Predictor significance of β2-microglobulinuria in determining the risk of cardiovascular complications in patients with chronic ischemic heart disease

BACKGROUND. The relevance of identifying new biomarkers of the cardio-renal syndrome in patients with coronary heart disease is beyond doubt. It is promising to study the indicators of tubular dysfunctions as predictors of the risk of cardiovascular complications in patients without primary kidney pathology.THE AIM. Analysis of the effect of β2-microglobulinuria on the prognosis of cardiovascular complications in patients with chronic ischemic heart disease in the long-term period after myocardial revascularization.PATIENTS AND METHODS. The study included 90 patients with coronary artery disease and indications for myocardial revascularization. Coronary bypass surgery was performed in 64 people, coronary artery stenting - in 26. Clinical and anamnestic data were collected in all patients, standard laboratory and instrumental diagnostics were performed. In addition, the level of β2-microglobulin (β2-MG) in the first morning portion of urine was determined at different study dates. The endpoint was considered to be the presence of acute forms of coronary heart disease - myocardial infarction and unstable angina. Survival after 5.8 ±0.1 years after myocardial revascularization was 69 %.RESULTS. A positive linear relationship of weak strength was established between the level of diastolic blood pressure (DBP) and β2-MG of urine obtained before myocardial revascularization (r = 0.28, p = 0.03). Moreover, the Kaplan-Meyer survival analysis showed the effect of an increase in β2-MG of urine over 0.2 ng/ml on the risk of AMI in the long-term period after myocardial revascularization (p = 0.025). It was found that an increase in the concentration of β2-MG in urine determined before myocardial revascularization is a statistically significant risk factor for the development of unstable angina in the long-term period after RM (χ2-criterion = 7.17, p = 0.007).CONCLUSION. It has been shown that an increase in the concentration of β2-MG in urine, reflecting the presence of tubular dysfunctions, can be considered as a predictor of an unfavorable cardiovascular prognosis in patients in the long-term period after myocardial revascularization.

Small Vessel Disease: Another Component of the Hypertrophic Cardiomyopathy Phenotype Not Necessarily Associated with Fibrosis

Background: Hypertrophic cardiomyopathy (HCM) is characterized by myocardial disarray, small vessel disease (SVD), and fibrosis. The relationship between SVD and replacement-type fibrosis is still unclear. Methods: Histopathologic assessment of replacement-type fibrosis and SVD in HCM patients with either end-stage heart failure (HF) or sudden cardiac death (SCD). Chronic ischemic heart disease (IHD) patients served as controls. Results: Forty HCM hearts, 10 HF and 30 SCD, were studied. Replacement-type fibrosis was detected in all HF and in 57% of SCD cases. In SCD, replacement-type fibrosis was associated with older age, greater septal thickness, SVD prevalence, and score (all p < 0.05). Prevalence of SVD did not show significant differences among SCD, HF, and IHD (73%, 100% and 95%, respectively), while SVD score was higher in HF than IHD and SCD (2.4, 1.95, and 1.18, respectively) and in areas with replacement-type fibrosis vs. those without in HF (3.4 vs. 1.4) and SCD (1.4 vs. 0.8) (all p < 0.05). Conclusions: SVD is a frequent feature in HCM independent of the clinical presentation. A higher SVD score is observed in HCM-HF and in areas with replacement-type fibrosis. Although SVD is part of the HCM phenotype, further remodeling of the microcirculation might occur secondarily to fibrosis.

Antithrombotic therapy for chronic ischemic heart disease: how to balance risk and benefit in different categories of patients?

The review focuses on current guidelines for the use of medications that affect hemostasis in the treatment of patients with chronic ischemic heart disease (IHD). The review shows the important impact of negative outcomes of IHD on mortality from cardiovascular system diseases in the Russian Federation. The results of the most significant randomised clinical trials, which assessed the efficacy and safety of various antithrombotic therapy options in patients with various clinical manifestations of IHD, as well as methodological methods for individual assessment of ischemic and hemorrhagic risks, were discussed. Theoretically, the use of anticoagulants in combination with antithrombocytic drugs to reduce the risk of atherothrombotic complications in the phase of the stable course of the IHD is justified. The results of the COMPASS study, which proved the positive effect oflow-dose addition of rivaroxaban to acetylsalicylic acid on the risk of cardiovascular events, cardiovascular death and death from all causes in patients with chronic IHD with maintained sinus rhythm, are reviewed in detail. Discussions were held on how to determine the optimal duration of double antithrombocytic therapy in patients with IHD after percutaneous coronary intervention (PCI), taking into account individual values of ischemic and hemorrhagic risks. Long-term antithrombotic therapy schemes for patients with chronic IHD and atrial fibrillation (AF) that have not been exposed to PCI are presented, as well as current recommendations on how to choose the best antithrombotic therapy scheme for patients with IHD that have been exposed to PCI depending on the risk of stent thrombosis and the risk of bleeding. It has been substantiated that active differentiated antithrombotic therapy should be widely used in everyday practice, which, provided that ischemic and hemorrhagic risks are adequately assessed, creates a real prospect of reducing mortality from IHD and circulatory system diseases in general.

Abstract 14451: Bone Marrow Cell Therapy Improves Cardiac Function, Survival, and Clinical Outcomes in Patients With Chronic Ischemic Heart Disease

Introduction: The effects of bone marrow cell (BMC) therapy in patients with chronic ischemic heart disease (CIHD) remain controversial. Hypothesis: We hypothesized that injection of BMCs in patients with CIHD would improve left ventricular (LV) structure and function. We also hypothesized that BMC therapy would improve clinical outcomes in CIHD patients. Methods: We performed a systemic review and meta-analysis of pooled data from published randomized controlled trials (RCTs) that evaluated the efficacy of BMC administration in patients with CIHD. The effects of BMC injection on LV ejection fraction (LVEF), LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV), infarct size, and patient outcomes were analyzed using random-effects meta-analysis. Results: The literature search yielded 30 RCTs enrolling 1,548 patients. Transplantation of BMCs resulted in an improvement in LVEF in cell-treated patients compared with controls (2.89%; 95% confidence interval (CI): 1.80 to 3.97; P <0.001). There was a trend toward reduced LVESV (-4.96 ml; 95% CI: -11.64 to 1.71 ml; P = 0.14) and LVEDV (-5.95 ml; 95% CI: -12.09 to 0.18 ml; P =0.06). The improvement in LVEDV was more pronounced (-7.42 ml; 95% CI: -13.68 to -1.17ml; P =0.02) in patients with baseline LVEF <40%, indicating improved LV remodeling. BMC injection was also associated with marked reduction in the risk of all-cause mortality, rehospitalization due to heart failure, and ventricular arrhythmias in CIHD patients. Conclusions: BMC injection improves cardiac function and remodeling in patients with CIHD. These benefits are more pronounced in patients with LVEF <40% at baseline. Perhaps more importantly, BMC therapy also improves clinical outcomes that are critically important for this patient population with LV dysfunction, including survival, rehospitalization due to heart failure, and ventricular arrhythmias.