BackgroundAlthough remote ischaemic preconditioning (RIP) provides protection against myocardial ischaemia and reperfusion injury during cardiac surgery, it is not widely used. Systemic intermittent hypoxic–hyperoxic training (IHHT) may be a suitable alternative.MethodsThis is a prospective, single-centre, randomised controlled trial. 127 patients with ischaemic heart disease and indication for coronary artery bypass graft (CABG) surgery from the Cardiology Clinic IM Sechenov First Moscow State Medical University were randomly assigned to IHHT, IHHT-control or RIP. Primary endpoint was serum concentration of troponin I and lactate 2 and 24 hours after surgery.ResultsMedian value for troponin I 24 hours after surgery was 1.068 (0.388–1.397) ng/mL in the IHHT group and was significantly lower compared with IHHT-controls with 1.980 (1.068–3.239) ng/mL (p=0.012) and to the RIP group with 1.762 (1.288–2.186) ng/mL (p=0.029), while there was no significant difference between RIP and the IHHT-control. Serum lactate after surgery was 1.74 (1.23–2.04) mmol/L in the IHHT group and was also significantly lower compared with IHHT-controls with 2.10 (1.80–2.29) mmol/L (p=0.045) and RIP with 2.12 (1.91–2.33) mmol/L (p=0.032). No significant complications or serious adverse events were observed during IHHT. Intraoperative and early postoperative complications did not differ significantly between groups.ConclusionsThe results of this first trial using IHHT for myocardial protection against perioperative ischaemic myocardial injury in patients undergoing CABG surgery are promising and further larger trials should be done with adequate power to detect clinical rather than surrogate marker benefits.

Objective:to study potantial of remote ischemic preconditioning (RIP) as method of cardioprotection during coronary artery bypass surgery with cardiopulmonary bypass (CPB) and anesthesia with propofol.Materials and methods.We included in this study 87 patients (7 were excluded) with ischemic heart disease, hospitalized in the clinic of aortic and cardiovascular surgery of the I. M. Sechenov First Moscow State Medical University clinical hospital № 1. All patients had indications for direct myocardial revascularization by coronary artery bypass surgery. One day before operation patients were randomly assigned to 2 groups depending on preparation scheme: main group of RIP and the control group. The frequency of complications during surgery and in the postoperative period was assessed. Troponin I level was measured before, and in 2 and 24 hours after surgery. The level of lactate in the venous blood was measured before and after surgery.Results. Numbers of intraoperative and early postoperative complications in the main and control groups were similar. There were no differences between groups in troponin I and lactate levels after surgery.Conclusions.Remote ischemic preconditioning has no effect on the outcome of coronary artery bypass surgery with cardiopulmonary bypass and anesthesia with propofol.

Результаты. Различные документально подтвержденные признаки поражения сердца выявлены у 6 (13%) больных (5 -с диагнозом АГУС, 1 -с КАФС). У 5 пациентов вовлечение миокарда развилось в дебюте заболевания в рамках полиор-ганного поражения. Заключение. Представлены наблюдения поражения сердца при ТМА разного генеза. Точная частота вовлечения миокарда и его прогностическое значение у пациентов с ТМА до настоящего времени неизвестны. Ключевые слова: тромботические микроангиопатии, атипичный гемолитико-уремический синдром, катастрофический антифосфолипидный синдром, некоронарогенный инфаркт миокарда, сердечная недостаточность.Aim. To describe cardiac involvement in patients with acute thrombotic microangiopathy (TMA). Materials and methods. The case histories of 46 patients with proven TMA, including 17 patients diagnosed with atypical hemolytic uremic syndrome (aHUS) and 29 patients with catastrophic antiphospholipid syndrome (CAPS), were analyzed. Results. Different documentarily verified signs of cardiac involvement were revealed in 6 (13%) patients (5 and 1 patients diagnosed as having aHUS and CAPS, respectively). Five patients developed myocardial involvement at disease onset in the presence of multiple organ dysfunction. Conclusion. Cases of cardiac involvement in TMA of various genesis are presented. The exact incidence of myocardial involvement and its prognostic value are unknown so far. Key words: thrombotic microangiopathies, atypical hemolytic uremic syndrome, catastrophic antiphospholipid syndrome, noncoronarogenic myocardial infarction, heart failure.АГ -артериальная гипертония АГУС -атипичный гемолитико-уремический синдром АД -артериальное давление АФС -антифосфолипидный синдром ГД -гемодиализ ГУС -гемолитико-уремический синдром ИВЛ -искусственная вентиляция легких ИМ -инфаркт миокарда КАФС -катастрофический антифосфолипидный синдром КГ -коронарография КРС -кардиоренальный синдром ЛДГ -лактатдегидрогеназа ЛЖ -левый желудочек МЖП -межжелудочковая перегородка МНО -международное нормализованное отношение ОПН -острая почечная недостаточность ОПП -острое повреждение почек ОРИТ -отделение реанимации и интенсивной терапии ОЭКТ -однофотонная эмиссионная компьютерная томо-графия ПВВГДФ -продленная веновенозная гемодиафильтрация ПН -почечная недостаточность СДЛА -систолическое давление в легочной артерии СЗП -свежезамороженная плазма СКВ -системная красная волчанка СКФ -скорость клубочковой фильтрации СН -сердечная недостаточность ТМА -тромботические микроангиопатии ТТП -тромботическая тромбоцитопеническая пурпура ЦНС -центральная нервная система ЭК -эндотелиальные клетки ЭКГ -электрокардиограмма ЭхоКГ -эхокардиография ADAMTS-13 -a disintegrin and metalloprotease with thrombospondin-1-like domains, member 13 (металлопротеиназа AD-AMTS-13) VWF -фактор Виллебранда β 2 -ГП -β 2 -гликопротеин Тромботические микроангиопатии (ТМА) -гетеро-генная группа заболеваний, объединенных общностью гистологической картины и клинических проявлений при различии патогенетических звеньев. Основными симпто-мами ТМА служат тромбоцитоп...

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