[Particularities of arterial stiffness dynamics on the background of breast cancer chemotherapy].

BACKGROUND: Modern breast cancer chemotherapy regimens (BC) consider individual patient parameters and ranges of cardiotoxic doses. However, clinicians often record clinical and laboratory-instrumental signs of cardio- and vasculotoxicity in patients, which emphasizes the high importance of searching for markers of early toxic response. AIM: To study the characteristics of the response of arterial stiffness on the background of anthracycline-containing chemotherapy to determine potential markers of vasculotoxicity in BC patients. MATERIALS AND METHODS: 20 women with a BC were included. The patients received 4 cycles of chemotherapy in the doxorubicin + cyclophosphane (AC) regimen with an interval of 2-3 weeks, then they were injected with paclitaxel weekly for 12 injections, or docetaxel once every 3 weeks. All patients underwent TTE, arterial stiffness determination by the "gold standard" method and using volumetric sphygmography before the start of treatment, after the completion of the anthracycline component and after the end of taxanes. RESULTS: The average age of the patients was 45.5±5.31 years. After completing the course of anthracyclines, there was a significant increase in heart rate (from 65.6±9.3 to 73.3±10.1 beats/min.), a decrease in SBP (from 122.6±9.9 to 116.5±12.3 mmHg) and DBP (from 78.9±8.5 to 76.2±8.6 mmHg), a decrease in carotid femoral pulse wave velocity (cfPWV) (from 9.32±1.41 to 7.85±1.57 m/s), CAVI index on the left (from 6.78±0.81 to 6.5±0.88), the velocity of the cardio-ankle pulse wave on the right and left (from 6.7±0.6 to 6.5±0.7 m/s; from 7.0±0.6 to 6.3±0.8 m/sc, respectively). After the completion of the taxane, there was a tendency to increase these indicators, however, they remained significantly lower compared to the values before the start of treatment. CONCLUSION: A comparative analysis of arterial stiffness indicators at different stages of chemotherapy showed a more pronounced reaction of cfPWV, CAVI, cardio-ankle pulse wave to the administration of anthracyclines, which presumably may be associated with concomitant hemodynamic restructuring.

[Subclinical markers of liver damage in patients with arterial hypertension and obesity].

AIM: To investigate the possibility of preclinical detection of liver damage in patients with hypertension and obesity. MATERIALS AND METHODS: The study included 168 patients with hypertension aged 30 to 60 years. All patients underwent general clinical and laboratory-instrumental examination, including ultrasound of the abdominal organs with Doppler assessment of blood flow and determination of markers such as ALT, AST, TG, lipid profile indicators at inclusion, after a month, three months and nine months. RESULTS: Depending on the presence of obesity, all patients with hypertension were divided into two groups. Obese patients had a statistically significant increase in office blood pressure, FSI, the ratio of TG and LDL-C to HDL-C, a more significant higher average levels of glucose, TG and ALT levels, as well as impaired hepatic blood flow according to ultrasound. CONCLUSION: Indicators of FSI, ALT/AST ratio, ratio of TG and LDL-С to HDL-C as well as assessment of hepatic blood flow indicators can be used for early diagnosis of nonalcoholic fatty liver disease, as they predict liver steatosis.

[Arterial stiffness in patients with acute cerebrovascular accident]. / Zhestkost' arterial'noi stenki u bol'nykh s ishemicheskimi narusheniyami mozgovogo krovoobrashcheniya.

OBJECTIVE: To identify correlations between parameters of vascular stiffness and characteristics of the clinical course of acute cerebrovascular accident (stroke). MATERIAL AND METHODS: Two hundred and seven patients with stroke (mean age 64.6±10.9 years; 115 men) treated in a neurological department of «Municipal Clinical Hospital Br. Bakhrushins of the Health Care Department of Moscow¼ were studied. All patients underwent a standard neurological and clinical-instrumental examination, including assessment of arterial stiffness by sphygmography. Analysis of the data was carried out depending on the severity of stroke and the pathogenetic subtype of stroke. RESULTS: The pathological value of the CAVI was detected in all patients with cerebral infarction. The highest values were noted in patients with an atherothrombotic subtype of stroke. A positive correlation was revealed between CAVI and the age of patients (r=0.57; p=0.0001), left ventricular myocardial mass index (r=0.55; p=0.0001), NIHSS score (r=0.6; p=0.0001) The inverse correlation was found between CAVI and glomerular filtration rate (r= -0.4; p=0.02). CONCLUSIONS: The factors determining the severity of stroke are age, arterial hypertension, type 2 diabetes, carotid atherosclerosis, left ventricular remodeling, and decreased glomerular filtration rate. The CAV and the toe-brachial index, rather than the ankle-brachial index, significantly distinguished patients with ischemic stroke from patients with transient ischemic attack.

[Obesity in metabolic syndrome, as well as kidney dysfunction]. / Ozhirenie pri metabolicheskom sindrome i pochechnaia disfunktsiia.

The presence of metabolic syndrome (MS) in a patient allows him to be assigned to a group at high risk for atherosclerosis, cardiovascular events, coronary heart disease, and type 2 diabetes mellitus. In addition, MS negatively affects not only the heart and vessels, but also kidney function, which leads to chronic kidney disease (CKD). MS is pathogenetically associated with CKD and is an independent prognostic factor of the development of the latter, namely, the involvement of the kidney frequently determines prognosis and quality of life in these patients. The paper gives a modern view on the concept of MS and CKD and considers its main diagnostic criteria, etiology, and pathogenesis. The study of the relationships between MS and CKD may suggest that the high prevalence of kidney dysfunction in the general population is largely determined by metabolic nephropathies, including obesity-related nephropathy. The identification of risk factors and poor prognostic markers in this category of patients seems to be extremely important for the early diagnosis of the disease and their timely elimination is one of the main approaches to the comprehensive prevention of CKD in these patients.