Early diagnosis of acute renal injury in patients with acute decompensation of chronic heart failure.

AIM: To study the possibilities of previously diagnosing acute renal damage in patients with acute decompensation of chronic heart failure with reduced systolic function using biomarkers of acute renal injury. MATERIALS AND METHODS: The study included 60 patients (62.0±11.1 years) with HADS (BNP >500 pg/ml) and a reduced left ventricular ejection fraction (LV 27.05% [23.25; 32.75], c FC III-IV NYHA). The level of creatinine, urea, uric acid, albumin in serum was determined in all patients, as well as a number of biomarkers: lipocalin associated with neutrophil gelatinase (NGAL) and cystatin C (CysC) in serum; kidney damage molecule-1 (KIM-1) and angiotensinogen (AGT) in the urine. RESULTS: AKI is determined based on changes in serum creatinine concentration or diuresis value. The results obtained indicate a high specificity and sensitivity of the use of biomarkers for the diagnosis of AKI in patients with ADHF. NGAL AUC - 0.833 (p<0.001), Se - 82.8%, Sp - 4.2%. CysC AUC - 0.823 (p<0.001), Se - 79.3%, Sp - 74.2%. KIM-1 AUC - 0.782 (p<0.001), Se - 75.9%, Sp - 74.2%. AGT AUC - 0.829 (p<0.001), Se - 82.8%, Sp - 77.4%. In a multifactorial regression analysis, it was found that with NGAL greater than 157.35 ng/ml, the risk of AKI increases 13.1 times (95% CI 1.365-126.431), with an increase in KIM-1, the risk of the development of AKI increases 20.6 times (95% CI 1.802-235.524), and with an increase in AGT more than 14.31 leng/ml, the risk of AKI increases 32.8 times (95% CI 2.752-390.110). CONCLUSION: Acute kidney injury develops in 48.3% of patients hospitalized with acute decompensation of chronic heart failure. Patients with acute decompensation of chronic heart failure and AKI have significantly higher serum NGAL and CysC, KIM-1 and AGT values in the urine compared with patients without impairing renal function. These biomarkers can serve both for the early diagnosis of acute kidney damage and the prediction of AKI in patients with acute decompensation of chronic heart failure.

[24-hour systolic wave increment index monitoring in patients with low-renin arterial hypertension].

AIM: To analyze the circadian rhythm of blood pressure (BP) and daily reflected wave values in patients with low-renin hypertension with normal and elevated aldosterone production. SUBJECTS AND METHODS: The investigation included 66 patients. 24-hour BP monitoring was carried out and arterial wall rigidity and reflected wave values were assessed in all the patients. RESULTS: The patients with hyperaldosteronemia were found to have not only statistically significant severer hypertension, impaired circadian rhythms of BP, but also impaired augmentation index (Aix)--mainly its nocturnal increase. A positive correlation was found between nocturnal Aix and resting plasma aldosterone concentrations (r = -0.31; p = 0.002). CONCLUSION: The findings suggest the expediency of 24-hour systolic wave increment index monitoring in hypertensive patients ofthis category.

[Eosinophilic cation protein and development of restenosis of drug covered stents].

Aim of the study was to assess activation of eosinophils as well as allergic and inflammatory reactions of the body in development of restenosis after implantation of stents with drug covering. We included into the study 32 patients with ischemic heart disease (IHD) and stable angina subjected to repeat coronary angiography during first year after endovascular myocardial revascularization with the help of stents with drug covering, and 11 healthy persons. Levels of eosinophilic cation protein (ECP), immunoglobulin E (IgE), and C-reactive protein (CRP) in blood plasma of patients and healthy persons was determined by immunoenzyme assay. According to results of angiographic study patients were divided into 2 groups: the first comprised 19 patients in whom no instent restenosis was found, the second comprised 13 patients in whom formation of restenosis at least in one stent was noted. Patients in these groups did not differ by age, sex, smokers and nonsmokers ratio, presence of hyperlipidemia, and angiographical characteristics of involved arteries. In patients with restenosis of stents blood plasma ECP level was 17.7 (11.2-24.0) g/ml and significantly higher than in patients without restenosis [9.0 (6.4-12.9) g/ml; p=0.017]. Blood level of IgE in these groups of patients did not differ [58.8 (42.1-164.0) and 52.9 (12.8-76.1) mg/ml, respectively; p=0.40] and did not differ from IgE level in blood of healthy volunteers [32.0 (21.2-80.8) mg/ml; p=0.91]. CRP level in patients with IHD was higher than in healthy volunteers [0.36 (0.1-0.75) mg/ml; p=0.0008)], but did not differ significantly in groups of patients with and without restenosis [2.38 (0.30-4.08) and 1.63 (0.61-2.47) mg/ml, respectively; p=0.52]. It was found that in the group of patients with low blood level of ECP (<11 g/ml) restenoses were revealed in 19% while in the group with higher blood level of ECP (>11 g/ml) - in 62% of cases (p=0,019). In patients subjected to coronary stenting with higher level of ECP in blood we noted more frequent development of restenoses than in patients with low level of this protein. The data obtained allow to suggest presence of relationship between development of restenosis and elevated activity of eosinophilic granulocytes in patients with IHD after revascularization.

[Changes of content of regulatory lymphocytes and concentration of soluble interleukine-2 receptor in blood of patients with ischemic heart disease after coronary artery angioplasty with implantation of stents with rapamycin covering].

We studied dynamics of content of subpopulation of lymphocytes including regulatory and effector T-lymphocytes as well as concentration of soluble form of interleukine-2 receptor (sCD25) in peripheral blood of patients after coronary stenting (CS) with implantation of stents with rapamycin covering (SRC). We included into the study 62 patients with stable effort II-III functional class angina. Coronary angiography (CA) was carried out in all, CS with implantation of 1 - 2 SRC - in 42 patients. Blood samples were taken before CA/CS, in 24, 48 hours, 7 days, 1 and 3 months after intervention. Content of T-, helper and cytotoxic T-cells, -, NK-, NKT-cells, activated effector T-lymphocytes (CD4+CD251owCD127high) and regulatory T-lymphocytes (CD4+CD25highCD1271ow) were measured by direct immunofluorescence and flow cytometry. CD4+ lymphocytes were isolated from mononuclear cell fraction of donor blood by magnetic separation. Content of regulatory T-lymphocytes in culture were determined by expression of a specific marker FOXP3+. Concentration of sCD25 was measured by chemiluminescent method. It was shown that content of main subpopulations of lymphocytes in blood changed after CS or CF. Blood content of regulatory T-lymphocytes and sCD25 significantly increased after 7 days and 1 month after CS but not after CA. Plasma sCD25 concentration correlated with content of regulatory T-lymphocytes in 1 month after SRC implantation. During cultivation of CD4+ lymphocytes in the presence of rapamycin we noted antiproliferative effect relative to FOXP3-cells and accumulation of regulatory +-lymphocytes. Thus implantation of SRC in coronary arteries leads to increase of number of circulating regulatory T-lymphocytes and blood concentration of sCD25. Changes of these parameters after CS can reflect peculiarities of local and systemic reaction arising in response to introduction of stent with drug covering and be significant for assessment of prognosis of the disease.

[Peculiarities of dynamics and prognostic value of NT-proBNP level in different variants of treatment of patients with acute coronary syndrome].

UNLABELLED: Aim of the study was to assess dynamics of NT proBNP in ACS as well as to analyze effect of different methods of treatment on the level of the parameter and its prognostic value. MATERIAL AND METHODS: Patients aged 30-70 years were included into the study: 52 patients with ST segment elevation ACS (STEACS), 61 patients with non ST-segment elevation ACS (NSTEACS). Control group comprised 20 people of the same age without ischemic heart disease. In all patients serum was taken for subsequent measurement of NT proBNP at admission, on day 3 of hospitalization, and before discharge (days 7-10). RESULTS: In ACS baseline NT proBNP concentration was significantly higher than in stable angina and in control group. During period of hospitalization NT proBNP level rose in the group of patients with STEACS and fell in the group of patients with NSTEACS. After early restoration of coronary blood flow (less than 4 hours after onset on the pain syndrome) in patients with STEACS dysfunction of the left ventricular myocardium was less pronounced (NT proBNP level was lower). High level of NT proBNP was an unfavorable prognostic factor in ACS irrespective of the selected tactics of treatment.

[Comparative dynamics of markers of inflammation and NT-proBNP in different variants of treatment of patients with ACS].

STUDY AIM - assessment of dynamics of markers of inflammation (CRP, Il-6, Il-10, TNFa, CD40L, fibrinogen) and N - N in acute coronary syndrome (ACS) as well as analysis of effect of various methods of treatment on level of these parameters. Patient aged 30 - 70 years were included in the study: 52 patients with ACS with ST-segment elevation (STEACS) and 61 - without ST-segment elevation (NSTEACS). Initial level of markers of inflammation (Il-6, CRP) in STEACS was lower than in NSTEACS. Initial level of antiinflammatory Il-10 was significantly higher in patients in the STEACS group (72.6 +/- 39.1 and 6.6+4.2 pg/ml, < 0.01). At admission the highest values of N - N were noted in the group of NSTEACS (761.5 pg/ml compared with 451.1 pg/ml in STEACS, =0.04). During period of hospitalization elevation of N - N occurred in the group of STEACS while its lowering occurred in the group of NSTEACS. In STEACS patients with early restored coronary blood flow dysfunction of the myocardium was less pronounced (lower level of N - N ). In patients with NSTEACS during period of hospitalization levels of CRP, Il-6 fibrinogen lowered. In invasively treated patients with NSTEACS levels of CRP and fibrinogen lowered to a greater extent than in conservatively treated.

[The correlation of the indices of humoral immunity and of the activity of the renin-angiotensin-aldosterone system in hypertensive patients]. / Sootnoshenie pokazatelei gumoral'nogo immuniteta i aktivnosti renin-angiotenzin-al'dosteronovoi sistemy u bol'nykh gipertonicheskoi bolezn'iu.

The content of IgA, IgM, IgG and IgE was measured in 55 male patients with uncomplicated essential hypertension (EH) running a labile course (25 patients) and a stable course (30 patients). Analyzing the material, account was taken of aggravated heredity factor as regards arterial hypertension, established according to the anamnesis in relatives of the first degree kinship. A group of patients with the aggravated familial anamnesis as regards arterial hypertension were distinguished. They suffered from labile hypertension with a tendency to hyperreninemia and IgE overproduction, which may be unfavourable in terms of EH progression and development of cardiovascular complications.

[The effect of a submaximal physical load on the beta 2-adrenoreceptor-dependent adenylate cyclase system of the lymphocytes in hypertension]. / Vliianie submaksimal'noi fizicheskoi nagruzki na beta 2-adrenoretseptorzavisimuiu adenilattsiklaznuiu sistemu limfotsitov pri gipertonicheskoi bolezni.

Effects of dynamic exercise on lymphocyte beta 2-adrenoreceptor density (BARD) and adenylate cyclase activity (ACA) basal and stimulated by isoproterenol (I). Gpp(NH)p, Gpp(NH)p+I, and forskolin (F), on plasma adrenaline and noradrenaline levels, renin activity (PRA) were compared in 6 healthy donors and 12 patients with essential hypertension (EH). Acute stimulation of sympathetic activity by dynamic exercise leads to a rapid increase in lymphocyte BARD in normotensive and hypertensive subjects. The rise in BARD was accompanied by a significant increase in lymphocyte basal ACA in normotensive subjects, but not hypertensive patients. In patients with EH, basal ACA changed after exercise according to their renin status: patients with low baseline PRA showed a decrease in basal ACA after exercise, whereas patients with normal baseline PRA showed an increase as did normotensive subjects. Patients with decreased basal ACA after exercise also showed a lower ACA stimulation by IPR, F, Gpp (NH)p and Gpp(NH)p+IPR, which did not change after exercise. These patients also exhibited substantial rises in PRA with exercise. These was an inverse relationship between exercise-induced changes in PRA and basal ACA. So the acute regulation of lymphocyte BARD-ACA system is changed in a subset of patients with EH. The pattern of the regulation of this lymphocyte system is associated that of baseline renin activity and of its response to exercise in patients with EH.

[Combined use of hemosorption and isolated ultrafiltration of the blood in patients with refractory heart failure]. / Sochetannoe primenenie gemosorbtsii i izolirovannoi ul'trafil'tratsii krovi u bol'nykh s refrakternoi serdechnoi nedostatochnost'iu.

Combination of isolated blood ultrafiltration (IBUF) and hemosorption (HS) produced subcompensation of severe congestive heart failure (CHF) in 10 of 14 patients refractory of IBUF alone and to drug therapy. HS included in the therapy complex was the only way to correct secondary hyperaldosteronism, to reduce antidiuretic hormone blood level, to increase diuresis and natriuresis and to reduce kaliuresis as well as to normalize blood electrolyte level. The withdrawal of excessive water with IBUF and bilirubin and creatinine with HS as well as direct detoxication effect on the liver with HS reduced in most patients hyperbilirubinemia, hypoproteinemia and azotemia--aggravating factors in patients with CHF.