LEFT VENTRICLE REMODELING IN PATIENTS WITH POSTINFARCTION CARDIOSCLEROSIS AND OBESITY, TAKING INTO ACCOUNT FABP 4 AND CTRP 3 LEVELS

The objective – to study the structural-functional condition of the left ventriclemyocardium (LV) in patients with postinfarction cardiosclerosis and surplus body weighttaking into account the levels of adipokines FABP4 and CTR3.Material and methods. The study involved 189 patients. The first group consisted of60 patients with postinfarction cardiosclerosis, the second group included 68 patientswith postinfarction cardiosclerosis and excess body weight (EBW), the third groupcomprised 61 patients with postinfarction cardiosclerosis and obesity. The content ofFABP 4 and CTRP 3 was determined by enzyme-linked immunosorbent assay. Statisticalprocessing of the survey results was performed using the licensed software package“IBM SPPS Statistics 27.0”. According to the sample size and distribution of indicators,the parametric Student’s test was used. Evaluation of the significance of the differencebetween the means of multiple comparisons for quantitative traits with normaldistribution using Bonferroni correction was performed by one-way analysis of variance(ANOVA).The mean and the error of the mean were determinedThe correlations of theindicators were determined using the Pearson correlation coefficient (r). At a value ofp˂0.05, the difference was considered significant.Results. Patients with post-infarction cardiosclerosis and obesity in comparison withpatients without excess body weight were found to have an increase in end-systolicvolume (ESV), end-diastolic volume, end-diastolic size (EDS), end-systolic size (ESS),stroke volume, thickness of interventricular septum, thickness of the posterior wallof the left ventricle, size of the left atrium, mass of the left ventricular myocardium,LVMMI. A direct relationship between FABP 4 and ESS, ESV, LVMMI1in patients withpostinfarction cardiosclerosis and obesity was determined. There was a significantinverse correlation between CTRP 3 and EDS, ESS, ESV, LVMMI1 in patients withpostinfarction cardiosclerosisand obesity.Conclusions. The study showed that in patients with postinfarction cardiosclerosi 34sand obesity there was an increase in echocardiographic parameters. The influence ofFABP 4 and CTRP 3 content on the structural and functional state of the left ventricularmyocardium was determined.

INDICATORS OF CENTRAL CARDIOHEMODYNAMICS IN PATIENTS WITH ARTERIAL HYPERTENSION WITH POSTINFARCTION CARDIOSCLEROSIS AND DIABETES MELLITUS TYPE 2

Central hemodynamic parameters in 40 patients with arterial hypertension, postinfarction cardiosclerosis and type 2 diabetes were evaluated. Based on the study, it is proved that type 2 diabetes mellitus is a predictor of concentric LV myocardial hypertrophy, which can be considered as a reaction of the heart to prolonged increased load and disruption of myocardial microcirculation, contributes to complex structural and functional reorganization of the heart with a tendency to reduce myocardial contractility. Comorbidity of hypertension, postinfarction cardiosclerosis and type 2 diabetes increases the incidence of signs of left ventricular diastolic dysfunction type 1 (type of relaxation disorder), which leads to a worsening of the prognosis of cardiovascular complications.

Features of comorbid pathology spectrum and age structure of oxygen-dependent patients with severe coronavirus disease 2019 (COVID-19) depending on outcomes of the disease

The aim was to analyze spectrum of comorbid pathology and age structure of oxygen-dependent patients with severe coronavirus disease 2019 (COVID-19) depending on outcomes of the disease. Materials and methods. The study included 85 oxygen-dependent patients with severe COVID-19. The patients were divided into groups: I – 70 patients with recovery; II – 15 patients in whom the disease was fatal. Statistical data processing was performed in the program Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J). Results. Among the patients with fatal outcomes of the disease, elderly and senile were dominated – 93.3 % (14 of 15) versus 67.1 % (47 of 70) among patients who recovered (P < 0.05). Analysis of comorbid pathology structure in oxygen-dependent patients with severe COVID-19 showed that patients who died more often had hypertension (93.3 % vs. 30.0 %, P < 0.001), postinfarction cardiosclerosis (26.7 % vs. 2.9 %, P < 0.001), rhythm disturbance as persistent atrial fibrillation (20.0 % vs. 1.4 %, P < 0.01) as compared to those who survived. The patients of group II were more commonly diagnosed with chronic kidney disease (20.0 % vs. 4.3 %, P < 0.05) as the comorbid pathology. The presence of ischemic stroke in COVID-19 infection influenced the disease outcome (20.0 % vs. 4.3 %, P < 0.05). Fatal outcomes in the patients with COVID-19 were associated with a combination of 3 or more comorbid conditions in 46.7 % versus 17.4 % among oxygen-dependent survivors with severe disease (P < 0.01). Conclusions. Elderly and senile oxygen-dependent patients are more likely to die from severe COVID-19 (P < 0.05). Comorbid hypertension, postinfarction cardiosclerosis, arrhythmia in the form of persistent atrial fibrillation, chronic kidney disease and ischemic stroke or the combination of 3 or more comorbid conditions listed are more common among patients with COVID-19 who died (P < 0.05) as compared to survivors.

COPD and Kidneys: Two Sides of the One Problem

The problems of diagnosis, treatment, prevention of chronic obstructive pulmonary disease remain relevant due to the increase in morbidity, disability and mortality of patients. Recently, the level of renal dysfunction in the progression of chronic obstructive pulmonary disease has increased. The purpose of research was to study the indicators of renal dysfunction in chronic obstructive pulmonary disease, depending on the severity and frequency of chronic obstructive pulmonary disease exacerbations, comorbidity, respiratory function, morphological and functional state of the myocardium to optimize the diagnosis and prognosis of chronic obstructive pulmonary disease. Material and methods. The article presents the results of examination of 81 patients in different groups of chronic obstructive pulmonary disease (BCD) with comorbidity (arterial hypertension in 49 patients, diabetes mellitus type 2 – in 16, postinfarction cardiosclerosis – in 6, diffuse cardiosclerosis – in 53, angina pectoris – in 5 patients). The external respiration function was made by using a computer spirograph. The morphological and functional state of the myocardium was studied by the standard ultrasound examination. Glomerular filtration rate was estimated by using the Cockcroft-Gault formula. The A/C ratio, microalbuminuria in the morning urine portion, and the level of C-reactive protein were also studied. The results of the studies were analyzed by methods of nonparametric statistics with an assessment of differences between groups of patients using the Mann-Whitney U-test; to assess the parameters of the relationship between indicators, the method of pair rank correlation by Spearman was used. Results and discussion. Signs of renal dysfunction, hypoxia (SpO2), systemic inflammation of low intensity C-reactive protein were found only in group D of patients with chronic obstructive pulmonary disease. In the same group, the greatest number of correlations of indicators of renal dysfunction and SpO2 with various indicators of the morphofunctional state of the myocardium according to echocardiography, the frequency of exacerbations, and comorbidity with hypertension, diffuse and postinfarction cardiosclerosis was revealed. In group B and C, no correlations of indicators of renal dysfunction with other indicators were found. In the group of patients with GFR less than 90 ml/min/1.73m2, there were correlations of the A/C ratio with the frequency of exacerbations, C-reactive protein, correlations between microalbuminuria and dyspnea, daily proteinuria, and SPPA. Conclusion. In the future, it is necessary to continue the search for early specific available biomarkers of renal dysfunction that can be used for early prescription of pleiotropic therapy, and timely initiation of nephroprotection from the standpoint of network medicine

AGE-DEPENDENT CHANGES IN ADRENOREACTIVITY IN EXPERIMENTAL POSTINFARCTION CARDIOSCLEROSIS

В настоящее время возрастает интерес к изучению активности симпатико-адреналовой системы (САС) в процессе старения организма и развитию заболеваний сердечно-сосудистой системы, связанных с возрастом. Целью исследования стала оценка β-адренореактивности мембран эритроцитов (β-АРМ) у интактных животных и животных с постинфарктным кардиосклерозом (ПИКС) в трех возрастных группах: 1-я - 20 животных 4 мес; 2-я - 20 животных 12 мес; 3-я - 20 старых животных 24 мес. В каждой возрастной группе было выделено 10 интактных и 10 опытных животных, которым методом коронароокклюзии моделировали ПИКС. Эксперименты были выполнены на крысах-самцах линии Wistar . Показано, что у интактных животных показатель β-АРМ статистически значимо увеличивался в группе 12-месячных животных по отношению к группе 4-месячных. В группах 12-и 24-месячных интактных животных не было отмечено значимых различий показателя β-АРМ. Выраженность гипертрофии сердца у животных с ПИКС находилась в обратной зависимости от возраста - 4>12>24 мес. Сформировавшийся ПИКС у животных 4 и 12 мес сопровождался выраженным увеличением β-АРМ, у животных 24 мес с ПИКС β-АРМ значимо не изменялся. Изменения показателя β-АРМ, характеризующего состояние рецепторного звена САС, в условиях ПИКС имеют возрастные особенности: у взрослых 12-месячных особей при ПИКС увеличение β-АРМ относительно показателя у 4-месячных животных свидетельствует о компенсаторной десенситизации β-адренорецепторов при активации САС в ответ на развитие сократительной недостаточности миокарда. В группе 24-месячных животных при сформировавшемся кардиосклерозе компенсаторная активация САС проявлялась в меньшей степени. Presently, there is growing interest in studying the activity of the sympathoadrenal system in the aging process of the body and the development of diseases of the cardiovascular system associated with age. The intention of the research is evaluation of β-adrenoreactivity of erythrocyte membranes (β-ARM) of intact rats and rats with postinfarction cardiosclerosis at the age of 4, 12 and 24 months: the first group contained twenty 4 months old animals; the second group - twenty 12 months old animals; the third group - twenty 24 months old animals. In the each group were distinguish 10 intact rats and 10 experimental rats, that have postinfarction cardiosclerosis (PICS) modeled by coronary occlusion. The experiments was completed on 60 male-rats. It was shown, that in intact animals the indicator of β-ARM significantly decreases by 12 months in relation to the group of 4 monthly animals. In the groups of intact animals of 12 and 24 months, there were no significant differences in β-ARM. The severity of cardiac hypertrophy in animals with PICS was inversely related to age - 4>12>24 months old. Formed PICS in animals aged 4 and 12 months was accompanied by a expressed increase of β-ARM, in animals 24 months with PICS β-ARM did not significantly change. Changes in the β-ARM index characterizing the state of the CAS receptor link under PICS conditions are age-related, in adults 12 months of age with PICS, an increase in β-ARM relative to the parameter at 4 months. animals indicates compensatory desensitization of β-adrenergic receptors upon activation of CAS in response to the development of contractile myocardial insuffi ciency. In the age group of 24 months with the formed cardiosclerosis, compensatory activation of CAS is manifested to a lesser extent.

Relationship of individual components of antiphospholipid syndrome with different types of left ventricular remodeling in patients with post-infarction cardiosclerosis and arterial hypertension

The aim – to establish the features of left ventricular myocardial remodeling in men with postinfarction cardiosclerosis and to evaluate its relationship with the components of the antiphospholipid syndrome. Materials and methods. 164 patients with stable coronary heart disease and postinfarction cardiosclerosis were examined (100 % male, 53.0±9.14 years). The total antiphospholipid antibodies (aPL) to cardiolipin, phosphatidylserine, phosphatidylinositol, antibodies to β2-glycoprotein 1 (anti-β2-GP1) IgG and IgM classes were determined by ELISA. Echocardiography was performed by conventional methods, the type of left ventricular (LV) geometry was determined according to Ganau. Results and discussion. Positive levels of aPL and anti-β2-GP1 IgG were detected in 56.7 % of patients, including 33.5 % – double positivity for these antibodies. Positivity for aPL and anti-β2-GP1 IgG was associated with more significant echocardiographic signs of LV systolic and diastolic dysfunction. Among patients with positive levels of aPL and anti-β2-GP1 IgG LV hypertrophy were higher (2.5–3.0 times, p<0.05) than among patients with negative antibody levels. Increased levels of anti-β2-GP1 IgG were found to be an independent predictor of increased LV myocardial mass index (β=0.344, p<0.0001) in men with postinfarction cardiosclerosis. Conclusions. In men with postinfarction cardiosclerosis who had positive levels of aPL and anti-β2-GP1 IgG, associated with the development of systolic and diastolic dysfunction and with a higher risk of maladaptive LV remodeling.

AB0434 PREVALENCE OF ANTIPHOSPHOLIPID SYNDROME COMPONENTS IN MEN WITH STABLE СORONARY HEART DISEASE AND POSTINFARCTION CARDIOSCLEROSIS AND CONECTION WITH ECHOCARDIOGRAPHIC EVALUATION OF CARDIAC STRUCTURE AND FUNCTION 1.0.0.20

Background:Antiphospholipid syndrome (APS) as an independent factor in different forms of coronary heart disease (CHD) has been attracting more attention in recent years [1]. The prevalence of AFS in the general population is low (1-5%) but among patients with acute coronary syndrome it ranges from 6.1% to 43.3%. The persistence of high titers of antiphospholipid (aPL) antibodies, especially antibodies to cardiolipin, accelerates the development of endothelial dysfunction and atherothrombotic lesions of the coronary arteries, worsens the course of acute myocardial infarction. It has been experimentally demonstrated that aPL antibodies can directly affect myocardial status through pro-apoptotic signaling pathways and increased cardiomyocyte apoptosis [2].The impact of aPL antibodies on the course of postinfarction myocardial remodeling in patients with CHD has not been established.Objectives:To study the prevalence of APS components in men with stable CHD with postinfarction cardiosclerosis and to evaluate the relationship with structural and functional state of left ventricular myocardium.Methods:164 patients with CHD with postinfarction cardiosclerosis were examined (100% males at the average age of 53,0±9,14 (M±σ)). The diagnosis of CAD was made according to the recommendations of the ANA / ACC (2014) and ESC (2013). The content of IgG and IgM of aPL antibodies - antibodies to cardiolipin, phosphatidylserine, phosphatidylinositol, phosphatidylacetate and levels of IgG and IgM to β2-glycoprotein I (β2-GP-I) in the blood serum were determined by ELISA. Echocardiography in M-, B- and D-modes was performed.Results:Among 164 patients with post-infarction cardiosclerosis: 75% had Q myocardial infarction (MI), 10.4% had recurrent MI, 7.9% had a stroke or transient ischemic attack and 4.2% had livedo reticularis. 93 (56.7%) patients had positive levels of total aPL antibodies and antibodies to β2-GP-I of IgG class (58 (35,4%) patients had low positive levels of antibodies, 35 (21.3%) patients had medium positive levels of one or both types of antibodies. Positive levels of aPL antibodies and antibodies to β2-GP-I of IgM were detected in 11.6% of patients. Positive levels of aPL antibodies and antibodies to β2-GP-I were more commonly found in men who had Q MI (OR 2.58 95% CI 1.26 - 5.28) and recurrent MI (OR 2.52 95% CI 0.83 - 7.67). Increases of levels of aPL antibodies and antibodies to β2-GP-I correlated with an increase of left ventricle (LV) mass index (r = 0.259 and 0.331, p <0.001). In patients with positive levels of antibodies of IgG to β2-GP-I in postinfarction LV remodeling was more likely to occur by concentric type of hypertrophy of LV than in patients with negative levels of antibodies to β2-GP-I (OR 6.50, 95% CI 2.49 - 16.9, p <0.001). Hypertension had no significant differences within these groups.Conclusion:The risk of persisting positive levels of aPL antibodies and antibodies to β2-GP-I in the postinfarction period is significantly increased in men who had Q MI. Patients with CHD with positive antibodies to β2-GP-I of IgG are associated with an increased risk of postinfarction LV myocardial remodeling by concentric type of hypertrophy of LV.References:[1]Kolitz, T., Shiber, S., Sharabi, I., Winder, A., & Zandman-Goddard, G. (2019). Cardiac manifestations of antiphospholipid syndrome with focus on its primary form.Frontiers in immunology,10, 941.[2]Bourke, L. T., McDonnell, T., McCormick, J., Pericleous, C., Ripoll, V. M., Giles, I., ... & Ioannou, Y. (2018). Antiphospholipid antibodies enhance rat neonatal cardiomyocyte apoptosis in an in vitro hypoxia/reoxygenation injury model via p38 MAPK.Cell death & disease,8(1), e2549-e2549.Disclosure of Interests:None declared