Vol 12, No 3 (2021)

Original articles

Study of markers of systemic inflammation (matrix metalloproteinase-9, vascular endothelial adhesion molecules of type 1) in patients with ST -segment elevation myocardial infarction at the hospital and outpatient stages

Zakovryashina I.N., Suroedov V.A., Khaisheva L.A., Shlyk S.V., Samakaev A.S.


Aim. To study the level of MMP-9 and VCAM-1 in patients with AMI with ST-segment elevation at the hospital stage and one year after the index event, depending on the development of complications and changes in BMI and waist size (WS).

Material and methods. The study included 126 people with STEMI after PCI, as well as 27 people in the control group. The level of MMP-9 and VCAM-1 in peripheral blood was analyzed. In addition to the standard methods of examination and diagnosis, BMI and WS were measured to identify groups with visceral obesity. The assessment of the frequency and nature of complications after STEMI was performed.

Results. The levels of biomarkers of vascular endothelial adhesion molecule type 1 and matrix metalloproteinase type 9 are increased in the acute period of STEMI, statistically significantly reduced, but remain elevated 12 months after the index event, with VCAM-1 by 3.5 times, and MMP by almost 2 times compared to the initial values. The level of MMP-9 is significantly higher in excess body mass index and waist size, and VCAM-1 has no association with visceral obesity. Vascular endothelial adhesion molecules of type 1 and matrix metalloproteinases of type 9 are increased in patients with a fatal outcome, as well as with an increase in the severity of OSN and CHF. The level of matrix metalloproteinase has a strong relationship with fatal outcome and repeated MI, and the vascular endothelial adhesion molecule type 1 has a stronger relationship with the severity of CHF.

Conclusion. The article studied markers of systemic inflammation (matrix metalloproteinase type 9 and vascular endothelial adhesion molecules type 1) in patients with ST-segment elevation myocardial infarction, depending on the presence of obesity at the hospital and outpatient stages. Simultaneous determination of MMP-9 and VCAM-1 levels can be used to assess the intensity of the inflammatory process and the risk of adverse outcomes.

CardioSomatics. 2021;12(3):124-131
pages 124-131 views

Characteristics of clinical signs, laboratory and instrumental examinations in various mechanisms of development of type 2 myocardial infarction

Oblavatckii D.V., Boldueva S.A.


Aim. To identify different pathogenetic variants of myocardial infarction type 2 (MI-2).

Material and methods. Reviewed 4168 cases of MI admitted in multidisciplinary hospital for 10 years. 353 patients met the criteria for MI-2 without signs of coronary atherothrombosis (CA). In the study group, the features of clinical and laboratory-instrumental manifestations were evaluated.

Results. Cases of IM-2 were subdivided into 4 clinical-pathogenic variants (CPV): 1-CPV developed due an increasing in myocardial oxygen demand; 2-CPV, arising from a decrease in the supply of oxygen; 3-CPV associated with local coronary circulation disorder; 4-CPV developed due to the combined oxygen-energy imbalance. In 72 (20.4%) cases, 1-CPV was detected, caused by a hypertensive crisis and/or tachyarrhythmias; 2-CPV observed in 73 (20.68%) patients with hypotension, anemia, microvascular dysfunction, respiratory failure; 3-CPV caused by spasm and embolism of CA was detected in 47 (13.31%) cases; in 161 (45.61%) patients, IM-2 is associated with increased myocardial oxygen demand with reduced oxygen delivery. The gender and risk factors in groups are comparable. The average age of 1-CPV- and 3-CPV-patients was less and amounted to 65.7 and 56.5 versus 70.2 and 73.8 years in the 2-CPV and 4-CPV. Typical clinical and laboratory-instrumental signs of MI were common for patients with 1-CPV and 3-CPV, while 2-CPV and 4-CPV more often had chronic severe pathology, multivessel coronary disorder, and the clinical presentation and ischemic signs were less common.

Conclusion. Clinical manifestations and results of examination of patients with MI-2 depend on the mechanism of its development.

CardioSomatics. 2021;12(3):132-138
pages 132-138 views

Novel approaches to the assessment of cardiorespiratory readiness of patients after coronary artery bypass surgery aimed to the efficient cardiac rehabilitation performance

Kakuchaya T.T., Dzhitava T.G., Kuular A.M., Pachuashvili N.V., Tokaeva Z.K.


Aim. To develop novel strategies of patients’ selection and risk stratification after coronary artery bypass surgery before starting aerobic cardiorespiratory training programs.

Material and methods. One hundred thirty seven patients 4 weeks after coronary artery bypass surgery were included in our study. RARE scale (risk of activity related events), ergospirometric test, FIT treadmill score and certain laboratory parameters like hemoglobin and alaninaminotransferase were used.

Results. Logical interdependence is revealed between certain indicators of cardiorespiratory capacity and risk of developing unfavorable events due to aerobic training activities. Comprehensive protocol is developed based on multifactorial regression analysis, which allows to differentiate patients into low and high class of readiness to physical activities, including aerobic cardiorespiratory training programs.

Conclusion. The protocol includes following variables METs, RARE scale, FIT treadmill score, left ventricular ejection fraction, hemoglobin and alaninaminotransferase levels. It is very userfriendly, easy, practical and efficient.

CardioSomatics. 2021;12(3):139-146
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Influence of physical rehabilitation on oxygen and lactate status in "inotrope-dependent" patients with chronic heart failure in class III–IV

Bortsova M.A., Demchenko E.A., Bautin A.E., Fedotov P.A., Marichev A.O., Fedorova M.A., Korneva L.O., Sitnikova M.Y.


Aim. To assess the effect of physical rehabilitation on dynamics of oxygen and lactate status indicators in “inotrope-dependent” patients with stable chronic heart failure (CHF) of III–IV functional class (FC).

Material and methods. A randomized prospective study included 120 men, aged 18–65, hospitalized at Almazov National Medical Research Centre due to CHF III–IV FC, left ventricular ejection fraction (LVEF) ≤30%; with blood pressure (BP)≥90/60 mm Hg. Patients who received dobutamine or dopamine for ≥2 weeks were randomized into 3 groups: 1st – participating in the program of physical training (PPT), 2nd – not participating; 3rd group – patients without inotropic support participating in PPT.

Results. Oxygen extraction ratio (O2ER) at rest was increased, while central venous oxygen saturation (ScvO2) was decreased in all groups at baseline, after 3 and 6 months. Initially, at rest, central venous blood lactate (lactate) was normal in all groups. By the 6th month, lactate in group 2 became higher than in group 1 (p=0.005) and group 3 (p=0.008). Initially, after 3 and 6 months, at peak of exercise in groups 1 and 3, lactate and O2ER increased, and ScvO2 decreased without development of life-threatening adverse events. By the 6th month, in groups 1 and 3, the distance of 6-minute walk test increased: p=0.004 and p<0.00001 and the strength of hand muscles increased: p=0.01 and p=0.005.

Conclusion. In patients with CHF III–IV FC at rest, regardless of participation in PPT and inotropic therapy, there were comparable disturbances of oxygen status, characterized by decreased level of ScvO2 and increased level of O2ER, in the absence of decrease in arterial blood saturation. At peak of aerobic exercise of mild and moderate intensity in patients with advanced CHF, regardless of inotropic support, there was a comparable increase in the level of lactate and O2ER, as well as a decrease in ScvO2, which was not accompanied by life-threatening adverse events. The participation of “inotrope-dependent” patients in PPT is associated with decrease in blood lactate at rest, which, along with increase in hand muscle strength and exercise tolerance, may indicate an improvement in condition of muscle tissue.

CardioSomatics. 2021;12(3):147-157
pages 147-157 views

Antithrombotic therapy and its impact on prognosis in patients with atrial fibrillation and myocardial infarction. Long-term observation results

Soloveva M.V., Boldueva S.A.


Aim. To study antithrombotic therapy (ATT) in patients with myocardial infarction (MI) type 1 and preexisting atrial fibrillation (AF), effect of ATT on prognosis.

Material and methods. 100 patients with type 1 MI and preexisting AF were selected. The exclusion criterion was severe concomitant pathology.

Results. Only 13.0% of AF patients took anticoagulants (AC) adequately before hospitalization. 94.0% of patients in hospital and 80.5% at discharge were prescribed triple ATT at least for 1 month with transition to dual ATT (AC + disaggregant) for 12 months. ACs were prescribed in hospital in 100.0% of cases, at discharge – in 93.1%. After 1 year 8.4% of patients stopped taking ACs, after 2.3±1.9 years – 15.7%. The incidence of ischemic and hemorrhagic events didn’t differ in patients with different regimens of ATT (double/triple) and types of AСs (vitamin K antagonists/non-vitamin K antagonist ACs). In the long-term period patients, who took ACs incorrectly or stopped taking ACs, had increased risks of stroke (OR 9.580; 95% CI 1.153–79.599, p=0.0365); combined endpoint: recurrent MI + stroke + cardiovascular mortality (OR 2.556; 95% CI 1.104–5.918, p=0.0284).

Сonclusion. Patients with preexisting AF had a low adherence to ACs prior to MI. It increased after hospitalization and decreased during follow-up. In the long-term period patients, who took ACs incorrectly or stopped taking ACs, had significantly increased risks of stroke, combined endpoint. There were no differences in the prognosis depending on the type of ACs, the regimens of ATT administered in accordance with ischemic and hemorrhagic risks.

CardioSomatics. 2021;12(3):158-165
pages 158-165 views

Pathogenetic aspects of cardiovascular diseases: at the reception of a patient with atrial fibrillation. Pilot study data

Balashova N.V., Gulia L.D., Benyia R.M.


A major problem in arrhythmology is supraventricular arrhythmias – atrial fibrillation. Remodeling of the myocardium and the formation of fibrosis zones are the cause of cardiac arrhythmias. Violations of the extracellular framework of myocardiocytes with the formation of zones of sclerotically altered areas lead to violations of the pulse from the sinoatrial node. The inflammatory reaction, which results in fibrosis, has been repeatedly confirmed by the results of histological examination of lung vein and myocardial tissue samples in patients with rhythm disorders – atrial fibrillation. The paper considers the possibility of determining in the blood of patients with atrial fibrillation a highly sensitive C-reactive protein, widely used in clinical practice, as an indicator of the activity of sluggish inflammation in the myocardium with simultaneous determination of the level of vitamin D (25-OH), known, among other things, for its anti-inflammatory effects. The data of the pilot study are presented.

CardioSomatics. 2021;12(3):166-169
pages 166-169 views


Main trends and regularities of the formation of disability due to ischemic heart disease in Russia in 2006–2017

Chandirli S.A., Puzin S.N.


The article analyzes features and structure of disability due to coronary heart disease in Russia and identifies the main trends and patterns of the formation of primary, secondary and general disability over a long period (2006–2017). New scientific data has been obtained on the structure of disability by age and severity.

CardioSomatics. 2021;12(3):170-176
pages 170-176 views

Cardiotoxic effects induced by the use of antimetabolites in the chemotherapy of oncological diseases

Aliab'eva A.A., Mal G.S.


In modern medical practice, the treatment of cancer is one of the most pressing issues. Many of the drugs used in the treatment of cancer have a toxic effect on the cardiovascular system of patients. The main clinical manifestations of cardiotoxicity are ischemic heart damage, rhythm disturbances, thrombosis, angina, asymptomatic changes in the electrocardiogram, and others. Side effects can develop both during the treatment period and months after the end of the course of chemotherapy. This is especially important for patients with concomitant cardiac or vascular pathology, since the severity of developing side effects can lead to disability or death of cancer survivors. The article discusses the data on the frequency of detection of the negative effect of pyrimidine, purine and folic acid antagonists on the cardiovascular system of cancer patients, the mechanisms of cardiotoxic effects of drugs in such patients, the possibilities of preventing heart damage and correcting for already developed lesions. The aim of this work is to collect, compare and systematize the available disparate data on the cardiotoxic effects of antitumor drugs of the antimetabolite group. An important condition for saving and preserving the quality of life of cancer patients is the identification of cardiovascular pathologies at the stage of preparation for chemotherapy, which can be facilitated by the active cooperation of oncologists and cardiologists. The search for information was carried out on the bases of scientific medical publications (eLibrary.ru, PubMed) taking into account the clinical recommendations for the treatment of malignant neoplasms.

CardioSomatics. 2021;12(3):177-181
pages 177-181 views

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