антигипертензивной терапии у больных артериальной гипертонией с абдоминальным ожирением

Peculiarities of parameters of lipid metabolism and concentration of C-reactive protein of patients with chronic coronary heart disease who were treated by transluminal balloon angioplasty with stenting

This article presents a comparative evaluation of the parameters of lipids metabolism and high-sensitive C-reactive protein in patients with chronic coronary heart disease, depending on the degree of stenosis of coronary arteries. The dynamics of the studied parameters before and after the year of transluminal balloon angioplasty with stenting. Significant excess of atherogenic lipid fractions in the group of patients with hemodynamically significant stenosis of the coronary arteries is identified. After the year of operative measure positive dynamics of lipids profile and increase of concentration of high-sensitive c-reactive protein are registered.В данной статье представлены данные сравнительной оценки параметров липидного обмена и высокочувствительного С-реактивного белка у пациентов с хронической формой ишемической болезни сердца в зависимости от степени стеноза коронарных артерий. Прослежена динамика изучаемых параметров до и через 1 год после проведения транслюминальной баллонной ангиопластики со стентированием. Выявлено достоверное превышение атерогенных фракций липидов в группе пациентов с гемодинамически значимым стенозом коронарных артерий. Отмечена положительная динамика параметров липидного спектра и повышение концентрации высокочувствительного С-реактивного белка через год после проведения оперативного вмешательства

Comparative analysis of prospective study data of biochemical parameters of blood serum in patients with ischemic heart disease with the presence and absence of type 2 diabetes

Purpose: to conduct a prospective comparative analysis of laboratory parameters of the lipid profile, markers of the inflammatory response and functional activity of the endothelium in groups of patients with ischemic heart disease and coronary heart disease in combination with diabetes under condition of absence of significant lesion of coronary arteries. Determine a set of laboratory parameters that determine the likelihood of developing cardiovascular complications. Materials. According to the data of selective coronary angiography, patients without significant coronary stenosis were identified. Group 1 - patients with IHD (n = 29), 2nd group - CHD with type 2 diabetes mellitus (DM), (n = 39). The study of laboratory parameters of blood serum was performed against the background of standard therapy before and after 12 ± 2.4 months of follow-up. Results. In both groups, the excess of the reference values of the parameters of the lipid profile and the markers of vascular inflammation was revealed. In the 2nd group the levels of total cholesterol, LDL, Apo-B, high-sensitivity C-reactive protein, homocysteine, interleukin 1 beta are significantly higher than in the 1st group. Prospective observation with standard therapy demonstrated the presence of negative dynamics of the lipid spectrum, the preservation of a prolonged response to the activation of the inflammatory reaction, which was indicated by interleukin 1β, homocysteine, matrix metalloproteinase 9 and the persistence of disorganization of the endothelin system in both groups of patients. Conclusion: The results of the study indicate the preservation of a prolonged inflammatory response in the endothelium in both the 1 st and 2 nd group of patients, which can become a provoking factor for the destabilization of the atherosclerotic process. The increased risk of atherothrombosis in both groups of patients requires a strict control of the effectiveness of the therapy in the conditions of real clinical practice.Цель: провести сравнительный анализ лабораторных параметров липидного профиля, маркеров воспалительной реакции и функциональной активности эндотелия в группах больных ИБС и ИБС в сочетании с СД при условии отсутствия значимого поражения коронарных артерий по данным коронароангиографии. Выделить комплекс лабораторных параметров, определяющих вероятность развития сердечно-сосудистых осложнений. Материалы: Согласно данным селективной коронарной ангиографии выделены пациенты без значимого коронарного стеноза. 1-я группа - больные ИБС (n=29), 2-я группа - ИБС с сахарным диабетом типа 2 (СД), (n=39). Исследование лабораторных параметров сыворотки крови проводилось на фоне стандартной терапии до и через 12±2,4 месяцев наблюдения. Результаты: В обеих группах выявлено превышение референсных значений параметров липидного профиля и маркеров сосудистого воспаления. Во 2-ой группе достоверно выше уровни общего холестерина, ЛПНП, Апо-В, высокочувствительного С-реактивный белка, гомоцистеина, интерлейкина 1 β по сравнению с 1-ой группой. Проспективное наблюдение на фоне стандартной терапии продемонстрировало наличие негативной динамики липидного спектра, сохранение пролонгированного ответа активации воспалительной реакции, индикатором которой явились интерлейкин 1 β, гомоцистеин, матриксная металлопротеиназа 9 и сохранение дезорганизации эндотелиновой системы в обеих группах больных. Заключение: Результаты исследования свидетельствует о сохранении как в 1-ой, так и во 2-ой группе пациентов пролонгированного воспалительного ответа в эндотелии, что может стать провоцирующим фактором для дестабилизации атеросклеротического процесса. Повышенный риск развития атеротромбоза в обеих группах пациентов требует жесткого контроля эффективности проводимой терапии в условиях реальной клинической практики

The study of the dynamics of clinical and laboratory-instrumental parameters in hypertensive patients with obesity who underwent COVID-19-associated pneumonia

BACKGROUND: According  to the results of the ESSE-RF study, the frequency of obesity in the population  reached 29.7%. Obesity is one of the main risk factors for the development of cardiovascular diseases. Features of the course of COVID-19 in patients with obesity is a very urgent problem.AIM: The aim of the study was a comparative investigation of clinical and laboratory-instrumental parameters in AH patients with or without obesity who had COVID-19 associated pneumonia, to identify the role of obesity as a potential predictor of post-COVID cardiovascular complications 3 months after discharge from the hospital.MATERIALS AND METHODS: Materials and methods. The study included 174 patients with COVID-19-associated pneumonia. Group 1 included 78 patients with AH without obesity, group 2 — 96 patients with AH and obesity. All patients were tested with a blood sample at the time of admission and 3 months after discharge from the hospital. We assessed parameters of general blood test, biochemistry, hemostasis, inflammation biomarkers — concentration of C-reactive protein (CRP), highly sensitive CRP (hs-CRP), homocysteine, IL-6, etc. All patients initially underwent computed tomography  of the chest. In both groups, 24-hour blood pressure monitoring was performed using BPLaB device, according to the standard protocol; echocardiography using  an expert class ultrasound diagnostic  system Vivid S70. The study is registered with the Clinical Trials.gov database Identifier: NCT04501822.RESULTS: Results. The biomarker that significantly distinguished the both groups of patients, as well as subgroups according to the degree of obesity was the concentration of maxCRP and hs-CRP, which was significantly higher in group 2. In addition, the registered maximum values of MPO, NT-proBNP, IL-1,6, TNA-α and NRL parameters in group 2 of patients with 2–3 degrees of obesity, may indicate the highest probability of developing  delayed adverse cardiovascular complications  in this group of patients. Mean systolic blood pressure, variability of systolic and diastolic blood pressure, and heart rate at night were significantly  higher in AH patients with obesity. Numerous correlations of obesity with laboratory and instrumental parameters have been registered, which may indicate an increased likelihood of delayed unwanted cardiovascular complications in this particular group of patients. Multiple regression showed that obesity is an independent predictor of an increase in LDH, hs-CRP and right atrium.CONCLUSION: Dynamic control of the studied parameters in patients with AH and OB registered an increased concentration of CRP at the initial stage and 3 months after treatment, with a general trend towards a decrease in the increased initial structural parameters of ECHO CG. The logistic regression method showed that the presence of OB in patients with AH is an independent factor causing increased levels of immune inflammation (CRP), a marker of tissue destruction (LDH), and load on the right atrium

Characteristics of the inflammatory response and markers of endothelial dysfunction in patients with hemodynamically insignificant coronary stenosis at baseline stable and unstable angina

Were examined 48 patients (male and temale) aged 60,1 ± 10,7 years with coronary heart disease (CHD). According to selective coronary angiography, isolated group of patients with hemodynamically insignificant coronary stenosis. In groups (stable and unstable angina) equally showed signs of dyslipidemia moderate activation of systemic inflammatory response (increase in the level of TNF -a) and endothelial dysfunction (overproduction of endothelin -1). In the group of patients with unstable angina showed a tendency to increased hs-CRP, homocysteine and a significant increase in MMP- 9, which reflects the pathogenetic mechanisms of instability of atherosclerotic plaques.Обследовано 48 пациентов (мужского и женского пола) в возрасте 60,1+10,7 лет с ишемической болезнью сердца (ИБС). Согласно данным селективной коронарной ангиографии, выделена группа пациентов с гемодинамически незначимым коронарным стенозом. У пациентов вне связи с клиническим течением ИБС (стабильная и нестабильная стенокардия) выявлены признаки умеренной дислипидемии, активации системного воспалительного ответа, представленного повышенным содержанием ФНО-а и дисфункции эндотелиальной системы в виде гиперпродукции плазменного эндотелина-1. В группе пациентов с нестабильной стенокардией отмечена тенденция к повышению hs-CRP, гомоцистеина и достоверное повышение ММР-9, что, характеризуя повышенный уровень воспалительного ответа, отражает патогенетические механизмы провокации нестабильности гемодинамически незначимой атеросклеротической бляшки