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1.
Kardiologiia ; 61(6): 41-51, 2021 Jul 01.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-34311687

RESUMO

Aim      To study features of diagnosis and treatment of acute myocardial infarction (AMI) in Russian hospitals, results of the treatment, and early and late outcomes (6 and 12 months after AMI diagnosis); to evaluate the consistence of the treatment with clinical guidelines; and to evaluate patients' compliance with the treatment.Material and methods  The program was designed for 3 years, including 24 months for recruitment of patients to the study. The study will include 10, 000 patients hospitalized with a confirmed diagnosis (I21 according to ICD-10) of ST segment elevation acute myocardial infarction (MI) (STEMI) or non-ST segment elevation MI (NSTEMI) based on criteria of the European Society of Cardiology Guidelines on Forth Universal Definition of Myocardial Infarction (2018). The follow-up period was divided into three stages: observation during the stay in the hospital and at 6 and 12 months following inclusion into the registry. The primary endpoint included cardiac death, nonfatal MI during the hospitalization and after one-year follow-up. Secondary endpoints were 6-months and one-year incidence of repeated MI, heart failure, ischemic stroke, clinically significant hemorrhage, unscheduled revascularization after discharge from the hospital, and the proportion of patients who continue on statins, antiplatelet drugs, and drugs of other groups for 6 months and 1 year.Results The inclusion of patients into the registry started in 2020 and will continue for 24 months. By the time of the article publication (June, 2021), more than 2,000 patients will be included.Conclusion      REGION-MI (Russian rEGIstry Of acute myocardial iNfarction) is a multicenter, retrospective and prospective observational cohort study that excludes any interference with the clinical practice. Results of the registry will help to analyze a real picture of medical care provided to patients with myocardial infarction and to schedule ways to improve the situation.


Assuntos
Infarto do Miocárdio , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Estudos Prospectivos , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Federação Russa/epidemiologia , Fatores de Tempo , Resultado do Tratamento
2.
Kardiologiia ; 61(1): 4-11, 2021 Feb 10.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-33734050

RESUMO

Aim      To evaluate the diagnostic accuracy of cardiac perfusion computed tomography (PCT) with transesophageal electrocardiostimulation (TE ECS) for detection of ischemia in patients with borderline coronary stenosis (50-75 %) compared to measurements of fractional flow reserve (FFR).Material and methods  The study included 25 patients with borderline (50-75 %) coronary stenosis as per data of computed tomography angiography (CTA) or coronary angiography (CAG). Later the patients underwent invasive measurement of FFR and cardiac PCT on a 320-row detector tomograph in combination with the TE ECS stress test.  FFR values <0.8 indicated the hemodynamic significance of stenosis. Myocardial perfusion was evaluated visually based on consensus of two experts.Results All patients completed the study protocol. Cardiac pacing duration was 6 min for all patients. Four patients required intravenous administration of atropine sulphate. PCT with TE ECS detected significant for FFR stenoses with sensitivity, specificity, and predictive value of a positive result and predictive value for a negative result of 47, 90, 87, and 53 %, respectively.Conclusion      PCT with TE ECS in combination with CTA can be considered as an informative method for simultaneous evaluation of the condition of coronary arteries and detection of myocardial ischemia. This method is particularly relevant for assessing the hemodynamic significance of borderline coronary stenoses.


Assuntos
Doença da Artéria Coronariana , Estenose Coronária , Reserva Fracionada de Fluxo Miocárdico , Imagem de Perfusão do Miocárdio , Constrição Patológica , Angiografia Coronária , Estenose Coronária/diagnóstico , Vasos Coronários/diagnóstico por imagem , Teste de Esforço , Hemodinâmica , Humanos , Valor Preditivo dos Testes
3.
Kardiologiia ; 61(1): 44-51, 2021 Feb 10.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-33734055

RESUMO

Aim To evaluate factors associated with unfavorable predictive characteristics of ST-segment elevation acute myocardial infarction (STEMI) as per data of magnetic resonance imaging (MRI).Material and methods The study included 52 patients with STEMI who underwent a primary percutaneous coronary intervention (pPCI). Contrast-enhanced cardiac MRI was performed for all patients on days 3-7. Delayed contrast-enhancement images were used for assessing infarct size, presence of microvascular obstruction (MVO) areas, and heterogeneity zones.Results Multifactorial analysis showed that independent predictors of MVO were type 2 diabetes mellitus (DM) (relative risk (RR) 1.9, confidence interval (CI): 1.1-3.26, р=0.012), increased levels of brain natriuretic peptide (BNP) (RR 2.04, CI: 1.39-2.99, р=0.004) and creatine kinase (CK) (RR 2.06, CI: 0.52-0.80, р=0.02), and infarct size (IS) (RR 2.81; CI: 1.38-5.72, р=0.0004). Construction of ROC curves provided the quantitative values of study indexes, at which the risk of MVO increased. For BNP, this value was ≥276 pg/ml (sensitivity, 95.7 %; specificity, 37.9 %); for CK ≥160 U/l (sensitivity, 74.1 %; specificity, 61.9 %); and for IS ≥18.8 % (sensitivity, 79.3 %; specificity, 69.6 %). Correlation analysis of risk factors for increased size of the heterogeneity zone showed significant correlations of the heterogeneity zone size with older age of patients (r=0.544, р<0.0001), higher concentrations of BNP (r=0.612, р<0.0001), CK (r=0.3, 95 % CI: 0.02-0.5, р=0.03), and C-reactive protein (CRP) (r=0.59, CI: 0.3-0.7, р=0.0001). Increased levels of CK (r=0.53, 95 % CI: 0.29-0.70, р=0.0001) and BNP (r=0.55, 95 % CI: 0.28-0.70, p=0.0003) significantly correlated with increased IS.Conclusion Risk of MVO formation as per MRI data increased in the presence of type 2 DM and IS ≥18.8 % (р<0.05). Formation of MVO in patients with STEMI was associated with increased levels of BNP ≥276 pg/ml and CK ≥160 U/l (р<0.05). Increased levels of BNP, CK, and CRP were associated with a larger size of heterogeneity zone according to data of the correlation analysis. A larger heterogeneity zone was more typical for older patients. Increased levels of CK and BNP were also associated with larger IS. The correlation analysis did not show any significant interactions between the size of heterogeneity zone, IS, and MVO size (р>0.05).


Assuntos
Diabetes Mellitus Tipo 2 , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Idoso , Humanos , Laboratórios , Imageamento por Ressonância Magnética , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico
4.
Kardiologiia ; 60(12): 64-75, 2021 Jan 19.
Artigo em Russo | MEDLINE | ID: mdl-33522469

RESUMO

Aim      To evaluate structural characteristics of atherosclerotic plaques (ASP) by coronary computed tomography arteriography (CCTA) and intravascular ultrasound (IVUS).Material and methods  This study included 37 patients with acute coronary syndrome (ACS). 64-detector-row CCTA, coronarography, and grayscale IVUS were performed prior to coronary stenting. The ASP length and burden, remodeling index (RI), and known CT signs of unstable ASP (presence of dot calcification, positive remodeling of the artery in the ASP area, irregular plaque contour, presence of a peripheral high-density ring and a low-density patch in the ASP). The ASP type and signs of rupture or thrombosis were determined by IVUS.Results The IVUS study revealed 45 unstable ASP (UASP), including 25 UASP with rupture and 20 thin-cap fibroatheromas (TCFA), and 13 stable ASP (SASP). No significant differences were found between distribution of TCFA and ASP with rupture among symptom-associated plaques (SAP, n=28) and non-symptom-associated plaques (NSAP, n=30). They were found in 82.1 and 73.3 % of cases, respectively (p>0.05), which indicated generalization of the ASP destabilization process in the coronary circulation. However, the incidence of mural thrombus was higher for SAP (53.5 and 16.6 % of ASP, respectively; p<0.001). There was no difference between UASP and SASP in the incidence of qualitative ASP characteristics or in values of quantitative ASP characteristics, including known signs of instability, except for the irregular contour, which was observed in 92.9 % of UASP and 46.1 % of SASP (p=0.0007), and patches with X-ray density ≤46 HU, which were detected in 83.3 % of UASP and 46.1 % of SASP (р=0.01). The presence of these CT criteria 11- and 7-fold increased the likelihood of unstable ASP (odd ratio (OR), 11.1 at 95 % confidence interval (CI), from 2.24 to 55.33 and OR, 7.0 at 95 % CI, from 5.63 to 8.37 for the former and the latter criterion, respectively).Conclusion      According to IVUS data, two X-ray signs are most characteristic for UASP, the irregular contour and a patch with X-ray density ≤46 HU. The presence of these signs 11- and 7-fold, respectively, increases the likelihood of unstable ASP.


Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Placa Aterosclerótica , Síndrome Coronariana Aguda/diagnóstico por imagem , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Humanos , Placa Aterosclerótica/diagnóstico , Tomografia Computadorizada por Raios X , Ultrassonografia de Intervenção
5.
Kardiologiia ; 60(10): 122-131, 2020 Nov 12.
Artigo em Russo | MEDLINE | ID: mdl-33228515

RESUMO

Computed tomography angiography (CT-angiography, CTA) allows noninvasive visualization of coronary arteries (CA). This method is highly sensitive in detecting coronary atherosclerosis. However, standard CTA does not allow evaluation of the hemodynamic significance of found CA stenoses, which requires additional functional tests for detection of myocardial ischemia. This review focuses on possibilities of clinical use, limitations, technical aspects, and prospects of a combination of CT-angiography and CT myocardial perfusion imaging in diagnostics of ischemic heart disease.


Assuntos
Doença da Artéria Coronariana , Estenose Coronária , Isquemia Miocárdica , Imagem de Perfusão do Miocárdio , Angiografia Coronária , Humanos , Isquemia Miocárdica/diagnóstico por imagem , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X
6.
Kardiologiia ; 60(2): 104-110, 2020 Mar 05.
Artigo em Russo | MEDLINE | ID: mdl-32345206

RESUMO

The article aims to review the main trials, meta-analyses and guidelines regarding to various practical aspects and unsolved questions of an appliance of the therapeutic hypothermia in out-of-hospital and in-hospital cardiac arrest.


Assuntos
Parada Cardíaca , Hipotermia Induzida , Humanos
7.
Kardiologiia ; 60(11): 1295, 2020 Dec 15.
Artigo em Russo | MEDLINE | ID: mdl-33487153

RESUMO

Aim      To identify clinical, echocardiographic, and angiographic factors related with an increase in the frontal QRS-T angle (fQRS-T) and the spatial QRS-T angle (sQRS-T) in patients with inferior myocardial infarction.Material and methods  The study included 128 patients aged (median [25th percentile; 75th percentile]) 59.5 [51.5; 67.0] years diagnosed with inferior wall acute myocardial infarction. fQRS-T was calculated as a module of difference between the QRS axis and the Т axis in the frontal plane. sQRS-T was calculated by a synthesized vectorcardiogram as a spatial angle between the QRS and Т integral vectors.Results The fQRS-T for the group was 54.0 [18; 80] and sQRS-T was 80.1 [53; 110]. The correlation coefficient for fQRS-T and sQRS-T values was 0.42 (p<0.001). Both fQRS-T >80° and sQRS-T >110° compared to their lower values were associated with a higher frequency of history of postinfarction cardiosclerosis (44% and 12 %, respectively; p<0.05), a lower left ventricular ejection fraction (51 [47; 60]% at fQRS-T >80° and 55 [50; 60]% at fQRS-T <80° (p<0,05); 49 [44; 57]% at sQRS-T >110° and 57 [51; 60] % at sQRS-T <110° (p<0.01); more frequent development of acute heart failure (16 and 2 %, respectively; p<0.05); and early postinfarction angina (13 and 2 %, respectively; p<0.05). The increased fQRS-T was associated with a higher incidence of damage to the circumflex artery (45 and 20 %, respectively; p<0.05). The increased sQRS-T was associated with a history of arterial hypertension (97 and 76 %, respectively; p<0.05), chronic heart failure (22 and 3 %, respectively; p<0.05), chronic kidney disease (19 and 4 %, respectively; p<0.05), and a larger myocardial lesion (mean number of damaged segments by echocardiography was 3.8 [2; 6] at sQRS-T >110° and 2.6 [1; 4] at sQRS-T <110°; p<0.01). sQRS-T was significantly greater in multivascular damage (87 [68; 121]° than in one- or two-vascular damage (72 [51; 100]°; p<0.05). sQRS-T values were significantly lower with spontaneous reperfusion (66 [29; 79] than without spontaneous reperfusion (77 [55; 115]°; p<0.05).Conclusion      In patients after inferior wall acute myocardial infarction, increases in fQRS-T and sQRS-T were associated with more severe damage of coronary vasculature, decreased left ventricular ejection fraction, and more severe course of disease.


Assuntos
Infarto Miocárdico de Parede Inferior , Idoso , Ecocardiografia , Eletrocardiografia , Humanos , Infarto Miocárdico de Parede Inferior/diagnóstico , Volume Sistólico , Função Ventricular Esquerda
8.
Kardiologiia ; 59(9): 52-63, 2019 Sep 20.
Artigo em Russo | MEDLINE | ID: mdl-31540576

RESUMO

During several recent decades spontaneous coronary artery dissection (SCAD) has been known as one of causes of development of acute coronary syndrome (ACS). It has been assumed that this condition is extremely rarely met and is associated with pregnancy and postpartum period. The use in clinical practice of high sensitivity troponin, coronary angiography (CAG) in early period of ACS, in conjunction with the growing awareness of doctors about this pathology led to a revision of the viewse on prevalence of the disease. At present SCAD is considered as one of the causes of ACS in young and middle-aged women. In this review we present results of studies of pathogenesis, diagnostics, and treatment of SCAD, describe various angiographic types of this disease, and discuss problems of choice of optimal strategy of management of patients with SCAD.


Assuntos
Anomalias dos Vasos Coronários , Angiografia Coronária , Humanos , Fatores de Risco
9.
Ter Arkh ; 91(4): 28-36, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31094473

RESUMO

AIM: to assess the diagnostic meaning of cardiac magnetic resonance imaging (CMR) in various clinical forms of myocarditis. MATERIALS AND METHODS: 11 (8 men, mean age 32.8±11.1 years) patients (pts), hospitalized with suspected acute coronary syndrome, while an acute myocardial infarction was excluded during the examination (group I); 48 pts (31 men, 43.1±12.7 years), with clinical and instrumental signs of dilated cardiomyopathy (DCM) - group II; and 20 patients (12 men, 39.5±14 years), with episodes of ventricular tachycardia (group III) underwent cardiac magnetic resonance imaging (CMRI). In 38 patients endomyocardial biopsy (EMB) was performed. RESULTS: According to EMB, signs of active myocarditis were revealed in 10 (34.5%) group II pts and in 3 (37.5%) group III pts; signs of resolved myocarditis - in 8 (27.6%) patients in group II and in 3 (37.5%); minimal morphological changes - in 11 (37.9%) patients of group II and in 2 (25%) patients of group III. In 9 (81.9%) patients of group I MRI data allowed to establish the diagnosis of acute myocarditis. Signs of active inflammation from MRI data were detected in myocardium 5 (10.4%) in group II pts and 7 (35%) in group III pts. In 22 (45.8%) pts in group II and 10 (50%), CMR data corresponded to the picture of resolved myocarditis. In 21 (43.8%) cases of group II and 3 (15%) of group III, MRI revealed minimal structural changes. In pts with clinical and instrumental signs of DCM and/or ventricular tachycardia MRI allows to identify signs of "active myocarditis" with a sensitivity of 37.5% with a specificity of 83.4%. At the same time, in cases of resolved myocarditis and minimal morphological changes MRI has high sensitivity (70 and 71.5%) and specificity (71.5 and 75%, respectively). CONCLUSION: CMR has high diagnostic significance in patients with infarct-like course of myocarditis. In patients with clinical syndrome of dilated cardiomyopathy or arrhythmias, the sensitivity of MRI in detecting active myocarditis is low (37.5%) with high specificity (83.4%). In cases of minimal structural changes in the myocardium and resolved inflammation, CMR is a good alternative to EMB.


Assuntos
Cardiomiopatia Dilatada/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Miocardite/diagnóstico por imagem , Adulto , Biópsia , Humanos , Espectroscopia de Ressonância Magnética , Masculino , Miocárdio , Adulto Jovem
10.
Ter Arkh ; 91(9): 115-123, 2019 Sep 15.
Artigo em Russo | MEDLINE | ID: mdl-32598822

RESUMO

Takotsubo Syndrome is a transient condition characterized by left ventricular systolic dysfunction. Although the prognosis is excellent in most cases, rare cases of serious complications can occur. We present a case of a 81-year - old woman with Takotsubo Syndrome complicated by ventricular septal rupture that was successfully closed with an occluder Occlutech with good immediate and long - term outcomes.


Assuntos
Comunicação Interventricular , Dispositivo para Oclusão Septal , Cardiomiopatia de Takotsubo , Cateterismo Cardíaco , Feminino , Humanos , Resultado do Tratamento
11.
Acta Naturae ; 9(4): 74-83, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29340220

RESUMO

In search of genetic markers of myocardial infarction (MI) risk, which have prognostic significance for Russians, we performed a replication study of MI association with genetic variants of PCSK9 (rs562556), APOE (epsilon polymorphism, rs7412 and rs429358), LPL (rs320), MTHFR (rs1801133), eNOS (rs2070744), and the 9p21 region (rs1333049) in 405 patients with MI and 198 controls. Significant MI association was observed with variants of the lipid metabolism genes (PCSK9, APOE and LPL), and of eNOS. The SNPs in the MTHFR gene and the 9p21 region were not significantly associated with MI one by one but were included in several different MI-associated allelic combinations identified by multilocus analysis. Since we have not revealed nonlinear epistatic interactions between the components of the identified combinations, we postulate that the cumulative effect of genes that form a combination arises from the summation of their small independent contributions. The prognostic significance of the additive composite model built from the PCSK9, APOE, LPL, and eNOS genes as genetic markers was assessed using ROC analysis. After we included these markers in the previously published composite model of individual genetic risk of MI, the prognostic efficacy in our sample reached AUC = 0.676. However, the results obtained in this study certainly need to be replicated in an independent sample of Russians.

12.
Kardiologiia ; 56(12): 5-10, 2016 12.
Artigo em Russo | MEDLINE | ID: mdl-28290798

RESUMO

OBJECTIVE: to elaborate a complex model for myocardial infarction (MI) risk assessment considering the combined effect of genetic predisposition, age and smoking. MATERIALS AND METHODS: The study included two independent samples of ethnic Russians: 325 patients with MI and 185 individuals without history of cardiovascular diseases (controls) from the Moscow region, and 220 patients and 197 controls from the Republic of Bashkortostan. Genotyping of polymorphic loci of genes CRP (rs1130864), IFNG (rs2430561), TGFB1 (rs1982073), FGB (rs1800788) and PTGS1 (rs3842787) was performed. To construct the predictive models, we used logistic regression with stepwise inclusion of variables. The predictive value was evaluated by the area under the curve (AUC) in a ROC-analysis. The factor was considered as a marker at pAUC <0.05 calculated by the method of DeLong. The marker was considered effective at AUC >0.60. RESULTS: Three separate genetic variants FGB rs1800788*T, TGFB1 rs1982073*TT, CRP rs1130864*TT, and biallelic combination IFNG rs2430561*A + PTGS1 rs3842787*T whose association with MI we described earlier, were used to construct the composite genetic marker (AUC=0.66 in the training and test samples) by the logistic regression method. Adding to the obtained composite genetic marker such parameters as age and smoking allowed to create a complex MI risk marker, which was characterized by the predictive value stability (AUC=0.77 in the training sample and 0.82 in the test sample). CONCLUSION: The obtained complex model for MI risk assessment was reproduced in two independent samples of Russian ethnicity individuals from different regions of Russia with different gender identities, and allowed to have a reasonable chance (about 80%) of distinguishing patients and healthy individuals.


Assuntos
Fatores Etários , Infarto do Miocárdio/etiologia , Fumar , Feminino , Marcadores Genéticos , Predisposição Genética para Doença , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético , Fatores de Risco
13.
Kardiologiia ; 55(5): 80-8, 2015.
Artigo em Russo | MEDLINE | ID: mdl-26615630

RESUMO

In most cases direct cause of acute coronary syndrome and sudden death is an intracoronary thrombus formed on a surface of unstable atherosclerotic plaque (UAP). The following are main characteristics of UAP: active inflammation; large lipid rich nucleus occupying a40% of plaque volume; thin (< 65 mm) fibrous cap; erosions of intima over plaque; tear of plaque cap; superficially located calcium nodules; intraplaque hemorrhage. Visualization of UAP in coronary arteries is a very important direction in diagnostics. During recent years both invasive and noninvasive methods of detection of UAP have been actively developed. In this review we present main noninvasive techniques used for detection of UAP: multislice computed tomography, magnetic resonance tomography, positron emission tomography and single-photon emission computed tomography. In the review we have covered main advantages and limitations of each invasive method of UAP detection and delineated perspectives of development of this direction.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Diagnóstico por Imagem/métodos , Placa Aterosclerótica/diagnóstico , Síndrome Coronariana Aguda/etiologia , Humanos , Tomografia Computadorizada Multidetectores , Placa Aterosclerótica/complicações , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada de Emissão de Fóton Único
14.
Kardiologiia ; 55(7): 5-13, 2015.
Artigo em Russo | MEDLINE | ID: mdl-26688920

RESUMO

AIM: to compare noninfarct-related lesions in patients with acute myocardial infarction (MI) with culprit and non-culprit lesions in patients with stable angina pectoris (SAP) using intravascular ultrasound virtual histology (VH-IVUS). MATERIAL AND METHODS: Overall 70 patients were enrolled: 38 with ST elevation (STE) MI and 32 with stable angina pectoris (SAP). All patients underwent three-vessel coronary angiography and gray-scale and VH-IVUS after percutaneous coronary intervention (PCI) of infarct-related lesion in STEMI or culprit lesion in SAP. RESULTS: A total of 130 plaques were examined: 70 in patients with STEMI and 60 in patients with SAP. Noninfarct-related lesions in acute MI compared with non-culprit lesions in SAP had significantly larger plaque burden and plaque volume, smaller minimum lumen area, and more positive remodeling. STEMI, hyperlipidemia, plaque burden, and hypertension were independent predictors of unstable plaques.


Assuntos
Angina Estável/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Infarto do Miocárdio/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea , Reprodutibilidade dos Testes
15.
Kardiologiia ; 55(7): 5-13, 2015 Jul.
Artigo em Russo | MEDLINE | ID: mdl-28294910

RESUMO

AIM: to compare noninfarct-related lesions in patients with acute myocardial infarction (MI) with culprit and non-culprit lesions in patients with stable angina pectoris (SAP) using intravascular ultrasound virtual histology (VH-IVUS). MATERIAL AND METHODS: Overall 70 patients were enrolled: 38 with ST elevation (STE) MI and 32 with stable angina pectoris (SAP). All patients underwent three-vessel coronary angiography and gray-scale and VH-IVUS after percutaneous coronary intervention (PCI) of infarct-related lesion in STEMI or culprit lesion in SAP.

16.
Kardiologiia ; 54(3): 64-70, 2014.
Artigo em Russo | MEDLINE | ID: mdl-25102751

RESUMO

The role of innate immunity factors in the pathogens of ACS is not well studied, although there is evidence in the literature about their impact on the course of cardiovascular diseases. Mannose-binding lectin (MBL)--one of the key factors of the humoral innate immune system that activates one of complement activation pathways. The literature suggests an ambiguous, complex role of MBL, which can in different clinical situations either improve the prognosis of patients, or be a risk factor for complications. MBL could potentially be relevant to all main links in the pathogenesis of coronary artery disease and myocardial infarction: inflammation, thrombosis, apoptosis, and so on. At different stages of atherogenesis, including the formation and destabilization of the atherosclerotic plaque, thrombosis, MBL may have a significant impact. The review analyzes currently available literature on the impact of MBL on atherosclerosis, ischemic heart disease and acute coronary syndrome. Moreover, in the review there is data on the role of MBL in physiological reactions in innate immunity, gene structure of MBL2 and possible mutations leading to deficiency of MBL in blood, and the role of MBL in the pathogenesis of various diseases.


Assuntos
Síndrome Coronariana Aguda , Aterosclerose , Lectina de Ligação a Manose , Isquemia Miocárdica , Síndrome Coronariana Aguda/imunologia , Síndrome Coronariana Aguda/metabolismo , Aterosclerose/imunologia , Aterosclerose/metabolismo , Lectina de Ligação a Manose da Via do Complemento , Humanos , Imunidade Inata/genética , Inflamação/metabolismo , Lectina de Ligação a Manose/genética , Lectina de Ligação a Manose/metabolismo , Isquemia Miocárdica/imunologia , Isquemia Miocárdica/metabolismo , Fatores de Risco
17.
Kardiologiia ; 54(1): 27-33, 2014.
Artigo em Russo | MEDLINE | ID: mdl-24881308

RESUMO

UNLABELLED: Mannose-binding lectin (MBL) is a key component of innate immunity that starts one of the ways of complement activation. Factors of neutrophil activation are cell factors of innate and acquired immunity. AIM: to study MBL levels and factors of neutrophil activation in patients with acute coronary syndrome (ACS). METHODS: A total of 45 patients with ST elevation (STE) ACS and non ST-elevation (NSTE) ACS were enrolled in the study, 15 persons were age-matched controls. RESULTS. Compared with control group MBL level was higher in patients with ACS (52.7 vs 127.2 hg/ml, respectively, p = 0.07), and significantly higher in patients with NSTE ACS (52.7 vs. 164.7 hg/ml, p = 0.03). There was no difference between MBL levels in STE ACS and NSTE ACS patients. Patients with inferior myocardial infarction (MI) had significantly higher MBL level than those with anterior MI (182.8 -92.7 hg/ml, p = 0.02). Patients with concomitant diabetes had statistically higher MBL level than patients without diabetes (225 vs 100 hg/ml, OR 2.25, p = 0.03). MBL level was lower in patients with low (<40%) ejection fraction - 92.7 vs 148.9 hg/ml in patients with EF > or = 40% (p = 0.19). No difference of neutrophil activation factors between ACS patients and controls was found (phagocytic activity of neutrophils 74.5 vs 74.3%, phagocytic number 3.34 vs 4.36, phagocytic reserve 88 vs 85.5 in ACS and control group, respectively). CONCLUSION: Elevated innate immunity factor (MBL) level was associated with ACS, especially in patients with diabetes mellitus. No association between cell immunity factors with ACS was found.


Assuntos
Síndrome Coronariana Aguda/imunologia , Leucócitos/imunologia , Lectina de Ligação a Manose/imunologia , Fagocitose/imunologia , Síndrome Coronariana Aguda/sangue , Adulto , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Lectina de Ligação a Manose/sangue , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Neutrófilos/imunologia
18.
Kardiologiia ; 54(11): 46-56, 2014.
Artigo em Russo | MEDLINE | ID: mdl-25902659

RESUMO

In most cases direct cause of acute coronary syndrome and sudden death is an intracoronary thrombus formed on a surface of unstable atherosclerotic plaque (UAP). The following are main characteristics of UAP: active inflammation; large lipid rich nucleus occupying a 40% of plaque volume; thin (< 65 mm) fibrous cap; erosions of intima over plaque; tear of plaque cap; superficially located calcium nodules; intraplaque hemorrhage. Visualization of UAP in coronary arteries is a very important direction in diagnostics. During recent years both invasive and noninvasive methods of detection of UAP have been actively developed. In this review we present main invasive techniques used for detection of UAP: intravascular ultrasound study with virtual histology; optical coherent tomography; near-infrared spectroscopy; thermography; intravascular magnetic resonance imaging; direct visualization by angioscopy. In the review we have covered main advantages and limitations of each invasive method of UAP detection and delineated perspectives of development of this direction.


Assuntos
Síndrome Coronariana Aguda/prevenção & controle , Vasos Coronários/patologia , Placa Aterosclerótica , Síndrome Coronariana Aguda/etiologia , Pesquisa Comparativa da Efetividade , Humanos , Angiografia por Ressonância Magnética/métodos , Placa Aterosclerótica/complicações , Placa Aterosclerótica/diagnóstico , Placa Aterosclerótica/fisiopatologia , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Termografia/métodos , Tomografia de Coerência Óptica/métodos , Ultrassonografia de Intervenção/métodos
20.
Kardiologiia ; 52(3): 15-21, 2012.
Artigo em Russo | MEDLINE | ID: mdl-22839439

RESUMO

In recent years levels of a number of inflammatory markers namely C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor (TNF) etc. are measured for the purpose of postinfarction risk evaluation. Dynamics of inflammatory markers concentrations can reflect processes occurring in atherosclerotic plaque and coronary arteries. Concentrations of inflammatory markers depend particularly on genetic factors affecting transcription levels of individual genes. This data suggest that genotypes which determine increased inflammatory markers levels in blood can increase risk of unfavorable events after myocardial infarction. STUDY PURPOSES: Analysis of influence of allelic polymorphisms C1444T of CRP gene (rs1130864), G(-174)A of IL6 gene (rs1800795), A(-308)G of TNF gene (rs1800629), G252A of LTA gene (rs909253), (-509) of TGFB1 gene (rsl800469) and delta32 (w/d) of CCR5 gene (rs333) on development of cardiac unfavorable events in Russian patients with MI during two years follow-up. 211 Russian patients were included (52.3+/-10.3 years), 160 men (50.1+/-10.6 years) and 51 women (55.2+/-10.1 years). After two years of follow-up patients were examined in hospital, or telephon call occurred for determination of patient's condition or end point assessment. The end points were cardiac death, recurrent MI, recurrent hospitalization with unstable angina or stroke, CABG or PTCA performing. The genotyping was performed by methods based on polymerase chain reaction (PCR): PCR-SSP and PCR-RFLP. Analysis revealed association of allele T (p=0.036, OR=1.6, 95%CI: 1.052.6) and of allele T carriage (genotypes CT+TT) (p=0.046, OR=1.9, 95%CI: 1.053.6) of polymorphism C1444T of CRP gene with unfavorable events development. Analysis of survival rate by Kaplan-Meier estimation showed that cumulative part of patients without unfavorable events was significantly lower among allele T carriers than among carriers of genotype C/C of polymorphism C1444T CRP. Allele A of polymorphism A252G of LTA gene was also associated with unfavorable events risk (p=0.034, OR=1.96, 95%CI: 1.073.06). There was no association of polymorphisms delta 32 (w/d) of CCR5 gene, A(-308)G of TNF gene, G(-174)C of IL-6 gene, C(-509)T of TGFB1 gene with unfavorable events development.


Assuntos
Interleucina-6/genética , Infarto do Miocárdio , Receptores CCR5/genética , Medição de Risco/métodos , Fator de Crescimento Transformador beta1/genética , Fatores de Necrose Tumoral/genética , Adulto , Biomarcadores , Vasos Coronários/metabolismo , Feminino , Seguimentos , Predisposição Genética para Doença , Testes Genéticos , Humanos , Inflamação/etiologia , Inflamação/genética , Inflamação/metabolismo , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/genética , Infarto do Miocárdio/mortalidade , Avaliação de Resultados em Cuidados de Saúde , Placa Aterosclerótica/etiologia , Placa Aterosclerótica/genética , Placa Aterosclerótica/metabolismo , Polimorfismo de Nucleotídeo Único , Prognóstico
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