Radiotherapy is an integral part of the cancer treatment, including with mediastinum, breast cancer. In this case, cardiovascular complications of the treatment are quite common. The long-term prognosis can be determined not only by the effectiveness of radiotherapy, but also by cardiovascular risks. A feature of cardiotoxicity of radiation therapy is the high probability of its occurrence in the delayed period of 3–30 years after treatment. The article highlights the results of published epidemiological studies of cardiotoxicity of radiotherapy, as well as the available screening algorithms for cardiovascular complications in patients who underwent radiotherapy. Own clinical observation of the early debut of coronary artery disease after combined chemoradiotherapy of diffuse large B-cell non-Hodgkin lymphoma is presented.

Ремоделирование миокарда относится к факторам, повышающим риск сердечно-сосудистых событий у лиц с артериальной гипертонией (АГ). Структурно-функциональные изменения миокарда могут быть следствием не только отчетливого влияния гемодинамических причин, но и ряда метаболических нарушений. Цель. Анализ ассоциаций инсулинорезистентности и ремоделирования левого желудочка (ЛЖ) в когорте молодых пациентов с нелеченой неосложненной АГ и высоким нормальным артериальным давлением (АД). Материал и методы. В когортное поперечное исследование включено 105 человек, у которых проанализированы клинико-демографические, антропометрические характеристики, выполнены биохимический анализ крови (креатинин, калий, липидный спектр, глюкоза, инсулин, мочевая кислота) с расчетом индексов инсулинорезистентности (HOMA-IR, METs-IR, TyG), анализ крови на гликированный гемоглобин, определяли соотношение альбумина/креатинина в разовой порции мочи. Всем обследованным измеряли офисное АД, выполняли суточное мониторирование АД, эхокардиографию с технологией 2D-спекл трекинг. Результаты. Медиана возраста составила 23 года, 85% мужчин. Избыточную массу тела или ожирение имели 51%, 39% -дислипидемию, 21% -инсулинорезистентность. Признаки ремоделирования ЛЖ наблюдались у 38 (40%) обследованных, из них у 32 (34%) -концентрическое ремоделирование, у 5 (5%) -концентрическая гипертрофия ЛЖ (ГЛЖ), у 1 (1%) -эксцентрическая ГЛЖ, нарушение глобального продольного систолического стрейна ЛЖ у 44 (47%) лиц молодого возраста с АГ и предгипертонией. При ступенчатом многофакторном регрессионном анализе независимым предиктором нарушения глобальной продольной деформации ЛЖ оказался индекс TyG (b=0,38, p=0,001). Заключение. В когорте молодых лиц с АГ и высоким нормальным АД отмечается высокая частота как инсулинорезистентности, метаболических нарушений, так и ранних признаков ремоделирования ЛЖ и субклинического снижения его систолической функции. Индекс TyG, доступный для расчета на основании рутинного биохимического обследования, является независимым фактором, влияющим на глобальную продольную деформацию ЛЖ.Ключевые слова: артериальная гипертония, молодые, предгипертония, инсулинорезистентность, гипертрофия левого желудочка, нарушение деформации левого желудочка, глобальный продольный систолический стрейн левого желудочка, 2D-спекл трекинг эхокардиография. Отношения и деятельность: нет.

Objective: Triglyceride-glucose (TyG) index is a marker of insulin resistance (IR) which has previously appeared to be a promising predictor of hypertension (HTN), coronary artery calcification and non-alcoholic fatty liver disease. However, the interrelation between TyG index and subclinical left ventricular systolic dysfunction has never been studied. Design and method: We evaluated anthropometric and metabolic characteristics, clinical blood pressure and performed 24-hours ambulatory blood pressure monitoring (ABPM) and echocardiography including two-dimensional speckle tracking in 94 young treatment-naive hypertensives (age 23 [21;25] years, 85,1% males, body mass index (BMI) 25,88 ± 4,78 kg/m2) free of diabetes mellitus. Most patients (67%) had masked HTN and diagnosis was stated with ABPM. IR was estimated with HOMA-IR and TyG index which was calculated as ln[fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. All patients were divided in two subgroups according to LV GLS median, e.g. with GLS of -20,05 or less and > -20,05. Then we compared main clinical variables including obesity and metabolic characteristics and blood pressure levels in derived subgroups. We used Student's t-test and Mann-Whitney U-test to compare variables with normal and non-normal distribution, respectively. To investigate the relationship between IR indices and GLS we performed simple and multiple linear regression analysis. Results: The subgroups were comparable in age, sex and race composition; there was also no significant difference in BMI, waist circumference (WC), waist-to-hip ratio (WHR), WC to height ratio. Insulin and HOMA-IR values were identical. The groups were significantly different in triglycerides levels (0,86 ± 0,31 vs 1,32 ± 0,79 mmol/L for GLS < -20,05 and > -20,05, respectively, p < 0,001) and TyG index (8,05 ± 0,39 vs 8,44 ± 0,55, respectively, p < 0,05). 24-hours SBP and DBP were higher in group with worse GLS: 131,2 ± 11,4 vs 139,3 ± 16,7 mm Hg and 77 [73;85,5] mm Hg, respectively, with p < 0,05 for both. In simple linear regression TyG index was a significant predictor of GLS value with beta = 0,407 (p < 0,001). After addition of age, sex, WHR and office DBP into the model TyG index remained independently associated with GLS with beta = 0,253 (p < 0,05). Conclusions: In young hypertensives TyG index is an independent predictor of GLS impairment.

Objective: Hypertension (HTN) and target organ damage rate in young subjects is underestimated in clinical practice according to latest population studies and treatment strategy of HTN is not well defined due to minor and controversial data of clinical studies. As a part of cohort study of HTN detection and evaluation in young population we investigated renal function in untreated hypertensive subjects with primary diagnosed essential hypertension. Design and method: We performed office BP evaluation and ambulatory blood pressure monitoring with oscillometric cuff-based device in 102 young subjects with untreated essential hypertension defined with ESH criteria of HTN according to office and ambulatory blood pressure monitoring (age 26.2 ± 7.7 (M ± SD) years, 88.3% male, office SBP 134.7 ± 15.8 mm Hg, office DBP 73.2 ± 12.4 mm Hg). Serum creatinine and albumin/creatinine ratio in urine were measured. GFR was calculated with CKD-EPI. For comparison of variables in quartiles of blood pressure we used one-way ANOVA for parametric ones and Kruskal-Wallis test – for non-parametric variables. Results: We compared glomerular filtration rate (GFR) and albumin/creatinine ratio (ACR) in quartiles of office and 24 h systolic and diastolic blood pressure. Significant difference in GFR was registered in office SBP quartiles: GFR in 1st and 4th quartiles was 105,1 ± 21,7 vs 90,3 ± 14 ml/min/1,73m2, with F 4.035, P value 0,0097 while there was no any significant difference of ACR levels according to office BP levels. ACR was significantly different in quartiles of mean nighttime DBP: ACR median in 1st quartile – 4 [0,75; 5,0] vs 8 [3,0; 29,0] in last quartile, P value 0,0056 with no significant difference for daytime DBP and daytime and nighttime SBP. Significant correlation between mean nighttime DBP and ACR was observed: r 0,243, P value 0,023. R for office SBP and GFR was (-0,325) with P value 0,002. Conclusions: In young untreated hypertensive subjects elevation of office SBP is associated with GFR decline while ACR has association with nighttime DBP elevation.