[Features of the course of non-ST elevation myocardial infarction in patients with a history of COVID-19].

Aim      To study the clinical course of non-ST segment elevation myocardial infarction (NSTEMI) in hospitalized patients after COVID-19 and to evaluate the effect of baseline characteristics of patients on the risk of complications.Material and methods  The study included 209 patients with NSTEMI; 104 of them had had COVID-19. The course of myocardial infarction (MI) was analyzed at the hospital stage, including evaluation of the incidence rate of complications (fatal outcome, recurrent MI, life-threatening arrhythmias and conduction disorders, pulmonary edema, cardiogenic shock, ischemic stroke, gastrointestinal bleeding).Results Mean age of patients after COVID-19 was 61.8±12.2 years vs. 69.0±13.0 in the comparison group (p<0.0001). The groups were comparable by risk factors, clinical data, and severity of coronary damage. Among those who have had СOVID-19, there were fewer patients of the GRACE high risk group (55.8 % vs. 74.3 %; p<0.05). Convalescent COVID-19 patients had higher levels of C-reactive protein and troponin I (p<0.05). The groups did not significantly differ in the incidence of unfavorable NSTEMI course (p>0.05). However, effects of individual factors (postinfarction cardiosclerosis, atrial fibrillation, decreased SpO2, red blood cell concentration, increased plasma glucose) on the risk of complications were significantly greater for patients after COVID-19 than for the control group (p<0.05).Conclusion      Patients with NSTEMI, despite differences in clinical history and laboratory data, are characterized by a similar risk of death at the hospital stage, regardless of the past COVID-19. Despite the absence of statistically significant differences in the incidence of in-hospital complications, in general, post-COVID-19 patients showed a higher risk of complicated course of NSTEMI compared to patients who had not have COVID-19. In addition, for this category of patients, new factors were identified that previously did not exert a clinically significant effect on the incidence of complications: female gender, concentration of IgG to SARS-CoV-2 ≥200.0 U/l, concentration of С-reactive protein ≥40.0 mg/l, total protein <65 g/l. These results can be used for additional stratification of risk for cardiovascular complications in patients with MI and also for development of individual protocols for evaluation and management of NSTEMI patients with a history of COVID-19.

[Efficacy of levosimendan vs dopamine in patients with resistant cardiac failure].

AIM: Effects of levosimendan treatment compared to dopamine treatment on a clinical course, central hemodynamics and prognosis in patients with resistant cardiac failure (RCF). MATERIAL AND METHODS: A total of 30 RCF patients (16 females and 14 males aged 50-80 years) were divided into two groups. Patients of group 1 received inotropic drug levosimendan intravenously in the initial dose 12-24 mcg/kgfor 10 min with subsequent 24-hour infusion in a dose 0.1 mcg/kg/min. Patients of group 2 received dopamine intravenously for 24 hours in a mean dose 2.2 mcg/kg/min. The patients were followed up for 6 months. RESULTS: In group 1 cardiac failure regressed earlier than in group 2. Left ventricular performance index after infusion hour 1 increased from 2.9 to 3.3 (kg.m)/m2, in group 2 it decreased from 2.6 to 2.3 (kg.m)/m2; p = 0.028). To infusion hour 24 this index in group 1 was 3.2 (kg.m)/m2, in group 2--2.6 (kg.m)/m2. Cardiac index (CI) in group 1 increased from 23 l/min/m2 at infusion min 1 to 2.7 l/min/ m2 after 10 min of infusion and 29 l/min/m2 after 24 hours, i.e. there was a 26% rise (p = 0.025). In group 2 the CI rise was insignificant--from 2.4 to 2.5 l/min/m2. To the end of levosimendan injection, systemic vascular resistance fell from 1520.9 to 1174.6 dyne.s.cm(-5) (p = 0.031), in group 2 no significant changes were seen. Hospital mortality in group 1 was 1 patient, in group 2--6 patients. CONCLUSION: Inotropic treatment in RCF patients with levosimendan vs dopamine produces earlier regress of cardiacfailure symptoms, better improvement of myocardial contractivity, is associated with a good prognosis.

[Myocardial metastasis of Wilms' tumor as a cause of focal electrocardiographic changes].

Nephroblastoma (Wilms' tumor) is an embryonic tumor, an adenomyosarcoma that is casuistically rarely encountered in adults. It most commonly develops in children aged 1 to 5 years. This type of malignancy does not usually spread to the myocardium. The paper presents a clinical case of Wilms' tumor in an adult female patient with a solitary metastasis in the heart.

[Brain natriuretic peptide in patients with ST segment elevation myocardial infarction. Prognostic significance].

AIM: To study changes in the level of brain natriuretic peptide (BNP) in patients with ST segment elevation myocardial infarction (MI) to assess prognostic value of this marker and validity of its use as a criterion of therapy effects. MATERIAL AND METHODS: The trial enrolled 217 patients (102 males and 15 females, mean age 63.96 +/- 0.73 years) admitted to hospital on MI day 1. Plasmic level of BNP (Nt-proBNP) was measured 1, 7, 21 days, 8 weeks and 6 months after MI. RESULTS: The severity of chronic cardiac failure (CCF) correlated with peptide content in the blood: it was by 46.6% higher in patients with chronic heart failure (CHF) functional class (FC) IV than in those with CHF FC I (p = 0.047), in FC III by 27.5% higher (p = 0.003) and in FCII--by 13.1% (p = 0.485). Initially high levels of BNP correlated with early development of CHF (R2 = 0.9058), with hospital lethality (in the deceased--1040.0 +/- 65.8 fmol/ml, in the survivors--461.4 +/- 26.2 fmol/ml, r = 0.35, p < 0.001) and overall lethality. A more pronounced decrease in the peptide level was seen in patients after 3 week intake of beta-adrenoblocker esmolol than in those who did not take it (by 125.2 vs 74.1 fmol/ml, respectively, p < 0.05). By BNP level, efficacy of perindopril vs captopris was studied (group 1 and group 2, respectively), in patients with ejection fraction under 40%. Initially, BNP levels were elevated and did not differ among the groups. On MI week 8 there was a decrease in the level of BNP by 25.4% (p = 0.004), 19.1% (p = 0.06) in groups 1 and 2, respectively. Six months after MI patients of group 1 had normal levels of BNP (up to 269.6 +/- 18.3 fmol/l). CONCLUSION: Measurements of BNP levels are useful for prediction of poor prognosis in MI patients and evaluating efficacy of the treatment.

[Trimetazidine in complex therapy of acute myocardial infarction at the background of diabetes mellitus type 2.].

Patients (n=52) with acute myocardial infarction (MI) and diabetes mellitus type 2 older than 18 years were distributed within first 24 hours of MI into 2 groups. In patients of group 1 (n=28) standard therapy was supplemented with trimetazidine (70 mg/day) for 30 days, patients of group 2 received only standard therapy. The following parameters were assessed: rate of recurrent MIs, inhospital mortality, dynamics of MB CR, rate of development and progression of heart failure, dynamics of brain natriuretic peptide, parameters of echocardiogram. Mortality in group 1 at the background of thrombolytic therapy (TLT) was 5.9% (n=1) what was significantly lower than in group 2 where this parameter was equal to 35.7% (n=5), p=0.006. A tendency was noted to lowering of rate of recurrent MIs (17.6 and 21.4% in groups 1 and 2, respectively). Analogous parameters did not differ significantly between subgroups of patients not treated with TLT. In group 1 significant 31% lowering of MB CK level was noted in TLT treated patients. In group 2 level of MB CK after 27-30 hours significantly increased by 30.16% compared with initial level (p=0.001). At analysis of analogous parameters in subgroups not treated with TLT significant differences were not obtained. There were no significant differences between groups according to echocardiography data, however ejection fraction in group 1 was 12.6% higher than in group 2 (p>0.05).

[The use of esmolol in patients with myocardial infarction complicated with acute left ventricular failure].

Forty patients with acute Q-wave myocardial infarction and Killip class I-II heart failure were randomized to treatment with esmolol (n=22) or just to standard therapy (n=18) and followed up for 30 days. Esmolol treated patients had significantly lower in-hospital mortality (p<0.02), less frequently had postinfarction angina (p<0.05) and heart failure progression (p<0.01) and demonstrated significant decrease of brain natriuretic peptide level (by 25%, p<0.05). Incidence of heart rhythm disturbances and values of parameters of echocardiogram were similar in both groups.