The Role of Modi-fiable and Non-Modifiable Factors in the Development of Right and Left Ventricular Myocardial Dysfunction in High-Risk Patients.

Aim      To study early manifestations of left ventricular (LV) and right ventricular (RV) myocardial remodeling in high-risk patients.Material and methods  Intracardiac hemodynamics was studied by equilibrium radionuclide ventriculography (ERVG) in 83 patients (mean age, 61.1±8.9 years) with preserved LV ejection fraction according to echocardiography data, a body weight index (BWI) >25 kg /m2, obesity, and type 2 diabetes mellitus (DM2). Parameters of intracardiac hemodynamics were compared in patients with different degrees of obesity and DM2 durations in age groups of younger and older than 60 years.Results All patients had both LV and RV diastolic dysfunction. The diastolic dysfunction progressed with age and DM2 duration, primarily by the restrictive type. The increase in BWI, in contrast, was associated with increases in ventricular volumetric parameters. It was noted that specifically modifiable risk factors (obesity and DM2), but not the age, mostly facilitated the impairment of RV relaxation.Conclusion      The strategy of normalizing the body weight and carbohydrate metabolism is priority in combatting the development and progression of chronic heart failure in high-risk group patients.

[The importance of matrix metalloproteinases in the development of atrial fibrillation in obesity].

BACKGROUND: One of the trends in modern cardiology is the study of the matrix metalloproteinase (MMP) system. Currently, an increase in plasma concentrations of some MMPs and their tissue inhibitors is considered as one of the earliest biochemical markers of myocardial fibrosis in various diseases of the cardiovascular system. Discusses the importance of MMP in the development of atrial fibrillation (AF). AIM: To study the effect of the MMP system on the development of AF in obese patients. MATERIALS AND METHODS: The study included 105 patients with a body mass index of more than 30 kg/m2. Depending on the presence of AF, the patients were divided into 2 groups. The criterion for inclusion of patients in group 1 was the presence of documented AF paroxysm in 55 obese patients. The comparison group (group 2) consisted of 50 obese patients without heart rhythm disorders. When patients were included in the study, in order to assess the severity of visceral obesity, all patients underwent a general clinical examination, echocardiography. To determine the activity of the MMP system, venous blood was taken from patients. RESULTS: Significantly higher values of MMP-9 were detected in patients with obesity and paroxysmal AF 315.753.4 ng/ml than in patients with obesity without heart rhythm disorders 220.954.7 ng/ml (p=0.002); the values of tissue inhibitor of metalloproteinase 1 were 185.342.2 and 119.242.6 ng/ml, respectively (p=0.007). In patients with obesity and paroxysmal AF, a correlation of moderate strength between the level of MMP-9 and the volume of left atrium and a direct dependence of moderate strength between the ratio of waist volume to height and the plasma values of MMP-9 was revealed. The MMP-9 index (AUC 0.92) had a high diagnostic value for determining the probability of having a paroxysmal form of AF in obese patients. With an increase in the level of MMP-9 more than 295 ng/ml, it is possible to predict the presence of paroxysmal AF in obese patients with a sensitivity of 74.5% and a specificity of 94%. CONCLUSION: In patients with obesity and paroxysmal AF, a significant increase in the parameters of the MMP system (MMP-9 and tissue inhibitor of metalloproteinase 1) was revealed when compared with obese patients without heart rhythm disorders (p0.05). With an increase in MMP-9 of more than 285 ng/ml in obese patients, the appearance of AF with a sensitivity of 74.5% and a specificity of 94% can be predicted.

Diagnostic difficulties of primary hemochromatosis in a patient with posthemorrhagic anemia.

Hereditary hemochromatosis (HH) is a disease with an autosomal recessive hereditary type, stipulated by the genetic defect that leads to a high intestinal absorption of iron and primary accumulation in the parenchymal cells of the liver and other organs. This is the most common hereditary disease among White population, the frequency is about 1 case per 250 people. The prevalence of HH is inhomogeneous, people from countries in Northern Europe, especially Scandinavian, are more susceptible to this disease. Mutations of the HFE gene account for approximately 90% of HH cases. In HH excess iron deposits mainly in the cytoplasm of parenchymal cells of various organs and tissues: in the liver, pancreas, endocrine glands, skin and joints. The clinical picture of HH is characterized by the classical triad development: cirrhosis of the liver, diabetes mellitus (DM) and hyperpigmentation. HH may also manifest itself as various endocrinopathies (hypofunction of hypophysis, adrenal glands, thyroid gland, arthropathy, cardiomyopathy). Diagnostics of HH is based on the determination of the iron metabolism values: serum iron, transferrin saturation, the amount of ferritin, the genetic tests, liver biopsy data are used to confirm the diagnosis. Despite the fact that HH is a well-studied disease, in some cases it is complicated to diagnose it. Developed posthemorrhagic anemia in a patient is one of such reasons when the iron metabolism test is not informative.

Mantle Cell Lymphoma Case Report.

INTRODUCTION: Due to the beginning of the use of immunophenotypic and cytogenetic techniques, new nosological forms of lymphoproliferative diseases have appeared over the past few decades. According to the WHO classification (2008), today there are more than 50 known lymphoproliferative diseases. CASE PRESENTATION: We present the case of a 51-year-old man with lymphoproliferative syndrome. Our patient underwent morphological and immunohistochemical investigations of biopsy materials from the right inguinal lymph node. The morphological picture was characteristic for small cell lymphoma. Immunophenotypically, tumor proliferate cells expressed CD20, CD76b, CD5, and cyclin D, and the tumor immunophenotype matched mantle cell lymphoma. DISCUSSION: At the present stage of the development of medicine, the diagnosis of lymphoproliferative diseases is based on the clinical picture of the disease with the definition of localization and characteristics of the tumor process, morphological study of tumor tissue and cells, and immunophenotypic and/or cytogenetic analyses are mandatory to determine the final diagnosis.

Vitamin D deficiency and cardiovascular pathology.

Vitamin D deficiency is widespread worldwide and present in about 30-50% of population. In most cases, this problem is associated with musculoskeletal system pathology: rickets in children, and osteomalacia or osteoporosis in adults. However, in recent years, convincing data was obtained on the links between vitamin D deficiency and cardiovascular pathology. Low Vitamin D levels in humans are associated with the unfavorable cardiovascular risk factors, such as arterial hypertension (AH), diabetes mellitus, and dyslipidemia, which are the predictors of the severe cardiovascular diseases, including strokes and infarctions. It has been demonstrated that vitamin D has a strong vasoptotective effect via endothelial dysfunction improvement, prevents blood vessels and myocardium remodeling, improves blood pressure parameters, reduces the risk of development of left ventricular hypertrophy, slows down fibrosis, reduces the risk of atherosclerosis, reduces insulin resistance, and also affects inflammation and immunity. This article provides data of Russian and foreign studies demonstrating the effect of Vitamin D deficiency on the development of atherosclerosis, AH, heart rhythm disorder and progression of chronic heart failure.