Features of adipokine status in hypertensive patients with chronic kidney disease

The study aimed at optimization of diagnosis and evaluation of chronic kidney disease (CKD) in hypertensive patients by studying the role of adipokines (leptin, omentin, visfatin, resistin) in patients with hypertension combined with chronic kidney di­sease. Materials and methods. The study enrolled 100 patients with hypertension of II and III degrees of Stage 2, of which 51 patients were diagnosed with chronic kidney disease. The control group consisted of 20 apparently healthy people. Results. Our study showed that leptin, omentin, resistin, and visfatin levels were significantly higher in patients with essential hypertension (EH) combined with CKD, in contrast to patients with EH without CKD and in the control group. The results of the Kraskel-Wallis dispersion analysis demonstrated that in patients with EH combined with CKD, adipokines significantly correlated with systolic blood pressure (BP), diastolic blood pressure, hypertension degree, body mass index, low-density lipoproteins, thyroglobulin, glomerular filtration rate, creatinine, end-diastolic size, relative wall thickness index, left ventricular myocardial mass, left ventricular myocardial mass index, presence of diastolic dysfunction, type of diastolic function. Conclusions. Hypertensive patients with CKD presented with a significant increase in adipokine levels (leptin, omentin, resistin, visfatin) in the blood compared to patients with EH without CKD (p < 0.05) and apparently healthy individuals (p < 0.05). The data obtained indicate that adipokines (leptin, omentin, resistin, visfatin) have a significant pathogenetic role in patients with hypertension combined with chronic kidney disease.

P1829CARDIOVASCULAR DISORDERS IN CHILDREN WITH CHRONIC KIDNEY DISEASE

Background and Aims Pathology of the cardiovascular system is the leading cause of death in patients with CKD, while determining the causes of the formation of cardiac events is often difficult. Method We conducted an analysis of echocardiography data performed by 50 children with CKD. On the echoCG, the final systolic and diastolic sizes of the left ventricle (FSS and FDS), the final systolic and diastolic volumes of the left ventricle (FSV and FDV) were determined; measured the thickness of the interventricular septum (IVS) and the posterior wall of the left ventricle (PWLV). Left ventricular myocardial mass (LVMM) was determined by the formula proposed by R. Devereux and N. Reichek: LVMM = 1.04x (/ IVS+PWLV+FDS/3-FDS3) - 13.6where, IVS - thickness of IVS in diastole,PWLV-thickness of PWLV in diastole, FDS-final diastolic size of the left ventricle. Results We conducted an analysis of echocardiography data performed by 50 children with CKD. On the echoCG, the final systolic and diastolic sizes of the left ventricle (FSS and FDS), the final systolic and diastolic volumes of the left ventricle (FSV and FDV) were determined; measured the thickness of the interventricular septum (IVS) and the posterior wall of the left ventricle (PWLV). Left ventricular myocardial mass (LVMM) was determined by the formula proposed by R. Devereux and N. Reichek: LVMM = 1.04x (/ IVS+PWLV+FDS/3-FDS3) - 13.6where, IVS - thickness of IVS in diastole,PWLV-thickness of PWLV in diastole, FDS-final diastolic size of the left ventricle. Conclusion The mechanisms of damage to the heart and blood vessels in patients with CKD begin to function already in the initial stage of renal failure and increase as it progresses. The need to know the data of clinical, laboratory and instrumental examination methods at the terminal stage of CKD is dictated, first of all, by the possibility of exposure to them. An important stimulus for conducting an echocardiographic examination is the early detection and correction of cardiovascular disorders, in connection with the prospect of increasing the survival of patients after kidney transplantation.

Clinical and hemodynamic predictors of cognitive dysfunction in patients with coronary heart disease

The aim – to determine the clinical and hemodynamic risk factors for the development of cognitive dysfunction in patients with coronary heart disease.Materials and methods. 110 patients with a history of acute myocardial infarction, unstable angina pectoris, or coronary artery revascularization were included in the study. Depending on the diastolic function, the patients were divided into three groups: I group – normal diastolic function, II group – impaired relaxation, III group – pseudonormalization or restriction. Cognitive function was assessed on the MMSE, MoCA scales, Frontal Assessment Battery (FAB), Trial Making Test and Rey audio-verbal test.Results and discussion. The average number of points on the MMSE scale with an increase in the severity of diastolic dysfunction (DD) decreased and amounted to 25.40±2.58 in the I group, 24.95±2.69 in the II group, and 22.30±3.17 in the III group (p1,3<0.0001, p2,3=0.001); on the MoCA scale it equaled to 23.47±3.41 in the I group, 22.09±3.48 in the II group and 19.85±5.19 in the III group (p1,2=0.039, p1,3=0.004, p2,3>0.05). A negative correlation of average degree (r=–0.35, p<0.05) between MMSE score and the type of DD was revealed, and a negative correlation of the strong degree (r=–0.50, p<0.00001) – between MMSE score and left ventricular filling pressure (LVFP). The MoCA scale showed a moderate degree negative correlation (r=–0.30, p=0.0018) with DD and a strong degree negative correlation (r=–0.41, p<0.05) with LVFP. A negative correlation of a weak degree was also revealed between the score on the FAB and LVFP (r=–0.24, p<0.05). It was found that the number of points on the MMSE scale reliably correlates with smoking status, left atrium indexed volume and left ventricular myocardial mass index (r=0.23, r=–0.25, r=–0.25, respectively). The values of the left atrium volume index and left ventricular myocardial mass index correlated with the score on the MoCA scale (r=–0.25, r=–0.18, respectively). The likelihood of development of cognitive dysfunction increased with an increase in glycated hemoglobin (OR 2.65, 95 % CI 1.08–6.48, p=0.033), diastolic function worsening (OR 3.18, 95 % CI 1.18–8.59, p=0.023) and an increase in LVFP (OR 6.03, 95 % CI 2.32–15.69, p=0.0002) on the MMSE scale, and with a worsening of diastolic function (OR 2.86, 95 % CI 1.18–6.94, p=0.020) on the MoCA scale. According to the results of direct multiple logistic regression, it was revealed that among all the indicators, only LVFP significantly affected the total number of points on the MMSE scale (OR 1.28, 95 % CI 1.11–1.47, p=0.0007).Conclusions. It was revealed that the diastolic function has a significant influence on the state of cognitive function. A negative correlation was noted between the type of DD, LVFP, and the scores on the scales of cognitive functions. The likelihood of cognitive dysfunction on the MMSE scale increased with an increase in glycated hemoglobin, diastolic function worsening, increase in LVFP, diastolic function worsening (on the MoСA scale). According to the results of multiple regression, only LVFP significantly affected the total number of points on the MMSE scale.

4310Left ventricular myocardial mass index is a predictor of clinical outcomes in patients with Fabry disease

Fabry disease (FD) is a rare lysosomal storage disorder characterized by severe complications in young patients. The aim of the study was to determine predictors of clinical outcomes in patients with FD. Methods The diagnosis of FD was confirmed by enzymatic and genetic studies. The outcomes included death and a composite of end-stage renal disease (ESRD), cardiac (clinically significant arrhythmia and cardioverter/pacemaker implantation) and cerebrovascular (transient ischemic attack, stroke) events. Cox regression model was used to examine the risk of clinical outcomes. Results One hundred adult patients (65 males and 35 females, median age 40 [32; 50.8] years) with a definite diagnosis of FD were enrolled in our study. The majority of patients had classic phenotype (94.2%) and missense mutations in the GLA gene (69.0%). Forty-seven patients (38 males and 9 females) experienced clinical outcomes which included arrhythmias in 10 patients (atrial fibrillation in 8 of thems), ESRD in 33 patients, and cerebrovascular events in 8 patients. The median age of the first outcome was 39 (32; 49) years. In males, the outcomes occurred more frequently than in females (58.5% vs. 25.7%, respectively, p=0.002). Eleven males died at the median age of 43 (37; 46) years. All of them had ESRD. The most frequent cause of death was sudden cardiac death (n=9). Left ventricular myocardial mass index (LVMMI) was higher among patients with outcomes than in patients without outcomes (153 g/m2 [102; 203] vs. 92 g/m2 [78; 122], respectively, p<0.0001). However, there was no correlation between LVMMI and cardiac events (p=0.12). Using Cox regression analysis, LVMMI (HR 1.01 [1.002; 1.02], p=0.015), eGFR <60 ml/min/1.73m2 (HR 3.79 [1.87; 7.66], p<0.0001) and albuminuria>300 mg/day (HR 1.29 [1.04; 1.59], p=0.022) were associated with a higher risk of a composite outcome after adjustment for gender and age. Albuminuria>300 mg/day (HR 1.57 [1.05; 2.35], p=0.029) and LVMMI (HR 1.006 [1; 1.012], p=0.038) were predictors of death after adjustment for gender. However, this effect has been lost after adjustment for hemodialysis duration. The type of mutation in the GLA gene was not a predictor of clinical outcomes. Conclusion Left ventricular myocardial mass index was a predictor of clinical outcomes in patients with FD. Poor prognosis in our cohort was related to ESRD that accounted for all deaths.

Dynamics of Indicators of Structural and Functional State of the Heart in the Post-Infarction Period Depending on the Presence of Decompensated Heart Failure

Echocardiographic indicators in decompensated heart failure demonstrate a high prevalence of structural and hemodynamic abnormalities. In the patients with decompensated heart failure in the early and late post-infarction period, echocardiographic indicators were found to significantly differ from those recorded in the patients without heart failure. Thus, reduced ejection fraction, increased end-diastolic volume and end-diastolic dimension indicate left ventricular systolic dysfunction and left ventricular cavity dilation. Since echocardiography of the heart and the pulmonary artery enables real-time estimation of cardiac filling, signs of systolic dysfunction and pulmonary congestion, it may serve as a predictor of decompensated heart failure development in the early and late post-infarction period. The objective of the research was to determine the main echocardiographic indicators in terms of rapid monitoring of deterioration in the main parameters of left ventricular overload for early diagnosis of decompensated heart failure, as well as structural and geometric remodeling of left ventricular myocardium in the early and late post-infarction period. Materials and methods. There were examined 160 patients with acute myocardial infarction. Depending on the development of decompensated heart failure in the early and late post-infarction period, the patients were divided into two subgroups being homogeneous by age and gender. Results. The results obtained indicated significant hemodynamic changes in the patients with decompensated heart failure in the post-infarction period. They included significantly lower values of ejection fraction indicating left ventricular systolic dysfunction and the signs of left ventricular cavity dilation as evidenced by the increase in left ventricular end-diastolic volume and end-diastolic dimension. The tendency for an increase in left ventricular posterior wall thickness and interventricular septal thickness, as well as left ventricular myocardial mass, left ventricular myocardial mass index and left ventricular radius to wall thickness ratio indicated concentric left ventricular remodeling. Conclusions. Modern management of patients with decompensated heart failure should be guided by an objective value of left ventricular ejection fraction as it plays a key role in selecting management strategy for this cohort of patients since a significant reduction in this parameter indicates cardiac decompensation. Pulmonary artery pressure and concentric left ventricular hypertrophy play a significant role in cardiac failure development as well.

Restoration of clinical and instrumental parameters of the cardiovascular system in patients with diffuse toxic goiter after resolution of thyrotoxicosis

Rationale:Evaluation of the cardiovascular system in patients with common thyroid disorders could be of interest from the perspective to identify new risk factors for cardiovascular events. Whether cardiovascular abnormalities associated with thyrotoxicosis would be reversible after its treatment, needs elucidation.Aim: To assess the degree of restoration and prerequisites for reversion of the signs and symptoms of cardiac injury in the long term after conservative and surgical cure of thyrotoxicosis in patients with diffuse toxic goiter (DTG).Materials and methods: This was an open longitudinal retrospective study performed in the Regional Center for Endocrine Surgery, Chelyabinsk Municipal Clinical Hospital No. 1 in 124 patients with past history of DTG. By the time of examination, all patients were in a stable clinical and laboratory remission after the withdrawal thyrostatic agents or were in controlled post-operative hypothyroidism for 1.5 to 5 years after surgery for DTG. The mean age of the conservatively treated patients (n=62) was 39.9±1.31 years (19 to 55 years). The mean age of the patients that had been treated surgically (n=62; subtotal thyroid resection) was 41.1±1.4 years (21 to 56 years). We compared with patients' complaints, electrocardiographic and echocardiographic parameters by the time of examination with the corresponding data at the time of the primary referral.Results: In the long term after the elimination of thyrotoxicosis, 56.5% (35/62) of the patients who had underwent surgery, were complaining of dyspnea, 54.8% (34/62) of palpitations, and 50% (31/62) of cardialgias (p<0.01), whereas among the conservatively treated patients the corresponding complaints were present in 59.7% (37/62), 64.5% (40/62), and 56.5% (35/62) (p<0.01). Ninety nine (99) percent of the patients, who had arterial hypertension before the treatment, remained hypertensive at the follow-up. In 30% of the surgically treated patients the severity of arterial hypertension was higher than initially. In the surgery group, there was a decrease in the left atrium diameter in 17 patients and in the end-diastolic diameter of the right ventricle in 24 patients; all these patients did not have hypertension at baseline. No restoration of the heart chamber diameters was seen after conservative treatment and after surgery in patients with arterial hypertension. ST segment and T wave abnormalities were not associated with any clinical symptoms both at baseline and in the long term. At the long term follow up all patients had normal thyroid-stimulating hormone (TSH) and thyroxine (T4) levels, with no associations between TSH and T4 levels and clinical and instrumental assessment results. All patients with past history of DTG continued to have tachycardia, arterial hypertension, diastolic dysfunction and increased left ventricular myocardial mass.Conclusion: Cardiovascular abnormalities persisted for a long time after the elimination of DTG. Arterial hypertension that had arisen against the background of DTG had a negative impact on the structural and functional state of the heart in this disease, irrespective of the treatment method used. In the patients with past history of DTG, we identified such predictors of heart failure as tachycardia, arterial hypertension, diastolic dysfunction, increased left ventricular myocardial mass.