No abstract

Background.According to the recommendations of the European Society of Cardiology, ultrasound examination of the lung can be used to assess congestive changes, however, this method has so far a low recommendation class IIb and a level of evidence C, which can be regarded as a consequence of its insufficient knowledge.The aim of the research.To study ultrasound characteristics of the lung tissue in patients with intermediate left ventricular function after resolving of acute decompensation of heart failure.Materials and methods. The ultrasound profile of the lung tissue was studied in 71 patients after resolution of acute heart failure decompensation under intermediate left ventricular function. The average age of patients studied was 65.2 ± 3.6 years. 64.3% of them were males ,25.7%-females. Using the ultrasonic method, B-lines were studied, the distance between them being 3 mm and 7 mm in a semi-quantitative manner, according to the method of E. Picano in 2016. The results were statistically processedResults.In persons after the acute decompensation of the heart failure residual congestion persisted with interstitial component dominated in both lungs. Appearance of interstitial lung edema to be considered as prognostic factor of re-hospitalizations rate increasing.Conclusion.Interstitial congestion in the pulmonary parenchyma considered as a factor in the deterioration of the clinical course of heart failure sign of its acute decompensation. In this connection, it is interesting to identify interstitial pulmonary edema at the early stage to prevent real clinical presentation of acute decompensation of the heart failure.

Aim To study ultrasonic characteristics of lung tissue in patients with heart failure with left ventricular (LV) mid-range ejection fraction (HFmEF) and predictive value of these characteristics after reversing acute decompensated heart failure (ADHF).Material and methods Ultrasonic characteristics of lung tissue were studied by prospective observation in 71 patients (mean age, 65.2±3.6 years; men, 64.3 %) with HFmEF (LVEF from 40 to 49 %) following ADHF reversal. Semiquantitative evaluation of B-lines was performed by the E. Picano (2016) method at 5+2 days after hospitalization and on discharge from the hospital. The distance between B-lines was 3 mm (В3 lines) and 7 mm (В7 lines). Patients’ catamnesis was studied for determining the predictive value of lung tissue ultrasonic characteristics for two years since the index hospitalization. Statistical analysis was performed using the McNemar’s χ2 test (for evaluation of linked samples and of changes in the presence/absence of B-lines as determined by lung ultrasound examination (USE)) and the Wilcoxon test (for evaluation of quantitative changes). Differences were considered significant at p<0.05.Results B7-lines characteristic of interstitial component of pulmonary parenchymal edema prevailed in patients with HFmEF. В3-lines characteristic of alveolar edema were found in a small amount. In the anterior-superior segment, B7-lines predominated over B3-lines (80 % vs. 20 %, p<0.01) on the right; however, on the lest, significant differences were not observed (64 % vs. 36 %, p>0.05). In the anterior-inferior segment, В7-lines prevailed over В3-lines on the right (75 % vs. 25 %, p<0.05); however, on the left, the difference was not significant (67 % vs. 33 %, p=0.05). In the lateral superior segment on the right, В7-lines predominated over В3-lines (75 % vs. 25 %, p<0.01); in contrast, on the left, there were no differences (67 % vs. 33 %, p>0.05). In lateral-basal segments on both sides, significant differences were present (73 % vs. 27 % on the right, p<0.05; 72 % vs. 28 % on the lest, p<0.05). The results of lung ultrasound were also used for evaluation of the B-line predictive value in patients with ADHF and mid-range EF on discharge from the hospital after reversal of X-ray and clinical symptoms of pulmonary congestion. In the next two years, 35 patients (49.2 % of sample) were rehospitalized with signs of ADHF (39 hospitalizations, 1.1 hospitalizations per patient). The rehospitalized patients were divided into two subgroups, with an increased number of B-lines and small congestion on discharge (6–15 В-lines) and without signs of congestion (<5 В-lines). For patients with a minimal (small) congestion on pulmonary ultrasound but regression of clinical and X-ray congestion, the number of rehospitalizations was 25 vs. 11 in patients with the number of B7-lines <5. In the ROC-analysis, the area under the curve was 0.706, which corresponded to the expert assessment as “good”. The position sensitivity was 78.6 % and the specificity was 79.7 %.Conclusion “Ultrasonic pulmonary edema syndrome” in patients with LV mid-range ejection fraction after reversing ADHF was characterized by predomination of the interstitial component, despite the absence of X-ray congestion, correlated with the blood level of NT-proBNP measured at the same time, and was associated with rehospitalizations.

Государственное бюджетное учреждение «Санкт-Петербургский научно-исследовательский институт скорой помощи им И. И. Джанелидзе», Санкт-Петербург, Россия «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава России, Санкт-Петербург, Россия Резюме Целью данного исследования явилось оценить клиническое течение инфаркта миокарда (ИМ) у больных с острым повреждением почек (ОПП) на госпитальном этапе в зависимости от наличия полиморфизма генов: Leu28Pro APOE, G681A CYP2C19, Trp212Ter CYP2C19, Val174Ala SLCO1B1, C786T NOS3. В исследование включены 86 пациентов, лечившихся в ГБУ СПб НИИ скорой помощи им. И.И. Джанелидзе в 2016 году по поводу ИМ. Все пациенты были разделены на 2 группы. В первую (I) вошли 34 больных с ИМ и ОПП. Во вторую (II)-52 человека с ИМ, но без ОПП. Всем пациентам производился забор венозной крови, для выявления полиморфных вариантов генов. Метод основывался на анализе геномной ДНК человека, выделенной из лейкоцитов крови, методом полимеразной цепной реакции. Произведено сопоставление полученных лабораторных данных и клинической картины заболевания между группами. Репрезентативность и достоверность различий между параметрами в выборках оценены с использованием углового преобразования Фишера, t-критерия Cтьюдентa, проведен однофакторный анализ. Было доказано, что у больных с ИМ и ОПП достоверно чаще выявляются мутации в генетических вариантах: G681A CYP2C19, C786T NOS3, Val174Ala SLCO1B1, на фоне чего отмечалось ухудшение течения ИМ в госпитальном периоде и увеличение случаев летальных исходов. Ключевые слова: полиморфизм генов, инфаркт миокарда, острое повреждение почек.

Background. At present close attention is paid to the study of genetic mutations and markers of systemic inflammatory response (SIR) in patients with cardiorenal syndrome. Aim. To evaluate the effect of NOS3 gene t786c polymorphism and SVR on the clinical course of hospital and long-term periods in patients with myocardial infarction (MI) and acute kidney injury (AKI). Materials and methods. 108 patients treated for MI were examined. All patients were divided into 2 groups: the first — 56 patients with IM and AKI, the second — 52 patients with IM but without AKI. Results. In patients with MI and AKI, heterozygote and homozygote by allele С with NOS3 gene polymorphism Т786С, as well as leukocytosis and elevated C-reactive protein (CRP) in the blood were significantly more frequently detected. In the hospital period there was a large percentage of relapses of acute coronary syndrome (ACS), which led to high mortality. In the long-term period recurrent ACS and stent thromboses were also significantly more frequent, as well as high mortality rate. The conclusion. Patients with IM and AKI revealed high frequency of allele C inheritance with polymorphism t786c gene NOS3, which in combination with the induction of SVR, being manifested by leukocytosis and increase in the content of CRP in the blood, was associated with the severity of the clinical picture, both in hospital and in the long-term periods.