Purpose of the study. To reveal the relationship between the serum concentration of vascular endothelial growth factor and the structural and functional state of the myocardium in patients in the post-infarction period at the stage of rehabilitation. Materials and methods. We examined 94 patients at the outpatient stage of rehabilitation after ad hoc stenting 6 weeks after myocardial infarction, 10 healthy volunteers without somatic pathology. All participants in the study underwent standard transthoracic echocardiography with assessment of thickness of epicardial fat, assessment of the concentration of vascular endothelial growth factor (VEGF) in peripheral blood by ELISA. Results and discussion. VEGF values above the median values were associated with lower left ventricular ejection fraction and left ventricular fraction shortening, which indirectly may indicate a more pronounced expression of VEGF in patients with left ventricular systolic dysfunction. Assessing the parameters of LV diastolic dysfunction in groups with different levels of VEGF, no significant differences were found in patients after myocardial infarction. Correlation relationships between the content of VEGF and the thickness of epicardial adipose tissue were not found either among patients or in the control group. Conclusions. Elevated VEGF values in patients with coronary artery disease at the 6th week of rehabilitation were accompanied by left ventricle systolic dysfunction, in contrast to diastolic dysfunction. There was no direct correlation between the thickness of epicardial fat and the concentration of VEGF in the blood serum in patients with coronary artery disease.
Platelets play a special role in the systemic inflammatory response syndrome, as they acquire the ability to become activated and aggregate. Literature has no direct evidence of a link between platelet aggregation activity and the severity of the systemic inflammatory response syndrome in patients with pulmonary tuberculosis. The aim of the paper is to study platelet aggregation in patients with pulmonary tuberculosis with severe systemic inflammatory response syndrome. Materials and Methods. Spontaneous and induced by ADP (0.1, 1.0 and 5.0 ml) platelet aggregation was determined by Born turbodynamic method. The study enrolled 27 patients with severe and 33 patients with indolent systemic inflammatory response syndrome Spontaneous and induced by ADP (0.1 and 1.0 ml) platelet aggregation was evaluated in absorbance units (a.u.); platelet aggregation induced by 5.0 ml of ADP was measured in percentage terms. Statistica 10 was used to process the results. Discrepancy tests were used to determine the significance of differences of mean values; McNemar’s test and Fisher’s exact test were used to estimate event rate, p<0.05. Results. In Group 1 spontaneous and induced by ADP (0.1, 1.0 and 5 ml) platelet aggregation was 0.85–2.65 (1.210.1) a.u., 0.81–3.67 (3.030.38) a.u., 1.06–6.25 (6.50.51) a.u., 5–66 % (39.53.6); in Group 2 – 0.84–1.36 (1.10.04) a.u., 0.77–2.49 (2.10.26) a.u., 0.64–5.49 (2.200.08) a.u., 8–66 (35.74.14) %, respectively. Frequency of spontaneous and induced by ADP (0.1, 1.0 and 5 ml) platelet hypoaggregation in Groups 1 and 2 was 33.3 % and 27.3 %; 14.8 % and 24.2 %; 0 % and 39.4 %; 14.8 % and 24.2 %, respectively; frequency of hyperaggregation was 14.8 % and 0 %; 11.1 % and 9.1 %; 29.6 % and 0 %; 0 % and 0 %, respectively. Conclusion. Platelet aggregation activity in patients with pulmonary tuberculosis is determined by the severity of the systemic inflammatory response syndrome. A pronounced systemic inflammatory response syndrome is associated with increased spontaneous and induced by ADP (1.0 ml) platelet aggregation in 14.8 % and 29.6 % of cases, respectively.
Taking into account the conflicting literature data and the ambiguity in the interpretation of parameters of diastolic heart function in patients with coronary heart disease, we conducted an analysis of diastolic heart function in patients after myocardial infarction at the outpatient rehabilitation stage. Aim of the study was to investigate the diagnostic information content and the feasibility of diastolic stress testing to assess the functional condition of postinfarction myocardium. Material and methods. 86 patients were examined at the outpatient stage of rehabilitation 6 weeks after myocardial infarction with coronary artery stenting ad hoc. The control group consisted of 10 healthy volunteers. Structural and functional examination of the heart was performed at rest and immediately after exercise using stress echocardiography. Results and discussion. Patients after myocardial infarction have a larger indexed volume of the left atrium (30.71 ± 8.88 vs. 20.49 ± 4.04 ml/m2) and an E/e` ratio (8.45 ± 3.27 vs. 6.46 ± 1.42) in comparison with the control group. 38 (62.3 %) patients with normal left ventricular (LV) ejection fraction (EF) had unimpaired LV diastolic function, 19 (31.1 %) and 2 (3.3 %) patients had type 1 and type 2 diastolic dysfunction, respectively, 2 patients (3,3 %) had an indeterminate result. Patients with reduced LV EF have a significantly lower early diastolic mitral annular velocity (e`). The diastolic stress test revealed a significant post-exercise increase in E/e` in only one patient (from 8.92 to 18.37), who also had an initially reduced EF (32 %). The stress test showed no significant changes in diastolic heart parameters after exercise in patients suffering from heart failure with preserved EF, which may indicate relatively good diastolic reserves of the heart. Conclusions. Myocardial infarction is accompanied by the presence of LV diastolic dysfunction in 53,5 % of the patients at the 6th week of the rehabilitation period. The diastolic stress test is accompanied by a rare occurrence of stress-induced diastolic dysfunction (4 %) in patients with reduced LV EF after myocardial infarction.
Aim: to comparatively estimate the nature and direction of alcohol-induced changes of vascular endothelial growth factor in the experiment and in the clinic. Materials and methods. The experimental part of the research was performed on 50 outbred mature rats (15 females and 15 males exposed to alcohol intoxication for 30 days, and 10 females and 10 males formed a control group). The average age of males was 38 (37.25–39) weeks, females - 40.5 (40-42.5) weeks. The body weight of females was 340 (329.5–345.5) g, males – 469 (464.5–474.25) g. After fixation, the control group animals were injected with intragastrically sterile 0.9% aqueous sodium chloride solution, the rest of the animals – 40% ethanol daily at the rate of 10 ml / kg, so that the animals reached a mild degree of intoxication. Clinical part of the research included 60 young patients: 30 males and 30 females, mean age was 35,97 (34,00-40,00) in females and 37,5 (34,00-41,00) in males, who were admitted to the narcological hospital for treatment of intoxication with diagnosed alcohol use disorder. The serum concentration of VEGF-A was evaluated in the blood serum of the studied patients and animals. Results. Alcohol intoxication caused an increase of serum concentration of VEGF-A in both animals and patients in comparison with control groups. The changes were unidirectional with no significant gender differences. Conclusion. The analysis of the experimental-clinical comparison of alcohol-induced changes in the serum content of VEGF-A indicates the unidirectional nature of the biological (angiogenic) effect in the form of VEGF-A expression under the action of ethanol. In the clinical interpretation of the physiological or pathological expression of angiogenesis, accompanied by an increase in the serum concentration of VEGF-A, it is necessary to take into account the specifics of the pathological process.
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