Clinical Medicine

Interorgan interactions in cardiology: variants, predictors, prognostic value, prophylactic therapeutic strategies

Research studies on the prevalence, key pathophysiological mechanisms and prognostic value of interorgan interactions, the search for highly sensitive markers and predictors of their development. Assessment of the cardiovascular system and kidneys, liver and brain in patients with various cardiovascular diseases using a combination of traditional and innovative methods of functional diagnostics and research of serological and genetic biomarkers. The study of the possibilities of using the domestic apparatus of bioimpedance vector analysis (BIVA) - a non-invasive low-cost and easy-to-use method for assessing the status of hydration. Accumulated over the past few years, data on the leading role of hyperhydration in the development of organ dysfunction and adverse outcomes in patients with HF (heart failure) make the use of BIVA extremely important in this population - controlled water balance management in a particular patient will allow you to implement a personalized approach in treating systemic stagnation and reduce the risk of complications. To date, this potentially effective method for assessing subclinical stagnation and water balance control is not implemented.

The study of the cardiovascular system and the relationship between its segments

The study of ventricular-arterial interaction is extremely important for understanding the mechanisms and potential therapeutic goals in the treatment of heart failure, especially with the intact ejection fraction, since modern drugs used in this pathology do not have an evidence base to influence the prognosis. To study the structural and functional state of the heart, the parameters of left ventricular deformation, left ventricular-arterial conjugation and arterial stiffness as possible predictors of subclinical left ventricular remodelling and heart failure in patients with uncomplicated arterial hypertension, in the acute period of myocardial infarction, at various stages of chronic kidney disease. The most important advantage of the study is its practical orientation: the work will allow developing different aspects of interorgan relationships in cardiology and studying innovative approaches to identify early predictors of progression of both target organ injury and cardiovascular diseases.

Determining the level of hepatospecific micro-RNA of blood plasma in patients with hepatitis, for the formation of a diagnostic panel

Viral hepatitis (VHC) is today a major medical and social problem and is the most common form of viral hepatitis, with parenteral transmission and mostly unfavourable course of the disease. The success of treatment depends on the genotype of the virus and the adherence to the treatment plan. For effective treatment, it is necessary to track the dynamics of the process. Any invasive diagnostic manipulation, including biopsy, is accompanied by a certain risk of complications. The question of the expediency of its implementation is decided after evaluating all the arguments in favour of a morphological study of the liver tissue and its contribution to the solution of a specific clinical task and the degree of danger to the patient’s life with possible complications during and after the manipulation. The proposed approaches to search for informative markers in the blood plasma will allow avoiding this procedure. Micro-RNA studies have shown that the expression level of a number of micro-RNAs is associated with the effectiveness of treatment. The ability to obtain specific micro-RNA from peripheral blood allows the use of minimally invasive and effective markers to assess the effectiveness of antiviral therapy, and in the future to take into account these data when developing specialized treatment based on the use of micro-RNA, since the effectiveness of standard treatment regimens of the prevailing forms of VHC is only slightly more than 50%. New drugs against hepatitis C can ease the course of the disease and effectively fight its development.

The introduction of new methods of etiological diagnosis of infective endocarditis

The increase in the incidence of infective endocarditis (IE) is associated with an ageing population, extensive use of invasive instrumental techniques (angiography, catheters, electric cardiac pacemakers), an increase in the number of surgeries on the heart and vessels, an increase in drug addiction, HIV-infected patients, and the number of patients on hemodialysis. Heart failure and kidney damage may be important clinical manifestations of IE, which make it worse and worsen the prognosis. Of particular interest to study are the cardiorenal relations in IE, in connection with which the widespread introduction of renal biomarkers into the practice, which remains little studied, is discussed. The most reliable and significant criterion for IE is a positive blood culture, which determines the choice of effective antibacterial therapy. It is not always possible to establish the etiological factor. In European countries, culture-negative IE occurs in 2.5-31% of patients, in Africa - in 40-69.7%, and in Russia - in 31.7-87%. Histopathological examination of resected valve tissue or embolic fragments remains the gold standard for diagnosing IE. To improve the etiological diagnosis, especially in culture-negative IE, the use of immunochemical (indirect immunofluorescence reaction or enzyme immunoassay) and molecular-biological methods [polymerase chain reaction (PCR), cyclic sequencing reaction] are proposed. Most studies on the use of PCR for the etiological diagnosis of IE are based on a study of the tissues of the excised affected valves during surgery. Studies on direct comparison of blood culture and blood PCR are practically non-existent or they are a small cohort. There is no clear opinion on the use of PCR in IE to date. The role of viruses in IE also remains an open question. In connection with the foregoing, it is of interest to directly compare bacteriological and molecular biological methods for the etiological diagnosis of IE in blood and in resected heart valve tissue, with the study of not only the role of bacteria but also viruses.