PROGNOSTIC ROLE OF EEG INDICATORS FOR CHANGES IN COGNITIVE PERFORMANCE IN PATIENTS IN THE EARLY AND LONG-TERM POSTOPERATIVE PERIODS OF CORONARY ARTERY BYPASS GRAFTING

Aim. To study the prognostic role of background EEG activity indicators recorded in patients in the preoperative period of coronary artery bypass grafting (CABG) for the development of cognitive impairment in the early and late postoperative periods.Methods. A total of 85 patients with coronary artery disease (CAD) who underwent CABG were included in the study. Before CABG (3-5 days) all neuropsychological testing and EEG studies were performed, at the 7-10th days and 1 year after CABG only neuropsychological testing. EEG predictors of early (n = 85) and long-term (n = 65) postoperative cognitive dysfunction were detected using the method of multiple linear regression.Results. EEG predictors of deterioration of cognitive status in the early postoperative period of CABG were basic higher values of theta-rhythm power in the posterior regions of the cortex of both hemispheres with closed and open eyes. Whereas higher preoperative parameters of beta2-rhythm biopotentials in the left frontal areas with eyes open and lower alpha-rhythm power in the left occipital parts of the cerebral cortex with eyes closed were associated with long-term postoperative cognitive dysfunction.Conclusion. associations of preoperative eeg indicators with deteriorations of cognitive status in the early and longterm postoperative periods of cabg were revealed. Aim. To study the prognostic role of background EEG activity indicators recorded in patients in the preoperative period of coronary artery bypass grafting (CABG) for the development of cognitive impairment in the early and late postoperative periods.Methods. A total of 85 patients with coronary artery disease (CAD) who underwent CABG were included in the study. Before CABG (3-5 days) all neuropsychological testing and EEG studies were performed, at the 7-10th days and 1 year after CABG only neuropsychological testing. EEG predictors of early (n = 85) and long-term (n = 65) postoperative cognitive dysfunction were detected using the method of multiple linear regression.Results. EEG predictors of deterioration of cognitive status in the early postoperative period of CABG were basic higher values of theta-rhythm power in the posterior regions of the cortex of both hemispheres with closed and open eyes. Whereas higher preoperative parameters of beta2-rhythm biopotentials in the left frontal areas with eyes open and lower alpha-rhythm power in the left occipital parts of the cerebral cortex with eyes closed were associated with long-term postoperative cognitive dysfunction. Conclusion. associations of preoperative eeg indicators with deteriorations of cognitive status in the early and longterm postoperative periods of cabg were revealed

THE EFFECT OF MILD COGNITIVE IMPAIRMENT ON EEG TOPOGRAPHIC CHANGES AFTER ON-PUMP CORONARY ARTERY BYPASS GRAFTING

The purpose. Previously it was shown that on-pump coronary artery bypass grafting (CABG) induced cerebral ischemia and cognitive decline. The patients with mild cognitive impairment (MCI) could be a high-risk group of CABG-associated cognitive decline. Non-invasive neuromonitoring can provide information regarding subclinical symptoms and topography of cerebral ischemia. The aim of this study was to investigate the topographic changes in electroencephalogram (EEG) spectral power in coronary artery disease (CAD) patients with or without MCI before and after on-pump CABG.Methods: 62 males with CAD were divided into two groups according to their Mini-Mental State Examination: without MCI (n = 37) and with MCI (n = 25). Clinical factors were assessed, including the severity of coronary lesions (SYNTAX score), the left ventricular ejection fraction (LVEF). Eyes-closed rest EEG was recorded from 62 channels positioned according to the International 10–20 system. Spectral EEG power was calculated for frequencies from 0.1 to 50 Hz.Results: The patients with MCI had theta-1 (4–6 Hz) power increase 7-10 days after on-pump CABG only in frontal and fronto-central clusters of right and left hemispheres as compared to the preoperative values, whereas in the groups without MCI this effect was widespread over the brain. In the beta-1 band (13–20 Hz), CABG patients with MCI had power increase in the frontal, fronto-central and fronto-temporal regions of the brain cortex. Similar power changes in patients without MCI were observed only for occipital brain clusters.Conclusions: CAD patients with MCI have demonstrated EEG signs of cortical dysfunction focused on the frontal brain areas. Cortical dysfunction in this localization can be associated with the progression of cognitive deficits, causing loss social integration in CAD patients with MCI.The purpose. Previously it was shown that on-pump coronary artery bypass grafting (CABG) induced cerebral ischemia and cognitive decline. The patients with mild cognitive impairment (MCI) could be a high-risk group of CABG-associated cognitive decline. Non-invasive neuromonitoring can provide information regarding subclinical symptoms and topography of cerebral ischemia. The aim of this study was to investigate the topographic changes in electroencephalogram (EEG) spectral power in coronary artery disease (CAD) patients with or without MCI before and after on-pump CABG.Methods: 62 males with CAD were divided into two groups according to their Mini-Mental State Examination: without MCI (n = 37) and with MCI (n = 25). Clinical factors were assessed, including the severity of coronary lesions (SYNTAX score), the left ventricular ejection fraction (LVEF). Eyes-closed rest EEG was recorded from 62 channels positioned according to the International 10–20 system. Spectral EEG power was calculated for frequencies from 0.1 to 50 Hz.Results: The patients with MCI had theta-1 (4–6 Hz) power increase 7-10 days after on-pump CABG only in frontal and fronto-central clusters of right and left hemispheres as compared to the preoperative values, whereas in the groups without MCI this effect was widespread over the brain. In the beta-1 band (13–20 Hz), CABG patients with MCI had power increase in the frontal, fronto-central and fronto-temporal regions of the brain cortex. Similar power changes in patients without MCI were observed only for occipital brain clusters. Conclusions: CAD patients with MCI have demonstrated EEG signs of cortical dysfunction focused on the frontal brain areas. Cortical dysfunction in this localization can be associated with the progression of cognitive deficits, causing loss social integration in CAD patients with MCI

ДЛИТЕЛЬНОСТЬ ДВОЙНОЙ АНТИТРОМБОЦИТАРНОЙ ТЕРАПИИ

The review article updates on the key challenge in the present-day cardiology duration of dual antiplatelet  therapy (DAPT) in patients with a history of acute coronary syndrome. The relevant clinical guidelines are analyzed, and results of the recent clinical trials and meta-analyses  are highlighted. A risk assessment scale for evaluating ischemic and bleeding risks based on the study of DAPT is presented.В обзорной статье представлены современные данные по одному из ключевых вопросов современной кардиологии — продолжительности двойной антитромбоцитарной терапии (ДАТТ) у пациентов с перенесенным острым коронарным синдромом. Проведен анализ актуальных клинических рекомендаций, освещены результаты недавних клинических исследований и проведенных метаанализов. Представлена шкала оценки рисков ишемических и геморрагических событий, сформированная по результатам исследования DAPT

EFFECT OF METOPROLOL ON COGNITIVE FUNCTION IN HYPERTENSIVE PATIENTS OF YOUNG TO MIDDLE AGE

Aim. To evaluate the effect of metoprolol tartrate on blood pressure (BP) and cognitive function in young to middle aged patients with essential hypertension (HT).Material and methods. 40 men (age of 49,0±1,9 y.o.) with HT of I-II stage not taking antihypertensive medication regularly were enrolled into the study. All patients were given metoprolol tartrate (start dose 50-100 mg/d). Variables of 24-h BP monitoring and clinic BP, left ventricular mass index (measured by echocardiography) and characteristics of cognitive function (memory, attention, thinking and neurodynamic) were assessed at the start, after 1 and 6 months of therapy.Results. Good and satisfactory antihypertensive effect was achieved in 75% of hypertensive patients with metoprolol (186,6±13,4mg/d) monotherapy. Metoprolol significantly decreased maximum day-time systolic and diastolic BP, maximum night-time diastolic BP, mean day-time systolic and night-time diastolic BP, time-index, load-index and variability-index for night-time diastolic BP, day-time and night-time pulse BP. Left ventricular mass index reduced significantly (p<0,0001). After 6 months of therapy significant improvement of memory, attention, thinking and neurodynamic was observedConclusion. Metoprolol had beneficial effect on cognitive function in hypertensive patients, which demonstrate its cerebroprotective properties in addition to antihypertensive action. Metoprolol can reduce the risk of dementia in young to middle aged patients with HT

Clustering of indicators of the cognitive status in cardiac surgery patients to assess the risk of postoperative decline

The aim of the study. To determine the informational value of psychometric indicators used for the integral assessment of cognitive status in cardiac patients, and to find those that would help differentiate the individual sensibility to postoperative cognitive dysfunction (POCD).Materials and methods. The clustering methods were analyzed the extended psychometric testing data in 256 cardiac surgery patients. The psychometric testing carried out 3–5 days before and on days 7–10 after surgery using the psychophysiological complex program “Status PF”.Results. The cluster analysis revealed that the most informative tests for a screening risk assessment of POCD are the testing the speed of response to visual stimuli with feedback of changes in the stimuli exposition according to the individual reaction time and the testing short-term memory (memorized words). While the analysis of postoperative psychometric indicators, the patients in a modified clustering group were characterized by a deterioration of verbal memory and a decrease of the time reaction to visual stimuli whereas that its observed acceleration in the general “stable” group.Conclusion. The clustering methods enabled the identification of cardiac surgery patients in the preoperative stage who had less cognitive reserve for recovery after surgery. The changes in the relationship of complex visual and motor response, attention, and memory indicators, which depended on the belonging to the identified clusters, suggest that the preoperative period is characterized by the dedifferentiation of cognitive functions indicating a cognitive deficit

Acute coronary syndrome in patients with prior coronary artery bypass grafting. Literature review

Invasive management of patients with ST- segment elevation acute coronary syndrome (ST-ACS) and non-ST-elevation acute coronary syndrome (NSTE-ACS) is a priority and reflected in the current guidelines for management of this category of patients with a high evidence level (class I, level of evidence A). One of the limitations in invasive strategy is prior coronary artery bypass grafting in patients with multivessel artery coronary disease. This analytical review reflects modern ideas about the features of diagnosis and management of patients with acute coronary syndrome and previous coronary artery bypass surgery, approaches to revascularization from the standpoint of efficiency and safety

Изменения в структуре когнитивных функций и тревожности у кардиохирургических пациентов в зависимости от выраженности стенозов сонных артерий

Highlights. The article revealed that severe (more than 50%) carotid artery (CA) stenosis was associated with significant slowdown of the information selection processes, and these patients were characterized by older age and tendency to an increase in trait anxiety compared to the patients without CA stenosis.It was found that the reduced attention and memory was a typical feature of the cognitive status in patients with severe CA stenosis in the early postoperative period of cardiac surgery in comparison with the patients without CA stenosis. At the same time the speed characteristics indicators of the information selection processes in these patients are positively related to state anxiety.Aim. The cardiac surgery patients were studied in order to analyze the postoperative changes in the efficiency of selection information and memory processes depending on the degree of carotid artery (CA) stenosis (including more than 50%) and the age and the role of the trait anxiety indicator assessed before surgery.Methods. The prospective study included 229 patients undergoing elected coronary artery bypass grafting (CABG) or CABG and carotid endarterectomy (CEE). Each study participant underwent clinical, instrumental and extended psychometric examination before cardiac surgery and at 7-10 days after surgery. The evaluation of the extracranial vessels state was carried out before surgery using color duplex scanning. Based on the results of assessing the extracranial vessels state, all patients were divided into three groups: no stenosis (n = 124), CA stenosis less than 50% (n = 69) and more than 50% (n = 36).Results. It was found out that the patients with CA stenoses more than 50% are characterized by a slower reaction under different conditions of visual stimuli selection and by an older age as compared with patients with no stenoses as well as patients with stenoses less than 50%. In the postoperative period of cardiac surgery in comparison with testing before surgery there was an improvement in the information selection stability (an increase in the number of processed symbols per 4 minute of the Bourdon's test (p<0.00006)) and short-term memory (p = 0.03) only in the group of patients without stenoses. The patients with stenoses of less than 50% had an increase the of the information selection stability but the short-term memory decrease (p<0.05) whereas the group with stenoses more than 50% had a decrease in both the stability of information selection and short-term memory (p<0,05). Additional factors of cognitive deficit in CA stenosis patients were trait anxiety associated with memory impairment and a history of stroke that related to a decrease in the effectiveness of a complex visual-motor reaction.Conclusion. The comprehensive analysis of the cognitive status of cardiac surgery patients with different severity of CA stenosis showed that an increase in the age and stenosis degree is the factor of the reaction time slowdown under different conditions of information selection. To differentiate groups of patients depending on the severity of stenosis in the postoperative period the testing short-term memory and stability of attention is informative. These indicators improve in the group without stenosis but decrease in the group with pronounced stenosis. The trait anxiety and the history of stroke were the additional factors of memory impairment due to CA stenosis.Основные положения. Впервые показано, что выраженный (более 50%) стеноз сонных артерий (СА) приводит к значимому замедлению формирования реакции при селекции информации и эти пациенты характеризуются старшим возрастом и тенденцией к росту личностной тревожности по сравнению с больными с отсутствием стенозов СА.Обнаружено, что отличительной особенностью когнитивного статуса пациентов с выраженными стенозами СА в раннем послеоперационном периоде кардиохирургического вмешательства служат снижение объема внимания и ухудшение памяти в сравнении с больными с отсутствием стенозов СА, при этом скоростные показатели селекции информации положительно связаны с личностной тревожностью.Цель. Проанализировать послеоперационные изменения эффективности селекции информации и памяти в зависимости от степени стеноза сонных артерий (СА) (более 50%) и возраста пациентов и выяснить роль показателя личностной тревожности, измеренного до оперативного вмешательства.Материалы и методы. В проспективное исследование включены 229 больных, перенесших изолированное коронарное шунтирование (КШ) либо КШ в сочетании с каротидной эндартерэктомией. Клиническое, инструментальное и расширенное психометрическое обследование выполнено до вмешательства и на 7-10-е сут после операции. Оценка состояния экстракраниальных сосудов проведена до операции с использованием цветного дуплексного сканирования. По результатам этой оценки сформированы три группы пациентов: отсутствие стеноза СА (n = 124), стеноз СА менее 50% (n = 69) и более 50% (n = 36).Результаты. Больные со стенозами СА более 50% отличаются от пациентов с отсутствием стенозов и стенозами менее 50% более медленной реакцией в разных условиях селекции зрительных стимулов и старшим возрастом. В послеоперационном периоде кардиохирургических вмешательств только в группе лиц без стенозов отмечено улучшение устойчивости селекции информации (увеличение количества обрабатываемых за 4 минуты символов теста корректурной пробы Бурдона; p<0,00006) и кратковременной памяти (р = 0,03) в сравнении с тестированием до операции. У пациентов со стенозами менее 50% наряду с повышением устойчивости селекции информации показатели кратковременной памяти снижались (р<0,05), а в группе со стенозами более 50% отмечено как уменьшение устойчивости селекции информации, так и кратковременной памяти (р<0,05). Дополнительными факторами когнитивного дефицита при стенозе СА выступают личностная тревожность, связанная с ухудшением памяти, и наличие ОНМК в анамнезе, ассоциированное со снижением эффективности сложной зрительно-моторной реакции.Заключение. В результате комплексного анализа когнитивного статуса кардиохирургических пациентов с разной выраженностью стенозов СА установлено, что увеличение возраста и степени стеноза служит фактором замедления формирования ответа в разных условиях селекции информации. Для дифференциации групп больных в зависимости от выраженности стеноза в послеоперационном периоде информативно тестирование кратковременной памяти и устойчивости внимания, показатель которого улучшается в группе без стеноза, но снижается в группе с выраженным стенозом

Single-Photon Emission Computed Tomography in the Diagnosis of Early Postoperative Cognitive Dysfunction After Combined Carotid Endarterectomy and Coronary Artery Bypass Grafting

Objective: to study the contribution of regional cerebral blood flow (rCBF) indicators to the diagnosis of early postoperative cognitive dysfunction (POCD) in patients with multifocal atherosclerosis (MFA) with heart and brain revascularization.Material and methods. The study involved 45 patients with MFA of coronary and precerebral arteries. We analyzed patients’ cognitive indicators and conducted brain scintigraphy before and after revascularization. The criteria for inclusion in the study were: scheduled combined revascularization of coronary and precerebral arteries; signed informed consent to participate in the study. Criteria for exclusion were: refusal to participate in the study, diseases that would prevent examination. The study of cognitive functions was performed using flow was assessed by single-photon emission computed tomography using lipophilic radiopharmaceutical 99mTc-HMPAO “Ceretec”.Results. The frequency of early POCD in the isolated coronary artery bypass grafting (CABG) group was 73.3%, in the combined carotid endarterectomy (СEA) and CABG group it was 72.5% (p ˃ 0.05). The rCBF index in the isolated CABG group compared with the combined СEA and CABG group was higher in the right and left temporal lobes (p = 0.01 and p = 0.04), in the right frontal lobe (p = 0.03), right parietal lobe (p = 0.005), and in the right and left occipital lobes (p = 0.03 and p = 0.03). In the postoperative period, in the isolated CABG group, right parietal lobe perfusion (p = 0.01), and right and left occipital lobe perfusion (p = 0.01 and p = 0.01) decreased compared to the baseline values. In the combined СEA and CABG group, in the early postoperative period, cerebral perfusion did not change significantly. Right parietal lobe perfusion was higher in the isolated CABG group compared with the combined CABG and СEA group (p = 0.04). The greatest contribution to the development of early POCD in patients after isolated CABG was made by the left temporal lobe perfusion (p = 0.025), in patients after combined CABG and СEA – by the right parietal lobe perfusion (p = 0.04) in the early postoperative period.Conclusion. Assessment of cerebral perfusion in patients before and after surgery can be used to identify areas affected during surgery, as a method for monitoring the safety of procedure, and as an assessment of the preventive methods against POCD

Profibrotic genetic polymorphisms as possible risk factors for the development of diastolic dysfunction in patients with epicardial adiposity

Aim. To determine the associations of variable sites of fibrogenesis genes with the risk of left ventricular (LV) diastolic dysfunction (DD) in patients with epicardial adiposity (EA).Material and methods. The study included 101 men with general obesity (Altai Territory) without cardiovascular diseases, diabetes and documented LVDD, of which, after determining the epicardial fat thickness (EFT), 2 groups were formed: group 1 — with EA (EA+), EFT ≥7 mm or more (n=70); group 2 — without EA (EA-), EFT <7 mm (n=31). The control group was formed from Kemerovo region residents of the corresponding sex and age and without a history of cardiovascular diseases and general obesity. Polymorphisms of the MMP9 rs17576, TGFB1 rs1800469, MMP3 rs6796620, MMP3 rs626750, MMP1 rs514921, LOC101927143 rs4290029, TIMP2 rs2277698 genes were determined in all patients using the polymerase chain reaction. After 4,7±0,3 years, all patients with general obesity underwent repeated echocardiography to assess LVDD.Results. We found that in the group with EA for rs626750 MMP3, the carriage of the homozygous T allele is 2 times more common (recessive inheritance, p=0,0022). After 4,7±0,3 years, LVDD was registered in 18 patients in the EA+ group and in 2 patients in the EA- group. When analyzing inheritance patterns, as well as comparing genotypes in groups of patients with EA with developed LVDD (n=20) and without LVDD (n=78), we found that patients with EA and LVDD are 3,4 times more likely to be a carrier of the homozygous T allele (recessive inheritance, p=0,02) for rs1800469 TGFB1.Conclusion. In patients with EA and LVDD, the carriage of the T rs1800469 TGFB1 allele is more common, which probably contributes to cardiac fibrosis and LVDD according to a recessive inheritance