Changes in the structural and functional characteristics of the epicardial adipose tissue (EAT) are recognized as one of the factors in the development of cardiometabolic diseases. However, the generally accepted quantitative assessment of the accumulation of EAT does not reflect the size of adipocyte and presence of adipocyte hypertrophy in this fat depot. Overall contribution of adipocyte hypertrophy to the development and progression of coronary atherosclerosis remains unexplored. Objective: To compare the morphological characteristics of EAT adipocyte and its sensitivity to insulin with the CAD severity, as well as to identify potential factors involved in the realization of this relationship. The present study involved 24 patients (m/f 16/8) aged 53–72 years with stable CAD, who underwent coronary artery bypass graft surgery. Adipocytes were isolated enzymatically from EAT explants obtained during the operation. The severity of CAD was assessed by calculating the Gensini score according to selective coronary angiography. Insulin resistance of EAT adipocytes was evaluated by reactivity to insulin. In patients with an average size of EAT adipocytes equal to or exceeding the median (87 μm) the percentage of hypertrophic adipocytes was twice as high as in patients in whom the average size of adipocytes was less than 87 μm. This group of patients was also characterized by the higher rate of the Gensini score, lower adiponectin levels, and more severe violation of carbohydrate metabolism. We have revealed direct nonparametric correlation between the size of EAT adipocytes and the Gensini score (r_s = 0.56, p = 0.00047). The number of hypertrophic EAT adipocytes showed a direct nonparametric correlation with the Gensini score (r_s = 0.6, p = 0.002). Inverse nonparametric correlations were found between the serum adiponectin level and size (r_s = −0.60, p = 0.001), hypertrophy of adipocytes (r_s = −0.67, p = 0.00), and Gensini score (r_s = −0.81, p = 0.00007). An inverse nonparametric correlation was found between the Gensini score and sensitivity of EAT adipocytes to insulin, estimated by the intracellular redox response (r_s = −0.90, p = 0.037) and decrease in lipolysis rate upon insulin addition (r_s = −0.40, p = 0.05). The intracellular redox response of adipocytes to insulin was directly correlated with fasting insulin and inversely with postprandial insulin. Our data indicate that the size and degree of hypertrophy of the epicardial adipocytes are related to the CAD severity. According to our results, insulin resistance of adipocytes may be considered as one of the factors mediating this relationship.

The aim of the study was to compare the morphological features of epicardial adipose tissue (EAT) adipocyte with the circulating inflammatory biomarkers and parameters of extracellular matrix remodeling in patients with coronary artery disease (CAD). We recruited 42 patients with CAD (m/f 28/14) who were scheduled for coronary artery bypass graft surgery (CABG). EAT adipocytes were obtained by the enzymatic method from intraoperative adipose tissue samples. Concentrations of secreted and lipoprotein-associated phospholipase A2 (sPLA2 and LpPLA2), TNF-α, IL-1β, IL-6, IL-10, high-sensitive C-reactive protein (hsCRP), metalloproteinase-9 (MMP-9), MMP-2, C-terminal cross-linking telopeptide of type I collagen (CTX-I), and tissue inhibitor of metalloproteinase 1 (TIMP-1) were measured in blood serum. Patients were divided into two groups: group 1—with mean EAT adipocytes’ size ≤ 87.32 μm; group 2—with mean EAT adipocytes’ size > 87.32 μm. Patients of group 2 had higher concentrations of triglycerides, hsCRP, TNF-α, and sPLA2 and a lower concentration of CTX-I. A multiple logistic regression model was created (R_N² = 0.43, p = 0.0013). Concentrations of TNF-α, sPLA2 and CTX-I appeared to be independent determinants of the EAT adipocyte hypertrophy. ROC analysis revealed the 78% accuracy, 71% sensitivity, and 85% specificity of the model, AUC = 0.82. According to our results, chronic low-grade inflammation and extracellular matrix remodeling are closely associated with the development of hypertrophy of EAT adipocytes, with serum concentrations of TNF-α, sPLA2 and CTX-I being the key predictors, describing the variability of epicardial adipocytes’ size.

Background/Objectives: Biological aging phenotypes in coronary artery disease (CAD) include coronary atherosclerosis, vascular aging, and endothelial dysfunction. The aim of the present study was to investigate the potential links between aging phenotypes, regulatory immune cells, and features of the thymus in patients with CAD. Methods: A single-center, cross-sectional, comparative study was conducted. Patients were stratified according to the severity of coronary atherosclerosis: patients with a Gensini score ≥ 65 points and patients with a Gensini score < 65 points. Peripheral blood and thymus biopsy were obtained. Imaging flow cytometry, ELISA, and immunohistochemical analysis were used for analysis. Results: Thymic morphology ranged from total fatty involution to a preserved structure of the thymus (20–80% area in 31% of obtained samples) but was not associated with the severity of atherosclerosis. Meanwhile, patients with a Gensini score ≥ 65 had impaired thymus cellular composition compared to patients with a Gensini score < 65 points; increased frequency of CD8+ T lymphocytes and NK cells; and decreased frequency of CD4 + CD8+ T lymphocytes. In peripheral blood, the main determinants of a Gensini score ≥ 65 points were low absolute counts of eMDSCs and CD25^low Tregs with FoxP3 nuclear translocation, while advanced vascular aging was associated with elevated eMDSC absolute counts. Advanced coronary atherosclerosis was also associated with decreased numbers of endothelial progenitor cells in circulation. Conclusions: Thymus dysfunction accompanies CAD progression and is manifested in changes in cellular composition rather than morphology. In CAD patients, MDSC and Treg lymphocytes are equally involved in the progression of coronary atherosclerosis, which is aggravated by the decreased regulatory potential of the endothelium. Vascular aging represents a distinct phenotype of biological aging in CAD patients, characterized by the expansion of eMDSCs.

Aim. To cоmpare the results оf infra-spinal reconstructions of the lower extremities with the formatiоn of a distal anastomоsis below the knee joint fissure with the use of a bioprosthesis and autovein in critical limb ischemia (CLI).Methods. The hospital results of revascularization were retrospectively analyzed in 53 patients with CLI who underwent primary prosthetics of the femoral-popliteal segment with the fоrmation of a distal anastomоsis belоw the knee joint gap. All patients, depending on the prоsthetic material used, were divided into two groups: 1) autovein was used as a prosthesis (39.6%, n = 21)) and 2) a bioprosthesis was used (“KemAngioprosthesis” closed joint-stock company “NeoCor” Kemerovo, Russia) (60.4%, n = 32).Results. In the early postoperative period, thrombosis developed in group 1 in 7 cases (33.3%): in 5 patients – on the first day after the surgery; 2 out of 5 patients were with chronic arterial insufficiency (CAI) of the fourth degree, 1 was with acute arterial insufficiency of the first degree, and 2 patients with the third degree of CAI. In group 2, there were 6 prosthetic thrombosis (18.7%), 4 cases of which developed thrombosis on the first day, 3 patients with CAI of the fourth degree and 1 case with acute arterial insufficiency of the second degree.Conclusion. The application of infra-lingual reconstructions using bioprostheses is quite effective and safe in patients with CLI, in particular with purulent-necrotic trophic processes when a suitable autovein to be used as a prosthetic material is absent.

ПРАВИЛА И ПРИНЦИПЫ ОТБОРА ПАЦИЕНТОВ НА ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ПРИОБРЕТЕННЫХ ПОРОКОВ СЕРДЦА, ОСЛОЖНЕННЫХ ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ

Aim. To identify the factors influencing the development of postoperative atrial fibrillation (POAF).Methods. The study included 100 patients with indications for cardiac surgery, aged 53 to 82 years (mean age 67.2±17 years). The group included patients who had no history of AF before surgery. Cardiac surgery in the group was presented in 63 patients by coronary artery bypass grafting, and in 37 – by intervention on the heart valves. All respondents were divided into 2 groups: the first included 39 people (39%) who had AF paroxysms lasting more than 30 seconds in the early postoperative period, with a peak at 1–2 days, in 13 (33.3%) cases of AF relapsed. The second group of patients was represented by 61 patients (61%) without cardiac arrhythmias after surgery.Results. The dependence of the development of POAF on age, the concentration of C-reactive protein in the peripheral blood taken on the day of cardiac surgery, the longitudinal size of the left atrium before surgery was revealed.Conclusion. It was found out that a number of factors such as age, preoperative left atrium size, C-reactive protein level in the first days after surgery suggest the development of POAF. The use of the predictors obtained can make it possible to develop an effective strategy for the prevention of POAF.