Vol 13, No 2 (2022)

Original articles

Associative role of polymorphism of the gene of MMP-9 (rs11697325) in development of arterial hypertension in patients with the rheumatoid arthritis

Nikulina S.Y., Chernova A.A., Tolstokorova Y.A., Varavko Y.O.

Abstract

Aim. To study a contribution of polymorphism A-8202G (rs11697325) of a gene of matrix metalloproteinase-9 (MMP-9) in development of arterial hypertension (AH) in patients with the rheumatoid arthritis (RA).

Materail and methods. 143 patients with RA were examined, among which a group of patients with RA without AH (n=50) and a group of patients with RA in association with AH (n=93) were identified. Healthy volunteers (n=151) were also divided into 2 groups comparable in age, sex and number with the main groups (control group 1 – n=54, control group 2 – n=97). The work used a range of clinical, laboratory, instrumental methods. A molecular genetic study was also performed. Blood samples were taken from all study participants. DNA isolation was carried out by the standard phenol-chloroform method. Genotyping for the MMP-9 gene was performed by PCR-RFLP analysis (polymerase chain reaction – restriction fragment length polymorphism). PCR was carried out with a set of primers to the corresponding regions of the genome. PCR products were analyzed by electrophoresis in 4% polyacrylamide gel followed by staining with ethidium bromide.

Results. In the course of a molecular genetic study, a statistically significant predominance of the homozygous AA genotype and the A allele of the MMP-9 (rs11697325) gene polymorphism was observed in the group of patients with RA, both separately and in association with AH, in comparison with the data of control groups. The risk of developing RA estimated by the odds ratio (OR) in carriers of the AA genotype of the MMP-9 gene is 1.8 times higher (95% confidence interval – CI – 1.136–2.950; p=0.02) than in carriers of the GG and GA genotypes; in carriers of the A allele, the risk of developing RA is 1.6 times higher compared to the G allele (95% CI 1.119–2.578; p=0.01). The OR risk of developing RA in association with hypertension in carriers of the AA genotype of the MMP-9 gene is 2.8 times higher (95% CI 1.283–6.54; p=0.04) compared to GA and GG genotypes, 2.1 times higher in carriers of the A allele (95% CI 1.113–4.127; p=0.02) compared to the G allele.

Conclusion. Thus, the results of the study indicate that the homozygous AA genotype and the A allele of the MMP-9 (rs11697325) gene polymorphism are the predictors of the development of RA both as a separate nosological unit and in association with AH.

CardioSomatics. 2022;13(2):76-80
pages 76-80 views

Mid-term results of open transaortic implantation of the «MedLab-CT» prosthesis: prospective clinical study

Bazylev V.V., Voevodin A.A., Slastin Y.S., Kuznetsova A.A., Patel M.P.

Abstract

Aim. To evaluate the mid-term clinical and hemodynamic results of open transaortic implantation of the balloon-expandable prosthesis «MedLab-CT» in patients with high surgical risk.

Material and methods. The study included 41 patients (mean age 65.7±11.7 years) who underwent open implantation of the «MedLab-CT» (MedInzh, Russia) aortic valve (AV) prosthesis under cardiopulmonary bypass and cardioplegia, belonging to the cohort of high surgical risk according to the data EuroSCORE II scale, with critical symptomatic aortic stenosis, high functional class according to the classification of the New York Heart Association (NYHA). All studied patients had clinical indications for transcatheter AV replacement, however, given the concomitant surgical pathology of the heart (critical multivessel coronary artery disease unsuitable for endovascular treatment and/or damage to other valves), as well as the morphological features of the aortic root («low» location coronary artery ostia relative to the annulus fibrosus of the AV, large calcifications of the coronary cusps according to computed tomography, with a high risk of ostium occlusion), they were denied a minimally invasive procedure. The incidence of adverse clinical events and hemodynamic parameters of the AV prosthesis in the medium-term period were assessed.

Results. The average follow-up period was 13.1 months, the maximum was 3 years. Mortality – 2.4% (n=1), there were no cases of stroke. The average gradient in the long-term period on AK «MedLab-CT» is 8.5±3.1 mm Hg. Paravalvular regurgitation above grade 2 and transvalvular regurgitation were not detected. Thus, no cases of dysfunction of the aortic prosthesis were noted.

Conclusion. In the medium term, satisfactory clinical and hemodynamic results of open implantation of the «MedLab-CT» balloon-expandable prosthesis were obtained in high surgical risk patients.

CardioSomatics. 2022;13(2):81-86
pages 81-86 views

Structural and functional features of the heart and the dynamics of biomarkers in the progression of chronic heart failure with a moderately reduced ejection fraction of the left ventricle in patients with diabetes mellitus

Efremova L.S., Vasilieva L.V., Gosteva E.V.

Abstract

Aim. To study the relationship between serum levels of aldosterone, tissue inhibitor of matrix metalloproteinases-1 (TIMP-1), tumor necrosis factor-alpha (TNF-α) and structural and functional changes in the heart during the progression of chronic heart failure (CHF) with a moderately reduced ejection fraction (CHFunEF) in patients with type 2 diabetes mellitus (DM).

Material and methods. 58 patients were examined – 30 (51.7%) men and 28 (48.3%) women – diagnosed with DM and CHFunEF (EF=41–49%), with functional class (FC) I, II and III of CHF according to New York Heart Association (NYHA). The control group consisted of 16 people. Patients underwent echocardiography, determination of serum levels of aldosterone, TIMP-1 and TNF-α by ELISA. The patients were divided into 2 groups: 1st group – patients with DM and CHFunEF who had a myocardial infarction (MI) – 27 people (46.6%), 2nd group – patients with DM and CHFunEF – 31 people (53.4%). Statistica v. 10.0 software (USA) was used for statistical analysis. Differences were considered statistically significant at р<0.05.

Results. Serum levels of aldosterone, TIMP-1 and TNF-α were significantly higher than those of the control group and increased with an increase in CHF FC. In patients of the 1st group, the volume and index values of the left parts of the heart and serum levels of biomarkers significantly exceeded those of the 2nd group.

Conclusion. Activation of the aldosterone system, increased profibrotic and immuno-inflammatory processes with the progression of CHFunEF in patients with DM lead to an increase in serum levels of aldosterone, TIMP-1 and TNF-α with an increase in CHF FC. Patients with DM and CHFunEF who have undergone MI have more pronounced structural and functional changes in the heart and greater values of volumetric and index parameters of the left heart than patients with DM and CHFunEF. Serum levels of aldosterone, TIMP-1 and TNF-α in patients with DM and CHFunEF who have undergone MI exceed those in patients with DM and CHFunEF, these biomarkers can be used to diagnose the progression of CHFunEF in patients with DM.

CardioSomatics. 2022;13(2):87-93
pages 87-93 views

Influence of bisoprolol and nebivolol on the regulatory-adaptive status of patients with diastolic chronic heart failure

Khilkevich P.V., Tregubov V.G., Shubitidze I.Z., Tregubova A.V.

Abstract

Background. Chronic heart failure (CHF) is the most common outcome of cardiovascular disease, of hypertension disease (HD). Beta-blockers contribute to the correction of hypertension, reduce heart remodeling, slow the progression of CHF. At the same time, bisoprolol and nebivolol differing pharmacochemical properties can have a multidirectional effect on the regulatory-adaptive status (RAS).

Aim. To determine the effect of bisoprolol or nebivolol therapy on the RAS of patients with diastolic CHF on the background of HD III stage.

Material and methods. The study involved 68 patients with diastolic CHF who were randomized into two groups for treatment with bisoprolol or nebivolol. As part of the combination therapy, patients were administered quinapril was prescribed (13.5±2.5 mg/day, n=34 and 12.8±2.8 mg/day, n=34), and if indicated, acetylsalicylic acid, atorvastatin. Initially and after 24 weeks of therapy were carried out: quantitative assessment of RAS, echocardiography, treadmill test, six-minute walking test, subjective assessment of quality of life, determination of the level of N-terminal propeptide of brain natriuretic hormone in blood plasma, daily monitoring of blood pressure.

Results. Both schemes of combined therapy comparably improved the structural and functional state of the heart, controlled arterial hypertension. In comparison with bisoprolol, nebivolol differed positive impact on RAS, more increased tolerance to physical activity and improved quality of life.

Conclusion. In patients with diastolic CHF and HD III stage, the use of nebivolol in combination therapy may be preferable due to the positive effect on RAS, in comparison with bisoprolol.

CardioSomatics. 2022;13(2):94-100
pages 94-100 views

Case reports

A rare case of systemic AL-amyloidosis under the mask of myocardial infarction in the absence of myocardial hypertrophy: case report

Boldueva S.A., Evdokimov D.S., Rozhdestvenskaya M.V., Vinnichuk S.A., Mitrofanova L.B.

Abstract

Systemic amyloidosis is a group of diseases associated with extracellular deposition of fibrillar proteins, resulting in the loss of normal organ structure and function. AL-amyloidosis occurs when amyloid is deposited, consisting of full-length lambda or kappa immunoglobulin light chains, or fragments thereof. This article describes the complexity of timely diagnosis of systemic AL-amyloidosis with a predominant heart lesion in the absence of myocardial «hypertrophy» on the example of an elderly patient in whom the leading manifestation of the disease was heart failure with a preserved left ventricular ejection fraction.

CardioSomatics. 2022;13(2):101-106
pages 101-106 views

Takotsubo syndrome (stress-induced cardiomyopathy): case report

Evdokimova A.G., Struk R.I., Evdokimov V.V., Voronina G.V., Mikhailova I.S., Golikova A.A.

Abstract

Takotsubo syndrome (CТ) is an acutely developing reversible myocardial dysfunction, leading to left ventricular balloning during systole and the development of acute heart failure in 15–45% of cases. There are primary and secondary CT. The article reflects the issues of pathogenesis, clinical manifestations and modern criteria for the diagnosis of this disease. A clinical case of the primary variant of CT, resembling acute coronary syndrome, is given.

CardioSomatics. 2022;13(2):107-114
pages 107-114 views

Reviews

Heart failure with preserved left ventricular ejection fraction amidst diabetes mellitus: from general mechanisms to possible therapy tactics

Larina V.N., Skiba I.K., Larin V.G., Mikhailusova M.P., Skiba A.S.

Abstract

The review discusses the relationship between chronic heart failure and diabetes mellitus type 2, metabolic phenotypes of patients w ith chronic heart failure with preserved left ventricular ejection fraction (HFpEF), features of the pathophysiological interaction between diabetes mellitus and HFpEF. Chronic inflammatory condition, metabolic disorders and comorbidities are the pathophysiological basis of HFpEF. The review discusses the concept of diabetic cardiomyopathy, its molecular mechanism and current possibilities of treating this pathology, considering the impact on the prognosis.

CardioSomatics. 2022;13(2):115-123
pages 115-123 views

The role of rs3025058 polymorphism in the development of ischemic stroke in patients with cardiovascular diseases (review)

Nikulin D.A., Chernova A.A., Nikulina S.J., Maksimov V.N.

Abstract

Acute cerebrovascular accident (ACC) is a formidable complication of a number of cardiovascular diseases, in a significant percentage of cases leading to disability and mortality. The literature available to us provides information on the role of type 3 matrix metalloproteinase gene (MMP-3) polymorphism in the development of stroke. It is believed that MMP-3 plays an important role in the natural processes of tissue remodeling and pathological processes. The mechanism of regulation of tissue remodeling MMP-3 is based on the activation of procollagenase-1. The associations of the single-nucleotide variant rs3025058 (5A/6A) with the development of ONMK in patients with cardiovascular pathology and risk factors of its development for the implementation of measures of primary prevention of this disease are considered. The article discusses issues related to the role and identification of associations of the single nucleotide variant rs3025058 (5А/6А) with the development of stroke in patients with cardiovascular pathology. When preparing the review, publications were searched in the MEDLINE/PubMed, Scopus, Cochrane Library, PEDro, eLIBRARY databases and Google Scholar. In preparing the literature review, the analysis of publications for the last 15 years is carried out. Represented evidence suggests the need for further study and effective use of the results of the study of the rs3025058 MMP-3 polymorphism for the implementation of primary prevention measures in the development of acute cerebrovascular accident, especially in the families of these patients.

CardioSomatics. 2022;13(2):124-127
pages 124-127 views


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