ABSTRACT
Cardiovascular toxicity is one of the important problems of clinical oncology. Atherosclerosis progression was demonstrated in patients with cancer and chemotherapy.Te aim - to evaluate the vascular wall characteristics and to determine the predictors of AS of brachiocephalic arteries progression during anticancer therapy in patients with breast cancer. METHODS: Te study involved 43 patients with newly diagnosed breast cancer (BC) (II-III stage) with overexpression of HER2; median age 50 (40;57) years. All patients underwent neoadjuvant drug therapy with antracyclines, taxanes and trastuzumab followed by surgery, radiation and hormone therapy according to the indications. Before anticancer therapy the general clinical examination was conducted and lipid profle, plasma lipoprotein (a) [Lp(a)] level, titres of autoantibodies IgM and IgG to lipoproteins and their oxidized derivatives were estimated. Te vascular wall stiï¬ness (pulse wave velocity on the carotid-femoral (PWVcf) and shoulder-ankle (PWVsa) segments, the central pressure, carotid intima-media thickness (CIMT) and the degree of stenosis of the brachiocephalic arteries) were determined at baseline and at each stage of anticancer therapy. Te atherosclerosis progression was determined if the new stenosis (≥15%) or increase of preexisting stenosis (≥5%) were revealed; CIMT increase ≥ 0.1 mm. Te parameters of cellular immunity (peripheral blood lymphocyte phenotyping via direct immunoï¬uorescence and ï¬ow cytometry), lipid spectrum parameters, serum concentration of Lp (a), autoantibodies IgM and IgG against lipoproteins and their oxidized derivatives, as well as PWVÑf and PWVsa were assessed in 17 BC patients before the onset of neoadjuvant therapy and in 20 healthy women. RESULTS: BC patients and healthy women were comparable in traditional cardiovascular risk factors but diï¬ered in PWVsa and PWVcf levels (p<0.05). In BC patients the activation of T-cell immunity with the stimulation of both subpopulations with pro-inï¬ammatory and regulatory properties was observed (p<0.05). Te direct correlations between the content of activated T-lymphocytes (T-act), T-helpers (T) 1 and PWVsa (p<0.05), as well as T-act, T1 and T2 and PWVcf (p<0.05) were revealed in the general group. Te decrease of systolic blood pressure (SBP), central SBP (SBPc), central diastolic blood pressure (DBPc), PWVcf and PWVsa levels accompanied with a temporary heart rate increase were observed during anticancer therapy; SBP, SBPc, PWVcf levels restored by the end of the follow-up period. Te CIMT increase was detected in 22 (51%), and the atherosclerosis progression in 26 (60%) BC patients during anticancer therapy. Lp (a) level above 12.8 mg/dl was associated with CIMT increase (p<0.05). Age > 48 years and radiation therapy were risk factors for CIMT increase and atherosclerosis progression (p<0.05), respectively. CONCLUSIONS: Te vascular stiï¬ness is increased in BC patients, which is associated with the activation of eï¬ector subpopulations of T-lymphocytes and the elevation of circulating level of both pro-atherogenic and anti-atherogenic T-cells. Te level of Lp (a) above 12.8 mg/dl is associated with atherosclerosis progression, which requires further research. Age and radiation therapy are the risk factors for atherosclerosis progression during anticancer therapy.
Subject(s)
Atherosclerosis , Breast Neoplasms , Vascular Stiffness , Adult , Arteries , Carotid Intima-Media Thickness , Female , Humans , Middle Aged , Pulse Wave Analysis , Risk FactorsABSTRACT
Transthoracic and transesophagal echocardiography (TT EChG and TE EChG) were performed in 43 patients with infectious endocarditis (IE). Sensitivity and specificity of TE EChG in detection of vegetations were higher (92 and 75%, 81 and 50% for TE EChG and TT EChG, respectively). Vegetations and thromboembolism were unrelated. With TE EChG, morphologically verified perforations of valvular cusps were revealed 3 times more frequently than with TT EChG. Along with detection of vegetations and dysfunction of the prosthetic valve, an essential diagnostic marker of IE of the artificial valve is visualization of paraprosthetic fistulas in 2 of 5 patients. Indications for TT and TE EChG and techniques of their performance are described. TT EChG is used in screening for IE. TE EChG is conducted in complications of IE.
Subject(s)
Echocardiography, Transesophageal/methods , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/microbiology , Pseudomonas Infections/complications , Salmonella Infections/complications , Staphylococcal Infections/complications , Adolescent , Adult , Aged , Humans , Middle AgedABSTRACT
Fluorescent method for measuring mass (total) albumin concentration in human blood serum is suggested. Fluorophore K-35 previously suggested for measuring the effective concentration of albumin is recommended. Total albumin concentration is measured in acid pH range in the presence of nonionic detergent. Conditions under which the effects of factors impeding albumin assay virtually do not manifest were found. The resultant values of total albumin concentration coincide with the values determined by the bromocresol purple method.
