[RELATIONSHIP BETWEEN SMOKING AND INDICATORS OF SYSTEMIC INFLAMMATION IN PATIENTS WITH CORONARY HEART DISEASE].

Aim: To estimate the severity of systemic inflammation in subjects with coronary artery disease (CAD) without bronchopulmonary system comorbidity depending on smoking factor. Materials and methods: The subjects were divided into groups depending on smoking factor. We estimated the following laboratory markers of nonspecific inflammation: interleukine (IL)-12, -1ß, tumour necrosis factor-α, matrix metalloproteinase-9, C-reactive protein. The examination of lungs respiratory function included spirometry, body plethysmography and assessment of diffusing lung capacity. Results: 29.9% of the subjects with CAD smoked, 40% reported discontinuation of smoking in their histories. Smoking in CAD subjects without the history of bronchopulmonary system comorbidity was associated with a higher level of inflammatory markers (IL-12, IL-1ß, TNF-α, ММР-9 and CRP) than in subjects who ceased to smoke and those who have never smoked. No differences in the levels of inflammatory markers were revealed in subjects who had smoked before and never smoked. Conclusion: Smoking is widespread among CAD subjects. It is associated with a higher level of markers of nonspecific inflammation as compared to subjects who have never smoked before or ceased smoking.

[Pulmonary function in patients with type 2 diabetes and coronary artery disease].

Currently, there is no convincing evidence of respiratory failure in patients with diabetes mellitus (DM) and coronary artery disease (CAD). Aim: To evaluate the differences in the main parameters of pulmonary function in patients with isolated type 2 diabetes and diabetic patients with CAD. Materials and methods: Patients with diabetes were allocated to two groups depending to the presence of CAD. The assessment of carbohydrate and lipid metabolism, as well as the measurement of inflammatory markers were performed using standard methods of clinical and biochemical analysis. Respiratory function and diffusion capacity of the lungs (DLCO) were assessed using a body plethysmograph Elite Dl-220v. Results: Main pulmonary functional test parameters were within normal values, except residual volume in diabetic patients. Patients with concomitant CAD demonstrated lower values of the studied parameters compared to non-diabetic ones. A number of volume and flow rate parameters as well as DLCO correlated with systemic inflammation, decompensation of carbohydrate and lipid metabolism, and duration of diabetes. Conclusion: Diabetic patients with CAD suffered from respiratory failure, manifested as decline in pulmonary function and DLCO. Blood glucose levels, inflammation symptoms, dyslipidemia and myocardial dysfunction are among suspected causes contributing to the development and acceleration of this decline.

[Rate of Detection of Atherosclerosis in Patients With ST Elevation Myocardial Infarction and Concomitant Chronic Obstructive Pulmonary Disease of Light or Moderate Degree of Severity].

PURPOSE: to study frequency of detection of atherosclerosis among patients with ST elevation myocardial infarction (STEMI) and concomitant chronic obstructive pulmonary disease (COPD) of light or moderate degree of severity, and to elucidate its relation to lung function and level of C-reactive protein (CRP). MATERIAL AND METHODS: STEMI patients (n = 154) were enrolled into 2 groups: with (n = 58, group 1) and without (n = 96, group 2) COPD of light or moderate degree of severity. Examination of all patients included pulmonary function tests, color duplex scanning of arteries, determination of C-reactive protein using high sensitive assay (hs CRP) on days 10-14 from STEMI onset. RESULTS: Group 1 patients often had multivessel coronary lesions and signs of multifocal atherosclerosis (MFA).The extent of peripheral artery disease negatively correlated with parameters of lung expiratory function. Patients of this group had higher levels of hs CRP. At the same time STEMI and COPD patients demonstrated higher CRP levels, which reflected the activity of inflammation--one of mechanisms of atherosclerosis development. CONCLUSION: In patients with STEMI and COPD of light or moderate severity impairment of expiratory lung function and elevated level of hs CRP are associated with the presence of multifocal atherosclerosis and hemodynamically significant lesions in arteries.

[Impact of chronic obstructive pulmonary disease on one-year prognosis in patients with ST-segment elevation myocardial infarction].

AIM: To assess the role of chronic obstructive pulmonary disease (COPD) in the development of unfavorable outcomes of long-term (one-year) prognosis of ST-elevation myocardial infarction (STEMI). SUBJECTS AND METHODS: A total of 529 patients diagnosed with STEMI and no age limits were examined. Group 1 included 65 (12.3%) patients with previously diagnosed COPD; Group 2 consisted of 464 (87.7%) patients without COPD. One-year prognosis was studied in 384 (81.5%) patients. The investigators evaluated the following endpoints: evolving recurrent myocardial infarction (MI), progressive angina pectoris, decompensated chronic heart failure (CHF), repeat percutaneous coronary interventions, stroke, and death. RESULTS: The prevalence of COPD was 12.3% in the patients with STEM]. Unfavorable one-year prognosis was significantly more often registered in the comorbidity group regardless of age, gender, and smoking status. COPD increased the risk of combined endpoints by 1.9 times within a year after MI and that of decompensated CHD by 2.6 times during a year after STEM. CONCLUSION: COPD may be an independent risk factor for unfavorable outcomes during a year after MI.

[Relationship between respiratory function and myocardial structure and function in patients with type 2 diabetes mellitus and ischemic heart disease].

PURPOSE: To analyze main parameters of respiratory dysfunction in patients with type 2 diabetes mellitus (DM) with and without concomitant ischemic heart disease (IHD). MATERIAL AND METHODS: We examined 104 patients with DM without (n = 64, 61.5%) and with (n = 40, 38.5%) concomitant IHD. Examination included taking medical history, registration of parameters of myocardial and respiratory function and lung diffusion capacity. RESUTS: Respiratory dysfunction in patients with DM was related to disease duration and glycose level. Presence of IHD and chronic heart failure of high functional class was associated with more pronounced reduction of forced expiratory volume in 1 sec and lung diffusion capacity. CONCLUSION: Revealed association between respiratory parameters and characteristics of the state of myocardium evidence for possible contribution of the latter in development of respiratory dysfunction in patients with DM.

[Relationship Between Respiratory Function and Myocardial Structure and Function in Patients With Type 2 Diabetes Mellitus and Ischemic Heart Disease].

PURPOSE: to analyze main parameters of respiratory dysfunction in patients with type 2 diabetes mellitus (DM) with and without concomitant ischemic heart disease (IHD). MATERIAL AND METHODS: We examined 104 patients with DM without (n= 64, 61.5%) and with (n=40, 38.5%) concomitant IHD. Examination included taking medical history, registration of parameters of myocardial and respiratory function and lung diffusion capacity. Resuts. Respiratory dysfunction in patients with DM was related to disease duration and glycose level. Presence of IHD and chronic heart failure of high functional class was associated with more pronounced reduction of forced expiratory volume in 1 sec and lung diffusion capacity. CONCLUSION: Revealed association between respiratory parameters and characteristics of the state of myocardium evidence for possible contribution of the latter in development of respiratory dysfunction in patients with DM.

[New-onset chronic obstructive pulmonary disease and its clinical significance in patients with ST-segment elevation myocardial infarction].

AIM: To estimate the prevalence of new-onset chronic obstructive pulmonary disease (COPD) and its clinical significance in patients with ST-segment elevation myocardial infarction (STEMI) on an electrocardiogram. SUBJECTS AND METHODS: The trial enrolled 154 patients with STEMI who underwent external respiratory function examination with a bronchodilatation test, as well as body plethysmography. The level of high-sensitivity C-reactive protein (CRP) was determined 10-14 days after the onset of clinical manifestations of STEMI. RESULTS: Thirty-four (22%) of the 154 patients were known to have a history of COPD. Our examination was first to reveal irreversible postbronchodilatation airway obstruction and to diagnose COPD in 24 (20%) of 120 patients having no evidence of lung pathology in the history. All patients with new-onset obstructive pulmonary disease had varying degrees of respiratory symptoms before this hospitalization; however, they did not seek medical advice. The patients with STEMI concurrent with COPD were recorded to have lower diffusing lung capacity, higher CRP levels, more frequent recurrences of myocardial infarction, early postinfarction angina, but the incidence rate of pneumonia in in-hospital myocardial infarction achieved significant differences. CONCLUSION: The trial has disclosed that screening spirometry should be performed to detect COPD in patients with ischemic lung disease, which will be able to reduce the risk of complications and to improve prognosis in this patient group.

[Prognostic role of C-reactive protein in progression of atherosclerosis in a year after coronary bypass surgery].

Aim of the study was to assess prognostic role of high sensitivity C-reactive protein (CRP) in progression of atherosclerosis in patients with ischemic heart disease (IHD) in a year after coronary artery bypass grafting (CABG). We examined 49 patients with stable IHD subjected to elective CABG (45 with and 4 without without cardiopulmonary bypass). In a year after surgery patients were divided into 2 groups: with (group 1, n=18, 36.7%) and without (group 2, n=31, 63.3%) progression of atherosclerosis of any localization. Contribution of various clinical and instrumental factors, type of intervention, CRP level before and in 1 year after surgery was analyzed. Before CABS CRP level was 3 times higher in group 1 compared with group 2 (=0.03). Increase of intima-media thickness was registered in a year after CABS in both groups, but it was significant only in patients with atherosclerosis progression (=0.04). Other clinical factors, gender characteristics of groups, type of intervention exerted no significant influence on progression of systemic atherosclerosis.

[The incidence and significance of chronic obstructive pulmonary disease in patients with myocardial infarction and elevated st segment].

The aim of this work was to study the clinical picture and outcome of myocardial infarction in patients w'ith elevated STsegment and concomitant COPD. It involved 529 patients. Group I included 65 (12.3%) patients with previously diagnosed COPD. Group 2 was comprised of 464 (87.7%) patients without COPD. The study lasted 1 year. The patients of group 1 were older and smoked more heavily than in group 2. They had a higher clinical class of cardiac failure and more frequently showed reduced (by 40%) left ventricular ejection friction. Also, they required significantly longer hospital treatment, developed more complications, and showed higher inpatient mortality rate. The annual prognosis for them was less favourable than in group 2.

[The role of subclinical inflammation in the formation of early signs of cardiac lesions in hypertensive disease].

Compromised diastolic relaxation of the left ventricle occurs in hypertensive disease with and without its hypertrophy. Classic ventricular hypertension takes some time to develop during which manifestations of myocardial diastolic dysfunction remain the sole criterion (marker) of the lesion. Patients with uncomplicated arterial hypertension display interrelated changes in inflammation, endothelial function, and disorders at the level of different organs. These relationships are believed to be underlain by common neurohumoral mechanisms.

[Determinants of the respiratory system status in hypertensive disease].

AIM: To analyze the respiratory system in hypertensive disease (HD). SUBJECTS AND METHODS: Forty-six hypertensive patients (mean age 43.2 +/- 4.0 years) were examined. Office blood pressure (BP) was measured. Electrocardiography, echocardiography, color Doppler ultrasonography of the brachial artery, 24-hour BP monitoring, spirography, body plethysmography, and study of the diffusion lung capacity for carbon monoxide were performed. The serum levels of interleukins 6, 8, and 10, tumor necrosis factor (TNF), and C-reactive protein (CRP) were measured. RESULTS: Inflammatory processes have been ascertained to contribute to the development and progression of HD. The increase in HD degree and stage is attended by a significant elevation of the plasma concentrations of proinflammatory cytokines, TNF, and CRP, which is due to the contribution of inflammatory processes in the vessel wall to the development of endothelial dysfunction, vascular remodeling, and organ lesions, including diminished lung function in HD. CONCLUSION: Arterial hypertension, inflammatory indicators, endothelial function, and the degree of lesions to organs, including those in the respiratory system, are related. The basis for this relation is the common neurohumoral mechanisms of progression of nonspecific inflammation, endothelial dysfunction, and target organ lesions.

[Clinical significance of nitric oxide levels in patients with chronic glomerulonephritis].

Nitric oxide (NO) takes an active part in the regulation of the main renal functions, water-salt metabolism, and system arterial pressure. Under pathological conditions, NO plays the leading role in the development and progression of nephrosclerosis. The aim of this study was to evaluate the clinical significance of serum and urine levels of stable NO metabolites in patients with various clinical forms of chronic glomerulonephritis (CGN), as well as CGN patients with chronic renal failure (CRF). Ninety-seven CGN patients, including 56 ones with preserved nitrogen excretion and 41 ones with CRF, were examined. The levels of stable NO metabolites (nitrites and nitrates) in serum and 24-hour urine were measured. The highest serum and urine NO levels were found in patients with nephrotic and hematuric CGN; patients suffering from latent and hypertonic CGN displayed the lowest levels. Patients with CRF had higher serum levels of NO compared with non-CRF patients. A reverse correlation between serum levels of creatinine and NO in patients with CRF was revealed. In CGN patients without CRF, the activity of inflammatory process, observed by high C-reactive protein levels, was associated with elevation of blood and urine levels of NO, while such an association was not found in patients with CRF.