Introduction. Changes in melatonin (MT) production affected by earth magnetic field (EMF) were documented, including but not limited to patients with cardiovascular diseases. Thus far, the connection between MT content and atmospheric and heliogeophysical factors with regard to acute coronary syndrome (ACS) patients has not been thoroughly studied and the existing data are controversial. Material and methods. The levels of MT metabolite 6-hydroxymelatonin were measured in urine at night (MTn) and day (MTd) time in 114 ACS and 26 stable angina (SA) patients on days 1-3 of hospital stay. Results. Significant inverse correlation between MTn content and EMF H and D-components (H, D) of EMF was found in ACS patients as well as direct correlation between the MTn levels and solar radiation flux density at a wavelength of 10.7 cm (F-10.7) and the number of sun spots (the Wolf number - W). Significant direct correlation was shown between EMF D-component value, Kp- and Ap- geomagnetic activity indices in ACS patients developing cardiovascular complications. For ACS patients, the risk of development of cardiovascular complications was 1,62 and 1,15 times greater at high Kp- and Ap-indices respectively. Conclusion. Direct connection between MTn level and solar activity factors was observed in ACS patients together with inverse correlation with geomagnetic activity which confirms the influence of heliogeophysical factors on MT production. The risk of developing cardiovascular complications increases at higher Kp-and Ap- indices which proves the effect of heliogeophysical factors on the clinical course of cardiovascular pathology. The MTn content was shown to decrease in winter in these patients.
Aim. To measure blood IL-6, IL-10, creatinine levels, calcium, sodium and potassium in blood and saliva, melatonin in urine of patients with acute coronary syndrome without ST segment elevation for the prediction of the clinical course at the posthospital stage. Material and methods. The study included 93patients with complicated (n=46) and uncomplicated (n=47) coronary syndrome without ST segment elevation. Blood IL-6, IL-10, creatinine levels, calcium, sodium and potassium in blood and saliva, melatonin in urine were determined on days 1-3 after hospitalization. 6-hydroxymelatonin was measured by HPLC in urine collected between 23 p.m. and 8 a.m., melatonin i in urine collected between 8 a.m. and 23 p.m. Results. Complicated coronary syndrome was associated with increased levels of melatonin (night), blood IL-10 and Na, salivary Na and Ca while the uncomplicated condition with increased blood melatonin (daytime), IL-6, creatinine, Ca, Na, K, and salivary K. 90 patients were followed up within 12 months after discharge. End-points developed in 36 (40%) of Original investigations them. Logistic analysis yielded variables and 2 logistic regression equations The data on night melatonin +5 and +4 were included in ROC analysis. The night melatonin +5 values over 0.7453 were associated with increased risk of complications in the post-hospital period (6 months) and values of0.7453 or lower with the enhanced probability of uncomplicated clinical course. Prognostic sensitivity was estimated at 90%, specificity at -54.39%. The night melatonin +4 values over 0.2903 were associated with increased risk of complications in the post-hospital period (12 months) and values of 0.2903 or lower with the enhanced probability of uncomplicated clinical course. Prognostic sensitivity was estimated at 77.8%, specificity at -59.26%. Conclusion. The night melatonin +5 and +4 models can be used to predict the clinical course of acute coronary syndrome during 6 and 12 months of the post-hospitalization period.
Aim To evaluate clinical features of the course of acute coronary syndrome (ACS) in patients with oncological diseases (OD) and to determine the role of biomarkers GDF-15, NT-proBNP, and hs-CRP in short-term and long-term prognoses.Material and methods In 88 patients (34 patients with ACS and OD and 54 patients with ACS without OD), complaints and historical, objective, and laboratory and instrumental data were evaluated and blood concentrations of GDF-15, NT-proBNP, and hs-CRP biomarkers were measured on the first day of hospitalization. Incidence of cardiovascular complications (CVC) and outcomes of hospital and long-term (6 months) periods were analyzed. Statistical analysis of results was performed with the Statistica 12.0, MedCalc 19.1.7 software. The level of statistical significance was р<0.05.Results In the ACS+OD group as compared to the ACS without OD group, the onset of disease was mostly atypical, with shortness of breath and/or general weakness; the ACS+OD patients more frequently had III-IV Killip class acute heart failure (29 and 7 %, р=0.01); mean hemoglobin concentration (125.6±27.9 and 141±16.6 g/l, р=0.003), prothrombin index (76.4±15.2 and 84.9±17.6 %, р=0.003), and left ventricular ejection fraction (47.7±6.1 and 50.7±7.2 %, р=0.02) were lower; and median concentrations of GDF-15 (1.95 [1.3; 2.8] and 1.45 [1.2; 2.0] ng/ml, р=0.03), NT-proBNP (947.3 [517.8; 1598.2], and 491.1 [85.1; 1069.1] pg/ml, р=0.006), and hs-CRP (14.1 [8.15; 36.75] and 7.8 [4.4; 16.2] mg/l, р=0.01) were higher. The presence of OD was associated with development of CVC, including urgent endpoints in the long-term and also increased the probability of fatal outcome within 6 months after discharge from the hospital. To predict the risk of CVC in patients with ACS and OD, two models with high prognostic values (AUC>0.9) were proposed. In the long-term, the value of NT-proBNP (cut-off point >524.5 pg/ml) was a statistically significant predictor for development of endpoints with a high predictive value (AUC>0.8).Conclusion The features of the clinical course of ACS in patients with OD indicate the importance of isolating such patients into a separate group. Additional use of the developed models, along with a standard risk assessment by the GRACE scale, will allow individualized management of patients with ACS and OD during the hospital and long-term (6 months) periods.
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