Saratov JOURNAL of Medical and Scientific Research

Malinova L.I.

Saratov State Medical University n.a. V I. Razumovsky Department of Therapy and Gerontology, 3rofessor, Doctor of Medical Science

Age and age-dependent predictors for the risk assessment in elderly and senile patients with chronic heart failure

Year: 2020, volume 16 Issue: №1 Pages: 172-176
Heading: Тhematic supplement Article type: Original article
Authors: Malinova L.I., Lipatova Т.Е., Zhuk A.A., Dolotovskaya P.V., Furman N.V., Denisova T.P.
Organization: Saratov State Medical University
Summary:

Objective: to assess the presence and nature of age-dependent changes in the predictors used for risk stratification of patients with chronic heart failure (CHF). Material and Methods. We perform an analysis of predictive models of CHF, including a comparative assessment of predictors and age of patients. At the second stage, age-dependent changes in the most commonly predictors of CHF were characterized. The study included hospitalized patients with CHF (36-94 years, n=2764). Results. We analyzed 275 prognostic models based on results of large studies (n=36062±5814). The mean age of the patients involved was 68.9±7.6 years. The major predictors included the patient's age and/or potentially age-dependent parameters: hemoglobin, creatinine, RDW, LVEF, SBP and NT-proBNP. In the study sample all of these parameters correlated with the age of the patients with the maximum correlation strength of "NT-proBNP — age" (R=0.57; p<0.05) and "hemoglobin level — age" (-0.57; p<0.05). Conclusion. The prevalence of mature and elderly patients in the populations of studies used to develop the majority of risk instruments for heart failure is revealed. The age-dependent nature of the predictors used in the risk of heart failure is established (hemoglobin, creatinine, RDW, LVEF, SBP and NT-proBNP). The simultaneous use of age and age-dependent parameters as predictors when creating risk-assessment tools may be considered as one of the reasons for the unsatisfactory quality of risk stratification in CHF, including elderly and senile patients.

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Chronic coronary syndromes: clinical features, diagnosis

Year: 2020, volume 16 Issue: №1 Pages: 150-155
Heading: Тhematic supplement Article type: Lecture
Authors: Denisova Т.Р., Lipatova Т.Е., Malinova L.I.
Organization: Saratov State Medical University
Summary:

The lecture is devoted to existing ideas about the diagnosis and treatment of coronary heart disease. The concept of chronic coronary syndromes (CCS) is introduced in accordance with The ESC Guidelines forthe diagnosis and management of chronic coronary syndromes, 2019. CCS pathogenetic mechanisms, clinical flow scenarios and diagnostic methods are considered. Particular emphasis is placed on the late age category of patients.

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Comorbidity in patients with acute coronary syndrome in real (everyday) clinical practice

Year: 2019, volume 15 Issue: №3 Pages: 821-825
Heading: Cardiology Article type: Original article
Authors: Furman N.V., Dolotovskaya P.V., Malinova L.I., Reshetko O.V.
Organization: Saratov State Medical University
Summary:

The purpose of the study was to assess prevalence of comorbidity in the population of patients with acute coronary syndrome in Saratov region. Material and Methods. Inpatient and outpatient records of 484 patients with acute coronary syndrome (ACS) were analysed (64% of them residents of Saratov). Cases of cardiac and non-cardiac comorbidity were evaluated, Charlson Comorbidity Index (CCI) was calculated. Results. Only 20.5% of patients were without cardiac or non-cardiac comorbidity. Comorbid non-cardiac diseases were observed in 37.5% of patients (the most common diseases of the digestive system — 43% of all cases of non-cardiac comorbidity). Comorbid cardiovascular diseases were detected in 76.9% of patients, among the most common ones were arterial hypertension (88.4% of all cases of non-cardiac comorbidity) and documented hypercholesterolemia 42.2%). A correlation was found between the CCI and an unfavorable hospital outcome (0.227, P<0.0001). Conclusion. Patients with ACS in the vast majority of cases have at least one concomitant disease (cardiovascular or non- cardiac) that can significantly affect their prognosis. To determine individual prognosis for ACS patients with concomitant diseases, it is advisable to calculate the Charlson comorbidity index.

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Platelet functional pools under pharmacological suppression of aggregation in ST segment elevation myocardial infarction

Year: 2019, volume 15 Issue: №3 Pages: 779-783
Heading: Cardiology Article type: Original article
Authors: Malinova L.I., Dolotovskaya P.V., Furman N.V., Puchinyan N.F., Lipatova Т.Е.
Organization: Saratov State Medical University
Summary:

The purpose of the study is to investigate clinical significance of peripheral pool platelets functional heterogeneity, assessed with combination of collagen and ADP, under pharmacological suppression of platelet aggregation in acute coronary syndrome. Material and Methods. The study involved 374 patients with acute coronary syndrome (ACS). Functional activity of platelets (FAT) was studied on the first, the 7th and 30th days after ACS manifestation in the whole blood by impedance and luminescent aggregometry. The functional heterogeneity of platelets was studied using our own method with an estimate of AAk (functional subpopulation of platelets aggregation (cluster II)), ASk (the functional subpopulation of platelets secretion (cluster II)) and ДА (a parameter of platelets functional heterogeneity). The follow-up period was 24 months after ACS manifestation. Results. In the study sample ADP- and collagen-induced platelet aggregation remained almost constant during the whole observation period. It was established that in patients treated with double antiplatelet therapy parameters of functional platelet heterogeneity statistically significantly decreased by the seventh day of observation: ЛАк 2(0; 3)vs 1 (0; 2) Ohm, p=0,049; AS 0.26 (0.15; 0.47) vs 0.19 (0; 0.26) nmol, p=0.07. The excess of ЛАР measured on the second day after ACS manifestation, a threshold of 2 Ohms, was associated with a significant increase in the 30-day risk of rethrombotic events (HR 1.8; Cl 1.2; 3.1). Conclusion. The dynamics of platelet functional heterogeneity was revealed in patients with acute coronary syndrome treated with double antiplatelet therapy. A high degree of platelet functional heterogeneity in patients with acute coronary syndrome was associated with a significant increase in the 30-day risk of rethrombotic events.

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Tentative analytic biomarker panel of maladaptive myocardial remodeling (systematic review)

Year: 2019, volume 15 Issue: №3 Pages: 773-779
Heading: Cardiology Article type: Review
Authors: Malinova L.I., Denisova Т.Р., Furman N.V., Dolotovskaya P.V., Puchinyan N.Ph., Povarova T.V.
Organization: Saratov Road Clinical Hospital, Saratov State Medical University
Summary:

The purpose is to design a tentative analytical panel of biomarkers (BM) of maladaptive myocardial remodeling/extracellular myocardial matrix dysfunction. eLibrary.ru and PubMed were used for data extraction. Reproducibility of the obtained data was calculated, as well as the intragroup correlations of BM maladaptive myocardial remodeling/extracellular myocardial matrix dysfunction with the clinical phenotype of heart failure (HF) — т. The tentative BM panel design was carried out using the ranking method (R). Analysis included data from 5085 publications. The highest reproducibility was traced in nautriuretic peptides ((3 0.91 and 0.89) and cardiac troponins ((3 0.84), while the highest correlation ratios of BM and the clinical phenotype of CH were detected in natriuretic peptides and ST2 (т 0.81; 0.77 and 0.71). PIIINP and decorin did not reveal any significant correlation with the HF clinical phenotype. A rank of >0.5 was identified in galectin-3, GDF-15, and osteopontin. A set of biomarkers with a proven participation in the pathogenesis of heart failure, which potentially has the greatest diagnostic and prognostic value was designed, i. e. a tentative analytical panel of biomarkers of maladaptive myocardial remodeling/extracellular myocardial matrix dysfunction: NT-proBNP, BNP, cardiac rf-troponins, ST2, GDF-15, galectin-3 and osteopontin.

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Erythrocyte system in elderly: ageing aspects

Year: 2018, volume 14 Issue: №2 Pages: 341-345
Heading: Gerontology and geriatrics Article type: Original article
Authors: Malinova L.I., Denisova Т.Р., Lipatova Т.Е., Khvostikova D.E., Yegorova A.V.
Organization: Saratov State Medical University
Summary:

The purpose of the study was an assessment of erythrocyte system age-dependent characteristics in elderly population dwelling in the same territory during the time period equal to the average life span in the region. Material and Methods. We perform the compare of hematological parameters of 800 patients with hypertension and coronary heart disease hospitalized during 25-years period. Results. In senile patients, red blood cells and hemoglobin levels signifi- cantly decrease, but platelet characteristics remain intact. Revealed differenced are similar during all 25-year period of observation. Conclusion. Over the past 25 years, the trend of age-related decline in the number of red blood cells and hemoglobin has been preserved. The average hemoglobin content in erythrocyte (MCH) during the aging process tends to decrease, which has become statistically significant in recent years. The principal difference of the obtained data from the results of obtained 25 years ago is the absence of an age-related increase in the volume of erythrocytes and a higher level of the average concentration of hemoglobin in the erythrocyte.

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Clinical diagnosis in terms of insurance medicine

Year: 2018, volume 14 Issue: №2 Pages: 327-330
Heading: Gerontology and geriatrics Article type: Author's opinion
Authors: Denisova Т.Р., Lipatova Т.Е., Malinova L.I., Tyultyaeva L.A., Kovalev Е.Р., Alipova L.N., Vakhlyueva O.G.
Organization: Saratov Regional Hospital for Veterans of Wars, Saratov State Medical University
Summary:

Medical institutions in the conditions of insurance medicine are faced with not always justified interference of insurance companies in the structure of diagnosis and diagnostic process, whose violate the essence of the concepts of clinical classifications and statistical coding of diagnoses provided by ICD-10. Such a situation ultimately harms the patient and society, makes it difficult both to monitorthe adequacy of the ongoing treatment activities, and to protect the patient's rights to receive qualified medical care and doctor's rights.

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Natriuretic peptides and Galectin-3 in senile heart failure patients with preserved ejection fraction.

Year: 2015, volume 11 Issue: №1 Pages: 041-046
Heading: Gerontology and geriatrics Article type: Original article
Authors: Malinova L.I., Podbolotov R.A., Povarova T.V., Pletneva G.F.
Organization: Saratov State Medical University, Saratov Road Clinical Hospital, Regional Hospital for War Veterans, Saratov
Summary:

Purpose: to characterize biomarker panel in senile patients with heart failure with preserved ejection fraction (HF-pEF). Material and Methods. 356 senile patients with chronic heart failure with preserved ejection fraction (HFpEF) were examined to form the study sample of 48 male patients without atrium fibrillation, anemia, diabetes mellitus, onco-pathology and missing clinical data. NT-proBNP, galectin-3 (gal-3) and proANT assay was performed by commercially available ELISA kits. Results. In patients without left ventricular (LV) regional wall motion abnormalities (RWMA). gal-3 (2,13 (0,98; 3,50) vs 5.16 (4,34;9.63) ng/mL, p = 0.011) and NT-proBNP (5,59 (1,00; 10.13) vs 32,04 (15,40; 46,18) fmol/mL, p=0,006) levels were significantly lower than in patients with LV RWMA. Contrarily proANP level was lower in patients with LV RWMA (3,24 (2,47; 3,75) vs 1,38 (0,83; 2,29) nmol/mL, p=0.071). proANP was the only biomarker to increase significantly in long livers (7,30 (4,52; 7,63) vs 2,68 (1,88; 3,32) nmol/mL, p=0.006). NT-proBNP positively correlated with glucose level and negatively with hsCRP (R=0,52, p=0,007). Conclusion. Biomarker panel in senile heart failure patients with preserved ejection fraction has characterized: increase in NT-proBNP and galectin-3 is associated with more severe clinical course and presence of regional wall motion abnormalities in senile patients.

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Heart ischemic disease and longevity: unsolved problems

Year: 2015, volume 11 Issue: №1 Pages: 037-041
Heading: Gerontology and geriatrics Article type: Original article
Authors: Markova T.Yu., Malinova L.I., Denisova Т.Р.
Organization: Regional Hospital for War Veterans, Saratov, Saratov State Medical University
Summary:

The purpose of the study was to estimate clinical signs and course of coronary heart disease in long-livers and centenarians. Material and Methods. The study included overall population of Saratov — Engels agglomeration's long-livers (>=90 years old, n=198). Results. The rates of major clinical forms of coronary heart disease were detected: atrial fibrillation — 10.6%, chronic heart failure (with preserved ejection fraction) — 10.1 % and angina — 5.1 %. Myocardial infarction was verified in 9.6% of long-livers. Myocardial scar criteria prevailed over myocardial infarction history. Received data corroborated dissolving phenomena of coronary heart disease and noninsulin dependent diabetes mellitus in long-livers. Gender differences in electrophysiological parameters were detected in long-livers. Centenarians with the history of myocardial infarction preserved a satisfactory level of physical activity. Conclusion. Received data confirm a presence of an excessive security: prevention of coronary heart disease manifestation and progression in longevity. Long-livers should be considered as a natural model of an antiatherogenic factors and mechanisms.

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Polybiomarker approach in myocardial dysfunction assessment in senile patients

Year: 2015, volume 11 Issue: №1 Pages: 031-036
Heading: Gerontology and geriatrics Article type: Original article
Authors: Malinova L.I., Podbolotov R.A., Povarova T.V., Avdienko I.V.
Organization: Regional Hospital for War Veterans, Saratov, Saratov State Medical University
Summary:

Purpose: to evaluate interaction of obesity, inflammation and myocardial dysfunction in senile myocardial infarction survivors. Material and Methods. Patients aged 70 and older were involved in the study (n=108) and divided into 2 groups according to the history of myocardial infarction (Ml) — 5 years before involvement: senile Ml survivors (n=26) vs senile patients without history of Ml (n=82). Measurements of serum levels of adipokines (leptin, adiponectin), myocardial dysfunction markers (BNP, NT proBNP, proANP, galectin 3) and inflammatory cytokines (TNF, interleukin 6) were performed. Results. Both groups were comparable by age and major clinical characteristics. Ejection fraction was preserved in both groups under the study (67 (64; 70) %vs67 (64; 68) %, p=0,655). Frequency of diastolic dysfunction was comparable in both groups. However it was more severe in Ml survivors. BNP and NT proBNP levels were significantly lower in patients without the history of Ml (p=0,021; 0,004, respectively). On the contrary serum levels of proANP had tendency to increase in patients with the history of Ml, but not significantly: p=0,821. Adiponectin and galectin-3 were significantly higher in patients with the history of Ml (p=0,019and p=0,011). Conclusion. Pathogenetic peculiarities of chronic heart failure with preserved ejection fraction in senile patients with and without myocardial infarction history were revealed. More expedient biomarker panel appropriate for senile patients with probable heart failure should include NT-proBNP, galectin-3 and adiponectin.

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