Chronic Heart Failure in Patients Hospitalized in 2002 and 2021: Comparative Analysis of Prevalence, Clinical Course and Drug Therapy

AIM

Comparative analysis of the prevalence of chronic heart failure (CHF), clinical and medical history data, and drug therapy of patients admitted to a cardiology hospital in 2002 and 2021.

MATERIAL AND METHODS

The study analyzed the medical records of patients with a confirmed diagnosis of CHF who were admitted in 2002 (n=210) and 2021 (n=381) to a specialized cardiology hospital.

RESULTS

According to medical records of 2021, the proportion of patients with a confirmed diagnosis of CHF (87.6%) in the cohort of patients admitted to a cardiology hospital was twice as high as in 2002 (46.4%; p<0.001). The majority of patients with CHF in the study sample were patients with preserved left ventricular ejection fraction (HFpEF). The proportion of such patients significantly increased to reach 75.9% in 2021 compared to 58.6% in 2002 (p<0.001). At the same time, the number of severe forms of CHF (NYHA functional class (FC) IV) decreased by 10% and was 13.2% in 2002 and 1.3% in 2021 (p<0.001). In the majority of patients, ischemic heart disease (98.1 and 91.1% in 2002 and 2021, respectively, p<0.001) and hypertension (80.5 and 98.2%, respectively, p<0.001) were diagnosed as the cause for CHF. Furthermore, the incidence of comorbidity increased significantly: atrial fibrillation was detected in 12.3% of patients in 2002 and 26.4% in 2021 (p < 0.001); type 2 diabetes mellitus, in 14.3 and 32% of patients (p <0.001); and obesity, in 33.3 and 43.7% of patients, respectively (p=0.018). The frequency of using the major groups of drugs increased during the analyzed period: renin-angiotensin-aldosterone system blockers were administered to 71.9% of patients in 2002 and to 87.7% in 2021 (p<0.001); beta-blockers were administered to 53.3 and 82.4% of patients (p<0.001); and mineralocorticoid receptor antagonists, to 1.9 and 18.6% of patients, respectively (p=0.004).

CONCLUSION

In 2021, the proportion of patients with a confirmed diagnosis of CHF in the patient cohort admitted to a cardiology hospital was twice as high as in 2002; the phenotype with preserved left ventricular ejection fraction predominated in the CHF structure. During the analyzed twenty-year period, the prevalence of comorbidities increased among CHF patients. The prescription frequency of pathogenetic evidence-based therapy has significantly increased by 2021, however, it remains insufficient even in patients with CHF with reduced left ventricular ejection fraction.

[Stress-Echocardiography in Low-risk Acute Coronary Syndrome Without Persistent ST-segment Elevation Diagnostic Algorithm]

This review addresses the capabilities of stress EchoCG as a simple, non-invasive, non-radiation method for diagnosing occult disorders of coronary blood flow in patients with non-ST-elevation acute coronary syndrome on a low-risk electrocardiogram. The capabilities of the enhanced stress EchoCG protocol are based on supplementing the standard detection of transient disturbances of local contractility, generally associated with coronary artery obstruction, with an assessment of the heart rate reserve, coronary reserve and other parameters. This approach is considered promising for a more complete characterization of heart function during exercise and an accurate prognosis of the clinical case, which allows determining the tactics for patient management not limited to selection for myocardial revascularization.

[Repeated Coronary Artery Bypass Surgery 18 Years After the Primary Revascularization of Myocardium in a Patient With Acute Coronary Syndrome Without the Segment ST Elevation]

This article describes a clinical case of successful repeated coronary bypass grafting 18 years after the initial surgery in a patient with non-ST-elevation acute coronary syndrome.

Association of coronary microvascular dysfunction and cardiac muscle injury in acute myocardial infarction: results of comparison of dynamic SPECT and cardiac MRI

Aim      To study the interrelation of changes in coronary microcirculation by data of dynamic single photon emission computed tomography (SPECT) and myocardial injury by data of magnetic resonance imaging (MRI) in patients with acute myocardial infarction (AMI).Material and methods  The study included patients admitted to the emergency cardiology department with new-onset AMI. Contrast-enhanced cardiac MRI was performed for all patients on day 2-7 of admission. Dynamic SPECT of the myocardium with evaluation of semiquantitative and quantitative parameters of perfusion was performed on day 7-10.Results All patients were divided into two groups based on the type of MR contrast agent accumulation: 1) patients with the ischemic type of contrast enhancement (n=34; 62 %); 2) patients with the non-ischemic type of contrast enhancement (n=21; 38 %). According to data of myocardial perfusion scintigraphy (MPS), the group of ischemic MR pattern had larger perfusion defects at rest and during a stress test. Moreover, this group was characterized by lower global stress-induced blood flow and absolute and relative myocardial flow reserve (MFR). When the study group was divided into patients with transmural (n=32; 58 %) and non-transmural (n=23; 42 %) accumulation of the MR-contrast agent, lower values of global stress-induced blood flow and of absolute and relative MFR were observed in the group of transmural MR-enhancement pattern. A moderate inverse correlation was found between the stress-induced myocardial blood flow and the volume of myocardial edema (r= -0.47), infarct area (r= -0.48) and microvascular obstruction area (r= -0.38).Conclusion      The variables of dynamic SPECT characterizing microcirculatory disorders that are independent on or due to injuries of the epicardial coronary vasculature reflect the severity and depth of structural changes of the myocardium in AMI. In this process, quantitative variables of myocardial perfusion are interrelated with the myocardial injury more closely than semiquantitative MPS indexes. The findings of the present study can also contribute to the heterogenicity of a patient group with acute coronary syndrome and AMI. Further study is required for understanding the prognostic significance of dynamic SPECT parameters.

Subacute myocardial infarction detected by technetium-99m-labeled somatostatin analog scintigraphy

Recently, the applicability of somatostatin receptor-targeted (SSTR-t) radiotracers for post-ischemic myocardial inflammation imaging has been shown using PET. Currently, there are no studies which demonstrate ability of SPECT and technetium-99m SSTR-t radiotracers to detect inflammation, which appears in response to acute myocardial infarction (AMI). A case of 51-year-old male with acute anterior myocardial infarction (AMI) with ST elevation has been presented. This patient on 7th day after AMI onset underwent SPECT/CT (by cardiac cadmium-zinc-telluride gamma-camera) with 99mTc-Tectrotide, cardiac MRI with gadolinium and, on 9th day after AMI, myocardial perfusion scintigraphy (MPS) at rest. Clear myocardial uptake of 99mTc-Tectrotide, predominantly in apical and intermediate anterior wall of left ventricle was detected. The uptake matched with areas of hypoperfusion (by SPECT) and myocardial injury (by MRI). This case demonstrated the applicability of technetium-99m-labeled SSTR-t radiotracers for post-infarction inflammation imaging. Currently assumed, that SSTR-t radiotracers reflect an increased number of activated macrophages infiltrating infarcted myocardium, which is not possible using any other imaging technique. Thus, potentially, SSTR scintigraphy may be useful for diagnosis and monitoring of myocardial post-infarction inflammation as well as for anti-inflammatory image-guide therapy assessment.

Complete atrioventricular block as the first manifestation of dermatomyositis

Dermatomyositis is a rare systemic autoimmune disease characterized by primary damage of the skin and striated muscles with the development of chronic muscle weakness. Due to the polymorphic nature of the clinical picture, early diagnosis of dermatomyositis is challenging since patients may visit different specialists depending on predominating symptoms. This entails a late diagnosis and, as a result, the absence of necessary treatment. The article presents a clinical case of a late diagnosis of dermatomyositis, which resulted in the development of autoimmune myocarditis with complete atrioventricular block in a female patient.

[Intra-aortic balloon pump in patients with myocardial infarction and cardiogenic shock of stages A and B]

This article presents two clinical cases of patients with myocardial infarction and stage A (at risk) and B (beginning) cardiogenic shock who underwent intra-aortic balloon counterpulsation (IABP). In patients with a high risk of classic cardiogenic shock and/or the no-reflow phenomenon, stenting of the infarct-related coronary artery during this type of mechanical circulatory support was performed without complications. Theoretical and practical aspects of using IABP at different stages of cardiogenic shock are discussed.

Intracoronary epinephrine and verapamil in the refractory no-reflow phenomenon in patients with acute myocardial infarction

Despite modern advances in performing percutaneous coronary interventions, refractory no-reflow remains a serious problem that worsens in-hospital and long-term prognosis. Low-dose adrenaline may exhibit potent beta-receptor agonist properties that mediate coronary vasodilation.

Aim. To evaluate the efficacy and safety of intracoronary administration of epinephrine and verapamil, as well as their combination, compared with standard treatment in patients with ST-segment elevation myocardial infarction (STEMI) and refractory no-reflow during percutaneous coronary interventions.

Material and methods. Patients with STEMI and refractory no-reflow will be randomized into 4 groups: standard therapy, intracoronary adrenaline, intracoronary verapamil, intracoronary epinephrine + verapamil. All patients will be assessed for epicardial blood flow using the Thrombolysis in Myocardial Infarction (TIMI) and Myocardial Blush Grade (MBG) scales, peak troponin levels, ST segment changes, echocardiography, magnetic roesnance imaging, and dynamic single photon emission computed tomography.

Results. Based on the pharmacodynamic effects of epinephrine and verapamil, their combination is expected to have a more potent vasodilating effect.

Conclusion. If the Intracoronary administration of EPInephrine and VERapamil in the refractory no-reflow phenomenon (EPIVER) study will be successful, a novel, more effective method for managing refractory no-reflow phenomenon will appear. This will ensure better preservation of left ventricular systolic function, as well as improve the prognosis and clinical course of the disease.

Health care quality and changes in the clinical characteristics of patients with non-ST elevation acute coronary syndrome in a regional vascular center during the COVID-19 pandemic

Aim. To perform a comparative assessment of the clinical and demographic characteristics of patients with non-ST elevation acute coronary syndrome (NSTE-ACS) and health care quality during the coronavirus disease 2019 (COVID-19) pandemic.

Material and methods. Data obtained from medical records were used. Statistical processing was performed using the Statistica 10.0 software package. The analysis included patients with NSTE-ACS treated in 2020 (n=524) and 2019 (n=395). The group for further analysis consisted of patients with non-ST elevation myocardial infarction treated in 2020 (n=233) compared to 2019 (n=221).

Results. An increase in the relative number of patients with unstable angina in the NSTE-ACS group was revealed. COVID-19 was verified in 5,5% of patients with NSTE-ACS. Of these, pneumonia was diagnosed in 10 (34,5%) patients, while 11 (37,9%) patients were transferred to pulmonary hospitals. The remaining 18 (62,1%) patients were discharged for outpatient treatment. Infected patients had a higher risk of in-hospital mortality according to the Global Registry of Acute Coronary Events (GRACE) score relative to general cohort of patients — 2,0 (1,0; 9,0) vs 1,0 (0,8; 3,0) (p=0,04). In addition, 215 (92,3%) patients underwent invasive coronary angiography, which is higher than in 2019 (78,7%) (p<0,001). An increase in revascularization prevalence in patients ≥75 years old was found (p=0,01).

Conclusion. COVID-19 pandemic has led to a change in the clinical characteristics of patients, while not having a significant impact on the scope of endovascular interventions and health care quality for patients with NSTE-ACS in the emergency cardiology department.

Oncostatin M is associated with adverse left ventricular remodeling in patients with ST-segment elevation myocardial infarction

Introduction

The development of adverse left ventricular remodeling (LVR) after myocardial infarction (MI) remains a significant problem despite current achievements in invasive and pharmacological treatment. A large number of biomarkers are known that reflect various processes and pathophysiological mechanisms of the pathogenesis of MI and the development of adverse cardiovascular events in the post-infarction period. Oncostatin M (OSM) is a cytokine of the interleukin-6 family that is involved in the pathophysiology of cardiovascular diseases and takes part in processes of inflammation, tissue regeneration, cell development and growth.

Purpose

To assess the dynamics of serum levels of OSM and its association with the development of adverse left ventricular remodeling in the long-term post-infarction period in patients with acute primary myocardial infarction with ST-segment elevation (STEMI).

Methods

Subjects were 21 patients (59.2±8.1 y.o.) with STEMI, who underwent percutaneous coronary intervention during the first 24 h of the onset of MI. The serum level of OSM and echocardiography with 2D speckle tracking imaging were assessed at days 1 and 6 months after STEMI. The criterion of adverse LVR is an increased of end-diastolic (EDV) or/and end-systolic (ESV) volume more than 20% from admission to 6 month period.

Results

A significant increase of the serum levels of OSM during the first 24 hours of MI was detected [46.9 (18.9; 75.7)] pg/ml. A decrease of the OSM levels in 6 months after STEMI was revealed [13.1 (6.9; 19.6)] pg/ml (p&lt;0.0005). Correlation analysis showed strong positive association between the values of OSM with Troponin I (R=0.797 p=0.0001) and Nt-proBNP (R=0,713 p=0.0013). The relationship between OSM and Troponin I persisted in the long-term post-infarction period (R=0.751, p=0.0005). An inverse correlation between the OSM, measured at admission to hospital and the left ventricular ejection fraction at day 7 after MI was found (R=−0.63, p=0.023). Logistic regression analysis showed that the values of OSM at day 1 of the MI were associated with development of adverse LVR in the long term after STEMI. OSM level of more than 18.4 pg/ml at a time of admission was associated with the increased of ESV in 6 months after STEMI by more than 20% (p&lt;0.05).

Conclusions

Our study showed the serum levels of OSM statistically significantly decreased in 6 months after STEMI. The content of OSM was positive associated with Troponin I and Nt-proBNP. Elevated levels of OSM were associated with an increase of ESV in 6 months after STEMI. The serum levels of OSM can be used to predict of adverse remodeling in patients undergoing STEMI.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Science

Association macrophage subpopulation with cardiac biomarkers in patients with acute decompensated ischemic heart failure with reduced ejection fraction

Objective

To determine the association macrophage subpopulation with cardiac biomarkers (interleukin (IL)-1β, IL-6, IL-10, highly sensitive C-reactive protein (hsCRP), tumor necrosis factor alpha (TNF-α), troponin I, interferon gamma (IFN-γ), plasma brain natriuretic peptide (BNP), and N-terminal fragment of precursor protein brain-type natriuretic peptide (NT-proBNP), soluble interleukin 1 receptor-like 1 (ST2)) in patients with acute decompensated ischemic heart failure with reduced ejection fraction.

Methods

This open-label, nonrandomized, single-center, prospective trial was registered at clinicaltrials.gov (#NCT02649517) and included 25 patients (84% men, LVEF of 29.17±9.4%) with ADHF. Inclusion criteria were ADHF, not earlier than 6 months after optimal surgery (PCI or/and CABG) and optimal drug treatment for ADHF according to ESC guidelines. Invasive coronary angiography was performed in all patients to exclude the progression of coronary atherosclerosis. All patients underwent endomyocardial biopsy (EMB) with immunohistochemically analysis for diagnostic myocarditis. Macrophage infiltration in the heart was assessed by double immunofluorescence. CD68 was a marker for the cells of the macrophage lineage, CD80 was considered as M1-like macrophage and CD163, CD206, stabilin-1 were as M2-like macrophage biomarkers. Each area was evaluated in 5 random fields. On admission serum levels of IL-1β, IL-6, IL-10, hsCRP, TNF-α, troponin I, IFN-γ, ST2, BNP, and NT-proBNP were measured using enzyme-linked immunosorbent assay (ELISA). The double immunofluorescence has not been performed in 4 patients.

Results

An association was found between CD68+/CD80+ macrophages and level of TNF-α (r=0.512, p=0.042) in all patient. After EMB, all patients were divided into 2 groups. Group 1 comprised 16 patients (64%) with myocarditis; group 2 comprised 9 patients (36%) without myocarditis. In group 1 the association was found between CD68+/CD80+ macrophages and the level of troponin I (r=0.874, p=0.05). Besides, the association was revealed CD68-/CD206+ macrophages with the level of hsCRP (r= - 0.755, p=0.03), and CD163-/CD206+ macrophages with the level of IL-6 (r=0.843, p=0,009) in group 1. CD68-/stabilin-1 macrophages were in direct correlation with level of NT-proBNP (r=0.790, p=0.02) and in inverse correlation with level of troponin I (r= - 0.711, p=0.05) in group 1. In group 2 the association was found between CD68-/CD206+ macrophages and the level of ST2 (r=0.0.537, p=0.037).

Conclusion

Our data suggest that many associations identified between M1-like macrophages (CD 68+/CD 80+), M2-like macrophages (CD68-/CD206+, CD163-/CD206+) and markers of inflammation (hsCRP, IL-6) and myocardial damage (NT-proBNP, troponin I) in patients with myocarditis. Whereas in patients without myocarditis, only the association of M2-like macrophages (CD68-/CD206+) with the ST2 level was revealed, probably due to the continuing unfavorable remodeling of the heart.

Funding Acknowledgement

Type of funding sources: None.

Impact of microvascular injury various types on function of left ventricular in patients with primary myocardial infarction with ST segment elevation

AIM

To analyze the long-term effect of microvascular injury various types on the structural and functional parameters of the left ventricle assessed by echocardiography in patients with primary ST-segment elevation myocardial infarction (STEMI).

MATERIALS AND METHODS

The study included 60 patients with primary STEMI admitted within the first 12 hours after the onset of disease who underwent stenting of the infarct-associated coronary artery. Each patient included in the study underwent CMR imaging on the second day post-STEMI. MVO and IMH were assessed using late gadolinium enhancement and T2-weighted CMR imaging. Subsequently, all patients underwent the standard echocardiographic protocol on the 7th day and 3 months after MI.

RESULTS

We divided all patients into 4 groups: the 1st group didn't have any phenomena of IMH and MVO, the 2nd group had only MVO, patients of the 3rd group had only IMH and in the 4th group there was a combination of MVO and IMH. LV ejection fraction was significantly lower in patients with combination of MVO and IMH, if compared to those without it. Correlation analysis showed a moderate inverse correlation between the MVO area and LV contractile function: the larger the area, the lower the LVEF (R=-0,60; p=0,000002).

CONCLUSIONS

The combination of IMH and MVO is a predictor of a reduction in LVEF and an increase of volumetric measurements within 3 months after MI. In comparison with patients without microvascular injury isolated MVO is associated with lower LVEF. The size of MVO is directly correlated with the LV contractile function decrease. Isolated IMH was not associated with deterioration of left ventricular function.

Dynamic SPECT with assessment myocardial blood flow and coronary flow reserve in MINOCA patients: comparison with cardiac magnetic resonance

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): grant of the President of the Russian Federation

Background. In recent years a group of patients with acute myocardial infarction without obstructive coronary artery disease (MINOCA) is of interest. In this group of patients, there is a lack of information related to myocardial perfusion, blood flow and reserve, which could be important in term of risk and prognosis assessment.

Purpose. To assess the global and regional myocardial blood flow and coronary flow reserve impairment in MINOCA patients compared to cardiac magnetic resonance (CMR).

Methods. The study group comprised 28 patients (18 male, mean 62.9 ± 10.7years) with acute coronary syndrome. Based on ICA results all patients were divided into two groups: 1) MINOCA (n = 11); 2) patients with myocardial infarction with obstructive CAD (MICAD) (n = 17). A total of 12/17 (71%) MICAD patients underwent PCI with stenting; in 2/12 cases two arteries were revascularized.

Within 7-10 days after admission to the hospital all patients underwent SPECT myocardial perfusion scintigraphy (MPS) with the assessment of standard indices (SSS, SRS, SDS) and quantitative parameters: rest MBF (rMBF), stress MBF (sMBF) and CFR (on CZT gamma-camera). Also, all patients underwent CMR with evaluation of infarct size (IF), microvascular obstruction (MVO), size of myocardial edema (ME) and transmural extent of myocardial infarction (TE).

Results Visual analysis showed that SSS differed significantly (p = 0.001) among MINOCA and MICAD groups: 5 (3;6) vs 10 (5;13), respectively. According to the quantitative MPS data analysis, global sMBF and CFR values were significantly higher in MINOCA than in MICAD patients group: 1.2 (0.82;1.69) ml/min/g vs 0.62 (0.52;0.9) ml/min/g; 1.96 (1.23;2.42) vs 1.16 (0.98;1.64) , respectively.

CMR indices such as IS, ME and TE were significantly lower in MINOCA compared to MICAD patients: 1.6 (0;7.8) vs 14.8 (6.3;22.6)%; 8(0;14) vs 18.5 (10;23)%; 0 (0;5) vs 18 (10;25), respectively. Seven(40%) MICAD group patients showed MVO, whereas there were no such patients in MINIOCA group.

The regional analysis revealed that sMBF and CFR were significantly lower in LV regions characterized by myocardial injury compared to non-injured regions (based on CMR data): 0.78 (0.51;0.94) ml/min/g vs 1.11 (0.82;1.4) and 1.22 (0.91;1.74) vs 1.52 (1.14;2.42), respectively. Also, we found out significant correlation between regional quantitative SPECT indices and transmural extent of myocardial infarction evaluated by CMR: r=–0.4 for sMBF; r=–0.35 for CFR (p &lt; 0.05).

Conclusion. The analysis of quantitative MPS SPECT parameters showed that such approach allows identifying MBF and CFR disturbances both on global and regional level. These results showed that MINOCA patients characterized by mild reduction of myocardial blood flow and perfusion assessed visually and quantitatively. It means that despite the absence of obstructive coronary artery lesion this group of patients has more pronounced risk of cardiac events and need more aggressive observation and treatment.

[Peripartum cardiomyopathy or takotsubo cardiomyopathy? The clinical case with arterial hypotension and pulmonary edema]

A 29-year old female patient without a history of cardiovascular diseases was admitted on emergency to a surgical hospital with acute calculous cholecystitis in 3 months after uncomplicated term birth. During laparoscopic cholecystectomy, she developed arterial hypotension with pulmonary edema, which required intravenous sympathomimetics. On the next day, after improvement of the condition and stabilization of hemodynamics, cardiac ultrasound showed diffuse left ventricular (LV) hypokinesis with the ejection fraction (EF) of 38 %. Electrocardiogram detected transient left bundle branch block followed by persistent negative T waves in leads I, aVL, and V2 V6. Troponin I concentration was increased to 1.2 ng /ml. Beta-blocker and angiotensin-converting enzyme inhibitor were administered. At 10 days, the LV contractile function completely recovered with LV EF of 59 %. Magnetic resonance imaging did not reveal any signs of myocardial infarction or myocarditis. A differential diagnosis was performed between peripartum cardiomyopathy and Takotsubo syndrome. Considering the fast recovery of LV systolic function, the patient was discharged with a diagnosis of Takotsubo syndrome.

The main pulse of the Siberian Traps expanded in size and composition

Emplacement of large volumes of (sub)volcanic rocks during the main pulse of the Siberian Traps occurred within <1 m.y., coinciding with the end-Permian mass extinction. Volcanics from outside the main Siberian Traps, e.g. Taimyr and West Siberia, have since long been correlated, but existing geochronological data cannot resolve at a precision better than ~5 m.y. whether (sub)volcanic activity in these areas actually occurred during the main pulse or later. We report the first high precision U-Pb zircon geochronology from two alkaline ultramafic-felsic layered intrusive complexes from Taimyr, showing synchronicity between these and the main Siberian Traps (sub)volcanic pulse, and the presence of a second Dinerian-Smithian pulse. This is the first documentation of felsic intrusive magmatism occurring during the main pulse, testifying to the Siberian Trap's compositional diversity. Furthermore, the intrusions cut basal basalts of the Taimyr lava stratigraphy hence providing a minimum age of these basalts of 251.64 ± 0.11 Ma. Synchronicity of (sub)volcanic activity between Taimyr and the Siberian Traps imply that the total area of the Siberian Traps main pulse should include a ~300 000 km² area north of Norilsk. The vast aerial extent of the (sub)volcanic activity during the Siberian Traps main pulse may explain the severe environmental consequences.

[Multiplex analysis on the luminex platform in complex estimation of cardiovascular biomarker dynamics in patients with acute myocardial infarction.]

The multimarker approach more accurately reflects the key mechanisms of pathogenesis and biochemical interactions, compared with the use of individual indicators. It is a reason of steadily growing interest in the development and use of various combinations of biomarkers in assessing the prognosis and stratification of cardiovascular risk in patients with a wide range of cardiological profiles. Multiplex analysis technology on the Luminex platform is the best tool for the simultaneous quantitative determination of a complex of different biomarkers in a single. Using the MILLIPLEX^® MAP Human Cardiovascular Disease Panel, a multiplefold increase of FABP, Troponin I, CK-MB, BNP, Nt-proBNP, BNP in the first 24 hours after MI, decreasing in 6 months with a high degree of confidence, was shown. There were no differences in the content of LIGHT between the stages of observation, as well as in comparison with the reference range. The content of LIGHT on the first day of MI showed strong positive associations with markers of damage of myocardium and myocardial stress. On the first day of MI, a significant increase in the content of ESM-1, decreasing in 6 months after MI to the reference values was found. Strong positive associations of ESM-1 with Troponin I and BNP levels were established. A significant increase of proinflammatory cytokine OSM on the first day of MI, decreasing in the late post-infarction period to reference values was shown. Correlation analysis revealed direct relationships of OSM with Troponin I, CK-MB, Nt-proBNP and BNP. The use of the MILLIPLEX^® MAP Human Cardiovascular Disease Panel 1 diagnostic multimarker panel allowed for the simultaneous quantitative analysis of 11 biochemical parameters, associated with inflammation, atherogenesis, endothelial dysfunction, ischemia and myocardial necrosis. The results can be used to improve the effectiveness of complex diagnostics in patients with primary myocardial infarction with ST segment elevation.

[Hemostatic Gene Polymorphisms in Acute Coronary Syndrome with Nonobstructive Coronary Atherosclerosis]

PURPOSE

to study distribution of genes of the coagulation system, unfavorable in relation to the risk of thrombosis, and their influence on serum parameters ofthe hemostasis system in patients with nonobstructive coronary atherosclerosis (NCA) and acute coronary syndrome (ACS).

MATERIALS AND METHODS

We included in this nonrandomized open study patients with ACS older than 18 years with intact coronary arteries or confirmed at coronary angiography stenosis &lt;50%. Genotypes of these patients were analyzed by 8 polymorphic variants of the hemostatic system genes which previously were found to be associated with the thrombophilia risk: F2 (20210 G&gt;A) rs1799963, F5 (1691 G&gt;A) rs6025, F7 (10976G&gt;A) rs6046, F13 (163 G&gt;T) rs5985, F1 (-455G&gt;A) rs1800790, GP Ia - Ila (807C&gt;t) rs1126643, GP Ilb-IIIa (1565 T&gt;C) rs5918, PAI-I (-6755G&gt;4G) rs1799889. Activities of protein C, Von Willebrand factor, plasminogen, and antithrombin III were also determined.

RESULTS

Of 913 patients with ACS in 30 (3.3%) with mean age 54±11 years we detected NCA. Acute myocardial infarction (AMI) was diagnosed in 24 (80%), unstable angina - in 6 (20%) patients. Only in 1 patient we found no carriage of thrombosis associated genotypes. The frequency of occurrence of the heterozygous genotype of the factor V gene was 1 (3%). Heterozygous genotype of the factor XIII was registered significantly more often in patients with present atherosclerotic lesion compared with those with intact coronary arteries. Mean activity of protein C was 103% [90; 110], antithrombin III - 96% [88; 103], Von Willebrand factor - 137% [114; 162], plasminogen - 109% [102; 112]. At admission lowering of antithrombin III and protein C activities was detected in 4 cases (13%). In dynamics level of these parameters was restored. Elevation of Von Willebrand factor activity at admission was detected in 14 cases (14%) and remained elevated one year after the index event. There was no association between of fibrinogen level, protein C activity, rs1800790 and rs6025 gene polymorphisms, respectively. One-year mortality was 7% (n=2). For one year occurred 1 AIM recurrence (3%), heart failure developed in 15 patients (50%), 11 patients (37%) were repetitively hospitalized due to all causes. No association was revealed between activity of studied blood serum markers and 1 -year outcomes (death, re-AIM, rehospitalization).

CONCLUSION

Among ACS patients 3.3% had NCA, what corresponded to the literature data. Carriage of at least 1 polymorphic variant of 8 thrombosis associated genes of the coagulation system was found in 97 % of patients with ACS and NCA. Distribution of these variants was like that in the European population and in patients with AIM at the background of stenosing atherosclerosis. Level of serum markers did not depend on distribution of polymorphic variants of the coagulation system genes, and presence of atherosclerotic coronary artery lesions. There was no association between hospital and long-term outcomes and distribution of polymorphic variants of thrombosis associated coagulation system genes, as well as levels of blood serum markers.

P3596The role of MSCT and SPECT in patients with acute coronary syndromes and non-obstructive coronary artery disease

Background

Approximately 1–14% of patients with ACS not have obstructive changes in the coronary arteries according to the data of invasive coronary angiography (ICA) is myocardial infarction (AMI) with non-obstructive coronary artery- MINOCA. MSCT has the ability to assess the lumen of the vessel, visualize the artery wall, the structure of the atherosclerotic plaque. SPECT is used to detect myocardial ischemia, determine the functional significance of atherosclerotic plaques, and evaluate regional tissue perfusion. There are no data on a research of a structurally functional condition of a coronary blood-groove by means of MSCT, SPECT.Aim. To study the role of MSCT and SPECT in patients with MINOCA, to compare MSCT with invasive coronarography.

Material and methods

The study is registered on ClinicalTrials.gov. Inclusion criteria are listed on the site. All patients underwent CT, SPECT, on the 6th day from the beginning of the index event. All MSCT and SPECT studies were performed on a 64-section combined single-photon-emission and X-ray computer tomograph GE Discovery NM/CT 570C. Endpoint: Frequency of occurrence of atherosclerosis, frequency of occurrence of unstable plaques according to MSCT, the magnitude of a transient defect in myocardial perfusion according to SPECT.

Results

The study included 14 patients with MINOCA, women predominate – 11 (78.6%), the average age was 61.1±14 years. The risk of GRACE was moderate in 8 (57%) pts. 12 (85.7%) pts were hospitalized within the first 6 hours of the onset of the disease.Thrombolytic therapy was performed in 3 (21.4%) pts, 2 of them were effective (14%). 57% of patients at admission were troponin-positive.According to the results of ICA, intact coronary arteries were detected in 9 (64.3%) pts, 5 (35%) had stenosis up to 50%. Coronary slow flow (TIMI 2) was determined in 11 (78.6%) pts, of which 8 (57%) pts have coronary slow flow and intact coronary arteries. Coronary spasm was in 1 (7.1%) patient. According to MSCT, the proportion of pts with intact coronary arteries decreased (9 (64.3%) → 5 (35.7%)) and the proportion with non-obstructive atherosclerosis increased (5 (35%) → 9 (64.3%)). All pts had a positive remodeling index, soft-tissue, predominantly calcified stenoses and eccentric plaques. The average Segment Involvement Score was 2.1 (0; 5), the Segment Stenosis Score was −2.4 (1; 3). 12 pts (85%) had transitory perfusion defects. The median SSS values were 7.5 (4; 13), SRS 4.7 (1.0; 9.0), SDS 4.7 (3.0; 8.0).

Conclusion

In 78% of pts had a slowing of the coronary blood flow and intact coronary arteries according to ICAG. However, according to MSCT, only 36% of the patients did not have plaques. MSCT allows to identify eccentric soft tissue atherosclerotic plaques that have a high risk of rupture/erosion, and, accordingly, the high risk of the development of AMI in this group. Using SPECT revealed a statistically significant transient perfusion defect.

[Inflammation as a universal pathogenetic link between injury, repair and regeneration, in acute coronary syndrome. From experiment to clinic]

Theory of atherogenesis and its complications underwent numerous changes. Today we observe that inflammation is a universal pathogenetic link between various processes such as atherosclerosis, rupture of atherosclerotic plaques and following myocardial infarction, post-infarction cardiac repair and heart failure. This review discusses examples, difficulties, and prospects of implementation of anti-inflammatory therapies in management of acute coronary syndrome and its complications.

[Cardiogenic Shock in Patients with Myocardial Infarction]

This review article contains presentation of modern diagnostic criteria and prognostic scales for cardiogenic shock in patients with myocardial infarction as well as analysis of current clinical guidelines. Main results of clinical trials underlying recommendations of these guidelines are discussed. The article focuses on controversial and unfounded recommendations and issues requiring further research.

[Successful experience in the correction of post-infarction ventricular septal defect]

Rupture of the interventricular septum (MVP) as a complication of acute myocardial infarction is a rare event and associated with high mortality without timely surgical treatment. We present a case of a 68-year-old patient who had an acute myocardial infarc‑ tion with ST-segment elevation complicated by a rupture of MVP. In this article we discusse the difficulties of patient management with this pathology and the problem of choice of treatment tactics.

[Detection of Antigens of Cardiotropic Viruses in Atherosclerotic Plaques in Patients with Fatal Myocardial Infarction]

AIM

To assess the frequency of detection of cardiotropic virus antigens in coronary artery atherosclerotic plaques in patients with fatal myocardial infarction (MI).

MATERIALS AND METHODS

We examined fragments of coronary plaques of 12 patients with fatal type 1 MI. Immunohistochemistry (IHC) of plaques was performed with the paraffin blocks using antibodies to Herpes simplex virus (HSV)-1, HSV-2, HSV-6, cytomegalovirus (CMV), parvovirus B19, adenovirus, Epstein-Barr virus and enteroviruses.

RESULTS

According to the IHC all patients had virus antigens. The most common virus agents in fragments of coronary plaques were HSV-6 (10 patients) and enteroviruses (5 patients). Antigens of CMV, parvovirus B19, adenovirus, Epstein-Barr virus were not detected in any case.

CONCLUSIONS

In this study viral antigens in coronary artery atherosclerotic plaques were found in all victims of fatal MI. There was no difference in the frequency of detection and type of viral agents between plaques in culprit arteries and uncomplicated atherosclerotic plaques.

[Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock Due to Fulminant Myocarditis]

This article presents a clinical case of a 40-year-old woman with fulminant myocarditis which progressed rapidly to the development of cardiogenic shock resistant to standard intensive care, but with a positive response to extracorporeal membrane oxygenation.

[Dynamics of brain CD68+ and stabilin-1+ macrophage infiltration in patients with myocardial infarction]

Te aim of the study was to evaluate the temporal dynamics of brain CD68+ and stabilin-1+ macrophage infltration in patients with fatal myocardial infarction (MI) type 1.

MATERIALS AND METHODS

Te study included 31 patients with fatal MI type I. Te control group comprised 10 patients of 18-40 age group who died from injuries incompatible with life. Patients with MI were divided into two groups. Group 1 comprised patients who died during the frst 72 hours of MI, group 2 comprised patients who died on days 4‒28. Macrophage infltration in the brain was assessed by immunohistochemical analysis. We used CD68 as a marker for the cells of the macrophage lineage and stabilin-1 as an M2-like macrophage biomarker.

RESULTS

In group 1 the number of brain CD68+ macrophages was signifcantly higher than in the control group. In group 2 the intensity of brain CD68+ cells infltration was lower than in group 1 and higher than in the control group. Tere was a small amount of stabilin-1+ macrophages in the brain of healthy people, as well as of patients who died from MI. Tere were no signifcant differences in the number of stabilin-1+ cells between group 1 and group 2. Correlation analysis revealed the presence of positive correlation between the number of CD68 + macrophages in the infarct, peri-infarct, and non-infarct areas of the myocardium and the number of CD68+ macrophages in the brain in patients with MI. Tere were not correlations between the number of CD68 + and stabilin-1+ cells and the presence of diabetes mellitus, history of stroke, history of MI, and pre-infarction angina.

CONCLUSION

Te number of brain CD68+ macrophages signifcantly increased during the frst three days of MI. Te number of brain stabilin-1+ macrophages did not increase and did not differ from the control values. We observed a positive correlation between the number of CD68+ macrophages in the brain and myocardium.

Two-Stage Revascularization in Patients with Acute Myocardial Infarction and Massive Coronary Thrombosis

AIM

to investigate safety and angiographic efficacy of two-stage revascularization with percutaneous coronary intervention (PCI) with stenting delayed by one day in patients with acute myocardial infarction (MI) and massive coronary thrombosis.

MATERIALS AND METHODS

We included in this study 12 patients with massive infarct related coronary artery thrombus which length was greater than thrice the vessel diameter in the presence of TIMI grade II-III blood flow as detected by coronary angiography (CAG). The emergency PCI was not performed, and conservative antithrombotic therapy continued for 24 hours. After this day, CAG was repeated.

RESULTS

Repeat CAG in all patients showed thrombus regression which visually appeared as complete lysis in 8, and partial lysis - in 4 patients. Stenting of residual stenosis was performed in 11 patients without complications. In 1 patient residual stenosis was considered insignificant (&lt;50 %) therefore stenting was not performed. No-reflowphenomenon and recurrent MI were not observed.

CONCLUSION

These data suggest that in patients with massive coronary artery thrombosis conservative antithrombotic therapy for 24 hours followed by repeated CAG and, if required, by stenting of residual stenosis, is safe treatment tactics that might reduce the risk of the no-reflow phenomenon.

Characteristics and treatment of patients with heart failure admitted to a cardiology department in 2002 and 2016

AIM

To investigate the difference in characteristics of patients admitted to the Tomsk National Research Medical Center with a diagnosis of heart failure (HF) in 2002 and 2016.

METHODS

Medical charts of all patients hospitalised in a single centre, with a diagnosis of HF, were included. Two three‑month periods were compared from January 2002 (n=210) and January 2016 (n=378).

RESULTS

Fewer patients with HF had symptoms or required diuretics in 2016 (63 % vs 98,6 %, p&lt;0.001). During this period the percentage of patients with HFpEF increased from 58.6 % to 74.1 % (p=0.001) whereas those with HFrEF remained similar (19.5 % vs 14.0 %, p=0.1) and those with HFmrEF declined (21.9 % vs 11,9 %, p=0.007). In patients with HFrEF the prescription of ACEi / ARB remained similar (80.4 vs 88 %, p=0.3), beta‑blockers increased from 68 to 85 % (p=0.03) and aldosterone antagonists from 9.7 to 49 % (p&lt;0.001).

CONCLUSION

Prescription rates for prognostic medications in HFrEF improved in 2016. The substantial percentage of patients diagnosed with HFpEF without symptoms or diuretic raises the question of whether a diagnosis of HF was appropriate in some cases.

Refractory post-infarction myocardial ischemia: treatment potential

The treatment of recurrent, refractory post-infarction myocardial ischemia remains an unresolved clinical problem. Aggressive pharmaceutical therapy has limited effectiveness, while percutaneous coronary intervention or coronary artery bypass graft surgery are not possible in these patients, due to various reasons. Currently, alternative methods for refractory angina treatment are being developed for patients with chronic stable angina. The potential of these methods in patients with acute coronary syndrome should be investigated in the future studies.

Evaluation of the efficacy of granulocyte colony-stimulating factor for the treatment of experimental myocardial destruction in mice

We studied the effects of recombinant granulocytic CSF on heart remodeling in BALB/c mice after cryodestruction. Administration of granulocytic CSF was started 1 day after cryodestruction (subcutaneously, 10 μg/kg/day, for 4 days). As early as after the first injection, leukocytosis in the peripheral blood started to develop, leukocyte count peaked on days 4-6 and returned to normal on day 14. Treatment with granulocytic CSF significantly increased the content of progenitor cells in the bone marrow and led to rapid development of the inflammatory reaction and myocardium infiltration with mononuclear cells. Injections of granulocytic CSF did not reduce scar area, but provided significantly less pronounced heart hypertrophy, which attests to its better functional properties. By day 30 after cryodestruction, control animals and animals receiving granulocytic CSF exhibited similar morphological picture at the site of damage. Thus, our regimen of granulocytic CSF administration produced a mobilizing effect on bone marrow progenitor cells and postinfarction heart remodeling. Direct effects of granulocytic CSF on the heart have to be established for its use in the treatment of myocardial infarction.

Autologous mononuclear bone marrow cells during reparative regeneratrion after acute myocardial infarction

A randomized controlled study included 44 patients with acute myocardial infarction. It was found that intracoronary injection of bone marrow mononuclear cells is safe, ensures fixation of the injected cells in the myocardium, reduces blood levels of IL-1beta and TNF-alpha, increases the content insulin-like growth factor, and does not provoke malignant arrhythmias.

Cardiac contractility after transplantation of autologous mononuclear bone marrow cells in patients with myocardial infarction

Autologous bone marrow mononuclear cells were transplanted by intracoronary infusion to patients with myocardial infarction after recovery of coronary perfusion. Controls received traditional therapy alone. Echocardiography was carried out before and 3 and 6 months after cell therapy. Cell transplantation did not appreciably improved left-ventricular contractility in comparison with the control group. In none patient cell therapy provoked malignant ventricular arrhythmias. Intracoronary infusion of bone marrow mononuclear cells in patients with myocardial infarction did not improve cardiac contractility and did not aggravate the course of the disease.

[Dynamics of left ventricular remodeling in patients with acute myocardial infarction]

Dynamics of structural and functional left ventricular parameters was investigated in 51 patients with acute anterior myocardial infarction by means of serial (on days 1, 2, 3, 5, 7, 10 and 21 of infarction) echocardiographical study. Increase of end-diastolic volume index relative to initial values became significant on 5th-7th days and continued to progress until 3rd week of infarction. Left ventricular cavity became dilated and attained more occurred shape predominantly at the account of increased transverse diameters. Abnormalities of left ventricular contractile and pump functions were most pronounced during first 3 days of the disease. Between 5th and 10th days improvement and stabilization of myocardial functional state took place accompanied by progression of left ventricular dilation and increase of its sphericity with lessening of degree of myocardial asynergy.