No abstract

The aim of the study was to investigate specific clinical manifestations, homeostasis indices and parameters of the cardiovascular system in patients with acute ST-elevation myocardial infarction (STEMI) and acute ischemic kidney injury. Methods. 173 patients with STEMI participated in the study. The study group consisted of 111 patients with acute ischemic kidney injury associated with myocardial infarction (MI); 62 patients with MI and normal kidney function were enrolled in the comparison group. Clinical, anthropometric, laboratory, and instrumental diagnostic methods were used. Results. Compared with patients of the MI and normal kidney function group, those with MI and acute ischemic kidney injury had a higher average heart rate, required more prolonged vasopressor and/or inotropic therapy, and more frequently developed tachyarrhythmias with adverse prognostic impact and postinfarction aneurysms. The study revealed that patients of the MI and acute ischemic kidney injury group demonstrated more severe dilatation of the left ventricle (LV), more pronounced reduction in myocardial LV contractility according to echocardiography results; they developed multivessel coronary artery disease more frequently. Furthermore, patients of this group had a higher incidence of infarction-associated artery damage located in the proximal segments of major coronary arteries and more frequently developed thrombotic occlusion in the infarction-affected artery. Patients with MI and acute ischemic kidney injury had higher levels of inflammatory, myocardial necrosis, hemostasis and neurohormonal activation markers. Higher concentration of neutrophil gelatinase-associated lipocalin (uNGAL) was observed in patients with MI and acute ischemic kidney injury; moreover, in 14,1% of patients belonging to this group, elevated levels of this marker preceded the diagnostically significant increase in creatinine concentration and decrease in glomerular filtration rate. Conclusion. In patients with MI, the development of acute ischemic kidney injury was accompanied by more severe clinical manifestations, prognostically adverse indicators of early LV remodeling and coronary arteries disease, enhanced inflammatory processes and neuroendocrine system activity, as well as by elevated levels of myocardial necrosis and blood coagulation activity markers. The present study suggests applying uNGAL as an early marker of acute ischemic kidney injury in patients with MI.

Аннотация Цель: выявить особенности эндотелиальной функции у беременных с хронической артериальной гипертензией (ХАГ) и абдоминальным ожирением (АО). Материал и методы. Обследованы 30 беременных с ХАГ + АО (группа I), 28 беременных с ХАГ с нормальным индексом массы тела ИМТ (группа IIа), 27 беременных с АО без ХАГ (группа IIб) и 33 беременные без ХАГ и АО (контрольная группа-Кгр). Проведены проба с реактивной гиперемией, изучение уровня эндотелина-1 и гомоцистеина в сыворотке крови, анализ исходов беременности и родов. Результаты. Значения эндотелийзависимой вазодилатации (ЭЗВД) в группах беременных I (ХАГ и АО), IIа (ХАГ) и IIб (АО) были сопоставимы и составили 6,7 (3,2-9,1); 7,0 (3,9-11,4) и 7,2 (4,4-10,8)% соответственно. Выявлены статистически значимые различия показателей ЭЗВД между вышеперечисленными группами и Кгр-12,5 (10,5-13,9)%, р < 0,05. В группе ХАГ + АО концентрация эндотелина-1 составила 14,0 (10,3-17,5) пг/мл и превышала соответствующее значение группы ХАГ (р < 0,05), Кгр (р < 0,05). У пациенток с АО уровень эндотелина-1 в два раза превышал значение Кгр (р < 0,05). Отмечены статистически значимые различия между пациентками с ХАГ и Кгр (р < 0,05). При анализе гомоцистеинемии в группах исследования установлены статистически значимые различия между Кгр [6,1 (3,9; 8,0)] и группами ХАГ + АО [

The aim of the study was to assess the clinical significance of determining the level of lipocalin associated with neutrophil gelatinase in urine (uNGAL) at the time of hospital admission in patients with acute ST-elevation myocardial infarction (STEMI) and acute ischemic kidney injury. Methods. The study included 173 patients with STEMI complicated by hemodynamic disorders. 111 of them developed acute ischemic kidney injury (main group), 62 didn’t develop the disorder (comparison group). Blood samples to determine the level of creatinine, as well as urine to determine the level of NGAL were taken upon hospital admission before coronary angiography. Results. Acute ischemic kidney injury was diagnosed in 64.2% of patients with STEMI complicated by hemodynamic disorders. The level of lipocalin associated with neutrophil gelatinase in urine exceeded the reference values in all patients with acute ischemic kidney injury. Moreover, in 18.1% of cases elevated levels of this marker preceded the diagnostically significant increase in creatinine concentration. Threshold values of uNGAL were established allowing us to identify AKI upon hospital admission with high sensitivity and specificity, as well as to predict the development of CKD in the post- discharge period. Conclusion. Acute ischemic kidney injury is a frequent complication of STEMI. Based on the findings of the study uNGAL can be applied as an early marker of acute ischemic kidney injury and a predictor of post-discharge CKD in patients with MI.