[Determination of cytokines and adhesion molecules in elderly and senile patients with aortic valve calcification.]

A laboratory study of the cytokine profile and the content of the intercellular adhesion molecules was performed in 38 patients with initial signs of aortic hemilunus calcification. It has been determined that the content of IL-6 and IL-8 had significantly higher values compared with the control group, which indicates the direct role of nonspecific chronic inflammation in the development of calcifying aortic valve damage. A significantly lower content of sE-selectin was also identified, which may indicate the absence of activation of adhesion molecules at the initial stage of aortic valve calcification. Further study of the dynamics of sE- and sP-selectins content in the process of development of acceleration of blood flow in the aortic valve and the formation of stenosis is needed.

[Sarcopenia as the reason of hypodiagnostics of chronic kidney disease in patients with chronic heart failure.]

The purpose of the research is comparison of glomerular filtration rate calculated on the basis of serum concentrations of creatinine and cystatin C in patients with chronic heart failure and sarcopenia. In this research 86 patients with chronic heart failure and sarcopenia aged 60 to 92 years (mean age 75±7 years) were examined. GFR calculation was determined using formulas based on creatinine (CKD-EPIC), cystatin C (CKD-EPICys) in blood and both markers (CKD-EPICr-Cys). The concentration of cystatin C in blood serum was determined by the immunoturbidimetric method, and creatinine by the Jaffe kinetic method. Composite body composition was studied in all patients using dual-energy X-ray absorptiometry with calculation of the sarcopenia index (according to FNIH criteria, 2014) and measurement of total fat mass. A test with a 6-minute walk, an assessment according to the SHOKS scale (clinical condition assessment scale for CHF), transthoracic echocardiography with the measurement of EDD, ESD, LVEF, LVМ, LVIM, indicators of LV diastolic function was performed. Depending on the diagnostic criteria for sarcopenia, patients were divided into 2 groups: the first - a combination of heart failure and sarcopenia; the second - CHF without sarcopenia. In patients with CHF and sarcopenia, GFR was reassessed as calculated by the creatinine level by 23% (the absolute difference is more than 18 ml/min/1,73 m2) compared with GFR estimated by the level of cystatin C. In patients with heart failure and sarcopenia, when using a serum concentration of creatinine, there is a hypodiagnostics of the severity of chronic kidney disease. In this regard, if there are signs of sarcopenia, it is recommended to use the formula CKD-EPICys to calculate GFR.

[Indicators of lipid exchange as early markers of development calcific aortic valve disease.]

A comprehensive study of lipidograms of 36 patients with initial signs of calcification of aortic semilunium was performed. It was determined that the content of apolipoprotein A-1 was significantly lower in comparison with the control groups, which requires further studies of the evaluation of the effect on the process of early development of calcification of drugs capable to increasing its content. If the concentration of apolipoprotein A-1 is less than 1,1 mg/dl and/or the apoB/apoA ratio is increased by more than 1, it is advisable to recommend dispensary follow-up with regular (no less than 1 time in 5 years) echocardiographic study with a detailed study of the functional state of the aortic valve.

[The possibilities of ultrasound testing in diagnostics of sarcopenia in older patients with chronic heart failure.]

The article presents the results of a study of the possibility of ultrasound testing of sarcopenia in older people suffering from chronic heart failure. All patients (63 persons, mean age 77,2±7,7 years) underwent dual-energy X-ray absorptiometry. Sarcopenia was diagnosed in 31 patients (FNIH sarcopenia project, 2014). The area of the shoulder muscles (m. Biceps brachii), thigh (m. Rectus femoris) and 3 muscles of the forearm (m. brachioradialis, m. extensor carpi radialis longus, m. extensor carpi radialis brevis) was estimated. By performing multiple linear regression analysis, 2 ultrasound models of sarcopenia diagnosis with diagnostic accuracy of 92% and 93,6% are proposed. Models are based on the sum of limb muscle areas adjusted for gender, height and body weight.

[Actuality of pathomorphogenesis investment in calcific aortic valve stenosis.]

The increasing of lifetime industrial countries population leads to widespreading diseases of age. Dramatic growth of sclerodegenerative heart valve diseases in last decades is one of the best examples. We observed 814 patients of different gender and age with acquired heart valve diseases using echocardiography. We found out that the most common heart valve disease is degenerative aortic stenosis. Unfortunately, nowadays in Russia no more than 20% of the necessary operations on aortic valve are performed, the main reason of it is, more likely, insufficient and untimely diagnosis of the defect. However, the surgery of vice serves only as a mechanical elimination of the problem, without affecting the causes which led to its development. So we need modern data about sclerodegenerative heart valve diseases epidemiology and discloses actuality of the problem.

[CALCIFYING NANOPARTICLES IN PATHOMORPHOGENESIS OF STRUCTURAL LESIONS OF HEART VALVES].

Over the last 10 years, calcifying nanoparticles (CNP) have attracted attention as structures detected. together with many other nanostructures in biopsies from patients operated for the correction of aortic valve malformations. The results of the present work performed with the use of high-resolution transmission and scanning electron microscopes agree on the whole with the data of other authors. Some new findings include CNP adhesion to collagen fibers and specifically-shaped, shallow invaginations or craters at their surface. The possible pathophysiological mechanisms that promote involvement of CNP in the development of the disease are considered.

[ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH DEGENERATIVE AORTIC VALVE STENOSIS: THE STATE-OF-THE-ART].

Pathophysiological and clinical aspects of endothelial dysfunction in patients with degenerative aortic valve stenosis are considered with special reference to the markers of anticoagulative, fibrinolytic, proliferative, anti-inflammatory functions of endothelium and their pathogenetic role in vascular and valvular remodeling. Results of analysis of certain clinical studies with the use of determinants of endothelial dysfunction are presented for the assessment of clinical prognosis in patients with degenerative aortic valve stenosis.