Possibilities of predicting adverse cardiovascular events based on the analysis of clinical and instrumental research methods, as well as sST2 in patients after myocardial infarction

OBJECTIVE

Aim: To determine the possibility of predicting adverse cardiovascular events based on the analysis of clinical and instrumental research methods, as well as sST2 in patients after myocardial infarction.

PATIENTS AND METHODS

Materials and Methods: The study included 64 patients who suffered an acute myocardial infarction and underwent PCI with balloon angioplasty and stenting of the infarct-related vessel in the acute period. The predictors of adverse cardiovascular events were assessed events during 1 year of observation. Indicators of echocardiography and coronary angiography were assessed and concentrations sST2.

RESULTS

Results: A worse prognosis was associated with intermediate ejection fraction (EF) (odds ratio (OR)=3.981, p<0.05), left aneurysm ventricle (LV) (OR=29.5, p<0.05), high concentrations of sST2 (OR=1.017, p<0.05) and scores on the Syntax scale (OR=1.001, p<0.05).

CONCLUSION

Conclusions: In patients who underwent percutaneous coronary intervention for myocardial infarction, adverse outcome during the next 2 years is associated with coronary and echocardiographic parameters, as well as biochemical indicators of myocardial stress and fibrosis. HF patients with intermediate EF, LV aneurysm, high sST2 concentrations, and high Syntax scores have the worst prognosis.

FINE-NEEDLE ANGIOGRAPHY IN CHRONIC LIMB-THREATENING ISCHEMIA DIABETIC PATIENTS

OBJECTIVE

The aim: The features and efficiency of performing fine-needle angiography for Chronic Limb-Threatening Ischemia (CLTI) in Diabetic Patients diagnosis.

PATIENTS AND METHODS

Materials and methods: From 2015-2020, a total of 180 angiography procedures were performed in below-the-knee (BTK) arterial disease diabetic patients with CLTI (Rutherford category 4 to 6). Relative contraindications such as severe heart failure, myocardial infarction (MI), arterial hypertension, impaired renal function, allergy to contrast media and intolerance to antiplatelet therapy we carefully evaluated and compared with the major amputation risks. Patients were selected with adequate inflow to the common and popliteal arterys, as defined by presence of normal ipsilateral femoral and popliteal pulse, biphasic or triphasic Doppler waveform. Ultrasound controlled fine-needle angiography, by retrograde puncture of the superficial femoral artery (SFA) was performed with an 18G-70mm angiographic needle in 96 patients (1st group). Antegrade angiography using femoral sheath in 84 patients (2nd group).

RESULTS

Results: We have obtained adequate visualization BTK vessels by administering "Omnipak 300" 70% solution 9 mL with a power injector at a 3 mL/sec rate through the needle. Through the sidearm of the femoral sheath a total of contrast 15 mL, administered at 5 mL/sec rate. Fine-needle angiography 2.16 times reduces the injected contrast amount in patients. The hemorrhagic events frequency in the 1st group was significantly lower.

CONCLUSION

Conclusions: Fine-needle angiography is recommended for CLTI Diabetic Patients diagnosis.

THE CLINICAL EXPERIENCE OF THE EFFECTIVE USE OF DAPAGLIFLOZIN IN COMORBID CARDIAC PATIENTS WITH CONCOMITANT TYPE 2 DIABETES MELLITUS AND ARTERIAL HYPERTENSION ON THE BACKGROUND OF OVERWEIGHT IN OUTPATIENT SETTING

OBJECTIVE

The aim: To assess the efficacy and safety of dapagliflozin in the treatment of comorbid cardiac patients with type 2 diabetes mellitus (T2DM) in combination with arterial hypertension (AH) and overweight in outpatient setting.

PATIENTS AND METHODS

Materials and methods: Under observation were 19 patients who were treated in outpatient setting during 2019-2021 for AH and had T2DM, overweight or obesity. As part of complex treatment, patients received dapagliflozin 10 mg once a day for 12 months.

RESULTS

Results: The normalization of blood pressure, elimination of heart failure symptoms on the background of increased ejection fraction, improved indicators of the functional capacity of the kidneys, and a decrease in the degree of proteinuria/albuminuria were noted after treatment. The patients had an easier time losing weight (body mass index and waist circumference decreased; p<0.05) and decreased levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C). None of the monitored patients had cases of hypoglycemia or urinary tract infection. The number and/or doses of antihypertensive, hypouricemic and diuretic drugs were gradually reduced.

CONCLUSION

Conclusions: Using dapagliflozin in a standard dose of 10 mg/day in the complex therapy of patients with T2DM in combination with arterial hypertension and overweight contributes not only to the normalization of blood pressure, but also to a reduction in body weight and waist circumference. The proposed therapy can be an alternative for the treatment of patients with T2DM with concomitant overweight or obesity, arterial hypertension, with or without heart and/or renal failure as a first-line antidiabetic drug.

FEATURES OF THE COMORBID COURSE OF CHRONIC PANCREATITIS AND ARTERIAL HYPERTENSION

OBJECTIVE

The aim: To investigate the clinical features of the chronic pancreatitis (CP) clinical course in patients with concomitant arterial hypertension.

PATIENTS AND METHODS

Materials and methods: 100 patients with PD were investigated. In 60 patients, the course of CP and AH was combined - the main group, the comparison group - 40 patients with CP without concomitant pathology.

RESULTS

Results: In 52 patients (86.7%) with CP and AH abdominal pain was recorded versus 24 (60.0%) with CP (p<0.01). Correlation analysis revealed weak relationship between the intensity of pain acc. Visual analogue scale (VAS) of pain and the degree of steatorrhea (τ = 0.40, p <0.01), the degree of amilorrhea (τ = 0.39, p <0.01) and the average strength of the relationship with creatorrhoea (τ = 0.60 , p <0.01). Dyspepsia was revealed in CP and AH: flatulence in 55 (91.7%) compared with 26 (65.0%) with CP, diarrhea in 52 (86.7%) patients in the main group versus 23 (57.5%) in the comparison group, nausea in 52 (86.7%), vomiting in 45 (75.0%) in the main group versus 18 (45.0%) and 12 (30.0%) patients from the comparison group (p<0.01 in all comparisons). Asthenia is expressed in patients with CP and AH: weakness in 50 (83.3%) patients versus 6 (15.0%), psychoemotional lability in 44 (73.3%) versus 3 (7.5%), headache in 47 (78.3%) versus 6 (15.0%), sleep disorders in 45 (75.0%) compared with 1 (2.5%) patients with CP (p<0.01 in all comparisons).

CONCLUSION

Conclusions: The negative effect of concomitant hypertension on the clinical course of CP has been established. AH contributes to increased pain syndrome, dyspepsia, asthenia.

THE RELATIONSHIPS OF IRS-1 POLYMORPHISM WITH HEMODYNAMIC DISORDERS IN HYPERTENSIVE PATIENTS DEPENDING ON BODY WEIGHT AND METABOLIC COMORBIDITY

OBJECTIVE

The aim: The aim was to study the relationships of IRS-1 gene polymorphism with indicators of the structural and functional state of the heart and blood vessels in patients with arterial hypertension under conditions of different metabolic comorbidity and body weight.

PATIENTS AND METHODS

Materials and methods: We examined 340 patients with arterial hypertension with different body weight and different types of metabolic comorbidity and 30 healthy individuals aged 45-55. Anthropometric, Biochemical, Molecular genetic methods, Instrumental, Statistical methods were used.

RESULTS

Results: The presence of G/R + R/R genotypes in hypertensive patients with normal body weight was associated with an increase in intima-media thickness (CIMT), pulse wave velocity of carotid artery (cPWV) and lower endothelium-dependent vasodilatation (EDVD) compared with G/G genotype carriers. Hypertensive patients with obesity, carriers of G/R and R/R genotypes displayed more pronounced similar changes in vascular remodeling (higher CIMT, cPWV and lower EDVD) and as well as cardiac remodeling (larger sizes and left ventricular mass (LVM)) compared with G/G genotype carriers. Overweight carriers of the G/R + R/R genotypes were characterized by enlargement of LVM and its sizes, a higher CIMT indicator, but this effect was less than in the comorbidity of hypertension and obesity. In hypertensive patients with hypertension, obesity and type 2 diabetes mellitus, the presence of G/R + R/R genotypes was associated with an increase in left ventricular size, left ventricular mass index (LVMI) and CIMT.

CONCLUSION

Conclusions: The relationships of IRS-1 polymorphism with indicators of cardiovascular remodeling in hypertensive patients depending on body weight and the presence of various metabolic comorbidity have been established.

STATE OF AUTONOMIC REGULATION AND CEREBROVASCULAR REACTIVITY IN PATIENTS WITH HEADACHE WITH ARTERIAL HYPERTENSION

OBJECTIVE

The aim: A comprehensive assessment of the state of the autonomic nervous system and cerebrovascular reactivity of the cerebral blood flow in the patients with the headache accompanied by arterial hypertension (AH) and somatoform autonomic dysfunction (SAD).

PATIENTS AND METHODS

Materials and methods: We conducted the clinical, autonomic regulation and Doppler sonography examination of 124 young patients (18-45 years old), including 51 men and 73 women in the conditions of the clinical base of the Kharkiv Medical Academy of Postgraduate Education in 2018-2021. All patients with cephalgias were divided into three groups: with AH stage II (Group I - 41 patients), AH stage I (Group II - 40 patients), SAD (Group III - 43 patients). The control group consisted of 50 patients of the corresponding gender and age.

RESULTS

Results: The intensity of cephalalgia in patients with SAD was maximum. The autonomic tone (AT) was changed in 68.5%examined patients. It had a pronounced shift towards sympathicotonia. According to the visual analogue scale the maximum intensity of cephalgias was against the sympathicotonia. In the groups with organic lesions of the cerebral vessels the latent period delay was registered with the progression of the organic pathology. The regularity was revealed - the shortening of the evoked skin sympathetic potentials latency with the severity of cephalalgia, which can be interpreted as an increase in ergotropic effects with the realisation of the pain syndrome. The obtained data on the state of the AT indicate the depletion of the ergotropic processes with the progression of cerebral ischemia with a known increase in parasympathicotonia. In the patients of SAD group the CrCO2 and KrFNTvalues were significantly increased, in AH stage I group they slightly exceeded the standard values , in AH stage II group they were reduced. The reactivity to the orthostatic loads and functional metabolic test in all groups exceeded the control values.

CONCLUSION

Conclusions: 1. The cephalgic syndrome is one of the main symptoms of the autonomic dysfunction and arterial hypertension; the frequency and intensity of the headache increases with the hyperreactivity of the sympathetic system. 2. The SSP data indicate that the sympathetic activity triggers and maintains the pain syndrome, and can also be realized in the form of arterial hypertension. 3. The dysfunction of the central link of the GSR indicates the instability of the autonomous regulation, the work of the limbic-reticular complex, which is clinically manifested by the changes in the cerebral vascular tone. 4. The cerebrovascular hyperreactivity as a sign of the search for the optimal sanogenetic variant of the cerebral hemodynamics in patients with SAD and AH stage I occurs predominantly due to the vasodilatory component. 5. In the patients with AH stage II the vasoconstrictor reactions are observed with the depletion of the vasodilation reserves, which is a marker of the autoregulation failure.

ASSOCIATIONS OF POLYMORPHISMS NOS3-T-786C, MTHFR-C667T, P2RY12-T-744C, (GPIBα) -C482T AND GENE INTERACTIONS IN MACROANGIOPATHIES IN PATIENTS WITH COMBINED HYPERTENSION AND TYPE DIABETES MELLITUS 2

OBJECTIVE

The aim: To establish the role of allelic polymorphisms NOS3-T-786C, MTHFR-C667T, P2RY12--744C, (GPIbα)-C482T in the development of vascular lesions in patients with hypertension and diabetes mellitus type 2.

PATIENTS AND METHODS

Materials and methods: The study included 100 patients with hypertension and diabetes mellitus type 2 (main group) and 50 patients without type 2 diabetes (control group). Patients underwent echocardiography, color duplex scanning of extracranial, brachiocephalic and femoral vessels. The distribution of allelic polymorphisms was investigated by isolation DNA from leukocytes and polymerase chain reaction (PCR).

RESULTS

Results: The risk of vascular damages increases 2-fold when carrying all 4 risk alleles in monozygotic genotypes of polymorphic loci in patients with hypertension with concomitant type 2 diabetes (p<0,05). In gene-gene interaction, the values of contributions and directions of interaction between alleles of polymorphic loci are established (p<0,05). Genes create a paired hierarchy of interaction according to their functional activity; the largest contribution to the probable vascular damage depends on the allelic polymorphism NOS3-786CT (p<0,05), the lowest - on the allelic polymorphism P2RY12-744CC (H2H2). The genetic polymorphism of the MTHFR gene is independent of the influence of other studied polymorphisms (p<0,05); the genes P2RY12-744CT and GPIbα 482CT act synergistically with the gene NOS3-786CT, being in a weak negative interaction with each other.

CONCLUSION

Conclusions: Phenotypic manifestations of endothelial dysfunction may be modified by allelic polymorphism of genes associated with endothelial and platelet functions with the risk of vascular complications.