BIOMARKER SST2 AS AN EARLY PREDICTOR OF ACUTE RENAL INJURY IN PATIENTS WITH ST-SEGMENT ELEVATION ACUTE MYOCARDIAL INFARCTION.

One of the serious complications of ST-segment elevation myocardial infarction (STEMI) is acute kidney injury (AKI). Promising in this respect is the stimulating growth factor sST2. A sharp increase of ST2 level in case of injury is accompanied by inhibition of IL-33 favorable antihypertrophic effects. The purpose - to analyze the prognostic significance of sST2 biomarker in identifying the risk of AKI development in patients with STEMI. The study included 103 patients with STEMI, of which 75 patients were men (72.8%) whose mean age was (61.85±12.23) years. Patients were hospitalized at the intensive care unit during the first day of the disease. Patients were subjected selective coronary angiography (SCAG) with subsequent stenting of the infarct-related artery. Criteria for inclusion into the study concerned patients with STEMI, who arrived in the hospital during 24 hours after the onset of the symptoms and agreed to participate in the study. The level of sST2 was determined during the first 24 hours after the event. In multivariate regression analysis, we found that sST2 and blood glucose are the only significant predictors of acute kidney injury during the first 48 hours (R2=0.437, P<0.001) among the parameters included into the study, such as the NT-pro BNP biomarker, ejection fraction, E/A ratio, end diastolic volume and hemoglobin level. The first time a prognostic model has developed and this model used simple, but significant factors. The role of the biomarker ST2 in the early stratification of reduced kidney function in patients with STEMI suggests the development of AKI.

Removal of the Tumor Thrombus from the Right Atrium without Extracorporeal Circulation: Emphasis on the Displacement of the Tumor Apex.

OBJECTIVES: To assess the outcomes of cavoatrial tumor thrombus removal using the liver transplantation technique for thrombectomy, a retrospective study was conducted. MATERIALS AND METHODS: Five patients with atrial tumor thrombi who underwent piggy-back mobilization of the liver, surgical access to the right atrium from the abdominal cavity, and external manual repositioning of the thrombus apex below the diaphragm (milking maneuver) were included into the study. Extracorporeal circulation was used in none of the cases. The average length of the atrial component of the tumor was 20.0 ± 11.7 mm (10 to 35 mm), and the width was 14.8 ± 8.5 mm (10 to 30 mm). In this work, the features of patients and surgical interventions as well as perioperative complications and mortality were analyzed. RESULTS: External manual repositioning of the tumor thrombus apex below the diaphragm was successfully performed in all patients. Tumor thrombi with the length of the atrial part up to 1.5 cm were removed through the extrapericardial approach. For evacuation of the thrombi with the large atrial part (3.0 cm or more), a transpericardial surgical approach was required. Specific complications associated with the access to the right atrium from the abdominal cavity (paresis of the right phrenic nerve, pneumothorax, and mediastinitis) were not detected in any case. The average clamping time of the supradiaphragmatic inferior vena cava (IVC) was 6.3 ± 4.6 min. The volume of intraoperative blood loss varied from 2500 to 5600 ml (an average of 3675 ± 1398.5 ml). CONCLUSION: Our work represents the initial experience in the liver transplantation technique for thrombectomy in distinct and well-selected patients with atrial tumor thrombi. The effectiveness of this approach needs further study. The video presentation of our research took place in March 2019 at the 34th Annual EAU Congress in Barcelona.

NEPHRON-SPARING SURGERY IN PATIENTS WITH RENAL CELL CARCINOMA EXTENDING TO THE MAIN RENAL VEIN: INTRARENAL AND EXTRARENAL THROMBECTOMY.

In most cases RCC with venous extension is an indication for radical nephrectomy. However, in patients with imperative indications for nephron-sparing surgery a kidney resection with thrombectomy in rare situations is possible. We present a surgical technique for nephron-sparing surgery in patients with tumor spreading into the main renal vein. From 2007 to 2019 seven partial nephrectomies with removal of the tumor thrombus from the main renal vein were performed. Absolute imperative indications were recorded in 6 (85.7%) patients (4 with solitary kidney, 2 with bilateral tumors). Dimensions of renal tumor averaged 6.5±2.3 cm. Intravenous part of the tumor penetrated the initial portion of the renal vein in 3 cases, main trunk of the renal vein in 3 cases, and cavarenal portion of the IVC in 1 case. The average length of the tumor thrombus was 24.0±6.9 mm, and the width was 9.3±4.8 mm. Tumor thrombi were classified as intrarenal and extrarenal. In accordance with this principle surgical procedures were divided into partial nephrectomy with intrarenal (3/42.9%) and extrarenal thrombectomy (4/57.1%). Intrarenal thrombectomy was characterized by thrombus removal out of the vein lumen from the side of the kidney resection area, while extrarenal thrombectomy included additional opening the lumen of the main renal vein or inferior vena cava (IVC). In one patient hypothermic perfusion of the kidney in situ was used. In two cases the extracorporeal partial nephrectomy with kidney autotransplantation was performed. Warm ischemia time averaged 14.0 minutes. The time of ischemia during hypothermic perfusion in situ reached 76 minutes, the time of cold ischemia during extracorporeal surgery averaged 68.0 minutes. The volume of blood loss did not exceed an average of 621.4±146.8 ml. Early postoperative complications occurred in 4 (57.1%) cases (bleeding -1, ischemic stroke -1, deterioration of renal failure -2). Postoperative mortality was registered in 1 patient due to bleeding and heart failure. The follow-up period averaged 28.7±18.9 months. Distant metastases occurred in 1 (14.3%) patient after 16 months. Local tumor recurrence in the remnant kidney after nephron-sparing surgery was not detected in any case. Nephron-sparing surgery may be used to treat patients with kidney tumors and neoplastic venous thrombosis. However, this complex surgical approach requires further technical improvement.

[BIOMARKER ST2 AS A NEW PREDICTOR OF ACUTE KIDNEY INJURY IN PATIENTS WITH ACUTE ST SEGMENT ELEVATION MYOCARDIAL INFARCTION].

Aim - to research sST2 level in risk of acute kidney injury after ST-elevation myocardial infarction (STEMI). 103 patients with STEMI, 75 (72.8%) male and 28 (27.2%) female at average age 61.85±12.23 years were enrolled. All the patients were divided to 2 groups according to AKIN classification: with creatinine dynamic more than 26.4 µmol/l (1st and more stage) and without those. Serum level of sST2, N-terminated pro-B-type natriuretic peptide (NT- proBNP ) determined by enzyme-like immunoassay at the 1st day of STEMI. Serum median level of sST2 in the 1st and 2nd groups were 128.62 [13.05-381.4] ng/ml and 54.7 [16.4-262.2] ng/ml accordantly (р = 0.0004). Biomarkers were determined in the serum of STEMI patients on baseline prognosed acute kidney injury (AKI) across 48 hours. sST2 level increase more than 36.4 ng/ml and NT- proBNP more than 1345 pg/ml prognosed AKI in patients with STEMI. sST2 in addition to NT- proBNP might be used as a main instrument of risk stratification of AKI development in patients with STEMI.

PROGNOSTICATION OF CLINICAL OUTCOMES AFTER STEMI: THE ROLE OF VASCULAR ENDOTHELIAL GROWTH FACTOR-A.

Aim - to assess the role of Vascular endothelial growth factor-A (VEGF-A), which plays a key role in angiogenesis, in prognosis after myocardial infarction. 62 patients with ST-segment elevation myocardial infarction (STEMI), 51 (82.3%) male and 11 (17.7%) female at average age 58.63±8.90 years and 12 control group patients were enrolled to the study. Serum level of VEGF by enzyme-linked immunosorbent assay was determined. After a 6-month observation period afterinfarction angina were assessed. ROC-analysis revealed cut-off level of VEGF-A ≤172.4 pg/ml was determined on the 7th day of STEMI, which had became predictor of repeated coronary events after the 6-month observation period (AUC 0.697, sensitivity was 88,9% and specificity - 50.9%; 95% CІ 0.567-0.807, Р=0.0515). Multivariate logistic analysis determined that anxiety and depression were assessed with Taylor and HADS questionnaire associated with VEGF-A decrease in patients with STEMI (anxiety: OR 0.834, 95% CІ 0.726 - 0.959, Р=0.0107; depression: OR 0.741, 95% CІ 0.535 - 1.027, Р=0.0519. Anxiety and depression influenced on serum VEGF-A level decrease which indicates the lack of myocardial neovascularization after STEMI and makes a contribution to postinfarction angina development.

GROWTH DIFFERENTIATION FACTOR 15 AS A PROGNOSTIC MARKER OF CHRONIC HEART FAILURE PROGRESSION IN LONG-TERM FOLLOW-UP AFTER ACUTE CORONARY SYNDROME.

Acute coronary syndrome remains a significant problem for cardiologists. Despite improved therapy, mortality remains extremely high once CHF becomes symptomatic. Multimarker approach in cardiovascular risk prediction was proved as the most effective tool. One of the promising biomarkers is a stress-induced marker growth differentiation factor 15 (GDF-15). Purpose of the study was to improve stratification methods of CHF progression risk as a complication of ACS by studying levels of GDF-15. In our study we showed association between high level of GDF-15, determined at the first 24 hours after ACS, and CHF progression after 12 months.