[Нospital outcomes of coronary artery bypass grafting in patients with coronary heart disease with previous percutaneous coronary intervention].

AIM: Evaluation of the frequency hospital cardiovascular events in groups of patients with stable angina who underwent percutaneous coronary interventions (PCI) with stenting of the arteries before coronary bypass surgery, or who did not have previous myocardial revascularization. MATERIALS AND METHODS: The 120 patients with stable angina who underwent routine coronary artery bypass grafting were examined. Group composition: Men 80.8%, age 587.6, duration of coronary heart disease 65.7 years, history of myocardial infarction (MI) 77.5%. Arterial hypertension was present in 92.5%, diabetes mellitus in 12.5% of patients. Multivessel coronary artery disease in 72.5% of patients. 28 (23.4%) patients had previously undergone PCI with stenting of the coronary arteries. The period from PCI to coronary bypass surgery was 2032.6 months. Coronary bypass surgery on-pump was performed in 88.3%, coronary bypass surgery on off-pump in 11.7%. The number of distal anastomoses ranged from 1 to 4. RESULTS: There were no differences in clinical and angiographic indicators, pharmacotherapy, and operation characteristics between the groups of patients who were subjected to or did not have PCI before coronary bypass surgery. There were no differences between the analyzed groups of patients in the frequency of cardiac death (0 and 1.1%, p=0.58), non-fatal MI (3.6% and 9.8%, p=0.29), stroke (0 and 1.1%, p=0.58), acute heart failure (11.7% and 34.8%, p=0.06), the number of patients with paroxysms of atrial fibrillation (28.6% and 17.4%, p=0.94), the proportion of patients with resternotomies (3.6% and 3.3%, p=0.94) and gastrointestinal bleeding (3.6% and 4.3%, p=0.86). CONCLUSION: PCI with coronary artery stenting, prior to coronary bypass surgery, does not affect the frequency of post-operative hospital cardiovascular and hemorrhagic complications.

Risk Factors and Hospital Outcomes of Acute Kidney Injury in Patients Operated on for an acquired Valvular Heart Disease.

Aim      To determine predictors of acute kidney injury (AKI) related with surgeries for correction of acquired valvular heart disease (HD) and to evaluate the incidence of in-hospital complications in patients with postoperative AKI.Material and methods  This study included 62 patients after surgery for correction of acquired valvular HD (mean age, 61±10.9 years) with a disease duration of 11±5.3 years. NYHA functional class (FC) 1 chronic heart failure (CHF) was observed in 1.6 % of patients, FC 2 in 64.5 %, and FC 3 in 33.9 %.17.7% of patients had chronic kidney disease (CKD). Coronary lesions of ≥50 % of vascular lumen were detected in 27.4 % of patients. Surgical correction of mitral valvular disease was performed in 32 cases, aortic valvular disease in 36 cases, tricuspid valvular disease in 8 cases, and combined operations for correction of valvular disease and coronary bypass in 8 cases. Creatinine concentrations were measured according to the Jaffe method; glomerular filtration rate (GFR) was estimated with the CKD-EPI equation. AKI was diagnosed based on KDIGO (2012) criteria.Results The AKI incidence related with surgeries for correction of valvular HD was 16.1 % (8.1 % of patients had stage 1 AKI, 3.2 % had stage 2 AKI, and 4.8 % had stage 3 AKI), and 3.2% required kidney replacement therapy. AKI was associated with the presence of CKD at baseline (р=0.044), development of hemopericardium requiring drainage (р=0.012), more pronounced coronary lesions (in the AKI group: stenoses from 50 to 70 % in 20% of patients, from 70 to 90 % in 30 % of patients, and ≥90 % in 0 %; without AKI: from 50 to 70 % in 13.4 % of patients, from 70 to 90 % in 3.8 %, and ≥90 % in 5.8 % of patients, respectively; р=0.032). Probability of postoperative AKI significantly increased with the development of hemopericardium requiring drainage. Patients with postoperative AKI compared to persons without AKI had higher mortality (20 % and 0 %; р=0.001), greater incidence of decompensated CHF (40 and 9.6 %; р=0.012) and hemopericardium requiring drainage (30 and 1.9 %; р=0.012).Conclusion      The development of postoperative AKI is associated with CKD at baseline, more pronounced coronary injury, and hemopericardium requiring drainage.

[The role of vitamin D in the pathogenesis of arterial hypertension.]

In recent years, accumulated numerous data on the pathogenetic links of the formation of arterial hypertension. A number of studies have shown that vitamin D deficiency, associated with age, changes in sex hormonal status, increased tone of the reninangiotensin-aldosterone system, endothelial dysfunction, and calcium metabolism, can be one of the mechanisms of development and progression of arterial hypertension. The purpose of the review was to summarize the results of the original domestic and foreign studies, prospective observations and meta-analyzes on the relationship between vitamin D deficiency and arterial hypertension.

[The importance of modern high - sensitivity troponin tests in the diagnosis of myocardial infarction without ST-segment elevation].

The literature review presents the characteristics of modern high - sensitivity tests for detection of Tn (hs - cTn) in the blood and the results of large studies on the diagnosis of non segment elevation myocardial infarction (nonSTEMI) using hs - cTn. The results of these studies served as the basis for the development of three - and one - hour diagnostic algorithms nonSTEMI, presented in the recommendations of the European Society of Cardiology 2012 and 2015 and also in fourth Universal Definition of Myocardial Infarction 2018.

Risk factors and in-hospital outcomes of acute kidney injury that developed after coronary artery bypass grafting in patients with stable angina.

AIM: The aim of the study is to assess frequency, risk factors and in-hospital outcomes of acute kidney injury after coronary artery bypass grafting in patients with stable angina. MATERIALS AND METHODS: The study included patients with stable angina pectoris and indications for coronary artery bypass grafting. We examined 93 patients aged 58±7.6 years, with duration of coronary heart disease 6±6.0 years. Previous myocardial infarction had 79.6% of patients. Arterial hypertension was present in 92.5% of patients. Multi-vessel coronary disease was registered in 94.6%, stenosis of the left main coronary artery > 50% was in 16.1% of patients. Coronary artery bypass grafting in conditions of artificial circulation was performed in 89.2% of patients, coronary grafting on working heart was held in 10.8% of patients. At initial stage, on the first and second days after coronary grafting the level of creatinine was determined by the method of Jaffe. The presence, the severity of acute kidney injury after (AKI) coronary artery bypass grafting was evaluated according to the criteria KDIGO (2012). We took into account in-hospital complications: cardiac death, intraoperative myocardial infarction (iMI), stroke, atrial fibrillation (AF), acute heart failure (AHF) according to requirement in intraaortic balloon pump, and the use of adrenaline. RESULTS: The proportion of persons with transient AKI stage 1 after coronary artery bypass grafting was 31.2%, those of 2 stage was 3.2%. The development of AKI was associated with cases of AHF. The increase in the duration of therapy with adrenaline - more than 1±1.8 days (median) - was connected with increase of the relative risk of AKI developing in 1.9 times. The incidence of cardiac death, iMI, strokes, paroxysmal AF did not differ among patients with AKI and without it. CONCLUSION: The frequency of transient AKI after coronary artery bypass grafting was 34.4%. The development of AKI is associated with AHF that occurred during coronary artery bypass grafting. The frequency of hospital complications did not differ among patients with AKI after coronary artery bypass grafting and without it.

[Evaluation of the rate of lipid peroxidation and antioxidant defense in blood during gynecological laparoscopic operations].

The impact of gynecological operations on the rate of lipid peroxidation (LPO) and erythrocytic antioxidant defense (EAOD) was studied in women with uterine myoma. The higher rate of LPO and the decreased level of vitamin E were preoperatively found. A further increase in LPO activity and a reduction in vitamin E concentrations were observed 1-4 days after surgery. Recovery of the study parameters was seen on days 5-7 postoperatively. The enzyme glutathione-S-transferase was ascertained to play a pivotal role in the EAOD system.

[Association of goiter endemic and latent iron deficiency in Western Siberia].

The purpose of the investigation was to study the prevalence of latent iron deficiency and goiter endemic and their association in prepubertal children in Western Siberia. A total of 2238 prepubertal children (8-12 years) living in 3 subjects of the Tyumen Region were examined in 2005-2006. The classical criteria for Iodine deficiency (ID), such as iodurla, the frequency of goiter at palpation and ultrasonography, were studied. Serum ferritln was determined by enzyme-linked immunosorbent assay using the DRG-Diagnostics ПРОБЛЕМЫ ЭНДОКРИНОЛОГИИ. 2007. Т. 53, № 5. kits (USA). There was normalization of the median ioduria, which was 117,', in the implementation of the ID prevention program in Western Siberia. By taking into account the 2003 WHO standards, the severity of goiter endemic in 2006 is regarded as moderate in the southern districts of the region and as severe in its autonomous areas. In terms of a serum ferritin level of less than 15 a high frequency of latent iron deficiency was found in the everywhere. Hence it follows that the association of the serum ferritin levels with the thyroid volumes is caused by a concomitance of two significant conditions: severe goiter endemic and frequent latent iron deficiency.

[Assessment of the results of determination of the blood level of dehydroepiandrosterone sulfate by using various commercial reagents].

The results of determination of the blood levels of dehydroepiandrosterone (DHEA) sulfate (DHEA-S) were comparatively assessed, by using the test systems "Steroid-IEA-DHEA-sulfate" (ZAO "Alkor Bio" (Saint Petersburg, Russia)) and "DHEA-S ELISA ("DRG Instruments GmbH (Germany)). The studies were conducted in apparently healthy 19-59-year-old women living in the middle belt of Western Siberia. They revealed the high sensitivity of the study test systems to age-related changes in the blood concentration of DHEA-S. The normal blood DHEA-S concentrations levels given in the instruction to the "DHEA-S ELISA" test systems were found to be decreased in they are used to measure the content of the above analyzed parameter in women aged 19-39 years.