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Российский кардиологический журнал »» №8 (112) 2014

CONTENTS
СОДЕРЖАНИЕ

Address to the readers

Russ J Cardiol 2014, 8 (112): 5


CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russ J Cardiol 2014, 8 (112): 6


CLINICAL GUIDELINES

CARDIOVASCULAR RISK AND CHRONIC KIDNEY DISEASE: CARDIO-NEPHROPROTECTION STRATEGIES

Recommendations by the Joint Expert Committee of the Russian Society of Cardiology (RSC), the Scientific Society of Russian Nephrologists (SSRN), the Russian Association of Endocrinologists (RAE), the Russian Society of Hypertension (RSH), the Russian National Atherosclerosis Society (RNAS), and the Russian Scientific Society of Internal Medicine (RSSIM).

Russian Journal of Cardiology 2014, 8 (112): 7–37


ORIGINAL ARTICLES

CHRONIC KIDNEY DISEASE AND CEREBROCARDIOVASCULAR COMPLICATIONS IN ARTERIAL HYPERTENSION: RESULTS OF PERINDOPRIL А USAGE WITH INDAPAMID

Shemetova V. G.2, Orlova G. M.1, Nebesnykh A. L.1, Markhanova E. S.1

Abstract

Aim. To evaluate the development of cardio- and cerebrovascular complications in arterial hypertension depending on presence or absence of kidney injury, to evaluate organoprotective activity of perindopril with indapamide (the medications Noliprel A and Noliprel A Forte).

Material and methods. The three-year prospective investigation has been performed on 52 outpatients with AH. The diagnosis of CKD was set according to KDOQI 2002 guidelines. All patients received antihypertensive therapy with Noliprel 2,5 + 0,625 mg (Noliprel A) — (10) or 5 + 1,25 mg (Noliprel A Forte) — (42). Control group — 25 patients on antihypertensive treatmient without Noliprel. Primary endpoint was the development of CKD or worsening of already persisting CKD to the next stage. Secondary endpoints: cardio- and cerebrovascular accident (myocardial infarction, ischemic stroke, transitory ischemic attack).

Results. In the group of therapy with combination of perindopril A with indapamide primary endpoint was reached by 12 (23%) patients, in the group without this combination in 12 (48%) patients, p=0,05. Regression of severity of CKD was marked in 5 (15,5%) patients in the main group and in no one in comparison group. In the main group with CKD the cardiocerebral events occured in 11 (33,3%) patients, in the group without kidney injury in 1 (5,25%) patient had cardiocerebral event, p<0,05. Between the main and the comparison groups there are also significant differences by the prevalence of myocardial infarction and ischemic stroke: 12 (23%) vs. 14 (56%), p=0,009. In the group of patients not taken combination of perindopril A with indapamide, cardiovascular accidents occur almost 10 times more often than in the main group without CKD, and almost 2 times more often than in CKD group with drug combination.

Conclusion. Prospective observation has shown higher prevalence of ischemic stroke and transient ischemic attack, and cardiovascular accidents in the group of patients with chronic kidney disease comparing to the group without kidney injury. Dynamic observation of the AH patients, use of perindopril+indapamide combination allows to reach antihypertensive and organoprotective aim.

Russ J Cardiol 2014, 8 (112): 38–42

Key words: arterial hypertension, chronic kidney disease, cardiocerebral event, Noliprel A, Noliprel A forte.

1Irkutsk State Medical University, Irkutsk; 2Medical Autonomic Non-commercial Organization — Centre for Treatment and Prophylaxy, Angarsk, Russia.


PREVALENCE AND CAUSES OF TRANSITORY LOSS OF CONSCIOUSNESS IN GENERAL POPULATION (BY THE DATA FROM ЭССЕ-RF TRIAL)

Gudkova S. A.1, Cherepanova N. A.1, Golovina G. A.3, Duplyakov D. V.1,2, Khokhlunov S. M.1,2, Rotar O. M.4, Konradi A. O.4, Schlyakhto E. V.4

Abstract

Aim. To study prevalence of transitory loss of consciousness (TLC) in general population of the city Samara and to suggest its genesis according to anamnestic data.

Material and methods. The material for the study was provided by a simple randomized selection of persons from general population in Samara city, performed during the multicentre observational trial “Epidemiology of Cardio-Vascular Diseases in the Regions of Russian Federation — ЭССЕ-RF”. Total volume of the selection was 1796 persons (more than 80% responded to the call). Average age of the studied persons was 45,8±11,9 y., women — 1256 (69,9%), men — 540 (30,1%). In questionnaire module respondents analysed: 1) are there any cases of sudden death in family anamnesis at the age less than 45 y. and linked or suspicious to be linked to heart disease; 2) any complaints on palpitation; 3) presence of palpitations and their main characteristics; 4) episodes of TLC in anamnesis and their characteristics; and 14 questions more, than make it to suspect neuromediatory mechanism of TLC.

Results. The prevalence of TLC in analysed population was 23%, maximum at the age of 40–49 y., reaching 28%. TLC were 2 times more prevalent in women than in men (27,5% and 13,5% resp., p<0,01). Median of the age of first episode was 16 (11; 23) y. o., taken that in 333 (<85%) respondents at the age <30 y. o. Almost in the half of cases (53% men, 46% women) the first TLC occurred at the age between 10 and 19 y. o., and with increasing of age probability of TLC decreased to the minimum of 1% in women of 60–69 y. o. The average length of anamnesis was 27,7 (12; 47) y. Most respondents (83,5%) had no any background somatic pathology. About the episodes of sudden death of immediate family members in younger age reported 27 persons (6,5%).

Conclusion. In more than a half of patients, we found the signs showing a neuromediatory genesis of TLC (56%). These were the main cause for TLC in all age groups (50%-66%) as in men (60%) and women (55%). Th second cause was arrhythmic, having 6% of cases. In 35% the main cause for TLC by the method of questionnaire was not revealed.

Russ J Cardiol 2014, 8 (112): 43–48

Key words: transient loss of consciousness, neuromediatory syncope, arrhythmogenic syncope, epilepsy.

1SBHI Samara Region Clinical Cardiological Dispensary; 2SBEI HPE Samara State Medical University; 3FSBHI Samara Medical Clinical Centre of FMBA RF, Toliatti; 4FSBI Federal Medical Research Centre n. a. Almazov V. A. of the Ministry of Health, Saint-Petersburg, Russia.


THE INFLUENCE OF ENDOTHELIUM-DEPENDENT MECHANISMS OF VESSEL TONE REGULATION ON THE TISSUE OXYGENATION PARAMETERS IN PATIENTS WITH ISCHEMIC STROKE AT THE BACKGROUND OF ARTERIAL HYPERTENSION SYNDROME

Ryabchenko A. Yu.1, Dolgov A. M.1, Denisov E. N.1, Gumanova N. G.2

Abstract

Aim. To study properties of tissue oxygenation and role of nitricoxyde-ergic reactions of circulation in ischemic stroke at the background of arterial hypertension.

Material and methods. Totally 62 men and women included with the diagnosis of ischemic stroke. All patients underwent CT and MRI of the brain; cerebral flow was studied by extra-and transcranial ultrasound dopplerography, central hemodynamics was assessed by echocardiography, the basic clinical tests performed, and neurological and neuroophthalmological examination. Study of oxygen transport on the microcirculatory level was performed by polarographic method by transcutaneous measurement of oxygen pressure in tissues. Gases of the blood were measured on the analyzer Easy Stat “Medica Corporation” (USA). For the evaluation of nitric oxide (NO) level, we used the measurements of its stabile metabolites on blood — nitrites and nitrates. Neurological status was examined with the NIHSS score (The Score of the National Health Institute of the US, by T. Brot, H. P. Adams, 1989). All patients studied were then grouped into 3 groups according to severity of the stroke. Mathematical analysis was performed using software “Statistica 6.0” with non-parametric criteria of Mann-Whitney. Significant were the data with p<0,05.

Results. In patients with ischemic stroke, there were disorders of nitricoxide-ergic mechanism of the vessels. Decrease of the level of stable NO metabolites and impairment of tissue oxygenation were linked to the severity of the disease and prominence of neurologic deficiency.

Conclusion. In ischemic stroke, there are structural and functional changes in cerebral vessels, which do worsen by the impairment of systemic circulation, increase of systemic pressure, those then lead to tissue hypoxia and neurologic deficiency progression.

Russ J Cardiol 2014, 8 (112): 49–52

Key words: ischemic stroke, arterial hypertension, tissue oxygenation, nitric oxide.

1Orenburg State Medical Academy, Orenburg; 2State Scientific-Research Centre for Preventive Medicine, Moscow, Russia.


INTRAVASCULAR CHANGES IN PATIENTS WITH ARTERIAL HYPERTENSION COMPLICATED WITH ISCHEMIC STROKE

Dorenskaya O. V.1, Korichkina L. N.2

Abstract

Aim. To study the extensiveness and character of intravascular auto rosette formation and to measure the thickess of intima-media of internal carotid artery in patients with AH complicated with stroke.

Material and methods. Totaly 102 patients included (39 males, 63 females, mean age 67,1) with AH, complicated with ischemic stroke. Comparison group consisted of 121 patient with non-complicated AH of 2–3 stage (61 males, 60 females, mean age 63,9). All patients underwent laboratory sampling of capillary blood, and in blood smears the following were evaluated: total leucocytes, total number of auto rosettes and autorosettes with lysis. Also the intima-media thickness was measured in intrinsic carotid artery (by Philips IU-22, Netherlands). Control group consisted of 44 healthy volunteers (men 21, women 23, mean age 47,45).

Results. It was shown that in AH with ishemic stroke extensiveness of intravascular auto rosette formation (21,7 and 1,2 times, resp.) and intima-media thickness (1,6 and 1,2 times, resp.) were higher than in healthy volunteers and patients with non-complicated AH. First time there were rosette forming stab neutrofiles found in ischemic stroke, basophils and in quite large amounts platelets. The significant correlation is found for auto rosette formation and intima-media thickness of intrinsic carotid artery in non-complicated AH (r=0,45; p=0,005) and compicated by ischemic stroke (r=0,78; p=0,001).

Conclusion. It can be suggested that rosette forming cells of the blood take part not only in pathogenesis of ischemic stroke and microcirculation, but in structural remodeling of brain vessels in patients with arterial hypertension.

Russ J Cardiol 2014, 8 (112): 53–56

Key words: arterial hypertension, ischemic stroke, auto rosette formation, auto rosette, intima-media thickness of intrinsic carotid artery.

1LLC Clinic “Expert Tver”; 2SBEI HPE Tver SMA of the Ministry of Health, Tver, Russia.


STRUCTURE OF COGNITIVE DISORDERS AND DYNAMICS OF BIOELECTRIC ACTIVITY OF THE BRAIN IN PATIENTS AFTER DIRECT MYOCARDIAL REVASCULARIZATION

Trubnikova O. A., Tarasova I. V., Mamontova A. S., Syrova I. D., Maleva O. V., Barbarash O. L.

Abstract

Aim. To analyze structural chareacteristics and electroencephalographic (EEG) pattern of post-operation cognitive dysfunction (POCD) in patients after direct myocardial revascularization under artificial circulation (AI).

Material and methods. Totally 114 male-patients included, underwent scheduled coronary bypass grafting (CBG) under the AI, with average age 55,9±5,3 y. In 3–5 days before operation and on 7–10 day after all patients underwent neurophysiological testing; of those 65 patients also underwent EEG.

Results. The CBG operation with AI leads in 79% of cases to the early POCD. Cognitive impairment usually becomes prominent in the domains of neurodynamics and memory. It is shown that the early POCD is followed by EEG-signs of cortical dysfunction (increase of low-frequency theta-rhythm magnitude).

Conclusion. According to the results of the study, in post-operative CBG with AI period the structure of POCD consists of injury of neurodynamics and memory, which might be a cause of decreased life quality of patients and efficacy of surgery itself.

Russ J Cardiol 2014, 8 (112): 57–62

Key words: coronary shunting, CBG, artificial circulation, postoperative cognitive dysfunction, EEG.

FSBU SPI of the Complex Cardiovascular Disorders of SI RAMS, Kemerovo, Russia.


THE RELATION OF PERSONAL ANXIOUSNESS AND SELF-AWARENESS ABOUT THE HEALTH CONDITION, AND ITS INFLUENCE ON 16-YEAR RISK OF ACUTE CARDIOVASCULAR DISEASES DEVELOPMENT IN WOMEN 25–64 YEARS OLD

Gafarov V. V.1,2, Panov D. O.1,2, Gromova E. A.1,2, Gagulin I. V.1,2, Gafarova A. V.1,2

Abstract

Aim. To evaluate the influence of personal anxiousness (PA) on the relative risk of myocardial infarction and stroke development in the open cohort of women 25–64 years old during 16 years.

Material and methods. As a part of MONICA-psychosocial in 1994 the random representative group of women was studied in the age of 25–64 y. (n=870), living in one of the districts of Novosibirsk. PA was assessed by Spielberg test. During 16-year period (1994–2010) in this cohort, all cases of primary myocardial infarction and stroke cases were studied.

Results. The prevalence of higher PA in open population among women of 25–64 y. o. was 60%. Higher PA was related to lower self-assessment about health. During 16 years the relative risk of myocardial infarction development was 4.2 (p=0,05), stroke 3.5 (p<0,05) times higher in women with higher PA. The rate of myocardial infarction and stroke development was higher in married women with PA in social frame “senior manager” and “strenuous labour” with higher or lower level of education.

Conclusion. The studied prevalence of higher PA risk in open population of 25–64 y. o. women reached 60%. Women with higher PA had higher relative risk of myocardial infarction and stroke during 16 years follow-up, low self-awareness about the health; risk of infarction is related to social gradient.

Russ J Cardiol 2014, 8 (112): 63–67

Key words: personal anxiety, relative risk, myocardial infarction, stroke, self-awareness of the health.

1FSBI SRI for Therapy and Preventive Medicine of SI RAMS, 2Interdepartmental laboratory for epidemiology of cardiovascular diseases of SI RAMS, Novosibirsk, Russia.


A LIFE-EXHAUSTION: INTERRELATION WITH THE PREVALENCE OF ISCHEMIC HEART DISEASE

Kayumova M. M.1,2, Akimova E. V.1,2, Gafarov V. V.2, Kayumov R. Kh.1,2, Akimov A. M.1,2, Kuznetsov V. A.1

Abstract

Aim. To findout the interrelation of ischemic heart disease prevalence and higher level of life exhaustion in the open population of men 25–64 y. o. in the average-urbanized Siberian city.

Material and methods. Simultaneous epidemiological study was performed on representative group, made up from the lists of citizens in one of Tyumen districts, consisting of 1000 men, 250 by every decade of lifetime (25–34, 35–44, 45–54, 55–64 y. o.). The respond rate reached 85% — 850 participants. The levels of life exhaustion were assessed by the WHO algorithm MONICA — psychosocial, and the prevalence of CHD — by common epidemiological criteria.

Results. More than in the half of men 25–64 y. o. in Tyumen the life-exhaustion was revealed (standard value 54,5%). Higher level of LE in population was 15,9%. In open population of 25–64 y. o. men the odds ratio for the absence/presence of CHD was 6,02; definite form of CHD — 14,11; probable type of CHD with higher LE did not show significance.

Conclusion. The data witnesses the possibility of further studying of psychosocial risk factors in men of economic-active age in Siberian populations and the importance of preventive activities to reduce the influence of psychosocial risk factors.

Russ J Cardiol 2014, 8 (112): 68–72

Key words: open population, epidemiologic study, ischemic heart disease, life exhaustion.

1Filial of FSBI SRI for Cardiology of SI RAMS — Tyumen Cardiological Centre, Tyumen; 2Interdepartmental laboratory for epidemiology of cardiovascular diseases of SI RAMS (FSBI SRI for therapy and preventive medicine of SI RAMS, FSBI SRI of Cardiology SI RAMS, filial of FSBI “SRI of Cardiology” SI RAMS), Tyumen, Russia.


ELECTRICAL INSTABILITY OF MYOCARDIUM IN YOUNG MEN WITH ARTERIAL HYPERTENSION AND OCCUPATIONAL STRESS

Osipova I. V.1, Antropova O. N.1, Shakhmatova K. I.2, Kondakov V. D.1

Abstract

Aim. To evaluate prevalence of electrical instability of the heart in persons with stressogenic professions by a complex evaluation of the parameters of clinical and functional methods of investigation.

Material and methods. Totally 154 men included with AH of I–II stages; first group consisted of 78 motormen and their assistants having stressogenic profession, second grup consisted of 76 persons with minimal psychoemotional tension. A clinical and functional investigation was performed.

Results. In 1st group “possible existence” of delayed atrial and ventricular potentials was twice and three times (resp.) more prevalent comparing to the 2nd (with p=0,0001 and p=0,0002, resp.). A rigid circadian index in the 1st group was 1,7 times more prevalent (Х2=10,5; p<0,001). In those having AH with concomitant chronic gastritis and gastric or duodenal ulcer disease the circadian rigidity was 1,6 times more prevalent (x2 =5,9; p<0,05) in the 1st group. In first stage AH the shift of vagosympathetic balance to sympathic type is more common for the 1st group than for the 2nd.

Conclusion. In young men with AH and occupational stress comparing to men with low — stress profession the signs of electrical instabilty are more common.

Russ J Cardiol 2014; 8 (112): 73–77

Key words: electrical instability of myocardium, arterial hypertension, stress.

1SEI HPE The Altai State Medical University, Barnaul; 2Non-State Healthcare Institution the Departmental Clinical Hospital at the Barnaul station, Russia.


ISCHEMIC HEART DISEASE AND SPECIFICS OF PERIPHERAL MICROCIRCULATION IN VARIOUS AGE GROUPS

Kamenskaya O. V., Karas’kov A. M., Chernyavsky A. M., Klinkova A. S.

Abstract

Aim. To assess the condition of peripheral microcirculatory circulation (MCC) in patients with coronary heart disease (CHD) depending on the age, before and after revasculatization during different stages of operation treatment.

Material and methods. Totally 40 patients with CHD included. Two groups completed: 1–24 patients with the age up to 60 and 2–16 patients older than 60. The condition of MCC in lower limbs studied by laser-doppler flowmetry (LDF) using the occlusion test, before revascularization and level of peripheral MCC at different stages of surgical intervention.

Results. In those older than 60 we found lower level of MCC and lowered reactivity of microcirculatory bed. Lowering of the capillary reserve (CR) was found in two patients of both groups. The lowest level of peripheral MCC in both groups was detected at 30th min. of artificial circulation; at the end of operation there was increase of MCC to the values at start with the lowest level of circulation in the group older than 60.

Conclusion. In older CHD patients the lowest level and lowest reserve of MCC were found compating to those younger than 60. At the background of artificial circulation there is lowering of peripheral MCC in both circulatory circles; once blood circulation has returned there is no complete restore of MCC because of low circulation in patients older than 60.

Russ J Cardiol 2014, 8 (112): 78–83

Key words: ischemic heart disease, peripheral microcirculatory circulation.

FSBI Novosibirsk Scientific-Investigative Institute for Circulation Pathology n. a. acad. Meshalkin E. N. of the Ministry of Health, Novosibirsk, Russia.


THE ROLE OF INFLAMMATION FOR THE WORSE OUTCOMES IN PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION UNDERWENT TRANSCUTANEOUS CORONARY INTERVENTION, COMORBID WITH IMPAIRED GLUCOSE TOLERANCE

Belen’kova Yu. A.1,2, Karetnikova V. N.1,2, Djachenko A. O.2, Gruzdeva O. V.1, Blagoveshchenskaya O. P.3, Molodtsova T. S.3, Barbarash O. L.1,2

Abstract

Aim. To evaluate the significance of non-specific inflammatory markers for estimation of the risk for poor annual prognosis in patients after myocardial infarction with ST segment elevation (STEMI) and diabetes mellitus (DM) 2 type or impaired glucose tolerance (IGT), underwent transcutaneous coronary intervention (PCI).

Material and methods. Totally 601 STEMI patient included into registry study with mean age 62,9 (32,0–94,0). On 8–14th day all patients without any known glucose intolerance or postprandial glucose not higher than 11,1 mMpL underwent glucose tolerance test. On 10–14th day after MI blood samples were taken to measure inflammatory markers (fibrinogen, interleukines –6, —8, —12, tumor necrosis factor alpha TNF-α, high-sensitive C-reactive protein, sCD40L) with further control of postinfarction recovery during 1 year. The cytokine concentration was measured with competitive immunoferment assay, hs-C-rp was measured with solid-phase immunoferment analysis. With the data of angiography taken, primary PCI was done for 373 (62,06%) of patients, for 228 (37,94%) non-invasive treatment strategy was preferred.

Results. Patients with STEMI were divided into 3 subgroups: without IGT (n=429; 71,38%), with IGT (n=32; 5,33%), with DM (n=140; 23,29%), of those in 16 (11,42%) the diagnosis was first time. It was found out that PCI significantly improves prognosis of STEMI with and without IGT. The analysis of inflammatory markers in MI with DM or IGT comparing to those without IGT at the end of hospitalization showed significantly higher levels of IL-6 and sCD40L, and in patients with ICGT also there was significantly increased IL-12 comparing to the patients without IGT.

Conclusion. For the patients with STEMI and IGT, underwent PCI, processes of inflammation are responsible for the risk of negative vascular events during one year. Comorbidity of DM and IGT increases prognostic significance of inflammation for the negative outcome.

Russ J Cardiol 2014, 8 (112): 84–91

Key words: myocardial infarction, inflammation, impaired glucose metabolism, transcutaneous coronary intervention.

1FSBI Scientific-Practitioner Research Institute for the Complex Issues on Cardiovascular Diseases of Siberian Department of RAMS, Kemerovo; 2SBEI HPE Kemerovo State Medical Academy of the Ministry of Health, Kemerovo; 3SBHI Kemerovo Region Clinical Hospital, Kemerovo, Russia.


MORPHOLOGICAL AND FUNCTIONAL CHARACTERISTICS OF THE MAIN ARTERIES AND PULSE WAVE VELOCITY IN OLDER AGE INDIVIDUALS WITH ARTERIAL HYPERTENSION

Efremushkin G. G., Filippova T. V., Lomakina N. A.

Abstract

Aim. To study morpho-functional state and pulse wave velocity (PWV) in the main arteries (MA) in older patients with arterial hypertension (AH) and chronic heart failure (CHF).

Material and methods. Totally 122 patients studied (30 female) with AH+CHF at the age of 60–90 y. o., mean age 76,8±1,3. All patients had AH of the 3rd stage, 32 had isolated systolic hypertension (ISAH). AH of the 1st grade had 32, 2nd grade — 12, 3rd grade — 28 pts. CHF was at 1–2 stage with mean functional class 1,85±0,06. Control consisted of 48 healthy individuals at the age 19–25 (20,6±1,5). All participants underwent EchoCG and Dopplerography of common carotid arteries (CCA), brachial (BA) and femoral (FA) arteries with measurement of the diameter (D), intima-media thickness (CIM), velocity and volume values.

Results. In patients with AH minute volume was 40% higher than in healthy individuals: by 24,4% due to inotropic and by 15,6% — chronotropic reserves. Values of CIM and D in patients and in controls did not change with posture and were higher in patients. Velocity and share kinetic energy were lower in patients than in controls. PVW in MA in patients with AH was 54–60% faster than in controls. The relation of PWV CCA: BA — 1:4,4; CCA: FA — 1:6,4–6,9; BA: FA — 1:1,5, was the same in patients and controls. There was no correlation between PWV and CIM, D and BP in young patients. Also the positive correlation is found for the time of pulse wave and heart rate.

Conclusion. PWV does not directly relate to MA rigidity. Probably it is more depended on the conditions of the regulatory mechanisms of cardiovascular system and their reaction on everchanging states of central and peripheral hemodynamics, as with degeneration processes of aging, and can be named as one of the parts in adaptive correction of hemodynamics in MA. The increase of PWV and its kinetic energy compensates the loss of of blood flow velocity and maintains its volume by the unit of time during rapid phase of circulation.

Russ J Cardiol 2014, 8 (112): 92–97

Key words: arterial hypertension, older age, pulse wave velocity.

SBEI HPE Altai State Medical University of the Ministry of Health, Barnaul, Russia.


ACTUAL TOPIC

CARDIOEMBOLISM: DIALECTIC OF CHOICE IN REAL LIFE

Shaydyuk O. Yu.1, Kudinova M. A.2

Abstract

The article rises an issue with antithrombotic therapy in real clinical situation of cardioembolic risk at the background of atrial fibrillation. The main problem is scrutinized: incongruence of the individual and the statistical. The main reasons for this are provided, by those the solutions can be found. A practical approach is discussed, based upon increasing of competence and conscience of the main decision making person in healthcare: the practitioner.

Russ J Cardiol 2014, 8 (112): 98–99

Key words: oral anticoagulants, atrial appendage, individualized approach.

1RNRMU n. a. N. I. Pirogov, Moscow; 2CCH №15 n. a. O. M. Filatov, Moscow; Russia.


OPINION ON A PROBLEM

NOVEL UNDERSTANDING OF THE PHASIC STRUCTURE OF SYSTEMIC CIRCULATION

Garanin A. A., Ryabov A. E.

Abstract

The article provides novel approach to the phasic structure of systemic circulation for rheovasogramms of upper and lower extremities, based upon neither geometrical description with visual evaluation of rheographic complexes, but upon genesis of their main elements. We reveal systole and diastole of the large circle of circulation analogue to the heart phases. Diastole includes the phases: metabolic (synchronous to the right atrium diastole), pulse wave spread, rapid influx and slow influx. Diastole includes the phases: elastic and muscular outflow, capillary-venous outflow (synchronous to the systolic phase of right atrium). The phasic structure provided can be used for quantitative measurement of biomechanics of the systemic circulation using computed rheovasography, for calculation of the electrical conductivity or resistance parameters and hemodynamics; is able to link biomechanics of the systemic circulation with main arteries kinetics and biomechanics of the heart; to reveal causal interconnections among them, relation of central and peripheral hemodynamics, measure biomechanics of blood circulation in general.

Russ J Cardiol 2014, 8 (112): 100–105

Key words: biomechanics, systemic circulation, rheovasography, phasic structure.

SBEI HPE Samara State Medical University, Samara, Russia.


CLINICAL SIGNIFICANCE OF HEMOCIRCULATORY ANGIOARCHITECTONY OF THE HEART FOR THE ISSUES OF TREATMENT STRATEGY IN CORONARY HEART DISEASE

Milyukov V. E.1,2, Dolgov E. N.2, Zharikova T. S.1,3

Abstract

Coronary heart disease is higly prevalent in many world countries including Russia, and for several decades cardiovascular disease are being the main reason for death and are regarded as serious medico-social problem. Rapid development of cardiosurgery, invention and enhancement of diagnostic and endovascular interventions require not only a perfect knowledge of surgical heart vessels anatomy, but knowledge of antropometric parameters of hemocirculatory angioarchitectonic and morphological changes of myocardium. In the literature we could not find the data on principles of morphometric parameters of coronary vessels and structurally-functional condition of myocardial cells. So to say, the complex scientific studies required in this area to improve the diagnostic value and objectivity of indication to treatment methods, optimization and correction of surgical methods to improve quality of cardiovascular patients’ care.

Russ J Cardiol 2014, 8 (112): 106–108

Key words: heart, myocardium, coronary vessels, ischemic heart disease.

1SBEI HPE The 1st MSMU n. a. Sechenov, cathedra for human anatomy, Moscow; 2The Institute for Doctoral Staff Improvement of the MESCC n. a. Mandryka of the Ministry of Defense, cathedra for battlefield surgery, Moscow; 3FSBI SCI for human morphology of RAMS, Moscow, Russia.

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