Взаимосвязь бета-адренореактивности эритроцитов и особенностей течения острого инфаркта миокард

Aim.      To investigate the relationship between the osmotic fragility of erythrocytes and the course of acute myocardial infarction (MI).Methods.           An analysis of the osmotic fragility of erythrocytes was conducted using beta-blocker-based osmotic fragility test in sixty-two patients within the first 6 hours after onset of MI symptoms.Results. The results revealed that the patients with increased erythrocyte osmotic fragility experienced more complications after acute MI, such as left ventricular failure and cardiac arrhythmias (ventricular extrasystoles and ventricular tachycardia) (p = 0.026). Moreover, these patients exhibited greater myocardial injury - the concentration of biomarkers of myocardial necrosis, such as creatine phosphokinase, creatine phosphokinase MB and Troponin I was increased - p = 0.009, p = 0.032 and p = 0.001, respectively. In addition to that, the patients with high osmotic fragility had a larger number of hypokinetic and akinetic segments, high impaired myocardial contractility index, and low ejection fraction. The impaired myocardial contractility index was significantly higher in patients with increased erythrocyte osmotic fragility (1.5 (1.22; 1.75) vs 1.12 (1.0; 1.56), U = 157.5, p = 0.032).Conclusion. Increased erythrocyte osmotic fragility in patients was associated with greater myocardial injury, manifesting through the higher concentration of biomarkers of myocardial necrosis in blood, as well as higher number of hypokinetic segments.Цель. Проведен анализ бета-адренореактивности у 62 пациентов с острым ИМ в первые 6 ч от появления симптомов для определения уровня активности симпатоадреналовой системы.Материалы и методы. Для больных с повышенными уровнями показателя β-АРМ  характерно более частое развитие осложнений в остром периоде ИМ, таких как острые левожелудочковая недостаточность и нарушения сердечного ритма (желудочковая экстрасистолия высоких градаций и желудочковая тахикардия) (р = 0,026). Также среди пациентов с повышенными значениями показателя β-АРМ отмечен больший объем поражения сердечной мышцы, что проявляется кратным повышением концентрации биомаркеров некроза в крови - креатинфосфоки-назы, креатинфосфокиназы-МВ и тропонина I (р = 0,009, р = 0,032 и р = 0,001 соответственно) и визуализацией большего числа зон гипо- и акинеза; более высокими значениями индекса нарушения локальной сократимости при эхокардиографическом исследовании и более низкой фракцией выброса левого желудочка. Индекс нарушения локальной сократимости был значительно выше среди обследованных с повышенным уровнем β-АРМ (1,5 (1,22; 1,75)), чем в группе пациентов с нормальным показателем (1,12 (1,0; 1,56)) (U = 157,5, р = 0,032).Результаты. Для пациентов с гиперактивацией симпатоадреналовой системы, проявляющейся повышением значений показателя β-АРМ, характерен больший объем Заключение       поражения сердечной мышцы, что находит отражение в кратном повышении концентрации биомаркеров некроза в крови, а также визуализации большего числа зон гипо- и акинеза при эхокардиографическом исследовании

POPULATIONAL STUDY OF LONG TERM OUTCOMES OF ACUTE MYOCARDIAL INFARCTION IN TOMSK

Aim. To evaluate long term outcomes of acute myocardial infarction (MI), based on the populational registry.Material and methods. In the study, the survived post-MI patients were included, in the year 2007 registered in database of MI (n=439). Prospective observation was done during 5 years after index event. In the case of fatal outcome the protocols were analyzed, of pathology studies and summaries of forensic autopsies; relatives were interviewed and the witnesses of clinical cases. For statistics, the software “Statistiсa” V.10 was applied.Results. Mortality among patients included into the study, was 11% in one year post MI, and 35% at 5 years. In overall structure of the causes of fatal outcomes there were cases of second MI — 37%. Chronic coronary heart disease was found as a cause of death in 21%, and in 2% there was fatal stroke; in 5% pulmonary embolism, and in 5% sudden cardiac death. In 17% causes of death were not related to cardiovascular pathology.Conclusion. Patients after MI do demonstrate high level of mortality in 5 year outcomes. Leading causes of fatal outcomes during first 2 years are recurrent acute coronary events, acute strokes, thromboembolism

Beta-adrenergic reactivity of erythrocytes and the progression of heart failure in patients after myocardial infarction

Aim. To identify the associations between beta-adrenergic reactivity of erythrocytes and the progression of heart failure (HF) in patients after myocardial infarction (MI).Material and methods. The study included 50 patients with HF and history of MI 6 months ago. To determine the level of sympathoadrenal system activity, we analyzed beta-adrenergic reactivity by changing the osmotic resistance of erythrocytes by use of adrenoceptor blocking agent.Results. The frequency of HF progression after index MI was 26% (n=13). All patients were divided into 2 groups depending on the presence/absence of HF progression in the postinfarction period. When determining beta-adrenergic reactivity, it was found that patients with HF progression compared with patients without it had the higher level of beta-adrenergic reactivity of membrane (β-ARM) of erythrocytes: 58,8 (50,9; 78,0) CU and 46,8 (38,0; 66,3) CU, p=0,025). A ROC analysis made it possible to establish the β-ARM level ≥49,53 CU a cut-off point, which can be considered as a marker of HF progression in patients after MI (sensitivity 92,3%, specificity 62,2%). This level of β-ARM is associated with a more than five-fold increase of HF progression risk in patients after MI (OR 5,48; 95% CI 1,28-23,37; p=0,024).Conclusion. In patients with HF and MI history, there is a decrease in the adrenergic reactivity of erythrocyte cell membrane, which is reflected by an increase of β-ARM above normal range of 20 CU. At the same time, β-ARM in patients with HF progression compared with patients without it is significantly increased. Established cut-off point of β-ARM (≥49,53 CU) allows predicting the HF progression with high sensitivity and specificity

Predictors of adverse cardiovascular events in patients with coronary artery disease after percutaneous coronary intervention

Aim. To identify predictors of major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI).Material and methods. This prospective single-center study included 225 patients with stable CAD requiring drug-eluting stent implantation. The average follow-up period for patients was 14,5 (6;23) months. Levels of glycated hemoglobin (HbA1c), insulin, tumor necrosis factor (TNF)-α, interleukin-6 (IL-6), interleukin-10 (IL-10), endothelin-1 (ET-1) and the serum lipid profile were evaluated. Insulin resistance was assessed by the HOMA-IR index. The patients were divided into 2 groups: group 1 (n=98) — patients with MACE, group 2 (n=127) — patients without MACE over the follow-up period.Results. During the follow-up period, MACE were recorded in 43,5% of patients, of which: fatal outcome in 3 (3,1%) patients, acute coronary syndrome (ACS) — 14 (14,3%), decompensated heart failure (HF) — 8 (8,2%), non-fatal myocardial infarc tion (MI) — 4 (4,1%), stroke — 3 (3,1%), in-stent restenosis — 18 (18,4%), target vessel revascularization due to progression of atherosclerosis — 25 (25,4%), lifethreatening arrhythmias — 18 (18,4%), implantation of a cardiac resynchronization therapy defibrillator — 5 (5%). To determine critical levels for quantitative predictors, ROC curves were created with threshold values that increase the likelihood of MACE.Conclusion. As a result of the study, we found that the waist-to-hip ratio >1,0495, the HOMA-IR index >3,13 and the endothelin-1 >0,75 mmol/L are independent predictors of unfavorable prognosis in patients with CAD after PCI

Cohort profile. the ESC-EORP chronic ischemic cardiovascular disease long-term (CICD LT) registry

The European Society of cardiology (ESC) EURObservational Research Programme (EORP) Chronic Ischemic Cardiovascular Disease registry Long Term (CICD) aims to study the clinical profile, treatment modalities and outcomes of patients diagnosed with CICD in a contemporary environment in order to assess whether these patients at high cardiovascular risk are treated according to ESC guidelines on prevention or on stable coronary disease and to determine mid and long term outcomes and their determinants in this population