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14
045-047
СБОРНИК ТЕЗИСОВ
045 EFFECT OF MICROVASCULAR INJURY VARIOUS TYPES ON LEFT VENTRICULAR DISORDERS BY ECHOCARDIOGRAPHY ON LONG-TERM PERIOD AFTER MYOCARDIAL INFARCTION WITH ST SEGMENT ELEVATION
Alekseeva Y. V.
Research Institute of Cardiology, Tomsk National Research Medical Center of the Russian Academy of Sciences; Siberian State Medical University, Tomsk, Russia
Aim. To analyze the long-term effect of microvascular injury various types on the parameters of the left ventricle assessed by echocardiography in patients with primary ST-segment elevation myocardial infarction (STEMI).
Material and methods. The study included 60 patients with primary STEMI admitted within the first 12 hours after the onset of disease who underwent stenting of the infarct-associated coronary artery. Exclusion criteria: pulmonary edema, cardiogenic shock, estimated glomerular filtration rate <30 mL/ min/1,73 m2 or dialysis, severe comorbidity, acute psychotic disorders and inability to undergo or contra-indications for CMR. Each patient included in the study underwent CMR imaging on the second day post-STEMI. MVO and IMH were assessed using late gadolinium enhancement and T2-weighted CMR imaging. Subsequently, all patients underwent the standard echocardiographic protocol on the 7th day and 3 months after MI. The study was registered at ClinicalTrials.gov, with identification number NCT03677466.
Results. IMH and MVO were revealed in majority of the patients with primary STEMI. We divided all patients into 4 groups: the 1st group didn't have any phenomena of IMH and MVO, the 2nd group had only MVO, patients of the 3rd group had only IMH and in the 4th group there was a combination of MVO and IMH. Patients with combination of MVO and IMH had significantly lower LV ejection fraction, if compared to those without it. Correlation analysis showed a moderate inverse correlation between the MVO area and LV contractile function: the larger the area, the lower the LVEF (R=-0,60; p=0,000002).
Conclusion. The combination of IMH and MVO is a predictor of a reduction in LVEF and an increase of volumetric measurements within 3 months after MI. In comparison with patients without microvascular injury isolated MVO is associated with lower LVEF. The size of MVO is directly correlated with the LV contractile function decrease. Isolated IMH was not associated with deterioration of left ventricular function.
046 EVALUATION OF HEMOGLOBIN CONFORMATION STATE IN PATIENTS WITH PULMONARY HYPERTENSION
Allakhverdiev E. S.1, Slatinskaya O. V.2, Rodnenkov O. V.1, Maksimov G. V.2,3, Martynyuk T. V.1
1National Medical Research Center of Cardiology, Department of pulmonary hypertension and heart diseases, Moscow; 2Lomonosov Moscow State University, Moscow; 3National Research Technological University "MISiS", Moscow, Russia
Currently, much attention is paid to the study of the molecular mechanisms of pulmonary hypertension formation. It is known that changes in the oxygen (O2) transport function of red blood cells (RBC) are caused not only by hemodynamics, but also by the conformation of hemoglobin (Hb), which determines the ability to bind and discharge O2.
The study of the molecular mechanisms of idiopathic pulmonary arterial hypertension (IPAH) is associated with new opportunities in assessing the severity of disease, therefore the conformation of hemoglobin (Hb) might be of special interest. The changes in the oxygen (O2) transport function of red blood cells (RBC) are caused not only by hemodynamics, but also by the conformation of Hb, which determines the ability to bind and discharge O2.
Aim. To study the oxygen transport function of RBC in patients with IPAH.
Material and methods. In the experimental study we performed resonance Raman spectroscopy (RRS) for diagnosing the conformation state of Hb of 10 patients (pts)who were hospitalized in the Department of pulmonary hypertension. The diagnosis of IPAH was confirmed by complex investigation including right heart catheterization (RHC). 10 healthy volunteers served as the control group (CG). Blood samples were taken from the cubital vein into vacuum tubes containing heparin. The ratio of the intensities of the bands of the Raman spectrum was analyzed. Statistical analysis of the results was carried out using the Friedman test followed by Dunn's post hoc analysis.
Results. Assessment the oxygen transport function in blood, namely, the differences in the conformation of RBC hemoporphyrin hemoglobin in the cubital vein of CG and patients with IpAh. It was found that the relative ability of Hb to release ligand (including O2 and NO), the number of deoxyHb complexes and the affinity of Hb for O2 was significantly different in the blood RBC (in plasma) cubital vein (CV) of a patient with confirmed IPH. Using Raman spectroscopy we also investigated the changes in the conformation of hemoporphyrin hemoglobin RBC incubated in phosphate buffer RBC in order to assess how plasma components affect the oxygen transport function of the RBC on the conformation of hemoporphyrin Hb in the (CV) of both group. IPAH patients were characterized by lower indicators of Hb ability to release O2 as compared with CG.
The conformation of Hb of RBC from the cubital vein In IPAH patients was characterized by the decreased ability of hemoglobin to shed ligands decreases, lower affinity of heme for O2, and the proportion of deoxyHb complexes increases;
Conclusion. In patients with IPAH with a typical hemodynamic picture, changes were revealed in the ability of hemoporphyrin of Hb to bind O2.
The conformation of Hb of RBC from the cubital vein in control group and IPAH patients was different, in IPAH patients was characterized by the decreased ability of hemoglobin to shed ligands, lower affinity of heme for O2, and the proportion of deoxyHb complexes.; The revealed changes in the structure of hemoporphyrin in patients with IPAH might help to develop the new diagnostic approaches for assessing the severity of the disease using the Raman spectroscopy method.
This study was supported by Russian Science Foundation (grant No:19-79-30062) for MGV, as well as the Interdisciplinary Scientific and Educational School of Moscow University "Molecular Technologies of Living Systems and Synthetic Biology".
047 DIAGNOSTIC VALUE OF PARAMETERS OF GLOBAL MYOCARDIAL WORK IN PATIENTS WITH STEMI
Babina A. V., Galimskaya V. A., Golubeva A. V., Oleynikov V. E.
Penza State University, Penza, Russia
Aim. To identify differences in the global parameters of left ventricular (LV) myocardial function in patients with preserved ejection fraction (EF) after STEMI and in healthy individuals.
Material and methods. The study included 45 people with primary STEMI: 8 women and 37 men aged 32 to 64 years (52,3±7,4). The control group (CG) consisted of 58 healthy volunteers with an average age of 47,7±7,7 years. Myocardial infarction was confirmed by ECG data, a diagnostically significant level of cardiospecific markers (troponin T, CK-MB) and by the results of coronary angiography with the presence of one infarct-related coronary artery in the absence of hemodynamically significant stenoses of other arteries. Echocardiographic examination was performed on 6-7 days after STEMI and 6 months after the onset of the disease on an ultrasound scanner of Vivid GE 95 Healthcare (USA). The analysis of echocardiographic images was performed using the EchoPAC software version 202 (GE Healthcare). Standard echoparameters were determined: end diastolic volume (EDV, ml), end systolic volume (ESV, ml), LV myocardial mass index (ILVM, g/m2), left ventricular relative wall thickness (RWT), EF by the Simpson biplane method. The value of this indicator was
СБОРНИК ТЕЗИСОВ
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considered to be preserved by more than 50%. The following indicators of myocardial work were evaluated: global myocardial work index (GWI), which is calculated as the contour area, global constructive work (GCW, mm Hg%) — the sum of the work of all segments performed during fiber shortening in the systole and negative work during elongation in the isovolumetric relaxation phase, global wasted work (GWW, mm Hg%) — the sum of the negative work of all segments during elongation in the systole and positive work of all segments during diastole shortening, global work efficiency (GWE) — calculated as GCW/ (GCW+GWW), %. Heart failure was confirmed by a 6-minute walk test performed 6 months after the index event. The values are presented as mean and 95% confidence intervals (CI).
Results. 6 months after STEMI, 26 people registered a value of FV>50% (HFpEF), (58,3% [56,1; 60,5]). The average value of FV in KG was 60,8% [59,3; 62,1] and did not significantly differ from the indicators of the HFpEF group. In the group of patients with HFpEF, the average distance traveled in 6 minutes was 410,7 m [95% CI 378,9; 442,5], which corresponds to the NYHA FC II. Standard echocardiography parameters had the following values: EDV 122.5 [95% CI 104.4; 140,7], in CG-104,7 [95% CI 97,6; 111,8] (p<0,05); ESV 83,8 [95% CI 28,5; 139], in KG-42 [95% CI 38,6; 45,5] (p<0,05); LVMI 89,3 [95% CI 77,4; 101,1], in CG — 65,2 [95% CI 60,9; 69,5] (p<0,05); RWT 0,37 [95% CI 0,33; 0,4] in CG — 0,36 [95% CI 0,33; 0,39] (p>0,05). GWI was 1913 [95% CI 1750; 2076], in CG — 2138,4 [95% CI 2046; 2230,8] (p<0,05), GCW — 2145,5 [95% CI 1965,8; 2325,1] and 2436,5 [95% CI 2342,7; 2530,2] (p<0,05), respectively, GWW — 75,4 [95% CI 54,1; 96,8] and 70,1 [95% CI 53,4; 86,9] (p>0,05), GWE — 95,4 [95% CI 94; 96,7] and 96,5 [95% CI 95,8; 97,3] in the corresponding groups (p<0,05).
Conclusion. Thus, the indicators of myocardial function, except for GWW, had lower values in patients with HFpEF in contrast to healthy ones, despite the satisfactory values of EF.
048 PECULIARITIES OF CELLULAR
IMMUNITY IN ATHEROSCLEROSIS
Filatova A. Yu.
National Medical Research center of cardiology, Moscow, Russia.
Aim. The study aimed to analyze the content and functional activity of circulating pro- and anti-inflammatory subpopulations of lymphocytes and monocytes in the blood of patients with atherosclerosis of the coronary and carotid arteries to identify the individuals prone to the rapid progression of atherosclerotic disease; to evaluate the immunotropic effects of statins in vitro and the influence of statin intake on the parameters of cellular immunity in vivo.
Material and methods. 220 patients with different severity of coronary and carotid atherosclerosis were enrolled. Dynamic coronary angiography and carotid ultrasound were used for atherosclerosis verification and progression. Cell phenotyping was performed in blood samples and mononuclear leukocyte culture using direct immunofluorescence and flow cytometry. Activated T-helper (Th) cells were identified as CD4+CD25lowCD127high, regulatory T-cells (Treg) as CD4+CD25highCD127low and CD4+Foxp3+, IL10-producing T-cells as CD4+IL10+, Th17 as CD4+IL17a+, Th1 as CD4+INFy+. Monocytes were identified as classical (CD14++CD16-), intermediate (CD14++CD16+) and nonclassical (CD14+CD16++). The effects of statins were studied in the cultures of CD4+ T-lymphocytes and macrophages (Mph) differentiated from blood CD14+monocytes using GM-CSF and activated with LPS/INFy. CFSE dye dilution was used to assess the proliferative activity of lymphocytes; cell migration was studied with the Transwell system. The cytokine expression by activated macrophages was evaluated at the protein (ELISA) and RNA (reverse transcription and RT-PCR) levels.
Results. Elevated circulating Th17 level is associated with the severity of atherosclerosis in muscular (distal) but not elastic carotid artery segments (retrospective study, 70 patients). An imbalance between Treg and Th17 content with the predominance of proinflammatory Th17 is a risk factor
for progression of carotid atherosclerosis in patients with LDL levels below 3,5 mM (one-year prospective study, 33 patients, and 14 cases of progression). In patients with atherosclerosis, the number of circulating Tregs decreases with age; the number of effector T cells does not correlate with age (retrospective study, 111 patients). In patients with coronary atherosclerosis, the total number of circulating monocytes and the number of classical monocytes are lower, and the number of intermediate monocytes is higher. The content of classical monocytes is lower in patients with the most severe coronary atherosclerosis (retrospective study, 121 patients). Short-term high-dose therapy with atorvastatin is associated with a significant increase in Treg blood content and a decrease in CCR5 chemokine receptor expression by circulating monocytes (prospective study, 77 patients). Dose-dependent inhibition of migration and proliferation of CD4+ T-cells by statins, accompanied by an increase in the percentage of Foxp3+ cells, was found. Statins inhibit monocyte differentiation to Mph and cytokine synthesis by activated Mph at the posttranscriptional level. Cellular effects of "lipophilic" atorvastatin were manifested at lower concentrations compared to "hydrophilic" rosuvastatin.
Conclusion. The results of the study allow identifying patients prone to atherosclerosis progression; help to select drugs with an optimal combination of hypolipidemic, immunomodulatory, and anti-inflammatory activities, which is relevant for the treatment of patients with comorbidities, as well as to prevent complications.
049 EFFECTS OF AEROBIC PHISICAL
REHABILITATION ON MUSCLE TISSUE METABOLISM IN SEVERE HEART FAILURE PATIENTS
Galenko V.L.
Almazov National Medical Research Center, Saint-Petersburg, Russia
Aim. To evaluate efficiency and safety of aerobic physical rehabilitation (PR), based on original method; to study morphometric and metabolic changes in skeletal muscle fiber (MF) after PR.
Material and methods. 100 patients; heart failure (HF) with reduced ejection fraction (HFrEF), NYHA III, mean age 52±5,2 years, ejection fraction (EF) 27,3±4,2%, BMI 23,5±2,8 kg/m2. Before inclusion in PR program cardiopulmonary exercising test (CPET), echocardiography (EchoCG), quality of life (QOL), exercise tolerance (ET) were estimated. Physical training intensity was selected on the basis of lactate threshold (LT) achievement during CPET. PR efficiency was estimated on the basis of peak oxygen uptake (VO2peak), EF, QOL and ET dynamics after 6 months PR. Shin muscle biopsy was performed at baseline and after 3-6 months PR. In muscle samples activity of alkaline phosphatase (AP), lactate dehydrogenase (LDH) and succinate dehydrogenase (SDG) were evaluated with plag-method. Data were statistically processed using software package "Statistika, 9.0".
Results. After 6 months of training EF increased by 10,5±2,3%, ET increased by 9,7±0,5 points (pij2<0,05), QOL changed by 24,8±3,5 points (significant regression of symptoms), VO2peak increased by 5,2±0,5 ml/min/kg (p34<0,05). MF diameter (dMF) after PR slightly decreased in 6 patients, in 2 patients it did not change. After 3-6 months of training AP activity increased by 24,2% (p<0,05); LDH activity in glycolytic MF decreased by 24,4%, in oxidative MF it decreased by 6,0% only (pj<0,05, p2>0,05). SDG activity in glycolytic MF increased by 20%, in oxidative MF it increased by 30% (pi<0,05, p2<0,05). There was a positive relationship between heart failure functional class dynamics and dMF (r=0,4, p=0,05), increase in CPET parameters was associated with AP activity (r=0,5, p=0,05).
Conclusion. 1. Aerobic physical rehabilitation in stable HF pts, selected on the basis of LT achievement, was effective in improving values of EF, QOL, VO2peak and ET. After 3-6 months PR dMF slightly decreased; 2. Participating in the PR program decreased LDH activity in both oxidative and glycolytic muscle fibers; it also increased AP and SDG activity significantly.
