Vol 14, No 4 (2023)

Original study articles

Associations of the rs1132896 polymorphism of the matrix metalloproteinase type 2 gene with the development of acute cerebrovascular accident: prospective case–control study

Nikulin D.A., Chernova A.A., Nikulina S.Y., Prokopenko S.V., Cherkashina I.I.

Abstract

BACKGROUND: The study focused on the identification of new genetic predictors in the Russian population, particularly associations of the rs1132896 polymorphism of the matrix metalloproteinase type 2 gene (MMP-2) with the development of acute cerebrovascular accident (ACVA).

OBJECTIVE: To investigate the relationship of rs1132896 gene MMP-2 polymorphisms with ACVA development.

MATERIALS AND METHODS: The prospective, case–control study enrolled 318 patients with stroke (main group) and 323 controls (control group). The age of the patients in the main group ranged from 32 to 69 [57.0; 51.0–62.0] years. In the control group, the age of the patients ranged from 37 to 68 [55.0; 51.0–62.0] years, which was comparable to that of the main group. Sexual dimorphism was as follows: 191 men (age [56.5; 51.0–62.0]) and 127 women (age [57.0; 51.0–62.0]). The sex composition in the control group corresponded to that in the main group: 214 men (age [55.0; 51.0–62.0]) and 109 women (age [55.0; 51.0–62.0]). The main group underwent clinical examination, computed tomography of the brain, electrocardiography, echocardioscopy, duplex ultrasound scanning of the extracranial brachiocephalic arteries, 24-h monitoring of blood pressure and heart rate, and analysis of the blood coagulation system. Molecular genetic research was conducted at a branch of the Institute of Cytology and Genetics of the Siberian Branch of RAS (Novosibirsk). All patients provided written informed consent to participate voluntarily in the study. The duration of the study was 3 years, starting in 2019. The primary study endpoint was a diagnosis of stroke, verification of concomitant cardiovascular pathology, and risk factors for stroke development. Statistical processing of the results was performed using SPSS Statistics v. 22 (IBM Corp., USA) and MedCalc 22.006 (Microsoft, USA). When comparing extended variables, the Mann–Whitney U-test was used. Discrete values were compared using Pearson’s χ2 test.

RESULTS: When analyzing statistical significance, a predominance of the homozygous CC genotype was recorded in the group of male patients with stroke: n=24 (12.6%) vs n=20 (9.3%; p=0.0324). In addition, in the group of women, a statistically significant predominance of the heterozygous CG genotype was noted in women with stroke: n=67 (52.8%) vs n=42 (38.5%; p=0.0420).

CONCLUSION: The homozygous CC genotype in men and the heterozygous CG genotype in women may be genetic predictors of the development of ACVA. The study of genetic factors in the development of ACVA is necessary to create a personalized approach to patient management at the outpatient and inpatient stages of medical care.

CardioSomatics. 2023;14(4):215-222
pages 215-222 views

Factors determining the readiness of a patient with coronary artery disease to use telemedicine technologies for rehabilitation: prospective cohort study

Zvereva T.N., Pronina A.A., Babichuk A.V., Pomeshkina S.A., Barbarash O.L.

Abstract

BACKGROUND: Despite its relevance and established efficiency, the third stage of cardiac rehabilitation (CR) lacks a universal solution. The longest rehabilitation period requires many resources and effort on the part of the healthcare system. Digital technologies rapidly developing and being introduced into medicine can significantly assist in organizing the CR process. The healthcare system is already mastered and actively adopting telemedicine technologies into daily practice.

OBJECTIVE: We aimed to determine the patients’ preparedness for the upcoming surgical treatment of the chronic types of coronary artery disease to engage in remote cardiac rehabilitation programs using telemedicine technologies.

MATERIALS AND METHODS: A study of 213 patients treated for artery disease and preparing for planned coronary bypass surgery was conducted. Gender, age, socioeconomic factors, and digital literacy were analyzed. The patients were offered one of two options for completing the third stage of CR: a standard option in which CR is performed under the supervision of a medical worker in a medical organization at the place of residence according to the recommendations received upon hospital discharge or an alternative in which CR is performed at home using remote monitoring under the supervision of specialists from the CR laboratory of the Research Institute for Complex Issues of Cardiovascular Diseases. Patients were divided into two groups based on their choice: those who agreed to participate in the outpatient stage of CR using telemedicine technologies (loyal patients) and those who refused to use telemedicine technologies (nonloyal patients). The factors indicating more loyalty were identified using survey data and correlation analysis, and a portrait of a patient eager to use remote rehabilitation programs was formed.

RESULTS: Social factors, such as living in big cities (p <0.001) and having a spouse (p=0,030), were associated with increased loyalty to participating in CR via telemedicine technologies. Male gender (p <0.001), obesity (p <0.001), and smoking (p <0.001) were associated with the reluctance to participate in the alternative CR program. The education level (p=0.060) did not show a significant impact on the loyalty to use telemedicine technologies.

CONCLUSION: 46% of patients were interested in using remotely controlled CR programs. The social factors determine the loyalty to telemedicine technologies in patients.

CardioSomatics. 2023;14(4):223-232
pages 223-232 views

Role of angiotensin II and neuroendocrine factors in immunological regulation in patients with coronary heart disease: prospective cross-sectional study

Parfenyuk V.K., Logatkina A.V., Bondar S.S., Terekhov I.V., Nikiforov V.S.

Abstract

BACKGROUND: Among chronic noncommunicable diseases, cardiovascular diseases, particularly coronary heart disease (CHD), are the leading cause of death. The rennin-angiotensin-aldosterone system plays an important role in CHD development and progression; however, its role in the regulation of immunoneuroendocrine interactions requires further analysis.

OBJECTIVE: To study the relationship between angiotensin II (AT II) and molecular regulators of the activity of whole blood mononuclear cells (MNCs) in patients with angina pectoris.

MATERIALS AND METHODS: This cross-sectional study enrolled 65 patients with exertional angina aged 45–67 years, including 19 apparently healthy individuals. The levels of interleukins (ILs), transforming growth factor-β1 (TGF-β1), prostaglandin E2 (PG E2), serotonin, thyroid-stimulating hormone (TSH), and AT II in the blood serum were determined. In MNCs, the concentrations of protein kinases FAK, JNK, p38, and ERK, signal transducers, and activators of transcription (STAT 3, 5A, and 6) were determined.

RESULTS: In patients with coronary artery disease, the production of TGF-β1 increased by 7.2% (p=0.00001), AT II by 136.9% (p=0.0001), serotonin by 129.0% (p=0.00001), IL-18 by 92.5% (p=0.00001), TSH by 51.7% (p=0.0012), ERK protein kinase content by 86.4% (p=0.0001), JNK by 56.8% (p=0.0001), and FAK by 55.3% (p=0.00002). The levels of IL-15 also decreased by 38.1% (p=0.0001), PG E2 by 39.5% (p=0.0001), and STAT3 by 52.5% (p=0.0001).

CONCLUSION: The nature of the identified relationships among the analyzed factors allows us to consider AT II as a factor that ensures adaptive coupling of immune and neuroendocrine regulatory mechanisms in patients with coronary artery disease, contributing to a change in the balance between macrophages and T-helper types 1 and 2.

CardioSomatics. 2023;14(4):233-245
pages 233-245 views

Midterm outcomes of the Ozaki procedure in patients with a bicuspid aortic valve: retrospective single-center, non-randomized, parallel-group study

Bazylev V.V., Voevodin A.B., Karnakhin V.A., Potopalskiy I.D.

Abstract

BACKGROUND: An alternative to plastic surgery on the bicuspid aortic valve (BAV) can be replacement of the leaflets with autopericardium using the Ozaki technique. The procedure is characterized by excellent hemodynamic results in the short and long term in patients with tricuspid aortic valve (TAV). However, the question remains about the long-term results of the procedure and the frequency of reoperations in patients with BAV.

OBJECTIVE: To analyze the midterm outcomes of the Ozaki procedure in patients with BAV.

MATERIALS AND METHODS: Retrospective single-center, non-randomized, parallel-group study was conducted. Since January 2015 to October 1, 2023, the clinic performed 809 Ozaki procedures. The work included 540 patients with studied midterm and long-term outcomes for up to 5 years. Both isolated aortic valve replacement and combined operations with coronary artery bypass grafting and (or) correction of mitral and tricuspid valve defects were performed.

RESULTS: Midterm mortality was 5.7% (n=3) in the group with BAV and 7.3% (n=36) in the group with TAV. Reoperation for aortic regurgitation was required in 16 patients (2.9%): 1 patient (1.9%) in BAV group and 15 (3.3%) in TAV group. Freedom from reoperations in patients with BAV after the Ozaki procedure for up to 5 years was 95.4%, in the group with TAV — 92.6%. The peak gradient on the aortic valve in the group with BAV was 16±7.3, in TAV group — 16.4±10.9. 5 years after surgery, the mean gradient on the aortic valve does not exceed 10 mm Hg.

CONCLUSION: The Ozaki operation in patients with BAV is an effective and safe procedure in the midterm follow-up period.

CardioSomatics. 2023;14(4):247-255
pages 247-255 views

Reviews

Salusin-α and salusin-β as new biological markers in cardiovascular diseases: literature review

Alieva A.M., Reznik E.V., Teplova N.V., Gyzyeva M.K., Rakhaev A.M., Kotikova I.A., Nikitin I.G.

Abstract

Despite significant advances in medicine, cardiovascular disease continues to be the leading cause of death worldwide. An important task in cardiology is the search and study of new cardiovascular biological markers. In recent years, salusins have attracted the interest of scientists. Salusins are endogenous biologically active peptides, which were first identified in 2003. Thus far, studies have demonstrated that salusin-α and salusin-β play important roles in vascular remodeling, inflammation, hypertension, and atherosclerotic processes. Salusin-α exhibits an antiatherogenic effect, whereas salusin-β plays a proatherogenic role. Despite the diverse biological, physiological, and pathophysiological aspects of salusins, the exact mechanism of their cardiovascular effects is not fully known. Further in-depth studies of the role of salusins in cardiovascular diseases are required. The regulation of the concentration and expression of salusin-α and salusin-β may prove to be a promising strategy for the treatment of patients with cardiac diseases.

CardioSomatics. 2023;14(4):257-268
pages 257-268 views

Phenotype of a modern patient with valvular heart diseases: literature review

Dren' E.V., Lyapina i.N., Pecherina T.B., Barbarash O.L.

Abstract

In modern conditions, valvular heart diseases (VHD) are one of the most common pathologies among cardiovascular diseases with a dynamic change in the phenotype of patients. An increase in the prevalence of VHD is currently observed due to the active implementation of diagnostic methods in cardiology. Geographical differences in the genesis of the development of valvular heart defects are noted, and the portrait of patients also changes as a result of aging and the addition of comorbid pathology. The purpose of the literature review was to present current trends in changing phenotype of patients with VHD, to study current data on the epidemiology of valve pathology, the contribution of various cardiovascular risk factors and comorbidity of patients on the course of the disease. Current data on the number of surgical interventions performed for VHD based on Russian, European, American, Australian and other studies, data on patient survival and mortality, as well as differences in these indicators in age groups of different countries are presented. The review will be useful for doctors to understand the modern portrait of a patient with VHD, trends in cardiovascular risk factors that influence the course of the disease and prognosis in patients with VHD.

CardioSomatics. 2023;14(4):269-282
pages 269-282 views

Interleukin-38 and cardiovascular pathology: literature review

Alieva A.M., Baykova I.E., Pinchuk T.V., Kotikova I.A., Nikitin I.G.

Abstract

Cardiovascular pathology is a leading cause of morbidity and mortality. An important task of modern cardiology is the search and study of new biological markers. Scientists’ interest is actively focused on the study of interleukin-38. Interleukin-38 is an anti-inflammatory cytokine and a member of the interleukin-1 family. This study aimed to analyze literature sources devoted to the study of interleukin-38 as a cardiovascular biological marker. Literature sources, including all relevant publications in PubMed (MEDLINE), RSCI, Google Scholar, and Science Direct, were analyzed. The search depth was 9 years. Interleukin-38 is found in the skin, heart, placenta, fetal liver, spleen, thymus, and activated B cells of the tonsils. Interleukin-38 protein is detected in human plasma, serum, and cell cultures by enzyme-linked immunosorbent assay. Interleukin-38 regulates immune and inflammatory responses by binding to its receptors and activating downstream signals. Its deficiency is associated with increased systemic inflammation in aging, cardiovascular diseases, and metabolic diseases. Currently, not much clinical and experimental data have been accumulated regarding the effect of interleukin-38 on the cardiovascular system; however, further studies are expected to demonstrate the possibility of its use as an additional laboratory tool for diagnosis and assessment of prognosis in patients with cardiac problems. Regulating the concentration and expression of interleukin-38 is a promising strategy for the treatment of cardiovascular diseases.

CardioSomatics. 2023;14(4):283-293
pages 283-293 views


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