[Immune checkpoint inhibitors related cardiovascular toxicity: 3­mounth follow-up].

AIM: To analyze the condition of the cardiovascular system in oncological patients receiving immune antitumor therapy with immune checkpoint inhibitors (CPIs) based on results of laboratory and instrumental examinations during a 3-month follow-up. MATERIAL AND METHODS: This multicenter prospective observational study included 49 patients (25 men and 24 women aged 65.6±8.7 and 64.3±9.6 years, respectively). A laboratory screening (C-reactive proteins, troponin I, N-terminal pro-brain natriuretic peptide), EchoCG, and carotid ultrasound were performed for all patients. 27 patients were followed up at 3 months after the antitumor therapy initiation. Statistical analysis was performed with the StatPlus 8.0.3 software. RESULTS: Incidence of cardiovascular complications was 16.3 %. The following significant changes in EchoCG parameters were observed: LV EF; (p=0.017), increased LV end-systolic volume (ESV) (р=0.023), and increased LV index of myocardial performance (LIMP; р=0.016). The degree of changes in ESV (ΔESV) depended on a history of chronic heart failure (р=0.03), whereas the degree of changes in EF (ΔEF) depended on the patient's age at the initiation of antitumor therapy (р=0.006). Ultrasound showed an increase in maximum carotid stenosis (р=0.018). CONCLUSION: The study showed a high incidence of newly developed cardiovascular complications associated with the CPI treatment as well as the presence of changes in EchoCG parameters and data of carotid ultrasound.

[The metabolic and protein markers of dysfunction of mitochondria in patients with cardio-vascular diseases.]

The article deals with study concerning content of cytochrome C (CytC) and protein PGC1α (1alpha-co-activator of gammareceptor, activating proliferation of peroxisomes) in blood of patients with pathology of left ventricular outflow tract conjointly with low-molecular metabolites characterizing dysfunction of mitochondria and endothelium. The samples of blood plasma were analyzed taking from healthy persons (n=34), patients with aortic aneurysm (n=69), aortic stenosis (n=25) and without pathology of aorta (n=16). In the group of patients with disturbed blood circulation increasing of level of metabolic markers of dysfunction of mitochondria (lactate, ratio lactate/pyruvate) and endothelium (asymmetric dimethylarginine, total homocysteine) was established. The occurrences of cells death were detected according to increasing of level of CytC in 17% 0f patients. The evaluation of level of intermediates of energy metabolism and simultaneously of protein PGC1α permits detecting at least three degrees of dysfunction of mitochondria depending on stage of its progression: 1) without lactoacidemia but with detection of PGC1α in blood, 2) with lactoacidemia up to 2.2 mM and increased level of PGC1α in blood (more than 61 ng/l), 3) with lactoacidemia and loss of cells capacity to transfer this protein in blood. The application of common metabolic indicators of disorder of function of mitochondria supplemented by determination of level of CytC and PGC1α in blood permits evaluating more comprehensively development of dysfunction of mitochondria in patients with disorders of blood circulation of various genesis.