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Highlights. Patients with coronary artery disease and age-related disorders (sarcopenia, osteopenic syndrome, osteosarcopenia) who underwent elective on-pump coronary artery bypass grafting are at higher risk of developing cardiovascular complications, non-infectious complications, and death.Musculoskeletal disorders (sarcopenia, osteopenic syndrome, osteosarcopenia) in combination with traditional predictors (age, diabetes mellitus, prior myocardial infarction and stroke, cancer) are risk factors for unfavorable prognosis of postoperative period of coronary artery bypass grafting. Aim. To assess risk factors for unfavorable prognosis in patients with coronary artery disease (CAD) undergoing elective on-pump coronary artery bypass grafting, taking into account age-related disorders (sarcopenia, osteopenic syndrome, osteosarcopenia).Methods. This single-center study included 387 CAD patients admitted for elective coronary artery bypass grafting. Taking into account the diagnosed age-related disorders, four groups of patients were formed. The first group consisted of 52 (13.4%) patients with sarcopenia, the second group was comprised of 28 (7.2%) patients with osteopenia (osteopenia/osteoporosis), the third group included 25 (6.5%) patients with osteosarcopenia, and the fourth group consisted of 282 (72.9%) participants with coronary artery disease and without musculoskeletal disorders (MSD). Risk factors for a composite endpoint (myocardial infarction, stroke, paroxysmal atrial fibrillation, cardiac rhythm disturbances) and death, and noninfectious complications (resternotomy for bleeding, pneumothorax aspiration and thoracentesis) were assessed.Results. The composite endpoint occurred more frequently in patients with osteopenia (group I – 9.6%, group II – 32.1%, group III – 12%, group IV – 12.8%; p = 0.029), and non-infectious complications occurred more frequently in patients with sarcopenia and osteosarcopenia (group I – 17.3%, group II – 7.1%, group III – 12%, group IV – 5.3%; p = 0.002). MSD were associated with the risk of composite endpoint (odds ratio (OR) 1.73, p = 0.035), and osteopenia increased it three-fold (OR 3.01, p = 0.046). Moreover, MSD were associated with higher risk of non-infectious complications (OR 1.71, p = 0.026), especially in patients with sarcopenia (OR 2.02, p = 0.034). The assessment of risk factors for unfavorable prognosis highlighted the presence of osteopenic syndrome (100 CU), prior stroke (88 CU) and myocardial infarction (85 CU). The risk of non-infectious complications was associated with prior ischemic events (ranking level for myocardial infarction – 100 CU, stroke – 75 CU), and MSD (89 CU) and its types (osteosarcopenia – 77 CU, osteopenia – 69 CU, sarcopenia – 52 CU).Conclusion. Age-related disorders in combination with MSD increase the risk of a composite endpoint and non-infectious complications by one to three times.

Highlights. Taking into account the connection between the increase in the volume of myocardial adipose tissue and vessels with massive calcification of the coronary arteries in coronary heart disease, morphometry of epicardial and perivascular adipose tissue during routine tomographic examinations can be considered as a non-invasive technique for determining a surrogate marker of severe coronary lesion.Aim. To evaluate the relationship of coronary artery calcification (CA) and morphometric parameters of local fat depots in patients with coronary heart disease (CHD).Methods. 125 patients with stable coronary artery disease aged 59±8.9 years were examined. Visualization of local fat depots, abdominal fat depots, and coronary calcification (CC) was performed using multislice computed tomography with subsequent post-processing of images on the Siemens Leonardo workstation (Germany). Non-contrast magnetic resonance imaging of the heart was used to determine the EAT thickness.Results. Coronary calcification was detected in 95.2% of the examined patients with coronary artery disease (n = 119). There were higher indices of the EAT thickness of the right and left ventricles in case of massive CC, the thickness of the pericardial adipose tissue at the level of the trunk of the left coronary, anterior descending, circumflex arteries, and increased morphometry indices of the abdominal fat depot in comparison with the patients who had moderate and medium CC.Conclusion. An increase in the volume of adipose tissue of the myocardium and vessels in CAD is associated with massive calcification, which is reflected in the pathogenetic “adipovascular” continuum, characterized by the stimulation of adipogenesis against the background of atherocalcinosis of the coronary arteries. Morphometry of epicardial and perivascular adipose tissue during routine tomographic studies is a non-invasive technique for determining a surrogate marker of severe coronary lesions.

Aim. To determine the most significant predictors of an unfavorable progress of osteoporosis (OP) in men with coronary artery disease after coronary artery bypass grafting (CABG) according to long-term (5 years) follow-up data.Methods. The prospective study included 393 patients (men) hospitalized for CABG. All patients underwent multispiral computed tomography of the coronary and carotid arteries to assess the calcium score (CS) and determine the equivalent density of calcium deposits (EDCD), coronary angiography, and dual-energy X-ray absorptiometry. After 5 years (average 59 months) of follow-up, the prognosis (status alive/dead) was assessed in 335 patients. Mortality during follow-up in patients after CABG was 10.7% (36 patients died). 257 patients underwent repeated osteodensitometry, quantitative assessment of coronary and carotid calcification, assessment of the “end points” of bone status (osteoporotic fractures, osteoporosis).Results. During the five-year follow-up an increase in the prevalence of OP was noted from 76.1% to 90.7%, while in 43.6% of cases, the progression of OP was recorded. Fractures occurred in 39 patients (15.2%), and in 34 (13.2%) osteoporosis developed for the first time. OP progression is associated with smoking (OR 5.3, 95% CI 3.1–9.4), 30% or more carotid artery stenosis (OR 5.6, 95% CI 2.9–10.7), baseline severe (more than 400) calcification of the coronary arteries (OR 2.7 at 95% CI 1.3–9.8), low density of (EDCD less than 0.19 g/mm3 ) coronary (OR 1.7 at 95% CI 1.1–8.2) and carotid (OR 2.4, 95% CI 1.4–10.3) calcium deposits. Linear regression analysis made it possible to establish that the reliable predictors of an unfavorable course of OP are coronary CS, EDCD of the carotid arteries, and the absence of statin therapy.Conclusion. OP progression in patients in the long-term period (5 years) after CABG was noted in 43.6%. The predictors of OP progression and the complications are a high level of coronary artery calcification, a low EDCD in the carotid arteries, and 30% or more stenosis of the carotid arteries. Patients receiving statins were associated with a lower risk of osteoporosis.

Aim. To study the prevalence of musculoskeletal disorders in patients with stable coronary artery disease (CAD).Material and methods. Patients with stable CAD (n=387) were included in the study. The subjects were admitted to the hospital for planned myocardial revascularization (ages of 50-82). The median age was 65 [59;69] years. Most of the sample consisted of males - 283 (73.1%). 323 (83.5%) patients had arterial hypertension (AH), 57.1% - history of myocardial infarction, and a quarter of the patients had type 2 diabetes mellitus (DM). The study of musculoskeletal system included the identification of sarcopenia in accordance with The European Working Group on Sarcopenia in Older People (EWGSOP, 2019); verification of osteopenia/osteoporosis according to the WHO criteria (2008); diagnosing osteosarcopenia in case of sarcopenia and osteopenia/osteoporosis coexistence.Results. At the initial screening of sarcopenia in accordance with EWGSOP, clinical signs (according to the Strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire) were detected in 41.3% of cases, but further examination (dynamometry, quantitative assessment of skeletal muscle) confirmed this diagnosis only in 19.9% of patients with CAD. Among the examined patients with CAD a low T-score according to DEXA was found in 53 (13.7%) of cases, and osteopenia was diagnosed 10 times more often than osteoporosis (90.6% vs. 9.4%). Furthermore, due to combination of low bone density (osteopenia/osteoporosis) and reduced muscle mass and strength (sarcopenia), osteosarcopenia was verified in one patient. Thus, the study revealed the prevalence of particular types of musculoskeletal disorders in 105 (27.1%) patients with stable CAD. The most common type of musculoskeletal disorder was sarcopenia - 52 cases (13.4%); osteopenia/osteoporosis was detected in 28 patients (7.2%), osteosarcopenia in 25 (6.5%). The most pronounced clinical manifestation of sarcopenia and osteopenia/osteoporosis, reflected by a higher score on the SARC-F questionnaire, low handgrip strength, small area of muscle tissue, low musculoskeletal index, as well as low values of bone mineral density, were observed in patients with osteosarcopenia. Patients with osteopenia/osteoporosis did not differ significantly from patients without musculoskeletal conditions in most parameters, with the exception of the T-score, the average SARC-F score, and muscle strength in men. The conducted correlation analysis revealed not only the relationship between the parameters of musculoskeletal function, but also their association with age, duration of AH, CAD, and type 2 DM.Conclusion. Several types of musculoskeletal disorders were found in a third of patients with CAD. Sarcopenia was revealed to be the most frequent type of musculoskeletal disorder.

Aim. To assess the prevalence of frailty and describe clinical features of frail patients with stable coronary artery disease (CAD). Methods. 387 patients admitted to the hospital for elective primary coronary artery bypass grafting (CABG) were recruited in the study. Clinical data, demographic data, and the results of the instrumental examinations were collected for each subject. The primary screening of prefrailty and frailty in patients before the surgery was performed using the ’Age is not a hindrance’ questionnaire. The results were processed using the IBM SPSS Statistics 26.0.0 software package. A value of p ≤ 0.050 was considered statistically significant. Results. Frailty was found in 19% of patients with coronary artery disease and multivessel coronary artery disease before open myocardial revascularization, while 58% of patients had prefrailty. The presence of frailty and prefrailty was associated with older and advanced age (p = 0.003), female sex (p = 0.001), type 2 diabetes mellitus (p = 0.006), as well as with comorbidities, including cerebral atherosclerosis (p = 0.020), and heart rhythm disturbances (p = 0.050). Conclusion. The results obtained in this study are consistent with other studies reporting higher levels of comorbidities among frail patients.

Aim.To evaluate the effectiveness of the mathematical model for determining the probability of osteopenic syndrome in patients with multifocal atherosclerosis.Materials and methods. The study included 251 male patients with verified atherosclerosis of the coronary and carotid arteries. The average age of the patients was 60,56±8,7 years. All patients included in the study performed multispiral computed tomography of coronary and carotid arteries with a quantitative evaluation of calcification by the method of Agatston (calcium index and equivalent weight of calcium deposits), color duplex scanning of carotid arteries, densitometry. The obtained data were used to calculate the probability of having an osteopenic syndrome (р) using a mathematical model. Criterion for the risk of osteopenic syndrome in the patient is the value р>0,688. The results of the analysis were compared with the densitometry data chosen as the reference method.Results. According to the quantitative assessment of coronary artery calcification in patients with osteopenia and osteoporosis, significantly higher values of the calcium index and equivalent weight of calcium deposits were observed than in patients with normal bone mineral density. Regardless of the presence of bone mineralization, more than half of the respondents (66,7% of patients with normal bone mineral density and 59,6% of patients with osteopenic syndrome) had coronary artery stenoses up to 50%. Calcification and presence of stenosis more than 30% of carotid arteries prevailed in the group of patients with osteopenic syndrome. The results of calculating the probability of having an osteopenic syndrome using a mathematical model indicate that it is highly prevalent in the sample (69,3%) and does not differ significantly from the densitometry data (70,1%). The sensitivity of the mathematical model was 89,8%, the specificity was 78,7%, the prognostic value of the positive result was 90,8%, the prognostic value of the negative result was 76,6%.Conclusion. The mathematical model for assessing the probability of osteopenic syndrome is highly diagnostic in men with multifocal atherosclerosis.

Purpose To assess the prevalence of frailty in the preoperative period and to evaluate its effect on the risk of complications and adverse outcomes in patients undergoing coronary artery bypass grafting (CABG). Methods 387 patients undergoing preoperative management for elective primary CABG were recruited in the study. The study cohort was divided into three groups depending on the “Age is no disqualification” scores suggesting the presence or absence of frailty and the presence of prefrailty. Demographic and clinical data were collected for each patient, including surgery data, pre- and postoperative treatment, intra- and postoperative complications and outcomes of CABG. Statistical analysis was performed using the commercially available software package IBM SPSS Statistics 26.0.0. Results 74 (19%) patients had frailty, while 225 (58%) patients were diagnosed with prefrailty and 88 (23%) patients did not have any signs of frailty. All three groups had significant age differences, patients without frailty – 56 [63–67] years old, prefrailty group – 59 [65–69] years old, patients with frailty – 62 [66–72] years old, p=0,003. Patients with frailty or prefrailty more often suffered from diabetes mellitus (patients without frailty – 14,8%, prefrailty group – 25,8% and frailty group – 36,5%, p=0,006), atrial fibrillation or flutter (16,7%, 14,3% and 35,6%, respectively, p=0,05) and cerebral atherosclerosis (45,5%, 62,2% and 60,8%, respectively, p=0,02). Three groups were comparable in main clinical and demographic parameters. There were no significant differences found in the incidence of infections (3,4%, 2,2% and 4%, respectively, p=0,655) and haemorrhagic complications (1,2%, 1% and 0,5%, respectively, p=0,680). Patients with frailty or prefrailty in the intra- and early postoperative period after CABG had significantly higher incidence of low output syndrome (1,2%, 7,6% and 13,5%, respectively, p=0,01, OR 8,5, 95% CI, 1,1–63,5) and postoperative atrial fibrillation or flutter (5,7%, 16% and 12,2%, respectively, p=0,04, OR 2,9, 95% CI, 1,1–7,5). The incidence of myocardial infarction in the intra- and early postoperative period after CABG did not differ significantly between the groups (0%, 0,5% and 1,5%, respectively, p=0,476) as well as the incidence of stroke (2,3%, 1,8% and 4,1%, respectively, p=0,523). Patients with frailty and prefrailty had significantly higher cerebrovascular and cardiovascular mortality compared to those without frailty (1%, 0% and 5,4%, respectively, p=0,04, OR 2,6, 95% CI, 1,1–5,9). Conclusion Almost 19% of patients referred to CABG suffered from frailty. The presence of prefrailty or frailty increases the risk of death in the early postoperative period after CABG. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”, Kemerovo, Russian Federation

Objective. To examine the relationships between measures of bone mineral density (BMD), coronary atherosclerosis, and coronary artery calcification among men with ischemic heart disease (IHD).Materials and Methods. Seventy-four men with angiographically documented IHD were assessed. BMD was measured by dual-energy absorptiometry and defining the T-score, radiopaque selective coronary angiography with the analysis of severity of coronary artery lesions using the SYNTAX score, evaluating the coronary artery calcium score according to the Agatston method. Depending on the T-score, patients were divided into 2 groups: group I – patients with osteopenic syndrome (53 patients) aged 59 (52;68) years; group II – patients with normal BMD (21 patients) aged 58 (54;66 ) years.Results. Osteopenic syndrome among men with IHD was revealed in 71.6% of cases. Severe coronary lesions predominated among patients with osteopenic syndrome (p=0.041). Single-vessel coronary lesions in the group with osteopenic syndrome was detected less frequently than in the normal BMD (p=0.023) group. Calcium score values significantly correlated with the severity of coronary lesions according to the Syntax scale (r=0,53; p=0.002).Conclusion. Reduced bone mineral density among men is associated with hemodynamically significant lesion and correlates with the severity of coronary atherosclerosis, which confirms the likelihood of common pathogenesis of osteopenic syndrome and coronary artery atherosclerosis.

1. The method of radioactive indicators with the use of labeled glucose has been used to show that under the conditions for the synthesis of carbohydrates from formaldehyde the rate of the retroaldol splitting of the hexoses is significantly lower than the rate of synthesis. 2. Under the conditions for the condensation of the formaldehyde, a significant portion of the carbohydrates heavier than the hexoses forms as a result of the cocondensation and self-condensation of low-molecular-weight carbohydrates and possibly by means of the disproportionation of carbohydrates with the participation of hexoses and low-molecular-weight carbohydrates.