Download Kardiologicheskij Vestnik �4/2017

ENDOVASCULAR CORONARY ARTERY TREATMENT IN PATIENTS WITH CHRONIC CORONARY ARTERY DISEASE THROUGH OVERNIGHT HOSPITALIZATION
Basinkevich A.B., Matchin Y.G., Silvestrova G.A., Bubnov D.S., Atanesyan R.V., Danilushkin Y.V., Shamrina N.S., Ageev F.T.

Background: In order to reduce hospital stay before and after endovascular interventions for patients with chronic coronary artery disease down to 24 hours, new methods and patient treatment plans are currently introduced into clinical practice. These new approaches allow to improve availability of various types of endovascular interventions, shorter «waiting lists», and cut the cost of treatment due to a reduced hospital stay.
Objectives: To evaluate the safety of percutaneous coronary intervention (PCI) for patients with chronic coronary artery disease (CAD) during hospitalization for one night, and develop an algorithm for the management of the overnight patients.
Methods: The study included 204 patients with chronic coronary artery disease who underwent PCI with overnight: 92 patients underwent coronary angiography (CAG) plus PCI and 112 patients was carried out according to the results of previously performed CAG. We used standard radial and ulnar access for PCI. Also, we developed special standardized instructions for the patients, in case of complications during the night at home and the questionnaire, which assessed the satisfaction of patients suggested hospitalization for one night on a ten point scale.
Results: The procedure was successful in 203 patients (99%) of the 204 patients. The PCI - associate not Q-wave myocardial infarction (4 a type) was presented in one case (0,5%) in group CAG plus PCI occurred, this patient spent in the hospital 7 days. There was no serious cardiovascular event in all cases. The frequency of complications in puncture area was low: 2 (1%) patients had a hematoma at the puncture area and which did not require special therapy and 2 patients ( 1%) had asymptomatic occlusion of the radial artery, and the blood flow of the artery spontaneously recovered within three months after the PCI. In the evaluation of satisfaction 155 (76%) patients were very satisfied with the proposed approach of hospitalization, 19 (9,3%) patients satisfied and 30 (14,7%) patients were dissatisfied with this way of admission for various reasons.
Conclusions: Percutaneous coronary intervention for patients with stable chronic coronary artery disease with hospitalization for one night in a carefully selected category of patients is safe, with low complication rate and high satisfaction.

 

APPROACHES TO OPTIMIZATION OF ACUTE CORONARY SYNDROME PATIENTS CARE TIMING CHARACTERISTICS IN FEDERAL ACUTE CORONARY SYNDROME REGISTRY SYSTEM AND RUSSIAN MINISTRY OF HEALTH MONITORING SYSTEM
Beishenkulov M.T., Chazymova Z.M., Kaliev K.R., Toktosunova A.K., Abdurashidova T.Sh.

Aim: to research the left ventricle (LV) remodeling, interventricular and intraventricular asynchrony in combined inferior myocardial infarction (MI) and right ventricle (RV) myocardial infarction with stable and unstable hemodynamics.
Material and methods: There were included 56 patients with the first inferior myocardial infarction of LV combined with right ventricle MI to 1 monthly prospective research. Patients were separated into 2 groups: the 1st group – patients with inferior LV and RV MI with stable hemodynamics (n=29); the 2nd group – patients with inferior LV and RV MI and arterial hypotension in early period (n=27). Electrocardiography (ECG) and echocardiography (EchoCG) were done to all patients on the 1st, 3rd and 30th days after MI.
Results: On the 3rd day the LV and RV dysfunction was less pronounced in the 1st group than in the 2nd. Thus EDV LV was 134.8±3,0 ml3 in the 1st and 152.5±2.27 ml3 the 2nd group (p<0.0001), EDS RV 29.21±1.6 sm2 and 33.44±1.32 sm2 (p<0.05) resp.  It was decrease in LV systolic function in two groups to the 30th day – EF LV decreased in the 1st  group from 49.3±2.6% till 46.4±2.7% (p<0.05), and from 47.7±2.24% till 44.6±2.64% (p<0.05) resp. It’s interesting, that against the background of these changes the function of RV improved, and in the patients with arterial hypotension it was more noticeable than without hypotension. Thus, TAPSE in the 1st group increased from 15.2±1.6 mm till 16.6±1.2 mm (p<0.001), and in the 2nd – from 10.1±1.7 mm till 13.1±1.2 mm (p<0.05).
Conclusion: in inferior LV MI and RV MI, complicated by short time arterial hypotension, the function of LV and RV suffers more than in uncomplicated MI, and it was expected. In dynamic observation using the conservative therapy, it was detected that LV dysfunction increased, but the RV function become better in all groups, it was unexpectedly.

 

ANGIOTENSIN II ENHANCES THE ABILITY OF MESENCHYMAL STEM/STROMAL CELLS TO STIMULATE NEURITIS OUTGROWTH VIA TYPE 2 RECEPTOR
Ageeva L.V., Sysoeva V.Y., Tyurin-Kuzmin P.A., Semina E.V., Kalinina N.I.

Aim of study: to evaluate the effect of angiotensin II on the neurotrophic activity of MSC.
Material and methods: Mesenchymal stem/stromal cells (MSC) were isolated from human adipose tissue. Cells of 2nd-5th passages were treated by angiotensin II and then incubated in the fresh culture medium for 24 hrs. After that the culture medium was collected and applied to neuroblastoma cell line Neuro2A. Neurites outgrowth was analyzed 72 hrs later. The expression of neurotrophic factors was evaluated by real-time PCR. Receptors mediating the effect of angiotensin II on MSC's ability to stimulate neurites outgrowth were assessed using selective antagonists.
Results: Angiotensin II up-regulated the ability of MSCs conditioned medium to stimulate neurites outgrowth in neuroblastoma cell line. This was accompanied by elevated expression of neurotrophic factors mRNAs. Selective antagonist of angiotensin type 2 receptor blocked this angiotensin II effect on MSCs completely.
Conclusion: Angiotensin II promotes the ability of MSCs to stimulate neurites outgrowth via type 2 receptor. This is mediated by up-regulated expression of neurotrophic factors.

 

EFFECT OF CONTINUOUS POSITIVE AIRWAY PRESSURE ON COAGULATION ACTIVITY IN PATIENTS WITH SEVERE OBSTRUCTIVE SLEEP APNEA
Bugaev T.D. , Ageeva N.V. , Dobrovolskiy A.B. , Litvin A.Y.

The aim of our study is to evaluate possible effects of continuous positive airway pressure (CPAP) therapy on markers of coagulation activity in patients with severe obstructive sleep apnea (OSA).
Methods: We included 23 middle-aged (mean age 50[44; 57] years) male patients with arterial hypertension without antiplatelet, anticoagulant therapy and diabetes mellitus. According of sleep breathing study results in all patients was diagnosed severe OSA (mean apnea-hypopnea index (AHI) 53,9[39,0;75,0] per h). Patients underwent 3 months of effective CPAP therapy with evaluation of the blood analysis (hemostasis system markers and parameters of whole blood viscosity) at baseline and in the end of therapy.
Results: We found an abnormal increase of hematocrit, whole blood viscosity and tissue plasminogen activator/plasminogen activator inhibitor-1 (tPa-PAI-1) complex in the patients with severe OSA. After 3 months of CPAP therapy significantly decreased blood viscosity in fast shear rate, hematocrit and tPa-PAI-1 complex decreased to normal levels.
Conclusion: The coagulation status of blood is elevated in severe OSA patients. Few months of CPAP therapy can improve whole blood viscosity with achieved normal values of hematocrit and tPa-PAI-1 complex. These results suggest that CPAP therapy may reduce cardiovascular risk in OSA, in part through improving of whole blood viscosity and fibrinolytic capability of blood.

 

THE INFLUENCE OF AMBULATORY OBSERVATION TACTIC ON THE PATIENTS COMPLIANCE AND CLINICAL OUTCOMES OF PATIENTS WITH PERSISTENT VIOLATIONS OF RHYTHM
Getman S. I.

Synopsis: The research analyzes the influence of active dispensary monitoring on the distant forecast for patients with persistent arrhythmias.
Methods: 652 patients were examined. Group #1: patients with ventricular extrasystole – 92 people age 18 to 89. Group #2: patients with supraventricular extrasystole – 343 people age 17 to 83. Group #3: patints with combined arrythmia (both  ventricular and supraventricular extrasystole) – 106 people age 18 to 87. Patients with arrythmias were actively monitored with monthly visits to the doctor at outpatient clinic. To make a comparison there was formed a reference group of 159 people age 17 to 89 whose arrythmias were not fixed during their visit to the clinic. They were monitored in a usual way. The duration of monitoring was 2 years.
Results: By the end of the research those patients who had been actively monitored showed significant decrease of class of chronic heart failure (1,1 versus 1,5 in control group, �<0,05) and of arterial blood pressure (120 ±7/77 ±4 mm Hg versus 134 ±18/81 ±8 mm Hg, �<0,01/�<0,05).  Frequency of adverse events among actively monitored patients with arrythmias was 17,43%, as for the patients of control group it was 20,75%. The the level of compliance turned out to be significantly higher among actively monitored patients then that of the control group.
Conclusion: active ambulatory monitoring of patients with arrythmia stimulates significant improvement of clinical and functional parameters of the patients. One of the main mechanisms of realization of the positive effects of active monitoring of patients is the increase of patients ' adherence to provided therapy. 

 

COMPARATIVE EFFICACY OF PULMONARY VEIN ISOLATION VS ROTOR ABLATION IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION: MID-TERM RESULTS
Sapelnikov O.V., Cherkashin D.I., Shlevkov N.B., Nikolaeva O.A., Zhambeev A.A., Salami Kh.F., Partigulova A.S., Buldakova N.A., Grishin I.R., Ardus D.F., Stukalova O.V., Uskach T.M., Zhirov I.V., Tereshchenko S.N., Ternovoi S.N., Akchurin R.S.

Progression of atrial fibrillation in most cases leads to persistent and long persistent forms. It’s significantly worsens the quality of life and the prognosis of patients. Various methods have been proposed for the treatment. All of them are aimed at restoration and maintenance of sinus rhythm. The most interesting in our opinion is the focal impulse and rotor modulation. We compared the efficacy of the PVI procedure and the PVI procedure supplemented focal impulse and rotor modulation which was detected by noninvasive mapping in patients with persistent atrial fibrillation.

 

CHANGES OF THE P WAVE ON 12 LEAD ELECTROCARDIOGRAM AFTER RADIOFREQUENCY ABLATION IN ATRIAL FIBRILLATION
Sakhnova T.A., Blinova E.V., Sapelnikov O.V., Cherkashin D.I., Nikolaeva O.A., Akchurin R.S.

The aim of the work was to study the changes of the P wave on 12 lead electrocardiogram (ECG) after radiofrequency pulmonary vein isolation in patients with paroxysmal atrial fibrillation (AF) and to reveal the features of the P wave in patients with recurrence of AF after radiofrequency ablation (RFA).
Methods: We analyzed ECGs of 75 patients (44 men and 31 women, aged 60.2 ± 11.2 years) registered on sinus rhythm 1-17 days before the pulmonary vein RFA and 1-9 days after the operation.
The following ECG variables were analyzed: heart rate (HR), P wave duration (Pd), PQ interval duration, P wave axis, P wave amplitude in lead II (PII), P terminal force (Ptf) - the product of the amplitude and duration of the P wave negative phase in lead V1.
Results: On the initial ECG, 66 (88%) patients had an increase in the duration of the P wave, 39 (52%) patients had an increase in Ptf. The mean values ??of the remaining parameters were within the normal range. After surgery, there was a significant increase in heart rate (62.7 ± 9.4 beats per minute before surgery, 71.5 ± 9.6 after surgery, p <0.01); decrease in Pd (127 ± 14 ms before operation, 122 ± 15 ms after, p <0.01); decrease in Ptf (0,052 ± 0,046 mm*s before the operation, 0,024 ± 0,023 mm*sec after, p <0,01). At follow-up of 1 to 3 years, recurrences of AF, which required repeated surgical intervention, developed in 8 (11%) patients. These patients were characterized with smaller initial values ??of PII (0.87 ± 0.57 mm in patients with recurrences, 1.25 ± 0.46 mm in the rest of the group, p <0.05) and a more pronounced decrease in Pd after surgery (difference in Pd before and after surgery, 14.5 ± 12.8 ms in patients with recurrences, 4.4 ± 10.5 ms in the rest of the group, p <0.05).
Conclusion: Radiofrequency pulmonary vein isolation in patients with paroxysmal AF leads to a significant decrease in the duration of the P wave and P terminal force, which may reflect a decrease in the volume of electrically active atrial tissue after surgery. Recurrences of AF after RFA of pulmonary veins may be observed both in patients with significantly increased parameters of the P wave, and in patients with small values ??of these parameters.

 

MYOCARDIUM PERFUSION ASSESSED BY SINGLE-PHOTON EMISSION TOMOGRAPHY IN PATIENTS WITH VARIOUS PROBABILITIES OF FAMILY HYPERCHOLESTERINEMIA
Sergienko I.V., Kurbanismailova P.M., Sergienko V.B.

Aim: to assess the features of cell perfusion according to single-photon emission computed tomography (SPECT) in patients with severe hypercholesterolemia (HCh) and various probabilities of familial hypercholesterolemia (FH).
Material and methods: single-photon emission computed tomography (SPECT/CT) with 99mTc-MIBI, using standard rest/stress protocol, was performed in two groups of patients (n=32 and n=36) with TCh level ≥7.5 mmol/l and/or LDL ≥4.9 mmol/l, included in the Russian Registry of Family Hypercholesterolemia (RuFH). Group 1 (with HCh and established IHD) was evaluated for severity of LV myocardial perfusion defects and transient ischemia. In Group 2 patients (asymptomatic patients with HCh without IHD, AH, history of ACS), the isolated effect of HCh on the cellular myocardial perfusion was assessed.
Results: in both groups, visual inhomogeneity of myocardial perfusion, according to SPECT, was visualized, more severe at rest images and in group 1. In group 1 higher frequency of positive exercise test result was shown, higher values ??of LV myocardial perfusion heterogeneity and defect severity parameters according to SPECT (p<0.01). No significant LV ischemia in patients of group 2 was detected. Perfusion heterogeneity in patients of group 2 was significantly higher in “probable” FH diagnosis compared with “possible” (p=0.07). Positive correlations were found between the levels of TCh/LDL and σsev/σhet (r=0.38, p=0.02, r=0.40, p=0.015, respectively).
Conclusion: in case when genetic test is not possible to perform in patients with suspected FH, the question of an additional examination of these patients appears. Myocardial perfusion SPECT is a sensitive and reproducible method that allows to visualize earliest impairments of myocardial perfusion in patients with a high IHD risk, including severe hypercholesterolemia.

 

EVALUATION OF MYOCARDIAL DEFORMATION AND ROTATIONAL PROPERTIES  IN PATIENTS WITH CHF WITH A PRESERVED AND REDUCED SYSTOLIC FUNCTION OF THE LEFT VENTRICLE WITH THE USE OF NEW ECHOCARDIOGRAPHIC TECHNOLOGIES OF THE NON-DOPPLER IMAGING OF THE MYOCARDIUM IN TWO- AND THREE-DIMENSIONAL REGIMES
Sohibnazarova V. Kh., Saidova M. A., Tereshenko S. N.

Aim:  to study the peculiarities of deformation and rotational properties of the left ventricle in patients with CHF with a preserved and reduced systolic function of the LV according to the echocardiographic technology of the non- Doppler imaging  of the myocardium in 2D and 3D Speckle Tracking Imaging in 2D and 4D regimen in patients with CHF with a preserved and decreased left ventricular ejection fraction.
Methods: 50 patients with chronic heart failure with a preserved and reduced systolic LV function were included in the study. In addition to the standard transthoracic echocardiography, all patients were evaluated for myocardial deformation and LV rotational properties using the technology of non -Doppler imaging of the myocardium in 2D and 3D Speckle Tracking. The results of the study show that when comparing these two methods of CHF patients, with a preserved and reduced systolic function, the three-dimensional regimen showed lower strain rates compared to the two-dimensional regimen.
Results: A comparative analysis of the obtained data showed that in the two-dimensional regimen in patients of group II there was a significant decrease in LV myocardial deformation in comparison with group I and CG (control group). When comparing the parameters of global longitudinal deformation of the left ventricle (GLS, %), a statistically significant decrease was observed in group II patients (-7.7 ± 2.6%) (p <0.05) compared with CG (-20 ± 6, 2%). It is important to note that the values ??of GLS in group I patients (-16.3 ± 4.9%) were below acceptable values ??(p <0.05). The values ??of the global radial deformation (GRS) were reduced to a lesser extent in patients of the I group (32.8 ± 12.8%) (p = 0.05) compared to patients of the II group (12.7 ± 7.5%)  (p <0.05) and CG (42.4 ± 4.2). Global circumferential deformation (GCS) in group I patients (-18.0 ± 5.2) did not differ significantly from CG (-18.6 ± 2.7) (p> 0.05), but this index was significantly lower in patients group II (-10.0 ± 3.2%) (p <0.05) �s compared with CG. The values ??of LV twisting and untwisting parameters were also lower in patients of group II (4.3 ± 2.7) (-33.2 ± 21.5) (p <0.05), but practically the same in group I (14, 2 ± 6.9) (86.0 ± 37.1) and CG (16.1 ± 6.9) (-79 ± 24.5) (p> 0.05).
In the statistical processing of data, it was shown that the parameters of LV deformation in the three-dimensional regime in patients of group II were reduced: (GLS = -3.3 ± 4.0%, GRS = 8.5 ± 5.9%, GCS = -4, 3 ± 2.7%, GAS = 7.4 ± 2.0%) compared to CG (GLS = -12.6 ± 3.1%, GRS = 25.5 ± 5.2%, GCS = -17 , 9 ± 2,7%, GAS = (-21,1 ± 5,0%) (p <0,05) . In group I patients in the estimation of global longitudinal and radial deformations (GLS = -7.4 ± 3, 1%, GRS = 22,6 ± 7,1%) there was a significant decrease in these indices both in the two-dimensional and in the three-dimensional regimens of the non -Doppler  image of the myocardium. When evaluating the global circumferential deformation, a decrease in this index was observed in 3D Strain (GCS = -10,3 ± 2,9%) (p <0,05), however the 2D Strain  values ??were within acceptable values.
Conclusion: the results of the study showed that in patients with CHF with reduced LV systolic function, the deformation parameters from the data of the two-dimensional and three-dimensional regimens of the non-Doppler imaging were lower in comparison with patients with preserved LV systolic function, which indicates a deeper LV lesion. When comparing these two technologies, the 3D Speckle tracking showed lower indices of myocardial deformation compared with the two-dimensional regimen, which, perhaps, is associated with a more complete assessment of the deformation properties of the LV myocardium.

 

THE CLINICAL SUBTYPE OF SYSTEMIC SCLEROSIS, ASSOCIATED WITH PULMONARY ARTERIAL HYPERTENSION
Yudkina N.N. , Nikolaeva E.V. , Martynyuk T.V. , Volkov A.V.

Pulmonary Arterial Hypertension (PAH) is a complex and multidisciplinary problem of medicine, besides idiopathic form of the disease, PAH can be associated with connective tissue diseases, in particular systemic sclerosis (SSc). Identification of SSc signs, associated with PAH, could be improving early identification this devastating complication.
Material and methods: The research has included 51 patients with PAH-SSc, observed in V.A. Nasonova Research Institute of Rheumatology and National Medical Research Center of Cardiology. As the control group were studied 65 patients with SSc without PH. Summary statistics, univariate and multivariable logistic regression were used to determine the factors (odds ratio - OR), associated with PAH.
Results: Only 14% of patients until development of PAH were observed by the rheumatologist. More than at 60% of patients the diagnosis of a system disease is suspected by the cardiologist after PAH diagnosis. We have revealed 32 SSc manifestations connected with existence of PAH. The most significant of them were: anticentromere antibodies (OR 15,2; 95% CI 5,4-42,9, �<0,00001), telangiectasia (OR 13,7; 95% CI 3,8-41,3, �<0,00001), increase in a ratio of the forced vital capacity to diffusive ability of lungs (FVC/DLCO) (OR 7,8; 95% CI 2,9-20,1, �<0,00001), uric acid level of uric more than 340 mmol/l (OR 7,7; 95% CI 3,3-18,2, �<0,00001), Raynaud phenomenon duration before skin involvement more than 14 months (OR 3,8; 95% CI 1,7-8,5, �<0,0005). Treated the signs reducing possible risk of development of PAH: diffuse scleroderma (OR 0,2; 95% CI 0,1-0,4, �<0,00001), tendon contractures (OR 0,2; 95% CI 0,1-0,5, �<0,00001), existence of indurative changes (sclerodactilia) (OR 0,2; 95% CI 0,1-0,4, �<0,00001), damage of skin in a disease debut (OR 0,1; 95% CI 0,05-0,4, �<0,00001), antibodies to topoisomerase-1 (Scl-70) (OR 0,046; 95% CI 0,01-0,2, �<0,00001). The sensitivity of SSc classification criteria 2013, one of which is PAH, was authentically above. Most often Raynaud's phenomenon (100%), capillaroscopic changes (96%), telangiectasia (94%) and anticentromere antibodies (67%) were detected.
Conclusion: PAH-SSc is the unique phenotype combining manifestations of SSc and PAH with pathogenetic mechanisms, changing each other. Identification of SSc signs, associated with PAH and new classification criteria validation will promote early diagnostics of this devastating disease by cardiologists.

 

THE POSSIBILITY OF ULTRASOUND DUPLEX SCANNING IN ASSESSING THE MOTION OF ATHEROSCLEROTIC PLAQUE
Balakhonova T.V., Pogolelova O.A., Tripoten M.I., Arkhipov I.V., Gavrilov A.V.

The article presents a new method for determining the mobility of atherosclerotic plaques using ultrasound duplex scanning. The method consists in obtaining a series of successive ultrasound images of an atherosclerotic plaque in the longitudinal view of the artery during a single cardiac cycle. Ultrasonic images of the plaque are processed using specially developed algorithms and utilities. These utilities allow operator to contour the base and surface of the plaque in one of the initial images of the cardiac cycle. The contour of the plaque is then divided into three segments - distal, proximal and central and the displacement parameters for the selected segments relative to the base during the period of the cardiac cycle are measured. Ultrasound speckle-tracking technique is used to measure the position of the selected segments of the contour line for each frame in a series of images. The mobility of the atherosclerotic plaque is assessed by the parameters of the tangential velocity, the shear strain and the shear deformation rate of the plaque segments. The presented method can be used to assess the mobility of an atherosclerotic plaque in a carotid (or other large and medium-sized artery) in patients with atherosclerosis in order to determine its dynamic stability.

 

APPROACHES TO OPTIMIZATION OF ACUTE CORONARY SYNDROME PATIENTS CARE TIMING CHARACTERISTICS IN FEDERAL ACUTE CORONARY SYNDROME REGISTRY SYSTEM AND RUSSIAN MINISTRY OF HEALTH MONITORING SYSTEM
Sagaydak O.V., Oschepkova E.V., Popova Y.V., Kiselev A.R., Konosova I.D., Gridnev V.I.

One of the main characteristics of acute coronary syndrome (ACS) patients care quality is its timeliness. Estimating of treatment time delays plays a key role in the assessment of ACS patients care organization quality. In Russia treatment time delays data are available in Federal ACS Registry and Russian Ministry of health Monitoring systems
Aim: the aim of the study was to evaluate methods of ACS patients’ treatment time delays assessment and to optimize it.
Material and methods: we analyzed timing parameters data in Federal ACS Registry and Russian Ministry of health Monitoring systems in the 01.01.2016 - 31.12.2016 period.
Groups were as follows: data from Federal ACS Registry - 27 459 ACS patients and from Russian Ministry of health Monitoring system - 557 226 ACS patients. Only two parameters were matching in two systems: «symptom – emergency call» time and «symptom – balloon» time in patients with ST elevation ACS, who were transferred to hospital in 12 hours from symptom beginning.
Results: In the study timing parameters from two systems were compared and there was no significant difference between medians (p>0,01). Therefore, both systems are suitable for obtaining high quality treatment time delay data. We think it is reasonable to reduce the amount of timing parameters in Russian Ministry of health Monitoring system and to use it as an instrument of the whole result evaluation. For Federal ACS Registry we developed “step-by-step” timing model and we recommend to address it for more detailed information and for reasons of organization mistakes.
Conclusion: ACS patients medical care quality assessment can be performed with both Federal ACS Registry and Russian Ministry of health Monitoring systems. Though to obtain complex detailed information about treatment time delays there is a necessity in optimizing timing parameters in these systems.

 

MODERN POSSIBILITIES OF ADRENORECEPTOR STYDING IN REAL-LIFE CLINICAL SETTING
Smolyakova E.V., Ambat'ello L.G., Klimova A.A., Nistor S.Yu. , Agapova O.Yu., Galicin P.V., Chazova I.E. , Zykov K.A.

Due to high prevalence of cardio-pulmonary diseases there are a lot of difficulties in clinical practice with combined therapy with b1-adrenoblockers and b2-agonists, which acting through β-adrenergic receptors (β-AR).
Until recently, the methods of β-AR research (PCR-RV, Western blot, ELISA, cytofluometry, radioligand analysis, level of secondary messengers, cyclic AMP evaluation) have clear limitations for being used in a clinical practice (low reproducibility, non-availability, laboriousness, high cost, high blood sampling). The newly developed modified radioligand method allows to estimate, � new parameter - the binding activity of β-AR with specific ligand. This modification allows to evaluate the dynamics of adrenoreceptor binding activity under the influence of medicines affecting β-AR. The data obtained with this modified radioligand analysis will help to study the correlation of the clinical and receptor changes. It will provide information that will lead to a deeper understanding of the pathogenesis of cardiorespiratory pathology and will help to create optimized approaches for treat such patients.

 

OPTIMIZATION OF PATIENTS SELECTION FOR PERFORMING CARDIAC RESYNCHRONIZATION THERAPY: THE ROLE OF ELECTROCARDIOGRAPHY AND ECHOCARDIOGRAPHY
Kashtanova S. Yu., Mironova N. A., Gupalo E. M., Dolgopolova V. V., Saidova M.A., Golitsyn S.P.

This review highlights modern electrocardiographic criteria of complete left bundle branch block and features of excitement propagation through myocardium. Pathophysiological aspects of myocardium mechanical dyssynchrony formation and possibilities of its assessment by means of various echocardiographic techniques are considered in detail. This review focuses on the most significant data concerning the possibility of applying criteria of myocardium mechanical dyssynchrony for patient selection for cardiac resynchronization therapy.

 

EFFECT OF OCTREOTIDE THERAPY ON CHYLOPERICARDIUM AFTER CARDIAC SURGERY: CLINICAL CASE
Partigulova A.S., Vasilyev V.P., Galyautdinov D.M., Shiryaev A.A., Akchurin R.S., Barinova I.V., Prostakova T.S., Ageev F.T., Lazutkina V.K., Korobkova I.Z., Bedimogova S.S., Fedotenkov I.S.

In this paper we report a case of isolated chylopericardium which occured after coronary artery bypass grafting in 66-years old male. The efficacy of treatment with somatostatin analog Octreotide is shown. It was used subcutaneously at 300 μg daily dose for 10 days with complete regress of chylopericardium to the end of the course. The problems of the differential diagnosis of chylopericardium from postoperative pericardial effusion are discussed as well.

Download Kardiologicheskij Vestnik �3/2017

PREDECTIVE COPEPTIN SIGNIFICANCE IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE
Narusov O.Yu., Skvortsov A.A., Protasov V.N., Koshkina D.E., Kuznetzova V.P., Masenko V.P., Tereschenko S.N.

Purpose: to evaluate the significance of copeptin in the risk stratification of the patients with a reduced LV ejection fraction during long-term follow-up after acute decompensated heart failure (ADHF).
Methods: In the prospective single-center study were included 159 pts with ADHF. On admission and on the day of hospital discharge the concentration of the N-terminal fragment of the prohormone of the brain natriuretic peptide (NT-proBNP), the highly sensitive troponin T, and copeptin has been examined. The combined endpoint included cardiovascular (CV) death, first re-hospitalization due to decompensation of HF, decompensation of HF needded intravenous diuretics and cardiovascular death with successful reanimation.
Results: During the hospitalization in patients with ADHF a significant decrease of the concentration of copeptin from 40,61 (29,07; 48,89) pmol/l at admission to hospital to 28,72 (20,04; 37,45) Pmol/l [?%=-25,85 (-36,03; -19,21)]% at discharge from the hospital (p <0.0001) has been seen. The concentration of NT-proBNP also decreased significantly from the initial 3615.0 (1578.0-6289.3) pg/ml to 2165.5 (982.7, 4221.3) pg /ml [Δ% = -38, 27 (-49.7; -24.34)]% at discharge from the clinic (p <0.0001). At the same time, the values of highly sensitive troponin T for the period of hospitalization changed insignificantly: on admission - 29.95 (21.85, 49.63) pg/ml, at discharge - 28.37 (21.29, 46.6) pg / ml , Δ% = -11.23 (-5.67, -21.12)%.
During the year of observation, combined endpoint reached 56 patients (35.2%). 78 CV events were recorded (49.1%). In the group of patients who did not reach the endpoint, the concentrations of markers were significantly lower in comparison with patients who reached it. In the ROC analysis, it was found that for the values of the markers determined in patients admitted to hospital with the ADHF, the area under the curve for the concentration of copeptin was somewhat worse compared to NT-proBNP [respectively, AUC = 0.667 (0.575-0.778) p = 0.002 And 0.700 (95% CI 0.613-0.788); P <0.0001], and was inferior in strength to the standard clinical and biochemical model (sex, age, ischemic cause of heart failure, systolic blood pressure, diabetes mellitus, LV ejection fracture, FC of heart failure, blood creatinine) [0.718 (95% CI 0.624 to 0.839); P <0.0001]. However, for the concentration of markers when discharging patients from the hospital, the area under the curve (AUC) for copeptin was absolutely comparable to the values for NT-proBNP [respectively, AUC = 0.735 (0.640, 0.830) p <0.0001 versus 0.727 (0.639-0.816); P <0.0001] (Figure 1). Similar results were obtained when estimating the medium-term forecast (180 days): [respectively AUC = 0.739 (0.640, 0.838) p <0.0001 versus 0.732 (0.637-0.826); P <0.0001]. In the subsequent analysis and introduction of NT-proBNP in the initial model the values of copeptin in patients at discharge were not accompanied by its amplification and an increase in the area under the curve: AUC = 0.725 [(95% CI 0.622-0.827), p <0.0001. At the same time, when carrying out multivariate analysis, the introduction of copeptin values in standart clinical and biochemical model [AUC=0,718 (0,624;0,839) p<0,0001]  for patients at admission and discharge from the hospital led to a significant increase in the initial model and an increase in the area under the curve to 0.759 (0.659, 0.858), p <0.0001 and 0.810 (0.722, 0.899), p <0.0001. A similar introduction of the NT-proBNP values of patients at discharge increased the AUC to 0.763 (0.675, 0.857), p <0.0001. In comparison with copeptine and NT-proBNP, the predictive value of highly sensitive troponin T for development in patients of combined endpoint for long-term follow-up was minimal: 0.642 [(95% CI 0.532-0.753), p = 0.016] and 0.665 [(95% CI 0.557- 0.774), p = 0.005] on admission and discharge from the hospital, and 0.694 [(95% CI 0.584-0.804) with the introduction of discharge values of highly sensitive troponin T in clinical and biochemical model. The risk of developing combined endpoint in long-term follow-up in patient after suffering HF decompensation was significantly higher if the patient had values of copeptin ≥42.48 pmol / L [OR at 95% CI 3.53 (0.99-12.59) p = 0.042] And ≥28.31 pmol / L [OR at 95% CI 5.14 (2.204-11.98), p <0.0001] and NT-proBNP ≥3249.5 pg / ml [OR in 95% CI 3.15 (1 , 53-6.48); P = 0.001] and ≥1696 pg / ml [OR in 95% CI 4.41 (1.41-9.624), p <0.0001] (on admission and discharge from the clinic).
Conclusion: The predictive value of the concentration of copeptin determined at discharge of the patient after ADHF does not concede to NT-proBNP and exceeds the highly sensitive troponin T and standard clinical and biochemical model. The combination of NT-proBNP and copeptin does not increase their prognostic value. The greatest predictor for the development of combined endpoint is the combination of  clinical and biochemical model and copeptin. The risk of developing of combined endpoint in long-term follow-up of a patient after suffering HF decompensation is significantly higher if the patient has copeptin values of ≥42.48 pmol / l at admission and ≥28.31 pmol /l at discharge of the patient from the hospital. 
Keywords:Chronic heart failure, acute decompensated heart failure, biomarkers, NT-proBNP, copeptin, prognosis

 

COMPARATIVE EVALUATION OF THE CLINICAL EFFICACY OF AZILSARTAN MEDOXOMIL AND FOSINOPRIL IN PATIENTS WITH ARTERIAL HYPERTENSION AND CONCOMITANT CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Grigoryeva N. Yu., Korolyova M. E., Samolyuk �.�.

Purpose of the study is compare of the clinical efficacy of Angiotensin II receptor blocker (ARB) azilsartan medoxomil and angiotensin converting enzyme inhibitor  (ACEI) fosinopril of patients with hypertension and concomitant chronic obstructive pulmonary diseases (COLD).
Materials and methods. In the open-label study included 49 patients with 1 and 2 the degree of arterial hypertension and concomitant COPD. Initially, all patients were treated with a diuretic hydrochlorothiazide in a dose of 12.5 mg per day and various ACEI, but target BP levels were not achieved, therefore, these ACE inhibitors were abolished in all patients. The method of closed envelopes patients were divided into two groups. As the basic antihypertensive drug for the first group of patients was assigned to ARB azilsartan medoxomil (Edarby, Takeda, Japan). For the second group of patients was assigned ACEI fosinopril (Monopril, OOO VALEANT, Russia). At baseline and after 4 weeks of treatment all patients conducted ambulatory BP monitoring (ABPM), the study of the function of external respiration (HPV), measurement of mean pulmonary artery pressure (SSRA) and endothelial function was studied by instrumental and laboratory methods.
Results. After 4 weeks of treatment azilsartana medoksomil in 20 patients (87%) failed to achieve target BP (less than 140/90 mm Hg. V.). ABPM showed a significant decrease in the variability of both systolic (SBP) and diastolic blood pressure (DBP). According to echodopplercardiography, 16 patients (70%) experienced a decrease in SSRA. As a result of treatment, a significant improvement in endothelial function was observed (EDVD increased to 9.5 ± 1.7%). In the study of HPD in patients, there was no significant change in the volume of forced expiration in 1 second (FEV1),  although there was a positive tendency to increase it.
After 4 weeks of treatment of fosinopril, 22 patients (85%) achieved target BP (less than 140/90 mm Hg). Daily monitoring of blood pressure showed a significant decrease in the variability of SBP and DBP. In 15 patients (58%) there was a decrease of SSRA. A slight improvement in endothelial function was revealed. Changes from the bronchopulmonary system for the treatment of fosinopil were not identified.
Conclusion. In patients with arterial hypertension and concomitant COPD of mild and moderate severity, the main antihypertensive agent are using BRA of azilsartan medoxomil and ACE inhibitor fosinopril, allows rapid and optimal control of BP, as well as beneficial effects on pulmonary hemodynamics and endothelial function. However, with the comparable effect of these two classes of drugs on the level of blood pressure, BRA of azilsartan medoxomil has a greater positive effect on the profile of BP than fosinopril, and more significantly affects endothelial function and pulmonary hemodynamics.
Keywords: arterial hypertension, chronic obstructive pulmonary disease, endothelial dysfunction, azilsartan medoxomil, fosinopril

 

STUDYING THE NEURONAL ACTIVATION OF THE BRAIN IN RESPONSE TO PSYCHOEMOTIONAL STRESS IN PATIENTS WITH CORONARY HEART DISEASE ACCORDING TO THE FUNCTIONAL MAGNETIC RESONANCE IMAGING
Zashezova M.Kh., Ustyuzhanin D.V., Shariya M.A., Vyborov O.N., Masenko V.P., Konovalov R.N., Kaverina A.R., Chernorizov A.M., Ternovoy S.K., Chazov E.I.

Objective: To study neuronal activation in response to psychoemotional stress in patients with coronary heart disease, according to a functional magnetic resonance imaging.
Methods: The study included 23 male patients with coronary heart disease; Control group consisted of 27 male volunteers. Neuroimaging studies conducted on magnetic resonance imaging with Philips Achieva magnetic field strength of 3.0 Tesla. All subjects were functional MRI using a simple block paradigm was carried out. Activation period consisted of the presentation of the subject of stress in the form of tactile electrical stimulation that causes unpleasant sensations subbolevye. The data were analyzed using SPM8  (Statistical parametric mapping) based on MatLab 7.4 (2010a).
Results: The analysis of group card activation found that patients with coronary artery disease marked decrease in total brain activation and identify additional activation area in the right hemisphere of the brain region of the island of the roof: the volume activation zone 323 voxel, MNI (x, y, z) 48 , 10, 2 (mm), pFWE <0.001. Additionally in 8 patients with CHD deactivation zone determined in response to the stress effect in precuneus and wedge, and in the medial frontal lobes.
Conclusion: The study revealed in particular the activation of the cerebral cortex in response to the stress effect may be useful to clarify the mechanisms of the effect of stress on the development of coronary heart disease.
Keywords: coronary artery disease, functional MRI, psychoemotional stress

 

FORTELYZIN® VERSUS METALYSE® IN ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION: RESULTS OF MULTICENTER RANDOMIZED TRIAL FRIDOM 1
Markov V.A., Duplyakov D.V., Konstantinov S.L., Klein H.V., Aksentiev S.B., Platonov D. Ju., Vyashlov Eu.V., Ponomarev Ed.A., Rabinovich R.M., Makarov Eu.L., Kulibaba E.V., Krickaya O.V., Baranov Eu.A., Talibov O.B., Gerasimetc E.A.

Aim: To assess the efficacy and safety of the single bolus of Fortelyzin® agent in comparison with the single bolus of Metalyse® agent in ST-segment elevation myocardial infarction patients with 12 hours after symptoms onset.
Methods: The FRIDOM1 trial was planned as “non-inferiority study” and was performed in 11 Russian clinical centers since 2014 till 2016.
382 STEMI patients were equally randomized in Fortelyzin® and Metalyse® groups.
Fortelyzin® was introduced in the dosage of 15 mg by single bolus during 10-15 sec without body mass limitations; Metalyse® – also by single bolus in the dosage of 30-50 mg in accordance of body mass.
Thrombolytic therapy was coupled with anticoagulant (nonfractioned or low molecular weight heparin) and double antiagregant (acetylsalicylic acid and clopidogrel) treatment in standard dosages and followed by percutaneous coronary intervention (PCI). Emergency PCI was performed if thrombolysis failed; otherwise PCI was performed in 3-24 hours after thrombolysis. The FRIDOM1 study was performed up to 30 days after randomization.
Results: The trial showed that after Fortelyzin® treatment the reperfusion according to 90 min ECG data occurred in 80 % and according to coronary angiographic data (CAG) in – 70 %. These results were similar in comparison with Metalyse® group.
The assessment “of non-inferiority study” was performed by the difference in CAG criteria (TIMI 2 + TIMI 3) in Fortelyzin® and Metalyse® groups. This criteria was equal 0,81 % and didn’t come out of the corridor of 12,5 % of clinical evidence. Such proved the “non-inferiority” hypothesis of Fortelyzin® versus Metalyse®.
The primary combined end point in FRIDOM1 trial was a composite of death of any case, reinfarction and cardiogenick shock up.
This primary combined end point in FRIDOM1 trial occurred in 12,63 % in Fortelyzin® and 12,56 % (p>0,99) in Metalyse® groups and was similar with STREAM primary end point data – 12,4 %.
In FRIDOM1 trial there was no intracranial hemorrhage in both groups. Major bleeding was in 1 patient in each group and they required the blood transfusion. Minor bleeding were statistically less in Fortelyzin® group – 3,7 %, than in Metalyse® group – 10,5 % (p = 0,02).
Conclusion: the trial showed that single bolus of Fortelyzin® in the dosage of 15 mg together with anticoagulant and double antiagregant therapy coupled with timely PCI is not less effective and safe than the single bolus of Metalyse® in the dosage of 30-50 mg together with the for named treatment in STEMI patients within 12 hours after symptoms onset.
Keywords: STEMI, thrombolysis, pharmaco-invasive strategy, Fortelyzin®, Metalyse®

 

DETECT LATENT CARBOHYDRATE METABOLISM DISORDERS AMONG HOSPITALIZED PATIENTS WITH CHRONIC HEART FAILURE USING ORAL GLUCOSE TOLERANCE TEST
Noruzbaeva A.M., Kurmanbekova B.T., Osmankulova G.E., Duishenalieva M.T., Mamasaidova S.Sh.

Objective: to evaluate character and frequency of latent carbohydrate metabolism disorders in hospitalized patients with chronic heart failure by dint of oral glucose tolerance test.
Materials and Methods: via standart oral glucose tolerance test (OGTT) latent carbohydrate metabolism disorders (CMD) are defined in 279 hospitalized patients with different etiology of chronic heart failure (CHF) functional class (FC) II-IV (NYHA) without impaired glucose tolerance (IGT), type 2 diabetes mellitus (T2DM) and glucose-lowering drugs intake in anamnesis. Also were conducted such investigations as: anthropometric data, FINDRISK questionnaires, definition of the glycemic and lipid profiles, glycosylated hemoglobin, creatinine levels with estimated glomerular filtration rate by CKD-EPI.
Results: During OGTT among 279 patients with different etiology (ischemic heart disease (IHD) – 73,8%, heart defects – 21,1%, myocarditis and cardiomyopathies – 5,01%) CHF FC II-IV (NYHA) IGT was identified in 77 (27,6%) patients, impaired fasting glucose (IFG) in 7 (2,5%) patients, T2DM newly diagnosed – in 38 (13,6%) patients, in 157 (56,3%) – CMD were not identified. Total number of points by FINDRISC questionnaire was significantly higher in groups with CMD, in comparison with group without CMD. Moreover, they were more likely to encounter such risk factors, as obesity, overweight, heredity and hypoalphalipidemia. Ejection fraction indicators in patients with and without CMD did not differ significantly. At the same time patients with T2DM had a long duration of CHF in comparison with patients without CMD.
Conclusion: Prevalence of latent CMD in patients with CHF FC II-IV (NYHA) without IGT, T2DM and glucose-lowering drugs intake in anamnesis, during OGTT, was significant - 43,7%. In patients with CHF more common CMD as IGT – 27,6% and T2DM – 13,6%, IFG was rarely occured – in 2,5%. Such risk factors as obesity, overweight, heredity and hypoalphalipidemia were most often in patients with CMD. Patients with newly diagnosed T2DM had a longer duration, comparing with patients without CMD. But ejection fraction did not differ in patients with and without CMD. 
Keywords: chronic heart failure, disorders of carbohydrate metabolism, pre-diabetes, diabetes mellitus, oral glucose tolerance test

 

AUTOARTERIAL AND AUTOVENOUS GRAFTING EFFECTIVENESS FOR SMALL LEFT ANTERIOR DESCENDING ARTERY
Akchurin R.S., Shiryaev A. A., Balakhonova T. V., Vasil’ev V. P., Galyautdinov D. M., Salichkin D. V.

Objective. The aim of this article is the efficacy evaluation of left internal mammary artery (LIMA) and saphenous vein utilizing for bypassing of less than 1,5mm left anterior descending artery (LAD).  
Material and methods.  176 patients undergone CABG were enrolled. Everyone had bypassed LAD in diameter less than or equal to 1,5mm. Small artery size determined with angiography and confirmed intraoperatively after gauging with calibrate probes. All patients were divided in two groups. 58 patients with autovenous grafting of LAD which underwent CABG within the period from 1985 to 1992 were included in group 1. Group 2 included 118 patients with LIMA-LAD grafting performed from 1997 to 2004. Preoperative clinical status and angiographic picture as well as early and longterm outcomes of surgical treatment were analyzed. All procedures were performed with the same technic. Each distal anastomosis was formed under the surgical microscope with 8-0 prolene continuous suture. Short-term and long-term graft patency were assessed by computer tomography, bypass angiography and Doppler ultrasonography in cases of LIMA.
Results. Preoperative clinical status and lesion volume of coronary run-off conditions were comparable in both groups. Autovenous and autoarterial graft patency within a year after CABG were 83% and 97% respectively (p=ns). Ten years patency of autoarterial graft was twice as much as autovenous graft patency (95% vs 49%, p<0.05). 
Conclusion. Diffuse coronary lesion and a small size of LAD should not be contraindication to CABG. Left internal thoracic artery is a preferable conduit in case of small coronary arteries.
Keywords: diffuse lesion, small coronary artery, left anterior descending artery, autovenous graft

 

A FIVE-MINUTE TILT TABLE TEST AS PART OF DIAGNOSTIC ALGORITHM OF SYNCOPE
Kheymets G.I, Pevzner A.V, Pogoza A.N., Golitsin C.P.

The purpose of the study – establishing of the diagnostic model based on results of Tilt Table Test (TTT) using changes of parameters in hemodynamics of cardiovascular system during early period of orthostatic changes to improve testing algorithm for patients with syncope.
Materials and methods: We included 212 patients with history of vasovagal syncope (72.6% males, median age 41). During preliminary evaluation we ruled out other reasons for syncope. All patients had TTT using standard protocol developed at Institute of Clinical Cardiology (Moscow, Russia) that includes monitoring of parameters of hemodynamics using method of impedance cardiography, as well as spectral analysis of cardiac rhythm and changes in arterial blood pressure taken using Korotkoff’s technique.
Results: Based on results of TTT all patients were divided in two groups: with vasovagal syncope during the test – TTT(+) (n=110) and without syncope – TTT(-) (n=102). Based on comparison of hemodynamic parameters during first 5 minutes of TTT between 2 groups, using method of logistic regression we developed this formula:
Y=3.8 MAP+(%MPVR)+14(%EIC)+(%LFN), where
MAP – mean arterial blood pressure;
%MPVR - % change of peripheral vascular resistance;
%EIC – change of basal electric impedance chest area;
%LFN – change of the normalized power of low frequency of rhythmogram.
First 3 parameters are taken at the end of 1 st minute of orthostasis, and the 4 th parameter – at the end of 5 th minute. Percent of change of the 2-4 parameters are calculated relative to their initial values with patient in supine position. Based on ROC analysis Y=500 devided patients with syncope and without syncope with sensitivity of 74.5% and specificity of 82.4%.
Thus, calculation of the above parameters during 5 minute TTT allows us to determine prognostic results  of TTT in patients with vasovagal syncope.
Keywords: tilt table test, vasovagal syncope, impedance cardiography, spectral analysis of cardiac rhythm

 

THE ROLE OF THE ANGIOTENSIN RECEPTORS BLOCKER TELMISARTAN IN THE TREATMENT OF ARTERIAL HYPERTENSION
Martynyuk T.V., Chazova I.�.

The problem of the optimal choice of antihypertensive drug (AHD) remains extremely relevant, since in our country only one of five patients reaches the target levels of blood pressure (BP). The main advantages of angiotensin receptors blockers (ARB) are pronounced antihypertensive efficacy, perfect, placebo-comparable tolerability profile, which ensures the highest adherence of patients to therapy as compared to other AHD classes. With sartans effective BP control is achieved throughout the day without sudden fluctuations, but with a sufficient decrease at night. The antihypertensive effect does not depend on the age, sex, race of the patients, as well as the activity of the renin-angiotensin-aldosterone system (RAAS) and the hemodynamics type. Unlike the inhibitors of the angiotensin-converting enzyme, ARBs have no "escaping" phenomenon, since the antihypertensive effect does not depend on the way of angiotensin II. formation.         Telmisartan has unique pharmacological properties, the greatest lipophilicity among ARBs, which contributes to good penetration into tissues and a powerful effect on local RAAS. With a high selective affinity for the angiotensin II type 1receptors it causes the most prolonged blockade in comparison with other ARBs. This leads to a prolonged decrease of BP and superiority in the organoprotection in hypertensive patients. The review presents the distinctive characteristics of telmisartan, key clinical studies on its use in patients with hypertension. Recently, generic telmisartan (Dr.Reddy's Laboratories Ltd., India), which has proven high bioequivalence to the original telmisartan, has appeared in our arsenal. It greatly expands the possibilities of using this ARB in the real clinical practice.
Keywords: arterial hypertension, antihypertensive therapy, angiotensin II receptor blockers, telmisartan

 

CATHETERAL CRYOABLACTION IN TREATMENT OF ATRIAL FIBRILLATION. OPPORTUNITIES AND PROSPECTS
Sapelnikov O.V., Kulikov A.A., Grishin I.R., Cherkashin D.I., Partigulova A.S., Shiryaev A.A., Akchurin R.S.

Medical therapy of atrial fibrillation (AF), the most common arrhythmia in the population in general, has a very modest efficacy in controlling symptoms and restoring and maintaining sinus rhythm. Since 1998 when it was found out that AF trigger zones are in most cases located in pulmonary veins, electrical isolation of all pulmonary veins became a cornerstone of ablation technics in patients with symptomatic AF. However, due to the elaborate and tiresome technique of the traditional point-by-point method with radiofrequency ablation guided by electroanatomical mapping, more modern and universal techniques, such as cryoballoon ablation, began to develop progressively. Cryoballoon pulmonary veins isolation appears to be the most promising and effective approach, and in this review we are presenting all available relevant data from the literature and our own experience.
Keywords: atrialfibrillation, cryoablation pulmonary veins

 

DISLOCATION OF EMBOLIC MICROSPIRAL IN A PATIENT WITH HAEMODYNAMICALLY SIGNIFICANT CORONARY FISTULA
Safiullina A. A., Tereshchenko S. A., Merkulov E. V., Uskach T. M., Samko A. N.

The prevalence of coronary fistulas depends on many factors and unknown until the end. Coronary fistulas are congenital or due to injury or surgery. The standard treatment for symptomatic coronary fistulas is surgical repair. Transcatheter embolization is the method of choice for uncomplicated fistula anatomy moves and the absence of heart disease. The clinical manifestations of coronary fistulas can be varied depending on the anatomy and have similarities with various heart diseases.
In our case presents an example of successful treatment of a patient with dilated cardiomyopathy and hemodynamically significant coronary fistula between the anterior descending artery and pulmonary artery. Also described one of the possible complications of transcatheter embolization of coronary fistulas.
Keywords: dilated cardiomyopathy, coronary fistula, transcatheter embolization

 

STENTING FOR LEFT MAIN CORONARY ARTERY COMPRESSION SYNDROME IN A PATIENT WITH PULMONARY ARTERIAL HYPERTENSION AND SIGNS OF THE LEFT VENTRICULAR MYOCARDIAL ISCHEMIA: A CLINICAL CASE AND A BRIEF REVIEW OF THE LITERATURE
Chernichka K.S., Danilov N.M., Matchin U.G., Mitroshkin M.G., Fedotenkov I.S., Ansheles A.A., Chazova I.�.

The left main coronary artery compression syndrome by the dilated pulmonary artery is a rarely diagnosed cause of myocardial ischemia in patients with pulmonary arterial hypertension. The treatment strategy of this syndrome currently remains controversial, and is based more on the degree of compression according to coronary angiography than on the objective degree of severity of myocardial ischemia. Endovascular correction of the left main compression syndrome can be an effective and safe alternative to aorto-coronary bypass surgery in patients with pulmonary arterial hypertension.
This article presents a clinical case of stenting for left main coronary artery compression syndrome in a patient with pulmonary arterial hypertension and signs of myocardial ischemia and a brief literature review.
Keywords: pulmonary arterial hypertension, left main coronary artery compression syndrome, left main coronary artery stenting, intravascular ultrasound

Download Kardiologicheskij Vestnik �2/2017

THE LOCAL ARTERIAL STIFFNESS AND VASOMOTOR ENDOTHELIAL FUNCTION IN PATIENTS WITH RESISTANT HYPERTENSION AND EFFECT OF RENAL DENERVATION ON THEM
Shchelkova G.V., Zairova A.R., Danilov N.M., Rogoza A.N., Chazova I.E.

Aim: to evaluate the effect of renal denervation (RDN) on the indicators of local arterial stiffness and vasomotor endothelial function in patients with resistant hypertension.
Material and methods: RDN was performed in 20 patients with essential resistant hypertension with average blood pressure (BP) 153/90 mm Hg by 24-hour ambulatory blood pressure monitoring (ABPM) on 5,1 ± 0,7 antihypertensive drugs with diuretic. Patients were examined at baseline, 7 days and 6 months after the RDN. All patients were divided into two groups by ABPM in 6 months after RDN: responders (decrease of mean SBP ≥ 5 mm Hg) and non-responders (decrease of mean SBP < 5 mm Hg). The local stiffness of the carotid and radial arteries was assessed by ultrasound method using eTRACKING technology. We studied peripheral augmentation index (AIp% AIp75%), stiffness index (SI) and reflection index (RI) characterizing the state of the main arteries and peripheral vascular resistance respectively, by the pulse wave contour analysis on the "Angioscan-01." Vascular age" was calculated and also endothelial vasomotor function was determined by inducing reactive hyperemia.
Results: Within 6 months after RDN in the « responders» group average SBP decreased by 16 mm Hg (p=0,002) and average DBP decreased by 8 mm Hg (p=0,03), in «non-responders» SBP increased by 3 mm Hg (�=0,045) and DBP increased by 1 mmHg (p=0,04). In both groups we found tendency to improve the elastic properties of the vascular wall but it was significant in the general group of patients (elastic modulus (EPcar) decreased by 32,5 kPa, p=0,02) after RDN. In long-term after RDN in «responders» group there were decrease of peripheral augmentation index (AI�%) to 6,2 (p=0,02) and "vascular age" to 6 years (p=0,04), but there was no significant change of endothelial vasomotor function in large and small arteries. In "non-responders" group all studied parameters did not improve (p> 0,05).
Conclusion: The combined effect of RDN in patients with resistant hypertension was detected only after 6 months after the procedure and was manifested in the reduction of BP, peripheral augmentation index, "vascular age" and improving of the elastic properties of carotid arteries. Initially impaired vasomotor endothelial function parameters did not improve after RDN.
Key words: resistant hypertension, renal artery denervation, local arterial stiffness, vasomotor endothelial function

 

CLINICO-PSYCHOLOGICAL SEVERITY MARKERS OF OBSTRUCTIVE SLEEP APNEA SYNDROME IN PATIENTS WITH HYPERTENSION
Konovalova K., Yarovaya �., Fedorova V., Litvin A.

Objective: to identify the clinical and psychological factors that determine the severity of obstructive sleep apnea syndrome in patients with obstructive sleep apnea syndrome and hypertension.
Materials and methods: The study included 180 patients with obstructive sleep apnea of varying severity and hypertension. Anthropometric data, cardiorespiratory polysomnography studies, questionnaires on anxiety scales and daytime sleepiness were analyzed.
Results: 25 (14%) out of 84 patients with obstructive sleep apnea syndrome of varying severity and hypertension showed a combination of increased anxiety, sleepiness, and the second and higher degrees of obesity (body mass index over 35 kg/m²), 21 patients among them were diagnosed with severe obstructive sleep apnea syndrome. In addition, this group of 21 patients had a higher apnea/hypopnea index, higher desaturation index, lower level of the minimum oxygen saturation compared with other patients.
Conclusion: The combination of body mass index greater than 35 kg/m², severe anxiety and severe daytime sleepiness in patients with arterial hypertension gives grounds for suspicion of the presence of severe obstructive sleep apnea syndrome, combined with a high apnea/hypopnea index, high desaturation index and low minimum saturation.
Key words: Obstructive sleep apnea, hypertension, anxiety, sleepiness, sleep apnea/hypopnea index, the minimum saturation

 

CORRELATION BETWEEN THE CONCENTRATION OF CIRCULATING Β2-MICRIGLOBULIN, DYNAMIC CONTRAST MRI DATA AND STANDARD INSTRUMENTAL METHODS IN PATIENTS WITH CHRONIC LOWER LIMB ISCHEMIA
Maslennikova N.S., Stukalova O.V., Bulkina O.S., Butorova E.A., Vorobyova O.V., Koshurnikova M.V., Maslennikov M.A., Balakhonova T.V., Karpov Yu.A., Ternovoy S.K.

Objective: to study the concentration of circulating biomarkers in patients with chronic lower limb ischemia (CLLI) versus the control group, and to compare the data obtained with ultrasound duplex scanning of the arteries of the lower limbs, the parameters of the ankle-brachial pressure index (ABI), the treadmill test data and dynamic contrast magnetic resonance imaging (MRI) as part of an integrated approach to examining patients with intermittent claudication.
Materials and methods: 86 subjects were included in the study, 45 of them with peripheral atherosclerosis and CLLI IIa-IIb stage according to Fontaine-Pokrovsky classification and a control group. In addition to the standard biochemical blood test, all patients were assessed levels of C-reactive protein, fibrinogen, β2-microglobulin, activity and concentration of urokinase, VEGF-A. All patients underwent dynamic contrast MRI to study muscle perfusion. Patients with CLLI  were subjected to a physical exercise test, and ABI measurement.
Results: In a comparative analysis of groups of subjects, a significant difference was found between the group of patients with CLLI and a group of healthy volunteers according to the level of "classical" studied markers of atherosclerosis, such as fibrinogen and C-reactive protein, and the level of activity of urokinase and β2-microglobulin. When analyzing the subgroup with CLLI, it was shown that the arterial input flow (AIF) under load did not differ significantly from that at rest with a significant increase in peak tissue perfusion (PTP). The correlation relation exists between the time to PTP at the load and the ABI  under load; AIF at rest and ABI at rest and under load; Time to AIF at loading and level of C-reactive protein; Time of reaching the PTP at load and ABI under load and a number of other indicators.
Conclusion: on the basis of an integrated approach to the examination of patients with CLLI, it was possible to compare the main instrumental indicators with MRI data and the concentration of plasma markers. Further development of a screening program can help to objectify the patient's condition and to better understand the pathophysiology of the disease.
Key words: dynamic contrast MRI, chronic lower limb ischemia, C-reactive protein, fibrinogen, β2-microglobulin, urokinase

 

COMPARISON OF EFFICACY AND SAFETY OF LOSARTAN FIXED COMBINATION WITH AMLODIPINE OR HYDROCHLOROTHIAZIDE IN HYPERTENSIVE PATIENTS DURING HEATWAVES
Smirnova M.D., Fofanova T.V.,  Ageev F.T., Blankova Z.N., Vitsenya M. V., Tsybulsckaya T.V., Neverova E.F., Neverova N. S.

Objective: To compare efficacy and safety of a fixed combination of blockers of angiotensin II receptor antagonists of calcium channels (ARB + ACC) and hydrochlorothiazide (ARB +HCTZ) during heatwaves.
Materials and Methods: 52 patients with hypertension of 1-2 degrees randomized to receive losartan fixed combination with amlodipine (L +AML) and hydrochlorothiazide (L+ HCTZ). Take measurements of blood pressure, ECG, sphygmography, blood chemistry, blood osmolarity evaluation, visual - analogue scale (VAS) questionnaire for patients exposed to heat, the test of of the Morisci-Green, home BP monitoring(HBPM).  Inclusion visit was in the spring 2016, 1st visit was in V -VI, 2nd was during heat waves, 3rd was in the IX -X 2016.
Results: there was a decrease in SBP and DBP in both groups. Target blood pressure achieved in 81% in group L + AML and 46% in L + hydrochlorothiazide (p <0.05), during the heatwave - in 58% and 42%, in the fall – in 63% and 31% (p <0.05). Snizhenie Heart rate (p = 0,007) to 3 visit, DBS (p = 0,01) - 1 - 3 visit, CAVI to -2,1 (-2,9; -0,65), p = 0,01 - 2, uric acid (p = 0,04) at 1-3 and the visit creatinine visit 2 (p = 0,02) was only in the group L + AML. No significant electrolyte shifts and increase blood osmolarity in the heat wave period is not revealed. In group L + hydrochlorothiazide urea levels increase to 3rd visit. The increase of adherence and quality of life in both groups was
Conclusion: Both combinations are effective and safe during heat waves. However, L + AML does not lose efficiency in the the autumn period, improves the elastic properties of the arteries, lowers uric acid levels and does not cause adverse metabolic changes during heat waves.Key words: secondary atrial septal defect, transcatheter correction, electric axis of the heart, right ventricular hypertrophy, right bundle branch block.
Key words: arterial hypertension, heatwave, amlodipine, losartan, hydrochlorothiazide fixed combination

 

Hybrid coronary revascularization versus PCI in patients with multivessel coronary disease
Shilov A., Kochergin N., Ganyukov V., Ivanov S., Kozyrin K., Kokov A., Barbarash L.

Background. Hybrid coronary revascularization combines bypass grafting of the left anterior descending coronary artery with percutaneous coronary intervention of non-LAD vessels. Hybrid coronary revascularization has been performed as an alternative to Coronary Artery Bypass Graft Surgery or multi-vessel PCI.
Aim. To compare the results of PCI and HCR amongst patients with multivessel coronary artery disease.
Materials and Methods. Patients with multivessel coronary artery disease confirmed by coronary angiography were included in our prospective, single-center, randomized study. We performed analysis of 1-year follow-up of patients with stable coronary artery disease who underwent either PCI or hybrid coronary revascularization. Hybrid coronary revascularization (two-staged intervention) was performed as follows: in the first stage – LIMA grafting to the LAD artery via left anterior mini thoracotomy (MIDCAB); in the second stage – coronary artery stenting.
Conclusion. There were no significant differences in 1-year outcomes between two groups. The results of our trial show that hybrid coronary revascularization is feasible in select patients with multivessel coronary artery disease.
Key words: coronary revascularization, PCI, MIDCAB

 

ECG MONITORING OF PATIENTS IN EARLY FOLLOW UP PERIOD AFTER RADIOFREQUENCY CATHETER ABLATION OF ATRIAL FIBRILLATION
Shokhzodaeva Z.O., Ryabirina G.V., Sapelnikov O.V., Latypov R.S, Cherkashin D I., Makeev M I., Kogemeakina E.S., Sobolev A.V.

The monitoring results of 24 patients in early follow-up period after   radiofrequency catheter ablation of atrial fibrillation have shown in the article. Results of 12-lead electrocardiography (ECG) monitoring and 24 hour Holter monitoring demonstrate early recurrence of AF in 7 patients within 48 hours after ablative treatment. Patients with early recurrence of atrial fibrillation (AF) have significantly larger size and volume of the left atrium and the left ventricular mass in contrast with patient free of AF. We speculate that the possible cause of early AF recurrence can be detected sinus node dysfunction in 4 patients out of 7 with recurrence of AF.
Key words: atrial fibrillation, radiofrequency catheter ablation, ambulatory ECG monitoring transthoracic echocardiography

 

THE CONNECTION OF PREOPERATIVE ADHERENCE TO TREATMENT WITH THE RISK OF DEVELOPMENT OF EARLY POSTOPERATIVE COGNITIVE DYSFUNCTION IN PATIENTS UNDERGONE CORONARY ARTERY BYPASS GRAFTING
Argunova Yu.A., Trubnikova O.A., Kagan E.S., Barbarash O.L.

Purpose: Assessment of the impact of preoperative adherence to treatment in patients with coronary artery disease (CAD) underwent coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB) on the risk of postoperative cognitive dysfunction (POCD) development.
Materials and methods: We examined 113 men with CAD who underwent CABG under CPB. In a postoperative period 2 groups of patients were allocated: a group with the presence of early POCD 1 month after CABG – 46 persons (mean age – 56,1±4,9 years) and a group without early POCD – 67 persons (56,0±5,9 years). The following indicators of neuropsychological status were assessed: neurodynamics, attention and memory. The estimation was performed 5-7 days prior to CABG, on the 7th-10th day and 1 month after surgery. We analyzed the medication and the parameters of patients’ adherence to non-pharmacological treatment at the outpatient stage prior to surgery.
Results: The analysis of clinical and anamnestic parameters in the preoperative period showed that the patients with early POCD had a longer duration of arterial hypertension history, a higher level of depression and trait anxiety as compared to the group without early POCD. The analysis of the parameters of patients’ preoperative adherence to treatment demonstrated a higher prevalence of smoking in the group of patients with POCD. The patients of this group more rarely reached the targeted heart rate and significantly more rarely adhered to 4-component CAD treatment regimen as compared to the patients without the signs of early POCD. The performed regression analysis showed that preoperative patients’ adherence to treatment is one of the factors determining the probability of POCD development 1 month after CABG.
Conclusion: The patients with poor adherence to treatment during the period of preparation to CABG have a higher risk of POCD development 1 month after surgery that actualizes the importance of reaching the targeted adherence parameters in the preoperative period.
Key words: coronary artery bypass grafting, postoperative cognitive dysfunction, adherence to treatment

 

A FIXED-DOSE COMBINATION OF THE ANGIOTENSIN II RECEPTORS BLOCKER AZILSARTAN AND DIURETIC CHLORTHALIDONE: NEW POSSIBILITIES IN THE TREATMENT OF ARTERIAL HYPERTENSION
Ostroumova O. D., Vikentiev V., Abrosimov A. G., Smolyarchuk E. A., Bondarets O. V.

The article presents nowadays approaches to the pharmacological treatment of patients with arterial hypertension. The advantages of the fix dose combination (FDC) of angiotensin II receptor blockers, diuretics were discussed, and clinical situations where its use is a priority were considered. The advantages of azilsartan medoxomil among other angiotensin II receptor blockers and chlorthalidone among diuretics are described. Detailed literature data on the efficacy and safety on FDC of azilsartan medoxomil with chlorthalidone are analysed in detail.
Key words: arterial hypertension, fixed dose combinations of antihypertensive drugs, angiotensin II receptor blockers, azilsartan medoxomil, diuretics, chlorthalidone

 

THE SPATIAL QRS-T ANGLE AND VENTRICULAR GRADIENT: DIAGNOSTIC AND PROGNOSTIC VALUE
Sakhnova T.A., Blinova E.V., Yurasova E.S.

Ventricular gradient (VG) is an electrocardiographic index, which is calculated as the sum of the areas under the QRS complex and the T wave and represents the degree of myocardial electrical heterogeneity. Closely related in meaning, spatial QRS-T angle characterizes the spatial difference of depolarization and repolarization vectors. Although the concept of VG was first introduced in 1934, evaluation of VG and spatial QRS-T angle has not yet received the widespread introduction into clinical practice. Widespread introduction  of digital ECGs allows easy calculation of VG and QRS-T angle, and now it is a growing interest in their use as a tool for risk stratification. This review summarizes research on the prognostic value of QRS-T angle and VG, discusses electrophysiological meaning of these indicators; factors affecting VG and QRS-T angle in health and disease are considered.
Key words: electrocardiogram, vectorcardiogram, spatial QRS-T angle, ventricular gradient

 

Clinical case: MULTI-ELECTRODE RENAL DENERVATION FOR TREATMENT IN PATIENT WITH RESISTANT HYPERTENSION
Agaeva R.A., Danilov N.M., Shchelkova G.V., Sagaydak �.V., Matchin U.G., Chazova I.�.

Renal sympathetic denervation (RSDN) or renal denervation (RDN) is a contemporary method for the treatment of resistant hypertension. It is based on decrease of sympathetic nerve system activity, as a main purpose. The researches using single-electrode catheter showed low effectiveness. In 2013 multi-electrode bipolar catheter of the second generation Vessix Renal Denervation SystemTM was developed.
In this article, a clinical case of the possibility of using RDN with a multi-electrode catheter Vessix in patient with resistant hypertension.
Key words: radiofrequency denervation, multielectrode catheter, resistant hypertension, renal artery

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COMPARATIVE ANALYSIS OF ECG PARAMETERS IN CHILDREN AND ADULTS AFTER TRANSCATHETER CORRECTION OF ATRIAL SEPTAL DEFECT
Abdyzhaparova E.K., Dzhishambaev E.D., Dadabaev M.Ch.

Endovascular closure of secondary atrial septal defect (ASD) Amplatz occluder was performed for the purpose of a comparative analysis of the dynamics of an electrocardiogram (ECG) in 90 patients with secondary ASD, including 50 adults (16 to 67, an average of 34,3 ± 2,4 years) and 40 children (under 16 years) between the ages of 3 to 15 (mean 10,2 ± 1,2) years. Long-term results of correction of the defect studied in the period from 1 to 12 months. Comparative analysis of ECG parameters before and after transcatheter correction of secondary ASD showed that in children compared with adults there is a more pronounced reduction dynamics electrical axis of the heart (EAH) deviation to the right (40%) and the trend towards verticalization EAH (58%) (p <0.05). In addition, children regress ECG signs right ventricular hypertrophy, coupled with the normalization of the electrical axis of the heart, or a significant reduction in its deviation to the right, there is already 6 months, whereas in adults regress signs right ventricular hypertrophy and verticalization EAH notes at a later date (12 months).
strong>Key words: secondary atrial septal defect, transcatheter correction, electric axis of the heart, right ventricular hypertrophy, right bundle branch block.

 

ULTRASONIC METHODS IN EVALUATION OF LOCAL AND REGIONAL AORTIC STIFFNESS IN PATIENTS WITH TAKAYASU AORTOARTERITIS
Andreevskaya M.V., Chichladze N.M., Saidova M.A., Rogoza A.N.

The aim: Analysis of local and regional stiffness of the abdominal and thoracic  aorta with the use of complex ultrasound studies in patients with Takayasu aortoarteritis different types and different degrees of inflammatory activity.
Materials and methods: The study is included 23 patients with Takayasu aortoarteritis (TAA), all female, at the age of 39 (34;55)years and 34 healthy volunteers from the control group (15 men and 19 women) at the age of 43(37;46)years. Pulse wave velocity in the aorta (aPWV) using ultrasound duplex scanning and local stiffness of the abdominal (AA) and thoracic aorta (TA) were measured in all studied. Activity of the inflammatory process on the criteria of high parameters of  high sensitive C-reactive protein (hsCRP) and erythrocyte sedimentation rate (ESR) was determined in patients with TAA.
Results: According to ultrasound method in patients with TAA aPWV significantly and reliably increased 9,3 (7,6;11) m/s compared to the control group 5,2 (4,8;5,5)m/s �?0,0001. Local stiffness for β TA also significantly increased to 11.8 (7,3;20), in comparison with the control group at 4.9 (4,1; 5,5), �?0,0001. The increase in stiffness index β AA in patients with TAA was less pronounced - 7.2(4;11,4) in comparison with the control group 5,3 (4,8;5,8). The maximum increase in aortic stiffness is observed in patients with activity of inflammatory process in comparison with the patients with remission: β TA – 32% - 14 (8.6;19.5) compared to 10.6 (6.8;18.1); and aPWV – 30% - 11.2(7.7;13.6)m/s compared to 8.6 (7; 10.6) m/s, respectively. The increase of stiffness index β AA expressed less than 8% - 7.8(3.6;11) in patients with activity of inflammatory process in comparison with 7.2(4.5;11.4) in patients with remission. In the analysis of relation of indexis of aortic stiffness with the criteria of inflammation were observed moderate significant correlation of the level of hsCRP and aPWV with a correlation coefficient of 0,46.
Conclusion: Aortic stiffness is significantly increase in patients with TAA.  Aortic stiffness in patients with TAA with active inflammatory process is higher than that in patients with remission. In the analysis of the hsCRP and aPWV there is a moderate significant correlation with a correlation coefficient of 0,46. The study confirmed the view that one of the determinants of the increase of aortic stiffness is inflammatory process of the arterial wall.
Key words: aortic stiffness, ultrasonography, ultrasound duplex scanning, aortic pulse wave velocity, aortic stiffness index, Takayasu aortoarteritis

 

EFFECT OF ROSUVASTATIN ON THE PARAMETERS OF MICROCIRCULATION IN PATIENTS WITH CORONARY ARTERY DISEASE
Boiko V.V., Soboleva G.N., Fedorovich �.�., Karpova I.E.

Methods: This open-label single-arm study included 24 CAD patients (16 male; mean age 57.1 ±6.4 years), who did not receive lipid-lowering therapy for 4 weeks. At baseline and after 12 weeks of treatment with rosuvastatin 10 mg daily all patients underwent laser Doppler flowmetry (LDF) with amplitude-frequency wavelet analysis of skin blood flow oscillations.
Results: At 12 weeks rosuvastatin therapy decreased mean total cholesterol level from 5.69 ± 1.17 mmol/l to 4.02 ± 1.18 mmol/l, LDL-C level from 4.14 ± 1.10 mmol/l to 2.30 ± 0.91 mmol/l (� < 0.01). LDF demonstrated significant increase in tissue perfusion level by 35% (� < 0.01), as well as significant increase in amplitude of passive vascular tone regulation mechanisms (cardiac and respiratory). Additionally, there was significant increase in amplitude of all active vascular tone regulation mechanisms – endothelial, neurogenic (sympathetic) and myogenic.
Conclusion: Lipid-lowering therapy improves microcirculatory blood flow in patients with CAD by means of 1) increase in total tissue perfusion level 2) enhanced endothelium-dependent arteriolar vasodilation and 3) decrease in neurogenic and myogenic tone of arterioles.
Key words: microcirculation, atherosclerosis, statins, laser Doppler flowmetry, wavelet analysis

 

THE INFLUENCE OF OXIDATIVE STRESS ON THE LENGTH OF TELOMERIC REPEATS IN CHROMOSOMES OF WHITE BLOOD CELLS IN PATIENTS WITH DIFFERENT RISK OF CARDIOVASCULAR DEATH AND PATIENTS WITH CORONARY ARTERY DISEASE
Dorosh�huk N.A., Tikhaze A.K., Lankin V.Z., Konovalova G.G., Mednikova T.K., Postnov A.Yu., Kukharchuk V.V.

Aim: to investigate the influence of oxidative stress on the length of telomeric repeats in chromosomes of white blood cells in people with different risk of cardiovascular death (by SCORE scale) and with coronary artery disease.
Materials and methods:  was examined three groups of patients with different risk of cardiovascular death by SCORE scale (209 patients with low risk; 215 patients with high risk) and 189 patients with clinical manifestations of coronary artery disease. The length of telomeric repeats in chromosomes was measured with the use of quantitative real-time PCR, the level of oxidized low density lipoproteins was determined by immunochemistry.
Results: the level of oxidized LDL in the blood plasma was significantly increased (P<0,05) in patients with increased risk of cardiovascular death by SCORE scale and in patients with coronary artery disease while the length of telomeric repeats in blood leukocytes, on the contrary, significantly decreased with increasing risk of cardiovascular death and in patients with coronary artery disease (P<0,005).
Conclusion: we found that there is negative correlation between the level of oxidized low density lipoproteins and length of telomeric repeats in chromosomes of leukocytes in patients with high risk of cardiovascular death and in patients with coronary artery disease.
Key words: telomeres, oxidized low density lipoproteins, oxidative stress, coronary artery disease.

 

ASSOCIATIONS OF INVERSIONS OF EMOTIONAL REFLECTION WITH THE CLINICAL CHARACTERISTICS OF ACUTE CORONARY SYNDROM IN PEOPLE LIVING IN THE NORTH
Kozhokar K.G., Urvantseva I.A., Nikolaev K.Yu.

The aim of our research is to study associations between inversions of emotional reflection with the clinical characteristics of acute coronary syndrome in people living in the North.
Materials and methods. 269 patients (female n = 57, n = 212 men) with acute coronary syndrome were examined, their average age was 56,0 ± 6,1 years (45-64 years). The complex of diagnostic studies and surveys of patients on a specially designed questionnaire consisting of general questions, the «AUDIT» test and the assessment of the psychological state of the individual was accomplished.
Results. The level of emotional support was significantly higher in patients with low and moderate frequency of reversals 37 (33; 41), p <0,01. Associations between the low-level instrumental support, low total score of social support with the development of myocardial infarction in the group of persons with a high frequency of reversals of emotional reflection (r = 0,30, p <0,05 and r = 0,30, p <0,05 ) were detected. The manifestation of alexithymia correlates with the development of myocardial infarction in patients with the high level of inverting (r = 0,26, p <0,05). The direct association of situational anxiety with the severity of coronary lesions on a scale of SYNTAX (r = 0,26, p <0,05) and probable hospital mortality by Grace scale (r = 0,41, p <0,01) in the group with high frequency of inversions was found. With the help of binary logistic regression it was stated that the key factors of the high-level inversions of emotional reflection are male sex, low levels of social integration and the total score of social support (p <0,05); however, other analysed indicators did not significantly affect the dependent variable above.
Conclusion. The inversion of emotional reflection is a marker of the neurotization degree of the personality and it can be considered as a risk factor directly associated with the development of acute coronary events in people living in the North. The key factors of the high level of emotional reflections' inversions are male sex, low values ??of the indicators of social integration and social support.
Key words: acute coronary syndrome, psychosocial factors, the inverse of emotional reflection, social support.

 

Molecular mechanisms of homocysteine’s toxic action
Medvedev D.V., Zvyagina V.I.

In recent years hyperhomocysteinemia attracts more and more attention of clinicians and researchers, as it is associated with many human diseases. This literature review provides information on hyperhomocysteinemia as a risk factor for human diseases, homocysteine’s metabolism, a normal level of this aminoacid in the blood plasma, forms of hyperhomocysteinemia and its causes; describes the most important mechanisms of the toxic action of homocysteine such as homocysteinylation and disruption of protein structure, the auto-oxidation and development of oxidative stress, S-nitrosylation and influence on the metabolism of nitric oxide (II), activation of matrix metalloproteinases. The necessity of further study of hyperhomocysteinemia is demonstrated, as an importance of the homocysteine in the pathogenesis of human diseases is still unclear.
Key words: hyperhomocysteinemia, homocysteinylation, oxidative stress, nitric oxide (II), matrix metalloproteinases.

 

CYSTATIN C AND RISK FACTORS OF CARDIOVASCULAR DISEASE AMONG INDIGENOUS AND NON-INDIGENOUS RESIDENTS OF MOUNTAIN SHORIA
Filimonov E.S., Mulerova T.A., Uchasova E.G., Epifanceva N.N., Vjalova V.N., Heringson L.G., Ogarkov M.Ju.

Introduction. At the present stage cystatin C has been recognized as a reliable marker of renal function assessment. Value of cystatin C based on identification of the high risk of cardiovascular events among individuals with normal glomerular filtration rate and creatinine.
Goal. To study the concentration of cystatin C in blood among the residents of Mountain Shoria and assess the relationship of its high-level with hypertension, risk factors of cardiovascular diseases and the presence of kidney dysfunction.
Material and methods. Examined 1217 indigenous and non-indigenous residents of Mountain Shoria, matched by sex and age. The cohort of persons with studied concentration of cystatin C was highlighted among them. All surveyed identified the blood creatinine level and glomerular filtration rate is calculated according to the formula CKD-EPI, studied blood pressure values, blood lipid spectrum.
Results. Established larger proportion of individuals with overweight and obesity, including abdominal among examinees with an increased concentration of cystatin C, more significant among the non-indigenous population. In both ethnic groups discovered the association with hypercholesterolemia. Correlation analysis revealed an inverse relationship between the increased value of cystatin C and estimated glomerular filtration rate, and direct communications between the blood pressure values.
Conclusion. The average level of cystatin C and its frequency were lower in indigenous compared to non-indigenous residents of Mountain Shoria. The average value of the estimated glomerular filtration rate in the examinees with higher cystatin C concentration was higher among the indigenous population than the non-indigenous population. Arterial hypertension and kidney dysfunction were associated with an increased value of cystatin C in both ethnic groups.
Key words: Cystatin C, arterial hypertension, kidney dysfunction, glomerular filtration rate.

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COMORBIDITY IN PATIENTS WITH HEART FAILURE (HEART FAILURE ACCORDING THE REGISTER)
Lazareva N.V., Oshchepkova E.V., Tereschenko S.N.

The aim of the research was to study the frequency of comorbidity diseases in patients with heart failure (HF).
Materials and methods: medical data from 6 465 patients with HF I-IV class (NYHA) and the most complete information in the Registry records were selected for the analyses from 8700 patients, included in the CHF Registry. The data was collected with the help of the HF Register, that is a special computer program which allows to collect data from the medial institutions online.
Results: the research was conducted with the help of the Register, where a number of concurrent diseases was evaluated. The average age was 64±7 years in the selected patients with CHF, among them 42% were women, the most frequent concurrent diseases in the past medical history were: chronic kidney disease (48%), diabetes mellitus (18%), anemia (15%), atrial fibrillation (10%), chronic obstructive pulmonary disease (9%), stroke (8%). The restrictions of the research: the patients with the permanent atrial fibrillation were included in the study according to the electrocardiogram criteria.
Key words: Heart failure, register heart failure, diagnostics, comorbidity.

 

COMPARISON OF INSTANTANEOUS WAVE-FREE RATIO AND FRACTIONAL FLOW RESERVE SAFETY IN THE ASSESSMENT OF THE FUNCTIONAL SIGNIFICANCE OF CORONARY ARTERY STENOSES IN PATIENTS WITH CHRONIC CORONARY ARTERY DISEASE
Darenskiy D.I., Mitroshkin M.G., Atanesyan R.V., Bakashvili G.N., Gramovich V.V., Zharova E.A., Matchin Y.G.

Objective: the aim of our study was to compare the safety of measurement of instantaneous wave-free ratio (iFR) to fractional flow reserve (FFR) with intracoronary papaverine administration in assessment of the functional significance of coronary artery stenoses in patients with chronic coronary artery diseases (CAD).
Methods: 50 patients with chronic CAD or with suspected CAD and moderate coronary stenoses (50-70%) were included in the study. iFR and FFR values were measured consistently in all patients. Papaverine was used as a vasodilator (intracoronary bolus injections 20 mg to the left coronary artery and 12 mg to the right coronary artery).
Results: after intracoronary administration of papaverine QTc interval increased from 410±14 msec to 546±29 msec (p<0,001). Measurement of FFR was not performed because of persistent arterial hypotension in 6 cases (8%). Papaverine induced polymorphic ventricular tachycardia was observed in 5 cases (7%), defibrillation was done in 3 cases (4%). There were no any complications during measuring of iFR (p=0,028).
Conclusion: intracoronary papaverine administration during FFR measurement was associated with an increased risk of serious ventricular arrhythmias. The study demonstrated good safety of iFR measurement in patients with chronic CAD.
Key words: safety, papaverine, iFR, FFR, CAD

 

FEATURES OF CUTANEOUS MICROCIRCULATORY BLOOD FLOW IN PATIENTS WITH IDIOPATHIC PULMONARY ARTERIAL HYPERTENSION ON SILDENAFIL THERAPY ASSESSED BY LASER DOPPLER FLOWMETRY
Dolgova E.V., Fedorovich A.A., Martynyuk T.V., Rogoza A.A., Chazova I.E.

Aim: to evaluate dynamics of microcirculatory processes in the skin assessed by laser doppler flowmetry (LDF) on the sildenafil therapy in patients with idiopathic pulmonary arterial hypertension (IPAH).
Methods: in study included 17 patients with IPAH with negative acute pharmacological test (APT) on inhaled nitric oxide (mean age 40,9±14,5 years) and 25 healthy volunteers (39,3±10,1 years). All the patients initially and on 16 weeks sildenafil therapy underwent a six-minute walking test (6-MWT), transthoracic echocardiography, thorax organs radiography, right heart catheterization (RHC) with APT on inhaled nitric oxide, assessment of NT-proBNP level in the blood and LDF with constrictory and dilatatory functional tests.
Results: on 16 weeks sildenafil therapy 13 patients (76%) demonstrated improvement of clinical course of IPAH and hemodynamic status — increase of 6-MWT distance, left ventricular internal diastolic dimension, cardiac index, venous mixted blood saturation, decrease of NT-proBNP level. According to the LDF with amplitude and frequency wavelet analysis of oscillations of blood flow was noted significantly decreasing endothelial and neurogenic (sympathic) tonus of skin precapillary arterioles. IPAH group on sildenafil therapy had decreased constrictory activity of resistive microvessels for all types vasoconstrictor stimulations in functional tests at the average of 9-14% and improvement of reaction for dilatator stimulations at the average of 40%.
Conclusion: in the APT-patients sildenafil therapy results to improvement of hemodynamic parameters in the pulmonary circulation and the systemic circulation (skin microvessels), and it in the end leads to improvement of clinical patients status.
Key words: idiopathic pulmonary hypertension, sildenafil, microcirculation in the skin, laser Doppler flowmetry.

 

POSITIONAL ISOMERS OF PALMITIC AND OLEIC TRIGLYCERIDES, LIPOLYSIS, apo�/�-100 LIGAND, THE UPTAKE OF VERY LOW DENSITY LIPOPROTEINS BY ELLS UNDER THE EFFECT OF STATINS
Titov V.N.1, Yakimenko �.V.2, Kotlovsky �.Yu2, Aripovsky �.V.3, Smirnov G.P.1, Malyshev P.P.

Our objective was to evaluate changes in serum contents of positional isomers (PI) of oleic and palmitic triglycerides (TG) and individual fatty acids (FA) during statin therapy. Two weeks after Simvastatin therapy (40 mg) serum content of; phosphatidylcholines (PCH) decreased, statistical significance of the unesterified alcohol cholesterol (CL) being higher. No changes were detected in the contents of individual FA. In apoB-100 lipoproteins PCH+CL form a polar monolayer which covers TG bound to apo�-100 in oleic and palmitic very low density lipoproteins (VLDL), thus impairing the bioavailability of the substrate TG for postheparin lipase. This CL pool is inhibited by statins, thus activating lipolysis in VLDL. Blood contents of palmitic PI in TG: palmitoyl-palmitoylpalmitate (PPP) and palmitol-palmitoyl-oleate (PP) and oleic PI: oleyl-oleyl-palmitate (OOP) and oleyl-oleyl-oleate (OOO) were measured. Statistically significant differences in OOO and OOP contents were recorded, they were lower in patients than in healthy subjects. Simvastatin (40 mg) reduced PPO content, statistically significant decrease was observed in PP� and ��P compared with those before therapy. Determination of PI contents allows one to �) define the impairments of palmitic FA, oleic FA and oleic and palmitic TG and VLDL, b) b) prescribe individual diet therapy, and c) control patient’s compliance with medication. Primary prevention of atherosclerosis and atheromatosis should be based on reduction in dietary contents of long-chain saturated FA, predominantly, palmitic FA.
Key words: positional isomers of triglycerides, statins, unesterified cholesterol, fatty acids, prevention of atherosclerosis.

 

ECG IN ATRIAL FIBRILLATION: MODERN POSSIBILITIES AND PERSPECTIVES
Blinova E.V., Sakhnova T.A.

The review discusses the diagnostic possibilities of electrocardiography (ECG) in atrial fibrillation (AF): ECG predictors of AF in the general population, in high-risk groups; possibilities of the ECG application for predicting the success of cardioversion and catheter ablation in patients with AF. The approaches to the analysis of f waves in the ECG recorded during AF are considered.
Key words: atrial fibrillation, electrocardiogram, risk stratification, P wave, catheter ablation.

 

CONFORMATIONAL EFFECTS OF MOLECULAR DOCKING FOR 3D BOVINE TESTICULAR HYALURONIDASE MODEL WITH CHONDROITIN SULFATE AND HEPARIN LIGANDS
Maksimenko A.V., Beabealashvili R.S.

Aim: the purpose of research is ascertainment of mechanism regulation for hyaluronidase functioning in organism by means of molecular docking methods with 3D bovine testicular hyaluronidase (BTH) model and chondroitin sulfate threemer or heparin tetramer.
Subjects and methods: we used the computational biochemistry methods in silico for docking analysis of builded by us earlier 3D BTH model with glycosaminoglycan ligands.
Results: the presence of some binding sites on molecular surface of 3D BTH model was shown for chondroitin sulfate threemer and heparin tetramer. The reversible conformational changes of 3D BTH model were demonstrated. Conformational changes become irreversible and the aminoacid residues responsible for catalytic BTH function (Glu-149 and Asp-147) remove from active site area of native enzyme to hyaluronidase molecule periphery inactivating this biocatalyst. The interaction of glycosaminoglycan ligands with enzyme active site has not specific but electrostatic character.
Conclusion: the transition of reversible BTH inhibition (with chondroitin sulfate threemer and heparin tetramer) to irreversible was uncurtained theoretically. Obtained data indicate the possible presence of threshold interactions in protein structure grounding their elicitation for aimed regulation of hyaluronidase functioning on vascular wall.
Key words: bovine testicular hyaluronidase, 3D structure model, chondroitin sulfate threemer, heparin tetramer, docking.

 

POSSIBILITIES TECHNIQUES OF MEASUREMENT OF FRACTIONAL FLOWRESERVE IN DETERMINING THE HEMODYNAMIC SIGNIFICANCE OF THE TANDEM CORONARY LESIONS (REVIEW OF THE LITERATURE, AN EXAMPLE OF CLINICAL USE)
Sinkov M., Kotchergin N., Vakkosov K., Bogdanov O., Ganyukov V.

The article discusses the possibility of usingf ractional flow reserve measurement and methodology in determining the hemodynamic significance of coronary lesionstandem. Aretwocases of clinical use of thistechnique in patients with chronic ischemic heart disease.
Key words: fractional flowreserve, coronary artery disease, coronary arterie standem coronary lesions.

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ABILITY OF N-TERMINAL FRAGMENT OF NEUROPEPTIDE GALANIN TO ATTENUATE ISCHEMIA AND REPERFUSION INJURY OF RAT HEART
V.S. Shulzhenko, L.I. Serebryakova, I.M. Studneva, Yu.A. Pelogeykina, O.M. Veselova, A.S. Molokoedov, M.V. Ovchinnikov, M.E. Pal’keeva, M.V. Sidorova, O.I. Pisarenko

Aim: this study was designed to explore action of exogenous peptide galanin (2-11) (Gal) using ex vivo and in vivo rat models of myocardial ischemia and reperfusion.
Materials and methods: isolated working rat heart perfused with Krebs-Henseleit solution (KHS) supplied with 11 mM glucose was subjected to global normothermic ischemia and reperfusion. Gal was infused for 5 min prior or after global ischemia. Regional myocardial ischemia in narcotized rats was induced by coronary artery occlusion and accompanied by recovery of coronary flow. Gal was administrated intravenously (i/v) after period of regional ischemia. Recovery of cardiac function and metabolism, limitation of myocardial infarction (MI) and a decrease in the activity of lactate dehydrogenase (LDH) and creatine kinase MB fraction (CKMB) in the blood plasma were used as indices of cardioprotection.
Results: cardiac function recovery of a rat heart was more efficient when Gal was infused not before but after global ischemia. It was combined with substantial improvement of the energy state of reperfused heart. Coinfusion of Gal with the inhibitor of glycolysis 2-dexoglucose or with KHS containing 5.5 mM glucose enhanced recovery of cardiac function at reperfusion comparing with the indices observed in the absence of the peptide. I/v Gal administration at doses of 0.7 or 1.3 mol/kg body wt. slightly affect hemodynamic indices in rats but significantly reduced a size of MI (an average of 25%) and decreased LDH and CK-MB activities in blood plasma at the end of reperfusion as compared with control.
Conclusions: N-terminal fragment of peptide galanin (2-11) reduces myocardial injuries induced by ischemia and reperfusion. Mechanisms of its beneficial action are associated with triggering intracellular signaling activated by binding of the peptide with GalR2 � GalR3 receptors and involve enhancement of glucose utilization in postischemic heart.
Key words: galanin, myocardial ischemia and reperfusion, energy metabolism, intracellular signaling.

 

PREDICTORS OF ADVERSE CARDIOVASCULAR EVENTS IN ACUTE MYOCARDIAL INFARCTI ON WITH ST-SEGMENT ELEVATI ON IN ELDERLY
D. B. Nemik, G. V. Matyushin, A.V. Protopopov, A. V. Shulmin, S.A. Ustyugov, E.V. Samokhvalov

Advanced age contributes significantly to mortality in STEMI in clinical practice, as an important independent predictor of worse in-hospital prognosis.
Aim: to identify predictors of adverse in-hospital prognosis in acute myocardial infarction with ST-segment elevation in patients over 75 years of age.
Materials and methods: in our own single-centre retrospective study analyzed in-hospital outcomes of the treatment in patients older than 75 years in two groups: 103 patient treated with primary percutaneous coronary intervention, and 55 patients treated with pharmaco-invasive management strategy (FAST-PCI). Excluded patients with time “first medical contact (FMC) – ballon” less than 60 minutes and “symptom - FMC” more than 6 hours. The majority of patients were in a time interval “FMC - ballon” of about 120 minutes. Conducted the randomization on the key characteristics. Conducted multivariate analysis assessing the key factors of mortality.
Results: shown no differences in mortality in PPCI and FASTPCI. While TLT assessed to be highly effective in this group of patients (the success in 60,3% of cases). Frequent development of left ventricular dysfunction and life-threatening cardiac arrhythmias have led to a high mortality rate in both groups of 17.5% at PPCI and 16.7% in FAST-PCI (p = 0,616). When conducting multivariate analysis the most important risk factors in this age population is female patients and the presence of AF, which are independent predictors of high mortality. The development of life-threatening arrhythmias (frequent ventricular extrasystoles, paroxysmal ventricular tachycardia) and conduction (AV block II and III gradations) also dramatically increases mortality in this group of patients.
Conclusion: female sex and presence of AF should be considered in risk stratification and selection of therapeutic strategy in patients older than 75 years.
Key words: Thrombolytic therapy, acute myocardial infarction with ST-segment elevation, percutaneous coronary intervention, pharmaco-invasive strategy, elderly.

 

THE RESULTS OF OUTPATIENT CORONARY STENTING IN PATIENTS DIRECTED FROM HOSPITALS WITHOUT THEIR OWN CATHETERI ZATI ON LABORAT ORIES
V.M. Paramonov, Z.H. Dadacheva, T.V. Martynyuk, Yu.G. Matchin, I.Ye. Chazova

Objective: to assess the influence of long-term sildenafil therapy on clinical and functional status, hemodynamic parameters as well as tolerability of therapy with the duration of more than 12 months in patients with idiopathic pulmonary arterial hypertension (IPAH).
Materials and methods: the study included 19 patients with negative acute pharmacological test, functional class II-III (WHO). All patients took sildenafil in the daily dose of 60 mg. All patients were followed for 14 ± 2 months. 5 visits were performed: at the initial and final visit all patients underwent a comprehensive examination, including right heart catheterization. At visit 3 the 6-minute walking test included the assessment of Borg index, desaturation index and the degree of oxygenation, transthoracic echocardiography and chest X-ray were performed.
Results: by 14 ± 2 months of sildenafil treatment functional class significantly improved (FC (I / II / III) with 0% / 48% / 52% to 26% / 53% / 21% (p <0.01). The average increase of the distance in 6 minute walking test was + 52 meters. The stabilization of clinical and functional statusaccompanied by the significant reduction of the Borg index, desaturation index and the degree of oxygenation. Echocardiography revealed no significant changes.
To 14±2 months DPAP by right heart catheterization decreased significant, in patients with baseline FC II there was an increase in cardiac output. After taking 1-2 doses of sildenafil IPAH pts experienced side effects - nasal congestion (16%), headache (47%) and flushing (53%), which were transient and did not require dose reduction.
Conclusion: specific sildenafil monotherapy was highly effective in IPAH patients with FC II-III for 14 ± 2 months. Stable functional and hemodynamic status of patients was maintained for 26 ±4 months with good tolerability.
Key words: sildenafil, idiopathic pulmonary arterial hypertension, right heart catheterization.

 

ETHNIC INFLUENCE FACT OR ON-ORGAN DAMAGE IN HYPERTENSION IN THE POPULATI ON OF MOUNTAIN SHORIA
T.A. Mulerova, M.Yu. Ogarkov, A.Yu. Yankin, E.S. Filimonov, O.V. Gruzdeva, D.P. Tsygankova, O.L. �arbarach

Goal: to determine the relationship of the major CVD risk factors with organ damage in hypertension among the indigenous (Shor) and the non-indigenous population Mountain Shoria.
Material and methods: conducting clinical and epidemiological study of compact living of the population in remote areas of the Mountain Shoria (village. Orton, Ust-Kabyrza, village. Sheregesh Kemerovo region). A continuous survey in 1178 by the residents of these villages, the sample consisted of adults (18 years and older).
Results: the prevalence of hypertension among the population surveyed Mountain Shoria was 42.3%. Hypertrophy of the left ventricle and increased thickness of the intima media among patients with hypertension were detected more frequently among shor compared to non-indigenous people. Percentage of surveyed with increased rigidity of the vascular wall did not differ between the two groups. Established ethnically caused particular relationship hypertrophy of the left ventricle to the degree and duration of the course of the disease, female sex, body weight, triglyceride levels, and smoking; TIM - to the degree and duration of the course of the disease, female sex, body weight, abdominal obesity, lipid disorders (in the form of hypercholesterolemia, giperbetaholesterinemii) and smoking; vascular stiffness – only with history of disease duration.
Conclusion: with the development of Hypertrophy of the left ventricle associated degree, the duration of hypertension and current smoking in an indigenous ethnic group, the duration of a history of the disease, abdominal obesity and hypertriglyceridemia - in the non-indigenous group. With the defeat of the carotid arteries associated age, smoking, hypercholesterolemia in a cohort Shor, prescription history of hypertension, age, giperbetaholesterinemiya - in a cohort of non-indigenous population. Change in the ABI correlated with the degree of hypertension and the age of the indigenous ethnic group.
Key words: organ damage, hypertrophy of the left ventricle, the thickening of the intima-media, indigenous people.

 

THE EXPERIENCE OF OUTPATIENT CORONARY STENTING IN PATIENTS DIRECTED FROM HOSPITALS WITHOUT THEIR OWN CATHETERI ZATI ON LABORAT ORIES
Y.V. Danilushkin, Y.G. Matchin, N.S. Shamrina, R.V. Atanesyan, A.B. Basinkevich, D.S. Bubnov, F.T. Ageev

Aim: to study the safety of outpatient coronary stenting in the group of patients, directed from hospitals without catheterization laboratories with the same-day discharge back to the referring hospital.
Subjects and methods: 802 patients, directed from hospitals withcardiology departments and intensive care units but without catheterization laboratories, which underwentcoronary stentingfrom January 2010 till October 2014 were included in the study. Mean age was 60,6±8,2 years,586 (73%)of patients were male. 322 (40%) patients had acute coronary syndrome (ACS) medically stabilizedat most, and 480 (60%) - chronic ischemic heart disease (CIHD).
Results: procedure was successfulin 787 (98%) patients. In 15 (2%) cases it was unsuccessful. 7 (1%) patients after procedure had an enzymatically determined non-Q wave myocardial infarction. There were no major cardiovascular complications during the procedure, and after transfer back to the referring hospital. 8 (1%) patients were admitted for extended observation. There were no statistical difference in the success of the procedure and the frequency of complications in groups of patients with ACS and the CIHD.
Conclusion: the outpatient coronary stenting in the group of patients, directed from hospitals without catheterization
laboratories, with same-day discharge back to the referring hospital is a safe procedure with high rate of success and low rate of complications. This approach is equally safe for the patients with chronic ischemic heart disease, and patients with acute coronary syndrome after preliminary stabilization of the patient.
Key words: outpatient coronary stenting, interventional cardiology

 

PULMONARY ARTERIES STRUCTURAL CHANGES VISUALI ZED BY INTRAVASCULAR ULTRAS OUND DURING ACUTE VASOREACTIVITY TESTING IN PATIENTS WITH IDIOPATHIC PULMONARY HYPERTENSION
�.V. Sagaydak, N.M. Danilov, Y.G. Matchin, T.V. Martynyuk, I.�. Chazova

Idiopathic pulmonary hypertension is a rare severe disease. Having in mind standard diagnostic algorithm of pulmonary hypertension medicine society is also looking for some new diagnostic methods. One in a row is intravascular ultrasound (IVUS).
Aim: the aim of present study is to evaluate structural pulmonary arteries changes by IVUS during acute vasoreactivity testing in patients with Idiopathic pulmonary hypertension.
Material and methods: sixteen patients with Idiopathic pulmonary hypertension were enrolled in the study. During right heart catheterization before and after vasodilator inhalation IVUS was performed
Results: the comparison of all IVUS parameters between “responders” and “non-responders” was made. Among all parameters only one was significant – the changes in lumen diameter (p<0,001)
Conclusion: in this study we have shown for the first time the structural element of vasoreactivity in patients with Idiopathic pulmonary hypertension.
Key words: idiopathic pulmonary hypertension, intravascular ultrasound, acute vasoreactivity testing

 

AIR TEMPERATURE AND HEART RATE VARIABILITY IN WITH STABLE CORONARY HEART DISEASE
I.L. Kozlovskaya, O.S. Bulkina, E.V. Lukoshkova, V.V. Ermishkin, V.V. Lopukhova, N.A. Chernova, O.V. Ivanova, T.E. Kolmakova, A.T. Shubina, O.A. Fomicheva, E.V. Sorokin, K.A. Talitskyi, I.V. Starostin, V.V. Buza, F.F. Byazrova, S.V. Emelina, K.G. Rubinstein, A.N. Rogoza, Y.A. Karpov

Objective: to assess the changes of heart rate variability in a panel of patients with stable coronary disease at different temperature regimens via wireless ECG recorder AATOS (www.pmtonline.ru).
Materials and methods. The investigation of meteorological influence on coronary heart disease involved 100 subjects (see publication in “Doctor.ru”), living in Moscow. According to the protocol, we telemonitored 48 patients with stable coronary heart disease on therapy in accordance with up-date guidelines. ECG was self-registered simultaneously and on regular basis by all the patients at home for 3-30 min via wireless ECG recorder AATOS. We used standard methods of time-domain and frequency-domain analysis. We chose the fragments of trend not less than 3 min with <10% ectopic beats. The disturbances of trend monotony were interpolated. The recordings of 20 patients were analysed. The temperature data were inquired in Hydrometeorological Centre of Russia. The study period comprised 2013-2014 years. We used nonparametric
methods for statistical analysis.
Results. Throughout the study periodthere were 3250 recordings eligeable for time-domain and frequency-domain HRV analisis obtained. We observed statistically significant decrease in parasympathetic activity measurements (pNN50, RMSSD, RR_HF) at average daily temperature below -2°C («cold») and over +21°C («hot»). Average daily temperature over+21°C was also associated with RR_LF and RR_LF/HF decrease which might reflect baroreflex attenuation.
Conclusion. During cold and hot periods significant decrease in parasympathetic activity measurements were observed. Hot weather is associated with baroreflex attenuation. The suggested HRV dynamics telemonitoring method is patient friendly. It may provide better patient control and can be implemented in investigating in HRV-weather interactions.
Key words: ischemic heart disease, telemetry, heart rate variability, ambient temperature, heat, cold.

 

EFFECT OF SILDENAFIL IN DIFFERENT DOSAGE REGIMEN ON LEFT VENTRICULAR-ARTERIAL COUPLING AND CARDIAC REMODELING IN PATIENTS WITH IDIOPATHIC ARTERIAL PULMONARY HYPERTENSION
Z.H. Dadacheva, V.M. Paramonov, A.A. Belevskaya, M.A. Saidova, T.V. Martynyuk, I.Ye. Chazova

In recent years the treatment possibilities of patients with idiopathic pulmonary arterial hypertension (IPAH) have improved dramatically due to the introduction into clinical practice of new pathogenetic drugs, among them- phosphodiesterase type 5 inhibitors (PDEI-5) that influence NO-dependent pathway of pulmonary vasodilation. IPAH progression affects both right ventricle (RV) and left ventricle (LV). "Ventricular-arterial coupling" means the interaction between ventricles and arterial system This phenomenon is poorly described in the literature.
Aim: to assess clinical efficacy and safety of 16-wk treatment with sildenafil in different dosage regimen in IPAH pts, as well as its impact on left ventricular-arterial coupling and cardiac remodeling.
Materials and methods: 29 IPAH pts at the age of 42,8±10,6 yrs II-IV functional class (FC) (WHO), on the stable standard therapy (anticoagulants, diuretics, glycosides, calcium channel blockers) for 16 wks were treated with sildenafil 20mg TID for 16 wks. At baseline and after 16 wks we evaluated FC, distance in 6-minute walking test (6-MWD), transthoracic echocardiography (Echo) and right heart catheterization (RHC).
Results: initial 6-MWD was 329.7±106,9m. Estimated systolic pulmonary artery pressure (SPAP) according to Echo was 89.3±19,3mmHg. RHC showed the increase of mean pulmonary artery pressure (PAPm) to 49.4±16, 5mm.Hg, pulmonary vascular resistance (PVR) to 1368.1±680dinxsekxsm-5, decrease in cardiac output (CO) to 3,2 ± 0,77l/min/m2).To 4 wks of therapy there was a slight increase in 6-MWD by +53m (p <0.01) with the improvement of clinical status. Echo showed SPAP decrease 84.9±16,7mm. Hg. To 16 wks the 6-MWD increase was +113m (p <0.01), SPAP decreased to 76.6±12,9mmHg (p<0.05) by Echo following by FAC increase (p<0.01). Sildenafil improved the key hemodynamic parameters- PAPm (p<0.05), PVR (p<0.05), CO (p<0.05) to 16 wks. In IPAH pts different sildenafil dosage regimen resulted in the comparable 6-MWD increase (+118m and +106m respectively), PAP decrease, improvement in cardiac remodeling and contractile RV function, reducing the LV stiffness. Side effects occurred during the first 2-3 days of treatment. They were just noticeable and did not require dose adjustment.

Conclusion: 16-wk sildenafil therapy in IPAH pts showed positive clinical and hemodynamic effects as improved 6-MWD, Borg index, Echo and RHC parameters. The dosage regimen of sildenafil 60 mg and 240 mg daily were equally effective, resulted in clinical and functional improvement, the comparable 6-MWD increase, PAP decrease, positive dynamic of cardiac remodeling indicators, RV contractile function, the reduction of LV stiffness. Sildenafil therapy in both dosage regimen characterized by favorable tolerability profile and low incidence of side effects.

Key words: idiopathic pulmonary arterial hypertension, phosphodiesterase type 5 inhibitors, sildenafil.

 

MULTI VESSEL STENTING VERSUS STAGED REVASCULARIZATI ON WITH SECOND GENERATI ON DRUG ELUTING STENTS IN ST-ELEVATI ON MYOCARDIAL INFARCTI ON PATIENTS : RESULTS OF RANDOMIZED TRIAL
R.S. Tarasov, V.I. Ganyukov, K.M. Vakkosov, O.L. Barbarash, L.S. Barbarash

Aim: the assessment of the 12-month results of the two strategies after percutaneous coronary intervention (PCI) with implantation of zotarolimus-eluting stents (ZES) in multivesseldisease patients with ST-elevationmyocardial infarction (STEMI) in a randomized trial (NCT01781715).
Methods: from 2013 to 2015 136 STEMI patients after primary PCI was included. Inclusion criteria were as follows: (1) STEMI <12 h; (2) Multivessel coronary disease; (3) The implantation of the second generation ZES; (4) Signed informed consent to participate in the trial; Exclusion criteria were: (1) Left main coronary artery stenosis ≥ 50%; (2) Severe acute heart failure (Killip III-IV); (3) A history of stent thrombosis; Patients were randomized in two groups: (1) Multivessel stenting (MS) within the primary PCI (n = 67); (2) Staged PCI within the hospital period (10,1 ± 5,1 days), (n = 69).Adverse cardiovascular events (death, myocardial infarction (MI), re unplanned revascularization, stent thrombosis and the combined endpoint) wereevaluated for 30 days and 12 months..
Results: the average age in the total study sample of patients (n = 136) was 59 ± 10.6 (31-88) years, dominated by male patients (n = 92, 67.2%). The mean left ventricular ejection fraction was 51.2 ± 8.3%. One in five patients (n = 30, 22.1%) suffered from diabetes, one in four (n = 33, 24.3%) had multifocal atherosclerosis. Acute heart failure (Killip II) observed in 13% of patients. About half of the patients (n = 63, 46.3%) had three-vessel coronary disease with an average value of SYNTAX score 18.9 ± 7.5 points. The average number of implanted ZES was 2.7 ± 0.7, the average length of stented segment 57.8 ± 14.6 mm, an average diameter 3.3 ± 0.5 mm. The groups of patients were comparable for all baseline demographic, clinical and angiographic parameters. Over the 12 months of observation was not received significant differences in frequency of adverse cardiovascular events among the groups: death from all causes 3% and 2.9%, reinfarction 7.5% and 2.9%, re unplanned revascularization 3% and 2.9%, stent thrombosis 5.9% and 2.9%, the combined endpoint (death + MI + unplanned revascularization) 5.9% and 4.3% in the MS group and staged PCI group, respectively (p> 0.05).
Conclusion: complete revascularization during hospital period using two strategies in STEMI patients using second generation ZES demonstrates a satisfactory comparable results for 12 months of observation.
Key words: STEMI, primary PCI, multivessel stenting, staged revascularization, second generation drug-eluting stents

 

ENDOTHELIAL GLYCOCALYX IS SIGNIFICANT CONSTITUTIVE PART OF DOUBLE PROTECTIVE LAYER INTO VASCULAR WALL: DIAGNOSTIC INDEX AND THERAPEUTIC TARGET
A.V. Maksimenko

The functions of endothelial glycocalyx were considered as regulator of plasma and vessel wall homeostasis. The data of glycocalyx impairment were generalized according to actions of pathological processes. Actual task for preservation from destruction and recovery of injured glycocalyx was formulated with help of remedial means. The review of research approaches was performed in respect to search for such derivatives and a perspective of multi-disciplinary development fulfillment were emphasized.
Key words: glycocalyx, endothelial cells, proteoglycans, glycosaminoglycans, glycoproteins, glycosidases, glycocalyx destruction, vascular permeability, glycocalyx reconstruction, 3D protein structure models.

 

COMPARISON OF PROGNOSTIC INDICAT ORS IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE WITH MYOCARDIAL REVASCULARIZATI ON AND MEDICAL TREATMENT (REVIEW)
V.P. Lupanov

The decision to revascularize a patient should be based on the presence of significant obstructive coronary artery stenosis, the amount of related ischemia and the expected benefit to prognosis and/or symptoms. When technically feasible, with an acceptable level of risk and a good life expectancy, revascularization is indicated in chronic angina refractory to optimal medical therapy. Percutaneous coronary intervention also significantly reduce the rates of cardiac death and all-cause mortality or myocardial infarction. In addition, objective evidence of ischaemia was reduced in the revascularization group. The review provides with recommendations helping physicians with decision making on patients treatment with ischemic heart disease in evering practice.
Key words: ischemic heart disease, stable angina, stenotic coronary atherosclerosis, treatment strategy, management tactics, prospective observation, prognosis.

 

HIGH-INTENSIVE TREATMENT WITH AT ORVASTATIN IN PATIENTS WITH CORONARY HEART DISEASE
G.V. Kuznetsova, A.V. Potekhina, T.I. Arefieva, E.A. Noeva, E.A. Zharova, S.I. Provatorov

This report summarizes the effects of high-intensive treatment with of atorvastatin in patients with stable coronary heart disease (CHD) and acute coronary syndrome, as well as after percutaneous coronary intervention. The results of the main randomized clinical trials evaluating the intensive therapy with atorvastatin in CHD patients are discussed.
Key words: �oronary heart disease, acute coronary syndrome, percutaneous coronary intervention, atorvastatin, clinical trials.

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TREATMENT OF CHRONIC AND ACUTE HEART FAILURE POSSIBILITIES OF DIAGNOSTICS AND THE DETECTION RATE OF OBSTRUCTIVE SLEEP APNEA IN PATIENTS WITH VARIOUS FORMSOF ATRIAL FIBRILLATION
BairambekovE.Sh., Pevzner A.V., LitvinA.Yu., Elfimova E.M.

Aim: to investigate the prevalence and severity of respiratorydisturbances during sleep in patients with paroxysmal, persistentand permanent atrial fibrillation (AF).
Patients and methods: we studied 110 pts (51 men (46%);mean age 63±10 years) with AF. 73 (67%) pts had paroxysmalAF, 18 (16%) - persistent form and 19 (17%) - permanent AF. Forthe detection of obstructive sleep apnea (OSA) all pts were askedto complete a modified questionnaire for pts with suspected sleepapnea. Cardiorespiratory monitoring (KRM) was performed for allpts. With the aim of identifying possible methodological limitationsin the diagnosis of OSA associated with heart rhythm disorders,nocturnal pulse oximetry was held for 14 pts with persistent AFfollowed by comparing its results with KRM’s data.
Results: while conducting KRM OSA was diagnosed in 96(87%) of AF pts, in 2/3 of all cases moderate and severe respiratorydisorders were revealed. Comparing with KRM’s results, thismodified questionnaire was able to detect the presence of apneain 91 cases out of 96 (sensitivity 94%) and its absence - in 6 casesout of 14 (specificity 43%). For pts with current AF, the index ofapnea/hypopnea according to the KRM in 10 cases out of 14 (71%)significantly exceeded the value of the index of desaturation,defined by nocturnal pulse oximetry. Pts with permanent andpersistent AF in comparison with pts with paroxysmal AF werecharacterized by more frequent (95% vs. 84%) and also moresevere OSA (in 81% of cases moderate and severe respiratorydisorders vs. 62% were diagnosed).
Conclusion: patients with paroxysmal, persistent andpermanent AF are marked with high prevalence of OSA. There isa trend of increasing severity of respiratory disturbances duringsleep as you gain prolonged course of atrial fibrillation. A modifiedquestionnaire for the patient’s clinical survey is highly sensitivefor identifying respiratory disturbances during sleep that allows itto be recommended as screening diagnostics of obstructive sleepapnea. We must take into consideration that while analyzing theresults of pulse oximetry carried out for patients with current AFwe could probably underestimate the severity of OSA.
Keywords: atrial fibrillation, obstructive sleep apnea,cardiorespiratory monitoring, nocturnal pulse oximetry, a modifiedquestionnaire.

 

AUTONOMIC NERVOUS SYSTEM STATE IN PATIENT WITHMETABOLIC SYNDROME COMPLICATED BY CARDIAC ARRHYTHMIAS
Djishambaev E.D., Khakimova S.I., Kroshkin Y.A.

Objective: to study the heart rate variability in patients withmetabolic syndrome, complicated by cardiac arrhythmias.
Material and Methods: the study involved 196 male patientsaged from 35 to 55 years. Diagnosis was based on clinical andinstrumental criteria of ATP III Panel. Control group consisted of24 age-matched (average 44,3 ± 1,5 years) healthy men withoutcardiovascular disorder. Serum fasting glucose and 2 hours aftermeal, lipids profile and electrolytes were determined in all patients.Holter ECG data were used to study heart rate variability.
Results: patients with supraventricular and ventriculararrhythmias showed a decrease of temporal parameters of heartrate variability and increase of sympathetic tone and sympathovagalbalance. These changes were particularly pronounced in patientswith atrial fibrillation. The LF/HF ratio more than 4.5 was associatedwith 5.2 time� increased risk for paroxysmal atrial fibrillation.
Conclusions: cardiac arrhythmias may occur with metabolicsyndrome. Supraventricular arrhythmia were detected in 18.3%of cases and ventricular arrhythmia – in 11.2% and combinedones - in 7.6% of patients. There is an imbalance of the autonomicregulation at metabolic syndrome, characterized by relativehypersympathicotonia. The extent of these violations is most pronounced in the presence of paroxysmal atrial fibrillation.
Key words: metabolic syndrome, heart arrhythmias, heart ratevariability.

 

ATHEROSCLEROSIS AND MICROCIRCULATION. RESULTS OFTHE PILOT STUDY OF MICROCIRCULATION IN PATIENTS WITHCORONARY ARTERY DISEASE
Boiko V.V., Soboleva G.N., Fedorovich �.�., Kirdjaschkina T.A.

This article discusses the effects of atherosclerosis onmicrocirculatory parameters with regard to basic theoriesof the pathogenesis of atherosclerosis and structural andfunctional characteristics of coronary microcirculation. Theneed of microvascular dysfunction studies in clinical cardiology is explained. We provide a detailed description of non-invasivetechnique for assessing of cutaneous microvascular function,laser Doppler flowmetry. We also show the results of our pilot microcirculation study in patients with coronary artery disease(CAD) and coronary artery atherosclerosis.

Aim: to investigate the microcirculation parameters in patientswith CAD and coronary artery atherosclerosis compared to healthyvolunteers.
Material and methods: a total of 26 patients with CAD and21 healthy subjects were included in this study. All patientsunderwent the assessment of cutaneous microcirculation usinglaser Doppler flowmetry.
Results: No significant differences were observed betweentwo groups in basal skin perfusion. However, patients withCAD showed significantly increased vasoconstrictor responsein cold test (p < 0.05). Additionally, vasodilator response tolocal heating and arterial occlusion were significantly reducedin patients with CAD compared with healthy subjects (both p <0.05). Vasodilator response to electrostimulation was similarbetween two groups. The results are discussed in the light of dataavailable in literature. We consider possible ways for correction of microvascular disturbances, including pharmacological and nonpharmacologicalmodalities.
Conclusion: cutaneous laser Doppler flowmetry withfunctional tests revealed abnormalities in patients with CAD andcoronary artery atherosclerosis, possibly indicative of impairedmicrocirculation system.
Key words: atherosclerosis, microcirculation, coronarymicrovascular dysfunction, laser Doppler flowmetry, statins,ticagrelor

 

OXIDATIVE STRESS AND TELOMERE SHORTENING IN LEUKOCYTESOF THE BLOOD OF PATIENTS WITH NEWLY DIAGNOSEDTYPE 2 DIABETES
Doroshchuk N.A., Lankin V.Z., Tikhaze A.K., Odinokova O.A., Konovalova G.G., PostnovA.Yu.

Aim: to study the effects of oxidative modification ofbiopolymers in patients with type 2 diabetes with disorders ofcarbohydrate metabolism.
Material and methods: in patients with type 2 diabetes(16 people) and healthy people (67 people) was carried outspectrophotometric determination of the content of secondaryproducts of free radical oxidation - malondialdehyde (MDA) inthe blood plasma, immunochemical study of the level of oxidativemodified LDL and measuring the activity of erythrocyte antioxidantenzymes (superoxide dismutase - SOD, glutathione - GSH-Px andcatalase). Simultaneously we studied telomere length of bloodleukocytes using the polymerase chain reaction.
Results: in patients with type 2 diabetes with disorders ofcarbohydrate metabolism at the same time with the developmentof the manifestations of oxidative stress (increased content ofMDA in blood plasma, decreased activity of erythrocyte enzymesSOD and GSH-Px) observed shortening of telomere length inleukocytes of blood.
Conclusions: detected changes indicate that the reduction inlength of telomere repeats in diabetes may be associated withoxidative degradation of the DNA molecules.
Key words: oxidative stress, carbonyl stress, telomereshortening, malondialdehyde, antioxidant enzymes.

 

THE POSSIBILITIES OF TREATMENT OF HYPERTENSION INPATIENTS WITH ATRIAL FIBRILLATIONAFTERCARDIOEMBOLIC STROKE
Zolotovskaia I.A., Davydkin I.L., Tuchkova O.V.

Aim: to study possible azilsartanamedoxomil in the treatmentof hypertension in patients with atrial fibrillation who underwentstroke.
Material and methods: in accordance with the protocol for12 weeks in a prospective observational study of two groups ofpatients who had unstable blood pressure according to office BPmeasurement. To assess the daily blood pressure profile usedmethod of home blood pressure monitoring. For objectification ofthe dynamics of functional disorders associated with neurologicaldeficits used Barthel index. Cognitive function was assessedon a scale Mini-MentalStateExamination (MMSE). Laboratoryparameters were assessed: creatinine (the calculation ofglomerular filtration rate), urea, glycated hemoglobin, fibrinogen,prothrombin time, activated partial thromboplastin time, thrombintime, D-dimer.
Results: the results of the 12 week period of observation, themain group level of the amounted to SBP 130,0[125,0;135,5]mmHg. art., DBP - 79,5 [72,0;85,0] mmHg., (p=0.005; p=0,013).After 12 weeks, the level of functional activity, as measured by theBarthel index in both groups significantly statistically significantlyincreased (p<0.05), also there was significant (p=0.003)improvement of cognitive functions in patients of the main group.Tracked significant correlation between the decrease in the levelof SBP and DBP and improved some indices of hemostasis: PV (R=-0,73; p=0.002), prothrombin (R=0,61; p= 0.0016), fibrinogen(R=0,58; p=0.005).
Conclusion: therapy with medoxomilazilsartan was moreeffective in reducing BP in patients with hypertension incombination with AF and stroke in anamnesis amid poorantihypertensive control other antihypertensive drugs. The sameBP reduction on the background of treatment with azilsartan bymedoxomil can have a positive systemic effect on renal function,hemostasis and to reduce the severity of cognitive deficit. Shouldcontinue research to identify reliable predictors for prevention ofrecurrent stroke in patients with AF.
Key words: arterial hypertension, home blood pressuremonitoring, atrial fibrillation, cardioembolic stroke, azilsartanmedoxomil

 

EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORTFOR COMPLEX PERCUTANEOUS CORONARY INTERVENTIONSIN PATIENTS WITH NON-ST-ELEVATIONACUTE CORONARY SYNDROME
Ganyukov V.I., Tarasov R.S., Shukevich D.L.

It has been shown that extracorporeal membrane oxygenation(ECMO) may provide cardiopulmonary support during percutaneouscoronary interventions (PCI) in patients with refractory cardiogenicshock. Current guidelines consider ECMO and implantable leftventricular assist devices in selected non–ST- elevation acute coronarysyndrome (NSTE-ACS) patients. High-risk PCI remains a viablerevascularization strategy for those patients, who are not suitable forsurgery, or those refusing it. However, such a subset of patients isconsidered to be at an extremely high risk of PCI complications as thereis a risk of hemodynamic collapse during balloon inflations or complexprocedures, particularly, if coronary dissection with vessel closure or noreflow occurs. This chapter is devoted to the use of ECMO support forhigh-risk complex PCI in NSTE-ACS patients without cardiogenic shockbased on the theoretical rationale, observational retrospective singlecenterstudies and clinical case examples.
Key words: ECMO, High-risk PCI, Non-ST-elevation acute coronarysyndrome, Stable hemodynamics patients, Multivessel disease.

 

ASSESSMENTOF FUNCTIONAL SIGNIFICANCE OF INTERMEDIATECORONARY STENOSES BY INVASIVE METHODS
Darenskiy D.I., Zharova E.A., MatchinYu.G.

Key points of the use of invasive methods for evaluating thefunctional significance (coronary flow reserve, fractional flowreserve and instantaneous wave-free ratio) of intermediateseveritycoronary stenoses (50-70% of the vascular lumen)arediscussedin the review.
Key words: coronary artery stenosis, invasive methods, CFR,FFR, iFR.

 

REACTIVE PULMONARY HYPERTENSION IN PATIENTS WITHDIASTOLIC HEART FAILURE, THE POSSIBILITY OF ITS TREATMENTUSING THE INHIBITORS PHOSPHODIESTERASE TYPE 5
Gavryushina S.V., Ageev F.T.

Diastolic heart failure (DHF) - a serious disease withunfavorable prognosis, which accounts for50%of all cases ofheart failure. Until now, the search continues for drugs that wouldimprove the prognosis and the condition of patients with DHF.About a third of the DHF is complicated by the development ofpulmonary hypertension (PH), the formation of which involves"reactive" component due to the restructuring of pulmonaryvascular spasm and pulmonary arterioles; the mechanism of"inclusion" tutorage is not fully understood. Its removal can leadto a significant reduction of pulmonary artery pressure; improveclinical and functional status of these patients. This is possible bya inhibitorphosphodiesterase-5 sildenafil.
Keywords: diastolic heart failure, reactive pulmonaryhypertension, an inhibitor phosphodiesterase-5.

 

MECHANISMS OF DEVELOPMENT OF RESTENOSIS IN THE STENT OFTHE CORONARY ARTERIES IN PATIENTS WITH CORONARY HEARTDISEASE
Abduzhamalova N.M., Kabardieva M.R., Merkulov E.V., Naumov V.G.

Cascade cellular response to vascular injury after stentimplantation may be divided into three main phases: an earlyphase with platelet activation and inflammation; an intermediatephase with granulation tissue formation, which is a result ofsmooth muscle cells (SMC) media to intima migration andproliferation; and tissue remodeling phase with extracellularmatrix proteins synthesis. Most of the processes associatedwith restenosis are physiological and needed to cover the stentstruts and limit the effect of blood flow on stent and vessel wall,which is damaged. Thus, restenosis can be considered to be aform of hypertrophic wound healing as a result of interaction ofmonocytes, macrophages, T-cells and normal cellular elements ofthe vascular wall. This review presents the current understandingof an inflammation role in pathogenesis of restenosis.
Key words: restenosis, inflammation, stenting.

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NATIONAL CLINICAL GUIDELINE ON DIAGNOSIS AND TREATMENT OF HYPERTROPHIC CARDIOMYOPATHY

SPECT MYOCARDIAL PERFUSION AND SYMPATHETIC INNERVATION IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY
A.A. Ansheles, Ya.V. Schigoleva, I.V. Sergienko, S.N. Tereschenko

Aim: to determine the characteristics of myocardial perfusion and sympathetic activity (SA) assessed by single-photon emission computed tomography (SPECT) in patients with hypertrophic cardiomyopathy (HCM).
Material and Methods: the study included 36 patients with a confirmed diagnosis of HCM. All patients underwent clinical status assessment, Holter ECG monitoring, rest echocardiography. All patients, as well as a group of healthy volunteers (n=20) underwent myocardial perfusion SPECT with 99mTc-MIBI at rest and after bicycle exercise test, and myocardial neurotropic SPECT with 123I-MIBG, performed in 15 min (early phase) and 4 hours (delayed phase) after MIBG administration. Perfusion abnormalities were evaluated using standard quantitative parameters: Summed Stress Score (SSS) and Summed Difference Score (transient ischemia index, SDS). Global SA abnormalities were assessed with delayed heart/mediastinum ratio (H/Md) and MIBG Washout Rate in 4 hours (WR). Regional SA abnormalities were assessed using early Summed MIBG Score (SMSe).
Results: all myocardial SPECT parameters, both perfusion and neurotropic, significantly differed in HCM patients compared to the control group (p<0.001). According to perfusion SPECT, reliable transient myocardial ischemia (SDS>4) in the main group was detected in 33% of cases, while it was diffuse and had no connection with certain regions of coronary arteries. The volume of regional innervation defects (SMSe) in HCM patients was significantly higher than the total volume of perfusion defects (SSS), amounting to 15 (11-17) and 9 (8-11) points, respectively (p<0.001). SMSe and SSS had a positive correlation (r=0.52, p=0.002), but perfusion and innervation defects did not match in localization clearly. The severity of LV hypertrophy was a factor of more severe perfusion and innervation defects: we detected direct correlation between posterior LV wall thickness and LV cavity pressure gradient, measured by echocardiography (r=0.31, p=0.07), between LV mass index and SSS (r=0.51, p<0.005), WR (r=0.51, p=0.002), SMSe (r=0.34, p=0.03). No influence of LV outflow tract obstruction on parameters of Holter ECG, stress-test, perfusion and neurotropic myocardial SPECT was shown. SMSe was higher in HCM patients with arrhythmias (p=0.046), and lower in HCM patients with angina and cardialgias (p=0.04). More severe perfusion and innervation abnormalities were detected in patients with nondiagnostic exercise test result (p<0.05).
Conclusion: combination of myocardial neurotropic and perfusion SPECT has a certain diagnostic value in patients with HCM, since sympathetic innervation abnormalities is one of the earliest marker of myocardial damage.
Key words: myocardial perfusion, myocardial sympathetic activity, single photon emission computed tomography, hypertrophic cardiomyopathy.

 

LIPOPROTEIN - ASSOCIATED PHOSPHOLIPASE A2 IN PATIENTS WITH CORONARY ARTERY DISEASE AND METABOLIC SYNDROME
Osmankulova G.E., Noruzbaeva A.M.

Aim: to study the concentration of lipoprotein-associated phospholipase A2 (Lp-PLA2) in patients with coronary artery disease (CAD) and metabolic syndrome (MS).
Material and methods: the study enrolled 226 patients with stable CAD: 130 – with MS, and 96 - without MS. The diagnosis of CAD was determined by the standard criteria. The diagnosis of MS - in accordance with the criteria of AHA/NHLBI (2009).A clinical examination, lipid profile, glucose and Lp-PLA2 in the blood serum.
Results: the mean level of Lp-PLA2 in patients with MSwas 281±89 ng/ml and was significantly higher than the same indicator in patients without MS (254±83 ng/ml, p<0,05). A positive correlation between increased levels of Lp-PLA2 with the increase in the number of MS components (r = 0,15; p = 0,054) in the group.In addition, in patients with CAD and MS levels ofLp-PLA2 was positively correlated with total cholesterol (TC) (r=0,23; p=0,029), low density lipoprotein cholesterol (LDL cholesterol) (r=0,26; p 0,012) and atherogenic coefficient (AC) (r=0,24; p=0,023) in contrast to patients without MS.
Conclusion: an interconnection of Lp-PLA2 mass with the presence of MS and the number of its components among patients with CAD.
Key words: coronary artery disease, metabolic syndrome, lipoprotein–associated phospholipase A2

 

THE RELATIONS BETWEEN VARIOUS CARDIOVASCULAR RISK FACTORS AND IMPAIRED RENAL FUNCTION IN PATIENTS WITH ACUTE CORONARY SYNDROME
Zykov M.V., Kashtalap V.V., Shafranskaya K.S., Bykova I.S., Kalaeva V.V., Karetnikova V.N., Berns S.A., Barbarash O.L.

Aim: to assess the relations between various cardiovascular risk factors and renal dysfunction (RD) in patients with ST-segment elevation and non-ST segment elevation acute coronary syndrome (STE-ACS and NSTE-ACS).
Material and Methods: 950 patients with STE-ACS and 450 with NSTE-ACS were included in the study. Glomerular filtration rate (GFR) from serum creatinine was estimated with CKD-EPI within 1 hour from admission.
Results: all patients were assigned to four groups according to the ACS type and estimated GFR rate. GFR < 60 mL/min/1.73 m2 was more often found in STE-ACS patients (38.42%) compared to NSTE-ACS patients (32.77%), p = 0.046. The linear regression analysis was performed to identify independent factors associated with RD. The risk factors associated with decreased GFR in the total cohort of ACS patients were: advanced age, female gender, prior kidney disease, decreased systolic blood pressure, prior myocardial infarction (MI), increased heart rate and acute heart failure (AHF) on admission. However, there were differences between STE-ACS and NSTE-ACS patients. Despite gender and age, GFR in NSTE-ACS patients was associated with prior myocardial infarction, whereas the absence of a clear association between RD and hemodynamic derangements and AHF may be explained by their lower detection rates in this ACS type.
Conclusion: peripheral and coronary atherosclerosis adjusted for age and other cardiovascular risk factors did not prove to be independent predictors of RD. The multivariate analysis reported that RD did not depend on hemodynamic parameters and Killip class in patients with NSTE-ACS compared to patients with STE-ACS.
Key words: renal dysfunction, risk factors, acute coronary syndrome

 

PROGNOSTIC FACTORS OF CARDIOVASCULAR COMPLICATIONS DURING THE HEATWAVE OF 2010 (COHORT OBSERVATIONAL STUDY)
Smirnova M.D., Fofanova T.V., Yarovaya E.B., Ageev F.T.

Aim: of the study was to identify prognostic factors of cardio vascular complications during the heatwave of 2010.
Materials and Methods: observational cohort study involving 754 patients with moderate / low, high / very high risk and patients with CAD. Medical documentation and questionnaires was used. Selectively (344 pers.) were done sphygmography and brachycephalic arteries ultrasonic study. Visits were conducted in IV-V and IX-X 2010.
Results: during the heat wave had more cardiovascular complications than in the IX-X 2010 During the heatwave were more hypertensive crises, unscheduled visits to the doctor and arrhythmia than after the heat.The number of cardiovascular complications during heatwave correlated with waist circumference (r = -0,117; p <0,002), the dynamics of PWV (r = 0,132; p = 0.01). The share of "affected by the heat" is more in the group of CAD and among patients with hypertension and type 2 diabetes mellitus. The correlation between the quality of life (QOL) during the heatwave and BMI (r = 0,174; P = 0,03) (CAD group (r = 0,260; P = 0.02)), BMI (r = -0.206; P = 0,01), creatinine (r = 0.238; P = 0.01). QOL often reduced in men c CAD. �cetylsalicylic acid increases the risk of complications (RR 2.8), in the group of low / moderate risk - OR of 4.1. Statins reduced the risk by 50% in the group of CAD - by 56%. Diuretics increased risk of cardiovascular complications (OR 1,66; P <0,01) in the group of CAD.
Conclusion: at risk of developing cardiovascular complications heatwave includes CAD, hypertension, type 2 diabetes mellitus. Additional risk factors were coronary artery disease patients taking diuretics, and patients with low / moderate risk cardiovascular complications taking acetylsalicylic acid, non-statin patients with CAD. Subjectively worse heatwave tolerated males, especially patients with coronary artery disease
Key words: heatwave, cardiovasculardisease, cardiovascular complications, quality of life

 

PECULIARITIES OF T-CELL IMMUNITY IN CAROTID ATHEROSCLEROSIS
Osokina A.K., Pylaeva E.A., Potekhina A.V., Filatova A.Y., Tripoten M.I., Pogorelova O.A., T Balahonova.V., Noeva E.A.,  Ruleva N.Y., Krasnikova T.L., Arefieva T.I.

Aim: chronic inflammation plays a key role in the development of atherosclerosis. Immune cells with effector and regulatory properties migrate from bloodstream into artery wall participating in inflammatory reactions. T helper (Th) type 1 and Th17 cells promote inflammation and atherosclerosis, while regulatory T cells (Treg) possess anti-inflammatory and anti-atherogenic activity. We aimed to explore the relationship between T cell blood frequencies and the abundance of carotid atherosclerosis.
Materials and methods: 96 patients underwent duplex sonography to determine the degree of stenosis of distal segment of the common carotid artery (CCA), CCA bifurcation or internal carotid artery (ICA). Treg, Th1, Th17 blood frequencies were analyzed via direct immunofluorescence and flow cytometry.
Results: patients with ICA stenosis > 50% had increased Th17 and decreased Treg levels vs. patients with minimal lesions of ICA. Treg/Th17 ratio was lower in patients with CCA bifurcation stenosis > 35% vs. patients with initial atherosclerosis. No differences in Th1 blood content were observed. The degree of OSA stenosis was associated with the conventional risk factors (body mass index) but not with the investigated immunological parameters.
Conclusion: the disturbances in the balance of pro- and anti-atherogenic T-lymphocyte subpopulations may promote atherosclerosis in distal segments of carotid arteries.
Key words: atherosclerosis, inflammation, carotid arteries, regulatory T-lymphocytes, T-helpers 17.

 

EVALUATION OF THE DEGREE OF SATURATION OF BLOOD LPIPIDS BY PHYSICO-CHEMICAL AND BIOCHEMICAL METHODS. REGULATION OF FATTY ACID METABOLISM, NUMBER OF DOUBLE BONDS AND GLUCOSE UPTAKE BY INSULIN
Titov V.N., Sazhina N.N., Aripovsky A.V., Evteeva N.M., Tibilova �.�., Kukharchuk V.V.

Aim: evaluation of the biological role of insulin in the supply of insulin-dependent cells with substrates for mitochondrial production of ATP.
Materials and methods: in 31 patient, plasma and red blood cell fatty acid (FA) and nonesterified FA contents were measured by gas chromatography and the total double bond (DB) number was determined by automated ozone titration. FA ratios which reflect in vivo production of oleic monounsaturated FA (MFA) from palmitic saturated FA SFA) were calculated.
Results: the numbers of DB (degree of FA saturation) determined by ozone titration and gas chromatography were similar. The following FA ratios were calculated: �16:1/�16:0; �18:1/�16:0; �18:0/�16:0 and �18:1/�18:0. The first ratio reglects desaturation activity: conversion of exogenous palmitic SFA into ω-7 �16:1 palmitoleic MFA. The second characterizes a phylogenetically late two-stage  palmitic FA conversion which expresses insulin: endogenous glucose → �16:0 palmitic SFA → C18:0 stearic SFA → �18:1 ω-9 oleic MFA. Insertion of one DB includes two reactions: the third ratio reflects elongation and the forth reflects desaturation.
Conclusion: insulin activates cellular intake of glucose as a substrate for the synthesis of ω-9 �18:1 oleic MFA which is oxidized in mitochondria at the highest reaction rate constant, thus producing ATP.
Key words: insulin, glucose, fatty acids, double bonds, diabetes mellitus

EFFICACY OF MEDICATIVE ADMINISTRATION REGIMEN OF ANTIOXIDANT ENZYME DERIVATIVES GROUNDS NEW TASKS FOR THEIR BIOMEDICAL INVESTIGATION
Maksimenko A.V.

Aim: degree of rat survival with endotoxin shock was studied.
Subjects and methods: we used the endotoxin shock model in rats after intravenous bolus of lypopolysaccharide (LPS, from Salmonella enterica serotype Typhimurium).
Results: significant decrease of lethal degree in experimental group of rats (as compared with control group) has been demonstrated after preventive or medicative intravenous administration of superoxide dismutase – chondroitin sulfate – catalase bienzyme conjugate (SOD-CHS-CAT, administration of SOD-CHS-CAT conjugate at 10 min before LPS bolus or LPS bolus at 20 min before SOD-CHS-CAT administration, respectively). These data have been confirmed significantly the increase of animal vitality due to action of SOD-CHS-CAT conjugate. 24 hour survival of rats has been not shown significant distinction after peroral application of SOD-CHS-CAT (17.5 mg/kg/day for three weeks). Probably this effect was achieved due to proteolytic degradation of bienzyme conjugate. Meanwhile the lethal event in control group was happened earlier than in experimental group (for 2, 4, 5 hours). For initial 5 hour period the lethal degree in control group was 1.192 (p < 0.001) higher then in experimental group. Fastacting of SOD-CHS-CAT has been specified on expediency of condition selection for its personal use.
Conclusion: obtained results with literature data together have been grounded the research topicality of action mechanism of antioxidant enzymes (NO-dependent and/or NO-independent manner) and investigation of pathogenesis of vascular injury with determination of place and time for its evolution of oxidative stress.
Key words: vascular injury, endotoxin shock, oxidative stress, antioxidant enzymes, superoxide dismutase – chondroitin sulfate – catalase conjugate, lethal degree, antioxidant therapy.

 

HOMOZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA IN YOUNG WOMEN: CLINICAL MANIFESTATIONS AND CURRENT TREATMENT OPTIONS
Bliznyuk S. A., Ezhov M. V., Kukharchuk V.V., Komar O. A.

Homozygous familial hypercholesterolemia is a rare and hereditary disorder induced by a marked increase in low-density lipoprotein cholesterol (more than 13 mmol/l) with xanthomatosis and premature development and rapid progression of atherosclerotic lesions of arteries. The article presents a young woman with homozygous familial hypercholesteremia and current approaches to diagnosis and treatment.
Key words: homozygous familial hypercholesterolemia, low-density lipoprotein cholesterol, atherosclerosis, xanthomatosis.

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RECOMMENDATIONS FOR THE DISPENSARY OBSERVATION OF PATIENTS WITH CARDIOVASCULAR DISEASE

THE THERAPEUTIC POTENTIAL OF STRUCTURAL ANALOGS OF THE PEPTIDE APELIN-12 FOR INTRAOPERATIVE MYOCARDIAL PROTECTION
Yu.A. Pelogeykina, V.S. Shulzhenko, I.M. Studneva, O.M. Veselova, E.R. Pavlovich, A.V. Prosvirnin, A.A. Timoshin, M.E. Pal’keeva, A.S. Molokoedov, A.A. Az’muko, M.V. Ovchinnikov, M.V. Sidorova, O.I. Pisarenko

Aim: thisstudy was designed to evaluate the efficacy of structural analogues the C-terminal fragment of natural peptide apelin as additives to cardioplegic and reperfusion solutions for myocardial protection in a model of global heart ischemia and reperfusion.
Materials and methods: peptide apelin-12 (A12) and its structural analogues �I and AII were synthesized by the automatic solid phase method. Isolated perfused working rat hearts were subjected to normothermic global ischemia and reperfusion. Peptides A12, AI and AII were addedto St. Thomas’Hospital cardioplegic solution No.2 (STH2) or to Krebs solution (KS) at the stage of early reperfusion. Myocardial protection was assessed by recovery of metabolism and cardiac function, reduction of cardiomyocyte membrane and myofibril damage and decrease in reactive oxygen species (ROS) production during reperfusion.
Results: addition of the peptides toSTH2 (140μM) significantly improved myocardial energy state and cardiac function recovery during reperfusion. These effects were accompanied by less cardiomyocyte membrane and myofibril damage, and reduction of ROS generation. The overall protective effectof cardioplegia with analogue AII was slightly higher than with peptide A12 or AI. Infusion KS with the peptides at concentration of 140 μM at the stage of early reperfusion enhanced metabolic and functional recovery of the heart to a lesser extent.
Conclusions: the results indicate that addition of proteolytically stable analogues AI and AII of natural peptide A12 in STH2 improves myocardial protection during cardiac surgery.
Key words: apelin-12, cardioplegia, myocardial ischemia and reperfusion, cardioprotection.

 

CLINICAL EFFICASY OF ENDOVASCULAR TREATMENT OF RESISTANT HYPERTENSION
Protopopov A.V., Kochkina K.V., Nemik D.B., Malishkin D.A., Kochkina T.A., Evtyagin C.E.

Renal denervation is a safe and effective treatment of resistant hypertension.  We perform a single center experience of the procedure, successfully performed to 39 patients. The technical success was achieved in all cases. 28 patients (71.8%) demonstrated significant decrease of both systolic and diastolic pressures at 12 months of follow-up (decrease on 34.7 mm Hg of systolic pressure, from 174.9±14.52 to 140.2±24.1 mm Hg; decrease on 14.9 mm Hg of diastolic pressure from 98.2±14.5 to 83.3±9.4 mm Hg). Renal denervation can be safely and successfully used for treatment of resistant hypertension.
Key words: renal denervation, resistant hypertension.

AIR POLLUTANTS AND MYOCARDIAL INFARCTION IN A LARGE INDUSTRIAL REGION. IS THERE A RELATIONSHIP?
O.M. Polikutina, Y.S. Slepynina, E.D. Bazdyrev, O.L. Barbarach

Aim: to study the relationship between hospital admissions for acute myocardial infarction (MI) and environmental pollution in a large industrial region of Siberia (Kemerovo city).
Materials and methods: during the period from December 2010 to November 2014 the analysis of the main indicators characterizing the environmental pollution in Kemerovo and the number of hospital admissions for MI in the cardiology center of Kemerovo was carried out. The effect and the number of days per year with adverse weather conditions were also taken into the account. Assessment of relation and construction of equations depending on quantitative indicators were carried out by regression analysis method. Results are expressed as the regression coefficient B and correlation coefficient R. Differences were considered statistically significant at p <0.05.
Results: the associations between the increase in the number of hospitalizations for primary myocardial infarction and increased levels of oxide and nitrogen dioxide in the winter period compared to the summer period are revealed. It was found that during the entire observation period the increase in the concentration of nitrogen oxide in 10% of the MPC increases the number of hospital admissions for MI by 1.4 case, and the excess concentration of nitrogen dioxide by 0,9 cases. In winter period the excess of the average concentration of nitrogen oxide by 10% of the MPC was associated with an increase in the number of hospitalizations by 2.9 cases.
Conclusion: thus, there is a relationship between the frequency of hospitalizations of patients with primary myocardial infarction and environmental pollution (increasing of oxide and nitrogen dioxide, phenol concentration in the air). This pattern is more striking manifestation in winter period.
Key words: myocardial infarction, air pollution, cardiovascular disease.

 

APELIN PLASMA LEVEL IN PATIENTS WITH ARTERIAL HYPERTENSION AND OBESITY
A.V. Fedotova, T.N. Panova, A.A. Denidov, E.N. Chernysheva

Actuality: the great contribution to total cardiovascular risk is high blood pressure. New aspects of the pathogenesis of hypertension are opening each day. In humoral regulation of blood pressure, among other things, involved apelin- peptide synthesized by fatty tissue.
Objective: to investigate apelinplasma levels in patients withobese, depending on hypertension.
Design and Methods: we examined 80 obese men. The control group was composed of 30 men with normal weight and normal blood pressure levels. Patients  carried out a complex examination: anthropometric examination (height, weight, BMI calculation, waist circumference, hip circumference, calculation of OT/OB), blood pressure measurement,ELISA measurement of plasma apelin.
The Results: it was found that the plasma levels of apelin in obese patients is higher than in healthy volunteers. Reliable differences plasma level apelin obese patients, as well as high blood pressure, and without it, was found, but was revealed tendency to increase this index to increase blood pressure numbers.
Also, there is a statistically significant increase in plasma apelin with an increase in hypertension from 1 to 2nd degree, and in passing from 2 to 3 degrees AG plasma apelin decreases, but remains higher than the physiological level.
Conclusions: the level of plasma apelin in obese patients was significantly higher than in those with normal weight. The level of plasma apelin in obese is lower in people with hypertension than in those without hypertension. With an increase in the degree of hypertension from 1 to 2 is an increase in the content of the plasma apelin at 3 degrees is its reduction - failure of protective mechanisms.
Key words: apelin, hypertension, obesity.

 

CORONARY ARTERY BYPASS GRAFTING FOR DIFFUSE AND DISTAL LESIONS OF CORONARY ARTERIES
R.S. Akchurin, D.V.Salichkin, A.V.Emelianov, D.M. Galyautdinov, V.P. Vasilev, A.A. Shiryaev

Patients with diffuse coronary disease is a special category among those who are underwent coronary artery bypass grafting. Currently, increasing of number of  percutaneous coronary interventions has led to a growing percentage of patients with diffuse disease in coronary bypass surgery. This type of lesion is associated with worsening of outcomes and mortality. There are no standard criterions and classification of diffuse lesion of coronary arteries presently. It negatively impact on expected results. Diffusely coronary disease inclusion in models of patient-specific risk may improve their accuracy of prognosis.
Key words: coronary bypass grafting, diffuse lesions of coronary arteries.

 

DIFFERENCE IN FILOGENEZE ETIOLOGICAL FACTORS AND UNIVERSAL PATHOGENESIS OF METABOLIC PANDEMIAS. RELATIVE BIOLOGICAL  "PERFECTION" AND INCONSISTENCY OF  METABOLIC REGULATION IN VIVO
V.N. Titov

Regulation of metabolism in vivo can be better understood when phylogenesis of humoral, hormonal and vegetative regulatory factors is considered individually at the level of a) cells, b) paracrine regulated cell communities (PC), internal organs and their systems and c) the entire body. We suppose that each of these regulatory levels had formed at different stages of phylogenesis and terminated as “relative biological perfection” had been achieved. In our view, formation of internal organs and their systems also terminated  at the level of this perfection. A systemic approach analysis of the three levels which were achieved consecutively  in Homo sapiens has revealed regulatory discrepancies  “visible through” relative biological perfection. We think that phylogenetic discrepancies in metabolic regulation at three levels of relative biological perfection are etiological factors of metabolic pandemias (diseases of civilization). All metabolic pandemias, including atherosclerosis, metabolic arterial hypertension, insulin resistance, obesity, metabolic syndrome, and nonalcoholic fatty liver disease are caused by a discrepancy in phylogenetically late biological function of locomotion. Etiological basis of metabolic (essential) arterial hypertension is laid by a regulatory discrepancy leading to local compensation of an impaired biological reaction metabolism↔microcirculation in distal region of arterial bed involving endothelium-dependent vasodilation and systemic compensation at the entire organism level in proximal region of arterial bed. Two pools of phylogenetically separated fat cells (early visceral fat cells and late subcutaneous adipocytes) have been metabolically associated for millions of years. Insulin blocks  hydrolysis of triglycerides and release of nonesterified fatty acids into circulation only in adipocytes but it  cannot block lipolysis in phylogenetically early visceral fat cells and inhibit phylogenetically early hormones. An increase in plasma content of nonesterified fatty acids in the biological reaction of stress in vivo does not coincide with a proportional increase in albumin concentration. Function of phylogenetically early resident macrophages and monocytes→macrophages differentiated in arterial intima in situ and ex tempore is not the same. Adipocytes deposit fatty acids as nonpolar triglycerides in lipoproteins, while fatty acids are released in a polar nonesterified form.
Key words: phylogenesis, arterial hypertension, atherosclerosis, insulin resistance, metabolic syndrome, fatty acids.

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The modern characteristic of age dynamics of mortality of the population owing to blood circulatory system diseases in Azerbaijan
V.A. Azizov, E.M. Hatamzade

Aim: to estimate and compare the trend of age dynamics of the population mortality in Azerbaijan owing to blood circulatory system diseases, including coronary heart disease, a myocardial infarction and the cerebrovascular diseases.
Materials and methods: primary materials of research were health certificates on death for 2012 (54383 documents). Statistical processing was carried out by methods of the analysis of qualitative signs. The trend of frequency change of mortality cases on age groups decided by a choice of levels of regression on the greatest coefficient of determination (R2).
Results: at the age of 40-44 mortality frequency owing to blood circulatory system diseases among males(98,5) 2,55 times was more than among females(38,5). Among diseases of the blood circulatory system coronary heart disease, death rate owing to which made 58,7 among males and 22,5 among females prevailed (relative risk 2,61 for men on comparison with women). Mortality of males owing to the cerebrovascular diseases (28,0) and a sharp myocardial infarction (7,5) respectively 2,50 and 2,46 times was more than mortality of females owing to noted reasons (3,0 and 11,4). At the age of 45-49 on comparison with age 40-44 mortality owing to diseases of the blood circulatory system increased 2,70 times among males (265,5) and 2,33 times among females (89,6). Death rate of the population owing to blood circulatory system diseases at the age of 50-54 in Azerbaijan (283,4 among males, 124,5 among females) is rather less, than in Russia, but it is more than in the European Union countries. The ratio of death rates of males and females in Azerbaijan (≤3,0) at all ages is less than those in Russia and relatives that in the European Union countries.
Key words: age dynamics, blood circulatory system diseases, mortality.

 

The results of «MGUARD» stenting in patients with stenosis of venous grafts after coronary bypass grafting
G.N. Bakashvili, R.V. Atanesyan, Yu.G. Matchin

Aim: investigation of the safety and efficacy of stents «MGuard», covered by micromesh, in patients with stenosis of venous grafts after coronary bypass grafting.
Materials and methods: the study enrolled 15 patients after coronary artery bypass grafting (CABG) with recurrent angina, which was implanted stent «MGUARD» in venous grafts. The mean age of the patients was 67.4±9 years. To estimated the direct result of stenting and clinical status of patients at discharge and at 6 and 12 months. After 12 months in 5 (33%) patients a control angiography was performed.
Results: a total of 18 stents «MGuard» 15 vein grafts were implanted. The procedural success without distal embolization were 100%. In one patient with recurrent angina was performed stenting new stenosis in another vein graft.
Key words: coronary artery disease, vein grafts stenting, stent «MGuard».

 

�linical and genetic risk factors of arterial hypertension among in digenous populations Shoria
O.L. Barbarach, T.A. Mulerova, M.Yu. Ogarkov, G.V. Artamonova

Aims: determine the prevalence of non-genetic and genetic risk factors ofarterial hypertension and their association with the disease among the indigenous population Mountain Shoria.
Sabjects and methods: � clinical-epidemiological study of Mountain Shoria indigenous populations at isolated regions was undertaken. There were examined 395 people by continuous method, the sample collection consisted of adult population (18 years and older). Studied anthropometric data, the measurements of blood lipids, polymorphisms of genes ADRB1 (Ser49Gly, A/G, rs1801252) ADRA2B (I/D), ACE (I/D), eNOS (4a/4b) and MTHFR (C677T, Ala222Val, rs1801133).
Results: the most significant risk factors of arterial hypertension in an indigenous ethnic group Mountain Shoria were age, obesity and abdominal obesity.An average triglycerides, cholesterol and atherogenic index of very low density lipoproteins among indigenous population Mountain Shoria were higher among patients with homozygous DD genotype ADRA2B gene. The relative risk to detect the carriers of D allele ACE gene among persons with hypercholesterolemia is for 7.9 times higher than among people with normal levels of total cholesterol and for 11.2 times higher than in group with hyperbetaholesterinemia than in group with normal levels of low density lipoprotein cholesterol. For Aallele ADRB1 gene is associated with the risk of developing hypertension. The average SBP was higher in carriers of the homozygous AA genotype compared with carriers of the homozygous genotype GG.
Conclusion: with a relative risk of hypertension in the population is associated Shor: age, abdominal obesity, hypercholesterolemia, giperbetaholesterinemiya, obesity, atherogenic index increased value and carrier homozygous genotype AA gene ADRB1.
Key word: �andidate genes, hypertension, indigenous population.

 

Haemostatic factors and prognosis of thrombotic and bleeding events in patients with coronary artery disease after elective percutaneous coronary intervention
E.V. Guskova, E.P. Panchenko, A.L. Komarov, A.B. Dobrovolsky, A. D. Deev, E.V. Titaeva, A.N. Storozhilova, A.N. Samko

Aim: to investigate the association between clinical risk factors, haemostatic factors (D-dimer, fibrinogen, plasminogen activator inhibitor (PAI-1) activity, tissue plasminogen activator (tPA/PAI-1) complex, plasmin-antiplasmin complex (PAP)) and prognosis of thrombotic and bleeding events in patients with stable coronary artery disease (CAD) receiving double anti-platelet therapy (DAPT) during 12 month after elective percutaneous coronary intervention (PCI).
Material and methods: the study enrolled 188 patients with stable CAD undergoing elective PCI on DAPT. Blood samples were taken the day before PCI. Haemostatic factors were measured by ELISA method. Mean follow-up period was 1,09 �} 0,3 years. Registered ischemic events included acute coronary syndrome, ischemic stroke/transient ischemic attack, pulmonary embolism. Bleeding events had been characterized by BARC-defined bleeding classification (Bleeding Academic Research Consortium, 2011).
Results: the 1,1 year incidence rate of thrombotic and bleeding (BARC Types 2-5) events in patients with CAD after elective PCI was 20,2%. More than one half of patients with CAD, underwent elective PCI had higher levels of PAI-1 and D-dimer. The majority of patients had normal values of fibrinogen, PAP complex, tPA-PAI-1 complex. On univariate analysis (age- and sex-adjusted), only D-dimer (> 783,5 ng/ml) were significantly associated with risk of thrombotic and bleeding (BARC Types 2-5) events – OR 5.0 (95% CI 1.2-19.7, p=0,02). Other estimated variables (PAI-1, TPA/PAI-1, PAP, fibrinogen) had no significant relations to negative prognosis (thrombotic and BARC Types 2-5 bleeding events). Plasma level of D-Dimer was strongly associated with clinical risk factors, which had negative prognostic impact. Repeated ACS/PCI, thoracic/ abdominal aorta aneurysm, atherosclerotic disease of the aortic valve, CKD MDRD ≤ 88ml/min/1,73m2, omeprazole therapy, living alone were independently associated with risk of thrombotic and BARC Types 2-5 bleeding events. No significant relationship was found between D-dimer and negative prognosis (thrombotic and BARC Types 2-5 bleeding events) in multiple regression model.
Keywords: haemostatic factors, thrombotic and bleeding events, elective percutaneous coronary intervention.

 

The functional activity of phagocytes and metabolic syndrome
A.A. Chernyaev, S.N. Nakonechnikov, A.A. Demidov

The aim: to detect changes in cytochemical activity of neutrophils and monocytes in patients with metabolic syndrome depending on the presence of concomitant diseases of the gastrointestinal tract.
Materials and methods: the cytochemical activity of neutrophils and monocytes of blood before and after treatment in patients with metabolic syndrome without concomitant diseases of the gastrointestinal tract and with concomitant diseases was determined.
Results: the main difference between the examined groups of patients is in the qualitative composition of the reacting cells. The identified changes had unidirectional character and were expressed in increasing of activity of the investigated enzymes both before and after treatment.
Kee words: cytochemical activity, neutrophils, monocytes, metabolic syndrome.

 

Coronary artery bypass grafting in 62 y.o. patient with previous coronaritis
Komlev, T. Imaev, P. Lepilin, R. Akchurin

Having been commonly recognized as the leading cause of myocardial infarction in elder patients, in younger population coronary atherosclerosis tends to give the way to inflammatory diseases of coronary artery including Kawasaki’s disease. This condition saved untreated timely is characterized by regular involvement of coronary arteries with aneurysm formation and consequent stenotic lesions. The authors report on the case of coronary artery by pass grafting in patient with coronary lesion specific for the past history of coronaritis.
Key words: kawasaki's disease, coronaritis, coronary artery aneurysm, coronary artery bypass grafting

 

The morning rise in blood pressure: clinical implications and opportunities of candesartan in their correction
O.D. Ostroumova, O.V. Bondarets, T.F. Guseva, I.I. Kopchenov, E.A. Smolarczyk

The article is devoted to the problem of a rapid rise in blood pressure in the early morning hours in patients with arterial hypertension. Discusses the clinical significance of excessive morning surge in blood pressure. Underlines the difficulties and the importance of correction of morning rise in blood pressure as one of the goals of antihypertensive therapy. Discusses the results of studies on the high effectiveness of candesartan in the correction of morning rise in blood pressure.
Key words: arterial hypertension, ambulatory blood pressure monitoring, the morning rise in blood pressure, candesartan.

 

Medical treatment of accute coronary syndrome in patients with chronic obstructive pulmonary disease (review)
A.M. Namitokov, V.K. Zafiraki, E.D. Kosmacheva, V.A. Porhanov

Current recommendations for the treatment of acute coronary syndrome (ACS) do not reflect the features of the management of patients with some of comorbidities. This review is focused on the main questions of safety of different classes of drugs using for the treatment of ASC in patients with chronic obstructive pulmonary disease (COPD).
Key words: acute coronary syndrome, chronic obstructive pulmonary disease.

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Experience of application of the ulnar artery as access cite to perform coronary intervention
Atanesyan R.V., Matchin Yu.G., Shamrina N.S., Balakhonova T.V.

Aim: the purpose of this study was to evaluate the safety and effectiveness of diagnostic and therapeutic endovascular interventions on the coronary arteries through the ulnar and radial access.
Material and methods: since June 2009 till December 2012 in research have included 700 patients which were spent coronary angiography (CA) and angioplasty (PTCA), in control group included 2938 patients whom for operative access the radial artery was used. Clinical characteristics of patients in groups significantly didn't differ.
Results: successful arterial cannulation was obtained in 675 (96,4%) patients in the ulnar artery group and 2841 (96,7%) of patients in the radial artery group. The reason of an unsuccessful puncture of an ulnar artery in 11 (1,6%) cases was the spasm, in 5 (0,7%) cases - the expressed bend, in 9 (1,3%) cases – puncture failure. Procedures at all these patients are finished through alternative accesses. After procedures it was found 2 (0,29%) occlusion of an ulnar artery and 14 (0,48%) occlusion a radial artery (�=0.7), other complications weren't observed. The artery spasm in ulnar artery group was marked significantly less often - in 3% cases versus 12,7% at radial artery group (� <0,0001). Puncture time, fluoroscopy time and procedural time was no significant difference in the two groups.
The conclusion: using ulnar arterial access for diagnostic and endovascular treatment of coronary artery is safe and effective.
Key words: ulnar artery access cite, transulnar approach, transradial approach.

 

�omparison of the diagnostic capabilities of stress echocardiograms and exercise electrocardiograms in patients with different severity of coronary lesions
Elkanova M.M., Shitov V.N., Botvina U.V., Lopukhova V.V., Samko A. N., Saidova M.A., Karpov Y.�.

Aim: was the comparison of diagnostic possibilities of stress echocardiography and exercise ECG in patients with various factors in the development of coronary artery disease.
Materials and methods: the study included 268 patients, the age of the patients was 58,8 years on the average, men - 77,9%. All patients was conducted stress echocardiography: 110 – stress echocardiography with bicycle ergometry, 105 – pacing stress echocardiography, dobutamine stress echocardiography - 53. All depending on the test results all patients underwent coronary angiography.
Results: stress echocardiography with dobutamine demonstrated the highest diagnostic value in the detection of myocardial ischemia (sensitivity 93%, specificity 100%, accuracy - 82%), compared with other stress agents (for exercise stress Echocardiography: sensitivity 85%, specificity 83%, accuracy - 85%; for pacing stress Echocardiography: sensitivity 76%, specificity 74%, accuracy - 75%). In the detection of ischemia of the myocardium greatest sensitivity of stress Echocardiography was registered for left anterior descending artery - 88% compared with Lcx and RCA (82% and 80%, respectively). When comparing the sensitivity of stress Echocardiography and stress ECG in the detection volume of myocardial ischemia was demonstrated greater sensitivity of stress Echocardiography as for multivessel (88% vs. 40%) and one vessel disease (78% vs. 37%). Frequency registration reliable ischemic ECG changes was low regardless of the stress agent (VEM 31%, with CPES - 25% and dobutamine test - 17%). High information content were detected in the group with stenosis of more than 75% (sensitivity 82%, specificity 79%, accuracy - 81%), compared with less severe stenosis.
Conclusion: the results of our work showed high levels of informativeness stress Echocardiography compared with exercise ECG in different groups of patients, which allows its use for the detection of myocardial ischemia.
Key words: stress echocardiography, coronary artery disease, stress-induced myocardial ischemia, coronary angiography.

 

Heart ischemia and impaired lipid metabolism in the population of Gornaya Shoria
E. V. Rubtsova, T. A. Mulerova, A. A. Kuzmina, M. U. Ogarkov

Aim: To study the lipid profile and the prevalence of heart ischemia (HI) among both aboriginal and non-aboriginal inhabitants of Gornaya Shoria.
Materials and methods: we studied 453 inhabitants of Gornaya Shoria (221 Shorians, 232 non-aboriginal inhabitants). The characteristics of the blood lipid spectrum were analyzed. Electric cardiograms were taken and assessed according to the Minnesota Code. The subjects were divided into three age groups: 19 to 39 year old, 40 to 59 year old, and over 60 years.
Results: the prevalence of impaired lipid metabolism was lower among the aboriginal population compared to the non-aboriginal inhabitants. We found an association between ethnicity and the prevalence of HI. The arrhythmic form of HI was seen only among the non-aboriginal inhabitants (2,61%) and the middle age cohort showed a higher prevalence of possible myocardial ischemia among the non-aboriginal population (8,70%) compared to the aboriginal (1,77%). The Shorians showed a correlation between lipid spectrum characteristics (increased levels of triglycerides and very low density cholesterol lipoproteins) and the presence of asymptomatic HI.
Key words: heart ischemia, dislipidemia, aboriginal population, Minnesota Code.

 

Study of intima and media protein composition changes of thoracic aorta in patients with coronary artery disease in atherosclerotic lesions with proteomic technologies
R.A. Zhetisheva, M.A. Kovaleva, I.A. Kamenihina, I.E. Galahov, L.A. Novikova, M.H. Shogenova, �.M. Karpov, L.I. Kovalev, V.G. Naumov

Aim: to study intima and media protein composition changes in the thoracic aorta in normal and in atherosclerotic lesions using proteomic technologies with specificity of the protein composition determination and most pronounced protein changes identification. To expand a comprehensive multi-level database of aorta's medial layer proteins.
Materials and methods: the study materials were autopsy specimens, obtained from patients with advanced atherosclerosis (including coronary arteries) (n = 14). Proteins were investigated in normal tissue and affected with atherosclerosis. To study protein composition we used two-dimensional electrophoresis by O'Farrell; modifications NEPHGE, IEF; time-of-flight spectrometry and MALDI-TOF tandem mass spectrometry and others. Image analysis was performed using the MELANIE (version 6 and 7).
Results: proteomic study of thoracic aorta layers in atherosclerosis revealed accumulation of apolipoprotein A1 with altered physico-chemical characteristics, atypical protein products of β-fibrinogen and cathepsin D, 335R allelic variant of macrophage capping protein-1 and electrophoretic properties changes of glyceraldehyde-3-phosphate dehydrogenase isoform 2.
Conclusion: in all cases studied, the amount of non-regulatory proteins was more represented in the intima tissue, and to a lesser degree in the media, which apparently reflects the lesion depth of the aortic wall. Multi-level computer database of the medial layer proteins of human aorta is greatly expanded and could be useful for further atherosclerosis pathogenesis research.
Key words: atherosclerosis, intima and media protein composition, proteomics technologies.

 

Atorvastatin and metabolic syndrome
Blinova N.V., Pogorelova O.A., Tripoten M.I., Balakhonova T.V., Chazova I.E.

Aims: to study the effects of the atorvastatin on the lipids, glucose metabolisms, blood levels of vasoactive mediators, blood pressure and carotid intima media thickness in patients with metabolic syndrome (MS).
Design and methods: there were included 20 patients with MS, hypertension and dyslipidemia, who were treated atorvastatin monotherapy.Total cholesterol, triglycerides, HDL cholesterol and LDL cholesterol, fasting and postprandial blood glucose, insulin, measurements of the NO metabolitelevels, endothelin-1, (ET-1), thromboxane B2 (TxB2) and 6-keto-prostaglandin F1α (6-ketoPG F1α), 24-hour ambulatory blood pressure monitoring and carotid intima media thickness were performed at baseline and after 24 weeks of the therapy.
Results: atorvastatin in monotherapy were associated with the significant improvement ofall lipidsstudied parameters, some parameters of glucose metabolism and circadian BP profile of ambulatory blood pressure monitoring data. Atorvastatin treatment significantly decreased TxB2, 6-ketoPG F1α levelsand increase of NO metabolite. There was no increase carotid intima media thickness.
Conclusion: atorvastatin treatment showedpositive effects on the lipids, glucosemetabolisms, levels of vasoactive mediators and BPin patients with MS.
Key words: metabolic syndrome, atorvastatin, endothelial vasoactive mediators, atherosclerosis.

 

The possible methods for correction the hemorheologycal disturbanses and endothelial dysfunction in patients with ischemic stroke and diabetes mellitus
Shchepankevich L.A.

Stroke is one of the main causes of mortality, morbidity, disability in the population especially in Diabetic patients.
The aim of the research was the evaluation parameters of lipid profile and the haemorheology disorders in patients with ischemic stroke with diabetes mellitus type 2 and evaluate the dynamics of the normalization of lipid after administration of rozuvastatin (Crestor) 5 and 10 mgpd.
Materials and methods: the estimated concentration of total cholesterol, cholesterol of low density lipoproteins (LDL), cholesterol high density lipoproteins (HDL), triglycerides (Tg) in the blood serum of 81 patients with ischemic stroke and diabetes mellitus type 2. We measured the plasma activities of von Willebrand factor (vWf) as endothelial markers, platelet factor-4, β-thromboglobulin and the damaged red blood cells.
Results: there was a decrease in HDL cholesterol, the differences were reliable in comparison with the control group and the comparison group. The normalization of the lipid`s parameters and hemorheologycal and endothelial disorders has occurred after administration of Crestor 10 mgpd during the 6 months.
Key words: ischemic stroke, diabetes mellitus type 2, lipids, rozuvastatin.

 

Transcatheter aortic valve replacement in patient with severe aortic regurgitation and previous history of surgical mitral valve replacement
Imaev T., Komlev A., Kolegaev A., Lepilin P., Saidova M., Akchurin R.

Recently, with the increasing evidence for excellent results of TAVI in critically ill patients with severe aortic stenosis, there have been published a few data on applying TAVI for treatment of “pure” aortic regurgitation in extremely high-risk patients. In the case the authors share their own experience with TAVI in patient with predominant severe aortic regurgitation and previously implanted mechanical valve prosthesis in mitral position.
Key words: transcatheter aortic valve replacement (TAVI), «pure» aortic regurgitation.

 

Ykl-40 is a new marker of inflammation in patients with cardiovascular disease
Makeeva E.I., Shubin� A.T., Karpov Yu.A.

Cardiovascular diseases are the one of the leading causes of mortality worldwide. A lot of scientists discover predictors of adverse cardiovascular events, exactly biomarkers of inflammation, in clinical trials. In recent years, attention is paid to a new marker of inflammation, YKL-40, also known as cartilage glycoprotein - 39.
Key words: cardiovascular disease, atherosclerosis, inflammatory markers, cartilage glycoprotein-39.

 

A single mechanism of action of hypolipidemic drugs. Basic principles of primary prevention of atherosclerosis, atheromatosis and coronary syndrome
Titov V.N.

Irrespective of eh differences in mechanism of action, hypolipidemic drugs develop their effects according to a single algorithm. They normalize receptor-mediated uptake of polyenic fatty acids (PFA) by cells, thus restoring their functional, regulatory and structural state. Atherosclerosis is an in vivo pathology of each individual cell that cannot actively internalize PFA. Atherosclerosis is a syndrome of intracellular deficiency of ω-3 and ω-6 PFA. Compensatory production of humoral mediators (eicosanoids) from endogenous ω-9 � 20:3 digomo-Υ-linolenic unsaturated FA renders them aphysiological and capable of impairing all functional processes in vivo, which results in a multilevel clinical manifestations of atherosclerosis and development of atheromatosis. Although atherosclerosis and atheromatosis are related to each other, they are different processes. Neither statins, nor other hypolipidemic drugs have any pleiotropic activity. They normalize cellular uptake of PFA which produce their intrinsic pleiotropic effects. As peroxisomal prolilferators, Ω-3 eicosanoids oxidize excessive exogenous palmitic acid. Hypolipidemic effect of insulin is realized in conversion of entire palmitic FA synthesized in vivo from glucose into oleic FA. Hypolipidemic drugs are not the means of primary prevention of hyperlipidemia and atherosclerosis. This prevention should be based on �) normalization of the biological function of trophology and biological reaction of exotrophy and b) correction of quality and quantity of food according to real, quite limited functional possibilities of Homo sapiens. The biological function of intellect plays an important role in primary prevention of hyperlipidemias and atherosclerosis.
Key words: atherosclerosis, hypolipidemic drugs, pleiotropic activity, hypolipoproteinemia, nicotinic acid.

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Coronary collateral circulation and myocardial contractility in patients with chronic coronary artery disease
Starostin I.V., Talitskiy K.A., Bulkina O.S., Samko A.N., Karpov Yu. A.

Aim: to evaluate association between coronary collateral circulation and left ventricular contractility in patients with chronic coronary artery disease (CAD).
Sabjects and methods: data on left ventricular ejection fraction (LVEF) and zones with decreased regional contractility was obtained from echocardiographic imaging, performed in 579 chronic CAD patients before coronary angiography. Coronary angiography images were used to quantify coronary circulation characteristics, including collateral circulation evaluation with modified technique proposed by Rentrop. Potential associations between LV global/regional contractility and coronary collateral circulation were evaluated withmultiple linear models that incorporated main angiographic and clinical parameters.
Results: minimal LVEF was 19%, maximal 72%, median 60 [55; 65]. Better coronary collateral circulation was independently associated with higher LVEF (β = 0.19, �<0.0005). The rise of Rentrop score by one point is accompanied by a 1.2% (absolute) increase in LVEF. Better coronary collateral circulation was independently associated with lower LV regional contractility (β = -0.28, �<0.0005). The rise of Rentrop score by one point is accompanied by a 4.6% (absolute) fall in LV regional contractility.
Conclusion: �oronary collateral circulation is independently associated with left ventricular contractility in patients with chronic coronary artery disease.
Key words: collateral circulation, ejection fraction, regional myocardial contractility, coronary artery disease.

 

Method of instantaneous wave-free ratio in comparison with fractional flow reserve in assessment of the physiological significance of intermediate coronary stenosis
Y.G. Matchin, V.V. Gramovich, D.I. Darenskiy, M.G. Mitroshkin, R.V. Atanesyan, E.A. Zharova

Aim: the purpose of our study was to determine the diagnostic value of the method of instantaneous wave-free ratio (iFR) in comparison with fractional flow reserve (FFR) in assessment of the physiological significance of intermediate coronary stenoses. iFR is a new vasodilator-free pressure-only measure of the hemodynamic severity of a coronary stenosis. However, currently the diagnostic accuracy of the iFR requires clarification.
Sabjects and methods: iFR was compared with the conventional «gold standard» - FFR. The study included 30 patients with chronic coronary artery disease or with suspected coronary artery disease and intermediate coronary stenosis (50-70%). Values of iFR and FFR were calculated using automated algorithms. Papaverine was used as a vasodilator.
Results: values of iFR and FFR had a close correlation (R - 0,85, p <0,05) and high consistency. iFR cut-off point 0.93 had the best diagnostic efficiency in comparison with the 0.8 FFR cut-off point: ROC area under the curve - 0,89 ± 0,05 (95% CI: 0,76-0,96), specificity, sensitivity, negative predictive value, positive predictive value and diagnostic accuracy was 86,7%, 87,1%, 76,7%, 93,1% and 87%, respectively
Conclusion: according to our research iFR showed a sufficiently high diagnostic value in comparison with the FFR.
Key words: coronary artery disease, instantaneous wave-free ratio, fractional flow reserve.

 

The use of olmesartan in the complex therapy of hypertension in combination with sensorineural hearing loss
A.G. Evdokimova, S.A. Yunko, V.V. Evdokimov, O.V. Fedorova

The article presents a brief literature review of the possibility of optimizing the treatment of arterial hypertension (AH) in patients with chronic sensorineural hearing loss. Olmesartan - one of the most extensively studied and well known sartans, proved its antihypertensive efficacy with a cardiovascular and nephroprotection, pleiotropic properties. Property has its own experience of olmesartan in patients with hypertension I-II stage and sensorineural hearing loss.
Aim: evaluate the clinical efficacy of olmesartan in patients with hypertension and sensorineural hearing loss.
Sabjects and methods: 75 patients with hypertension in combination with sensorineural hearing loss aged 45-70 years (31% men) after the washout period were randomized into 4 groups. Olmesartan (10-40mg per day) and enalapril (10-40 mg per day). Additional antihypertensive therapy included indapamide and basic sensorineural hearing loss therapy. At baseline and after 6 months of therapy was evaluated ABPM results, determined by the thickness of the intima-media of the carotid arteries, platelet aggregation, blood rheology, lipid metabolism were evaluated audiometric data.
Results: there was significant reduction in blood pressure from baseline and it was similar in patients receiving olmesartan and enalapril, but the normalization of circadian blood pressure profile was better in patients treated with olmesartan. The positive results in more pronounced in olmesartan group, to reduce TIM, platelet aggregation, blood rheology and with positive dynamics of audiometry parameters.
Conclusion: olmesartan in patients with hypertension and HNT has a strong and persistent antihypertensive effect, positive effect on the remodeling processes in the vascular wall, improves platelet aggregation, blood viscosity, lipid metabolism parameters and audiometry.
Key words: angiotensin II, hypertension, enalapril, olmesartan, chronic sensorineural hearing loss.

 

Epidemiological-morphological research of atherosclerosis
V.S. Zhdanov, I.P. Drobkova, I.E. Galakhov

Aim: the aim of epidemiological-morphological research of atherosclerosis is to analyze the disease spread in various human populations, evaluate the frequency and severity of atherosclerotic lesions in given areas of arterial bed, and assess the effects of various risk factors on atherosclerosis progression.
Sabjects and methods: the research was performed in various ethnic populations according to the WHO program at 25- and 40-year intervals in five European and several cities of the formed Soviet Union. Visual-planimetric method was used.
Results: �cceleration of atherosclerosis development was revealed in male populations of all studied cities with exception of Prague and Malmo. Atherosclerosis was much less ronounced in native populations of Ashkhabad, Bishkek and Yakutsk than in nonabogines at both phases of the research. Accelerated development of atherosclerosis in Asian populations manifested itself as an increase in the lipid spot square in the aorta and coronary arteries in comparison with European populations. At the second stage of the research, an increase in the frequency and square of aortic and coronary calcinoses coincided with an increase in the frequency of coronary stenoses. Practically healthy individuals died of various causes can be the subjects of epidemiological-morphological research to study the development of atherosclerosis in a population.
Conclusion: �onsiderable changes in the rate of atherosclerosis development at the population level occur within a 20-25-year period, i.e., within one generation. This is important for controlling atherosclerosis rate by modifying its various risk factors.
Key words: atherosclerosis, CHD, epidemiology, morphology, coronary arteries, aorta, risk factors.

 

The rise of cardiac biomarkers due to planned PCI and 1-year prognosis
O. Mironova

Aim. The aim of our study was to assess the prevalence and prognosis of myocardial infarction (MI) type 4a and myocardial damage due to planned PCI in Russian population.
Material and methods. 281 patients were screened before the enrollment in our study. 183 patients with stable CAD were included in our study whose levels of cardiac troponin I and MBKK were studied after PCI. We divided patients into the groups according to their levels of cardiac troponin I after PCI (group I – no elevation, group II - elevation 1-3 upper limits of normal (ULN), group III - more than 3 ULN) and MB-KK (group I - no elevation, group II -1-3 ULN, group III - more than 3 ULN).
Results. The prevalence of MI type 4a was 10,7% and periprocedural myocardial damage - 14% respectively. After performing the discriminant analysis we sought to build a prognostic model and calculate the formula of periprocedural myocardial damage probability: 0,871*gender (male = 0, female = 1)+0,516*(angina pectoris functional class)+0,022*age (years)-0,011*eGFR (MDRD)+0,27(number of diseased coronary arteries)≥2,731. MI type 4a doesn’t increase 1-year mortality according to our data.
Conclusion. MI type 4a (with chosen diagnostic criteria) and myocardial damage after planned PCI do not enhance the probability of death and CHF decompensation during 12 months after the procedure. According to our data, the cardiac biomarkers’ rise after planned PCI without any other clinical and instrumental evidence doesn’t influence the 1-year prognosis in Russian population.
Key words: troponin, CK-MB, periprocedural myocardial infarction, myocardial infarction type 4a, myocardial infarction after PCI, percutaneous interventions, 1-year prognosis

 

Physico-chemical and functional differences of palmitic and oleic fatty acids. Pathogenesis of atherosclerosis, biological foundation for its prevention, and insulin
V.N. Titov

On the basis of phylogenetic theory of general pathology, the cause of a noninfectious disease whose occurrence in a population is >5-7% is an impaired biological function or reaction to the environment. From the general biology viewpoint, high mortality rate related to cardio-vascular diseases and atherosclerosis (intercellular deficiency of polyenic fatty acids, PFA) is just extinction of the Homo sapiens population upon adaptation to new environmental factors. The biological function of throphology (feeding) and biological reaction of exotrophy (external feeding) are impaired in several aspects, the major of which is nonphysiologically high dietary content of saturated FA, primarily, of palmitic FA. The lipoprotein system formed at early stages of phylogenesis cannot transport and provide physiological deposition of great amounts of palmitic FA, which leads to the development of an adaption (compensatory) and accumulation disease. This results in �) hypermipidemia, impaired bioavailability of PFA to cells, b) compesatory production of nonphysiological humoral mediators from ω-9 eicosatrienoic mead FA, c) disorders in physiological parameters of cell plasma membrane and integral proteins, d) nonphysiological conformation of apo�-100 in lipoproteins, formation of ligandless lipoproteins (biological litter) and impairments in the biological function of endoecology, e) utilization of ligandless lipoproteins in arterial intima by phylogenetically early macrophages that do not hydrolyze polyenic cholesterol esters, f) increase in the intensity of the biological reaction of inflammation, and e) destructive and inflammatory lesions in arterial intima of an atheromatosis or atherothrombosis type. Atheromatous masses are catabolites of PFA which were not internalized by phylogenetically late cells via receptor-mediated pathway.
Key words: phylogenetic theory of general pathology, atherosclerosis, atheromatosis, polyenic fatty acids, palmitic acid.

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Cytokines of pro- and anti-inflammatory macrophages subpopulations and their role in formation and stabilization of atherosclerotic plaques in human carotid arteries
V.S. Shishkina, M.A. Chelombitko, Yu.E. Efremova, A.V. Fedorov, O.P. Ilyinskaya, E.M. Tararak

Aim: distribution of several biologically active mediators, cytokines and chemokines contributing to functional activity of pro- (M1) and anti-inflammatory (M2) subpopulations of macrophages (Mf) in different types of atherosclerotic lesions was analyzed, and its potential role in formation and stabilization of human carotid plaques was investigated.
Sabjects and methods: morphological assessment of lesion types was done according to the H. Stary classification. Functional activity of M1 and M2 Mf subpopulations was analyzed by ELISA with determination of pro- (CCL3, MCP-1, IL-1b, IL-6 and IL-8) and anti-inflammatory (CCL18, CCL24 and TGFβ-1) cytokines content in homogenized lesions of different types (fatty dot or streak, atheroma, fibroatheroma, fibrous, fibrocalcific and complicated lesions).
Results: both Mf subpopulations were revealed in all types of lesions. However in various lesion types different factors were prevalent suggesting an increased functional activity of a given subpopulation in each case and its important role in a given step of atherosclerotic plaque formation. In fatty dots or streaks high levels of both inflammation associated groups of cytokines were revealed. A decreased level of CCL3 (M1 Mf marker chemokine) and an increased level of CCL24 (M2 Mf marker chemokine) in atheroma suggested an increase of M2 Mf activity leading to chronicity.
Conclusion: high levels of pro-inflammatory factors and low levels of anti-inflammatory ones in fibroatheroma suggested a prevalence of M1 Mf activity which escalates the inflammatory process, destabilizes fibrous cap and leads to its potential rupture. In complicated lesions high levels of pro-inflammatory cytokines were observed along with high levels of anti-inflammatory cytokines implying M2 Mf activation which provides tissue reparation and atherosclerosis stabilization. Low levels of all cytokines in fibrous and fibrocalcific plaques suggested a low functional activity of both Mf subpopulations leading to stabilization of lesions. In conclusion, the balance between functional activities of M1 and M2 Mf subpopulations significantly affected processes of formation, stabilization and proliferation of atherosclerotic lesions.
Key words: atherosclerosis, carotid arteries, pro- and anti-inflammatory macrophages subpopulations, pro- and anti-inflammatory cytokines.

 

The intensification of free radical peroxidation of low density lipoproteins in diabetes mellitus type 2
A.K. Tikhaze, O.A. Odinokova, G.G. Konovalova, L.V. Nedosugova, V.Z. Lankin

Aim: To study changes in the parameters of oxidative stress in patients with type 2 diabetes with disorders of carbohydrate metabolism before and after the sugar-lowering therapy.
Subjects and methods: The study included 16 patients with newly diagnosed type 2 diabetes mellitus (DM-2) with the level of glycated hemoglobin HbA1c>9% who have not previously received sugar-lowering therapy. Before and after 3-month therapy aimed at normalizing glucose metabolism, examined the basic parameters of carbohydrate/lipid metabolism and oxidative stress, including the levels of HbA1c , malonyldialdehyde (MDA) and oxidized lowdensity lipoprotein (oxLDL) in blood plasma, and the activity of erythrocyte antioxidant enzymes, including superoxide dismutase (SOD), glutathione peroxidase (GSH-peroxidase) and catalase.
Results: It was shown that the levels of LDL cholesterol and HDL cholesterol is not change in the process of effective sugarlowering therapy in patients with type 2 diabetes, although there was a significant reduction of total cholesterol level on 13% and atherogenic coefficient on 26%. At the same time, oxLDL and MDA levels (on 25% and 47%, respectively) in the blood of patients with type 2 diabetes after sugar-lowering therapy decreased, and the activity of erythrocyte GSH-peroxidase significantly increased on 28%, whereas the activity of SOD and catalase were not significantly changed.
Conclusions: These results indicate that under diabetes there is the intensification of free radical processes with subsequent accumulation of reactive carbonyl species (RCS), which iduced the atherogenic modification of LDL and facilitate manifestation of atherosclerotic lesions in vascular wall.
Key words: oxidative stress, reactive oxygen species, reactive carbonyl species, oxidized LDL, lipohydroperxides, malondialdehyde, type 2 diabetes mellitus.

 

Diagnostic and therapy efficiency evaluation of chronic limb ischemia performed by magnetic resonance tomography
Sinkevich N.S., Talitskiy K.A., Stukalova O.V., Karpov Y.A.

The prevalence of chronic limb ischemia ranges from 3 up to 10%. As the main cause of non-traumatic amputations, peripheral artery disease leads to a working-age population decrease. This is a serious health and social problem, which causes the urgent need to improve timely diagnostic and therapeutic approaches. Nowadays a great importance to develop new methods for sensitive and specific assessment of skeletal muscle perfusion and metabolic processes exists. MRI provides a non-invasive tissue perfusion and metabolic activity evaluation.
Key words: chronic limb ischemia, magnetic-resonance imaging, 31P magnetic-resonance spectroscopy.

 

Inflammation and chronic heart failure: the role of tumor necrosis factor
O.N. Gerasimova, E.N. Dankovtseva, S.N. Nakonechnikov, D.A. Zateyshchikov

This review is devoted to the modern concept of the role of inflammation in the development of heart failure. It describes the current understanding of the role of tumor necrosis factor (TNF) in inflammation, and genetic variability in the expression of TNF. Analyzed data on the involvement of TNF in the development and progression of cardiovascular diseases, including congestive heart failure, and prognostic value of its measurement.
Key words: chronic heart failure, tumor necrosis factor, TNF gene polymorphism.

 

Anaesthesiological management of transcatheter aortic valve implantation
K.A. Gruzdev, A.A. Margolina, M.G. Lepilin

The present review describes the problems of anesthetic management for transcatheter aortic valve implantation with transfemoral access on the basis on the data of modern literature. It provides the details of preoperative examination and management of patients who undergo transcatheter operations. In review discussed the possible types of anesthesia. Outlined controversial issues on the advantages and disadvantages of local and general anesthesia. Debated monitoring types of the cardiac patient. Emphasizes the role of an anesthesiologist at the main stages of the operation. Actively discussed the role of transesophageal echocardiography.
Key words: anesthesia, transcatheter aortic valve replacement, aortic stenosis, transcatheter aortic valve implantation.

 

Use of new biomarkers in risk stratification of patients with heart failure
V.N. Protasov, A.A. Skvortsov, D.E. Koshkina, O.Y. Narusov, S.N. Tereshchenko

This review is devoted to consideration of the prognostic significance of new biomarkers of heart failure (HF) such as soluble ST-2,midregional fragment proadrenomedullina (MRproADM) and copeptin. The biomarkers nature, involvement in the HF pathogenesis and significant contribution of these biomarkers in the assessment of individual risk in patients HF are described. It is particularly important that this review summarizes the results of studies obtained using a multimarker approach for HF risk stratification.
Key words: heart failure, biomarker, risk stratification, prognosis, multimarker approach, NT-proBNP, soluble ST-2, MRproADM, copeptin.

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Structural analogues of peptide apelin-12 are potential cardioprotectors in acute coronary syndrome
Yu.A. Pelogeykina, L.I. Serebryakova, O.V. Tskitishvili, I.M. Studneva, O.I. Pisarenko

Aim: study of cardioprotective properties of chemically modified analogues of apelin-12 in a rat model of myocardial regional ischemia and reperfusion in vivo.
Subjects and methods: structural analogues of apelin-12 (A12) were synthesized by the automatic solid phase method. Acute myocardial infarction (MI) in anaesthetized male rats was induced by LAD coronary artery occlusion with the subsequent coronary reperfusion. Peptides were administrated by i/v bolus injection after ischemia period. Hemodynamic parameters were monitored throughout the experiment. Myocardial injury was assessed by infarct size, activity of necrosis markers in plasma and metabolic state of the area at risk.
Results: studied peptides limited the infarct size, reduced LDH and MB-CK activity in plasma and improved metabolism of the area at risk at the end of reperfusion. The most effective of them decreased the systolic blood pressure and heart rate to a lesser extent than natural A12 peptide.
Conclusion: the structural analogues of apelin-12 may be used for creation of the drugs, which are applying for treatment patients with acute coronary syndrome.
Key words: apelin-12, pharmacological agonists of APJ receptor, myocardial infarction, markers of necrosis, metabolism of area at risk.

 

Pre-hospital and in-hospital lethality from acute myocardial infarction in the city of Tomsk according to the register of acute myocardial infarction
A.A. Garganeeva, S.A. Okrugin, K.N. Borel

Aim: the purpose of the research was to analyze the indicators of total, in-hospital, and pre-hospital mortality from acute myocardial infarction (AMI) in Tomsk during the 27-year-long follow-up study.
Sabjects and methods: the study was conducted as part of the WHO Register of Acute Myocardial Infarction. From 1984 to 2010, a total of 24,850 AMI cases were registered. During acute period of AMI, 9390 patients died including 3314 (36.3%) and 6076 (64.7%) patients at the in-hospital and pre-hospital stages, respectively.
Results: the total mortality rate was 35.98 %. The in-hospital mortality rates were higher in women of older age group; the rate increased exclusively due to higher mortality in patients older than 60 years. Compared with the in-hospital mortality, the pre-hospital mortality rate was higher and constituted not less than two thirds of the overall mortality.
Conclusion: an increase of the in-hospital mortality rate resulted from the worsening of the clinical and anamnestic AMI aspects due to an increase in the number of patients treated in the non-specialized hospitals and due to the high mortality rates in the past. The high pre-hospital mortality rate was mainly caused by the sudden onset of death and by inaccessibility of the established medical assistance system for most patients with fatal outcome. The findings suggest about the necessity to restore practice of performing comprehensive clinical examinations of patients with cardiovascular diseases, to improve training of the primary care physicians, and to promote health literacy of the population.
Key words: acute myocardial infarction, mortality.

 

Influence of lipoprotein apheresis on the course of atherosclerosis in vein grafts and native coronary arteries within the first year after coronary artery bypass grafting in patients with a hyperlipidemia, refractory to drug therapy
R.N. Adzhiev, M.V. Ezhov, L.N. Ilyina, O.I. Afanasieva, E.E. Vlasova, Y.G. Matchin, G.A. Konovalov, R.S. Akchurin, S.N. Pokrovsky

Aim: to evaluate the effect of a 12 month course of weekly lipoprotein apheresis on vein graft patency and coronary atherosclerosis after coronary artery bypass grafting (CABG) in patients with hyperlipidemia refractory to statins.
Sabjects and methods: in a 12-month prospective controlled clinical trial we enrolled 50 male patients (mean age 57,5±6,8 years) after successful CABG and low-density lipoprotein cholesterol (LDL-C) level >2.6 mmol/L prior to the operation despite statin treatment. Patients were allocated into 2 groups: active (n=25, weekly apheresis by cascade plasma filtration (CPF) plus atorvastatin), and control (n=25, atorvastatin alone). Graft patency and coronary atherosclerosis was evaluated by multisliced computed tomography at 3 months and coronary angiography at 12 months after an operation.
Results: both groups were comparable in clinical and biochemical characteristics. During each CPF procedure, LDL-C level decreased by 64±9%, apoB – by 65±8%, Lp(a) – by 52±15%,; these changes were significant compared to baseline and the control group. Mean net difference in LDL-C level between apheresis and control groups was 1,1±0,3 mmol/L. At 3 months there was trend to lower rate of vein graft occlusions in active group then in controls: 4% versus 11% (p=0.13). Vein graft patency at study end was 85,7% (66 of 77) in the apheresis group versus 72,6% (61 of 84) in the control group (p=0,05). Use of apheresis was associated with decreased vein graft occlusions by 46%: relative risk 0,52; 95% confidence interval 0,27 to 1.00; p=0.05.
Conclusion: the use of lipoprotein apheresis with cascade plasma filtration in CABG patients with hyperlipidemia refractory to statin treatment is associated with lower rates of vein graft occlusions at 12 months. There is trend to regression of atherosclerosis in native coronary arteries in patients received cascade plasma filtration.
Key words: hyperlipidemia, atorvastatin, lipoprotein apheresis, coronary artery bypass grafting, vein grafts, coronary atherosclerosis.

 

Determination of aortic pulse wave velocity using the method of ultrasound duplex scanning
M.V. Andreevskaya, A.N. Rogoza, M.A. Saidova, N.M. Chichladze

Aim: the development of the measurement of the regional aortic stiffness protocol (pulse wave velocity (PWVus)) using ultrasound duplex scanning and the due age values of PWV for identifying the patients with a higher aortic stiffness.
Sabjects and methods: the study is included 200 subjects: 75 healthy volunteers, 125 patients with cardiac profile, including: 17 patients with coronary heart disease, 68 patients with arterial hypertension, 40 patients with combined coronary artery disease and hypertension. All the patients got the aortic PWV measurement by the ultrasound duplex scanning and carotid-femoral pulse wave velocity (cfPWV) measurement by the sphygmographic method. The detailed methodology of the research is presented in the article.
Results: the feasibility of the method of ultrasound duplex scanning was 95%. The variation coefficient was equal to 7.6% in the study of intra-operator reproducibility and 9.3% in the study of inter-operator reproducibility. According to the data of ultrasonic method PWVus 6.5 (5,2;7,8) m/s; and was significantly lower than cfPWV according to classical methods, which was 8.0 (6,6;9,4) m/s, p<0,05. However, there was a close correlation between the two values of PWV, r=0.85, p< 0,0001. The strong dependence between PWVus and age was showed. The correlation coefficient was r=0,66 (p=0.0001). Due values for PWVus were developed above which it is concluded that «increased stiffness» of the aorta: in subjects under 30 years - 5.9 m/s, 30-39 years - 6.6 m/s, 40-49 years - 7.0 m/s, 50-59 years - 8,0m/s, 60-69 years - 10.3 m/s, with over 70 years of age 11,4m/s. PWVus more than 8 m/s was recommended as the universal criterion of the increased aortic stiffness. Sensitivity 83% and specificity 89% were obtained when the diagnostic accuracy estimate of PWVus took place. The degree of coincidence with the results of diagnostics of high aortic stiffness by sphygmographic method amounted 0.75±0,086; 95% CI = 0,58-0,92, indicating a high consistency of results between the two methods.
Conclusion: the technique of the aortic pulse wave velocity measuring by ultrasound duplex scanning is presented. The method is characterized by the high feasibility, reproducibility, accuracy. The PWVus values correlates with cfPWV values measured with the using of the methods recommended in the clinical practice. Due age values of PWVus in the aorta, obtained using the proposed Protocol of ultrasound research are developed.
Key words: aortic stiffness, pulse wave velocity, measurement of aortic stiffness, ultrasound duplex scanning

 

Susceptibility of low density lipoprotein and lipoprotein (�) to oxidation
V.Z. Lankin, O.I. Afanasyeva, G.G. Konovalova, E.A. Klesareva, E.A. Utkina, A.K. Tikhaze, E.M. Kumskova, S.N. Pokrovsky

Aim: �omparative investigation of free radical peroxidation of lipoprotein (a) [Lp(a)] and low-density lipoprotein (LDL) of human blood plasma.
Sabjects and methods: we investigate the kinetics of free radical peroxidation of Lp(a) and LDL using of UV-spectrofotometry of accumulated lipohydroperoxides under 233 nm.
Results: lipoprotein (a) is a supramolecular complex similar to low density lipoprotein (LDL) yet differing from it by the presence of apoprotein (a). We showed that Lp(a) particles were oxidized considerably slower than LDL particles which may suggest that apoprotein (a) acts as a «structural antioxidant». Lp(a) modification with natural dicarbonyls (malonyldialdehyde, glyoxal, methylglyoxal) significantly increased the rate of free radical peroxidation of Lp(a) however these aldehydes had no significant effect on the kinetics of Lp(a) oxidation. Modified Lp(a) were oxidized with almost the same intensity as unmodified LDL.
Key words: lipoprotein(a), low density lipoproteins, free radical peroxidation, malonyldialdehyde, glyoxal, methylglyoxal

 

Our experience recanalization of chronic occlusion of the left main coronary artery
A.S. Tereshchenko, E.V. Merkulov, V.M. Mironov, L.E. Konstantionova, V.G. Ertman, A.N. Samko

Chronic occlusion of the left main coronary artery is an extremely rare manifestation of coronary heart disease. This coronary lesion is a complete absence of antegrade flow in the left coronary artery. With this coronary artery disease is the main treatment for coronary bypass surgery, but apparently and percutaneous coronary intervention. We present a rare clinical case of chronic occlusion of the left main coronary artery disease in men 62 years of age, with a clinical picture of stable angina III-IV functional class.
Key words: chronic occlusion of the left main coronary artery, left coronary artery lesion, PCI of the left main coronary artery.

 

Lipotoxicity of fatty acid excess in cells: endoplasmic stress, nonphysiological protein folding, chaperones, biological reaction of inflammation and apoptosis
V.N. Titov

According to phylogenetic theory of general pathology, deposition of fatty acids (FA) as triglycerides in cells that normally do not accumulate them (hepatocytes, myocytes, macrophages, insular β-cells) is a manifestation of lipotoxicity and initiates endoplasmic stress, biological reaction of inflammation and apoptosis-like death of cells. Constant high plasma content of nonesterified FA in metabolic syndrome is caused by overconsumption of physiologically normal food, hypertrophy of omental fat cells at the level of paracrine communities and constant ‘intention’ of cells at the autocrine level to get rid of FA by secreting them into circulation. Macrophage conversion into foam cells and formation of intimal atheromatosis stems from inability of phylogenetically early resident macrophages that have no plasma membrane apoB-100 receptors to hydrolyze phylogenetically late nonpolar lipids (polyenic FA esterified by the alcohol cholesterol). Phylogenetically early visceral fat cells lacking insulin receptors fulfill all biological functions in vivo; phylogenetically late insulin-dependent adipocytes of subcutaneous fatty tissue are involved predominantly in realization of the biological function of locomotion. It seems unreasonable to refer to both these cell types as adipocytes. Visceral fat cells and adipocytes phylogenetically belong to loose connective tissue; however, from the paracrine community level they preserve the ability to realize the biological function of endoecology, biological reaction of inflammation, production of chaperones, biological reaction of apoptosis and the ability to separately secrete leptin and adiponectin in the regulation of visceral and subcutaneous fatty tissues at the entire body level.
Key words: fatty cells, adipocytes, macrophages, chaperones, leptin, adiponectin.

 

Diagnostic value of proton magnetic resonance spectroscopy of liver in the evaluation of treatment of steatosis and stetohepatitis
S.K. Ternovoy, D.T. Abdurakhmanov, G.A. Shiryaev

Aim: studying the diagnostic capabilities of the proton MR-spectroscopy in the liver to verify the results of treatment of steatosis and steatohepatitis.
Sabjects and methods: spectra were studied in 85 patients (50 men, 35 women), mean age was 48 ± 11 years. The studied group consisted of three sub-groups: healthy volunteers (15 men), patients with steatogepatosis (37 people), and steatohepatitis, identified by clinical examination (33 patients). There were two study points in groups of patients: before treatment and six months after treatment. For each patient was performed the alculation of lipid concentrations in the liver parenchyma using MR spectroscopy. If the value is greater than 6.5%, the presence of fatty liver was considered confirmed.
Results: according to our studies in a group of healthy volunteers the concentration of fat in the liver did not exceed 3,2% ± 1,5%. (normal range). In patients with hepatic steatosis in liver fat concentration in 16 cases exceeded 20% and accounted for 14 observations from 10 to 20%, in 7 cases - at least 10%. 18 patients (60%) showed a reduction in fat concentrations to normal values, 7 patients (23%) - a reduction of more than twice. Reduction was not detected in 5 patients (17%). In patients with steatohepatitis lipid concentration on the results of MR - spectroscopy ranged from 10.5% to 60% in average was 28,86 ± 19%. When the concentration of fat in 18 cases exceeded 20%, 10 cases were in the range 10-20%, in 3 cases - at least 10%. In the second point of study in this group of 29 patients the concentration of fat in the liver decreased only in 8 patients and did not reach normal values.
Conclusion: proton MR-spectroscopy is an effective noninvasive technique for diagnosis and quantification of hepatic steatosis and can be recommended for use in clinical practice for verification of the diagnosis of fatty liver disease, for monitoring the effectiveness of its treatment.
Key words: proton magnetic resonance spectroscopy, hepatic steatosis, steatohepatitis.

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Cryoablation for paroxysmal atrial fibrillation: two case reports
N.Yu. Mironov, E.B. Maykov, N.B. Shlevkov, Yu.V. Mareev, V.V. Vlodzyanovsky, K.A. Gruzdev, A.V. Pevzner

Atrial fibrillation (AFib) is the most prevalent symptomatic arrhythmia associated with significant morbidity and mortality. Management of paroxysmal AFib, the most common form of the disease, is often challenging due to limited efficacy and significant side effects of antiarrhythmic drugs and frequent AFib relapses. Endovascular pulmonary veins isolation demonstrated higher efficacy, however conventional radiofrequency catheter ablation technique requires multiple applications and potentially life-threating complications occasionally may occur. Balloon cryoablation is a new method of pulmonary vein isolation by local chilling of adjacent tissue resulting in complete isolation after a single application. We report two cases of successful cryoablation in patients with drug-refractory paroxysmal AFib.
Key words: cryoablation; paroxysmal atrial fibrillation; pulmonary vein ostia; antiarrhythmic drugs

 

Diagnosis and treatment of dilated cardiomyopathy by results of the registry of dilated cardiomyopathy in the Russian federation
S.N. Tereshchenko, E.N. Alaeva, O.Yu. Narusov, A.G. Kochetov, A.A. Scvortcov

Aim. Currently there are no reliable data about prevalence dilated cardiomyopathy (DCM) in Russia. Purpose: To assess the prevalence of dilated cardiomyopathy (DCM) among chronic heart failure (CHF) patients, the use of modern diagnostic and treatment methods for patients with dilated cardiomyopathy in usual clinical practice.
Sabjects and methods. Special questionnaires were sent to the hospitals of 20 regions of Russia, which had agreed to participate in the registry. Questionnaires investigated the number of patients with CHF and DCM, their comorbidities, diagnostic and treatment methods which had been used. 574 registries forms of patients with dilated cardiomyopathy were included in the study. The average age was 47,61±11,27 years. Male had 4 times as much dilated cardiomyopathy as female.
Results. The most frequent concomitant disease was hypertension (34%). Significant contribution was made by coronary heart disease (10 %) and alcohol (9.1 % ). And also comorbidities were toxic diseases (2.3%), autoimmune connective tissue diseases (1.9%), pericardium diseases (1.05%), cancer (0.7%), amyloidosis (0.7%) and HIV (0.4%). Diagnostics was carried out by the following methods: ECHO (99.5%), X-ray (76.8%), Holter monitoring (40.1%), 6-minute walk distance (17.7%), coronary angiography (22.9%), endomyocardial biopsy (4.7%), immunology (10%), serology (2.8%), real –time PCR (6.4%). Angiotensin converting enzyme inhibitors were prescribed in 88,6%, beta-blockers in 83,8%, diuretics (mainly loop diuretics) in 82,9% followed by digitalis (59%), aspirin (59,2%), metabolic therapy (50,1%), spironolactone (37,1%), anticoagulant therapy (33,7%), immuno-suppressive therapy (5,1%), immunemodulating therapy (3%).
Conclusion. Prevalence of dilated cardiomyopathy among CHF patients was 2.0%. The major co-morbidities were hypertension (34%), coronary heart disease (10%) and alcohol (9.1%). The most often used diagnostic method was echocardiogram. 4. Most patients were prescribed angiotensin converting enzyme inhibitors (88.64%) and beta blockers (83.8%). Bisoprolol and carvedilol were the most common agents among beta-blockers. Daily dosage of angiotensin converting enzyme inhibitors and beta-blockers was on average below the recommended target dose. More than half of the patients received drugs with unproven effects – antiplatelet agents (59.2%) and metabolic therapy (50.1%).
Key words: dilated cardiomyopathy, registry, prevalence dilated cardiomyopathy (DCM), Heart Failure, concomitant diseases, diagnostic and treatment methods for patients with dilated cardiomyopathy.

 

Prospects of use of microRNAs in the diagnostics and treatment of heart failure
A.G. Kochetov, I.V. Zhirov, V.P. Masenko, R.R. Gimadiev, O.V. Lyang, S.N. Tereshchenko

The review presents the latest data of foreign studies of regulators of the cardiovascular system – microRNA. Their biological role due to the ability to suppress expression of proteincoding genes in post transcriptional stage through mechanisms inhibiting the process of translation or degradation of matrix RNA. The article produces the results of studying the structure and the biological role of microRNAs, and also possibility of their use as biomarkers and therapeutic agents in heart failure.
Key words: microRNA, heart failure, dilated cardiomyopathy.

 

New opportunities in acute decompensated heart failure treatment
I.V. Kositsyna, S.N. Tereshchenko, T.M. Uskach, A.V. Golubev, S.N. Nasonova, I.V. Zhirov

Acute decompensated heart failure (ADHF) was consideredover the years as exacerbation of chronic heart failure due to volume overload which requires short-term intensification of diuretic therapy. To date, multiple evidences was obtained that ADHF is an unique clinical syndrome which has its own epidemiology, pathogenesis and requires specific treatment approaches; it became apparent, that ADHF is different from just worsening heart failure as well as myocardial infarction is something more than angina worsening. Introduction of Serelaxin, recombinant human relaxin-2, to clinical practice is one of the promising directions in ADHF treatment. It was shown in clinical trials that Serelaxin does not only relief signs and symptoms of ADHF, but has an effect on other pathogenetic mechanisms, particularly inflammation, oxidative stress, neurohormonal activation which lead to protection of heart, kidney and other organs during ADHF episode. To date, Serelaxin is the only drug that demonstrated beneficial effect on long-term outcomes in ADHF patients.
Key words: acute decompensated heart failure, chronic heart failure, relaxin-2.

 

Antiphospholipid syndrome and heparin-induced thrombocytopenia: an experience of angioplasty and stenting of the left main coronary artery performing (clinical case)
L.B. Krougly, O.A. Fomichyova, E.E. Vlasova, E.V. Merkulov, V.M. Mironov, M.A. Satybaldyeva, T.M. Reshetnyak, E.P. Panchenko, Yu.A. Karpov, E.L. Nasonov

Antifospholipid syndrome (APS) and heparin-induced thrombocytopenia (HIT) are immune mediated conditions caused by antibodies directed to protein-antigen complex. APS and HIT are associated with thrombocytopenia and with the high risk of development of venous or/and arterial thrombosis. In case of myocardial ischemia because of stenosis formation of the left main coronary artery (LMCA) the performance of the percutaneous coronary intervention in comparison with conservative treatment decreases both the number of complications and the lethality. This is the description of the case of the successful coronary intervention of LMCA of the patient with postinfarction cardiosclerosis and angina caused by the stenosing arteriosclerosis of LMCA when the fact of the presence of APS and HIT forced to choose bivalirudin for anticoagulant therapy.
Key words: antifospholipid syndrome, heparin-induced thrombocytopenia, left main coronary artery stenting, bivalirudin.

 

Genic regulation of matrix metalloproteinase level at patients with coronary atherosclerosis
A.V. Shevchenko, V.F. Prokofev, Yu.I. Ragino, A.M. Chernjavski, V.I. Konenkov

Aim. To analyse associativity of functional polymorphism of genes complex which products influence process of regulation of matrix metalloproteinase production (���), with serum level ���3 and ���9, being markers of risk of atherosclerotic process development.
Sabjects and methods. The analysis of frequency distribution of genotypes combinations of TNF, ��1B, ��4, ��6, ��10 cytokines genes; regulatory sites of Vascular Endothelial Growth Factor VEGF gene, ���2, ���3, ���9 matrix metalloproteinase genes by PCR method at patients with stenosis coronary atherosclerosis which was verified at selective coronographia with various serum level ���3 and ���9 is carried out.
Results. We reveal a number of complex genotypes of the analyzed genes, which are associated with high and low MMP 3 and MMP 9 serum level.
Conclusion. This data confirm complexity of mechanisms of regulation of matrix metalloproteinase production at atherosclerotic processes and emphasize necessity and importance of understanding of complex genic interactions at the analysis of the certain processes.
Key words: atherosclerosis, polymorphism of cytokines genes, matrix metalloproteinase

 

Lysine topography of hyaluronidase globule in silico – the approach to regulable posttranslational modification of enzymes
A.V. Maksimenko, A.D. Turashev, R.S. Beabealashvili

Aim. The knowledge of 3D enzyme structure is important for understanding the mechanism of biochemical reactions and the methods for their regulation. The enzymes of medical destination are actual especially. Such enzyme is bovine testicular hyaluronidase (BTH) destined for therapeutic monitoring the tissue permeability. The 3D structure of BTH is unknown. Due to homological modeling with crystal structure of human hyaluronidase (Chao K.L., Muthukumar L., Herzberg O. Biochemistry, 2007, 46, 6911- 6920) we have builded in silico novel 3D structure of BTH. The aim of research was the analysis of lysine hierarchy of BTH during biocatalyst modification and building the chondroitin sulphate modified BTH 3D model in silico.
Sabjects and methods. We used for alignment of aminoacid sequences the program CLUSTRALx and for local modeling the program Chimera. The check of obtained 3D structure of BTH was performed with help of programs Procheck and WhatCheck/WhatIf. The conditions for building the 3D structure are the vacuum with dielectric constant of isotopic medium inside protein molecule equal 4, outside molecule equal 80, ionic strength of medium equal 0.1 M.
Results. Resulting structure of BTH obtained on the base of five BTH models were identical practically (RMS less 2 A). Quality of 3D model of BTH is the same one as for archetype (human hyaluronidase) and 3D model of BTH modified by chondroitin sulphate was obtained. It was noted the lysine hierarchy of BTH: there are the lysine residuals of different access degree for surface biocatalyst modification.
Conclusion. The obtained date demonstrated the expedience of computational and experimental methods combination for productive biomedical research.
Key words: bovine testicular hyaluronidase, 3D structure model, chondroitin sulphate, modification of lysine residues, modified hyaluronidase-chondroitin sulphate derivative, modification degree of protein, chondroitin sulphate coat.

 

Pulmonary artery denervation in patient with idiopathic pulmonary hypertension
N.M. Danilov, S.L. Chen, �.V. Sagaydak, T.V. Martynyuk, Yu.G. Matchin, I.�. Chazova

Idiopathic pulmonary arterial hypertension is a rare and severe disease with bad prognosis. Traditionally medical care for such patients includes therapy with one or more target drugs. Until recently the only solution for patients with no effect from optimal doses of target therapy was transplantation of heart and lungs. Today prof. Sh. Chen et al. from Nanjing Medical University (China) has demonstrated a new opportunity for such patients – pulmonary artery denervation. After publishing successful results by Sh. Chen the first in Russia and in Europe pulmonary artery denervation was performed in Moscow Cardiology Research Complex.
Key words: idiopathic pulmonary hypertension, pulmonary arterial hypertension, pulmonary artery denervation.

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Oxidative stress causes an increase in arterial stiffness in patients with cardiovascular disease and type 2 diabetes mellitus
E.V. Oskola, A.K. Tikhaze, A.T. Shubina, M.V. Andreevskaya, A.R. Zairova, R.M. Bogieva, G.G. Konovalova, V.P. Masenko, A.N. Rogoza, Yu.A. Karpov, V.Z. Lankin

Aim. To investigate the interrelationship between the oxidative (carbonyl) stress parameters and indicators of arterial stiffness in the aorta (elastic type), common carotid artery (myoelastic type) and radial artery (muscle type) in patients with cardiovascular disease and type 2 diabetes mellitus (DM).
Materials and methods. The study included 65 patients with cardiovascular disease, among them - 43 with type 2 diabetes mellitus and 22 without type 2 diabetes. The estimation of carbohydrate and lipid metabolism, oxidative stress and stiffness of varioustypes of arteries.
Results. It has been obtained significant correlations between the activity of key erythrocyte antioxidant enzymes (superoxide dismutase) and stiffness of elastic vessels (aorta) (r= -0,48; �<0,05) and myoelastic (common carotid artery ) (r= -0,29; �<0,05).
Conclusion. The results indicate effect of free radical oxidation products in the modification (cross-linking) protein molecules, responsible for the elastic internals of the vascular wall (collagen , elastin).
Key words: type 2 diabetes mellitus, free radical processes, vessel stiffness , activities of antioxidant enzymes.

 

Association between different lipoprotein subfractions and coronary atherosclerosis in middle-aged men on statin therapy
E.A. Utkina, O.I. Afanasyeva, M.V. Yezhov, N.V. Artemieva, Yu.G. Matchin, S.M. Bayda, I.Yu. Adamova, S.N. Pokrovsky

The goal of the research was to study the relationship between the content of different subfractions of lipoproteins and the involvement of main coronary arteries in adult males.
Materials and methods. Lipid profiles were determined with «Biocon» kits (Germany). The diagnosis of coronary atherosclerosis was confirmed by coronaroangiography (CAG). Determination of subfractions of low density lipoprotein (LDL) and high density lipoprotein (HDL) was performed using the «Lipoprint system ® Quantimetrix», (USA).
Results. The relationship between the content of the various subfractions of LDL and HDL with coronary atherosclerosis in 110 adult males with clinical indications for coronary angiography was learned. A study group included 92 patients with confirmed coronary atherosclerosis, 18 patients with intact coronary arteries were included in the control group.
The study showed that in patients of the control group the non atherogenic profile A prevailed significantly. The correlation analysis showed that concentration of small dense LDL (sdLDL) in plasma was associated with the level of LDL cholesterol (r = 0,514, p < 0.0001), TG (r = 0,220, p = 0.02) and oxidized LDL (r = 0,298, p = 0.001). Single-factor analysis showed that there is no essential association between the presence of hemodynamically pronounced coronary atherosclerosis and the sdLDL level. Weakly positive correlation (r = 0.05) was observed between the number of affected heart arteries and the content of LDL-3 subfractions Multivariate analysis revealed the existence of the independent inverse association between the presence and/or amount of affected coronary arteries and the concentrations of HDL of intermediate subfractions and intermediate density lipoprotein (IDL).
Conclusion. The results of our study do not suggest sdLDL as an independent CVD risk factor in the examined patients with coronary heart disease that were receiving statin therapy. A strong negative correlation between the concentration of HDL subfractions of intermediate size and the presence and severity of coronary atherosclerosis, that is independent of HDL cholesterol, and can be considered intermediate HDL subfractions as a new diagnostic marker of coronary atherosclerosis, as well as additional anti-atherogenic factor.
Key words: coronary atherosclerosis, low-density lipoprotein subfractions, high-density lipoprotein subfractions.

 

Biologycal function of trophology and the pathogenesis of metabolic syndrome – syndrome of overeating. Phylogenetically theory of general pathology, role of leptin and adiponectin
V.N. Titov

Metabolic syndrome (overeating) is a phylogenetically-determined succession of symptoms with the same pathogenesis. There is only one etiological factor, namely, increased consumption of physiologically optimal food. Enterocytes and omental fat cells are a phylogenetically early paracrine-regulated cell community that realizes the biological reactions of exo- and endotrophy. Visceral obesity, high levels of unesterified fatty acids (FA), formation of a pool of micellar FA in the blood, integration of these FA into endothelial cell plasma membrane and enlargement of adipocytes are the causes of hydrodynamic pressure elevation. Toll-like receptors recognize the associates between albumin and greater than physiological number of FA as “foreing” and initiate inflammatory response. “Endoplasm stress” develops in lipid-overloaded cells, protein synthesis (folding) in them is impaired and apoptosis-like cell death is activated. Visceral fat is a phylogenetically early depot of FA to fulfill the biological function of homeostasis, trophology, endoecology and adaptation; it is regulated at the level of paracrine communities and is anatomically limited. The subcutaneous fat depot fulfills the phylogenetically late function of locomotion; the depot size is not anatomically limited. Visceral fat cells have no receptors for phylogenetically late insulin (INS); specialized adipo�yes bearing INS and GLUT4 receptors are cells that form the subcutaneous depot. These cells are regulated by phylogenetically late humoral factors at the entire body level. Leptin is an initiator of humoral hypothalamic regulation of in vivo number of ontogenetically programmed number of visceral INS-insensitive fat cells. It prevents “endoplasm stress” and apoptosis, being designed to regulate the amount of consumed food. Leptin initiates storage of FA from visceral pool into subcutaneous pool. Adiponectin is a phylogenetically late humoral hypothalamic regulatory factor that controls optimal number of fat cells in vivo. Its biological role consists in regulation of the number (proliferation) of insulindependent adipocytes in subcutaneous fatty tissue.
Key words: metabolic syndrome, unesterifed fatty acids, fatty cells and adipocytes, leptin and adiponectin

 

Eosinophilic cationic protein and its role in patients with coronary artery disease.
F.F. Byazrova, V.V. Buza, V.V.Lopukhova, K.A. Zykov, Yu.A.Karpov

In recent years, during a more detailed study of the pathogenetic aspects of atherosclerosis, there have been assumptions about a possible involvement in the process of eosinophilis. Its effect on the surrounding tissues is realized by allocating several proteins among which a special role is given to the eosinophil cationic protein (ECP).The ECP level is defined in most biological fluids and may be used as a marker of eosinophil activity. Several studies have showed that the elevated level of the initial ECP is a predictor of adverse cardiovascular events in patients after implantation of drug-eluting stents. An allergic reaction to the stent components possibly plays a role in development of late restenosis in drug-eluting stents. In this regard, our institute is working on assessing the severity of the eosinophilic inflammatory response after implantation of drugeluting stents, and we are studying the possibility of using the ECP as a predictor of adverse events in patients after stents are implantated. We hope that the findings will help facilitate understanding of the role of eosinophilis and ECP in patients with coronary artery disease and whether the ECP has an impact on the pathogenesis of atherosclerosis or is an independent predictor of adverse cardiovascular events in patients with coronary atherosclerosis.
Key words: eosinophilic cationic protein, coronary atherosclerosis, stenting, restenosis

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Mesenchymal stem cells: perspectives of cardiologic application
A.B. Smolyaninov, D.A. Ivolgin, A.A. Aizenshtadt

Since the description of mesenchymal stem cells as a separate cell type a lot of researches both preclinical (animal models) and clinica, for their application in various fields of medicine were carried out. One of the important directions of studying of MSCs is their use in cardiology as well as diseases of the cardiovascular system is still a leader in the structure of mortality. This paper describes the main sources of mesenchymal stem cell:s bone marrow, adipose tissue, umbilical cord, and others, with their comparative performance. Also the paper gives an overview of the results of recent trials of mesenchymal stem cells application in animal models and the results of ongoing clinical trials. The article describes the properties of human mesenchymal stem cells: ability to migrate and engraftment, differentiation into other cell lines, secretion of biologically active compounds. Also, the principles of application of MSCs in cardiology and basic mechanisms of action of mesenchymal stem cells with a focus on the use of various diseases of the circulatory system are given. Also promising areas of study and use of mesenchymal stem cells in cardiology are shown as well.
Key words: stem cells, tissue engineering, ischemic heart disease, cardiac decompensation.

 

Coronary artery bypass grafting for patients with recurrence angina after angioplasty and coronary stenting
R.S. Akchurin, A.A. Shiryaev, D.M. Galyautdinov, V.P. Vasilev, B.A. Rudenko, A.S. Kolegaev, D.I. Cherkashin, A.V. Emelianov, Yu.V. Vdovenko

Objective. Evaluation of the efficiency of coronary artery bypass grafting (CABG) and repeated percutaneous coronary intervention (PCI) for patients with recurrence angina after preceding coronary stenting.
Materials and methods. Outcomes of patients who had repeated angioplasty and stenting (80 observations in PCI group) or CABG after stening (72 observations in CABG group) were analyzed. All patients had PCI during periods from 3 months to 6 years. The endpoints of our study were: recurrence angina, reintervention, repeated hospitalization, due to cardiovascular disease, myocardial infarction (MI) and mortality. The follow-up period was one year.
Results. The clinical outcomes in the groups did not vary at the hospital stage. After one year of follow-up the differences in mortality (2,5% in PCI group and 0% in the CABG group) and incidence of MI (5,0 and 1,3% respectively) did not reach the statistical significance. However, reliable differences in recurrence angina (36 � 9,2%; �<0,05), repeated interventions (21 and 1,3%; �<0,05) and the necessity of antianginal drugs intake (26 and 4%; �<0,05) with the best results in the CABG group were distinguished.
Conclusion. IN one year after intervention the efficacy of surgical coronary revascularisation was significantly higher than repeated endovascular interventions for patients with recurrence angina after coronary stenting.
Key words: coronary artery disease, coronary artery bypass grafting, coronary stenting, microsurgical technique, coronary endarterectomy.

 

Hospital results of treatment of acute coronary syndrome without ST-segment elevation in multivessel coronary artery disease, depending on the method and strategies of revascularization
L.S. Barbarash, V.I. Ganyukov, V.A. Popov, R.S. Tarasov, S.A. Torgunakov, N.A. Kochergin, O.L. Barbarash

Aim. The purpose of the study was to evaluate the hospital outcomes of different approaches to the treatment of patients with non-ST elevation acute coronary syndrome (non-STEMI) with multivessel disease (MV) based on the single-center registery.
Methods. One hundred fifty non-STEMI patients were enrolled in the study in 2012. The inclusion criteria was verified two or more significant (≥70%) stenosis of the epicardial arteries and/or ≥50% stenosis of the left main. The endpoints of the study were major adverse cardiac events (death, myocardial infarction, cerebrovascular accident, target vessel revascularization, bleeding).
Results. The strategy of revascularization for the majority of patients (n=91; 60,6%) was percutaneous coronary intervention (PCI), which was performed in 103 (68,6%) patients. Coronary artery bypass grafting (CABG) was recommended to 40 (26,6%) patients, but was implemented only in 25 (16,6%) patients. Hybrid strategy (PCI and CABG) recommended to 10 (6,6%) patients, but was made only in 4 (2,6%) cases. Conservative strategy was elected for 9 (6%) patients, but has been implemented in 18 (12%) patients. Hospital mortality (15,3±4,2 day) in the overall cohort was 8,7%. In PCI group – 5,8%, 8% in CABG group, and 27,8% in conservative strategy group.
Conclusions. The majority of non-STEMI patients with MV disease are candidates for emergency or urgent PCI, which can be successfully performed. However, a significant proportion of patients should be considered as candidates for CABG. A significant proportion of patients requiring revascularization by CABG does not get it at the optimum time, which leads to the conversion of a number of non-STEMI patients to conservative therapy associated with a very poor prognosis.
Key words: acute coronary syndrome, multivessel disease, revascularization strategy, PCI, CABG.

 

Gender factor and risk of the development cardiovascular diseases in HIV – infected patients with safe immune function
I.I. Chukayeva, I.V. Komarova, A.V. Kravchenko, T.E. Kushakova

Aim. To evaluate the role of gender factor in the development of traditional and «new» cardiovascular risk factors in HIV – infected na�ve and on antiretroviral therapy patients with safe immune function.
Materials and methods. We have examined 21 na�ve HIV – infected patients without chronic disesases, 106 HIV – infected patients on antiretroviral therapy without chronic diseases, in control group was included 29 patients without HIV infection and chronic diseases. In all patients was evaluated lipid, carbohydrate, inflammatory and coagulator profile.
Results. We have discovered significant lower level of total cholesterol, low density lipoproteins and high density lipoproteins in na�ve HIV – infected man in comparison with HIV – infected patients man on antiretroviral therapy and men in control group. Also we have discovered significant higher level of tumor necrosis factor – a? in na�ve HIV – infected men and women in comparison with HIV – infected men and women on antiretroviral therapy and men and women in control group. We have found significant higher level of WF in na�ve HIV – infected men in comparison with na�ve HIV – infected women and HIV – infected men on antiretroviral therapy and men in control group.
Conclusion. Based on received data we can conclude, that in HIV – infected patients is retained the protection role of female sex in the development of traditional and «new» risk factors and effective antiretroviral therapy helps to decrease theirs expression in HIV – infected men.
Key words: cardiovascular diseases, risk factors, gender factor, HIV, antiretroviral therapy.

 

The influence of redox interaction components on comparative fibrinolysis in vitro
A.V. Vavaev, A.D. Turashev, A.V. Vavaeva, N.M. Kutuzova, A.V. Maksimenko

Aim. To elicit the influence of redox interaction (hydrogen peroxide and superoxide dismutase-chondroitin sulphate-catalase /SOD-CHS-CAT/conjugate) on fibrinolysis within and outward fibrin clot.
Materials and methods. Hydrogen peroxide and SOD-CHS-CAT were added to thrombin/fibrinogen mixture of forming fibrin clot (within it) or in buffer solution with urokinase and plasminogen (outward clot) for further control of fibrinolysis in model system in vitro.
Results. Hydrogen peroxide induced fibrinolytic resistance at any localization of it. Conjugate of SOD-CHS-CAT incorporated in fibrin clot decreasing antioxidant action and fibrinolysis. Simultaneous presence of bienzyme conjugate and hydrogen peroxide conduced the most high fibrinolysis.
Conclusion. Optimum of effective antioxidant doses and timeliness of its administration are determinant for efficient fibrinolysis at oxidative stress.
Key words: fibrin clot, oxidative stress, fibrinolysis, hydrogen peroxide, antioxidants, bienzyme superoxide dismutase-chondroitin sulphate-catalase conjugate, clot structure, resistance to fibrinolysis.

 

�hange in length of telomeres of the chromosomes under the influence of the climatic conditions that simulate hot weather at Moscow in summer 2010
N.A .Doroshuk, A.D. Doroshuk, O.V. Rodnenkov, M.K. Osyaeva, Z.B. Hasanova, Yu.D. Hesuani, A.Yu. Postnov, I.E. Chazova

The purpose of the study. To examine the state of telomeric repeats in chromosomes in Moscow and the impact of adverse weather conditions (simulating the conditions of heat, 2010 in Moscow) at the telomeres of chromosomes in peripheral blood leukocytes.
Materials and methods. DNA isolated from the peripheral blood of the inhabitants of Moscow and from the blood of six volunteers were in a separate room, where the heat conditions were reproduced in 2010 in Moscow. The relative telomere length was measured on the device in real-time PCR. Mathematical calculation of the relative telomere length was produced by the developed method.
Results. Developed a method for the mathematical calculation of relative telomere length. Defined relative norm length of telomeric repeats for residents of the Western District of Moscow.
Conclusion. Demonstrated a significant decrease in the relative telomere length is 16,5% of individuals in situations of hyperthermia, as well as elevated levels of CO.
Key words: the relative length of telomeres, DNA, real-time PCR.

 

Tone of the autonomic nervous system at different carbon monoxide in the atmosphere
A.V. Demin, A.V. Suvorov, Y.A. Shulagin

Aim. Set the tone changes autonomic nervous system (ANS) in healthy subjects with different content of carbon monoxide (CO) in the breathing air.
Materials and methods. In the paper, a statistical analysis of the effect of increased carbon monoxide in the atmosphere on the tone of the autonomic nervous system of six healthy people – crew hermetic object NEC RF SRC – Institute of Biomedical Problems. Blood pressure and heart rate were measured with tonometer Omron M10-IT. CO concentration in the alveolar air and the gas analyzer measured Micro CO and CO using gas chromatography-mass spektrometrometrich system with mass spectrometry-based Agilent 5973N GC Agilent 6890. HbCO in capillary blood tested for the CO-oximeter ABL800 FLEX.
Results. Found that the concentration of carbon monoxide factor significantly influenced the calculated parameters of circulatory vegetative index Kerdo – integrative physiological characterization human cardiorespiratory system, which has a physical sense. At levels of CO in the atmosphere 5 ppm and >12 ppm averages % HbCO were respectively 1,35±0,15% and 3,92±0,61%.
Conclusion. In 4 of 6 test with increasing levels of carbon dioxide in the atmosphere, the tone of the autonomic nervous system has changed unidirectionally toward limiting sympathetic tone.
Key words: statistical analysis, the tone of the human autonomic nervous system, Kerdo’s index, carbon monoxide, sealed volume.

 

The impact of climatic and meteorological factors on the course of ischemi heart disease
Y.A. Karpov, O.S. Bulkina, V.V. Lopukhova, I.L. Kozlovskaya

Weather factors influence the course of ischemic heart disease. The evidence of this influence is controversial. High and low air temperature, especially during a long-term period (temperature waves), barometric pressure and its fluctuations, relative air humidity and wind are considered to cause adverse effects. The relation between people’s health and weather factor is modulated by gender, age, chronical disease, conditions of life and labour, race, bad habits, living standards. While the fine mechanisms of deleterious weather impact remains unclear, the protective measures mostly come to the limitation of exposure. International programs and projects are launched by the WHO, The World Bank for the purpose of health preservation in the changing climate. The Recommendations for Climate Change Risk and Damage Assessment have been worked out and applied in our country.
Key words: ischemic heart disease, cardio-vascular disease, moratality, morbidity, climate, weather, air temperature, relative air humidity, barometric pressure, wind, snow cover, precipitation.

 

Unesterified and free fatty acids in blood plasma. Pathogenesis of arterial hypertension and symptoms of the overeating syndrome – metabolic syndrome (lecture)
V.N.Titov

We believe that, physiologically, metabolic syndrome is a syndrome of overeating, when food optimal in the fatty acid (FA) composition becomes non-physiologically abundant. This results in omental weight gain. Oleic triglycerides (TG) are accumulated in the adipocytes of the omentum and after activation of lipolysis at the level of paracrine-regulated cell communities and organs release considerable amounts of unesterified FA (UNFA) in the bloodstream, where they cannot be bound by albumin. Albumin-unbound polar FA, i.e., free FA form linear heterogeneous micellae that are spontaneously integrated into the plasma membrane of endothelial cells with formation of hydrophilic lipid pores via which ��++, Na+ and water enter the cell, and �+ leaves it. Hydration of the cytozol and hypercalcemia increase endothelial thickness, decrease the lumens of arterioles and increase blood flow resistance in distal arterial bed. A compensatory increase in hydrodynamic pressure in the proximal arterial bed leads to arterial hypertension. Phylogenetically late insulin (INS) cannot block lipolysis in omental adipocytes that lack INS-specific receptors. At high plasma content of UNFA cells do not uptake and oxidize glucose; thus, UNFA form INS resistance, hyperglycemia and hyperinsulinemia with an increase in blood TG concentration. An increase in the number of TG-overloaded adipocytes in loose connective tissue is a prerequisite of the biological reaction of inflammation up to apoptosis-like death of TG-overloaded cells, which coincides with high plasma content of C-reactive protein.
Key words: unesterified fatty acids, lipid pores, Na+, �+-��Pase, arterial hypertension, insulin resistance, metabolic syndrome.

 

Advanced diagnostic methods of �ardiac syndrome X
I.E. Karpova, G.N. Soboleva, L.E. Samoilenko, YU. A.Karpov

This review article is devoted to the diagnostic capabilities of Holter monitoring of ECG, stress testing, stress echocardiography, single photon emission computed tomography, positron emission tomography, and magnetic resonance imaging in combination with diagnostic tests for verification of myocardial ischemia in patients with Cardiac syndrome X. The review also contains the crucial questions of the pathogenesis of microvascular angina and contemporary diagnostic criteria.
Key words: cardiac syndrome X, microvascular angina, ischemic heart disease with normal coronary arthery.

 

Synthesized vectorcardiogram: past and future
E.V. Blinova, T.A. Sakhnova

The review presents the history of the use of synthesized vectorcardiography in various cardiovascular diseases, the basic methods of calculating vectorcardiogram from 12-lead ECG, highlights the prognostic and diagnostic value of the spatial QRS-T angle.
Key words: electrocardiogram, synthesized vectorcardiogram, 12-lead vectorcardiography, the spatial QRS-T angle.

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The history of the Cardiology Society in our country
E.I. Chazov

Parameters of microcirculatory blood flow in human skin under long-term thermal stress (model experiment)
�.�. Fedorovich, O.V. Rodnenkov, N.V. Ageeva, M.K. Osyaeva, A.N. Rogoza

Aim – to study peculiarities of skin microcirculatory blood flow of the upper limbs according to laser Doppler flowmetry (LDF) and computer capillaroscopy (CCS) during the model experiment, restoring the conditions of the hot summer of 2010.
Material and methods. The study included 6 healthy men aged 24 to 44 years (34,3�}9,6), who stayed in the airproof accommodation module for 30 days, with constant day temperature +30…+38°� (33,9�}2,3), relative humidity 30–50% (38,3�}6,9) and night temperature values +26…+31°� (28,1�}1,5), relative humidity 50–75% (68,5�}7,1). Investigation of microvasculature was performed twice a day (in the morning and evening) every other day in the sitting airproof accommodation module with air temperature +29…+30°� and humidity 30%.
Results. According to LDF data, the increase of cutaneous perfusion and amplitudes of endothelial, neurogenic and myogenic mechanisms of microvessels vasomotions was not detected. During the increase of the amplitude of respiratory blood flow oscillations there was determined the reduction of the amplitude of pulse fluctuations. After 6–8 days of the experiment was marked stable and significant elevation in the constrictor activity of skin microvessels with sympathetic nervous system activation and venoarteriolar constrictor response. According to the CCS, there were marked a dramatic increase in the capillary blood flow speed ����� 3500 Mm/s and significant elevation in the size of pericapillary zone (PZ), reflecting the hydration degree of the interstitial space. PZ had distinct daily fluctuations – in the morning it was higher (p<0,000001) than in the evening and significantly correlated with systolic blood pressure level: r=-0,59 (p=0,000000002), and diastolic blood pressure level: r=-0,46 (p=0,000007).
Conclusion. Under the conditions of long-term thermal stress the efficiency of skin thermoregulatory processes is determined by functioning of: 1) mechanism of arteriolovenular shunt perfusion in all cutaneous layers; 2) efficiency of filtering processes at the capillary level, which is necessary for sweat production. During long-term thermal stress a high constrictor activity of skin microvessels on all constrictor stimulus types.
Key words: heat stress, thermoregulation, microcirculation in human skin, laser Doppler flowmetry, capillaroscopy, constriction of microvessels, arteriolovenular shunting, pericapillary zone, blood pressure, blood viscosity.

 

The influence of summer heat on the parameters of oxidative stress in patients with cardiovascular disease
M.D. Smirnova, G.G. Konovalova, A.K. Tikhaze, M.K. Osyaeva, O.N. Svirida, L.G. Ratova, A.Yu. Postnov, F.T. Ageev, V.Z. Lankin, I.E. Chazova

Aim. To study the effect of summer heat on the cardiovascular system, oxidative stress development and disease course in patients with cardiovascular pathology.
Material and methods. Under clinical examination in the blood of patients with cardiovascular disease determined the content of oxidized low density lipoprotein, the level of 2-thiobarbituric acid reacting substances (malondialdehyde) and superoxide dismutase activity by using standard test kits.
Results. During the summer heat in the examined patients were observed oxidative stress development (increasing of levels of the primary and secondary products of free radical lipoperoxidation) and, as a consequence, exacerbation of cardiovascular disease. During the subsequent autumn lowering of temperature we found the normalizing of oxidative stress parameters.
Key words: free radical peroxidation, oxidized low density lipoprotein, malondialdehyde, superoxide dismutase, heat wave, exacerbation of cardiovascular disease.

 

Oxidative stress as a risk-factor for complications of cardiovascular disease and premature aging under the action of adverse climatic conditions
V.Z. Lankin, A.Yu. Postnov, O.V. Rodnenkov, G.G. Konovalova, N.A. Doroschuk, A.K. Tikhaze, M.K. Osyaeva, A.D. Doroschuk, Yu.D. Hesuani, I.E. Chazova

Aim. To investigate the influence of environmental factors (as a high temperature and an increase of CO in the air) on the basic parameters of oxidative stress (the content of free radical lipoperoxidation secondary product – malondialdehyde and activity of key antioxidant enzymes – catalase and glutathione peroxidase), as well as the oxidative injury of DNA molecules, in particular, the changes of the relative length of telomeric regions of DNA.
Material and methods. 6 RAS healthy volunteers (man aged 22 to 46 years) were exposed to artificial climatic conditions that occurred in July and August 2010 in Moscow. At the baseline and 30 days after the end of the test subjects to determine the level of malondialdehyde in plasma, catalase and glutathione peroxidase activity in red blood cells as well as the relative length of telomeric repeates in leukocyte chromosomes.
Results. After 30 days in the conditions of hyperthermia and hypoxia in the subjects showed a significant increase in malondialdehyde (+62%) and decreased activity of key antioxidant enzymes – catalase (-11%) and glutathione peroxidase (-19%). At the same time marked decrease in telomere length (-16,5%). These results indicate about the development of oxidative stress that can trigger complications of heart disease and premature aging.
Key words: reactive oxygen species, free radical peroxidation, malondialdehyde, catalase, glutathione peroxidase, DNA, telomere shortening.

 

Non-invasive assessment of myocardial contractility in rats
V.V. Ermishkin, E.V. Lukoshkova, V.L. Lakomkin, A.A. Abramov, V.A. Kolesnikov, S.V. Lakomkin, V.I. Kapelko 

Aim. To study in experiments on anesthetized rats the impedance method of myocardial contractility assessment, previously proposed for men, which is based on evaluation of preejection period (PEP).
Materials and methods. The modified impedance method adapted for rats combined with insertion of Millar tip catheter into aorta or the left ventricle has been used in anesthetized rats.
Results. The PEP estimates determined by impedance and invasive catheter methods manifested a very close correlation (r=0,95) and differed by only 5–6 ms. Also, a suitable correlation (r=0,75–0,78) was found between the PEP and invasive indices of myocardial contractility, dP/dtmax and dP/dtmax/P both in the control state and under the positive action of dopamine or negative effect of ketamine on myocardial contractility. Meanwhile, alterations in cardiac diastolic filling or arterial pressure level caused by tilt test or hypotensive drug, oxacom, also may influence PEP.
Conclusion. The value of PEP, as well as many invasive contractility indices, not only reflects changes in myocardial contractility per se, but also depends on mechanical factors influencing the cardiac performance. This should be taken into consideration when using PEP in experimental practice.
Key words: noninvasive method, cardiac contractility, impedance cardiography, preejection period, Millar pressure catheter, maximum rate of left ventricular contraction, anesthetized rats.

 

The association of mutations in mitochondrial genes of subunits 1, 2, 5 and 6 of NADH-dehydrogenase with atherosclerotic lipofibrous plaques in human’s aortas
M.A. Sazonova, S.D. Nurbaev, A.V. Zhelankin, M.M. Ivanova, K.Yu. Mitrofanov, I.A. Sobenin, A.Yu. Postnov

Aim of the study. The aim of this study was a pilot analysis of the heteroplasmylevel in 11 mutations in mitochondrial genes of subunits 1, 2, 5 and 6 of NADH-dehydrogenase in lipofibrous plaques and normal intima of human aortas.
Materials and methods. The materials for the study aretissue samples from aortal intima of 7 people, who died by accident or who had sudden death. Normal (unaffected) aortic intima was compared to lipofibrous plaques. Amplified by PCR fragments of DNA containing regions of investigated mutations were analyzed by original method of quantitative assay of mutant allele in mitochondrial genome, based on pyrosequencing technology.
Results. The level of heteroplasmy in lipofibrous plaques was significantly higher in comparison with normal (unaffected) vascular tissue in 29% aortic samples for �3336� and G14459A mutations, in 57% for C5178A mutation, and in 86% for G13513A mutation.<
Conclusion: Mutations �3336�, C5178A, G13513A, G14459A of mitochondrial genes of subunits 1, 2, 5 and 6 of NADHdehydrogenase are associated with atherosclerotic lesions.
Key words: mitochondrial mutation, heteroplasmy, atherosclerosis, intima, lipofibrous plaque, gene of NADH-dehydrogenase.

 

Morphologic features of atherosclerotic plaques in in relation to degree of coronary artery stenosis in patients with stable ischemic heart disease M.G. Mitroshkin, Yu.G. Matchin, M.S. Safarova, R.N. Adzhiev, M.V. Ezhov, V.V. Kukharchuk

Aim. To evaluate coronary plaque composition assessed by virtual histology intravascular ultrasound (VH-IVUS) in stable ischemic heart disease (SIHD) patients in relation to degree of stenosis assessed by quantitative coronary angiography (QCA).
Material and methods. We have included 50 patients (33 men, mean age 56�}8 years) with SIHD scheduled for clinically indicated coronary angiography. The degree of arterial stenosis was determined by QCA. VH-IVUS was performed in ≥1 native coronary arteries with a nonobstructive atheroma (20–75% narrowing of the luminal diameter), in segments free of major side branches and not treated by endovascular methods. Qualitative and quantitative IVUS analysis was performed according to international guidelines.
Results. IVUS-VH was performed in 92 lesions of the 52 coronary arteries. Thin-cap fibroatheromas were found in 17 (19%) segments in 12 (24%) patients. Of 92 lesions, 35 had a degree of coronary artery stenosis less than 50% stenosis, in 57 lesions degree of stenosis was ≥50%. There were not difference between significant and non-significant lesions by total atheroma volume (150�}71 mm3 vs 129�}71 mm3; p=0,3), necrotic core volume (23,9�}18,4 mm3 vs 19,2�}15,0 mm3; p=0,3), the volume of fibrous component (52,5�}24,5 mm3 vs 52,0�}33,7 mm3; p=0,9). However, significant stenosis had a higher calcium content comparing with non-significant lesions (11,6�}9,6 mm3 vs 6,2�}5,6 mm3; p=0,03). Correlation analysis did not reveal any correlation between the degree of narrowing of coronary arteries, atherosclerosis risk factors, and atheroma components.
Conclusion. There is unstable plaque phenotype in 24% patients with stable ischemic heart disease. The plaque composition does not depend on the degree of artery stenosis excepting higher calcium content in significant lesions.

 

Changes of orthogonal electrocardiogram in hypertensive patients with hyperaldosteronism
T.A. Sakhnova, E.V. Blinova, N.M. Chikhladze, Z.S. Valieva, A.A. Ermalitskaya, M.A. Saidova, S.V. Dobrovolskaya, A.N. Rogoza, I.Ye. Chazova

Objective – to study the changes of electrocardiogram (ECG) in patients with hypertension in comparison with the concentration in plasma aldosterone (CAP), echocardiographic data and ambulatory blood pressure monitoring (ABPM).
Materials and methods – parameters of orthogonal ECG, echocardiography and ABPM were evaluated in 40 patients with hypertension: 11 patients with CAP more than 150 pg/ml and 29 with CAP less than 150 pg/ml.
Results. In patients with CAP more than 150 pg/ml, there was a significant increase in the value of orthogonal ECG parameters used for diagnosis of left ventricular hypertrophy, there was a tendency to increase in end-diastolic dimension, wall thickness (WT), left ventricular myocardial mass (LVMM) and left ventricular myocardial mass index (ILVMM); there were no statistically significant differences in blood pressure levels between the groups. Statistically significant direct correlations between RX+SZ and the angle f and echocardiographic parameters LVMM, ILVMM and WT were revealed. Orthogonal ECG parameters SQRSxyz, SQRSxz and IADIM did not have any significant correlations with echocardiographic parameters.
Conclusion. ECG parameters in hypertensive patients with increased CAP can be influenced not only by the increase in LVMM, but also by the processes of electrical remodeling.
Key words: left ventricular hypertrophy, arterial hypertension, electrocardiography, aldosterone.

 

Renal replacement therapy after endovascular and hybrid operations on the heart and vessels
E.A. Tabakyan, A.E. Komlev, A.A. Margolina, S.A. Partigulov, M.G. Lepilin, R.S. Akchurin

Aim. To analyze the rationale for and efficacy of hemofiltration and hemodialysis used to prevent and treat acute kidney injury after hybrid operations on the heart and vessels.
Subjects and methods. The patients underwent coronary angioplasty, hybrid cardiac surgery: transcatheter aortic valve replacement, endovascular thoracic and abdominal aortic replacement in combination with left common carotid and subclavian artery bypass surgery, autovenous aortocoronary bypass without extracorporeal circulation. Low- and iso-osmolar contrast media (CM) were used in visualization. The risk for CM-induced nephropathy (CMIN) was assessed, as described by B.Barrett and P.Parfrey. Hemofiltration and hemodialysis were performed using a Diapact CRRT apparatus. The replacement solution DuosolR was utilized. Heparin was used as an anticoagulant.
Results. Hemofiltration was carried out in 8 patients with Stage III acute renal failure (ARF) according to RIFLE (2004) or acute kidney injury according to AKIN (2007). Multiple organ dysfunction occurred in 4 cases. Two patients died; six cases showed ARF regression and renal function recovery. Hemofiltration and plasmapheresis were done in one case of multiple organ dysfunction, hyperbilirubinemia, hyperenzymemia. In 4 patients at very high risk for ARF, hemofiltration or hemodialysis was performed prophylactically, just after cardiac surgery. There was no significant reduction in glomerular filtration rate or development of ARF following renal replacement therapy (RRT).
Conclusion. The causes of ARF after endovascular and hybrid operations on the heart are not only CM injection, but also perioperative complications: atrial fibrillation, hypovolemia, and hypotension. In cases of ARF, RRT eliminates life-threatening metabolic disturbances. In patients at very high risk for CMIN, RRT performed after surgery with CM injection prevents the significant reduction in glomerular filtration rate and the development of ARF.
Key words: hybrid cardiac surgery, coronary angioplasty, acute renal failure, hemofiltration, hemodialysis.

 

Heart rate turbulence parameters and its relationship with left ventricular ejection fraction and ventricular arrhythmias in patients, candidates for coronary artery bypass grafting
E.N. Dyuzheva, G.V. Ryabikina, A.V. Sobolev, A.E. Vlasova, R.S. Akchurin

Background – t� study the association of heart rate turbulence (HRT) parameters with left ventricular ejection fraction (LVEF) and ventricular arrhythmias (VA) before and after coronary artery bypass grafting (CABG).
Materials and methods. We studied 58 – multiple coronary vessel disease patients, mean age 63�}8 (16 – with LVEF=32�}6%, 42 – with LVEF=56�}7%). 44(76%) previously had myocardial infarction, 14 (24%) – diabetes mellitus. 17 controls with normal LVEF without CAD – comparable by age and sex. All underwent Holter monitoring (HM): we determined turbulence onset – TO, turbulence slope – TS (mean, maximum, minimum) before CABG. HM was repeated in 7–14 days and 4–6 mounth after CABG.
Results. There was significant difference in TO and TSmean between coronary artery disease (CAD) and control groups. TOmax was significantly higher in low LVEF subgroup (LVEFs) compared with preserved LVEFs. Preoperative TOmax moderately correlated with postoperative ventricular premature complexes – VPCs (r-0,5, p<0,05). Patients with postoperative unsustained ventricular tachycardia (VT) had significantly higher preoperative TOmax; 11 vs 5,9, p<0,05. Preoperative TSmin moderately correlated with postoperative ventricular premature complexes (VPCs) and ventricular pairs – VP (r=-0,6, p<0,05). If preoperative TSmin was less than -2, than there were significantly more postoperative VPCs and VP.
Conclusion. Interdependences were identified between preoperative TSmin TOmax and ventricular arrhythmias in the early postoperative period.
Key words: heart rate turbulence, ventricular arrhythmia, coronary artery bypass grafting.

 

Thrombus extraction from the coronary arteries in acute coronary syndrome
O.Yu. Mironova, R.M. Shakhnovich

The introduction of new methods of reperfusion therapy, both pharmacological and mechanical, contributed to the increase of survival rate of patients presenting with acute coronary syndromes in the last decades. Thrombectomy seems to be one of the most promising methods nowadays which is confirmed by many large randomized trials’ results and by the latest guidelines. This review article contains the latest information about the main methods, devices, indications, contraindications of thrombectomy and the main randomized trials’ conclusions.
Key words: thrombectomy, rheolytic thrombectomy, manual thrombectomy, thrombotic masses, reperfusion therapy.

 

The power of the climate. Impact of heat waves on human health. Part 1
F.T. Ageev, O.N. Svirida, M.D. Smirnova

In the era of anthropogenic climate change the questions of the influence of heat waves on human health appear to be urgent and topical. In this article we review the features of high temperature on the vital function, including the body aging. Risk factors for heat-related illness and mortality during heat waves are also analyzed here.
Key words: heat waves, risk factors, climate, acclimatization, thermoregulation.

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