[Informativeness estimation for the main clinical and laboratory parameters in patients with severe COVID-19].

AIM: To conduct a retrospective assessment of the clinical and laboratory data of patients with severe forms of COVID-19 hospitalized in the intensive care and intensive care unit, in order to assess the contribution of various indicators to the likelihood of death. MATERIALS AND METHODS: A retrospective assessment of data on 224 patients with severe COVID-19 admitted to the intensive care unit was carried out. The analysis included the data of biochemical, clinical blood tests, coagulograms, indicators of the inflammatory response. When transferring to the intensive care units (ICU), the indicators of the formalized SOFA and APACHE scales were recorded. Anthropometric and demographic data were downloaded separately. RESULTS: Analysis of obtained data, showed that only one demographic feature (age) and a fairly large number of laboratory parameters can serve as possible markers of an unfavorable prognosis. We identified 12 laboratory features the best in terms of prediction: procalcitonin, lymphocytes (absolute value), sodium (ABS), creatinine, lactate (ABS), D-dimer, oxygenation index, direct bilirubin, urea, hemoglobin, C-reactive protein, age, LDH. The combination of these features allows to provide the quality of the forecast at the level of AUC=0.85, while the known scales provided less efficiency (APACHE: AUC=0.78, SOFA: AUC=0.74). CONCLUSION: Forecasting the outcome of the course of COVID-19 in patients in ICU is relevant not only from the position of adequate distribution of treatment measures, but also from the point of view of understanding the pathogenetic mechanisms of the development of the disease.

[AL-amyloidosis with cardiac involvement. Diagnostic capabilities of non-invasive methods].

There are presented the literature data and a description of the clinical course of the disease in isolated/predominant cardiac amyloidosis. Amyloid cardiomyopathy is the most common phenocopy of hypertrophic cardiomyopathy. The modern possibilities of non-invasive diagnostics using osteoscintigraphy for the differential diagnosis between amyloid cardiomyopathy caused by AL- and transthyretin amyloidosis are described in detail.

[Characterisation of circulating microRNA-21 levels in patients with hypertrophic cardiomyopathy].

AIM: To study the levels of circulating microRNA-21 in patients with hypertrophic cardiomyopathy (HCM) of different ages. MATERIALS AND METHODS: The study included 49 patients with HCM. The proportion of females was 55.1%, males 44.9%. The average age was 50 [32; 65] (from 19 to 86 years). The control group for microRNA-21 included 44 healthy individuals, respectively, matched by the age and sex with the studied patients. Patients was made in accordance with the recommendations of the European society of cardiology. Plasma microRNA expression was determined by PCR with reverse transcription and real-time detection of results. The relative level of gene expression was calculated in accordance with the standard procedure 2-Ct. RESULTS: Septal wall thickness at end diastole has a significant negative correlation with age in patients with HCM (r=-0.56; р0.001). PWTd (posterior wall thickness at end diastole) has a significant positive correlation with age in patients with HCM (r=0.67, р0.001). The level of circulating microRNA-21 in plasma is higher in patients with HCM compared to healthy individuals (5.28 [2.64; 13.96] and 0.84 [0.55; 1.23], respectively; p0.001). Significantly higher levels of microRNA-21 were found in young patients aged from 19 to 45 years with the symptomatic course of HCM (36.76 [5.66; 42.22]) compared to patients with asymptomatic course 45 years of age (2.81 [1.45; 5.28]; p0.002) and symptomatic patients 45 years (3.88 [2.16; 8.63]; p0.002).) The calculated risk of SCD was significantly higher in young symptomatic patients with HCM (6.01 [3.64; 9.67]) compared to patients with asymptomatic course 45 years (2.41 [1.21; 3.89]; p0.001) and symptomatic patients 45 years (2.56 [1.67; 4.41]; p0.001). CONCLUSION: The level of circulating microRNA-21 is significantly in patients with HCM compared to control group. The maximum level of circulating microRNA-21 was detected in patients with symptomatic course of HCM at the age of 45 years.

[Left ventricular non - compaction: contemporary view of genetic background, clinical course, diagnostic and treatment].

This review highlights and discusses recent advances in understanding left ventricular non - compaction (LVNC). Clinical profile, prognosis and even diagnosis are still a great challenge faced by the world. The population prevalence of left ventricular non - compaction remains unknown. High variability of clinical manifestations, genetic heterogenity with overlap of different phenotypes, variability of hereditary patterns suggests that LVNC seems to be rather an isolated trait or a part of phenotypic expression of different cardiac diseases or complex genetic syndromes.

[Hypertrophic cardiomyopathy: modern aspects of pharmacologic treatment].

This article discusses recent advances in understanding genetic basis and classification of hypertrophic cardiomyopathy. Here, we review pharmacologic treatment strategies and new developments in disease - specific management of HCM.

[Transthyretin amyloidosis in a cohort of old and very old patients with chronic heart failure].

BACKGROUND: Life-time diagnostics of wild type transthyretin amyloidosis (ATTR(wt)-amyloidosis) is virtually absent, even though ATTR(wt)-amyloidosis is an underestimated cause for morbidity and mortality, particularly in the older age group. AIM: To study incidence, demographic characteristics, and morpho-functional features of ATTR(wt)-amyloidosis in patients with FC IV CHF and LV hypertrophy > 15 mm according to autopsy data. MATERIALS AND METHODS: Postmortem reports were retrospectively analyzed for patients (n=141; 19 % males, 81 % females) of cardiology departments aged ≥69 with the underlying CHF syndrome. From all formalin-fixed fragments of the myocardium embedded in paraffin were prepared 5-7 mkm cuts, which were stained with Congo red (Sigma, USA) and viewed under normal and polarized light. Immunohistochemical analysis was also performed using antibodies to AA-amyloid, transthyretin, kappa and lambda-light chains of immunoglobulins. RESULTS: deposits were found in both old and very old persons aged 91.25±9.67, mostly in women due to shorter life span of men. In different FCs associated with LV hypertrophy, according to autopsy data amyloid deposits were observed in virtually every fifth deceased (21 % of cases). The amount of myocardial amyloid deposits was generally small (56 % of cases had (+) and 27 % had (++) amyloid deposits); 17 % of cases had considerable amyloid deposits (7 % had (+++) and 10 % had (++++)). The presence of amyloid deposits did not influence indexes of myocardial hypertrophy, such as ventricular septum thickness, LV posterior wall thickness, and heart mass. In the presented cases we observed focal amyloid deposition in the myocardium typical for old age-related amyloidosis; in 97 % cases, amyloid was located in the interstitium, around cardiomyocytes and in 3 % of cases - exclusively around blood vessels. CONCLUSION: ATTR (wt)-amyloidosis was detected in every fifth patient in the old and very old cohort, primarily in women (83 %), and was not diagnosed during the life time. Characteristic morphological manifestations of ATTR(wt)-amyloidosis were focal amyloid deposits mostly in the myocardial interstitium.

Intravital and postmortem diagnostics of myocardial hypertrophy of the left ventricle:identity or convention?

AIM: The aim of the study is to assess the compliance of the results of electrocardiographic (ECG) and echocardiographic diagnostic methods of hypertrophy of left ventricular myocardium (LVH) with the postmortem finding of measurement of left ventricular myocardium mass (LVM). MATERIALS AND METHODS: We examined the data of intravital study of anthropometric measurements [age, height, weight, body mass index (BMI)], instrumental results [12-lead ECG, EchoCG], as well as the postmortem finding (direct measurement of LVM at autopsy) in 15 patients of general therapy department. While analyzing ECG we studied as conventional ECG criteria for the detection of LVH as well as the author's own criteria based on two models (regression and discriminant analyses), including voltage, sex and age criteria. Echocardiographic diagnostic method used to calculate LVM (according to ASE formula) and left ventricular mass index (LVMI). Postmortem finding of LVM was carried out according to the standard measurement method. According to the absence of the single conventional postmortem finding of measurement of LVH, we considered three different variants of the postmortem finding of LVH: the criterion of K. Bove et al. (CB); the criterion of A.M. Lifshitz, also called ventricular index (VI) and the criterion of P. Casale - the left ventricular mass index at autopsy (LVMI). RESULTS: Conventional ECG criteria for the detection of LVH showed high specificity (71-100%) using any method of the postmortem finding of measurement, but were characterized by extremely low sensitivity (0-37.5%). Their overall diagnostic accuracy was higher on using K. Bove or A.M. Lifshitz criteria (40-66.7%) and low - on using the criterion of P. Casale (13.3-40%). The author's ECG criteria were less specificity (50-100%) and had higher sensitivity (54-75%), and their diagnostic accuracy remained higher and showed small dependence on the method of the postmortem finding of measurement of LVH (60-66.7%). CONCLUSION: Usually the ECG criteria to diagnose left ventricular hypertrophy were expectedly showed low sensitivity using any method of the postmortem finding of measurement. Meanwhile, the author's own ECG criteria associated with the most sensitive electrocardiographic characteristics to LVH and sex and age-specific indexes of the examined patients exceeded the conventional ECG criteria in sensitivity and diagnostic accuracy.

AgNORs in the myocardium in ischaemic heart disease complicated by heart failure: a postmortem study.

AIM: To evaluate the interphase ribosomal RNA cistron activity of cardiomyocytes in case with ischaemic heart disease complicated by heart failure. METHODS: Nucleoli were investigated in postmortem myocardium samples from 31 cases with ischaemic heart disease (mean (SEM), 57.4 (6.5) years) with or without severe heart failure (18 and 13, respectively) and from eight healthy people who died in accidents (mean (SEM) 25.3 (4.0) years). Myocardium obtained within one hour after death was frozen in liquid nitrogen. Silver staining for nucleolar organiser regions (AgNOR) was performed with a standard procedure and the mean score obtained. On the basis of these data, the average number of AgNORs per nucleus was determined. The Student's t test was used to compare groups. RESULTS: Compared with controls, the mean numbers of AgNORs per nucleus in cardiomyocytes from ischaemic heart disease patients not complicated with severe heart failure were higher (8.0 v 9.9; p < 0.05), but cases with severe heart failure had a progressive decrease in cardiomyocyte AgNORs. A difference in AgNOR numbers between cases with different ischaemic heart disease courses was found when cases with the same New York Heart Association (NYHA) functional stage III of heart failure were studied. CONCLUSIONS: The significant decrease of AgNORs in cardiomyocytes from cases with severe ischaemic heart disease complicated by heart failure seems to be connected with cardiomyocyte adaptation (a variant of hibernation) to a diminished circulation that, hypothetically, may affect the level of ribosomal RNA synthesis.