Vol 14, No 2 (2023)

OBJECTIVE: To identify diastolic myocardial function features in late postmenopausal women with polymorphic variants of the integrin beta-3 (ITGB3) gene and arterial hypertension.

MATERIALS AND METHODS: This cross-sectional study enrolled 97 postmenopausal women, with a median age of 67 (65÷70) years. The duration of menopause was 18 (16÷21) years. Molecular genetic studies to assess ITGB3 (rs5918) T1565C polymorphism were performed. The study participants with the homozygous TT ITGB3 polymorphic variant comprised group 1, whereas group 2 included patients with the C allele (TC and CC genotypes). All patients underwent standard transthoracic echocardiography and assessment of left ventricular (LV) diastolic function by transmitral flow. LV diastolic dysfunction was classified into rigid, pseudonormal, and restrictive.

RESULTS: Homozygous allelic variant TT was detected in 65 (67%) patients, heterozygous TC in 29 (30%), and homozygous polymorphic variant CC in 3 (3%). LVDD occurred in all patients included in the study. Among patients with the TT allelic variant of ITGB3, rigid LVDD was diagnosed in 34 (52%), and its pseudo-normal variant was detected in 31 (48%). Among TC and CC genotypes of C allele carriers, a pseudo-normal variant of LVDD (p <0.01), which occurred in 20 (62%) patients, was statistically significantly more frequently recorded, and 12 (38%) patients had a rigid type of LVDD. In addition, a rigid type LVDD was not detected in any case. Calcification of the mitral and aortic valve leaflets was detected in 24 (37%) cases in group 1 and in 9 (28%) patients in group 2 (p=0.68). In fibrous rings, calcifications were found in 34 (52%) patients in group 1 and 16 (50%) in group 2 (p=0.31), and the differences were not statistically significant.

CONCLUSION: This study presents a significant contribution of the rs5918 polymorphism of ITGB3 in the development of myocardial remodeling and LVDD in postmenopausal women.

The demographic aging of the population causes an increase in the number of patients with both heart failure (HF) and osteoporosis. This is due to the strengthening of disease-preventive measures, multimorbidity, and presence of comorbid conditions such as senile asthenia. As a result, these pathological conditions can cause serious consequences such as loss of functional and social activity, disability, and high rates of hospitalization and mortality. The article considers the common risk factors of HF and osteoporosis and the leading pathophysiological mechanisms underlying these conditions. Modern ideas about the causes of bone metabolism disorders and their features in patients with HF are discussed. Data on the contribution of systemic and immune inflammation, rennin-angiotensin-aldosterone system activation in the pathogenesis, and progression of HF and osteoporosis are presented. The relationship between low bone mineral density and hemodynamic disorders in patients with HF is also shown. All this is considered in the prospect of distinguishing patients with HF as a risk group for osteoporosis and patients with decreased bone mineral density as having a high cardiovascular risk.

BACKGROUND: Cardiovascular complications during pregnancy and postpartum period are rare but often fatal. The causes and mechanisms of the development of such complications are not fully understood. Spontaneous dissection of the coronary artery against the background of the influence of sex hormones is one of the mechanisms for the development of acute coronary syndrome in the postpartum period. The false lumen of the intramural hematoma overlaps the true lumen, causing arterial obstruction, leading to acute myocardial hypoxia. Thus, awareness that the pathophysiology of spontaneous coronary artery dissection differs from that of acute coronary syndrome associated with atherosclerotic plaque rupture is important, and these patients require different treatment approaches. Currently, an unambiguous and precise strategy for this pathology has not been established, which is why difficulties remain in the management of these patients and choosing treatment strategies.

CLINICAL CASE DESCRIPTION: The article describes a complex clinical case of the development of acute myocardial infarction in the postpartum period in a young woman without risk factors against the background of spontaneous dissection of the coronary artery, complicated by cardiogenic shock, which required emergency percutaneous coronary intervention and stenting of the infarct-dependent artery. The postoperative period proceeded with complications, and extracorporeal membrane oxygenation was required. However, an integrated approach and correctly chosen treatment strategies help stabilize the patient’s condition.

CONCLUSION: Currently, no unambiguous and precise strategy of treatment has been established, so difficulties remain in the management of patients and decision making. In our opinion, an individual patient approach should be followed, taking into account the general state of the organism, type and volume of dissection, consequences and complications, and experience and technical capabilities of the clinic.

BACKGROUND: Myxoma is one of the most common benign neoplasms of the heart. The most characteristic localization is the inter-atrial septum in the region of the oval window. Clinically, myxoma can be represented by obstructive, thromboembolic, non-specific symptoms. However, the absence of pathognomonic signs is the reason for the late diagnosis and treatment.

CLINICAL CASE DESCRIPTION: A 78-year-old female patient was hospitalized at the department of cardiology for examination, correction of therapy, and determination of indications for diagnostic coronary angiography. During a routine examination, echocardiographic data revealed a formation in the left atrial (LA) cavity. To clarify the diagnosis and determine the treatment strategies, the patient underwent magnetic resonance imaging of the heart with gadolinium, which verified this formation as an LA myxoma measuring 10×12 mm. Considering the age of the patient, the presence of concomitant pathology, and absence of complications of myoxoma (obstructive and thromboembolic), the patient was further observed.

CONCLUSION: LA myxomas have clinical manifestations; however, quite often, they are accidental findings in echocardiographic studies. Surgical removal of the tumor is currently the main treatment method. The absolute indications for surgical treatment are large tumors and presence of complications (embolic and obstructive). However, in older patients, who, according to imaging methods, have small tumors and concomitant somatic diseases, dynamic follow-up appears suitable to assess the progression of tumor growth and determine the timing of surgical treatment.