Acute coronary syndrome in patients with cancer: features of the course and the possibility of predicting hospital and long-term (6 months) periods using GDF-15, NT-proBNP, hs-CRP biomarkers.

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.

[NGAL as a marker for some extrarenal complications in acute coronary syndrome].

AIM: To study the role of neutrophil gelatinase-associated lipocalin (NGAL) as a marker for extrarenal complications in patients with acute coronary syndrome (ACS). MATERIALS AND METHODS: For 110 patients with ACS on days 1-3 of hospitalization, concentrations of NGAL, serum (s-NGAL) and urinary (u-NGAL) NGAL, and N-terminal fragment of pro-B natriuretic peptide (NT-proBNP) were measured, and transthoracic echocardiography was performed. Incidence of cardiovascular complications was determined during the stay in the hospital; hemodynamic parameters (systolic and diastolic blood pressure, heart rate) were measured on admission. RESULTS: Concentrations of u-NGAL were significantly higher in acute heart failure (AHF) [10.4 (2.7; 51.2) ng/ml] than in absence of AHF [3.8 (1.7; 8.6) ng/ml, р=0.03]. Concentrations of u-NGAL and NT-proBNP were higher in patients with [10.17 (4.87; 51.2 ng/ml) and 744.6 (368.7; 2034.9) pg/ml] than without signs of pulmonary hypertension [3.41 (1.72; 7.39) ng/ml; р=0.004 and 431.8 (99.6; 780.1) pg/ml; р=0.012]. The u-NGAL values >9.96 ng / ml were shown to be predictive for AHF, and values >5.81 ng/ml - for pulmonary hypertension. Levels of u-NGAL significantly, directly correlated with values of end-diastolic dimensions and end-systolic dimensions and inversely correlated with values of end-diastolic volume and ejection fraction; levels of s-NGAL positively correlated with cardiac output and heart index. Levels of u-NGAL significantly, directly correlated with NT-proBNP values. CONCLUSION: Urinary levels of NGAL were significantly higher in ACS patients with than without AHF or signs of pulmonary hypertension. NGAL values >9.96 ng/ml were associated with an increased probability of AHF during stay in the hospital, and NGAL values >5.81 ng/ml - with a higher incidence of ACS patients with signs of pulmonary hypertension. In ACS, direct correlations of blood and urinary levels of NGAL with some echocardiographic parameters reflecting the systolic function and the LV dimensions and geometry were identified. Levels of u-NGAL were found to be positively correlated with blood levels NT-proBNP. NGAL may be used as a supplementary marker not only for acute kidney injury and chronic kidney disease but also for severity of cardiovascular conditions and heart remodeling in patients after exacerbation of ischemic heart disease.

[THE CONTENT OF ELECTROLYTES IN DIFFERENT BIOLOGICAL MEDIUMS UNDER ACUTE CORONARY SYNDROME].

The sampling of study included 172 patients with ischemic heart disease: 146 with acute coronary syndrome, including myocardial infarction (88 patients) and unstable stenocardia (58 patients); 26 patients with stable stenocardia functional class II-III. At the 1-3 day of hospitalization blood was taken of cubital vein. The mixed unstimulated saliva was selected. In both of them conte of calcium, sodium and potassium was tested (mmol/l). Under acute coronary syndrome, in blood content of calcium was 2. sodium--139.6 and potassium--4.5 i.e. the content was lower than in case of stable stenocardia (2.4; 139.8; 4.7 correspondingl In saliva under acute coronary syndrome higher content of calcium (1.05) and potassium (34.66) and lower content of sodiu (25.42) was established in comparison with stable stenocardia (0.81; 33.7; 28.08 correspondingly). The distribution coefficien (blood/saliva) of calcium, sodium and potassium were higher under myocardium infarction than under unstable stenocardia at uncomplicated course of acute coronary syndrome.

[BIOMARKER CONTENT AND ROLE IN HOSPITAL PERIOD OF ACUTE CORONARY SYNDROME].

The study involved 172 patients with coronary heart diseases (CHD) of whom 146 presented with acute coronary syndrome (ACS) including 88 with myocardial infarction (MI), 58 with unstable angina (UA) and 26 with FC II-III stable angina (SA). Interleukin (IL-6, 10), natriuretic peptide (NT-proBNP) levels in blood and 6-hydroxymelatonin level in urine were determined on days 1-3 after hospitalization. These daytime values in ACS were higher than in SA whereas the melatonin level at night was higher in SA than in ACS. Patients with ACS in the absence of ST elevation had higher IL and melatonin (night) levels but lower NT-proBNP and melatonin daytime levels than patients with ACS and elevated ST segment. IL-6 , 10 and melatonin (night and daytime) levels in MI were lower and NT-proBNP level higher than in UA. IL-6, 10 and melatonin daytime levels increased in uncomplicated ACS while melatonin (night) and NT-proBNP levels were higher in complicated ACS.

[The acoustic indicator of saliva under stress].

The situation of stress affects various organs and systems that results in development of functional disorders and/or somatic diseases. As a result, different noninvasive, including salivary, techniques of diagnostic of stress conditions are in the process of development. The dynamics of acoustic indicator of saliva is studied during the period of passing the exams. The relationship of indicator with levels of potassium, sodium, glucose and protein of saliva was analyzed. The sampling consisted of 102 students of 5 and 6 academic years of medical university. To detect the acoustic indicator of saliva acoustic analyzer AKBa-01- "BIOM" was applied. The level of potassium and sodium in saliva was detected using method of flame photometry. The level of glucose in saliva was detected by glucose oxydase technique using analyzer "EXAN-G". The protein in saliva was detected by biuretic technique. The correlation between acoustic indicator of saliva and analyzed indicators of saliva was established.

[The role of necrosis and inflammation markers in prognostication of acute coronary heart disease].

With the incessant growth of cardiovascular mortality, mainly due to myocardial infarction makes prognostication of acute coronary syndrome a principal goal of clinical practice. Biochemical markers (creatine phosphokinase-MB and troponins) are extensively used for diagnostics and prediction of acute coronary heart syndrome (ACS). However, drawbacks of necrosis markers necessitate the search for new ones identifiable at early stages of atherosclerotic plaque instability. Lately atherosclerosis has been considered as an immuno-inflammatory reaction involving cytokines, chemokines, C-reactive protein, natriuretic peptide, and tumor necrosis factor-alpha. Their prognostic value has been demonstrated in many clinical studies, but these data are contradictory and need to be confirmed.

[Characteristic of fatty acid metabolism in patients with CHD with affected and unaffected coronary arteries].

Cardiac syndrome X (CSX) is coronary heart disease (CHD) in the absence of or with minimal atherosclerotic changes in coronary arteries. This condition has a more favourable prognosis than classical angina but is associated with relatively poor quality of life. None of the many hypothesis of angina pathogenesis in CSX patients explains it exhaustively. We undertook to consider minor atherosclerotic changes in patients with CSX based on modem concepts of atherogenesis implying its relation to the level and metabolism of lipid fatty acids. Comparative analysis of their composition in blood and saliva provided material for the characteristic of CHD patients with intact and affected coronary arteries.