ABSTRACT
In the conditions of the existing pandemic, that affects both the physical and psychological health of people, it can be pre-dicted with a high degree of probability an outbreak in mental disorders and stress-associated mental illnesses, including depression. The problem of the relationship between depression and cardiac diseases, in particular coronary heart disease (CHD), has been studied by native and foreign scientists for several decades. Various mechanisms have been found and con-tinue to be studied, indicating that the presence of depression can affect more or less on the course of coronary heart disease and even become a predictor of new cardiac events. Dysfunction of the autonomic nervous system with changes in heart rate variability, hyperactivity of the hypothalamic-pituitary-adrenal axis and associated hypercortisolemia, disorders of serotonergic signal transmission pathways, high aggregation response and increased platelet activity, continuous increase of proinflamma-tory cytokines ((IL17A, IL6, TNFa and IL12p70) in patients’ plasma – such mechanisms probably underlie the correlation between depression and an increased risk of cardiovascular complications and cardiac death. The review includes some features of depression and its influence on various forms of coronary heart disease, particularly in different age and gender groups. In view of the ongoing COVID-19 pandemic, this theme seems to be relevant and requires targeted study. Probably it is necessary to conduct clinical researches, to create registers for a detailed assessment of the mutual influence of depression and coronary heart disease in existing conditions. Perhaps, the results of such work will contribute not only to the early detec-tion and treatment of depression, but also to the development of new ways in primary and secondary prevention of coronary heart disease and its acute forms. © 2022, Remedium Group Ltd. All rights reserved.
ABSTRACT
Background: Atherothrombosis and myocardial infarction are accompanied by the development of an inflammatory reaction. The severity of the immune reaction and its role in the acute myocardial infarction (AMI) remain contradictory to date. Purpose: The objective of this study was to analyze 39 cytokines and chemokines in the serum of patients hospitalized with AMI compared to the healthy volunteers. Methods: All patients included in the study were COVID-19 negative. Patients' blood was collected within 1-2 days after hospitalization in the cardiology department. Cytokine and chemokine detection in the serum of patients (n=20) and donors (n=20) was performed using a 39-plex set of cytometric beads. Results: Among all factors analyzed TGFa, IL-17A, IL-1b, 3, 5, 9 were not detected both in patient and donor sera. Three groups of factors were identified in the normal serum: housekeeping chemokines and vascular factors (F1) ranged from 1000 to 22000 pg/mL (Fig. a);sentinel innate immunity factors F2 (Fig. b), 30-200 pg/mL;and acute phase factors F3 (Fig. c, d), 0-30 pg/mL, detected only in 0-30% of donors but in all AMI patients. Severe imbalance was found in AMI sera at all three levels including chemokine, growth factors, and cytokines. Among AMI patients 65% (Gr1) demonstrated 2-4 times increased level (Fig. a, grey brackets) while 35% (Gr2) had a decreased level of F1 factors in a comparison with donor sera. There was not significant difference between clinical features of the patients in Gr1 and Gr2. GRO, PDGF-AA, and sCD40L levels decreased 35, 15, and 10 times accordingly. Gr1 and Gr2 also differed in F2 and some F3 concentrations: Gr1 had 3-5 times increased level of multiple factors (Fig, b), among them - IL-6, IL-8, and IL-10 were increased 5, 6, and 14 times. At the same time Gr2 had a normal level of these factors (Fig, b, blue brackets). Finally, multiple cytokines and growth factors F3 were significantly increased in both AMI groups (Fig, b, d, red brackets). Of note, IL-12, IFN-g, IL-15, GM-CSF, FLT-3T were increased 8, 6, 5, 5, 5 times accordingly in pooled Gr1+Gr2. There were no correlations found between cytokine profiles in Gr1 and Gr2 and their clinical parameters. Conclusions: Two types of humoral response in AMI patients were identified which differed in the levels of GRO, PDGF-AA, and sCD40L. IL-6 as well as TNF-a can not serve as master cytokines because their levels were increased only in Gr1 patients. These data show that Th1 cytokine increase is specific for AMI. Further studies are needed to identify groups of patients who may be exposed to new therapeutic targets.
ABSTRACT
The expert consensus of the Russian communities discusses the issues of comprehensive medical rehabilitation of patients with coronavirus disease 2019 (COVID-19). COVID-19 is a contagious infectious disease that can cause pulmonary, cardiac, motor, metabolic, neurocognitive and mental disorders, that is, multiple organ dysfunction. COVID-19 survivors, especially after a severe clinical course, face serious psychological and physical problems, posttraumatic stress, cognitive dysfunction, nutritional deficiencies and exacerbation of concomitant chronic diseases. Some patients, regardless of the COVID-19 severity, have a long clinical course of the disease (“chronic-COVID”, “long COVID”). There is evidence of post-acute COVID-19 syndrome. In this regard, patients after COVID-19 will need rehabilitation measures. The expert consensus of the Russian communities presents general principles, stages and aspects of medical rehabilitation after COVID-19, indications and contraindications for rehabilitation interventions. The paper includes recommendations on comprehensive cardiac and pulmonary rehabilitation, as well as specifics of rehabilitation care for different COVID-19 courses within the national three-stage rehabilitation system.