Цель. Изучение влияния симпатико-вагального баланса на развитие фибрилляции предсердий (ФП) у больных хронической обструктивной болезнью легких (ХОБЛ 47±0,422; p>0,05). Также не отмечено значимых изменений временных показателей: 4±122,53 мс против 846,1±126,20 мс; p>0,0,05), SDNN (98,2±30,37 мс против 118,7±56,35 мс; p>0,05), SDANN (87,5±31,58 мс против 97,13±46,81 мс; p>0,05), ASDNN (41,7±14,13 мс против 55,9±38,22 мс; p>0,05), rMSSD (30,7±15,12 мс против 38,2±25,02 мс; р>0,05), pNN50m (9,9±10,73% против 13,7±17,57%; р>0,05
Identification of risk factors associated with presence of atrial fibrillation (AF) in patients with aortic valve stenosis (AS) remains to be unraveled.The aim of the study was to investigate relationship between profibrotic biomarkers and presence of AF in AS patientsMethods. 191 patients (29,8% male, 77,7±0,59 years) with AS (defined as aortic valve area (AVA) ≤ 2,0 sm2) were enrolled in the study. Clinical, echocardiographic and biochemical variables, including serum TGFβ1 and osteopontin levels were compared between 2 groups of patients: with and without AF. Results. 83(36,5%) of AS patients had AF. In logistic regression models independent associations between AVA index (p=0,040), left atrial volume (p=0,021), OPN (р=0,009) and presence of AF were found. Patients with serum OPN level > 10,05 ng/ml had twice more higher AF incidence comparedto patients with serum OPN level ≤ 10,05 ng/ml (53,8% and 29,2%, respectively, p=0,020).Conclusion. Serum OPN level was independently associated with presence of AF in AS patients, thus we speculate on it’s predominant profibrotic role in the left atrium.
Aim To evaluate the prognostic significance of the left ventricular global function index (LV GFI) in patients with acute coronary syndrome (ACS) using echocardiography (EchoCG).Material and methods The LV GFI is an index that integrates LV cavity volumes, stroke volume, and myocardial volume. This study included 2169 patients with ACS (1340 (61.8%) men) aged 64.1±12.6 years from two observational multicenter studies, ORACLE I and ORACLE II. 1800 (83 %) cases were associated with increased concentrations of myocardial injury markers, including 826 (38.1 %) cases of ST segment elevation myocardial infarction (MI). The observation was started on the 10th day of clinical condition stabilization and lasted for one year. EchoCG was performed with evaluation of LV GFI, which was calculated as a ratio of LV stroke volume to LV global volume. The LV global volume was calculated as a sum of mean LV cavity volume (LV end-diastolic volume + LV end-systolic volume / 2) and LV myocardial volume.Results The main outcome of the study was all-cause death (n=193); recurrent coronary complications (n=253) were analyzed separately. The only EchoCG parameter indicating an adverse outcome during the one-year follow-up was a LV GFI decrease to below 22.6 % with a sensitivity of 72 % and a specificity of 60% (area under the curve, AUC=0.63). A LV GFI <22.6 % was an independent predictor of all-cause death (p=0.019) along with age (p=0.0001), history of MI (p=0.034), and presence of heart failure (HF) (p=0.044), diabetes mellitus (p=0.012), and peripheral atherosclerosis (p=0.001). The LV GFI <22.6 %, (p=0.044), heart rate upon discharge from the hospital (p=0.050), history of MI (p=0.006), presence of HF (p=0.014), and peripheral atherosclerosis (p=0.001) were also independent predictors for recurrent coronary complications. Decreased LV GFI was associated with the risk of fatal outcomes independent of the LV ejection fraction at baseline.Conclusion In patients with ACS, the left ventricular global function index is an independent predictor for all-cause death and recurrent coronary complications and may be used for risk stratification.
The COVID-19 pandemic has dramatically changed the lives of people and the work of hospitals and the health system. The rapid spread of infection, high mortality and congestion in hospitals are of high concern. Due to insufficiently causes, the number of admissions of patients with acute coronary syndrome (ACS) has significantly decreased in many centers, while timely intervention significantly improves the prognosis of AMI patients with ST segment elevation. Aim. To assess the clinical characteristics of patients with ST-segment elevation AMI during the re-profiling of the center for patients with COVID-19. Materials and methods. In total, the center worked to receive patients with COVID-19 and ACS for one month, during which 8 AMI patients with ST segment elevation were hospitalized. SARS-CoV-2 was diagnosed on the basis of nasopharyngeal or oropharyngeal smear PCR, serum IgM and IgG, or lung CT, which were performed on the day of admission, regardless of the severity of the condition. Segment elevation AMI was diagnosed based on typical clinical presentations accompanied by ST-segment elevation or newly diagnosed LBBB. Stenosis was considered as an infarction-related lesion in the presence of angiographic signs of thrombotic occlusion or subocclusion. Obstructive coronary artery disease was defined as >50% stenosis based on visual assessment of angiography. Results. All patients had ST-segment elevation, 6 (75%) patients had typical pain syndrome, 2 (25%) patients had pain syndrome accompanied by shortness of breath. SARS-CoV-2 was detected by PCR in 4 (50%), in 2 (25%) – an increased titer of IgM and IgG. CT scan showed 7 (87.5%) changes characteristic of COVID-19. Severe (CT3) and moderately severe (CT2) lesions were found in 4 (50%) patients. All patients underwent coronary angiography, thrombolysis was not performed. All patients had obstructive coronary artery disease requiring revascularization. When compared with the same calendar interval of the previous 3 years, the decrease in hospitalization for AMI with ST elevation was 50% or more. However, when comparing pain-door and door-balloon time intervals, no significant differences were found (p=0.786 and p=0.300, respectively). Conclusion. All patients with suspected ST-segment elevation AMI had obstructive coronary artery disease requiring revascularization. There was a significant decrease in the number of patients with AMI with ST-segment elevation without changing the time intervals before hospitalization and intervention. Keywords: acute myocardial infarction, COVID-19, revascularization For citation: Safaryan VI, Savostyanov KA, Sizgunov DS, Sargsyan AZ, Birukov PA. Acute ST-segment elevation myocardial infarction in COVID-19 patients: a single hospital experience. Consilium Medicum. 2021; 23 (1): 43–47. DOI: 10.26442/20751753.2021.1.200574
Degenerative aortic stenosis (DAS) may be accompanied by remodeling of the left atrium (LA). The aim of the study was to assess the effect of the morpho-functional parameters of the LA remodeling on the prognosis of patients with DAS. The prospective study included 383 patients (men – 33.9% of patients), aged 78.9 ± 0.40 years, with DAS (mild – 18.3%, moderate – 30.8%, severe – 50.9%). The patients did not undergo a surgical correction of the defect. The LA morpho-functional state was estimated by the LA size/volume and the ratio of the rate of the transmitral flow to the rate of the early diastolic movement of the fibrous mitral valve ring (E/e ratio). The average follow-up period was 603.9 ± 24.57 days. The general mortality was assessed. The information on the outcomes was collected by telephone contacts. Multivariate Сox-regression analyses showed that the LA remodeling was independently associated with the death risk: an increase in the LA size ≥45 mm (ОR 1.6, CI 1.06-2.37, р=0.026) and an increase in the Е/е ratio >15 (ОR 1.6, CI 1.08-2.39, р=0.021). Another risk factor was a decrease in the creatinine clearance <45 ml/min (ОR 1.7, CI 1.10-2.60, р=0.016), area of the aortic valve (ОR 0.4, CI 0.26-0.74, р=0.002) and a decrease in the left ventricular ejection fraction <40% (ОR 1.7, CI 1.02-2.71, р=0.042). The Kaplan-Meier survival analysis showed that the E/e ratio>15 and the LА size ≥45 mm were statistically significantly associated with an increased risk of the general mortality (р<0.0001, LogRank=14.5 and р<0.0001, LogRank=18.2, respectively). The areas under the ROC curves for the increased LA size ≥45 mm and the E/e ratio>15 were 0.62 and 0.61, respectively. Thus, the indices of the LA remodeling – the LA size ≥45 mm and the E/e ratio > 15 – are associated with a poor outcome in patients with DAS.
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