Cardioprotective mechanisms of sodium-glucose cotransporter 2 inhibitors

The findings of large-scale cardiovascular outcome trials have been demonstrated that sodium-glucose cotransporter 2 ­inhibitors (iSGLT-2) have shown beneficial cardiovascular effects. In this review proposed mechanisms underlying iSGLT-2-associated cardiovascular benefits have been discussed: haemodynamic and intracellular effects, including metabolic effects and electrolyte changes; and also, the effect on markers of cardiovascular disease (CVD). The hemodynamic effects of SGLT-2 are characterized by reduction of cardiac preload and afterload as a result of osmotic diuresis, a decrease in blood pressure and arterial stiffness. The metabolic effects of this medicine are accompanied by an increase the production of ketone bodies, followed by improving ATP production and myocardial energetics. Also, iSGLT-2 modulate ion transporters (NHE1 and NHE3). A reduction of cytoplasmic sodium and calcium levels and increasing mitochondrial calcium levels in the cardiomyocytes enhances the synthesis of ATP and increases cell viability. Effect of iSGLT-2 on CVD markers showed a decrease in the levels of the N-terminal pro-B-type natriuretic peptide and highly sensitive troponin I in elderly patients with type 2 diabetes mellitus (T2DM). Thus, this class of agents has a multifactorial effect on the functioning of cardiovascular system. Further studies will help to explain the all possible cardioprotective effects of iSGLT-2 in individuals with and without T2DM.

NT-proBNP level and lesion of the right ventricle in patients with pulmonary embolism

The aim – to study the relationship between the level of NT-proBNP, clinical-anamnestic and echocardiographic parameters in patients with pulmonary embolism (PE).Materials and methods. The study was carried out on 45 patients with PE, which was confirmed by computed tomo­­graphy. An echocardiographic study was carried out during hospitalization of patients according to the standard protocol. The examination plan of patients, along with standard laboratory tests, included the determination of the level of highly sensitive troponin I, C-reactive peptide (CRP) and NT-proBNP.Results and discussion. The level of NT-proBNP is increased in patients with PE, even in the absence of heart failure (2932±266 pg/ml). There were no significant differences in the level of the indicator depending on the gender of patients (p=0.3), on the presence of arterial hypertension (p=0.92) and the concomitant oncological process (p=0.88). A correlation was found between NT-proBNP level and the size of the right and left atrium: right atrium (p=0.014), left atrium (p=0.025). The relationship between the level of NT-proBNP and the pressure in the pulmonary artery according to ultrasound data was proved (in patients with PE without signs of pulmonary hypertension, the level of NT-proBNP is 405 pg/ml, versus 4067 pg/ml in the group of patients with increased pressure in the pulmonary artery (p=0.0047). A correlation was found between the levels of NT-proBNP and CRP.Conclusions. There is a significant increase in the level of NT-proBNP in patients with PE, the degree of which correlates with an increase in the size of the right atrium and pressure in the pulmonary artery (p=0.0047).

Assessment of quality of markers of myocardial damage using sigmametry

The purpose. To evaluate study quality markers of myocardial damage using Sigmametry.Materials and methods. The study was conducted in a Federal Centre for Cardiovascular Surgery. Data were collected in 2017–2018. Daily there controlled the following indicators: high-sensitivity troponin T, myoglobin, the MB fraction of creatine phosphokinase. The study was performed on an automatic immunochemical electrochemiluminescence analyzer cobas e411. The sigmametry values were calculated using CV (coefficient of variation), systematic error (bias), and total analytical error (TEmax).Results. The analysis of the quality of laboratory studies using the calculation of sigma values in 2017 revealed: sigma values less than 4 are noted in the study of the second level of the control material for highly sensitive troponin T, at the same time in the study of the first level of the control material sigma values more than 4 and amounted to 6.26. Analysis of the quality of laboratory studies in 2018, showed the following: the values of sigma is less than 4 it is noted in the study of the first level of the control material at a fraction of MB – creatine phosphokinase, at the same time in the study of level 2 control material values of sigma greater than 4, and amounted to 4.14.Conclusions. Оn the basis of sigmametry (calculation of sigma values) changes in the tactics of intralaboratory analysis were held, what allowed to improve the quality of laboratory studies.