Gender and age differences of compliance in liver transplant recipients

The aim of the paper was to evaluate the compliance in patients who have undergone orthotopic liver transplantation (OLT). A voluntary anonymous survey was conducted among liver transplant recipients. The control group included patients with chronic non-infectious diseases requiring persistent treatment. Liver transplant patients have higher levels of general, behavioral and emotional compliance compared to patients with chronic diseases. Neither gender nor age differences were identified in any types of complianc

Effect of cyclosporin and tacrolimus on kidney function in liver recipients

The objective of the study was to evaluate the dynamics of renal function, depending on the use of various calcineurin inhibitors in the long-term postoperative period in liver recipients in real clinical practic

Dyslipidemia in patients with atrial fibrillation on the background of acute coronary syndrome according to the register of the Krasnodar region

Aim. Atrial fibrillation (AF) is connected with the increased risk of stroke, mortality rate and costs for health care around the world. Earlier the predictive role of a dyslipidemia was not estimated in available literature.Material and methods. This retrospective study included 13,244 patients who consistently referred to Scientific Research Institute – Regional Clinical Hospital no. 1, Krasnodar, with acute coronary syndrome from November 20, 2015 to November 20, 2017. Primary final points were defined both as mortality from all reasons and from the cardiovascular events. Secondary final points were defined as repeated myocardial infarction. Follow up period was 12 months.Results. In the studied group ACS + AF we included 201 patients. This group of patients was divided into 3 subgroups: patients with originally developed AF episode accompanied with acute coronary syndrome, included 52 patients (Group 1), patients with constant AF form, included 96 patients (Group 2) and patients with paroxysmal or persistent atrial fibrillation registered before ACS episode, included 53 patients (Group 3). In Group 1 the level of the general cholesterol and low-density lipoproteins (LDL) was authentically higher. Among the survived and discharged patients after ACS episode there were 45 patients in Group 1, in Group 2 and 3 there were 81 and 47 patients, respectively. In 12 months the general mortality rate was comparable, however, the frequency of lethal and non-lethal myocardial infarction development was authentically higher in Group 1.Conclusions. Higher initial levels of the general cholesterol and LDL are connected with development repeated MI that does not affect the general mortality rate. However, these data are obtained in a small selection of patients and demand a further investigation

Description of rare clinical case of AA-amyloidosis with involvement in pathological process of heart and lungs

Amyloidosis is a unique group of disorders caused by the insoluble protein fibers accumulation known as amyloid fibrils in extracellular tissue and organ spaces. The involvement of different organs and tissues in amyloidosis is often the cause of missed or delayed diagnosis, and amyloidosis remains a major clinical problem as it is associated with 1/1,000 deaths in developed countries. We present a case of a 59-year-old female patient with complaints of breath shortness while talking, a sense of air lack in the horizontal position, swelling of the lower limbs, reduction of blood pressure to a minimum of 70/50 mm Hg, weight reduction by 7 kg in 6 months, dizziness. The patient was hospitalized to the Cardiology Department of Scientific Research Institute – Ochapovsky Regional Clinical Hospital no. 1 with heart failure. The electrocardiogram revealed left ventricular hypertrophy. Echocardiography showed biventricular myocardial hypertrophy with a maximum interventricular septum thickness of 16 mm, nonuniform ventricular myocardial structure and reduction of global left ventricular comparability to 38%. Computer tomography of chest organs demostrated interstitial swelling of parenchyma of both lungs. The infection during the further examination. For the final morphological verification of the diagnosis, it was necessary to perform peripheral transbronchial biopsy S 3, 4, 5 of the left lung and myocardial biopsy with specific staining on amyloid using congo red. In the lung and myocardial biopsy, the colour of the congo red is positive. An immunohistochemical study of the lung tissue and myocardial sample revealed Amyloid AA expression. This case represents a rare cause of heart failure in a woman. A feature of this observation is the rare involvement in the pathological process of both pulmonary tissue and myocardium with AA-amyloid deposition

Dyslipidemia in kidney receiver

Background. Kidney transplantation is the gold standard of treatment in patients with a terminal renal failure. Nevertheless, the main reason for death of recipients, loss of the renal allograft is cardiovascular disease, and disorder of lipid profile remains one of the most significant risk factors and progressing of cardiovascular pathology.Aim. We estimated dyslipidemia dynamics before and at various terms after kidney transplantation and we tried to reveal interrelation of disorder of lipid metabolism with renal transplant functioning.Material and methods.The retrospective observational research of the cohort in a uniform group of lipid profile dynamics observation in terms before kidney transplantation and in 6, 12 and 36 months of two hundred liver recipients at the age of 40.18 ± 10.33 years has been conducted. Among those there was 41.5% female patients and 58.5% male patients. The statistical analysis was carried out by means of STATISTICA 10.0 program. The critical significance value while checking statistical  hypotheses in this research was accepted equal 0.05. The method of multifactorial logistic regression was applied to search factors associated with a dyslipidemia. Results. Level of the general cholesterol before transplantation was 4.34 ± 1.21 mmol/l, in comparison with an initial indicator of the general cholesterol increase in dynamics in 12 and 36 months was 17.5% (р = 0.02), 22.9% (р = 0.03), respectively. The LDL level in the studied cohort of recipients was around 2.36 ± 1.21 mmol, and in 6 months it increased by 12.3% (р = 0.02), in a year for 5.9% (р = 0.21) and 36 months later differed from initial on 14.8 (р = 0.01). In three years after transplantation period LPVP decreased by 12.3% (р = 0.01). In comparison with initial level before transplantation  they increased on 8.9% (р = 0.03) и 16.7% (р = 0.01) in 12 and 36 months, respectively. The factors associated with dyslipidemia is the age – 1.21–1.7 (р < 0.02), diabetes – 1.1–1.5 (р < 0.03), the speed of glomerular filtration (kg/sq.m) – 1.23–1.32 (р < 0.02), proteinuria (g/l) – 1.55–2.1 (р < 0.001), the left ventricle myocardium mass index (kg/sq.m) – 1.23–1.55  (р < 0.03), hemoglobin (g/l) – 1.1–1.23 (р < 0.04), systolic arterial blood pressure – 1.2–2.1 (р < 0.001), diastolic arterial blood pressure – 1.1–2.2 (р < 0.002). The negative correlational interrelation between the level of cholesterol and survival of the renal allograft, estimated on the speed of glomerular filtration was revealed (р = 0.003). Level of the general cholesterol was a significant independent predictor for survival and functioning of the renal allotransplantat in 3 years after transplantation.Conclusion. Тhe progressing disorder of a lipid profile in the long-term post-transplantation period was revealed, dyslipidemia is a significant modified predictor of successful kidney transplantation

Role of heart rate variability and regulatory-adaptive status index in predicting the heart transplant rejection

Aim. To assess the diagnostic value of heart rate variability (HRV) parameters and regulatory-adaptive status index and their prognostic value after orthotopic heart transplantation.Material and methods. The study included 70 patients after orthotopic heart transplantation using a modified bicaval technique performed in the period from 2012 to 2015. The follow-up period was 36±1 month. Most of the recipients were men — 59 (84,29%). The mean age was 50,24±10 years. Twelve, 24 and 36 months after the operation, recipients underwent right ventricular endomyocardial biopsy, 24-hou relectrocardiographic monitoring, and a cardiorespiratory synchronization (CRS) test. Statistical data processing was carried out using the Statistica 10 software (StatSoft Inc., version 10.0.228.8, Oklahoma, USA). The informativeness of studied parameters in predicting rejection episode was assessed by ROC analysis.Results. Twelve months after transplantation, rejection episode was diagnosed in 23 (33%) recipients, 24 months — in 23 (34,8%), 36 months — in 19 (29,6%). CRS characteristics did not differ significantly depending on the presence of a rejection episode as 12 months after surgery (p>0,2) and subsequently (p>0,3). HRV values in the first year after surgery did not show differences in the groups with a rejection episode. After 2 years, the high-frequency component of the HRV frequency domain had the highest predictive value (AUC=0,693, p=0,005). Three years after the operation, all analyzed HRV parameters demonstrated informative value for the diagnosis of rejection episode, the highest predictive value among which had the heart rate (AUC=0,873, p<0,001).Conclusion. The study of HRV should be considered to assess the risk of a rejection episodes in recipients 2 and 3 years after surgery. The regulatory-adaptive status index, being an integral value of cardiac transplant reinnervation, does not demonstrate predictive value in relation to the rejection episode within 3 years after transplantation. However, it confirms the fact of cardiac transplant reinnervation and allows assessing the regulatory-adaptive status of recipients after surgery

CASE OF CORONARY ARTERY SPASM WITH FATAL OUTCOME IN THE EARLY PERIOD AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY OF THE RIGHT CORONARY ARTERY WITH IMPLANTATION OF BARE METAL STENTS

The paper presents a clinical case of coronary artery spasm after implantation of bare metal stents. The 60-year-old man was admitted to the hospital with the progression of the coronary heart disease and high angina pectoris functional class for coronary angiography. The patient had the main predisposing factor for the development of coronary artery spasm, which is 20-year smoking history. Based on the results of the coronary angiography, the decision was made to conduct endovascular treatment. The patient was discharged on the 2nd day after angioplasty with implantation of two stents in the right coronary artery. On the evening of discharge, the man developed a severe pain attack in the epigastric region and turned to the hospital. The electrocardiogram revealed ST-segment elevation in leads II, III, aVF, T-waves were negative in leads I, aVL and V3-6. Repeat coronary angiography showed the stent implantation sites were passable, there was a pronounced diffuse coronary artery spasm, which could not be eliminated by intracoronary administration of nitroglycerin.Coronary artery spasm induced by coronary angioplasty with stent placement is a rare complication that can develop at different time intervals after endovascular intervention. Based on the presented clinical case, it appears  likely that even after bare metal stents implantation, the development of endovascular dysfunction leading to coronary spasm is possible

Biomarkers of heart failure: current state of problem

There is constant increase in patients with heart failure every year worldwide. Early diagnosis and prediction of deterioration could upgrade management of patients and slow down the progression of heart failure.The brain natriuretic peptide precursor (NT-proBNP) is considered to be the universal biomarker, although it has several limitations. The search of ideal biomarker is directed into molecular biology and genetics. Microribonucleic acids (microRNAs) regulate different processes in human body, present myocardial specificity, and plasma stability. It has been proven in different trials that diagnostic and prognostic level of microRNAs is equal to NT-proBNP. Potential opportunities of the method are not only diagnosis but therapeutic targets for heart failur

Familial hypercholesterolemia: case series of a rare condition

Introduction. Cardiovascular events at a young age are often the first manifestation of a genetic disorder such as familial hypercholesterolemia. High cholesterol levels, xanthomas and xanthelasmas, as well as a positive family history of cardiovascular disease, make it possible to identify a group of patients subject to genetic research. The identification of a specific mutation helps to determine further strategy not only for a patient, but also to his or her immediate relatives, thereby effectively conducting both secondary and primary prevention of atherosclerosis complications.Brief description. Using the example of patients from the Krasnodar Lipid Center, the relevance of genetic testing and cascade screening is demonstrated. We show problems of delayed diagnosis and low medical adherence, as well as the ways to optimize care for patients with genetic lipid metabolism disorders.Discussion. The rise in the incidence of cardiovascular events at a young age in developed countries prompts the search for more improved screening and diagnostic methods for familial hypercholesterolemia. The optimal age of initiation of lipid-lowering therapy in children with established familial hypercholesterolemia is also discussed. While secondary prevention appears to be clearer, there is still insufficient achievement of low-density lipoprotein cholesterol targets in patients with a previous cardiovascular event

COVID-19 after emergency coronary artery bypass grafting: features of the postoperative course and prognosis

Introduction Coronavirus disease (COVID-19) caused by SARS-CoV-2 virus identified in 2019, forces cardiology departments to quickly adapt existing clinical guidelines to the new reality, and this is particularly relevant for scheduling patients with acute coronary syndrome (ACS). The article demonstrates how COVID-19 has affected emergency cardiac surgery care.Objective To analyze the features of completed cases of emergency coronary artery bypass grafting (ECABG) and COVID-19 diagnosed during the postoperative period at the Research Institute – Ochapovsky Regional Hospital no. 1 for the period from May 1, 2020 to February 1, 2021. Material and Methods Completed cases of ECABG have been retrospectively studied. EACS was performed in 145 patients: in 79 people with unstable angina pectoris (NS), in 40 with Q-negative myocardial infarction (MI), in 14 cases with primary Q-positive MI, in 12 patients with recurrent MI. The condition for ECABG was a negative SARS-Cov-2 PCR result and the absence of viral pneumonia by CT. The patients were divided into 2 subgroups. The first one included people with ECABG that were not diagnosed with COVID-19 during postoperative follow-up in the hospital. Subgroup II had patients with ECABG and COVID-19 diagnosed during the hospitalization.Results Contingency tables showed a statistically significant interaction between group membership and mortality, 2.3% (n = 3) in subgroup 1 and 20% (n = 3) in subgroup 2, Pearson’s test χ2 = 10.6, p < 0.05. When analyzing survival rate in the EACS + COVID-19 subgroup, it is worth paying attention to the cumulative proportion of survivors, considering the severity of the course of viral pneumonia. The proportion of such patients with CT-4 by the 32nd day of hospital stay was 0.3.Conclusions Mortality rate in the postoperative course after ECABG with COVID-19 is significantly higher. In patients who underwent ECABG and died in the early and late postoperative period from COVID-19, a new coronavirus infection was diagnosed at a later date. In these cases, a considerably longer duration of CPB and a higher level of ferritin were revealed at the time of transference to the observation department. Survival rate in ECABG patients due to primary Q-negative MI is significantly lower in comparison with patients hospitalized for unstable angina