203 research outputs found
Impact of recipient-related factors on structural dysfunction of xenoaortic bioprosthetic heart valves
No full textOlga Barbarash, Natalya Rutkovskaya, Oksana Hryachkova, Olga Gruzdeva, Evgenya Uchasova, Anastasia Ponasenko, Natalya Kondyukova, Yuri Odarenko, Leonid Barbarash Federal State Budgetary Scientific Institution Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia Objective: To analyze the influence of recipient-related metabolic factors on the rate of structural dysfunction caused by the calcification of xenoaortic bioprostheses. Materials and methods: We retrospectively analyzed clinical status, calcium–phosphorus metabolism, and nonspecific markers of inflammatory response in bioprosthetic mitral valve recipients with calcific degeneration confirmed by histological and electron microscopic studies (group 1, n=22), and in those without degeneration (group 2, n=48). Results: Patients with confirmed calcification of bioprostheses were more likely to have a severe clinical state (functional class IV in 36% in group 1 versus 15% in group 2, P=0.03) and a longer cardiopulmonary bypass period (112.8±18.8 minutes in group 1 versus 97.2±23.6 minutes in group 2, P=0.02) during primary surgery. Patients in group 1 demonstrated moderate hypovitaminosis D (median 34.0, interquartile range [21.0; 49.4] vs 40 [27.2; 54.0] pmol/L, P>0.05), osteoprotegerin deficiency (82.5 [44.2; 115.4] vs 113.5 [65.7; 191.3] pg/mL, P>0.05) and osteopontin deficiency (4.5 [3.3; 7.7] vs 5.2 [4.1; 7.2] ng/mL, P>0.05), and significantly reduced bone-specific alkaline phosphatase isoenzyme (17.1 [12.2; 21.4] vs 22.3 [15.5; 30.5] U/L, P=0.01) and interleukin-8 levels (9.74 [9.19; 10.09] pg/mL vs 13.17 [9.72; 23.1] pg/mL, P=0.045) compared with group 2, with an overall increase in serum levels of proinflammatory markers. Conclusion: Possible predictors of the rate of calcific degeneration of bioprostheses include the degree of decompensated heart failure, the duration and invasiveness of surgery, and the characteristics of calcium–phosphorus homeostasis in the recipient, defined by bone resorption and local and systemic inflammation. The results confirm the hypothesis that cell-mediated regulation of pathological calcification is caused by dysregulation of metabolic processes, which are in turn controlled by proinflammatory signals. Keywords: bioprostheses, calcium–phosphorus metabolism, inflammation, calcificatio
Dose-dependent effects of atorvastatin on myocardial infarction
No full textOlga Barbarash, Olga Gruzdeva, Evgenya Uchasova, Ekaterina Belik, Yulia Dyleva, Victoria KaretnikovaFederal State Budgetary Institution, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, the Russian Federation Background: Dyslipidemia is a key factor determining the development of both myocardial infarction (MI) and its subsequent complications. Dyslipidemia is associated with endothelial dysfunction, activation of inflammation, thrombogenesis, and formation of insulin resistance. Statin therapy is thought to be effective for primary and secondary prevention of complications associated with atherosclerosis.Methods: This study examined 210 patients with Segment elevated MI (ST elevated MI) who were treated with atorvastatin from the first 24 hours after MI. Group 1 (n=110) were given atorvastatin 20 mg/day. Group 2 (n=100) were given atorvastatin 40 mg/day. At days 1 and 12 after MI onset, insulin resistance levels determined by the homeostasis model assessment of insulin resistance index, lipid profiles, and serum glucose, insulin, adipokine, and ghrelin levels were measured.Results: Free fatty acid levels showed a sharp increase during the acute phase of MI. Treatment with atorvastatin 20 mg/day, and especially with 40 mg/day, resulted in a decrease in free fatty acid levels. The positive effect of low-dose atorvastatin (20 mg/day) is normalization of the adipokine status. Administration of atorvastatin 20 mg/day was accompanied with a statistically significant reduction in glucose levels (by 14%) and C-peptide levels (by 38%), and a decrease in the homeostasis model assessment of insulin resistance index on day 12.Conclusion: Determination of atorvastatin dose and its use during the in-hospital period and subsequent periods should take into account changes in biochemical markers of insulin resistance and adipokine status in patients with MI.Keywords: myocardial infarction, statin, insulin resistance, adipokines, atorvastati
Leptin resistance: underlying mechanisms and diagnosis
No full textOlga Gruzdeva,1,2 Daria Borodkina,3 Evgenya Uchasova,1 Yulia Dyleva,1 Olga Barbarash1,2 1Federal State Budgetary Institution, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation; 2Federal State Budget Educational Institution of Higher Education, Kemerovo State Medical University of the Ministry of Healthcare of the Russian Federation, Kemerovo, Russian Federation; 3Autonomous Public Healthcare Institution of the Kemrovo Region, Kemerovo Regional Clinical Hospital Named After S.V. Beliyaev, Regional Center for Diabetes, Kemerovo, Russian Federation Abstract: Leptin and its receptors have been identified as key regulators of body weight and energy homeostasis. A decrease in tissue sensitivity to leptin leads to the development of obesity and metabolic disorders, such as insulin resistance and dyslipidemia. Mechanisms underlying the development of leptin resistance include mutations in the genes encoding leptin and its receptors, as well as proteins involved in self-regulation of leptin synthesis and blood–brain barrier permeability. Leptin resistance encompasses a complex pathophysiological phenomenon with a number of potential research lines. In this review, we analyze the existing data on the methods used to diagnose leptin resistance. Keywords: leptin, leptin resistance, soluble leptin recepto
CYP2C19 polymorphism frequency in Russian patients in Central Russia and Siberia with acute coronary syndrome
No full textKarin B Mirzaev,1 Elena M Zelenskaya,2 Olga L Barbarash,3 Vladimir I Ganyukov,3 Konstantin A Apartsin,4,5 Natalya O Saraeva,4 Konstantin Y Nikolaev,6,7 Kristina A Ryzhikova,1 Galina I Lifshits,2,5,7 Dmitry A Sychev1 1Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russian Federation, Moscow, 2Federal State-Financed Research Institution “Institute of Chemical Biology and Fundamental Medicine”, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, 3Federal State-Financed Research Institution “Research Institute for Complex Issues of Cardiovascular Diseases”, Siberian Branch of the Russian Academy of Sciences, Kemerovo, 4State-Financed Health Institution “Irkutsk Regional Badge of Honour Clinical Hospital”, 5Federal State-Financed Research Institution “Irkutsk Research Center”, Siberian Branch of the Russian Academy of Sciences, Irkutsk City, 6Federal State-Financed Research Institution “Research Institute of Internal and Preventive Medicine”, 7Federal State Autonomous Institution of Higher Education “Novosibirsk National Research State University”, Novosibirsk, Russia Purpose: The aim of this study is to investigate the frequency of CYP2C19*2, *3 allelic variants, associated with poor response to clopidogrel, and CYP2C19*17, associated with excessive response to clopidogrel, in patients with acute coronary syndrome (ACS) from Siberia and Moscow regions of Russia.Patients and methods: The study included 512 ACS patients who were subsequently treated with coronary arterial stenting. The subjects assigned were from the cities of Central (Novosibirsk, Kemerovo), Eastern (Irkutsk), Northern (Surgut) Siberia regions and from Moscow region. The mean age of patients enrolled was 63.9±10.9 years. Among the assigned subjects, the proportion of men accounted for 80% and women 20%.Results: According to the results obtained in the present study, from 16% up to 27.5% of patients in different regions of Russia have at least one CYP2C19 “poor metabolizer” (PM) allele variant affecting clopidogrel metabolism and, therefore, suppressing its antiplatelet activity. CYP2C19*17 allele variant was identified with the frequency of 15.4% up to 33.3%. The study revealed the presence of statistically significant differences in CYP2C19*3 allele frequency between the Russian ethnic group patients from Eastern and Central Siberia (p=0.001; odds ratio=1.05 [95% confidence interval 1.01–1.09]).Conclusion: The study revealed statistically significant differences between the allele frequencies in Eastern and Central Siberia, which can probably be caused by a considerable number of Buryats inhabiting Eastern Siberia. Keywords: P2Y12 receptor inhibitors, clopidogrel resistance, dual antiplatelet therap
Effect of different doses of statins on the development of type 2 diabetes mellitus in patients with myocardial infarction
No full textOlga Gruzdeva,1 Evgenya Uchasova,1 Yulia Dyleva,1 Olga Akbasheva,2 Victoria Karetnikova,1 Aleksandr Shilov,1 Olga Barbarash1 1Federal State Budgetary Institution, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia; 2State Budget Educational Institution of Higher Professional Education, Siberian State Medical University, Russian Federation Ministry of Health, Tomsk, Russia Background: Cardiovascular diseases and type 2 diabetes mellitus (T2DM) may have common developmental mechanisms associated with lipid metabolism disorders. Dyslipidemia and progression of atherosclerosis in people with T2DM are accompanied by an increase in cardiovascular mortality. This study examined the dose-dependent action of atorvastatin on carbohydrate metabolism and adipokine status in patients within 12 months after myocardial infarction (MI).Methods: A total of 156 male MI patients who had received atorvastatin 20 mg/day (78 patients) or 40 mg/day (78 patients) starting from day 1 of onset were enrolled. Glucose, insulin, C-peptide, resistin, adiponectin, and ghrelin levels were measured at baseline, day 12, and months 3 and 12. Patients were monitored for new incidences of T2DM for 12 months after MI.Results: For acute phase MI, patients had moderate insulin resistance, hyperglycemia, and hyperinsulinemia, high leptin and resistin levels, and low ghrelin and adiponectin levels. Atorvastatin 20 mg/day was more effective at correcting the imbalances. Patients taking atorvastatin 40 mg/day (group 2) following MI showed increases in levels of glucose, insulin, and C-peptide and insulin resistance progression after 12 months of therapy, as evidenced by increased quantitative insulin sensitivity check index scores and detection of new T2DM cases.Conclusion: Atorvastatin improved adipokine profiles and ghrelin levels, with low doses showing more significant effects. Atorvastatin dose prescribed for MI patients should take into account the degree of insulin resistance and adipokine status. Keywords: statin, myocardial infarction, inflammation, adipokine, resisti
Efficacy and Safety of Prolonged Antiplatelet Therapy before Coronary Artery Bypass Grafting in Patients with Different Body Mass Index
No full textFOURTH UNIVERSAL DEFINITION OF MYOCARDIAL INFARCTION. FOCUS ON THE TYPE 2 MYOCARDIAL INFARCTION
No full textHere we review the current concept on the definition of myocardial infarction (MI) and its diagnosis. We briefly highlight features of all international documents on the universal definition of MI and specify type 2 MI as a particularly difficult form. We then consider clinical difficulties in providing medical care to these patients and underline the crucial importance of myocardial necrosis biomarkers (high-sensitivity troponins) in MI diagnosis. Finally, we talk about the principles of distinguishing MI from myocardial injury
Association of inflammatory markers and poor outcome in diabetic patients presenting with ST segment elevation myocardial infarction
No full textYulia Belenkova,1,2 Viktoria Karetnikova,1,2 Aleksey Diachenko,2 Olga Gruzdeva,1 Olga Blagoveshchenskaya,3 Tatiana Molodtsova,3 Evgenya Uchasova,1 Olga Barbarash1,2 1Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases, Siberian Branch of the Russian Academy of Medical Sciences, 2State Budgetary Educational Institution of Higher Professional Education Kemerovo State Medical Academy of the Russian Ministry of Health, 3State Budgetary Healthcare Institution Kemerovo Regional Clinical Hospital, Kemerovo, Russian Federation Objective: Carbohydrate metabolism disorders (CMD) significantly impact the development and progression of all forms of ischemic heart disease, and inflammation is regarded as a general pathogenetic link between CMD and ischemic heart disease. Methods: A total of 601 patients with ST segment elevation myocardial infarction (MI) (STEMI), admitted within 24 hours from the onset of symptoms during 1 year, were included in this registry study. The blood levels of inflammation markers were measured at days 10–14 with further follow up at 1 year. Results: The analysis of acute-phase percutaneous coronary intervention impact on the 1-year outcomes showed that endovascular revascularization significantly improved the 1-year prognosis of STEMI patients both with and without CMD. The analysis of inflammation markers showed significantly higher levels of interleukin (IL)-6 and sCD40L in MI patients with diabetes mellitus, and impaired glucose tolerance. Additionally, the patients with impaired glucose tolerance had significantly higher IL-12 levels. In the diabetic MI patients, the odds ratio of a poor 1-year outcome was high for patients with a high Killip classification of acute heart failure upon admission. Conclusion: Persistent inflammation in STEMI patients with CMD undergoing percutaneous coronary intervention might be responsible for vascular complications within 1 year after MI. Comorbid diabetes mellitus or impaired glucose tolerance can amplify the significance of the inflammatory response for the development of adverse 1-year outcomes. Keywords: carbohydrate metabolism disorders, inflammation percutaneous coronary intervention 
Effects of statins on inflammatory markers and matrix metalloproteinases in patients with ST-segment elevation myocardial infarction
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