СОДЕРЖАНИЕ
CONTENTS
CLINICAL MEDICINE NEWS
Clinical medicine updates: a review of international news
Russ J Cardiol 2013, 5 (103): 5
ORIGINAL ARTICLES
HEART RATE VARIABILITY AND HEMOSTATIC PARAMETERS IN PATIENTS WITH CORONARY HEART DISEASE AND CHRONIC HEART FAILURE
Buy M. Z., Lebedeva A. Yu., Gordeev I. G., Volov N. A., Taratukhin E. O.
Abstract
Aim. To assess the association between the changes in heart rate variability (HRV) and hemostatic parameters in patients with coronary heart disease (CHD) and chronic heart failure (CHF) as its complication.
Material and methods. In total, 65 patients were examined at the O. M. Filatov City Clinical Hospital No. 15. The main group included 51 patients with CHD and CHF (35 men, 16 women; mean age 62±6 years). The control group included 14 CHD-free patients with arterial hypertension (7 men, 7 women; mean age 56±7 years). The examination included standard methods, plus the assessment of HRV and a wide range of coagulogram parameters.
Results. CHD patients with CHF demonstrated the hyperactivation of sympathetic nervous system, which was manifested in increased LF/HF (up to 2,5 U), together with the suppression of parasympathetic activity (SDNNi decrease up to 39,1 ms; p<0,05). Circadian sympathetic-parasympathetic interactions were persistently disturbed, with increased sympathetic effects on cardiac rhythm and inadequately increased parasympathetic activity during nighttime (LF/HF circadian index 1,0±0,5; p<0,001). The main group demonstrated a significant increase in protrombin index (83,4±22,7% vs. 68,5±11,23%; p<0,05), increased ADP-induced (0,5 μM) platelet aggregation (1,42±0,45 U vs. 0,98±0,42 U), and increased thrombin time (18,6±6,4 vs. 12,9±2,9; p<0,01). In CHD and CHF patients who had higher levels of sympathetic activation (LF/HF >2,0 U), protrombin time was reduced by 10,9%, while hematocrit was increased by 10,2%. In patients with elevated spontaneous platelet aggregation, increased sympathetic tone during nighttime was manifested in the reduction of mean cardiac interval duration (893,1±111,5 ms vs. 982,7±66,7 ms; p<0,05). The increase in nighttime sympathetic activation (nighttime LF/HF >2,0) was associated with a significant reduction (–20%) in ADP-induced platelet aggregation.
Conclusion. Chronic pathological sympathetic hyperactivation in patients with CHD and CHF affects hemocoagulation parameters. Increased spontaneous platelet aggregation, reduced protrombin time, and elevated hematocrit, together with catecholamine-induced vasospasm, might increase the risk of thrombotic complications.
Russ J Cardiol 2013, 5 (103): 6–11
Key words: coronary heart disease, chronic heart failure, sympathetic nervous system, hemostasis.
Hospital Therapy Department No. 1, N. I. Pirogov Russian National Medical Research University, Moscow, Russia.
PULSE WAVE VELOCITY AS A CARDIOVASCULAR RISK MARKER IN PATIENTS WITH STABLE CORONARY HEART DISEASE
Ilukhin O. V.1, Ilukhina M. V.3, Tarasov D. L.2, Temirsultanova T. Kh.2, Lopatin Yu.M.1,2
Abstract
Aim. To assess pulse wave velocity (PWV) as a potential marker of adverse prognosis, compared to conventional factors of cardiovascular risk.
Material and methods. The study included 184 patients with myocardial infarction (MI). The MI diagnosis was confirmed by the presence of pathologic Q-wave on electrocardiogram and/or diagnostic elevation of cardiac biomarkers. Carotidfemoral PWV, reflecting the status of elastic arteries, was assessed using a standard method, with the automatic computerised system Colson (France). The follow-up period (from the start of the study to either the end-point development or the study end) varied from 1 to 60 months. The Kaplan-Meier method was used for the assessment of cumulative survival.
Results. In patients with coronary artery disease (CHD), the five-year survival was 0,89 among those with PWV <10 m/s (8,3±0,13 m/s); 0,84 among those with PWV 10–12 m/s (11,1±0,32 m/s); and 0,44 among those with PWV ≥12 m/s (13,3±0,21 m/s). This difference was statistically significant. Moreover, among patients under 60 years, survival was 90,7%, while in their peers aged 60 years and older, it was only 78%. Among 184 participants, 54 had reduced left ventricular ejection fraction (LVEF) values (<40%). The five-year survival in those with LVEF>40% and <40% as 89,2% and 68,9%, respectively (the difference was statistically significant). In patients with type 2 diabetes mellitus, the survival was 69,6%, which was 19% lower than in patients with preserved systolic function.
Conclusion. In CHD patients, increased PWV has a prognostic value similar to that for conventional cardiovascular risk factors and, therefore, can be regarded as an additional novel predictor of adverse prognosis.
Russ J Cardiol 2013, 5 (103): 12–17
Key words: pulse wave velocity, arterial stiffness, cumulative survival, risk factors.
1State Medical University, Volgograd; 2Regional Clinical Cardiology Centre, Volgograd; 3Regional Clinical Hospital No. 1, Volgograd, Russia.
PREDICTING THE LONG-TERM RISK OF REPEAT CORONARY EVENTS IN PATIENTS WITH UNSTABLE ANGINA
Markova I. A., Medvedeva E. A., Gelis L. G.
Abstract
Aim. To stratify the patients with unstable angina (UA) by the levels of long-term (12 month) risk of repeat coronary events.
Material and methods. The study included 180 UA patients, who were divided into two groups: with or without adverse outcomes (death, myocardial infarction, recurrent UA, urgent myocardial revascularisation, life-threatening cardiac arrhythmias and blockades) during the follow-up period. The levels of biomarkers of UA pathogenesis were also measured.
Results. Independent risk predictors included mean platelet volume (MPV), fibrinogen, and left ventricular ejection fraction (LVEF). The risk of adverse UA outcomes in patients with MPV levels ≥9,1 fl (sensitivity 44%, specificity 79%), fibrinogen levels >4,4 g/l (sensitivity 62%, specificity 62%), and LVEF levels ≤54% (sensitivity 83%, specificity 97%) is increased 10 times. The proposed screening scale for risk stratification is highly effective (sensitivity 62,5%, specificity 89,05, AUC=0,799) in the identification of UA patients at a high risk of repeat coronary events.
Conclusion. The dynamic assessment of such biomarkers as MPV, fibrinogen, and LVEF is important for early, effective pharmacological and invasive treatment, as well as for effective secondary prevention of repeat coronary events.
Russ J Cardiol 2013, 5 (103): 18–22
Key words: prognosis, unstable angina, repeat coronary events.
Republican Research Centre «Cardiology», Minsk, Belarus Republic.
SQUATTING STRESS ECHOCARDIOGRAPHY POTENTIAL IN CORONARY HEART DISEASE DIAGNOSTICS
Kuznetsov V. A.1, Krinochkin D. V.1, Premindra Chandraratna A. N.2, Pak Yu.A.1, Plusnin A. V.1, Gorbatenko E. A.1
Abstract
While stress echocardiography (EchoCG) is widely used in clinical practice for diagnosing silent myocardial ischemia, the search for new stress tests remains an important task in the diagnostics of coronary heart disease (CHD).
Aim. To assess the potential of squatting stress EchoCG in the diagnostics of CHD.
Material and methods. In total, 53 men (mean age 53,2±0,93 years) underwent stress EchoCG. At coronary angiography, the CHD diagnosis was verified in 37 men (mean age 54,1±1,2 years), while in the other 16 men (mean age 51,0±1,4 years), myocardial ischemia was not confirmed. All participants underwent standard stress EchoCG with dobutamine, as well as supine and squatting EchoCG. The myocardial ischemia criterion was the development of additional asynergy zones in left ventricular myocardium.
Results. The test was performed in all patients, without any complications. Disturbed local contractility was observed at the time of squatting and rapidly disappeared while standing up. The sensitivity and specificity of squatting stress EchoCG in the CHD diagnostics were 94,6% and 81.3%, respectively.
Conclusion. Therefore, we have demonstrated a high diagnostic value of squatting stress EchoCG for diagnosing myocardial ischemia. This value was comparable to that of stress EchoCG with dobutamine.
Russ J Cardiol 2013, 5 (103): 23–26
Key words: stress echocardiography, squatting stress test, left ventricular longitudinal myocardial deformation, peak systolic strain, coronary angiography, left ventricular local contractility.
Tumen Cardiology Centre, Research Institute of Cardiology, Siberian Branch, Russian Academy of Medical Sciences, Tumen, Russia; Irvine School of Medicine, University of California, USA.
ANGIOGENIC PROPERTIES OF ADIPOSE TISSUE-DERIVED MULTIPOTENT MESENCHYMAL STROMAL CELLS IN PATIENTS WITH CORONARY HEART DISEASE
Dzhoyashvili N. A.1, Efimenko A. Yu.1, Akchurin R. S.2, Tkachuk V. A.1,2, Parfenova E. V.1,2
Abstract
Aim. To compare angiogenic properties of adipose tissue (AT) derived multipotent mesenchymal stromal cells (MMSC) in patients with or without coronary heart disease (CHD) and to investigate potential effects of concomitant Type 2 diabetes mellitus (DM-2) on these properties.
Material and methods. To extract AT MMSC, subcutaneous adipose tissue samples were obtained during a surgical intervention in 19 controls (individuals without cardiovascular disease or DM-2), 28 patients with CHD and DM-2, and 32 CHD patients without DM-2. Angiogenic properties of AT MMSC were assessed by the length of capillary-like structures formed by endotheliocytes on Matrigel in the presence of the conditioned AT MMSC medium. Growth factor gene expression was measured using the real-time polymerase chain reaction. Growth factor levels in the conditioned AT MMSC medium were measured using the enzyme-linked immunosorbent assay (ELISA).
Results. In CHD patients, the total length of capillary-like structures, formed by endotheliocytes in the presence of the conditioned AT MMSC medium, was twice as low as in controls. However, there was no marked difference between CHD patients with or without DM-2. CHD patients did not demonstrate a reduction in the levels of main angiogenic factors, measured in the conditioned AT MMSC medium. On the contrary, the levels of some factors (VEGF, HGF, and PIGF) were elevated, as well as the levels of PAI-1.
Conclusion. Angiogenic activity of secretion end-products of AT MMSC was reduced in CHD patients, compared to CHD-free individuals. The presence of concomitant DM-2 did not affect angiogenic properties of AT MMSC in CHD patients. Reduced angiogenic activity of AT MMSC could be due to increased PAI-1 production. PAI-1 suppresses the activity of plasminogen activators and, therefore, may have angiogenic effects. To confirm this hypothesis, further research is needed.
Russ J Cardiol 2013, 5 (103): 27–34
Key words: angiogenesis, coronary heart disease, Type 2 diabetes mellitus, adipose tissue-derived stromal cells, paracrine function.
1Fundamental Medicine Faculty, M. V. Lomonosov Moscow State University, 2Russian Cardiology Scientific and Clinical Complex, Moscow, Russia.
LEFT CARDIAC CHAMBERS AFTER IMPLANTATION OF MITRAL VALVE PROSTHESES “MIX”, “MEDINGE-2”, “KEMCOR”, AND “PERICOR”
Rogulina N. V., Sizova I. N., Gorbunova E. V.
Abstract
Aim. To compare ultrasound parameters of left cardiac chambers after the implantation of mitral valve prostheses “MIX”, “MEDINGE-2”, “KemCor”, and “PeriCor”, using the 10-year follow-up data.
Material and methods. We analysed 2,543 echocardiography protocols of patients with mitral valve disease, who in 1995–2008 underwent the implantation of mitral valve prostheses “MIX” (n=122), “MEDINGE-2” (n=67), and biological prostheses “KemCor” or “PeriCor” (n=306). The exclusion criteria were aortal valve prosthesis, prosthesis dysfunction, and age under 18 years.
Results and conclusion. In the early post-intervention period, left ventricular (LV) ejection fraction tended to decrease (p>0,10); however, by the end of the first year, it was normalised. The use of biological prostheses resulted in a significant (p≤0,05) reduction in linear dimension of left atrium and in systolic pulmonary artery pressure, which was observed immediately after the intervention and persisted for several years. The dynamics of linear and volume LV parameters after mitral valve prosthesis implantation did not depend on the prosthesis type.
Russ J Cardiol 2013, 5 (103): 35–39
Key words: mechanical cardiac valve prosthesis, biological cardiac valve prosthesis, mitral valve disease, left atrium, left ventriculum, pulmonary artery pressure.
Research Institute for Complex Cardiac Disease Issues, Siberian Branch, Russian Academy of Medical Sciences, Kemerovo, Russia.
RADIOMETRY OF WATER-CONTAINING MYOCARDIAL TISSUE IN PATIENTS WITH ARTERIAL HYPERTENSION
Terekhov I. V.1, Solodukhin K. A.1, Nikiforov V. S.2, Lomonosov A. V.3
Abstract
Aim. To study the water-containing myocardial tissue in patients with arterial hypertension (AH), using the ultra-high frequency (UHF) radiometry method, in order to assess myocardial function parameters.
Material and methods. In total, echocardiography was performed in 30 patients, aged 40–60 years, with Stage I–III AH and Functional Class I–III chronic heart failure. Myocardial radiometry was performed with the diagnostic complex “Aquatone”, which assesses the status of water-containing tissues using the resonance probe radio emission (1 GHz) and stimulated tissue emission (65 GHz).
Results. There was a strong negative correlation between the radio signal intensity and left ventricular posterior wall thickness (r=–0,96), myocardial mass index (r=–0,82), and end-systolic dimension (r=–0,66), as well as a strong positive correlation with end-diastolic dimension (r=0,55) and ejection fraction (r=0,73).
Conclusion. The results obtained suggest the presence of pronounced changes in myocardial radio-physical characteristics in AH patients, as manifested in the disturbed myocardial ability to transform the external probe emission into the stimulated one.
Russ J Cardiol 2013, 5 (103): 40-43
Key words: myocardial hypertrophy, arterial hypertension, radiometry.
1Saratov Military Medical Institute; 2I.I. Mechnikov North-Western State Medical University; 3Saratov Region Ministry of Interior Clinical Hospital, Saratov, Russia.
CLINIC AND PHARMACOTHERAPY
EXPERIENCE OF USING A FIXED-DOSE COMBINATION OF PERINDOPRIL AND AMLODIPINE IN THE CLINICAL PRACTICE SETTINGS: A REAL-WORLD OPPORTUNITY TO INCREASE ANTIHYPERTENSIVE THERAPY EFFECTIVENESS
Ostroumova O. D., Guseva T. F., Bondarets O. V.
Abstract
The paper presents the results of the studies on effectiveness and safety of a fixeddose combination of perindopril A and amlodipine (Prestans) in the real-world clinical practice settings in Russia and other countries. The focus is on the evidence of fast and strong antihypertensive action of this medication, its excellent tolerability, and increased therapy compliance. The evidence presented justifies a wider use of this fixed-dose combination of perindopril A and amlodipine in order to improve blood pressure control in hypertensive patients.
Russ J Cardiol 2013, 5 (103): 44–49
Key words: arterial hypertension, fixed-dose combinations of antihypertensive agents, calcium antagonists, amlodipine, angiotensin-converting enzyme inhibitors, perindopril.
A. I. Evdokimov Moscow State Medico-Stomatological University, I. M. Sechenov First Moscow Sate Medical University, Moscow, Russia.
ANTIHYPERTENSIVE COMBINATION THERAPY EFFECTS ON CARDIAC REMODELLING IN ELDERLY PATIENTS
Gadzhieva L. Kh.1, Masuev K. A.2, Ibragimova M. I.2
Abstract
Aim. To investigate potential regression of left ventricular (LV) remodelling in elderly patients receiving antihypertensive combination therapy.
Materials and methods. The study included 80 patients (23 men, 57 women) with arterial hypertension (AH) and different levels of cardiovascular risk, aged 60–86 years (mean age 72,4±6,5 years; median age 72 years; interquartile range 69,5–76 years). The mean AH duration was 19,6±6,8 years. All patients underwent echocardiography at baseline and 6 months after the beginning of antihypertensive combination therapy: fixeddose combinations of an ACE inhibitor and a diuretic (perindopril + indapamide), or an ACE inhibitor plus a calcium antagonist (lisinopril + amlodipine). Statistical analyses were performed using “Statistica-6.0” software package (StatSoft Inc., 1984–2001).
Results. The study participants had high and very high levels of cardiovascular risk. Six patients (7,5%) had Stage II AH, while 72 (92,5%) had Stage III AH. In 60 patients (75,0%), AH was combined with coronary heart disease (CHD), in 2 (2,5%) with diabetes mellitus (DM), in 16 (20%) with CHD and DM. Isolated systolic AH (ISAH) was registered in 35 patients (44%). At baseline, echocardiography parameters were similar across clinical groups. After 6 months of combination therapy, positive dynamics of echocardiography parameters was observed: for example, left atrium size was significantly lower in patients treated with perindopril and indapamide, compared to patients who received lisinopril and amlodipine or controls. Similar findings were obtained for end-diastolic dimension and interventricular septum thickness. In contrast to the other two groups, the control group did not demonstrate any significant dynamics of end-systolic dimension (p>0,05). Patients treated with perindopril and indapamide showed the best dynamics of LV myocardial mass index (from 121,6±16,42 to 111,0±13,59) and LV myocardial mass (from 229,2±47,91 to 204,7±51,01). In all groups, there was an improvement in diastolic function, which manifested in a significant E/A reduction.
Conclusion. In elderly AH patients with high and very high cardiovascular risk, antihypertensive combination therapy was associated with a significant regression in LV remodelling. The optimal combination included an ACE inhibitor and a diuretic (perindopril arginine and indapamide).
Russ J Cardiol 2013, 5 (103): 50–55
Key words: left ventricular remodelling, arterial hypertension, antihypertensive combination therapy, elderly patients.
1Dagestan Republic Medical Centre; 2Dagestan State Medical Academy, Makhachkala, Russia.
INDAPAMIDE RETARD AS THE MEDICATION OF CHOICE IN ELDERLY PATIENTS WITH ARTERIAL HYPERTENSION
Chukaeva I. I., Spiryakina Ya.G.
Abstract
The modern society faces a steady increase in the numbers of elderly people, which is associated with a range of social and medical problems. Age-related aspects of body anatomy and physiology, multiple comorbidity, and cognitive decline restrict the choice of medications in elderly patients. The paper discusses the need for the agreement between the choice of antihypertensive agents in elderly patients and the importance of organoprotection. From the evidence-based medicine standpoint, indapamide retard is considered as the medication which meets all the requirements for arterial hypertension treatment in elderly patients.
Russ J Cardiol 2013, 5 (103): 56–60
Key words: elderly patients, arterial hypertension, organoprotection, indapamide retard.
N. I. Pirogov Russian National Medical Research University, Moscow, Russia.
LITERATURE REVIEWS
MODERN OPPORTUNITIES OF HEART RATE REGULATION IN CORONARY HEART DISEASE
Zagidullin N. Sh.1, Gareeva D. F.1, Zagidullin B. I.2, Travnikova E. O.1, Zulkarneev R. Kh.1, Zagidullin Sh.Z.1
Abstract
It has been demonstrated that high heart rate (HR) levels are an independent risk factor of cardiovascular events and mortality from coronary heart disease and chronic heart failure (CHF). Recently, the so-called If-inhibitors which selectively block the pacemaker current in sinoatrial node cells (ivabradine, or CoraxanR) have been introduced to clinical practice. The latest large randomised clinical trials, such as SHIFT and BEAUTIFUL, have shown that in patients with stable effort angina, CHF, and HR >70 bpm, ivabradine reduces the incidence of cardiovascular end-points: myocardial infarction, coronary interventions, hospitalisations, and other events. These results justified the inclusion of ivabradine in the international clinical guidelines.
Russ J Cardiol 2013, 5 (103): 61–65
Key words: heart rate, heart failure, ivabradine, coronary heart disease.
1Bashkir State Medical University, 2Urgent Medical Care Hospital, Ufa, Russia.
DIAGNOSTICS AND TREATMENT OF CHRONIC KIDNEY DISEASE IN MODERN CLINICAL GUIDELINES: WHAT DO PRACTITIONERS NEED TO KNOW?
Skibitskyi V. V., Fendrikova A. V.
Abstract
Chronic kidney disease (CKD), widely prevalent in real-world clinical practice settings, is associated with an increased risk of cardiovascular and renal complications. Modern clinical guidelines on the management of CKD patients provide recommendations on the early diagnostics of renal functional and structural pathology, as well as on the adequate treatment which prevents or postpones the progression of these pathological changes. Currently, the assessment of glomerular filtration rate and albuminuria severity is considered obligatory in the CKD diagnostics. These criteria are reflected in the CKD classification, presented in the modern clinical guidelines. The presence of CKD requires the administration of effective treatment, including renin-angiotensin-aldosterone system (RAAS) blockers. At the same time, most CKD patients also require antihypertensive combination therapy, which includes RAAS blockers, diuretics, and/or calcium antagonists. The choice of antihypertensive agents is defined by the specific clinical situation. One of the effective calcium antagonists with proven nephroprotective activity is lercanidipine. The treatment of CKD patients should also include adequate glycemia control and lipid-lowering agents.
Russ J Cardiol 2013, 5 (103): 66–72
Key words: chronic kidney disease, renal function, albuminuria.
Kuban State Medical University, Krasnodar, Russia.
L-CARNITINE IN CARDIOLOGY: REALITY AND PERSPECTIVES
Aronov D. M.
Abstract
Carnitine is a substance close to vitamins B, which participates in the mitochondrial energy synthesis. L-carnitine controls the rate of the long-chain fatty acid oxidation and acts as a specific co-factor facilitating their tr ansport via the internal mitochondrial membrane. It also participates in the elimination of long-chain fatty acid excess from mitochondria and cytoplasm. These effects prevent cytotoxicity. This review presents the results of the studies which comply with the standards of evidence-based medicine. It has been shown that in patients with acute myocardial infarction (AMI), L-carnitine therapy was associated with a reduction in myocardial necrosis and an improved clinical course of AMI (end-point incidence in the main and control groups was 15,6% and 26%, respectively). In the first 5 days of L-carnitine therapy, there was a significant reduction in mortality in the main group of AMI patients. In patients with stable angina, L-carnitine reduces the risk of all-cause mortality, repeat AMI, and ventricular arrhythmias. In patients with intermittent claudication, L-carnitine significantly increases the pain-free walking distance. This medication is well tolerated, with no registered major adverse effects.
Key words: L-carnitine, acute myocardial infarction, intermittent claudication.
Russ J Cardiol 2013, 5 (103): 73–80
N. I. Pirogov Russian National Medical Research University, Moscow, Russia.
ACETYLSALICYLIC ACID IN PRIMARY PREVENTION AMONG PATIENTS WITH ARTERIAL HYPERTENSION
Melekhov A. V., Ryazantseva E. E.
Abstract
Arterial hypertension (AH) remains one of the most prevalent cardiovascular diseases (CVD) and is an important risk factor of severe, often fatal complications. CVD prevention in AH patients is a complex task, including not only blood pressure reduction, but also targeting additional risk factors. The HOT study was the first attempt to assess the effects of acetylsalicylic acid (ASA) on CVD risk in AH patients. It was shown that ASA reduced the risk of major cardiovascular events (non-fatal acute myocardial infarction (MI), non-fatal stroke, and cardiac death) by 15% (p=0,03). The risk of MI was reduced by 36% (p=0,02). In order to implement the HOT study results in the clinical practice, additional data analyses were performed, which demonstrated that ASA benefits were the most pronounced in patients with creatinine levels >150 mmol/l. The evidence from the HOT study, including the subgroup analysis results, has been included in the latest guidelines on AH management.
Russ J Cardiol 2013, 5 (103): 81–87
Key words: acetylsalicylic acid, arterial hypertension, essential arterial hypertension, primary prevention, cardiovascular complications, HOT study.
Hospital Therapy Department No. 2, N. I. Pirogov Russian National Medical Research University, Moscow, Russia.
STAGES OF ATHEROSCLEROTIC PLAQUE DEVELOPMENT AND UNSTABLE PLAQUE TYPES: PATHOPHYSIOLOGIC AND HISTOLOGIC CHARACTERISTICS
Ragino Yu.I.1, Volkov A. M.2, Chernyavskyi A. M.2
Abstract
This literature review focuses on the modern views on the problem of atherosclerotic plaque, its developmental stages (from the lipid steak to unstable atherosclerotic plaque), and various types of plaque instability (lipid, inflammatory, and degenerative-necrotic). Pathophysiologic (mechanisms of formation and development) and pathomorphologic (illustrated histologic description) characteristics of the process are also discussed.
Russ J Cardiol 2013, 5 (103): 88–95
Key words: atherosclerotic lesions of coronary arteries, unstable plaque, instability types, pathophysiology, histology.
1Institute of Internal Medicine, Siberian Branch, Russian Academy of Medical Sciences, Novosibirsk; 2Academician E. N. Meshalkin Novosibirsk State Research Institute of Circulation Pathology, Novosibirsk, Russia.
JUBILEE
Evgenyi V. Kolpakov
Russ J Cardiol 2013, 5 (103): 96