The aim – to understand effects of intermittent hypoxia training (IHT) in prediabetes patients 60 years age and over on microcirculatory system, glucose homeostasis and lipids.
Material and methods. A total of 82 subjects of different age were included into this analysis. All of them underwent glucose tolerance test (GTT). After GTT 19 prediabetes people 60 years age and over continued investigation with determination of plasma glucose, insulin and cortizol. Insulin sensitivity was evaluated by homeostasis model assessment of insulin resistance (HOMA-ІR). Lipid profile, endothelial function and microcirculatory system were studied before and after IHT in prediabetes patients 60 years age and over.
Results. It was shown that IНT promotes the normalization of carbohydrate metabolism in the elderly prediabetes people. Favorable changes were observed after the IHT course: the percentage of people with pre-diabetic disorders decreased from 100 % to 42.1 % (Р<0.01). One month after the IHT, an increase in the normalizing effect on the carbohydrate metabolism was noted: a statistically significant decrease in the fasting glucose from 5.8±0.2 to 5.5±0.2 mmol/l (Р<0.05), after 2 hours GTT – from 8.5±0.2 to 7.0±0.4 mmol/l (Р<0.01). Pre-diabetic disorders were detected in 15.8 % of the subjects (Р<0.001) after 1 month of IHT. In prediabetes subjects after course use of IHT there was statistically significant decrease in total cholesterol and cholesterol of low density lipoproteins.
Conclusions. The use of IHT is promising for correction of prediabetes disorders in the elderly, which reduces not only the risk of developing type 2 diabetes but also prevents cardiovascular complications.
The aim – to research associations between vascular endothelial growth factor-A (VEGF-A) level and left ventricular remodeling after ST elevation myocardial infarction (MI).
Material and methods. 62 patients with MI, 51 (82.3 %) male and 11 (17.7 %) female at average age 58.63±8.90 years were enrolled into the study. VEGF-A level was determined on the 7th day of MI by enzyme-linked immunoassay. Anxiety level was assessed by Taylor questionnaire during the period of 10–14 days before MI. After 6-month observation 47 patients were assessed.
Results. In patients with MI in comparison with the control group significant rise of serum VEGF-A level was observed, showing positive correlation with creatine kinase level. The level of VEGF-A below median 160 pg/ml in comparison with its level above the median 160 pg/ml was associated with higher frequency of MI in men (Р=0.023), anxiety before MI (Р=0.019), end diastolic diameter (EDD), end systolic diameter (ESD), end diastolic volume (EDV) increase in acute phase, EDD, ESD, EDV, left ventricular myocardial mass, Е/А, lower exercise tolerance after 6-month observation. This processes indicates unfavorable role of low VEGF-A levels and protective – of high VEG-A levels for intracardiac hemodynamic after myocardial infarction. The level of VEGF-A ≤ 201.86 pg/ml with sensitivity 57.9 % and specificity 85.7 % (AUC 0.711; 95 % CI 0.513–0.908; Р=0.036) have prognostic significance for adverse remodeling development.
Conclusions. VEGF-A level – important indicator to estimate the extent of myocardial injury and pathologic remodeling development.
The aim – to evaluate the cardioprotective effect of metabolic therapy in patients with coronary heart disease (ICD) by digital processing of a standard electrocardiogram using original software.
Material and methods. 46 patients with stable angina pectoris of II functional class were examined. In order to determine the cardioprotective effect of metabolic therapy, the results of digital processing of the standard ECG in patients with coronary heart disease were analyzed using original software. with the evaluation of the effect of drugs (tivortin, tivorel, tiotriazoline, corvitine) with antiarrhythmic anticipation, in comparison with the effects of amiodarone and bisoprolol on the main parameters of HRD and dispersion of the QT interval, the angle of inclination of the ST segment and the results of the analysis differentiated T wave. The possibility of an effective quantitative evaluation of the electrocardiogram with its digital processing (digitalization) with the use of its own Smart-ECG software in patients with stable angina pectoris was proven.
Results. In the complex analysis of effects from the use of drugs, it was found that tivortin/tivorel reduced the risk of adverse events with stable angina pectoris and activated parasympathetic contour, corvitine and tiotriazoline – reduced the dispersion of the QT interval, tiotriazoline, corvitine and tivortin, accelerated transient depression of the ST segment – reducing the risk of coronary heart disease and increasing antiarrhythmic effect. Bisoprolol and amiodarone increase the SDNN score and consequently reduce the risk of adverse events with stable angina pectoris, amiodarone stimulates the activation of the parasympathetic contour and less efficiently affects ST slope than bisoprolol, both drugs slightly optimize the ratio of maximum velocities and thus maintain anti-ischemic status.
Conclusions. Quantitative evaluation of the electrocardiogram with its digital processing (digitization) can be recommended for increasing the effectiveness of the individual approach in the treatment of patients with acute and chronic ischemic heart disease with the objectification of cardioprotection.
The aim – to compare patients with chronic heart failure and reduced left ventricular ejection fraction (LVEF) with absolute and functional iron deficiency (ID) state according to the main clinical, hemodynamic, laboratory parameters and clinical prognosis indicators.
Material and methods. In January – February, 2018, 128 stable patients with chronic heart failure (111 of men and 17 of women), 18–75 years old, NYHA class II–IV, with left ventricular ejection fraction < 40 % were screened. Patients were included in a clinical compensation phase. Quality of life was assessed by the Minnesota living with heart failure questionnaire (MLHFQ), physical activity was estimated by the Duke University index, functional status – by assessing the 6-minute walking test and a standardized lower limb extension test.
Results. ID was observed in 61 % of patients, 65 % had absolute ID. Patients with both types of ID were in higher functional class, had a poorer quality of life and worse clinical and laboratory indices than patients without ID. Regardless of the difference in the functional and absolute ID formation mechanisms, no significant distinctions in the clinical and functional parameters, quality of life, as well as the parameters of intracardiac hemodynamics were found. Contrary to expectations, elevated levels of hepcidin were not detected in patients with functional ID compared to the absolute ID group. The reliable differences in survival/hospitalization rate between patients without ID and both groups of patients with ID allow us to recommend the screening of iron deficiency in all patients with chronic heart failure and reduced LVEF.
Conclusions. ID is found in 61 % patients. Functional ID was found in 27 patients (21 %), absolute ID – in 51 patients (39.6 %). There were no differences between groups of patients with absolute and functional ID by age, functional class, LVEF, percentage of aneamic patients, 6-minute walking distance, thigh quadriceps endurance, quality of life, physical activity index, NT-proBNP, citrulline and hepcidin levels. Compared to patients with absolute ID, patients with functional ID had higher levels of hemoglobin, MCV, MCH, interleukin-6. Presence of both ID types was associated with worse survival and more frequent hospitalization.
The aim – to examine the relationship between parameters of the renal function and main characteristics in patients with chronic heart failure and reduced left ventricular ejection fraction during their clinical and instrumental examination.
Material and methods. The present analysis includes 134 patients and reduced left ventricular ejection fraction with II–IV New York Heart Association (NYHA) classes. All patients were in stable clinical condition. Baseline measurements included height, weight, blood preasure, heart rate, NYHA classification. All patients were examined by routine ECG, echocardiography. Glomerular filtration rate (GFR) was estimated using the CKD-EPI equation. Daily microalbuminuria and urinary albumine/creatinine ratio were determined. Definitions of levels of blood urea nitrogen, uric acid, interleukin-6, NT-proBNP and citrulin were performed. All patients received standard treatment.
Results. The performed study demonstrated the role of GFR as indicator most closely related to the clinical characteristics of the examined patients (NYHA class, age, hypertension, diabetes, anemia) and levels of interleukin-6 and citrulline. Microalbuminuria level and albumin/creatitine ratio in urine did not show a similar relation, except for the NYHA class. Blood urea nitrogen was higher in patients with higher NYHA class and with concomitant diabetes and anemia. All studied parameters of the renal function revealed a reliable association with uric acid level. There were no significant (P<0.05) relationships between renal function parameters and systolic blood pressure, heart rate, left ventricular ejection fraction and flow-dependent vasodilator response of the brachial artery, as well as the level of NT-proBNP in plasma.
Conclusions. Among stable patients with chronic heart failure and reduced left ventricular ejection fraction, there were significantly lower levels of GFR in patients with III–IV NYHA classes, in older women (≥ 63 years) and in patients with hypertension, diabetes and anemia. The level of GFR was directly related to the level of circulating biomarkers, such as uric acid, interleukin-6 and citrulline. The levels of microalbuminuria, urinary albumine/creatinine ratio, blood urea nitrogen were significantly higher in patients with ІІІ–ІV NYHA classes.
The aim – to study the activity of low-grade inflammation and determine an interaction of its parameters with characteristics of humoral systems of blood pressure regulation, hypertensive heart and kidney damage in patients with resistant arterial hypertension (AH).
Material and methods. The results of examination of 129 patients with AH (72 patients with controlled AH, 57 persons with resistant AH) were included into the analysis. All patients, besides routine clinical examination, underwent 24-hours’ blood pressure monitoring, evaluation of systemiс inflammation markers (C-reactive protein, fibrinogen, IL-6, TNF-α), MMP-12 activity, cystatin C, renin, aldosterone, citrulline blood concentration; 24-hours’ excretion of albumin and metanephrine.
Results. In the resistant AH, compared to the patients with controlled arterial hypertension, higher levels of inflammation active phase proteins (C-reactive proteins – by 17.3 %, fibrinogen – by 10.6 %) and proinflammatory cytokines (IL-6 by 21.8 % TNF-α by 13 %) were detected. The activation of low-grade inflammation in patients with resistant AH has been associated with higher renin-angiotensin-aldosterone system activity: the concentration of plasma aldosterone correlated with IL-6 level (r=0.334; Р=0.03) and matrix metalloproteinase 12 activity (r=0.326; Р=0.02); active renin blood contents – with IL-6 (r=0.416; Р=0.01) and TNF-α (r=0.323; Р=0.03) levels). In patients with resistant AH the increase of left ventricle myocardial mass index was accompanied by elevation of plasma IL-6, and decrease of glomerular filtration rate was associated with growth of plasma TNF-α blood level (r=0.318; Р=0.04). Correlation of MMP-12 activity with renal impairment markers – cystatin С (r=0.405; Р=0.01) and citrulline (r=0.338; Р=0.03) was detected. In resistant AH pts increase of LVMI was accompanied by elevation of IL-6.
Conclusions. Resistant AH was characterized by more expressed activation of low – grade inflammation, compared to controlled AH, which is associated with renin-angiotensin-aldosterone system activation and hypertensive injury of heart and kidneys.
The aim – 1) to evaluate the possibilities of ultrasound fetal heart examination in the detection and differential diagnosis of bradyarrhythmias; 2) to study the influence of arrhythmias on fetal hemodynamics; 3) to examine the role of fetal echocardiography in the management of prenatally diagnosed bradyarrhythmias for determining the optimal pregnancy and delivery tactics.
Material and methods. The analysis of echocardiographic examinations of the fetal heart from April 1996 to July 2016 has been performed. During this period 2073 pregnant women were examined and 213 cases of fetal heart arrhythmias were detected. Ultrasound examination of the fetal heart was conducted according to the general protocol. The anatomy of the fetal heart was assessed based on segmental analysis. Rhythm of the fetal heart was determined by simultaneous recording of mechanical events (contractions of the atria and ventricles), which are the consequence of electrical activity, with estimation of the ratio between them, as well as the measured time intervals of the cardiac cycle with calculation of their ratio. For this purpose, various ultrasound techniques (M-method, color, pulse-wave and tissue Doppler) have been used.
Results. During the study period 45 cases of fetal bradyarrhythmias were detected, (2.2 % of the number of all patients examined and 21.1 % of all arrhythmias). They included 20 cases (44.5 %) of periodic bradycardia of different duration, 9 cases (20 %) of sustained sinus bradycardia, 9 cases (20 %) of complete atrioventricular block, 5 cases (11 %) of blocked atrial bigeminy and 2 cases (4.5 %) of 2nd degree atrioventricular block. Persistent fetal bradycardia requires a complete echocardiographic examination to exclude structural pathology and assess possible hemodynamic complications. Bradyarrhythmias with a frequency of ventricular contractions of more than 60 bpm are well tolerated by the fetuses due to various adaptive mechanisms. Permanent forms of arrhythmia with a frequency less than 55 bpm, as usual, lead to serious hemodynamic comromise even in the absence of fetal congenital heart defects.
Conclusions. Ultrasound fetal heart examination provides not only the identification and reliable differential diagnosis of various types of fetal bradyarrhythmia, but also an assessment of its hemodynamic consequences and prenatal period monitoring of the fetal condition. This makes possible to choose the tactics of pregnancy management, determine the frequency of follow-up examinations, plan the time, place and route of delivery. The majority of fetal bradyarrhythmias are non-threatening rhythm disorders.
The aim – to elaborate and to validate the combined non-invasive method to reveal the obstructive сoronary artery disease (CAD) presence using its clinical pretest probability value in conjunction with tissue Doppler data of local systolic wall motion.
Material and methods. 81 pts with typical anginal and atypical chest pain and known absence of structural myocardial diseases as well as history of myocardial infarction and coronary revascularization, 64 % men, age 56.2±9.9 yrs old were examined. All patients were divided into investigational (teaching) and checking group (49 and 32 patients, accordingly) comparable by age, gender and main comorbidities rates. The index of coronary obstruction (INCO) was expressed in conventional units and was calculated as the ratio of CAD pretest probability to mean systolic wall motion velocity of 12 myocardial segments by tissue Doppler imaging.
Results. Invasive angiography identified obstructive lesions of coronary arteries in 37 patients, including 23 patients (47 %) of the investigational group and 14 (44 %) in checking group. The investigational group patients’ INCO composed 7.8±3.8 conv units with bimodal distribution of the parameter and cut-off point at 8 conv units which corresponds to 80 % sensitivity and 91 % specificity, AUC in ROC analysis 0,965. Comparable diagnostic properties of INCO at 8 conv units were confirmed during the further analysis in checking group with 85 % sensitivity and 95 % specificity, AUC 0.971.
Conclusions. New complex non-invasive diagnostic method including INCO calculation based on CAD pretest probability and local systolic wall motion velocities evaluation by tissue Doppler was proposed. High INCO sensitivity and specificity at value – 8 conv units to determine obstructive lesions in coronary arteries were shown. INCO calculation may be widely used at the first step of non-invasive diagnosis in suspected CAD, as well as for determination of the further strategy in patients after coronary revascularization.
The aim – to determine antiarrhythmic efficiency of eplerenone in the complex therapy of patients with arterial hypertension (AH) and frequent recurrences of atrial fibrillation (AF).
Material and methods. 146 patients with AH II stage and frequent recurrences of AF were examined. The age of the patients was from 37 till 86 years. Among them 68 (46.6 %) were males. Permanent antiarrhythmic therapy was prescribed in all patients. The antiarrhythmic efficiency was evaluated by patient-reported frequency of AF attacks and their course. Fixed combinations of perindopril with indapamide and losartan with hydrochlorothiazide were used as a starting antihypertensive therapy. Eplerenone 25 mg daily was added in a number of the patients. All patients were examined by determining serum aldosterone levels and daily ECG monitoring.
Results. Usage of eplerenone during 6 months decreased frequency of recurrences of AF and increased the duration of the period between recurrences (4.8 vs. 3.2 times, P=0.04). Antiarrhythmic effect of eplerenone was accompanied by significant increase of cases with complete elimination of supraventricular premature contractions (SPC) (P<0.001) and AF episodes (p=0.05), significant decrease of daily SPC frequency (P=0.007) and supraventricular paroxysmal tachycardias / atrial flutter episodes (P<0.04), decrease of QT interval dispersion (P<0.04). The probability of complete antiarrhythmic efficacy with additional use of eplerenone was significantly more in case of the adrenal AF (P<0.03). Factors increasing the probability of complete antiarrhythmic efficacy of eplerenone were: daily heart rate > 78 per minute, the ratio of left atrium /right atrium < 1.45, using of losartan in a dose of 100 mg/day, the dynamics of systolic blood pressure (BP) at the 4th week of treatment according to data of office measurement of BP > 32 mm Hg, and plasma level of aldosterone > 150 pg/ml.
Conclusions. Eplerenone provided additional antiarrhythmic effect in patients with AH and paroxysmal AF. Positive antiarrhythmic effect of eplerenone accompanied by a significant increase in cases with a complete elimination of SPC and AF episodes, significant decrease in the frequency of SPC for the day and SVPT/AF episodes, decrease in the dispersion of QT interval. The probability of complete antiarrhythmic efficacy with additional use of eplerenone significantly increases in the case of adrenal variant and decreases in the case of vagal varian of AF. As factors that increase the probability of complete antiarrhythmic efficacy of eplerenone are: daily HR > 78, the ratio LA/RA < 1.45, using of losartan in a dose of 100 mg/day, the dynamic of systolic BP at the 4th week of treatment according to data of office measurement of BP > 32 mm hg and plasma level of aldosterone > 150 pg/ml.
The aim – to investigate clinical and other factors associated with cognitive dysfunction in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction.
Material and methods. 124 patients with stable CHF and reduced left ventricular ejection fraction (< 40 %), NYHA II–IV not older than 75 years were examined. Vital signs, routine laboratory tests, glomerular filtration rate by CKD-EPI, electrocardiography and ehocardiography parameters were studied. Cognitive function was evaluated by standard neuropsychological tests – MMSE (Mini Mental State Examination), Shulte and HADS. Cognitive dysfunction was defined as MMSE ≤ 26 points. Apart from routine examination, quality of life evaluation by The Minnesota Living with Heart Failure Questionnaire (The MLHFQ); evaluation of functional capacity by Duke Activity Status Index, endothelium-dependent vasodilation test were performed.
Results. Cognitive dysfunction (abnormal MMSE) was observed in 85 (68.6 %) patients. There was no significant differences of MMSE and Schulte test results in men and women, groups of patients with atrial fibrillation (AF) and sinus rhythm. Instead, a significantly worse MMSE and Schulte tests were observed in groups of patients with higher NYHA class (Р<0.001 for both tests), arterial hypertension (P=0.04 and P=0.012, respectively), coronary heart disease (Р<0.001 for both tests) and after myocardial infarction (Р<0.001 and P=0.002, respectively). The group of elderly patients had significantly worse MMSE and Schulte scores (Р<0.001 for both tests). Levels of systolic blood pressure, heart rate and left ventricular ejection fraction did not significantly affect cognitive function, while lower glomerular filtration rate was associated with presence of the cognitive dysfunction.
There was a significantly higher prevalence of cognitive dysfunction in patients with diabetes (P=0.049). At the same time, MMSE and Schulte tests were significantly worse in patients with anemia (P=0.02 and Р<0.001, respectively) and renal dysfunction (GFR < 60 ml/(min · 1,73 m2)) (P=0.003 and Р<0.001, respectively).
Conclusion. Cognitive dysfunction was observed in 68.6 % of stable CHF patients. There was no significant influence of heart rate, systolic blood pressure, left ventricular ejection fraction, atrial fibrillation and COPD on cognitive tests. Cognitive dysfunction in patients with CHF is associated with older age, coronary heart disease, history of hypertension and myocardial infarction, anemia and renal dysfunction.