[Cardiohemodynamic Changes and Cardiac Arrhythmias After Coronavirus Infection].

Aim      To study changes in cardiohemodynamic alterations of the myocardium and heart rhythm disorders at 3 and 6 months following the coronavirus infection.Material and methods   EchoCG, ECG Holter monitoring, and Doppler ultrasonography of hepatolienal blood vessels were performed for 77 patients (mean age, 35.9 years) at 3 and 6 months after coronavirus infection. The patients were divided into the following groups: group 1, with injury of the upper respiratory tract; group 2, with bilateral pneumonia (CТ1, 2), and group 3, with severe pneumonia (CТ3, 4). Statistical analysis was performed with a SPSS Statistics Version 25.0 software package.Results At 6 months after the disease onset, the patients noted an improvement of their general condition. In patients with moderate pneumonia, early peak diastolic velocity (p=0.09), right ventricular isovolumic diastolic time (р=0.09), and pulmonary artery systolic pressure (р=0.005) where decreased, while tricuspid annular peak systolic velocity was, in contrast, increased (р=0.042). Both segmental systolic velocity of the LV mid-inferior segment (р=0.006) and the mitral annular Em / Am ratio were decreased. In patients with severe disease at 6 months, right atrial indexed volume was reduced (р=0.036), tricuspid annular Em / Am was decreased (р=0.046), portal and splenic vein flow velocities were decreased, and inferior vena cava diameter was reduced. Late diastolic transmitral flow velocity was increased (р=0.027), and LV basal inferolateral segmental systolic velocity was decreased (р=0.046). In all groups, the number of patients with heart rhythm disorders was decreased, and parasympathetic autonomic influences prevailed.Conclusion      At 6 months after coronavirus infection, practically all patients noted improvement of their general condition; incidence rate of arrhythmia and cases of pericardial effusion were decreased; and autonomic nervous system activity recovered. In patients with moderate and severe disease, morpho-functional parameters of the right heart and the hepatolienal blood flow were normalized, however, occult disorders of LV diastolic function remained, and LV segmental systolic velocity was reduced.

[The Association of Gene Polymorphisms of Matrix Metalloproteinases (-9, -12 and -20) and Collagen Type I Degradation Products With the Remodeling of the Left Ventricle in Patients With Acute Myocardial Infarction].

OBJECTIVE: to study associations of polymorphism of the genes MMP9 rs17576, MMP12 rs2276109, MMP20 rs2245803, COL1A1 rs1800012, COL1A1 rs1107946 with remodeling of the left ventricle in patients with acute myocardial infarction. MATERIALS AND METHODS: We examined 84 patients with myocardial infarction (MI). Type of early postinfarction left ventricular (LV) remodeling was determined by echocardiography on the third day of the disease. Concentration of matrix metalloproteinases (MMP) was measured by enzyme immunoassay using commercial kits; content of C-terminal telopeptide of collagen type I degradation products (ICTP) was measured by chemiluminescent immunoassay. Polymorphisms of the genes MMP9 rs17576, MMP12 rs2276109, MMP20 rs2245803, COL1A1 rs1800012 and rs1107946 were identified by PCR using primers. Statistical analysis was performed using the language R (http://cran.r-project.org) version 3.4.0, and additional packages (stats, forest plot, ROC). RESULTS: Significant association was found between A allele of MMP 20 rs2245803 and dilation type of LV remodeling (odds ratio [OR] 2.82, 95% confidence interval [CI] 1.186-6.695). The prognostic model containing systolic pulmonary artery pressure (SE=0.339) and G allele of MMP9 rs17576 (SE=1.097) was associated with LV dilation. The model containing C allele of the MMP20 rs2245803 (SE=-0.279) showed its relationship with LV hypertrophy. Combined carriage of the minor allele G of MMP9 rs17576 and C allele of MMP20 rs2245803 (SE=-2.228) was associated with hypertrophic modification of the LV geometry. CONCLUSION: In this work we revealed association of A allele of MMP20 rs2245803 with formation of dilative type of LV remodeling and established relationship between C allele of MMP20 rs2245803 and the hypertrophic morpho-functional modification of the left ventricle. Carriage of the G allele of MMP9 rs17576, along with other factors, increased the likelihood of LV myocardial hypertrophy. The role of this allele was augmented by cocarrying C allele of the MMP20 rs2245803. Identified gene associations can be used as additional early predictors of LV myocardial remodeling in patients with acute MI.

[Disorders of heart structure and function parameters and hepatolienal blood flow remodeling in patients with virus-induced cirrhosis].

AIM: To study heart structure and function parameters and hepatolienal blood flow in patients with virus-induced cirrhosis (VIC). MATERIALS AND METHODS: 95 patients with VIC (mean age, 38.6; disease duration, 4.5 years) were evaluated. Doppler EchoCG and Doppler ultrasonic examination of hepatolienal vasculature (VIVID E 95 apparatus) were performed. The control group consisted of 19 healthy individuals. Statistical analysis was performed using the Statistica 6.0 software. RESULTS: The study of hepatolienal blood flow showed that the splanchnic artery blood flow velocity was increased by 25%, the hepatic vein blood flow velocity was increased by 13%, and splanchnic arteries and veins were dilated. 24% of VIC patients had moderate pulmonary hypertension associated with a 20% dilatation of inferior vena cava (p=0.007), a 28% increase in hepatic vein blood flow velocity (p=0.0003), and a 13% decrease in portal vein diameter (p=0.001). Four types of left ventricular (LV) geometry were identified: 40% of VIC patients had normal geometry; 17% of patients had concentric hypertrophy; 23% of patients had concentric remodeling; and 19% had eccentric hypertrophy. Features of hepatolienal blood flow were related with the LV geometry type. LV diastolic filling was impaired in 44.3% and RV diastolic filling - in 33% of patients. In patients with VIC, the disturbed diastolic function was associated with 25% reduced hepatic vein blood flow velocity (p=0.05) whereas development of RV diastolic dysfunction was associated with 6% reduced portal vein diameter (p=0.04), 17% dilated portal vein (p=0.006), and 25% decreased portal vein blood flow velocity (p=0.001). Anti-viral therapy resulted in improvement of some hepatolienal blood flow parameters. Parameters of splanchnic circulation were correlated with cardiodynamic parameters with correlation coefficients from 0.51 to 0.95 at p.

[The dynamics of indicators of selenium, glutathione and anti-oxidant defense of blood in patients with anemic cardiomyopathy against the background of treatment with preparations of iron and selenium].

The study was carried out on samplings of 46 patients with asiderotic anemia of severe degree and complicated by cardiomyopathy and 16 healthy persons. The content of selenium was analyzed using I.I. Nazarenko technique of detection of mass concentration GOST 19413-89. The content of glutathione in blood was detected using the technique based on capacity of acid-soluble thiol aggregations at interaction with 5,5-dithio-bis(2-nitrobenzene) acid to form a colored compound--thio-2-nitrobenzene acid. The principle of technique of measurement of activity of glutathione peroxidase of blood ervthrocvtes is in capacity of peroxide hydrogen to form a resistant colored complex with molybdenum salts. The technique of detection of activity of glutathione peroxidase is based on its capacity to catalyze reaction of interaction of reduced glutathione with tretbutyl hydro peroxide and on capacity of glutathione reductase to catalyze NADFN-dependent reduction of oxidated glutathione. The principle of technique of detection of activity of superoxiddismutase is based on capacity of enzyme to suppress reaction of reduction of nitro blue tetrazolium with superoxide anion-radical generated in vitro in the system xanthine-xanthineoxidase. The study established decreasing of content of selenium in blood of patients with anemic cardiomyopathy up to 1.8 times as compared with control group. The content of total glutathione in blood of patients was decreased up to 17.7% at the expense of decreasing of level of reduced glutathione up to 18.5%. The study established decreasing of activity of catalase in erythrocytes up to 1.3 times, glutathione peroxidase up to 2.5 times, glutathione reductase up to 2.1 times and superoxiddismutase up to 1.5 times as compared with control group. After the preparations of iron and selenium ware applied to patients with anemic cardiomyopathy the increase of level of selenium in blood up to 80.4% was established. The level of total glutathione increased up to 54.5% at the expense of increase of content of reduced glutathione up to 59.5%. The activity of blood erythrocytes in patients against the background of treatment increased up to 9.1%, the activity of glutathione peroxidase, glutathione reductase and superoxiddismutase of blood erythrocytes increased up to 3, 2.1 and 2 times respectively.

[Features of structural and functional changes of the myocardium in patients with chronic viral hepatitis].

OBJECTIVE: Our aim was to evaluate the characteristics of structural and functional changes of the heart in patients with chronic viral hepatitis. METHODS: The study included 123 patients - 17 patients with aviraemnia after antiviral therapy (group 1), 38 patients with laboratory inactive hepatitis (group 2), 68 patients with biochemical active hepatitis (group 3). All patients had standard echocardiography, Doppler sonography and tissue Doppler echocardiography. RESULTS: Patients with chronic viral hepatitis were revealed to develop changes in the geometry of the left ventricle (increase in the wall thickness). Patients with active hepatitis had increase in the left atrium, the right ventricle and indexed left ventricular mass of the heart. Significant morphological changes were not confirmed statistically in patients after "therapy". Pulmonary hypertension was revealed in 19% of cases, mitral valve prolapse was confirmed in 48%, with the detection rates being not dependent on hepatitis activity. Abnormal left ventricular remodeling was identified in 45% of patients, in patients with active hepatitis more frequently. Compliance dysfunction of both right and left ventricles was detected, it depends on the activity of the inflammatory process in the liver. This disorder partially persists after antiviral treatment. CONCLUSION: Specifics of the structural and functional changes of the heart in patients with chronic viral hepatitis is the development of left ventricular hypertrophy, and in the presence of laboratory activity hepatitis - relative dilatation of the right heart and ventricular diastolic dysfunction of the heart. Carrying out specific antiviral therapy has a beneficial effect on cardiac hemodynamics parameters. Method of tissue Doppler echocardiography was efficient in evaluation of early disorders of diastolic function in patients with chronic viral hepatitis.

[TNF-α, IL-10, and eNOS gene polymorphisms in patients with influenza A/H1N1 complicated by pneumonia].

AIM: To study the specific features of cytokine gene polymorphisms (such as TNF G308A, IL10 C592A, IL10 C819T, IL10 G1082A) and vascular tone regulatory gene polymorphism (eNOS C786T) in patients with influenza A/H1N1 complicated by pneumonia. SUBJECTS AND METHODS: Patients treated for pneumonia in the presence of influenza A/H1N1, divided into 3 groups: 1) 37 patients with severe pneumonia; 2) 74 with mild pneumonia; and 3) 68 healthy individuals, were examined. Molecular genetic testing was made using a polymerase chain reaction technique. Serum TNFalpha, IL-10 and s-ICAM-1 concentrations were measured by enzyme immunoassay. RESULTS: As compared to the control group, the patients with influenza-related pneumonia were more frequently homozygous for the G allele of the TNF 308 G/A polymorphism. The IL-10 G allele (1082 G/A) was considerably prevalent as homozygous carriage and the IL-10 G allele (592 G/A) was as a homozygous type to a greater extent. An abnormal zygote of the eNOS T/T (786 C/T) polymorphism was found to be prevalent among the patients with influenza-related pneumonia; on the contrary, there were mainly heterozygous C/T carriers in the control group. In the C/T genotype group, the level of soluble intercellular adhesion molecule 1 (sICAM-1) was lower than in other polymorphic variants (786 C/T). CONCLUSION; The study of the patients' genetic status in influenza A/H1N1 will be able to evaluate the severity of the disease and to predict possible complications.

[Psychosomatic relationships in postmenopausal women].

AIM: To study the prevalence of depressive and anxiety disorders in postmenopausal disorders and their relationship with the manifestations of climacteric syndrome. SUBJECTS AND METHODS: The study enrolled 203 women, including 142 patients with surgical menopause and 61 with natural menopause. Psychometric testing using the Hamilton depression rating scale and the Spielberger test anxiety inventory, and 24-hour blood pressure (BP) monitoring with assessment of the 24-hour BP profile were performed. RESULTS: Depressive disorders (DD) were found in 82.5% of the postmenopausal women; all the patients had higher levels of situational and personality anxiety. The women with natural menopause developed moderate and severe DD and those who had undergone ovariectomy had mild DD. The prevalence of DD was higher in patients with essential hypertension (EH) than in those with normal BP (88.6 and 78.3%, respectively; p < 0.01); DD was more marked in these patients. The severity of DD also depended on the type of diurnal BP variations; the highest level of depression was recorded in patients without nocturnal BP reduction. The same group was found to have the highest level of personality and situational anxiety. CONCLUSION: The magnitude of DD depends on the type of menopause, the presence of EH, and the specific features of diurnal BP variations. The findings necessitate a detail examination of postmenopausal women for identification of affective disorders and their further correction.

[The role of imbalance of fatty acids in formation of endothelium dysfunction in women in menopause].

The article deals with the results of examination of 203 women in condition of natural (61 female patients) and surgical (142 female patients) post menopause. The rate of occurrence of impairment of functional state of endothelium made up to 67% (136 of examined female patients). The nitroxide-producing function of endothelium was decreased in all female patients, most of all in women with surgical menopause. The patients with endothelium dysfunction symptoms had a significant decrease of amount of omega-3 polyunsaturated fatty and arachidonic acids in erythrocytes' membranes and an increase of amount of gamma-linolenic and dihomo-gamma-linolenic acids. The multidirectional correlation dependences between indicators of endothelium function and amount of various fatty acids in erythrocytes' membranes was established.

[Peculiarities of clinical and X-ray picture of pneumonia in patients with influenza A (H1N1)].

A distinctive feature of pneumonia in influenza A (H1N1) is interstitial infiltration of lung tissues and high frequency of pulmonary lesions leading to acute lung injury/acute respiratory distress syndrome in half of the patients. Severe clinical course of the disease and complications (pleuritis, abscess, pulmonary thromboembolism) diagnosed by X-ray were recorded in 29% of the patients. The final X-ray examination revealed normalization of the lung structure only in 15.5% of the cases mostly the patients with mild pneumonia. 15.5% of them developed post-pneumonic changes in the form of diffuse pneumosclerosis, pleural adhesions, and dry cavities in the lung tissue. Pulmonary CT is believed to be the most informative method for diagnostics of pneumonia and its complications during influenza A (H1N1).

[The alterations in fatty acids content of membranes of erythrocytes and insulin resistance syndrome under primary gout].

The content of fatty acids of lipids of membranes of erythrocytes in patients with primary gout depending on presence of insulin resistance syndrome. The alterations of content of fatty acids in patients with gout and insulin resistance syndrome are characterized by increase of content of saturated fatty acids and decrease of unsaturated fatty acids. At that, in the pool of unsaturated fatty acids the content of monounsaturated acids is increased and the content of polyunsaturated acids is decreased. In the pool of polyunsaturated fatty acids the increase of content of gamma-linolenic and digomo-gamma-linolenic acids and significant decrease of arachidonic and docosapentaenic acids are noted. The shifts mentioned above can play a certain role in the formation of insulin resistance syndrome in patients with primary gout.

[Clinical significance of insulin resistance syndrome in development of endothelial dysfunction in patients with primary gout].

Endothelial function has been studied in 175 males with primary gout. It has been established that incidence of endothelial dysfunction in patients with primary gout was associated with the clinical course and was marked most of all in patients who had a chronic gout. The correlations found between the parameters of endothelial dysfunction and impaired carbohydrate metabolism suggest close link and coordination between the above processes which contribute greatly to development and progress of atherosclerosis in such patients.

[Clinical significance of abnormal fatty acid composition in red cell membranes and carbohydrate metabolism in patients with primary gout and arterial hypertension].

We studied changes in fatty acid composition in the lipid fraction of red cell membranes and carbohydrate metabolism in patients presenting with primary gout with and without arterial hypertension. They were characterized by an increased content of saturated and decreased level of unsaturated fatty acids. The latter contained more monoenoic and significantly less polyenoic acids compared with the normal values. The pool of polyunsaturated fatty acids (PUFA) contained a small amount of w-3 PUFA whereas that of w-6 PUFA varied oppositely, i.e. the relative amount of gamma-linolenic acid was elevated and that of dihomo-gamma-linolenic acid significantly decreased compared with healthy men. The fractional composition of higher fatty acids in patients with gout depended on AH and peculiarities of carbohydrate metabolism. The data obtained suggest the contribution of disturbances in fatty acid metabolism and insulin resistance to the development of AH syndrome in patients with primary gout.

[The aggregation capacity of thrombocytes, lymphocytic thrombocytic adhesion and content of D-dimers in patients with acute acetic acid intoxication].

In patients with acute acetic acid intoxication the diminution of degree and velocity of thrombocytes aggregation against the background of their amount attenuation in peripheral blood is established. The significant augmentation of amount of lymphocytic thrombocytic complexes and -dimers concentration in blood is revealed. The most marked alterations are determined on first and second days in patients with severe degree of intoxication.

[Prognostic value of platelet aggreagation capacity and lymphocyte-platelet adhesion in patients suffering acute poisoning with acetic acid].

The patients experiencing severe acute poisoning with acetic acid were divided into 2 groups with and without exotoxic shock to study platelet aggregation capacity and lymphocyte-platelet adhesion. The data obtained were used to develop exotoxic shock probability coefficient for patients with acute poisoning.

[Fatty acid composition of red blood cells in patients with iron-deficiency anemia in relation to the presence of cardiomyopathy].

The purpose of the investigation was to study the fractional composition of fatty acids (FA) of red blood cell membrane lipids in 51 patients with chronic posthemorrhagic iron-deficiency anemia (IDA) of first-third grade in relation to the presence or absence of anemic cardiomyopathy and in 15 healthy individuals. In IDA patients without cardiomyopathy, there was an increase in the sum of saturated FA at the expense of a palmitic acid fraction and a decrease in the sum of unsaturated FA at the expense of arachidonate as compared with these in healthy individuals. In patients with cardiomyopathy-complicated IDA, fatty acid impairments were greater pronounced: the concentrations of myristic and pentadecanoic FAs raised and the relative content of omega 3-polyunsaturated FA reduced.

[Vegetative disturbances and dysfunction of the endothelium in patients with postinfarction cardiosclerosis].

We assessed vegetative status and parameters of endothelial function in 53 patients with postinfarction cardiosclerosis. Balance of autonomic nervous system was characterized by the Kerdo index and heart rate variability at Holter monitoring, endothelial function - by quantity of desquamated endotheliocytes in blood and vasomotor function in test with reactive hyperemia. Patients with higher class of angina and sympatheticotonia had pronounced disturbance of endothelial function appearing as increase in number of circulating desquamated endotheliocytes and diminished sensitivity of brachial artery endothelium to shear stress.

[Lymphocyte-platelet adhesion and the content of D-dimers in patients with acute acetic acid poisoning].

Disseminated intravascular coagulation is a menacing complication due to acute acetic acid poisoning. However, many key mechanisms of this condition remain to be not clearly understood. The authors have studied lymphocyte-platelet adhesion and D-dimer concentrations in the blood. The most pronounced changes were observed in patients with severe poisoning in the first 24 hours, which were characterized by a significant increase in the number of lymphocyte-platelet complexes and D-dimer concentrations in the blood. A statistically significant correlation was established between the parameters being studied.

[Changes in fatty acids content in blood red cells of patients with iron-deficiency anemia treated with sorbifer and mildronate].

AIM: To study fractional composition of red cell membrane (RCM) lipids in patients with severe iron-deficiency anemia (IDA) complicated by myocardiodystrophy prior to treatment and after 1-month combined treatment with sorbifer and mildronate. MATERIAL AND METHODS: Fatty acid composition of RCM lipids was studied in 12 patients with severe chronic posthemorrhagic IDA complicated by myocardiodystrophy and in 15 healthy subjects. Extraction of lipids from blood red cells and methylation of fatty acids were performed according to K.M. Sinyak et al. (1976). Relative content of fatty acids was determined at chromatography. RESULTS: The study detected increased content of saturated fatty acids, especially palmitic and decreased content of unsaturated fatty acids especially fraction of omega6-polyunsaturated fatty acids: arachidonic and gamma-linolenic. CONCLUSION: Sorbifer in combination with mildronate improved fatty acid composition of blood red cells in patients with iron-deficiency anemia.

[Structural-functional parameters of the myocardium in patients with chronic iron deficiency anemia].

Aim of the study was investigation of structural-functional parameters of the myocardium and assessment of segmental diastolic left ventricular function with myocardial tissue dopplerography in 56 patients with iron deficiency anemia (IDA). We studied parameters of structure of the myocardium, its systolodiastolic function, as well as velocities of early (Ve) and late (Va) diastolic waves, Ve/Va ratio, isovolumic relaxation times in 15 segments of the left ventricle. We revealed changes of myocardial structure appearing as LV hypertrophy, dilation of chambers of the heart, as well as disturbances of global and segmental diastolic LV function. Most pronounced changes were observed in patients with IDA of II and III degree of severity. The method of myocardial tissue Doppler echocardiography allows to diagnose LV diastolic dysfunction at early stages and can be used for detection of preclinical stage of myocardial dystrophy.