The objective was to study the incidence of the late cardiovascular complications depending on the use of perioperative cardioprotection in patients with high cardiac risk.Materials and methods. We analyzed data of medical cards and telephone interviews of 307 patients aged 47 to 85 (67 [63–71]) years who underwent surgical procedures a year before the interview. Perioperative pharmacological cardioprotection (dexmedetmidine or phosphocreatin) was used in 168 (54.7 %) patients. The endpoints of the study were composite outcome (one or more cardiac events), MACCE (cardiac mortality, myocardial infarction, stroke or a combination of these) and 1-year cardiac mortality. To process the data, we used logistic regression with the calculation of the odds ratio (OR) and 95% confidence interval (95% CI) and ROC analysis.Results. During 12 months after vascular surgery, various cardiac events (composite outcome) developed in 29.3 % of patients, including MACCE in 11.4 % of cases and cardiac mortality in 3.3 %. Patients who received and did not receive cardioprotection had a different risk of composite outcome (OR 0.5392, 95 % CI 0.3287–0.8846, р=0.014) and risk of MACCE (OR 0.4835, 95 % CI 0.2372–0.9852, p = 0.041). Perioperative cardioprotection had no effect on the risk of 1-year cardiac mortality (OR 0.3994, 95 % CI 0.1177–1.3556, р = 0.125).Conclusion. Within one year after vascular surgery, more than 29 % of patients with high cardiac risk develop one or more cardiac events (composite outcome), including cardiac mortality in 3.3 % of cases. Perioperative cardioprotection with dexmedetomidine or phosphocreatine reduces the risk of composite outcome and the risk of MACCE, without reducing one year cardiac mortality.

The objective was to study the prognostic significance of intraoperative parameters of pulmonary artery catheterization (PAC), transesophageal echocardiography (TEE) and transpulmonary thermodilution (TPTD) in relation to the hemodynamic disorders in coronary artery bypass grafting (CABG).Material and Methods. A prospective observational study involved 67 patients aged 53 [46–64] years who underwent on-pump CABG. Hemodynamic parameters were recorded after the induction of anesthesia (stage I) and at the end of the surgery (stage II). Hemodynamic disorders were considered to be the inotropic index in post-bypass period >5, the duration of inotropic support >12 hours, the intensive care unit (ICU) stay >24 hours, the use of intraaortic balloon pumping (IABP), the ICU mortality, the presence of one or more complications (composite outcome). Logistic regression and ROC analysis were used.Results. At stage I, the left ventricular stroke work index (LVSWI) cut-off <31.7 gs•m/m2 was associated with ICU stay >24 hours (OR 0.9291, 95 % CI 0.8670–0.9958, AUC 0.716), and LVSWI <32.5 gs•m/m2 – with a composite the outcome (OR 0.9550, 95 % CI 0.9133–0.9985, AUC 0.704). The left ventricular area contraction fraction <34.2 % predicted the use of IABP (OR 0.9089, 95 % CI 0.8397–0.9839, AUC 0.889). At the II stage, the LVSWI cut-off <28.8 gs•m/m2 was associated with ICU stay >24 hours (OR 0.8805, 95 % CI 0.8226–0.9884, AUC 0.716), cut-off <25.6 gs•m/m2 – with the use of IABP (OR 0.8274, 95 % CI 0.7101–0.9641, AUC 0.804), and cut-off <23.0 gs•m/m2 – with mortality (OR 0.7486, 95 % CI 0.5951–0.9415, AUC 0.892). The left ventricular ejection fraction <26.1 % was also associated with mortality (OR 0.8901, 95 % CI 0.8164–0.9705, ACC 0.948). The global heart ejection fraction <18 % was associated with a composite outcome (OR 0.9018, 95 % CI 0.8297–0.9802, AUC 0.716). The other predictors cut-off values were practically normal. The remaining indicators provided models of average quality or had no predictive significance.Conclusion. To assess the risk of possible hemodynamic disorders in on-pump CABG, PAC and TEE are the most informative. In prebypass and in postbypass periods, LVSWI, reduced by 1.5–2.2 times, is associated with the risk of various hemodynamic complications and prolonged ICU stay. Decreased TEE parameters of left ventricular systolic function is associated with myocardial dysfunction and with the risk of mortality. The prognostic significance of the TPTD needs further investigations.

The aim of this study was to assess the incidence of cardiovascular complications (CVC) within 12 months after vascular surgery and to analyze inpatient perioperative examination data to identify potential predictors. Materials and Methods. A prospective cohort study included 103 patients aged 66 years [61–70] who underwent vascular surgery. Clinical outcomes within 12 months after surgery, including CVC and/or other cardiac events (composite outcome) and cardiac death, were assessed by telephone interviews with patients or their relatives. Patient physiological parameters, comorbidities, cardiac risk indices (CRI), platelet-lymphocyte ratio (PLR), concentration of N-terminal pro-B-type natriuretic peptide (NT-proBNP), and other parameters were obtained and analyzed from medical records. Logistic regression and ROC analysis were used to assess the predictive power of the investigated indicators. Results. The composite outcome was recorded in 33 % of cases and cardiac death occurred in 6.8 %. The risk of the composite outcome was associated with ASA class (OR 2.7413; 95 % CI 1.1126–6.7541), whereas the risk of perioperative myocardial infarction or cardiac arrest was associated with CRI (OR 1. 6051; 95 % CI 0.6645–2.0215), American University of Beirut (AUB) CRI (OR 2.1106; 95 % CI 1.0260–4.3414), PLR (1.0120; 95 % CI 1.0018–1.0222), and NT-proBNP concentration during hospitalization. Concurrent congestive heart failure (OR 5.0658; 95 % CI 1.2400–20.6956), revised CRI (OR 2.1024; 95 % CI 1.0572–4.1813), Khoronenko CRI (OR 103.76; 95 % CI 1.8752–5796.55), AUB CRI (OR 3.1902; 95 % CI 1.1040–9.2181), and NT-proBNP concentration all increased the risk of cardiac death. Predischarge NT-proBNP levels < 179 pg/mL (OR 1.0071; 95 % CI 1.0038–1.0104; AUC 0.795) and maximum postoperative NT-proBNP levels were reliable predictors of the composite outcome. The most effective predictor of postoperative mortality was a maximum NT-proBNP concentration > 303 pg/mL after surgery (OR 1.0039; 95 % CI 1.0015–1.0063; AUC 0.836). Conclusion. CVC developed in 33 % of patients within 12 months after vascular surgery, with cardiac death occurring in 6.8 % of cases. An NT-proBNP concentration > 179 pg/mL before hospital discharge or a maximum NT-proBNP concentration > 248 pg/mL in the postoperative period predicted CVC within one year. Postoperative NT-proBNP concentration > 303 pg/mL was a strong predictor of one-year cardiac mortality. Other factors associated with the risk of postoperative CVC did not provide an accurate prognosis.

The objective was to study the dynamics of B-type natriuretic peptide (BNP) and its relationship with hemodynamic parameters during on-pump coronary artery bypass grafting (CABG), and to evaluate the informativeness of the biomarker as a predictor of myocardial dysfunction.Materials and methods. The study involved 127 patients aged 59 [54–66.75] years with ischemic heart disease who underwent CABG. The BNP blood level was determined in the operating room at stages: I – before surgery (BNP1 ), II – at the end of surgery (BNP2 ). Hemodynamic parameters were analyzed at the same stages. Correlation analysis, logistic regression with the calculation of the odds ratio (OR) and 95% confidence interval (95% CI) and ROC analysis with the calculation of the area under the ROC curve (AUC) were used.Results. BNP1 blood level was 49 [25.6–91.6], BNP2 – 90 [47.8–140.2] pg/ml (p < 0.0001). BNP1 correlated with central venous pressure (CVP) at stage I (rho = 0.212; p = 0.017) and with pulmonary artery wedge pressure (PAWP) at stage II (rho = 0.204; p = 0.045). BNP2 correlated with PAWP at stage II (rho = 0.204; p = 0.045). BNP1 > 52.1 pg/ml was the predictor of ICU length of stay > 24 hours (OR 1.0290, 95% CI 1.0154– 1.0427, p < 0.0001, AUC 0.775), BNP1 > 71 pg/ml was the predictor of inotropic index > 5 c. u. (OR 1.0076, 95% CI 1.0015–1.0138, p = 0.014, AUC 0.705) and BNP1 > 90.8 pg/ml was the predictor of vasoactive inotropic index > 10 c. u. (OR 1.0070, 95% CI 1.0014–1.0126, p = 0.013, AUC 0.727). BNP2 > 67.5 pg/ml was the predictor of ICU length of stay > 24 hours (OR 1.0179, 95% CI 1.0073–1.0287, p < 0.0009, AUC 0.763), BNP2 > 94.3 pg/ml was the predictor of inotropic index > 5 c. u. (OR 1.0063, 95% CI 1.0010–1.0117, p = 0.020, AUC 0.713), BNP2 > 144 pg/ml was the predictor of intra-aortic balloon pumping (OR 1.0037, 95% CI 1 .0000–1.0074, p = 0.048, AUC 0.854), BNP2 > 159 pg/ml was the predictor of vasoactive inotropic index > 10 c. u. (OR 1.0072, 95% CI 1.0006–1.0139, p = 0.033, AUC 0.729) and BNP2 > 161 pg/ml was the predictor of early mortality in the ICU (OR 1.0040, 95% CI 1, 0000-1.0080, p = 0.049, AUC 0.845). Conclusion. In 78.7% of patients undergoing on-pump CABG, BNP blood level does not exceed the upper limit of normal; by the end of surgery, the biomarker level increases by 32.9 [17.7–62.0] pg/ml. Before and at the end of surgery, BNP values are weakly correlated with CVP and PAWP and do not correlate with other hemodynamic parameters. Before surgery, BNP blood level in the range of 52.1–90.8 pg/ml are predictors of ICU stay > 24 hours (AUC 0.775), inotropic scale > 5 (AUC 0.705) and vasoactive-inotropic scale > 10 c. u. (AUC 0.727). At the end of surgery, BNP > 67.5 pg/ml is associated with an ICU stay > 24 hours (AUC 0.763), and BNP > 90.4 pg/ml is associated with inotropic scale > 5 c. u. (AUC 0.713). The BNP, increased to 144.0–161.0 pg/ml, indicates severe myocardial dysfunction, including hemodynamic support with intra-aortic balloon pumping (AUC 0.854), vasoactive-inotropic scale > 10 c. u. (AUC 0.729) and the risk of early mortality in the ICU (AUC 0.845).

Nitric oxide (NO) is a cellular signaling molecule that causes smooth muscle relaxation in the vascular wall. Inhaled NO (iNO) has been used in intensive care for more than three decades. In Russia, this method was tested in the late 1990s. iNO acts as a selective pulmonary vasodilator, it effectively reduces pulmonary artery pressure and intra-pulmonary blood shunting. In patients with acute respiratory distress syndrome, iNO is used to improve oxygenation, but its role remains controversial. In cardiac surgery, numerous studies have reported the positive effect of iNO on pulmonary hypertension and the elimination of dysfunction and/or insufficiency of the right ventricle. Yet, various studies have failed to demonstrate significant differences in long-term clinical outcomes. Many clinical applications have been proposed at using iNO as a preventive measure for ischemic-reperfusion injury of various organs associated with cardio-pulmonary bypass. iNO has been used with evidence-based efficacy in neonatology in infants with persistent pulmonary hypertension. Yet, various studies have failed to demonstrate significant differences in long-term clinical outcomes for different use cases and applications in critical care medicine. Further studies of iNO are needed, possibly based on the phenotyping of patients’ sensitivity to iNO.

The objective was to study the occurrence of perioperative cardiovascular complications (CVС) and clinical and laboratory cardioprotection signs in patients treated with phosphocreatine infusion in intraoperative period of vascular surgery.Materials and methods. The study involved 204 patients with high cardiac risk (revised cardiac risk index > 2, risk of perioperative myocardial infarction or cardiac arrest > 1%) who underwent elective vascular surgery. The patients were randomly divided into two groups. Group I patients received intraoperative infusion of phosphocreatine at a dose of 75.9 [69.8–85.7] mg/kg during 120.0 [107.1–132.0] min. Group II was a control group. The occurrence of CVC, the blood level of the cardiospecific troponin I (cTnI) and N-terminal segment of natriuretic B-type prohormone (NT-proBNP) were analyzed. The data were statistically processed, using the Fisher’s exact test, Mann–Whitney test and logistic regression.Results. Perioperative CVС were recorded in 5 (4.9%) patients in group I and in 18 (17.6%) patients in group II (p = 0.007). Intraoperative administration of phosphocreatine was associated with a reduced risk of CVС: OR 0.2405, 95% CI 0.0856–0.6758, p = 0.007. The cTnI level in patients of groups I and II was 0.021 [0.016–0.030] and 0.019 [0.011–0.028] ng/ml (p = 0.102) before surgery, 0.025 [0.020–0.036] and 0.022 [0.015–0.039] ng/ml (p = 0.357) after surgery, 0.025 [0.020–0.031] and 0.028 [0.018–0.033] ng/ml (p = 0.531) before discharge from the hospital. At the same stages, the level of NT-proBNP was 233.5 [195.0–297.5] and 237.8 [171.3–310.1] pg/ml (p = 0.404), 295.5 [257.3–388.0] and 289.0 [217.5–409.5] pg/ml (p = 0.226), 265.5 [204.8–348.5] and 259.6 [171.0–421.6] pg/ml (p = 0.369).Conclusion. In patients with high cardiac risk undergoing vascular surgery, intraoperative phosphocreatine infusion at a total dose of 75.9 [69.8–85.7] mg/kg reduces the risk of perioperative CVC per 24%. Administration of phosphocreatine to patients with high cardiac risk during vascular surgery does not affect perioperative cTnI and NT-proBNP blood levels.

The objective was to study the effect of early planned use of transpulmonary thermodilution (TPTD) and therapeutic measures to stabilize blood circulation on the clinical outcome of sepsis.Materials and methods. The cohort study involved 132 patients with abdominal sepsis with SOFA >7 and blood lactate >1.6 mmol/L. Septic shock was diagnosed in 56 % of patients. TPTD in the early periods of intensive care was began in 53.8 % of patients. Logistic regression and ROC-analysis were used to process the data.Results. Early use of invasive monitoring (OR 2,3715, 95 % CI 1,1107–5,0635, p=0,026, AUC 0.655) and infusion volume >43 ml/kg per day (OR 1.0313, 95 % CI 1.0073–1.0558, p=0.01, AUC 0.677) were predictors of survival in patients with abdominal sepsis. The use of TPTD compared to patients of group II was accompanied by an increase in the daily infusion volume (53.7 [38.1–63.5] vs 38.2 [29.9–47.2], ml/kg per day, p = 0.0001), more frequent use of inotropic drugs (39.4 vs 16.4 %, p = 0.004), and higher level of the inotropic scale (0 [0–4.7] vs 0 [0–0], p = 0.01). There were no differences in the frequency of prescription (57.7 vs 65.5 %, p = 0.376) and dosages (0.2 [0.1–0.4] vs 0.3 [0.2–0.4] μg/kg/min, p = 0.554) of norepinephrine. Twenty-eight-day mortality in groups I and II was 31 and 50.8 % (p = 0.022), hospital mortality was 32.9 and 54.0 % (p = 0.014).Conclusion. When assessed by SOFA > 7 points and lactatemia > 1.6 mmol/L, the onset of TPTD and infusion volume > 43 mL/kg/day increase the likelihood of survival of patients with abdominal sepsis, as a result, 28-day and hospital mortality decrease by 1.6 times. The use of invasive monitoring of central hemodynamics in this clinical situation is accompanied by an increase in the prescription of inotropes by 2.4 times with an unchanged intensity of norepinephrine use.

The objective was to study the occurrence of perioperative cardiovascular complications (CVС) and clinical and laboratory cardioprotection parameters in patients treated with dexmedetomidine infusion in perioperative period of vascular surgery.Materials and methods. The study involved 204 patients with high cardiac risk (revised cardiac risk index > 2, risk of perioperative myocardial infarction or cardiac arrest > 1%) who underwent elective vascular surgery. The patients were randomly divided into two groups. Group I patients received perioperative infusion of dexmedetomidine at a dose 0.40 [0.34–0.47] mg/kg/h during 7.0 [6.0–8.0]) hours. Group II was a control group. In the perioperative period, the occurrence of CVC, the blood level of the N-terminal fragment of the prohormone B-type natriuretic peptide (NT-proBNP) and cardiospecific troponin I (cTnI) were analyzed. The data were statistically processed, using the Fisher’s exact test, Mann–Whitney test and logistic regression.Results. Perioperative CVC without taking into account arterial hypotension were recorded in 3 (2.9%) patients in group I and in 14 (13.7%) patients in group II (p = 0.009). Arterial hypotension was recorded in 14 (13.7%) patients in group I and in 5 (4.9%) patients in group II (p = 0.051). Perioperative dexmedetomidine infusion reduced the risk of CVC, except for arterial hypotension (OR 0.1905, 95% CI 0.0530–0.6848, p = 0.011) and increased the risk of arterial hypotension (OR 3.5787, 95% CI 1.1254–11.3796, p = 0.031). The cTnI level in patients of groups I and II was 0.017 [0.011–0.024] and 0.019 [0.011–0.028] ng/ml (p = 0.196) before surgery, 0.02 [0.011–0.029] and 0.02 [0.015–0.039] ng/ml (p = 0.050) after surgery, 0.018 [0.014–0.024] and 0.028 [0.018–0.033] ng/ml (p = 0.0002) before discharge from the hospital. At the same stages, the level of NT-proBNP was 221.5 [193.3–306.5] and 237.8 [171.3–310.1] pg/ml (p = 0.572), 237.0 [205–303.5] and 289.0 [217.5–409.5] pg/ml (p = 0.007), 250.5 [198.8–302.0] and 259.6 [171.0–421.6] pg/ml (p = 0.933).Conclusion. In patients at high cardiac risk undergoing vascular surgery, perioperative dexmedetomidine infusion reduces the risk of a composite outcome including cardiac mortality, nonfatal myocardial infarction, myocardial ischemia, pulmonary embolism, stroke, hypertension, and arrhythmias, while the risk of arterial hypotension increases significantly. The perioperative dynamics of cTnI and NT-proBNP require further research. The start of dexmedetomidine infusion in 2.7% of cases is accompanied by severe bradycardia, requiring discontinuation of the infusion.

The objective was to study the dynamics of NT-proBNP blood level during the perioperative period of vascular surgery and to study the association of this biomarker level at the stages of treatment with developed cardiovascular complications (CVC). Materials and Methods. The study involved 129 patients aged 66 [61–70] years who underwent elective vascular surgery. NT-proBNP blood level was determined at stages: I – before surgery, II – 24 hours after surgery, III – before discharge from the hospital. Correlation analysis, logistic regression and ROC-analysis were used for data processing. Results . Median NT-proBNP (pg/ml) at stage I was 54[42–215], stage II – 149[63–298] (p1–2 = 0.0001) and stage III – 78[48–288] (p1–3 = 0.037). NT-proBNP blood level at stage I correlated with the biomarker level at stages II (rho = 0.558, p < 0.0001) and III (rho = 0.689, p < 0.0001). The biomarker was associated with CVC at all stages: I – OR 1.0048, 95% CI 1.0021–1.0074, p < 0.0001, AUC 0.825; II – OR 1.0040, 95% CI 1.0020–1.0060, p < 0.0001, AUC 0.820; III – OR 1.0026, 95% CI 1.006–1.0046, p = 0.015, AUC 0.687. At stage I, NT-proBNP > 218 pg/ml was a CVC predictor (sensitivity 82%, specificity 85%), this biomarker level was registered in 30 (23.2%) patients; at stage II, NT-proBNP > 281 pg/ml was associated with CVR (sensitivity 81%, specificity 80%), at stage III NT-proBNP > 158 pg/ml was associated with CCC (sensitivity 79%, specificity 65%). Conclusions. After vascular surgery, the median NT-proBNP value increases significantly, remaining within the reference limits, and does not de[1]crease until the patients discharge from the hospital. The perioperative NT-proBNP dynamics may differ in patients with different initial biomarker levels. In 23.2% of vascular surgical patients, the preoperative NT-proBNP blood level increased to a level of more than 218 pg/ml, indicating CVC risk (very good quality predictor model). After surgery, the level of NT-proBNP associated with CVC (very good quality model) exceeds 281 pg/ml. Prior to discharge of patients from the hospital, the association of NT-proBNP with CVC is characterized by a moderate quality model (AUC 0.687). The prognostic significance of the biomarker at this stage of surgical treatment needs further research.

The objective was to perform a comparative analysis of the information content of potential predictors of cardiovascular complications of various types in patients operated on for vascular diseases. Materials and Methods. We examined 129 patients aged 66 [61–70] years who underwent elective vascular surgery. We analyzed comorbidity, general clinical indicators, special cardiac risk indices and biomarkers: N-terminal segment of B-type natriuretic peptide prohormone (NT-proBNP) and cardiospecific troponin I. We used logistic regression and ROC analysis. Results. 21 (16.3 %) perioperative cardiovascular complications were registered in 17 (13.2 %) patients. In one-factor regression, the predictors of cardiovascular complications were coronary heart disease (OR 4.5904; 95 % CI 1.3119–5.9340; p = 0.0171), combination of coronary heart disease and chronic heart failure (OR 2.9419; 95 % CI 1.0140–8.5350; p = 0.047), ASA class > 3 (OR 2.9402; 95 % CI 1.0304–8.3899; p = 0.0438), high cardiac risk surgery (OR 3.4741; 95 % CI 1.1162-10.8126; p = 0.0316), Lee cardiac risk index (OR 2.2353; 95 % CI 1.2842–3.8911; p = 0.0045), the American College of Surgeons cardiac risk index for assessing the risk of perioperative myocardial infarction or cardiac arrest (OR 1.5312; 95 % CI 1.0927–2.1456; p = 0.0133) and the preoperative level of the N-terminal prohormone B-type natriuretic peptide (NT-proBNP) (OR 1.0048; 95 % CI 1.0021–1.0074; p = 0.0004). In multivariate regression, the predictors of cardiovascular complications were high-risk cardiac surgery (OR 5.7439; 95 % CI 1.1027–29.9181; p = 0.0379) and NT-proBNP (OR 1.0044; 95 % CI 1.0015–1.0073; p = 0.0033). The biomarker level > 218 pg/ml discriminated against cardiovascular complications with sensitivity of 82.4 % and specificity of 85.3 % (AUC 0.825; 95 % CI 0.747–0.887; p < 0.0001). Conclusion. In vascular interventions, the most significant predictors of cardiovascular complications are high-risk cardiac surgery and the preoperative level of NT-proBNP > 218 pg/ml with a sensitivity and specificity level exceeding 80 %.

Subjects and Methods. The study involved 35 vascular surgery patients of varying degrees of cardiological risk. Blood specimens were collected from each patient at 3 time-points: 1. prior to surgery (NT-proBNP1), 2 — after the procedure (NT-proBNP2), 3 — before the discharge from the hospital (NT-proBNP3). Each specimen was split into equal aliquots for biomarker quantification using two different techniques (ELISA using domestic reagents — for the 1st series of analyses, and ICLA using an imported kit — for the 2nd series). Perioperative cardiovascular complications were recorded. The consistency of the measurement results obtained by two different methods was evaluated using the Bland–Altman technique. A discrimination ability of independent variables in relation to a binary dependent variable was studied using ROC analysis.Results. In the 1st series, ranges of the biomarker were as follows: NT-proBNP1 — 24–774 pg/ml, NT-proBNP2 — 41.2–889.1 pg/ml, NT-proBNP3 — 39.3–1013.3 pg/ml. In the 2nd series, NT-proBNP1 was 31.2–2087.0 pg/ml, NT-proBNP2 — 32.5–3754.0 pg/ml, NT-proBNP3 — 34.1–2728.0 pg/ml. In the Bland–Altman analysis, 97.03% of the values fell within the lower and upper limits of consistency (±1.96 SD of the average difference), which indicated comparability of the results in the series, but the values of NT-proBNP in the 1st series were lower than in the 2nd ones. Cardiovascular complications were registered in 3 (8.5%) patients. In the 1st series, NT-proBNP1 > 218 pg/ml predicted cardiovascular complications with a sensitivity of 66.7% and a specificity of 81.3% (AUC 0.844, 95% CI 0.681–0.944, P = 0.0003). In the 2nd series, NT-proBNP1 > 315 pg/ml predicted cardiovascular complications with a sensitivity of 66.7% and a specificity of 75.0% (AUC 0.828, 95% CI 0.663–0.934, P = 0.001).Conclusion. The domestic ELISA kit for solid-phase enzyme immunoassay proved its clinical informativeness for quantitation of NT-proBNP demonstrating its value for diagnostic and prognostic purposes, or scientific studies. The novel domestic technique provides consistently reproducible results, although with lower reference values as compared to the standard immunochemiluminescence assay.

The objective was to study the relationship between the increased preoperative N-terminal segment of B-type natriuretic peptide precursor (NT-proBNP) blood levels and the parameters of the heart ventricles function, as well as the conditions for coronary perfusion of their myocardium before and after on-pump aortic valve replacement. Materials and methods . The study involved 27 patients aged 57.7±2.5 years who underwent aortic valve replacement. NT-proBNP blood level was determined before surgery. The level of NT-proBNP > 1000 pg/ml was considered increased. Invasive hemodynamics, including the data of the right ventricle thermodilution volumetry, and transesophageal echocardiography data were analyzed at the stages: the 1st – after anesthesia induction, the 2nd – at the end of surgery. Logistic regression and ROC analysis were used for data processing. Results . Preoperative blood levels of NT-proBNP > 1000 (3163.0[2507.25–7319]) pg/ml were recorded in 55.6% of patients. At the 1st stage, the biomarker increased level was associated with increased index of left ventricular end-systolic volume (OR 1.0955, 95% CI 1.0097–1.1885, p = 0.028, AUC 0.903), decreased left ventricular ejection fraction (OR 0, 9447, 95% CI 0.8949–0.9973, p = 0.040, AUC 0.753) and area contraction fraction (OR 0.8868, 95% CI 0.8086–0.9726, p = 0.011, AUC 0.890), increased mean pulmonary artery pressure (OR 1.1824, 95% CI 1.0020–1.3952, p = 0.047, AUC 0.722), and increased transpulmonary gradient (OR 1.4497, 95% CI 1.0103–2.0802, p = 0.044, AUC 0.810), increased right ventricular stroke work index (OR 1.5151, 95% CI 1.0319–2.2246, p = 0.034, AUC 0.761), and decreased coronary perfusion gradients of the left (OR 0.8961–0.9241, 95% CI 0.8229–0.9459 – 0.8630–0.9896, p = 0.012–0.024, AUC 0.793–0.861) and right (OR 0.9519, 95% CI 0.9136–0.9918, p = 0.019, AUC 0.847) ventricles. At the 2nd stage, NT-proBNP blood values > 1000 pg/ml were associated with impaired left ventricular function, decreased mean arterial pressure (OR 0.9066, 95% CI 0.8264–0.9946, p = 0.038, AUC 0.761), and the vasopressor and inotropic support (OR 8.4000, 95% CI 1.2584–56.0694, p = 0.028, AUC 0.710). Conclusions . Prior to aortic valve replacement, the blood level of NT-proBNP > 1000 pg/ml is associated with a moderate decrease in the left ventricular ejection fraction and area contraction fraction, an increased left ventricular end-systolic volume with a normal end-diastolic volume, an increased index of right ventricular stroke work in combination with moderately increased mean pulmonary artery pressure and increased transpulmonary gradient, as well as a decreased coronary perfusion gradients. At the end of operations, increased NT-proBNP blood level is associated with signs of impaired left ventricular contractility, a tendency to arterial hypotension, and the vasopressor and inotropic support. Increased preoperative NT-proBNP blood level are not associated with right ventricular volumes and ejection fraction both before and after on-pump aortic valve replacement.

The objective was to study the relationship between the preoperative blood levels of the N-terminal segment of B-type natriuretic peptide precursor (NT-proBNP) and ultrasound and thermodilution indicators of cardiac function before and after on-pump surgery for aortic stenosis, as well as to evaluate the prognostic significance of the biomarker in relation to postoperative myocardial dysfunction. Materials and methods . The study involved 27 patients aged 57.7±2.5 years who underwent aortic valve replacement. NT-proBNP level was determined before surgery. The indicators of invasive hemodynamics and transesophageal echocardiography were analyzed at stages: I – after anesthesia induction, II – at the end of surgery. Correlation analysis, logistic regression and ROC analysis were used. Results. The preoperative NT-proBNP level was 2002.0 [540.8–4001.5] pg/ml. At I stage, NT-proBNP correlated with mean pulmonary artery pressure (rho = 0.468; p = 0.014), indices of left ventricular function (rho = –0.509; p = 0.007), end-diastolic and end-systolic volumes (rho = 0.737–0.757; p < 0.0001), as well as ejection fraction (rho = –0.556; p = 0.004) and area contraction fraction (rho = –0.783; p < 0.0001). At II stage, the level of NT-proBNP > 2000 pg/ml was a predictor of the left ventricular area contraction fraction < 50% (OR 1.0011, 95% CI 1.0002–1.0020, p = 0.028, AUC 0.799) , the left ventricular end-systolic area index > 9 cm 2 /m 2 (OR 1.0007, 95% CI 1.0001–1.0013, p = 0.027, AUC 0.886), vasoactive-inotropic score > 10 (OR 1.0006, 95% CI 1.0001–1.0012, p = 0.032, AUC 0.876), duration of sympathomimetic therapy > 24 h (OR 1.0001, 95% CI 1.0000–1.0003, p = 0.049, AUC 0.889). Conclusions. NT-proBNP blood level was increased in 66.7% of patients with aortic stenosis before surgery. Moreover, the biomarker level directly correlates with the mean pulmonary artery pressure, the indices of end-diastolic and end-systolic volumes, end-diastolic and end-systolic areas of the left ventricle, and it inversely correlates with the left ventricular stroke work index, ejection fraction and left ventricular area contraction fraction. The preoperative NT-proBNP level was a predictor of the postoperative decrease to the pathological level of the ejection fractions and left ventricular area contraction, an increase in the left ventricular end-systolic area index, intensive and prolonged sympathomimetic therapy. Myocardial dysfunctions were most pronounced in patients with biomarker levels above 2000 pg/ml.

The objective: to study changes and prognostic significance of the blood NT-proBNP in the patients with pulmonary sepsis.Subjects and Methods. The study included 34 patients aged 54.5 ± 2.9 years with pulmonary sepsis or septic shock. Lethality in the intensive care unit (ICU) was 47.1%. NT-proBNP, procalcitonin (PCT) levels, blood lactate and hemodynamic parameters were registered on the 1st day (stage 1) and on the 4th-5th day of the ICU stay (stage 2). Hemodynamics was assessed through transpulmonary thermodilution. The differences were considered statistically significant at p < 0.05.Results: At stage 1, NT-proBNP level was 5,220 [1,380‒17,850] pg/ml, did not decrease (p = 0.726) at stage 2 and amounted to 1,760 [631‒847] pg/ml. At stage 1, NT-proBNP correlated with extravascular lung water index (rho = 0.445; p = 0.038) and systolic pulmonary artery pressure (rho = 0.414; p = 0.023). At stage 2, NT-proBNP correlated with PCT (rho = 0.569; p = 0.003), blood lactate (rho = 0.525; p = 0.001), and mean arterial pressure to norepinephrine dosage ratio (rho = -0.422; p = 0.035). At stage 1, NT-proBNP was no predictor of lethality in the ICU: OR 1.0000; 95% CI 1.0000-1.0001. At stage 2, NT-proBNP > 4,260 pg/ml (sensitivity 87.5%, specificity 94.4%) was a predictor of lethality: OR 1.0004, 95% CI 1.0000-1.0008, p = 0.046 (AUC 0.893, 95% CI 0.732-0.974). Any increase of NT-proBNP level (> 0 pg/ml) between stages 2 and 1 was a predictor of lethality (sensitivity 87.5%, specificity 94.4%): OR 119.0, 95% CI 9.7432‒1,453.4241, p = 0.0002 (AUC 0.903, 95% CI 0.751-0.977).Conclusion: Patients with pulmonary sepsis are characterized by a significant increase of blood NT-proBNP. At stage 1, the biomarker correlated with pulmonary hypertension and moderate pulmonary edema and was no predictor of lethality. At stage 2, NT-proBNP correlated with the indices of infection and sepsis severity (procalcitonin, blood lactate, and mean arterial blood pressure/norepinephrine dosage ratio). At this stage, NT-proBNP levels greater than 4,000 pg/mL and/or any degree of increase in blood levels of the biomarker were both sensitive and specific predictors of a lethal outcome. Specific features of etiopathogenesis of BNP hyperproduction in pulmonary sepsis make it difficult to interpret the elevation of NT-proBNP as an indicator of septic cardiomyopathy but does not reduce its value as a sensitive and specific predictor of lethality.

The objective: to study hemodynamic and clinical effects of levosimendan depending on the clinical outcome in patients with sepsis and impaired cardiac pumping function.Subjects and Methods. the retrospective study involved 31 patients of 52.7 ± 2.8 years old with sepsis or septic shock which were treated with levosimendan at the dose of 0.16 [0.15‒0.17] mg/kg (0.11 [0.1‒0.12] μg × kg-1 × min-1) on days 1–4 of ICU stay. The patients were divided into the following groups: Group 1 ‒ survivors (n = 19) and Group 2 – non-survivors (n = 12). Central hemodynamics was assessed through transpulmonary thermodilution. The differences were considered statistically significant at p < 0.05.Results. Most of the hemodynamic parameters and vasopressors and inotropes doses had no differences between the groups before levosimendan administration. There were no differences in the cardiac index (3.8 ± 0.3 vs 3.5 ± 0.3 L/min/m2; p = 0.479) between the groups following levosimendan administration, however, Group 1 demonstrated the following parameters to be lower versus Group 2: central venous pressure (7 ± 0.7 vs 11 ± 1 mm Hg; p = 0.005), blood lactate (1 [0.9‒1.8] vs 2.4 [2.2‒3.3] mmol/L; p = 0.04), norepinephrine dosages (0.2 [0.15‒0.35] and 0.5 [0.4‒0.6] ng/kg/min; p = 0.023 ), global end-diastolic volume index (693 [688‒28] vs 870 [779‒961] mL/m2; p =0,0009) and the level of NT-proBNP (1,590 [1,080‒3,160] vs 35,000 [21,400‒35,000] pg/mL; p = 0,0001). Global heart ejection fraction (23 [21‒27] vs 15 [12‒20]%; p = 0.015) and heart function index (6 [5‒8] vs 3 [ 3-4] min-1; p = 0.003) ) were higher in Group 1 versus Group 2. APACHE II >19 (AUC 0.906; p < 0.0001), SOFA > 9 (AUC 0.805; p = 0.0002); heart rate > 114 min-1 (AUC 0.755; p = 0.0095), and index of total peripheral vascular resistance < 1,700 dyn × s × cm-5 × m2 (AUC 0.806; p = 0.001) before levosimendan administration were the independent predictors of death in patients treated with levosimendan.Conclusion: non-survivors patients with sepsis had significantly higher APACHE II and SOFA scores, higher heart rate and lower index of total peripheral vascular resistance before levosimendan infusion. In survivors levosimendan infusion at a standard dose led to a significant improvement in the heart pumping function accompanying by global heart ejection fraction and heart function index increasing and NT-proBNP decreasing. In non-survivors such favorable central hemodynamics changes did not occur, although the cardiac index increased after inodilator administration. Further studies of levosimendan efficacy in patients with sepsis of varying severity are advisable. It is necessary to specify the indications and contraindications for levosimendan administration to patients with sepsis.

The objective: to study information value of the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in the cardiac risk assessment in abdominal oncological surgery.Subjects and Methods. 94 patients of 68 [62‒73] years old who underwent elective surgery were examined.Results. Cardiovascular comortbidity was diagnosed in 69 (73.4%) patients. 11 (11.7%) perioperative cardiovascular complications were registered. Cardiac mortality was 4.3%. Hematological indices were not associated with cardiovascular diseases (NLR: OR = 0.59‒1.42; 95% CI 0.14‒2.60; p = 0.29‒0.74, PLR: OR = 0.99‒1.00; 95% CI 0.97‒1.01; p = 0.31‒0.99). NLR and PLR were not predictors of cardiovascular complications (OR = 0.67; 95% CI 0.19‒2.37; p = 0.46 and OR = 1.00; 95% CI 0.99‒1.01; p = 0.68) and cardiac death (OR = 0.21; 95% CI 0.01‒8.05; p = 0.23 and OR = 0.99; 95% CI 0.98‒1.01; p = 0.79).Conclusion. NLR and PLR cannot be recommended for the cardiac risk assessment in abdominal oncological surgery.

OBJECTIVES. To analyze the predictive significance of clinical and laboratory parameters in relation to the risk of mortality, the assessment of which is available in the first 24 hours of the stay of patients with sepsis in the intensive care unit (ICU), and to assess the feasibility of starting invasive monitoring of central hemodynamics in patients with predictors of poor outcome. MATERIALS AND METHODS. We analyzed the results of examination of 134 patients aged 58.5 (43–71) years with abdominal sepsis. APACHE II score was 13 (11–17) points, SOFA score was 6 (4–8) points; l lethality in ICU — 47 %. Central hemodynamics was studied using transpulmonary thermodilution. Descriptive statistics (data are presented as median, 25 and 75 % quartiles), logistic regression and ROC analysis were used. RESULTS. Independent predictors of death were SOFA score > 8 (OR 1.5712; 95% CI 1.1934–2.0686; p = 0.0001; AUC 0.813; sensitivity 74 %, specificity 81 %) and lactateemia > 1.8 mmol/l (OR 3.5293; 95% CI 1.7421–7.1500; p = 0.0001; AUC 0.799; sensitivity 63 %, specificity 79 %). A combination of established risk factors predicted cardiac index < 2.5 l/min/m2 (OR 37.0; 95% CI 3.9167–349.5290; p = 0.002) and cardiac function index < 5.8 min-1 (OR 11.8182; 95% CI 2.8189–49.5303; p = 0.0007). CONCLUSIONS. Among the clinical and laboratory parameters, the assessment of which is available in the first 24 hours of the stay of patients with sepsis in the ICU, significant predictors of lethal outcome are SOFA score > 8 points and lactateemia > 1.8 mmol/l. Most patients with a combination of these risk factors are characterized by the presence of signs of myocardial dysfunction, and for 50 % — a decrease in CI to a level of < 2.5 l/min/m2, which indicates the advisability of invasive monitoring of central hemodynamics, in particular with transpulmonary thermodilution.

The objective: to study the prognostic significance of the ratio of the absolute number of neutrophils to lymphocytes (NLR) and platelets to lymphocytes (PLR) in assessing the risk of cardiovascular complications in non-cardiac surgical interventions.Subjects and Methods. 85 patients aged 66 [61‒70] years who underwent elective vascular surgery were examined.Results. Concomitant circulatory diseases were diagnosed in 98.8%. PLR < 91.2 with the sensitivity of 60% and the specificity of 67.8% was associated with diabetes mellitus (AUC – 0.686; 95% CI 0.576‒0.783, p = 0.0022). Cardiovascular complications were registered in 9.3% of patients. NLR was an independent predictor of cardiovascular complications: OR – 5.216; 95% CI 1.246‒21.826, p = 0.005. NLR > 2.1 discriminated cardiovascular complications with the sensitivity of 75% and specificity of 75% (AUC – 0.827; 95% CI 0.690–0.921; p = 0.004). PLR was also a predictor of cardiovascular complications: OR – 1.0111; 95% CI 1.0001–1.0223; p = 0.027. PLR > 105.5 allowed identifying patients with NT-proBNP > 650 pg/ml with the sensitivity of 75.0% and the specificity of 61.8% (AUC – 0.740; 95% CI 0.630‒0.832; p = 0.0308).Conclusion. NLR and PLR can be used to identify patients with increased cardiac risk when undergoing vascular surgery. Further research in this field is advisable.

Aim of the study: to determine the predictive value of central hemodynamic parameters in relation to mortality and evaluate their potential acceptability for goal-directed therapy during days 1-4 of treatment in patients with sepsis.Material and methods. The results of investigation and treatment of 62 patients aged 50.9±2.13 years with abdominal sepsis were analyzed. The patient severity on admission to the intensive care unit was 13 [10-15] on the APACHE II scale, 8 [6.75-9.25] on the SOFA scale. Lethal outcome 15.6±1.4 days after admission occurred in 19 (31%) patients. Central hemodynamic parameters were studied by transpulmonary thermodilution according to the standard technique. Infusions and administration of sympathomimetic drugs were performed according to Sepsis-3 guidelines. Statistical analysis was performed using logistic regression and ROC analysis.Results. The median values of the main circulatory parameters during days 1-4 of sepsis treatment were within normal ranges. Cardiac index, afterload-related cardiac performance, global cardiac ejection fraction and cardiac function index were predictors of mortality at all stages of treatment. However, the first three parameters did not provide either sufficient model quality at the study stages or a stable cutoff value with acceptable sensitivity and specificity. The cardiac function index maintained good model quality (area under the ROC curve 0.708-0.753) and a stable cutoff value (≤5.75 to ≤5.81 min-1) with acceptable and balanced sensitivity and specificity of about 70% at all study stages.Conclusion. The cardiac index, afterload cardiac performance, global cardiac ejection fraction and cardiac function index during days 1-4 of intensive care of sepsis are predictors of lethal outcome. At the same time, only the cardiac function index maintains good model quality and consistent cut-off point value with acceptable sensitivity and specificity at all stages of the study. The feasibility of using the cardiac function index as one of the parameters of goal-directed therapy aimed at cardiovascular function improvement in sepsis needs further investigation.

The objective: to analyze the incidence and spectrum of cardiovascular complications within 12 months after noncardiac surgery, as well as to assess the association of preoperative values of various cardiac risk indices (CRI) and other potential risk factors with the actual development of complications.Subjects and Methods. We analyzed data of medical records and telephone interviews of 141 patients aged 65 [60-71] years who had undergone non-cardiac surgery a year before the interview The operations were low risk in 13.5% of observations, medium risk in 64.5%, and high risk in 22%. A retrospective calculation of the Revised CRI (RCRI), Individual CRI (Khoronenko CRI), and the American College of Surgeons Perioperative Risk for Myocardial Infarction or Cardiac Arrest (MICA) was performed.Results. Cardiac events (myocardial infarction, decompensation of chronic heart failure, new arrhythmias, stroke, and/or the need to prescribe or escalate the dose of cardiovascular drugs and/or hospitalization for cardiac indications, and/or death from cardiovascular diseases) within 12 months after elective noncardiac surgeries were detected in 27.7% of cases, and in 2.1% of patient's death occurred due to cardiac disorders. Predictors of cardiac events were concomitant ischemic heart disease (OR = 2.777; 95% CI 1.286-5.966; p = 0.0093) and chronic heart failure (OR = 2.900; 95% CI 1.224-6.869; p = 0, 0155), RCRI (OR = 1.886; 95% CI 1.2-8-2.944; p = 0.005), Khoronenko CRI (OR = 3254.3; 95% CI 64.33-164,638; p = 0.0001), MICA (OR = 1.628; 95% CI 1.156-2.292; p = 0.005), creatininemia on the first postoperative day (OR = 1.023; 95% CI 1.010-1.061; p = 0.005), and propensity for bradycardia during surgery (OR = 0.945; 95% CI 0.908-0.983; p = 0.005). Combined analysis of Khoronenko's CRI and postoperative creatininemia provided a very good model: area under the ROC-curve - 0.823 (95% CI 0.728-0.641; p = 0.0002).Conclusion. All studied CRIs can be used to predict posthospital cardiac events; however, the most promising is a joint assessment of Khoronenko's CRI and postoperative creatinemia.