The aim is to study the effect of microvascular reperfusion injury (RI) of myocardium on structural and functional changes of heart in patients with acute coronary syndrome with ST segment elevation (STE-ACS) and endovascular revascularization.   Materials and Methods. The study included 146 patients with STE-ACS (mean age 54 ± 10 years, 89 % men). Depending on the presence of microvascular RI, according to CMR, performed on 5 ± 3 days after myocardial infarction, patients were divided into groups: the first group included 73 patients (50 %) with microvasculature lesions, the second group consisted of 73 patients (50 %) without microvasculature lesions. All patients underwent endovascular myocardial revascularization within 12 hours of symptoms onset. The assessment of structural and functional parameters of heart was performed by CMR with contrast enhancement on 5 ± 3, 30 and 90 days, by echocardiography on 1-2 days, 1, 6 and 12 months after myocardial infarction.   Results. In our study microvascular RI was accompanied by a significant size of infarction, a high transmurality index (TI), a large size of edema and a low myocardial salvage index, was associated with LV dilatation, a decrease in  global and local myocardial contractility during the 12 months post-infarction period (p < 0.05). The risk of developing pathological remodeling of left ventricle with microvascular RI size >1.2 % of LV mass is OR=6.25, 95 % CI 2.25–17.35 (p < 0.001), myonecrosis size on day 5 ± 3 of MI >11.7 % of LV mass (OR=10.1, 95 % CI 4.72–21.69, p < 0.001), TI > 64.3 (OR=5.63, 95 % CI 2.37–13.39, p < 0.001), edema size >24.7 % of LV mass (OR = 2.33, 95 % CI 1.09–4.97, p < 0.02).   Conclusion. Microvascular RI of myocardium is associated with pathological remodeling of the left ventricle.

Aim. To evaluate the informative value of biomarkers (cardiac troponin l (cTnl), high-sensitivity C-reactive protein (hsCRP), N-terminal pro-brain natriuretic peptide (NTproBNP), stimulating growth factor (ST2)) as laboratory markers of myocardial ischemia-reperfusion injury in patients with ST-segment elevation acute coronary syndrome (STEACS) undergoing endovascular revascularization.Material and methods. The study included 115 patients with STEACS who underwent endovascular myocardial revascularization. To identify the informative value of biomarkers, the levels of cTnl, NTproBNP, hsCRP, sST2 were analyzed at baseline, as well as after reperfusion therapy on the 2nd (cTnl) and 5th (sST2, hsCRP, NTproBNP) days. Contrast-enhanced cardiac magnetic resonance imaging was performed 5 days after endovascular intervention.Results. Microvascular obstruction was detected in 54 patients (47%), of which 24 (44%) patients had a combination of microvascular obstruction and myocardial hemorrhage. ln 61 cases (53%), no microvascular damage was registered. lt was found that with an increase in the threshold initial NTproBNP levels >590 pg/ml, the odds ratio (OR) of myocardial reperfusion injury was 12,2 (95% confidence interval (CI), 4,81-30,92, p<0,001). In addition, we analyzed biomarker levels in the early period after myocardial infarction, at which threshold values of reperfusion injury parameters were established as follows: for cTnI >8,1 ng/ml, OR=7,17 (95% CI, 3,11-16,53, p=0,001); for hsCRP >14 mg/L, OR=12,71 (95% CI, 5,03-32,08, p=0,001); for NTproBNP >334 pg/ml, OR=11,8 (95% CI, 4,88-28,59, p=0,001); for sST2 >41 ng/ml, OR=7,17 (95% CI, 3,11-16,53, p=0,001). According to multivariate analysis, predictors of microvascular injury were the initial NTproBNP values, as well as the cTnI, hsCRP, and sST2 values in the early postinfarction period (sensitivity — 89,5%, specificity — 83,3%).Conclusion. Thus, the initial NTproBNP, as well as cTnI, hsCRP, sST2 values after percutaneous coronary intervention are more informative for assessing the risk of microvascular damage.

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The article reflects modern aspects of lipid-lowering therapy, based on the as­sessment of cardiovascular risk, and the possibilities of triple therapy, including statins, ezetimibe, and inclisiran.We present our own data on the use of the drug inclisiran in patients with lipid metabolism disorders in the framework of secondary and primary cardiovascular prevention. Low-density lipoprotein levels at different times after the injection is described. The potential of innovative lipid-lowering therapy in liver transplant recipients in the long-term postoperative period are discussed.The addition of inclisiran to statin and ezetimibe therapy is safe and leads to a decrease in low-density lipoprotein levels by more than 50% of baseline values in the general population.

ance, Group A patients had higher total cholesterol (224 ± 46 vs 211 ± 40 mg/dL, p < 0.001), non-HDL cholesterol (177 ± 42 vs 150 ± 52 mg/dL, p = 0.001), and uric acid levels (5.4 ± 1.4 vs 5.2 ± 1.3, p = 0.023) than Group B patients. VAI was directly correlated with total and non-HDL cholesterol in the whole sample and in either sex; a direct correlation with blood glucose was also present in women and in the whole sample, but not in men. Conversely, VAI was inversely correlated with age, both in men (r = −0.220, p = 0.02) and in the whole sample (r = −0.120, p < 0.01). Ten-year coronary risk (CR) was assessed by the Framingham equation in patients aged less than 74 years and without history of overt cardiovascular disease (N = 343). CR was higher in Group A (16.1%) than in Group B (11.8%), p < 0.001. The difference was highly significant in women (N = 282, p < 0.001) and approached statistical significance in men (N = 61, p = 0.058). In the stepwise multiple regression analysis, VAI was independently associated with CR and was included in the equation before uric acid, non-HDL cholesterol, and eGFR in this order (r 2 = 0.163).Conclusions: VAI may be a useful parameter in the assessment of cardiovascular risk in elderly outpatients.Objective: Many forms of Smokeless Tobacco products exist worldwide. In Venezuela, Chimó is the most common form of Smokeless Tobacco. It is compound by tobacco leaf, sodium bicarbonate, brown sugar, ashes from the Mamón tree, vanilla and anisette flavoring. The ingredients vary according to the region within Venezuela. A small amount of Chimó is placed between the lip or cheek and the gum and left there for some time, usually 30 minutes. The mixture of Chimó and saliva is spit out. There are relation smokeless tobacco and hypertension in many studies The relation between hypertension and chimó has not been studied. The hypothesis was that chimó may increase hypertension risk. Design and method:An observational cross-sectional study. During the years [2013][2014] 1938 subjects aged 20 or older were evaluated in Timotes, a medical center from Andean region of Venezuela. Standard questioner and anthropometric measurements were obtained from each participant. Blood pressure was measured with OMRO HEM-907XL model equipment, twice, in the non-dominant arm supported to the heart level, in sitting position, after five minutes of rest. Results:Overall, 1938 subjects with a mean age of 47.8 ± 0.62 years in men and 50.1 ± 0.50 years in women (p = 0.004), 59.5% was females. Chimó frequency use was 55.0% in men and 45.0% in women (p < 0.0001). The result of regression logis-