Search

Background. There is a lack of scientific data on the mechanisms of influence of type 2 diabetes mellitus (T2DM) and metabolic syndrome (MS) on the incidence of complications in patients with myocardial infarction; no effective methods of their correction have been developed. The purpose of the study was to evaluate the incidence of reperfusion complications and the effectiveness of upstream therapy in patients with acute myocardial infarction combined with T2DM and MS by including L-carnitine/L-arginine and dapagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, in the treatment program. Materials and methods. We examined 38 patients with acute ST-elevation myocardial infarction (STEMI) on the background of T2DM and MS (study group) and 38 patients with STEMI without T2DM and MS (control group). In addition to the use of general clinical methods, detailed laboratory and instrumental examinations were performed: biochemical blood tests, evaluation of glucose, insulin, HOMA-IR, lipidogram, coagulogram, creatine kinase-MB, troponin T, electrocardiography, transthoracic echocardiography and coronary angiography. The risk of in-hospital mortality was predicted by the GRACE score. All patients with STEMI underwent urgent coronary angiography with subsequent balloon angioplasty and the infarct-dependent internal carotid artery stenting, as well as standard drug therapy according to the Ministry of Health protocol and were additionally prescribed dapagliflozin 10 mg/day and 5 intravenous infusions of L-arginine-L-carnitine mixture (4.2 and 2.0 g, respectively) in 100 ml of solvent. Results. STEMI on the background of T2DM and MS is significantly more common in middle-aged men. The development of STEMI was associated with the presence of comorbid conditions: hypertension, T2DM and MS, chronic kidney disease, and combined risk factors for coronary heart disease. The severity of the patient's clinical condition was due to congestive heart failure III-IV and the presence of life-threatening complications of the acute period of myocardial infarction such as ventricular arrhythmias (45.3 %), conduction disorders (23.8 %), pulmonary edema (17.3 %), and acute left ventricular aneurysm (13.3 %). Compensation of carbohydrate metabolism in patients with myocardial infarction combined with T2DM and MS using dapagliflozin was accompanied by a significant reduction in the incidence of life-threatening complications: the incidence of rhythm disturbances in patients of the study group decreased from 87.5 to 50.0 %, heart failure (Killip class II-III) - from 70.0 to 12.5 %, which was significant compared with the control group. The inclusion of parenteral arginine (4.2 g/day) and L-carnitine (2.0 g/day) in the protocol therapy program contributed to a decrease in postinfarction cardiac remodeling and an increase in ejection fraction by 7 %. In this situation, cytoprotective therapy against the background of treatment with the SGLT2 inhibitor dapagliflozin acts as a pathogenetic upstream therapy. Conclusions. In patients with STEMI combined with T2DM and MS, hyperglycemia, insulin resistance and severe abnormalities of morphological and functional parameters of the heart with its systolic-diastolic dysfunction are observed at baseline, which are triggers of the complicated course of this pathology, with the development of heart failure syndrome, rhythm and conduction disorders. The comprehensive treatment with the inclusion of L-carnitine and L-arginine against the background of using the SGLT2 inhibitor dapagliflozin as upstream therapy helps restore tissue sensitivity to insulin, improve carbohydrate metabolism, central cardiovascular hemodynamics that is accompanied by a significant reduction in the frequency and severity of acute left ventricular failure and life-threatening reperfusion arrhythmias. [ABSTRACT FROM AUTHOR]

Background. The relevance of finding optimal methods for treatment of people with type 2 diabetes (T2DM) who had coronavirus disease 2019 (COVID-19) is due to the fact that these conditions have a number of common pathogenetic mechanisms that cause complications of both diseases. The purpose of the study was to assess the effect of antidiabetic therapy using sodium-glucose cotransporter-2 inhibitors (SGLT2i) on serum level of cardiovascular markers, ST2 peptide and homocysteine, in patients with T2DM in the post-COVID period compared to standard therapy (metformin/sulfonylurea derivatives). Materials and methods. Forty-three T2DM patients aged 44–85 were examined during the acute period of COVID-19 and nine months after recovery. Group 1 (n = 25) received treatment with SGLT2i in addition to metformin; group 2 (n = 18) continued taking a combination of metformin and sulfonylurea derivatives. Group 3 (control) consisted of 32 people without an impaired carbohydrate metabolism who have had COVID-19. The follow-up period was 9–12 months after recovery from COVID-19. Results. In 9 months of treatment, a significant decrease was noted in serum level of homocysteine, which was elevated in the acute period of COVID-19 and reached normal values: in group 1, from 16.8 to 9.9; in group 2, from 14.4 to 10.1 μmol/l; p < 0.05. In addition, in the post-COVID period, there was a significant decrease in the serum level of ST2, the biomarker of cardiovascular pathology, in patients of group 1 (from 5.4 to 4.8 ng/ml; p < 0.05), in contrast to group 2, where ST2 increased (from 4.9 to 5.7; p < 0.05). Patients of group 3, unlike individuals with T2DM from both groups, had a significantly lower average level of ST2 (p < 0.05), which did not change 9 months after the coronavirus infection (p > 0.05). Conclusions. The results obtained confirm the positive effect of taking SGLT2i on the level of cardiovascular risk markers in patients with T2DM who had received gliflozin therapy for 9 months after recovery from COVID-19, in contrast to the group of patients who received metformin/sulfonylurea derivatives. [ABSTRACT FROM AUTHOR]

A well-known and dangerous complication of COVID-19 infection is the development of hypercoagulation, which leads to thrombosis of various localization. Therefore, the problem of anticoagulant therapy was widely discussed during the first months of the pandemic and continues to be relevant. At the same time, concomitant cardiac pathology is associated with a more severe course of COVID-19 and higher risks of complications and mortality. Therefore, patients who underwent cardiac surgery require special attention. Individuals with prosthetic metal heart valves must constantly receive anticoagulant therapy, however, the literature describes cases of intracardiac thrombotic complications despite anticoagulation during COVID-19 infection. Currently, there are no randomized studies on this issue, and only individual clinical cases provide this information. The aim of the work was to describe a clinical case of thrombosis at the left ventricular apex during COVID-19 infection in a patient with a prosthetic aortic valve who received adequate warfarin therapy and to compare the tactics of patient management and therapeutic outcomes with other clinical cases. Materials and methods. The patient was followed-up after aortic valve replacement for 2 years. During the visits, a general clinical examination, laboratory examinations - clinical blood test, blood glucose, urea, creatinine, bilirubin, INR, NT-proBNP, echocardiography were performed. Results. The patient with a congenital heart defect, a condition after aortic valve replacement, mitral and tricuspid valve annuloplasty (15.03.2022) due to bicuspid aortic valve, combined aortic defect with predominance of stage III-IV regurgitation; stage III secondary arterial hypertension; chronic heart failure IIA, functional class III, stage C, reduced systolic left ventricular function; a two-chamber pacemaker due to complete AV blockade; paroxysmal atrial flutter presented to a cardiologist with worsening shortness of breath and weakness one month after a moderate COVID-19 infection. The patient received bisoprolol 5 mg, amiodarone 200 mg, spironolactone 50 mg, perindopril 8 mg, warfarin 5 mg, INR was carefully controlled, at presentation - 3.7. Echocardiography revealed a left ventricular apex thrombus, a decrease in left ventricular ejection fraction (LVEF) from 46 % to 38 %. Aspirin 75 mg/day, torasemide 10 mg/day, dapagliflozin 10 mg/day, and metabolic therapy were added to the treatment. After 1 month, the patient's condition improved, no thrombus was detected in the left ventricular cavity, LVEF increased to 46 %. Conclusions. This case demonstrates the problem of careful cardiovascular system state monitoring in patients with prosthetic valves during and after COVID-19, since symptoms of heart cavity or valve thrombosis, worsening heart failure can be mistakenly considered as signs of a viral infection or respiratory failure. [ABSTRACT FROM AUTHOR]

Aim. To determine the relationships between serum concentrations of growth and differentiation factor 15 (GDF 15) and NTproBNP and features of heart remodeling in patients with heart failure and preserved ejection fraction (HFPEF) depending on the history of Q-myocardial infarction (MI). Materials and methods. The study was performed on the basis of the Cardiology Department of the Municipal non-profit Enterprise "City Hospital of Urgent and Emergency Medical Care" of Zaporizhzhia City Council. 72 patients (mean age 62.1 ± 1.7 years) with HFPEF after MI were enrolled. The patients were divided into two groups depending on the time of previous MI. The patients were examined using two-dimensional echocardiography on a MyLab50 device (Esaote, Italy) according to the recommendations of the American Society of Echocardiography. Serum concentrations of GDF 15 and NTproBNP were measured by enzyme immunoassay using Elabscience reagent kits (USA). Results. In the 1st and 2nd groups of patients who suffered MI within a year, a significant increase in GDF 15 has been found (by 66.1 % and 74.7 %, respectively; p < 0.05) compared to the control group. The level of GDF 15 was significantly higher (by 41.8 %, p < 0.05) in the group of patients who had MI over a one-to-two-year period as compared to those who had MI within one year. The serum concentration of NTproBNP was also significantly higher in HFPEF groups compared to the control group (by 84.7 % and 87.2 %, respectively, p < 0.05). In the 2nd group of patients with the history of MI between 1 and 2 years, a significant increase in end-systolic volume (by 11.8 %, p < 0.05), end-diastolic volume (by 22.3 %, p < 0.05), left ventricular myocardial mass index (by 19.1 %, p < 0.05) and the E/e' ratio (by 20.9 %, p < 0.05) has been revealed as compared to the 1st patient group. A strong direct correlation has been shown between the time of MI occurrence and the concentration of GDF 15 (r = 0.58, p < 0.05), the interventricular septum thickness at diastole (r = 0.61, p < 0.05) and the left ventricular myocardial mass index (r = 0.63, p < 0.05), GDF 15 and E/e' (r = 0.37, p < 0.05), GDF 15 and the left atrial volume index (r = 0.41, p < 0.05), GDF 15 and NTproBNP (r = 0.56, p < 0.05). Conclusions. Progression of left ventricular myocardial hypertrophy and diastolic dysfunction with dilatation of the heart chambers has been observed in HFPEF patients with a longer history of MI. The time period of MI in patients with HFPEF was associated with the serum concentration of GDF 15, the interventricular septum thickness and the mass index of the left ventricular myocardium. The serum concentration of GDF 15 was significantly correlated with the deterioration of the left ventricular diastolic function, such as an increase in the E/e' ratio and the left atrial volume index. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most common extrapulmonary complication of the past SARS-CoV-2 infection. According to experts, almost 20% of patients with past COVID-19 have a history of atrial fibrillation and the incidence of new paroxysms of this arrhythmia ranges from 10 to 18%. Referring to the studied patients who experienced COVID-19 more than 6 months ago, the subjective perception of cardiac arrhythmia is the most frequent complaint, reported by approximately two-thirds of patients. The aim of our study was to determine the course of atrial fibrillation in patients after past 2019 coronavirus disease (COVID-19) during a dynamic 6-month follow-up after the initial hospitalization for atrial fibrillation in the specialized department of cardiac arrhythmias of the SI “National Scientific Center” “M.D. Strazhesko Institute of cardiology, clinical and regenerative medicine of the National Academy of Medical Sciences of Ukraine” depending on the clinical and anamnestic, demographic, anthropometric factors, the results of laboratory research methods and the received treatment. 36 patients were included in the study, 27 of them formed the first group, which included patients in whom the course of atrial fibrillation improved against the background of recommended antiarrhythmic treatment after initial hospitalization for AF and past COVID-19, who at the time of hospitalization had a negative PCR test, of which 17 were women and 10 were men, aged 62.38±1.83 years. The second group consisted of 9 patients including 4 women and 5 men, aged 69.88±2.60 years in whom the course of atrial fibrillation neither changed nor worsened. We determined that the number of patients in whom the course of atrial fibrillation improved during the 6-month follow-up was three times greater than those in whom the course of this arrhythmia neither changed nor worsened (75% and 25%, respectively). Patients with a more favorable course of atrial fibrillation were younger (on average by 7.5 years), three times less likely to suffer from diabetes and not often had arterial hypertension of the III stage, than those examined, in whom the course of this arrhythmia did not change or worsen. Systemic inflammation and severity of heart failure significantly worsen the course of AF within 6 months after the hospital stage of treatment. However signs of deterioration of lipid metabolism are characteristic of patients with an unfavorable course of atrial fibrillation during 6 months after hospitalization, which is probably caused by the activation of systemic inflammation in them. The improvement of the prognosis of the examined patients was probably influenced by the appointment of antiarrhythmic drugs, such as: amiodarone, flecainide, beta-blockers, statins – from the "up-stream" therapy drugs. [ABSTRACT FROM AUTHOR]

Background. Heart failure (HF) is the most common cause of hospitalization and mortality in patients with cardiovascular diseases. It is known that concomitant diseases and the dynamics of some biomarkers, hormones and genetic factors are associated with the course of HF and its progression. Gene polymorphisms of β1- and β2-adrenergic receptors (β1- and β2-AR) probably play an important role in the occurrence, progression of HF and the formation of response to therapy with β-adrenergic blockers. Conducting a comprehensive analysis can add arguments in favor of a cause-andeffect relationship between polymorphisms and disease phenotypes. This encourages new research in this direction. The purpose was to study the correlation between β1- and β2-adrenergic receptor gene polymorphisms and the risk of developing heart failure. Materials and methods. Two hundred and one patients with HF on the background of post-infarction cardiosclerosis were included. Control group consisted of 43 healthy persons of comparable age and sex. Genotyping was carried out for 3 polymorphisms (Gly389Arg of the β1-AR gene, Ser49Gly of the β1-AR gene, Gln27Glu of the β2- AR gene) using the polymerase chain reaction. Echocardiography was performed. Statistical analysis was done using SPSS and SNPStats programs. Results. The A allele (A/G-A/A) of the Ser49Gly polymorphism of the β1-AR gene is associated with a reduced risk of heart failure (odds ratio (OR) = 0.45 (0.23–0.91), p = 0.029, dominant model of inheritance). Data on a decreased risk of HF in the presence of the A allele of the Ser49Gly polymorphism of the β1-AR gene are also confirmed in codominant (OR = 0.43 (0.22– 0.87), p = 0.048), overdominant (OR = 0.43 (0.21–0.86), p = 0.02) and log-additive (OR = 0.51 (0.27–0.99), p = 0.051) inheritance models. During a comparative analysis of the distribution of the Ser49Gly (c.145A>G) polymorphism alleles of the β1-AR gene, a tendency towards a decrease in the frequency of the A allele in patients with HF was revealed compared to the control group (11.9 against 19.7 %, respectively; χ2 = 3.759; p = 0.053). Among patients with HF, a heterozygous genotype (G/A) occurred in 21.9 % of cases against 39.5 % in the control group (χ2 = 6.163; p = 0.046). The A allele (A/G-A/A) of the Ser49Gly polymorphism of the β1-AR gene is associated with a decreased risk of reduced left ventricular ejection fraction ≤ 40 % (OR = 0.43 (0.19–0.95), p = 0.048 in the dominant model, and OR = 0.42 (0.19–0.93), p = 0.033 in the overdominant model of inheritance). The risk of a decrease in left ventricular ejection fraction among patients with HF is lower among carriers of the G allele of the Gln27Glu polymorphic locus of the β2-AR gene (OR = 0.52 (0.30–0.92), p = 0.025). Conclusions. The risk of developing heart failure and its phenotype are associated with genetic differences in β-adrenergic receptors. The A allele of the Ser49Gly polymorphism of the β1-adrenergic receptor gene is associated with a reduced risk of developing heart failure (OR = 0.45; p = 0.029, dominant model of inheritance), and a decrease in the left ventricular ejection fraction ≤ 40 % (OR = 0.43; p = 0.048 in the dominant model). The risk of reduced left ventricular ejection fraction in patients with heart failure is lower in carriers of the G allele of the Gln27Glu polymorphic locus of the β2-adrenergic receptor gene (OR = 0.52, p = 0.025, overdominant inheritance model). [ABSTRACT FROM AUTHOR]

Aim. To evaluate the levels of soluble growth stimulator gene 2 (sST2) protein and N-terminal pro-brain natriuretic peptide (NTproBNP) in patients with acute coronary syndrome (ACS) depending on the presence of concomitant subclinical hypothyroidism (SH). Materials and methods. 125 patients with ACS aged 36 to 81 years (mean age - 60.98 ± 0.81 years) were included in the study. All the patients were divided into two groups according to the state of thyroid function. Group I consisted of 51 patients (40.8 %) with SH (thyroid-stimulating hormone (TSH) level >4 μIU/mL), mean age - 62.51 ± 1.18 years; Group II - 74 patients (59.2 %) with normal thyroid function (TSH level 0.4-4.0 μIU/mL), mean age - 59.93 ± 1.08 years. The state of SH was diagnosed at a TSH level of >4.0 μIU/mL and a serum free thyroxine (FT4) level within the normal range. Results. In the group of patients with ACS and SH (I), significantly higher mean levels of sST2 and NT-proBNP have been found compared to patients without thyroid dysfunction (II), 46.6 (27.9; 57.7) ng/ml (I) vs. 29.9 (22.0; 38.5) ng/ml (II), p = 0.001 and 173.0 (103.4; 1005.1) ng/l (I) vs. 95.9 (71.8; 178.6) ng/l (II), p = 0.0001, respectively. Among patients with ACS and SH (I), the sST2 level of 35-70 ng/ml was 1.94 times more often, and sST2 >70 ng/ml was 2.28 times more often as compared to those in patients with ACS without thyroid dysfunction (II), 22.74 % (47.06 ± 6.99 % (I) vs. 24.32 ± 4.99 % (II), p = 0.008) and 15.81 % (21.57 ± 5.76 % (I) vs. 9.46 ± 3.40 % (II), p < 0.05), respectively. The study on NT-proBNP levels in ACS patients with SH (I) has revealed a 75.67 % significantly higher proportion of individuals with NT-proBNP levels > 600 ng/L (33.33 ± 6.60 % (I)) as compared to ACS patients with normal thyroid function (II) (8.11 ± 3.17 % (II), p = 0.001). The level of NT-proBNP <125 ng/l has been detected 2.31 times more often in the group of ACS patients with normal thyroid function (II) compared to that in ACS patients with SH (I), by 36.06 % (63.51 ± 5.60 % (II) vs. 27.45 ± 6.25 % (I), p = 0.00002). A significant strong positive correlation has been found in the group of ACS patients with SH (I) (correlation coefficient (r) = 0.775, p < 0.001) in assessing the relationship between the mean levels of sST2 and NT-proBNP. In the group of ACS patients with normal thyroid function (II), a moderate correlation has been found between the mean levels of sST2 and NT-proBNP (r = 0.678, p < 0.001). Conclusions. In the group of ACS patients with moderately reduced thyroid function (SH), significantly higher mean levels of sST2 and NT-proBNP and significantly higher percentage of individuals with sST2 levels ≥ 35 ng/mL, NT-proBNP >600 ng/L have been detected compared to the group of ACS patients with normal thyroid function. These results may indicate a higher risk of development, progression and complications of heart failure due to a higher probability of myocardial fibrosis and subsequent left ventricular remodeling in ACS patients with SH. The significant strong positive correlation has been found between the mean levels of sST2 and NT-proBNP in the group of ACS patients with SH (I) (r = 0.775, p < 0.001). In the group of ACS patients with normal thyroid function (II), the correlation between the mean levels of sST2 and NT-proBNP was less pronounced (r = 0.678, p < 0.001). Combined assessment of these biomarkers may be more informative for the diagnosis and prognosis of heart failure in ACS patients with concomitant thyroid dysfunction than measurements of individual biomarkers. In particular, the simultaneous increase in sST2 and NT-proBNP above reference values allows to identify a very high-risk group for heart failure occurrence and progression in ACS patients. [ABSTRACT FROM AUTHOR]

The increase in the prevalence of cardiovascular disease has caused a rapid increase in the risk of developing heart failure. For many years, chronic heart failure (CHF) has occupied one of the leading positions in the structure of cardiac and all-cause mortality worldwide, resulting in not only negative social, but also economic effects. To optimize the timely detection of this pathological condition, laboratory biomarker-based diagnostics of heart dysfunction is widely used along with echocardiographic examination. Brain natriuretic peptide (BNP) is currently considered one of the most well-known and informative biochemical markers in heart failure. The aim of the work was to cover the results of current scientific research according to the principles of evidence-based medicine regarding the use of BNP and its precursor NT-proBNP for the diagnosis of CHF, prognosis and monitoring of the treatment effectiveness. To achieve this goal, an analysis of literary sources published in scientometric databases such as ScienceDirect, Web of Science, Google Scholar, PubMed, Scopus for the period 2013-2024 was carried out. Conclusions. BNP and NT-proBNP have been found to be informative markers for the early diagnosis of chronic heart failure and can also be recommended for dynamic assessment of patients' condition and the effectiveness of their treatment. It is proposed to continue the research on clarifying the threshold diagnostic levels of the biomarkers in patients with chronic heart failure and comorbid conditions such as type 2 diabetes mellitus, obesity, as well as in consideration of their sex, age, racial and ethnic characteristics, which in the future would promote the optimization of timely diagnosis, selection of appropriate treatment and improvement of further prognosis. [ABSTRACT FROM AUTHOR]

Background. Heart failure (HF) is the final stage of the cardiovascular diseases and one of the main causes of mortality due to them. The prevalence of HF has been steadily increasing in recent years and is ≈ 2 % of the adult population. Diabetes mellitus (DM) is among factors that worsen the prognosis of HF. Type 2 DM is an independent risk factor for the occurrence of HF, and the level of fasting plasma glucose, as well as an increased content of HbA1c are significantly associated with an elevated risk of developing HF. The purpose of the study was to investigate the features of the course of HF, which occurred against the background of postinfarction cardiosclerosis, in patients with concomitant atrial fibrillation (AF) and DM. Materials and methods. Three hundred and ninety-eight patients with HF on the background of postinfarction cardiosclerosis aged 45–65 (54.3 ± 7.2) years were examined, 198 (49.7 %) women and 200 (50.3 %) men. Two hundred and twenty-six (56.8 %) patients had permanent AF, 102 (25.6 %) had concomitant type 2 DM. Diagnoses of AF and HF were carried out in accordance with the clinical protocol for providing medical care to patients with atrial fibrillation and heart failure approved by the Order of the Ministry of Health of Ukraine dated July 3, 2006 No. 436 and in accordance with the 2021 European Society of Cardiology Guidelines for the diagnosis and treatment of acute and chronic heart failure. In addition to general clinical and biochemical blood tests, enzyme immunoassays were performed to determine brain natriuretic peptide, NT-proBNP, galectin-3 and ST-2. A standardized echocardiographic examination was conducted with calculations of the left ventricular ejection fraction (LVEF) and heart dimensions during hospitalization. Results. Patients with HF and concomitant DM, compared to participants without impaired carbohydrate metabolism, have a higher frequency of the disease phenotype with preserved LVEF (48.0 %), higher New York Heart Association functional classes (FC III — 70.0 %) and the risk of re-hospitalization (hazard ratio (HR) = 3.14 (2.05–5.68)). For patients with HF and a permanent AF, but without existing DM, a more pronounced dilatation of the heart cavities, a lower LVEF (by 15 %) and a high risk of re-hospitalization during the first year (HR = 1.235 (1.024–1.489)) are typical. Patients with HF and a concomitant combination of AF and DM have the most unfavorable course of heart pathology: the increased size of the left ventricle is more often registered, and its systolic function is worse (by 19.3 %), with high frequency of the phenotype with reduced LVEF (51.9 %), FC IV (46.2 %), the highest risk of re-hospitalization (HR = 11.30 (4.73–27.04)) and one-year death (HR = 2.95 (2.00–4.36)). Conclusions. Given the risk of re-hospitalization and one-year mortality, the most unfavorable combination of concomitant pathology in patients with heart failure of ischemic origin is atrial fibrillation and diabetes mellitus. [ABSTRACT FROM AUTHOR]

Patients with breast cancer (BC) are at high risk of cardiotoxicity (CT) due to combination of anticancer treatment. Cardio vascular (СV) complications lead to the delay or discontinuation of anticancer therapy, which significantly worsens the prognosis. Anthracyclines (AC) are the main drugs included in most anticancer treatment regimens. Detecting signs of CT at the early stages, when there is no cardiac dysfunction and signs of heart failure (HF), is important to develop individualized monitoring and prevention strategies in BC patients. The objective of the study was to investigate the incidence of CT of epirubicin and doxorubicin in the complex BC therapy, based on monitoring of left ventricular ejection fraction (LV EF), diastolic function of the LV, and to inves& tigate the incidence of signs and symptoms of HF. Material and Methods. The study included 44 BC patients. We analyzed the dynamics of LV EF before the start of antitumor treatment and within 6 months. A decrease in LVEF of > 10 % (percentage points) or below its threshold value (< 50 %) was considered to be a CT criterion. Patients were divided into 2 groups. Group 1 included patients with BC who received epirubicin (n = 18), group 2 included BC patients who received doxorubicin in the chemother& apy regimen (n = 26). Results. Before the start of chemotherapy, LV ejection fraction was normal and did not differ significantly between the groups. During follow up at 6 months after the start of treatment, in group 1 the proportion of patients with CT according to LV EF was 11.1 %, compared with 23.1 % in group 2 (p < 0.05). The number of patients with signs and symptoms of HF was 34.6 % in group 2, that was significantly higher compared with that in group 1 - 11.1 % (p < 0.05). According to the correlation analysis, LV EF in group 2 had an inverse correlation with the dose of dox& orubicin (r = &0.67, p < 0.05), with heart rate (r = &0.59, p < 0.05), and with body mass index (r = &0.55, p < 0.05), indicating a negative effect of doxorubicin on the CV system in patients with BC. Conclusions. The results of the study indicate a significantly higher incidence of LV EF reduction as a CT criterion when using doxorubicin in the chemotherapy regimens compared with epirubicin. Myocardial damage as a result of chronic cardiotoxicity is accompanied by a decrease in LV systolic function and a significantly higher incidence of HF. [ABSTRACT FROM AUTHOR]

Myxomatous degeneration of the mitral valve, or endocardiosis, represents the most prevalent cardiovascular pathology among small- and medium-sized dog breeds. The disease is chronic, with clinical signs possibly emerging over a period of 3-4 years from the initial involvement of the mitral valve leaflets. The primary therapy initiates at stage B2, according to the ACVIM consensus which is characterized by the absence of clinical signs. In our research, animals were chosen based on a medical history indicating symptoms including episodic coughing, decreased tolerance to physical exertion, and instances of dyspnea during periods of rest or sleep. A total of 12 animals presenting with pathognomonic signs of heart disease were investigated. The diagnosis was confirmed using echocardiography, and the animals were conditionally divided into one control and two exposed to humic acids formulation groups. The results of an echocardiographic investigation regarding the functional status of the heart in diseased animals treated with bioactive substance of humic origin are provided. During the 21 days the second experimental group was administered the "Humilid" preparation at a dosage of 10 mg/kg of active substance once daily. Echocardiographic measurements were performed at the onset of the study and on the 21st day of the investigation. Obtained results demonstrated that exposure to "Humilid" with the standard therapy on the 21st day of study improves the functional parameters of the heart. Specifically, there was observed a reduction in left atrial and left ventricular dilation by 12.5% and 11.8%, respectively, although statistically insignificant (p > 0.05). Nevertheless, the treatment with humic acids led to a decrease in severity of clinical symptoms. No effect of bioactive substances contained humic acids was observed in respect to the ejection fraction and fractional shortening. Aforementioned parameters were unaltered in both groups within the reference norms throughout the. Furthermore, no adverse or toxic impact of the humic acids formulation on the detected physiological parameters of the animals were observed. The findings from our study may serve for a comprehensive evaluation of the risk related to the development of stagnant phenomena, as well as in finding out the effects of humic substances on myocardial function and cardiac physiological properties. [ABSTRACT FROM AUTHOR]

Morgagni-Larrey hernia is a rare form of diaphragmatic hernia (2-5% of cases) usually diagnosed in children; in adults, it is often detected in emergency cases or accidentally, during examinations or during surgery. The symptoms of the disease are non-specific, so the diagnosis is made using imaging methods (computed tomography is the gold standard). Currently, there is no single method of treating Morgagni-Larrey hernias. Closure of the defect is performed with or without the use of various mesh prostheses through the abdominal or thoracic route; open or minimally invasive access. The aim. To conduct a retrospective analysis of the treatment of adult patients with a Morgagni-Larrey diaphragmatic hernia, including those with cardiovascular comorbidity, with a comparison of symptoms, contents of the hernial sac, with the use of laparoscopic techniques and composite mesh prostheses. Materials and methods. The results of the treatment of three patients with a Morgagni-Larrey hernia in the period from 2020 to 2022 at the Shalimov National Institute of Surgery and Transplantation are shown. In two patients, the content of the hernial sac was a loop of the transverse colon, in one, the content of the hernial sac was a greater omentum. Taking into account the accompanying cardiovascular pathology, an interdisciplinary council consisting of a surgeon, anesthesiologist, and cardiologist recommended laparoscopic surgical intervention. Laparoscopic allogeneoplasty with composite prosthesis implantation was performed in three patients. Conclusions. The laparoscopic method of treating diaphragmatic hernias is safe and effective. The use of composite prostheses in combination with tension closure of the defect allows to reduce the risk of recurrence of the disease in the distant postoperative period.

АНОТАЦІЯ. Активність та тривалість запального процесу при міокардиті впливає на тяжкість перебігу міокардиту та визначає розвиток кардіоміофіброзу, аритмій, дилатаційного синдрому, виникнення та прогресування серцевої недостатності. Досі не з’ясовані механізми, які впливають на перехід від активного запального процесу до хронічної шлуночкової дисфункції. Мета. Дослідити особливості перебігу гострого міокардиту та вплив на якість життя хворих, зв'язок показників запального синдрому, лізису кардіоміоцитів і серцевої недостатності з фактором росту фібробластів 23. Матеріали та методи. Проаналізовано особливості клінічного перебігу гострого міокардиту нез’ясованої етіології у 42 дорослих, лабораторні параметри, пов’язані з тяжкістю перебігу та процесами фіброзування міокарда. Статистичну обробку результатів дослідження проводили за допомогою програми StatSoft Statistica v 10.0 з відомою кількістю спостережень (n). Розраховували коефіцієнт рангової кореляції Спірмена. Результати. Міокардит був переважно середньо-тяжкого перебігу (69,1 %) із серцевою недостатністю (СН) ІІ А стадії (59,5 %). Складні порушення ритму і провідності були у 35,7% хворих. Встановлено достовірне зростання КФК-МВ і тропоніну Т, яке було більш виражене при тяжкому перебігу міокардиту. Маркери запалення (СРП, фібриноген), лізису кардіоміоцитів (КФК-МВ, тропонін Т) і фактора росту фібробластів 23 (FGF-23) достовірно корелювали між собою. Запальний процес у міокарді сприяв наростанню серцевої недостатності, що підтверджувалось достовірною кореляцією С-реактивний протеїном з NT-pro BNP (r=0,64, р

АНОТАЦІЯ. Гіпертрофічна кардіоміопатія – це одне із розповсюджених генетично обумовлених захворювань міокарда, яке супроводжується розвитком діастолічної, а згодом і систолічної дисфункції міокарда. Метою нашого дослідження стало вивчити клініко-інструментальні особливості хворих на гіпертрофічну кардіоміопатію із порушеними показниками глобального поздовжнього стрейну лівого шлуночка та оцінити його прогностичне значення на розвиток серцево-судинних подій в українській популяції хворих на гіпертрофічну кардіоміопатію. Матеріали та методи. Було ретроспективно проаналізовано дані 35 хворих на гіпертрофічну кардіоміопатію, яким проведене комплексне клініко-інструментальне обстеження з визначенням абсолютного показника GLS на спекл-трекінг-ехокардіографії. Хворі були поділені на дві групи: І група (показник глобального стрейну < 14,5) та ІІ група (показник глобального стрейну ≥ 14,5). Результати. Зниження GLS асоціювалося із більшою тривалістю захворювання (8 (5-11) і 3 (2-5) років, р=0,003), збільшенням кількості скарг на перебої в роботі серця (66,7% і 23,5%, р=0,018) та слабкість (61,1% і 23,5%, р=0,04), підвищенням систолічного артеріального тиску (130 (120-140) проти 110 (100-120) мм рт ст, р=0,009), відсутністю хворих без ознак СН (0 і 29,4%, р=0,019), збільшенням IVRT (106,19±28,62 і 84,57±27,54 мс, р=0,044) та більшою кількістю шлуночкових екстрасистол (17 (4-69) і 2 (0,5-3), з=0,014). За даними аналізу виживання Каплана-Мейера відносно фатальних та нефатальних серцево-судинних подій або комбінації їх з госпіталізацією з приводу СН у них було виявлено достовірно гірші показники виживання (Log-Rank, р=0,016 та р=0,003). Висновки Хворі на гіпертрофічну кардіоміопатію з поганими показниками GLS характеризувалися гіршими клініко-інструментальними даними та несприятливим серцево-судинним прогнозом.

Diabetic cardiomyopathy is a serious complication of diabetes mellitus (DM). Aim. Therefore, we aimed to study myocardial changes in adult rats with streptozotocin (STZ)-induced DM exposed to chronic immobilization stress (CIS). Materials and methods. A total of 26 adult albino male rats weighing 180-200 g were examined. All the animals were divided into three groups: Group I included 10 rats with STZ-induced DM exposed to CIS; Group II comprised 10 rats with STZ-induced DM; Group III included 6 intact animals. The samples were collected on the 14th and 56th days of the experiment. Histological, histochemical, electron microscopy, and biochemical methods were used. Results. On the 14th day of the experiment, in Group I and Group II, increased blood flow was observed in the capillaries, venules, and veins, while an arteriolar spasm in the microcirculation was found. In addition, cardiomyocyte surface area in different myocardial regions reduced due to low glycogen content as confirmed by histochemical and ultrastructural studies. On the 56th day of the experiment, in Group I and Group II, hyperemia occurred due to red blood cell aggregation and microthrombi. The surface area of all microcirculatory vessels increased as compared to that of intact animals, as evidenced by an increase in their wall surface area leading to an increase in their wall-to-lumen ratio. Such morphometric changes in the microcirculatory vessels were indicative of decreased vascular permeability and impaired myocardial blood flow. At the histological level, in Group I and Group II, focal cardiomyocyte lysis, moderate to diffuse stromal edema, lymphohistiocytic infiltration were seen. Such changes pointed to sterile inflammation, probably due to myocardial infraction secondary to diabetic microangiopathy. In cardiomyocytes, karyolysis, vacuolar degeneration, apical ballooning, subsarcolemmic edema, fibrosis and lysis of myofibrils, colliquative necrosis were observed. Conclusions. STZ-induced DM and stress resulted in pronounced destructive changes in the myocardium of rats, including interstitial edema, focal cardiosclerosis, myolysis. Such changes occurred on the background developing diabetic microangiopathy. The most pronounced myocardial changes were recorded in animals with a comorbidity. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases are the second leading cause of death among breast cancer (BC) patients. Prediction of cardiovascular toxicity (CT) is an important part of the successful treatment and survival of patients. Objective: to develop a risk score model for cardiovascular toxicity (CT) predicting, based on cardiovascular risk factors (RFs), RFs associated with cancer therapy, and troponin levels. Material and methods. The study included 76 BC patients with a prospective analysis of their clinical and treatment data, RFs, echocardiographic indicators before the start of treatment and after 6 months, and an increase in troponin level. Among all RFs, the most significant RFs of CT were: radiation therapy, treatment with anthracyclines, and cardiovascular diseases. Based on the obtained results, a combined CT risk score was developed and proposed. According to the sum of points, patients were divided into groups: group 1 -- with a low risk of CT development, the sum of points < 5; group 2 -- moderate risk, 6-7 points; group 3 -- high risk, > 8 points. Results. In a pilot prospective study, an analysis of the RFs of CT was provided, compared to echocardiography data and the degree of troponin increase in dynamic observation; the risk score model for the CT prediction was developed for BC patients stratification. According to the developed score, BC patients with a total of > 8 points are considered to have a high risk of CT complications. Conclusions. The use of the proposed risk model score with calculation of the RFs of CT along with high-sensitivity troponin increase during cancer treatment allows predicting the risk of CT developing at the early stages -- before the onset of clinical manifestations. Accordingly, these BC patients have a high risk of CT, and the use of personalized cardiac monitoring together with cardioprotective therapy can prevent cardiovascular complications. [ABSTRACT FROM AUTHOR]

An analysis of primary and secondary myocardial lesions under the conditions of transmission of the COVID-19 infection, causative factors and consequences of the progression of the pathological condition was carried out. Some possibilities of protection against infection and its consequences are noted. Among the first problems with the spread of SARS-CoV-2 in patients with heart failure is the need to distinguish viral lung disease from acute edema. Particular attention is paid to disorders of immune regulation and inflammation, which can exacerbate the imbalance between oxygen supply and myocardial energy needs. At the same time, the importance of troponin I, natriuretic peptide type B and C-reactive protein and creatinine, hypokalemia are highlighted. The central role is played by angiotensin-converting enzyme 2, the suppression of which enhances the local inflammatory response and fibrosis. Progression of infection is associated with stress cardiomyopathy and acute decompensation of chronic heart failure. They note the possibility of reducing infection, protecting the heart from systolic dysfunction, and correcting stress-induced biological reactions of the body, in particular, by the action of low temperatures. [ABSTRACT FROM AUTHOR]

Acute heart failure (AHF) is one of the most common complications of acute myocardial infarction (AMI). Currently, adropin, irisin, fatty acid binding protein 4 (FABP 4) and C1q/TNF-binding protein 3 (CTRP 3) are considered to be valid markers of energy homeostasis and the adipokine system in AMI patients. The aim of the study was to predict the development of AHF in AMI patients by taking into account indicators of energy homeostasis and adipokine system using generalized linear mixed model. The study examined 189 patients with acute ST-segment elevation myocardial infarction. Concentrations of adropin, irisin, insulin, FABP4 and CTRP3 were determined by enzyme-linked immunosorbent assay. Fasting capillary blood glucose level was measured by glucoseoxidase method. Insulin resistance (IR) was assessed using homeostasis model assessment of insulin resistance (HOMA-IR). The study identified thrombolysis in myocardial infarction (TIMI) grade before intervention. A generalized linear mixed model was used to develop a method for predicting AHF in AMI patients. The study showed decreased levels of adropin, irisin and CTRP3 and increased levels of FABP4 in AMI patients. A mathematical model for predicting AHF development in AMI patients was proposed. The model consisted of fixed effects, namely, two one-factor indicators (HOMA-IR and systolic blood pressure (BP)), one two-factor indicator (systolic and diastolic BP) and one three-factor indicator (adropin, irisin and CTRP3) and random effects such as four one-factor indicators (FABP4, TIMI Grade Flow, platelets, total cholesterol). The accuracy of predicting the absence of Killip class I AHF was 100%, Killip class II AHF – 0%, Killip class III AHF – 11%, Killip class IV AHF – 82%. It should be noted that systolic BP on day 1 was a strong negative prognostic factor, while HOMA-IR, the combined effect of adropin, irisin and CTRP3, the combined effect of systolic and diastolic BP were positive prognostic factors. Thus, the model showed a very high sensitivity in predicting Killip class IV AHF. The overall accuracy of the model was 89.4%. [ABSTRACT FROM AUTHOR]

Copyright of ScienceRise: Medical Science is the property of PC TECHNOLOGY CENTER and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim of the present study was to assess the efficiency of yoga practice in addition to the standard medical therapy in patients with chronic heart failure (HF) and dyslipidemia. One hundred and two patients with chronic HF and dyslipidemia were divided into the control group (CG) – 54 patients and the yoga group (YG) – 48 patients. The CG was prescribed standard therapy for chronic HF (angiotensin converting enzyme inhibitors, β-blockers, aldosterone antagonists, digoxin, loop diuretics, statins, antiplatelet agents) and dyslipidemia. The YG additionally followed lifestyle modification in the form of 1 h daily practice of yoga for a period of 3 months. All patients completed the questionnaire reporting on their age, gender, medical history and treatment. The fasting blood samples were analyzed for total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, C-reactive protein, interleukin-8 and tumor necrosis factor -α on admission to the department and after 3 months of treatment. The pre-specified duration of the enrollment period was two years and during that time we interviewed 168 patients. Forty-two did not meet the inclusion criteria for the study, 24 patients refused to participate. A total of 102 patients were enrolled, of them, 54 were included into the control group and 48 into the yoga group. At baseline, there were no significant (p>0.05) differences between the groups in clinical characteristics of the patients. On admission to hospital the patients of both groups received standard therapy in comparable doses. By the end of the study, a significant (p<0.05) reduction in TC, TG and LDL-C levels was observed in both groups with a tendency to more considerable changes in YG. Correlation analysis revealed the positive correlation relationship between TC, LDL-C levels and cytokines. The present study has shown that the practice of yoga in addition to the standard therapy in patients with HF and dyslipidemia could be associated with lipid profile improvements. [ABSTRACT FROM AUTHOR]

Некомпактний мiокард лівого шлуночка — рiдкiсна та маловивчена форма кардiомiопатiї, для якої характерне порушення ендомiокардiального морфогенезу, гiпертрофiя мiокарда лівого шлуночка з його надмiрною трабекулярнiстю і формуванням широких мiжтрабекулярних просторiв. При цій патологiї мiокард лівого шлуночка складається з двох шарiв мiокарда — нормального i некомпактного. Причиною виникнення некомпактного міокарду лівого шлуночка є недосконалий ембрiогенез, унаслідок якого порушується нормальний розвиток мiокарда. Наведено клінічний випадок некомпактного мiокарда лiвого шлуночка в новонародженого. Встановлено, що серцева недостатнiсть — найбільш поширений симптомокомплекс у пацiєнтiв із некомпактним міокардом. Некомпактний мiокард являє собою дезорганiзований шар м'язових волокон, в якому порушена нормальна архiтектонiка, що призводить до значного зниження скоротливої здатностi. Отже, чим вищий вiдсоток некомпактного мiокарда вiд загальної маси серцевого м'язу, тим більш виражені ознаки хронiчної серцевої недостатностi. Крiм цього, відмічається хронiчна iшемiя мiокарда внаслiдок порушення мiкроциркуляцiї. Летальнiсть протягом перших 6 рокiв становить до 50%. Прогноз погiршують шлуночкові порушення ритму. Своєчасна пренатальна підозра на захворювання міокарда, уточнення діагнозу безпосередньо після народження дитини та призначення терапії суттєво впливають на запобігання розвитку серцевої недостатності.

Diabetes mellitus (DM) is one of the most significant medical and social health problems worldwide. The main cause of death in patients with DM is cardiovascular diseases, which leads to the significant decrease in quality of life and life expectancy. The aim of this literature review is analyze of the frequency, mechanisms and manifestations of heart disease in diabetes patients. A significant amount of the modern researches is devoted to the diagnosis and treatment of the diabetes complications, including diabetic cardiomyopathy (DC). According to many authors, heart disease in diabetes is associated with the formation of DC, comorbid coronary heart disease and arterial hypertension. DC occurs in 16.8–54% of patients with diabetes and is an independent factor which increases the death risk by 50–60%. Numerous scientific studies have been devoted to the diagnosis and treatment of DC, emphasizing that in order to reduce cardiovascular disease and mortality in patients with diabetes, it is necessary, above all, to achieve glycemic control. Diabetic history, age, comorbidities, atherosclerotic lesions, smoking, overweight or obesity also play an important role. The main aspects of the development and impact of diabetes on the health and life of patients are the untimely diagnosis of this disease, its multifactorial pathogenesis, progressive course and severity of complications. Due to development of the early complications and disability, studies of morphofunctional changes in the myocardium in diabetes are extremely relevant, as cardiomyopathy may increase the risk of myocardial infarction and heart failure. The rapid increase in the number of patients with diabetes, many of whom die from cardiovascular complications, makes the problem of diabetic heart disease one of the most pressing health problems. Treatment of these patients should include correction of carbohydrate metabolism, control of blood lipid composition, decrease in myocardial ischemia, correction of the myocardial metabolism and the risk of heart failure. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine phenotypes of remodeling of heart and the status of systolic and diastolic function in patients with ischemic heart disease (IHD) combined with chronic obstructive pulmonary disease (COPD) with early symptoms and signs of heart failure (HF). We enrolled 108 males with stable IHD and spirometrically confirmed COPD which preceded the manifestations of IHD – the main group (group 1). As comparison groups 30 males with stable IHD (group 2) and 30 males with COPD (group 3) were examined. Control group included 30 males without IHD and respiratory diseases. All groups were comparable in age, groups 1 and 2 – in the duration of IHD, groups 1 and 3 – in the duration of COPD. The patients of the group 1 were divided into 3 subgroups: subgroup 1 – 45 patients with stable angina, subgroup 2 – 27 patients with postinfarction cardiosclerosis, subgroup 3 –36 patients with combination of stable IHD and arterial hypertension (AH) without history of myocardial infarction. The patients of group 1 had different phenotypes of heart remodeling, which depended on the clinical forms of IHD, the presence of concomitant AH, the severity of bronchial obstruction. The patients of subgroup 1 in 60.0% cases had concentric remodeling and concentric left ventricular hypertrophy (LVH), in 26.7% – normal LV geometry, in all these cases ejection fraction (EF) was preserved. Only in 13.3% of cases eccentric LVH with mildly reduced EF was found. 59.3% of patients in subgroup 2 had eccentric LVH, left atrium dilatation and 55.6% had reduced EF. All patients of subgroup 3 had concentric direction of LV remodeling. The phenotypes of HF with reduced and mildly reduced EF were accompanied by impaired LV diastolic function. In assessing the likelihood of HF with preserved EF the HFA-PEFF score showed better accuracy. Pulmonary hypertension had a mixed cause with predominance of postcapillar component. [ABSTRACT FROM AUTHOR]

Breast cancer patients (BC) have a high risk of cardiotoxicity (CT) due to a combination of cancer treatments. Cardiovascular (CV) complications lead to delay or withdrawal of BC therapy and worsen the survival. Therefore, it is important to detect CT at the early stages before the occurrence of cardiac dysfunction and heart failure (HF) signs. Objective: to study the dynamic changes of high-sensitivity (hs) troponin (Tn) T (hs-TnT) level in BC patients during cancer treatment with the use of chemotherapy and radiation therapy (RT) to predict and prevent CV complications during individualized management. Material and methods. 40 BC patients were included in the pilot study. The analysis of the dynamic changes of hsTnT and ejection fraction (EF) of the left ventricle (LV) was performed before and within 6 months of cancer treatment. Based on the data analysis, a definition of a significant increase in hs-TnT was developed and proposed. The rise of hs-TnT was calculated by the difference (%) between its baseline level and in the 6 months of cancer treatment. BC patients are grouped into tertiles according to the hs-TnT increase: group 1 - low level (0-50 %), group 2 - moderate level (> 50-100 %), and group 3 - high level (> 100 %). Results. Before the start of cancer treatment, LVEF did not differ significantly between groups (mean EF (62.6 ± 1.0) %) and the hs-TnT level was also within normal values (0.008±0.001 ng/ml). In 6 months of cancer treatment, LVEF was within the normal ranges and did not differ significantly in patients of group 1. However, in patients of groups 2 and 3 - LVEF drop (ΔLV EF) was 5.7 % (р < 0.01) and 10.8 % (р < 0.01), consequently. According to the correlation analysis, the percentage of increase in hs-TnT (Δhs-TnT) was associated with ΔEF LV (r = 0.39, р < 0.05) and the use of anthracyclines (AC) (r = 0.37, р < 0.05). Using logistic regression and ROC analysis, the diagnostic threshold value of the hs-TnT increase > 165 % was defined, which can be considered as a reliable marker of early biochemical CT, with a sensitivity of 99 % and a specificity of 56 %. Conclusions. In BC patients, based on the level of hs-TnT increase, proposed a new early biochemical CT detection method. Under the new approach, BC patients with hsTnT increase of > 165 % from baseline can be considered as a reliable marker of early biochemical CT, with a sensitivity of 99 % and a specificity of 56 %. [ABSTRACT FROM AUTHOR]

The aim was to evaluate serum levels of matrix metalloproteinases-9 activity, advanced glycation end products, galectin-3, C-reactive protein in men with heart failure and benign prostatic hyperplasia with testosterone deficiency. The testosterone level was determined by immune-enzyme analysis. The content of advanced glycation end products in plasma were analysed by quantitative autofluorescence. The metalloproteinases-9 activity was estimated with fluorometry. The level of galectin-3, C-reactive protein was determined by immune-enzyme analysis. 1st group was made up by the men with heart failure and benign prostatic hyperplasia with testosterone deficiency; 2nd group – by the men without testosterone deficiency. The men with heart failure and benign prostatic hyperplasia with testosterone deficiency had a significantly higher level of advanced glycation end products, galectin-3, matrix metalloproteinases-9 activity in comparison with men with heart failure without testosterone deficiency (p<0.001). Correlation relations between serum advanced glycation end products in patients of the main group with age, ejection fraction, testosterone level were determined – r=0.48 (p<0.001), r=-0.62 (p<0.001), r= -0.66 (p<0.001) respectively. Receiver operating characteristic analysis for predictive role in heart failure with preserved ejection fraction have shown high degree of sensitivity and specificity for advanced glycation end products in serum (p<0.001). Middle-aged men with heart failure with preserved ejection fraction and benign prostatic hyperplasia with testosterone deficiency are characterised by increased serum advanced glycation end products, galectin-3, matrix metalloproteinases-9 activity, C-reactive protein. Serum advanced glycation end products are potential biomarkers of development of heart failure with phenotype of preserved ejection fraction in this cohort. [ABSTRACT FROM AUTHOR]

Evaluating the efficacy of the treatment regimens used during the year, the benefits of using magnesium and potassium gluconic acid, eplerenone or rivaroxabane with basic therapy (BT) have been proven. In all of the groups under study, there was a positive trend in the treatment process in terms of reducing the number of heart rhythm disturbances. However, a probable decrease in the number of supraventricular and ventricular extrasystoles was noted in groups of patients with the use of salts of magnesium and potassium gluconic acid or rivaroxabane against the background of BT. The results of Holter monitoring of the electrocardiogram showed that the treatment regimens studied were effective in reducing the rate of myocardial ischemia. The treatment of patients with rivaroxiban resulted in a decrease in the total duration of myocardial ischemia per day by 51.93 %. Consequently, an intensive reduction of manifestations of myocardial ischemia and cardiac rhythm disturbance with the use of rivaroxaban on the background of BT in patients with chronic heart failure after myocardial infarction has been established. [ABSTRACT FROM AUTHOR]

Мета. Порівняльний аналіз віддалених результатів трансплантації стовбурових клітин пуповинної крові (ТСКПК) та хірургічної реваскуляризації у хворих з ішемічною кардіоміопатією (ІКМП). Матеріали і методи. Проаналізовано віддалені результати лікування 113пацієнтів з хронічною серцевою недостатністю на тлі ІКМП. У 38 (33,6%) пацієнтів було виконано ізольоване коронарне шунтування, у 35 (31,0%) - стентування коронарних артерій, у 20 (17,7%) - хірургічну реваскуляризацію було доповнено ТСКПК. Окрему групу склали 20 (17,7%) хворих, яким проводили тільки консервативну терапію. Термін спостереження становив 12 міс. Результати. Через 6 міс після ТСКПК у хворих з ІКМП фракція викиду лівого шлуночка зросла з 24,8 до 33,3% (р < 0,05), рівень попередника натрійуретичного пептиду (proBNP) знизився на 51,6% (з 499,0 до 257,5 пг/мл). Досягнутий ефект зберігався впродовж 12 міс спостереження. Холтерівський добовий моніторинг електрокардіограми, проведений через 3, 6 та 12 міс після ТСКПК, не показав достовірного збільшення ризику виникнення фатальної аритмії. Висновки. Застосування ТСКПК у комплексі лікування хворих з ІКМП поліпшує прогноз серцево-судинної смертності, знижує прояви серцевої недостатності, достовірно поліпшує якість життя і скоротливу функцію міокарда.

Статистичні дані останніх років свідчать про те, що однією з основних причин зниження якості життя у хворих, які перенесли інфаркт міокарда (ІМ), є розвиток серцевої недостатності (СН). Ішемічна хвороба серця – превалююча причина смерті в Європі, що забирає щорічно життя у 862 000 чоловіків (19 % від загальної смертності) та в жінок 877 000 (20 % від загальної смертності). В Україні, згідно з ECVDS – 2017, чоловіча смертність становить 59 % від загальної, жіноча – 75 %. Тому оптимізація методів ранньої діагностики та лікування ІМ на сьогодні вкрай важлива в щоденній клінічній практиці. Мета дослідження – оцінити клінічні переваги визначення Nt pro-BNP у хворих на гострий інфаркт міокарда. Матеріали і методи. Ми провели оцінку динаміки Nt pro-BNP імуноферментним методом у 58 хворих, на гострий ІМ. Середній вік обстежених становив (62,7±1,07) року. Оцінювали зв’язок показників із перебігом ІМ, післяінфарктним ремоделюванням серця та виживанням хворих. Результати досліджень та їх обговорення. Кореляційний аналіз, який ми провели, підтвердив дані літератури про вплив на рівень Nt pro-BNP віку (r=0,391; p=0,003), тютюнокуріння (r=0,322; p=0,046). Свідченням зв’язку даного маркера із СН cтала кореляція з частотою серцевих скорочень як в гострий період ІМ, так і через 3 місяці (відповідно r=0,433; p=0,008 і r=0,457; p=0,009). Показники післяінфарктного ремоделювання серця, за даними ехокардіоскопії, чітко корелювали з рівнем Nt pro-BNP, зокрема систолічний розмір лівого шлуночка (ЛШ) (r=394 p=0,022), ступінь систолічного вкорочення ЛШ (r=-0,425; p=0,015) фракція викиду ЛШ (r=-0,352; p=0,044). В динаміці також змінювалася товщина стінок ЛШ та індекс маси міокарда ЛШ (r=0,319; p=0,048 та r=0,361; p=0,028). Важливим підтвердженням прогностичного значення Nt pro-BNP став аналіз виживання пацієнтів після ІМ. Було чітко встановлено збільшення смертей у хворих із перенесеними коронарними подіями та підвищеним рівнем Nt-proBNP (r=0,297; p=0,023). Висновки. Визначення Nt pro-BNP у клінічній практиці має важливе значення для прогнозування перебігу післяінфарктного періоду. Підвищений рівень NT pro-BNP після виникнення ІМ вказує на розвиток СН, що дозволяє оптимізувати лікування та попередити можливі ускладнення.

Breast cancer patients receive combined antitumor treatment (surgery, chemotherapy, targeted drugs and radiation), so they are considered to be the patients with potentially high risk of cardiotoxicity (CT). Risk stratification of cardiovascular complications before the beginning and during the cancer treatment is an important issue. Objective: to develop a CT risk model score taking into account cardiological, oncological and individual risks. Material and methods. The study included 52 breast cancer patients with retrospective analysis of their medical history, risk factors, and echocardiographic parameters before the onset and in 12 months follow up. Based on the analysis of the data, a CT risk model score was developed and recommended. The patients were divided into groups according to the score: Group 1 – low risk of CT development – score < 4 points, Group 2 – moderate risk – 5–7 points, Group 3 – high risk > 8 points. According to the scale, BC patients with a total of > 8 points are considered to be at high risk for CT complications. Radiation therapy and anthracyclines, as well as associated cardiovascular diseases were the most important risk factors of CT. Results. Based on the study of retrospective analysis of risk factors, data of heart function monitoring during follow-up, the risk model score of cardiotoxicity has been developed for the BC patients’ stratification. According to the proposed score risk model, BC patients with a total score of > 8 points considered to have high risk of cardiotoxic complications. Conclusions. Using of the proposed risk model score with calculation of CT risk factors both before the beginning and during cancer therapy is important, because it allows predicting the risk of CT development – to identify high -risk patients, accordingly, to develop an individualized plan for cardiac function monitoring and to start timely car-dioprotective therapy. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Endocrinology / Mìžnarodnij Endokrinologìčnij Žurnal is the property of Zaslavsky O.Yu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicina Neotloznyh Sostoanij is the property of Zaslavsky O.Yu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

ATP-sensitive potassium channels (KATP-channels) have an exclusive cardioprotective role in endogenous heart protection from ischemic damage and regulate vascular tone. KCNJ11 (Kir6.2) polymorphisms I337V (rs5215) and G23L (rs5219, E23K), and ABCC8 (SUR1) polymorphisms S1369A (rs757110) was genotyped in 529 patients with myocardial infarction, acute and chronic heart failure, in adolescents with primary hypertension, and as control group in clinically healthy subjects of Ukraine population by the real-time polymerase chain reaction (RT-PCR). It was shown that the frequency of genotypes Glu/Glu, Glu/Lys and Lys/Lys of polymorphism E23K, and genotypes Ser/Ser, Ser/Ala and Ala/Ala of polymorphism S1369A was as follows: in 107 patients with myocardial infarction - 40.2, 43.9 and 15.9%; in 96 patients with acute heart failure - 41.7, 42.7 and 15.6%; in 99 patients with chronic heart failure - 43.4, 44.4 and 12.1%; in 104 adolescents with primary hypertension - 41.4, 46.2 and 12.5% respectively. The distribution of these genotypes in the control group in 98 clinically healthy people was 37.8, 46.9 and 15.3% respectively. Inheritance of SNPs E23K and S1369A were linked. The frequency of genotypes Ile/Ile, Ile/Val and Val/Val of polymorphism I337V was as follows: in 102 patients with myocardial infarction - 32.4, 51.0 and 16.7%; in 93 patients with acute heart failure - 37,6, 43,0 and 19,4%; in 98 patients with chronic heart failure - 40,8, 44,9 and 14,3%; in 90 clinically healthy people - 35.6, 45.6 and 18.9% respectively. Incidence of allelic polymorphisms I337V, E23K and S1369A corresponds to Hardy-Weinberg principle. By criterion χ², no significant differences were found between the groups. Thus, the frequency of allele polymorphisms I337V, E23K, and S1369A in patients with myocardial infarction, acute and chronic heart failure, and primary hypertension in adolescents was determined, and it has been shown that it does not significantly differ from the frequency in clinically healthy residents of Ukraine. [ABSTRACT FROM AUTHOR]

Фібриляція передсердь (ФП) – одна із найпоширеніших аритмій серця, також вона є потужним фактором ризику розвитку серцево-судинних захворювань (СС З) та смерті від усіх причин. Мета дослідження – виявити предиктори зростання ризику смерті від усіх причин у пацієнтів із постійною формою фібриляції передсердь (ПФФП) неклапанної етіології. Матеріали і методи. Ретроспективно проаналізовано 146 історій хвороб пацієнтів із ПФФП неклапанної етіології, що перебували на стаціонарному лікуванні, з них на момент проведення дослідження померло 16 хворих, які підлягали подальшому аналізу. Із метою контролю частоти серцевих скорочень (ЧСС) проводилась терапія ББ (бісопролол та карведилол). Кінцевою точкою дослідження була смерть від усіх причин. Оцінювали контроль ЧСС за даними ЕКГ та показників ЕхоКГ на момент виписки. Результати досліджень та їх обговорення. У групі пацієнтів, які підлягали аналізу, переважав жорсткий контроль ЧСС. Спостерігалось збільшення розмірів обох передсердь, об’ємів ЛШ , його помірна гіпертрофія, помірна регургітація на дво- та тристулковому клапанах за даними ЕхоКГ. На момент виписки дозування препаратів для контролю ЧСС було наступним: бісопролол – (5,6±2) мг, карведилол – (20±2,3) мг, дигоксин – (0,19±0,07) мг. Далі виконано визначення предикторів зростання ризику смерті від усіх причин. При проведенні однофакторного регресійного аналізу виявлено, що ризик смерті від усіх причин серед пацієнтів із ПФФП статистично значимо зростає при наявності в анамнезі у хворого ХОЗЛ (p=0,01), а також при підвищенні показника функціонального класу СН за шкалою NYHA на кожну одиницю (p=0,046). При здійсненні багатофакторного регресійного аналізу, де в якості факторних ознак використано показники, які відібрано методом покрокового включення та відкидання (Stepwise), виявлено зростання ризику смерті від усіх причин у хворих із ПФФП за наявності ХОЗЛ в анамнезі при стандартизації за іншими факторами ризику (p=0,01). Висновки. Незалежними предикторами зростання ризику смерті від усіх причин у пацієнтів із ПФФП неклапанної етіології є наявність ХОЗЛ в анамнезі та показник функціонального класу СН за шкалою NYHA . Ризик смерті від усіх причин у цих хворих значно зростає за наявності ХОЗЛ в анамнезі при стандартизації за іншими факторами. Дослідження доповнює існуючі дані про важливість контролю ЧСС у хворих із ПФФП і коректність терапії супутньої СН. Отримані результати є новими і мають важливе значення для виявлення причин високої смертності даної категорії пацієнтів та шляхів корекції їх лікування.

Copyright of Pocki is the property of Zaslavsky O.Yu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Pocki is the property of Zaslavsky O.Yu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Likarska Sprava is the property of J. Likarska Sprava and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: to study the features of the clinical course of the post-infarction period in mining workers. 102 patients with mining working experience from 12 to 35 years were examined. The diagnosis of a previous myocardial infarction (MI) was verified on the basis of anamnesis (analysis of medical documentation), if there are signs of cicatricial changes in the myocardium and zones of left ventricular myocardial asynergy on the electrocardiogram (ECG) according to the ultrasound of the heart. All patients underwent general clinical examination according to generally accepted standard criteria. ECG registration was performed in the classical 12 lead systems, as well as in the V3R-V5R at rest state and at the state of the dosed physical activity. The structural and functional state of the heart was examined using the "HDI - 1500" apparatus by a standard procedure. It is established that risk of MI in mining workers with CHD increases over the age of 40 years mainly and after 10 years of work in unfavorable industrial environments. Predictors of HF in post-MI miners are: age over 40 years, a segment-elevation myocardial infarction with ST, a front localization of infarction, complications in acute MI period, especially of cardiac arrhythmias and conductivity. [ABSTRACT FROM AUTHOR]

The aim of this study: on the basis of clinical and instrumental complex investigation of 320 patients with chronic heart failure (CHF) of ischemic etiology combined with chronic obstructive pulmonary disease (COPD) it was proposed to identify several phenotypes of including CHF with preserved ejection fraction (CHFpEF) without right ventricular dysfunction (RVD); CHFpEF with RVD; CHFpEF with right-side failure (RSF); CHF with reduced EF (CHFrEF) plus RSF (biventricular). Identification of these phenotypes creates the pathophysiologic basis to development of rathional pharmacotherapy of CHF in patients with ischemic heart disease combined with COPD. [ABSTRACT FROM AUTHOR]

Thyroid hormones have cardiotropic impact. Their excess causes hyperfunction of heart, has a toxic effect on the heart muscle and the cardiovascular system. It is based on processes of hyperfunction, hypertrophy, degeneration and cardiosclerosis. The aim of the study – examining of tolerance to physical activity and severity of heart failure of patients with varying severity of toxic goiter and its changes against the background of thyreostatic therapy and after thyroidectomy. Materials and Methods. As an indicator of tolerance to physical activity and assessment of severity of heart failure we used performance 6-minute walk test. Results and Discussion. With increasing severity of hyperthyroidism the length of distance traveled rates of oxygen consumption, increase heart rate and respiratory rate is reduced. Under the influence of treatment improving of tolerance to physical activity occurs. Conclusions. 6-minute walk test objectively reflects the severity of heart failure and tolerance to physical activity. Promising research is to continue to examine predictors of forecasting long-term results of treatment of patients with toxic goiter.