СВЯЗЬ УРОВНЕЙ ЭНДОТЕЛИНА-1 И N-КОНЦЕВОГО ПРЕДШЕСТВЕННИКА НАТРИЙУРЕТИЧЕСКОГО ПЕПТИДА ТИПА С СО СТАДИЕЙ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ ПОСЛЕ ПЕРЕНЕСЕННОГО COVID-19Шувалова А.С., Прокофьева Т

Objective. To analyse the course of coronary heart disease within a year after the development of myocardial infarction in residents of Astrakhan region with chronic obstructive pulmonary disease. Materials and Methods. We examined 325 patients with myocardial infarction, residents of Astrakhan region. 195 patients had heart attacks against the background of COPD and 130 patients without COPD. During 12-month follow-up 30 people dropped out - 19 in the group of patients with myocardial infarction against COPD, 11 in the group of patients with myocardial infarction without COPD. Correspondingly, by the end of the observation period the number of patients under observation was: 176 - in the group of patients with myocardial infarction against COPD, and 119 - in the group of patients with myocardial infarction without COPD. Results. It was found that in patients with myocardial infarction against COPD the annual mortality from conditions associated with cardiovascular pathology was twice as frequent as in patients with MI without COPD. There was also a tendency to more frequent development of recurrent myocardial infarction. In the structure of mortality in patients with myocardial infarction against COPD and without COPD and there was a tendency to a more frequent occurrence of acute heart failure expressed stages (Killip III-IV) and decompensation of chronic heart failure as causes of mortality. The odds of developing a combined endpoint, including recurrent myocardial infarction, stroke and mortality from cardiac causes, among patients with myocardial infarction against COPD were 2.7 times higher compared to patients with myocardial infarction without COPD. The combined endpoint, which combines clinically significant events in patients with myocardial infarction, makes the existing differences in the outcomes of infarction in patients with and without COPD evident.

УРОВНИ МАРКЕРОВ ЭНДОТЕЛИАЛЬНОЙ ДИСФУНКЦИИ У ПАЦИЕНТОВ С АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ И COVID-19 В ДИНАМИКЕШувалова А.С., Прокофьева Т.В., Полунина О

КЛИНИКО-ДИАГНОСТИЧЕСКАЯ ЗНАЧИМОСТЬ НЕЙТРОФИЛЬНО-ЛИМФОЦИТАРНОГО ИНДЕКСА ПРИ ОСТРОМ ИНФАРКТЕ МИОКАРДА У БОЛЬНЫХ ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНЬЮ ЛЕГКИХПрокофьева Т.В., Полунина О

УДЕЛЬНЫЙ ВЕС ЦИРКУЛИРУЮЩИХ МОНОНУКЛЕАРОВ В РАННЕМ АПОПТОЗЕ У БОЛЬНЫХ ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА (ИНФАРКТ МИОКАРДА) НА ФОНЕ ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНИ ЛЕГКИХПрокофьева Т.В., Полунина О

The aim of the study. To study the structure of lethal and non-lethal complications with an analysis of survival and the likelihood of non-lethal complications after mitral valve (MV) replacement with bicuspid mechanical prostheses over a five-year period. Materials and methods. The data of 260 patients who were treated in the period of 2012–2014 were analyzed a surgical intervention was performed – isolated MV prosthetics with mechanical bivalve prostheses. Among the patients, there were 84 (32.3 %) men and 176 (67.7 %) women. The median age was 51.0 [44.0–55.5] years. Statistical analysis was carried out using IBM SPSS Statistics 26.0 (USA). Results of the study and conclusions. According to the results of the five-year survival after MV prosthetics with mechanical prostheses, it was 86.6 %. At the same time, acute cardiovascular diseases (myocardial infarction, cardiac arrhythmias) were the leading cause of death. Among non-lethal thromboembolic complications, acute cerebrovascular accident prevailed, it developed in 65.3 %. Among nonlethal hypocoagulation complications, nosebleeds were most often recorded – in 40.5 % of patients. The probability of developing non-lethal thromboembolic complications by the fifth year is 20.0 % vs 18.5 % in the first six months after prosthetics with mechanical prostheses. And the probability of developing non-lethal hypocoagulation complications by the fifth year is 26.8 % vs 6.1 % in the first six months after prosthetics with mechanical prostheses.

ВЗАИМОСВЯЗИ УРОВНЯ БЕЛКА КЛОТО И ПОКАЗАТЕЛЕЙ ЭНДОГЕННОЙ ИНТОКСИКАЦИИ У ПАЦИЕНТОВ С ВНЕБОЛЬНИЧНОЙ ПНЕВМОНИЕЙЛевченко В.А., Полунина Е

Introduction. Frequent comorbidity of chronic obstructive pulmonary disease and myocardial infarction is due to the commonality of a number of etiopathogenetic links and the development of endogenous intoxication syndrome. The convincing markers of endogenous intoxication syndrome are medium and low molecular weight molecules including medium and low molecular weight substances and oligopeptides.Aim. To study the levels of medium and low molecular weight substances in patients with myocardial infarction against the background of chronic obstructive pulmonary disease.Materials and methods. 225 patients with myocardial infarction were examined. In 195 patients the infarction developed against the background of COPD, in 130 patients – without COPD. The comparison group consisted of 110 somatically healthy individuals. Substances of medium and low molecular weight (MLMWS) and oligopeptides (OP) were determined by direct spectrometry (according to M.Y. Malakhova, 1995) in plasma, erythrocytes and urine. Endogenous intoxication indices and intoxication coefficient were calculated on the basis of these indices. Statistical processing of the data was performed using SPSS 26.0 software package.Results. In blood plasma and erythrocytes, the levels of average molecules in both studied groups were statistically significantly higher compared to controls. The highest levels were detected in comorbid patients. In the group of patients with myocardial infarction without chronic obstructive pulmonary disease 60% of the examined patients had phase I endogenous intoxication. Phase III intoxication prevailed among comorbid patients with myocardial infarction against chronic obstructive pulmonary disease – 62,6%.Conclusions. Molecules of average mass have proven to be informative indices of endogenous intoxication syndrome in patients with myocardial infarction accompanied by chronic obstructive pulmonary disease. This opens the prospect of using these indices in the development of assessment scales and the creation of prognostic algorithms in patients with cardiorespiratory comorbidity.

Background. Chronic obstructive pulmonary disease is a socially significant disease affecting patient’s quality of life. Assessment of endogenous intoxication in patients with chronic obstructive pulmonary disease will allow to understand pathogenetic features of different phenotypes of this disease, which can be taken into account when predicting its course. The aim of the study. To determine the prognostic value of levels of mediumand low-molecular-weight substances and oligopeptides in patients with chronic obstructive pulmonary disease. Materials and methods. One hundred and four patients with chronic obstructive pulmonary disease (COPD) and 110 somatically healthy individuals were examined. Molecular weight medium and low molecular weight substances (LMWSM) and oligopeptides (OP) were determined in blood plasma, erythrocytes and urine. Based on these indicators mathematically calculated indices of endogenous intoxication and coefficient of elimination were defined. Statistical processing of the data was performed using the SPSS 26.0 software package (IBM Corp., USA). Results. In all biological fluids, the levels of average molecules and calculated indices in the COPD patients’ group were statistically significantly different from those in the control group. The indices characterizing endotoxin accumulation were statistically significantly higher, while those characterizing toxin elimination were lower. The level of endotoxemia was correlated with the frequency of exacerbations, clinical manifestations severity, quality of life, COPD group and phenotype. Conclusions. Frequent exacerbations, groups C and D, bronchitic and mixed COPD phenotypes are characterized by more severe endotoxicosis manifested by high levels of LMWSM, OP and calculated indices.

ЧАСТОТА РАЗВИТИЯ ТРОМБОЭМБОЛИЧЕСКИХ ОСЛОЖНЕНИЙ ПРИ НОСИТЕЛЬСТВЕ ПОЛИМОРФИЗМОВ ГЕНОВ, АССОЦИИРОВАННЫХ С ПОВЫШЕННЫМ РИСКОМ ТРОМБОЗОВ, В АСПЕКТЕ КОМПЛАЕНТНОСТИ У ПАЦИЕНТОВ ПОСЛЕ ПРОТЕЗИРОВАНИЯ МИТРАЛЬНОГО

The aim of the study. To develop a mathematical model for predicting the development of thromboembolic complications and bleeding in patients after mitral valve replacement with mechanical prostheses based on an analysis of a number of risk factors – age, compliance, heart rate at the postoperative stage, prosthesis manufacturer, hemostasis indicators.Materials and methods. There were examined 260 patients. The following risk factors were analyzed: patient compliance (Morisky-Green test), heart rate at the postoperative stage, prosthesis manufacturer (MedInzh, Carbomedics, ATS, On-X), hemostasis indices (international normalized ratio, activated partial thromboplastin time, D-dimer, fibrinogen, soluble fibrin-monomeric complexes).Results of the study and conclusion. The frequency of thromboembolic complications was 5.2 cases, bleeding 4.7 cases per 1000 patient-months. With an increase in the level of soluble fibrin-monomeric complexes by 1 g/L, the risk of thromboembolic complications increases by 1.63 times, the presence of a MedInzh’s prosthesis increases the risk of thromboembolic complications by 2.04 times compared to prostheses of other companies, with paroxysmal or permanent forms of atrial fibrillation the risk thromboembolic complications increase 16.29 times compared with patients with sinus rhythm. In compliant patients, the risk of bleeding is 52.5 (1/0.08) times lower than in non-compliant patients; with an increase in the activated partial thromboplastin time by 1 sec, the risk of bleeding increases by 1.07 times.

Objective: to study and compare the influence of such factors as: gender, age, family status, level of education and the frequency of determination of the international normalized ratio (INR) on the compliance of patients after mitral valve replacement (MC) with mechanical prostheses in dynamics - after 6 and 12 months. Materials and methods: it were analyzed data of 260 patients after MC prosthetics with mechanical bicuspid prostheses. The Morisky-Green test was used to assess compliance.Results: the most committed to treatment were female, middle-aged persons with secondary specialized and higher education, as well as married persons. Among patients who monitored INR on a monthly basis, the percentage of compliant patients was higher compared to patients where this indicator was determined less than once a month. The dynamics of a decrease in the number of compliant patients after 12 months of follow-up was established. Conclusions: the data obtained indicate the need to carry out more active work on the formation of compliance with «vulnerable» categories of patients: with men, with elderly and young patients, with persons with secondary education, unmarried. The revealed tendency to decrease compliance after 12 months, regardless of the studied factor, indicates the importance of maintaining compliance in the long-term postoperative period. Also, the data obtained indicate the presence of a relationship between the multiplicity of INR control and compliance.

OBJECTIVE:To study and analyze the dynamics of the mortality rate of the population of the Irkutsk region from cerebrovascular diseases (CVD) in 2010 and 2020 in terms of age and gender.MATERIAL AND METHODS:The study included all registered deaths among the population of the Irkutsk region in 2010 and 2020 years in age and gender groups from CVD. The grouping of the material was carried out by distributing the deceased by sex and five-year age intervals (from 15 to 85+ years) with the subsequent calculation of mortality tables. The method of analysis of the time series was used with the calculation of indicators of absolute increase, rate of increase, growth rate, the content of 1% increase in the mortality rate in cases.RESULTS:A significant increase in the 1% increase in mortality among males both in 2010 and in 2020 years was observed starting with the age group 55-59 years. The 1% increase in mortality was 1.24 and 1.69 deaths, respectively. Among females, a significant increase in the 1% increase in mortality was recorded in the 60-64 age group in 2010 year and in the 65-69 age group (1.25 and 1.31 deaths, respectively). In 2020 year, compared to 2010 year, both among females and males in almost all age groups, there was a decrease in the intensity of the 1% increase in mortality cases, except for the 55-59 age group among males. gender and except for age groups 40-44 years old and 55-59 years old among females.CONCLUSION:In the Irkutsk region, among males, the decrease in the mortality rate from CVD compared with females from 2010 to 2020 years was less pronounced. During the study period of observation, the intensity of the ratio of the increase in the mortality rate from CVD in men to women increased. So, in 2010 year, the maximum ratio was 2.1:1, in 2020 year - 5.0:1. The exponent 1% increase in deaths in males was higher than in females.

МАТЕМАТИЧЕСКАЯ МОДЕЛЬ ДЛЯ ОЦЕНКИ РИСКА РАЗВИТИЯ ЖИЗНЕУГРОЖАЮЩИХ ОСЛОЖНЕНИЙ В ОСТРОМ ПЕРИОДЕ ИНФАРКТА МИОКАРДАПрокофьева Т

The aim of the study. To analyze the indicators of hemostasis with adherence to treatment in patients operated on for mitral valve prosthetics with mechanical bicuspid prostheses in dynamics after 6, 12 and 60 months.Materials and methods. The study included 260 patients who underwent surgery for prosthetics with mechanical prostheses. Patients’ adherence to treatment was assessed using the Morisky – Green test. The following hemostasis parameters were analyzed: international normalized ratio (INR), activated partial thromboplastin time (APTT), D-dimer, fibrinogen and soluble fibrin-monomer complexes.Results of the study and conclusion. At all stages of the postoperative period, the hemostasis indicators of compliant patients corresponded to the reference values for people receiving anticoagulants, in non-compliant patients, these indicators did not reach the recommended values for patients on anticoagulant therapy. The presence of correlations between compliance and hemostasis indicators is evidenced by the results of correlation analysis. In most cases, the maximum strength of the relationship between compliance and hemostasis indicators was observed after 12 months of follow-up. A noticeable strength of interrelations was traced between compliance and levels of APTT, INR and fibrinogen.

The aim of the research. To study levels of the apoptosis biomarkers annexin A5 (AnxA5) and Bcl‑2 and to identify the presence of correlations of structural and functional parameters of the myocardium with the level of the studied biomarkers in patients with ischemic cardiomyopathy (ICMP).Materials and methods. Patients with ICMP (n = 47) were examined as the main group. The control group included 30 somatically healthy individuals. Bcl‑2 and APA5 levels were determined in the blood serum by the enzyme immunoassay.Results. It was found that in the group of patients with ICMP. The level of AnxA5 was statistically significantly higher (p < 0.001), and the level of Bcl‑2 was statistically significantly lower (p < 0.001) than in the control group. Based on the results of the correlation analysis a noticeable close relationship on the Cheddock scale was revealed between levels of the studied apoptosis biomarkers and the values of the sphericity index of in diastole and systole of left ventricle (LV), final diastolic and systolic volume of LV and ejection fraction of LV. Between the other parameters of myocardial remodeling and levels of the studied biomarkers of apoptosis, the closeness of relationships on the Cheddock scale were weak and moderate.

Objective. According to the results of a complex analysis of gender-anamnestic, clinical, biochemical and instrumental parameters using the cluster analysis method to identify phenotypes of chronic heart failure (CHF) in the examined patients.Materials and methods. It was examined 345 patients with CHF with different left ventricular ejection fraction and 60 somatically healthy volunteers. For the study, groups of indicators were formed that most widely characterize the pathogenesis of CHF: gender-anamnestic and clinical, instrumental (echocardiographic study, study of the functional state of the vascular endothelium and skin microcirculation, calculation of the volume fraction of interstitial collagen), biochemical parameters of the functional state of the vascular endothelium, collagen balance, inflammation and oxidative stress.Results. After the cluster analysis by the methods of hierarchical classification and k-means, we identified 4 clusters/phenotypes of CHF: fibrous-rigid, fibrous-inflammatory, inflammatory-destructive and dilatation-maladaptive. According to the results of the analysis of variance were identified 27 of the 48 indicators in which the level of statistical significance of intergroup differences (for the Fisher test) was less than 0.05, that is, indicators that make the greatest contribution to the division of patients with CHF into phenotypic groups.Conclusion. Our analysis with the release of phenotypes indicates that patients with CHF with different phenotypes have clinical and pathogenetic features. The data obtained in the future can be used to determine the prognosis of the disease and the choice of tactics for the management and treatment of patients with CHF depending on the phenotype.

Background. Stroke is a severe medical, social and economic burden for all countries of the world. The leading indicators characterizing the “epidemiological picture” of stroke are the incidence and mortality rates from stroke.Aims. Analyze the dynamics of stroke incidence and mortality rates in the regions of Russia that were included in the federal program for reorganizing care for patients with stroke for the period from 2009 to 2016.Material and methods. The study was based on the data of the territorial-population register for seven study areas in the regions of Russia that were included in the federal program for reorganizing care for patients with stroke (Republic of Bashkortostan, Sverdlovsk region, Republic of Tatarstan, Sakhalin region, Stavropol Territory, Ivanovo Region and Irkutsk Region). The age of the examined persons was 25 years and older.Results. In the period from 2009 to 2016, in the studied territories, there was a consistent stable decrease in the value of the stroke incidence rate. Stroke mortality rates fluctuated with a single increase in 2012. When comparing the average incidence of stroke and mortality from it between 2009 and 2016, we discovered a statistically significant decrease in the incidence of stroke – by 1.4 times and in the rate of mortality from stroke – by 2.3 times. According to the results of the cluster analysis, we revealed a significant conformity (similarity) of mortality rates between regions by 2016 and the absence of monotony (stability) of the rate of stroke incidence.Conclusion. In all the regions under study, an almost systematic annual decrease in the incidence and mortality rates from stroke among the adult population was revealed in seven studied territories. The results of cluster analysis of the “picture” of stroke incidence and mortality from it also demonstrate a positive trend by 2016 in all studied territories. Only one of the studied territories – the Republic of Tatarstan – despite the presence of a positive dynamics of stroke incidence over an eight-year period, in 2016 belonged to the rank with a high integral incidence rate.