[The impact of BMI on the course of the acute SARS-COV-2 infection and the risks that emerge during the first year after the hospital discharge. Subanalysis evidence of the AKTIV and AKTIV 2 registries].

BACKGROUND: There is enough evidence of the negative impact of excess weight on the formation and progression of res piratory pathology. Given the continuing SARS-CoV-2 pandemic, it is relevant to determine the relationship between body mass index (BMI) and the clinical features of the novel coronavirus infection (NCI). AIM: To study the effect of BMI on the course of the acute SARS-COV-2 infection and the post-covid period. MATERIALS AND METHODS: AKTIV and AKTIV 2 are multicenter non-interventional real-world registers. The АКТИВ registry (n=6396) includes non-overlapping outpatient and inpatient arms with 6 visits in each. The АКТИВ 2 registry (n=2968) collected  the  data  of  hospitalized  patients  and  included  3  visits.  All  subjects  were  divided  into  3  groups:  not  overweight  (n=2139), overweight (n=2931) and obese (n=2666). RESULTS: A higher BMI was significantly associated with a more severe course of the infection in the form of acute kidney injury (p=0.018), cytokine storm (p<0.001), serum C-reactive protein over 100 mg/l (p<0.001), and the need for targeted therapy (p<0.001) in the hospitalized patients. Obesity increased the odds of myocarditis by 1,84 times (95% confidence interval [CI]: 1,13-3,00) and the need for anticytokine therapy by 1,7 times (95% CI: 1,30-2,30).The  patients  with  the  1st  and  2nd  degree  obesity,  undergoing  the  inpatient  treatment,  tended  to  have  a  higher  probability  of  a  mortality  rate.  While  in  case  of  morbid  obesity  patients  this  tendency  is  the  most  significant  (odds  ratio  -  1,78; 95% CI: 1,13-2,70). At the same time, the patients whose chronical diseases first appeared after the convalescence period, and those who had certain complaints missing before SARS-CoV-2 infection, more often had BMI of more than 30 kg/m2 (p<0,001).Additionally, the odds of death increased by 2,23 times (95% CI: 1,05-4,72) within 3 months after recovery in obese people over the age of 60 yearsCONCLUSION.  Overweight  and/or  obesity  is  a  significant  risk  factor  for severe  course  of  the  new  coronavirus  infection  and  the associated cardiovascular and kidney damage Overweight people and patients with the 1st and 2nd degree obesity tend to have a high risk of death of SARS-CoV-2 infection in both acute and post-covid periods. On top of that, in case of morbid obesity patients this tendency is statistically significant. Normalization of body weight is a strategic objective of modern medicine and can contribute to prevention of respiratory conditions, severe course and complications of the new coronavirus infection.

[Pulmonary artery thrombosis: strategy of anticoagulation]. / Tromboz legochnoi arterii: taktika pri vybore antikoagulyantnoi terapii.

This review is devoted to the management of primary artery thrombosis (PAT). This disease was always considered only as a part of other venous thromboembolic events, in particular isolated pulmonary embolism (PE). Various studies show that PAT can develop as an independent event without concomitant damage to extra-vessels. PAT is characterized by own typical signs as primary and recurrent event that can determine special strategies of treatment. However, there are no studies devoted to this problem. We can only make some assumptions about PAT anticoagulation (AC) considering data on isolated PE comprising PAT. These data are available in PADIS-PE, ASPIRE, EINSTEIN-PE, Hokusai-VTE studies underlying modern guidelines of various societies. In the absence of studies on PAT AC these guidelines should regulate PAT AC approaches. AC is recommended in all cases of PE except isolated subsegmental PAT in ambulatory patients. Duration of AC depends on risk factors (major or minor). Anticoagulation for PAT following chronic inflammatory diseases is still disputable.

[CURRENT VIEWS OF DIAGNOSTICS AND STRATEGY OF THE TREATMENT OF STABLE ISCHEMIC HEART DISEASE].

Ischemic heart disease (IHD) is a leading cause of mortality worldwide and stable IHD is one of its most important clinical forms. Recent decades brought new data on algorithms of diagnostics, pharmacotherapy and myocardium revascularization in patients with stable IHD. They were summarised in American (2012) and European (2013) recommendations on the management of this condition. The present paper is designed to discuss these algorithms with reference to the currently available evidence, results of the last studies and international guidelines.

[Correction of sinus rate by inhibitors of If-channels in patients with acute decompensated heart failure].

The aim of the study was to assess heart rate reduction for a acute decompensated heart failure in patients with reduced left ventricular systolic function and in patients with heart failure without significant reduction in ejection fraction. Were examined 79 patients with an ejection fraction less than 40%. 38 of them took If-channel blocker, ivabradine, 41 amounted to a control group. A group of patients with diastolic dysfunction was 48 patients (23 in the treatment of ivabradine and 25 subgroups of control). During the 14 days of observation it was found that the positive effect of reducing the sinus rate by ivabradine was observed in patients with diastolic dysfunction. In this group of patients on the background of decreasing heart rate, improves the passive diastolic properties of the left ventricle and an increase in the distance traveled by the patients during 6-minute walk test compared with the control group. The data obtained in our study support the use of ivabradine in patients with acute decompensated heart failure. The most significant changes in hemodynamic parameters and functional status were obtained in patients with diastolic dysfunction. Given the small sample, the results need to be further confirmed in larger clinical trials.

[The influence of primary coronary balloon angioplasty on the systolic function of the left ventricle in patients with acute heart failure and myocardium infarction with low Q wave].

The investigation included 56 patients with MI of lower localization and acute left ventricle failure (ALVF). Group A included 33 patients with primary coronary balloon angioplasty (PCBAP), in group B there were 23 patients with MI and ALVF without revascularization. Group A was divided into 2 subgroups--A1 (patients with history of IM) and A2 (patients without previous MI). On the first and on the 14th days echocardiographic investigation was performed in all the patients. Ejection fraction (EF) of the LV in dynamics by the 14th day of the disease increased in group A from 32.8 +/- 1.8% to 36.1 +/- 1.6% (p < 0.05) at the expense of subgroup A2 (32.1 +/- 2.6% on the first day and 37.5% +/- 1.9 on the 14th day, p < 0.05), while in subgroup A1 there were no substantial changes of EF. In group B, on the contrary, there was decreased EF of the LV. Most of the group A patients had many injuries of the coronary bed vessels. After PCBAP of the right coronary artery (RCA) the increase of EF was followed by an improvement of the local contractility of the LV myocardium not only in the infarction zone, but also in the segments with ischemic dysfunction in which blood flows from the infarction-independent artery with its collateral filling from RCA.