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Российский кардиологический журнал »» №11 (115) 2014

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СОДЕРЖАНИЕ

Address to the readers

Russ J Cardiol 2014, 11 (115): 5


CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russ J Cardiol 2014, 11 (115): 6


ORIGINAL ARTICLES

THE GENE OF ALPHA2A-ADRENORECEPTOR AND ESSENTIAL ARTERIAL HYPERTENSION

Bairova T. A., Dolgikh V. V., Kolesnikova L. I., Kosovtseva A. S., Sholokhov L. F.

Abstract

Aim. To study the importance of -1291C>G gene polymorphism of α2А- adrenoreceptor in the arterial hypertension development in male adolescents.

Material and methods. Totally 207 adolescents included, of those 110 males with verified essential hypertension at the age of 14 to 17 (15,92±1,12) of slavic ethnicity. The control group consisted of 97 same by the age, gender and ethnicity almost healthy adolescents. The investigation program included clinical and anamnestic data, laboratory study with blood katecholamines, blood pressure monitoring, echocardiography and genotyping. The specimen for genomic test was total DNA. It was extracted from lymphocytes of peripheral blood with the “DNAsorb-V” equipment of FSSI CSRIE Rospotrebnadzor according to the manual. Genotyping was done by PDF-study by commercial equipment of FSPI GosSRIgenetics. The final detection was done on the “Gel-Doc 2000” equipment (Bio-Rad).

Results. The occurence of G-allele in populational cohort and among EAH did not differ (controls 0,242±0,030; among patients — 0,204±0,027, р=0,326). In G-allele carriers of -1291C>G polymorphism of α2А-adrenoreceptor gene the hyperdiastolic variant of vegetative supply dominates, and significantly higher the levels of common and mean peripheral resistance, that are combined with compensatory decrease of inotropic values (efflux volume, cardiac index, cardiac output). There were no significant differences of plasma katecholamines, including norepinephrine, in patients - various genes carriers.

Conclusion. G-allele carriers of -1291C>G polymorphism of α2А-adrenoreceptor gene ADRA2A should be marked as risky alleles for the risk of essential arterial hypertension in male europeoid adolescents.

Russ J Cardiol 2014, 11 (115): 7–12
http://dx.doi.org/10.15829/1560-4071-2014-11-7-12

Key words: arterial hypertension, gene of alpha2-adrenoreceptor, genetics, adolescents.

FSBI Scientific Centre of the Family Health and Reproductive Problems of the Siberian department RAMS, Irkutsk, Russia.


THE ERYTHROCYTE MEMBRANE ENDURANCE AGAINST TISSUE ISCHEMIA IN PATIENTS WITH HYPERTENSIVE DISEASE AND ISCHEMIC HEART DISEASE AND ITS RELATIONSHIP WITH ENDOGENOUS FACTORS

Sergeeva A. S., Pivovarov Yu. I., Kurilskaya T. E., Kuznetsova E. E.

Abstract

Aim. To find out the type of erythrocyte membrane endurance to local ischemia in patients with AH and AP including its relationship with endogenous factors.

Material and methods. Totally 60 men included with stable form of angina pectoris and 50 men with hypertension of the age 40-55 y. o. To compare the relationships that were found with normal values the parameters studied also were measured in healthy men (n=20) at the age 27±2,5 y. o. The prominence of changes in erythrocyte membrane was evaluated by their comparison before and after local ischemia. In every patient the endurance index (index(m)) was calculated for the erythrocyte membrane. Then we studied endogenous factors that modified the shifts of erythrocyte membrane endurance in the patients studied.

Results. During the study it was shown that the erythrocyte membrane endurance to tissue ischemia in AH and AP patients was significantly lower comparing to healthy males. Also in patients there was relation between shifts of membrane endurance and baseline level of various endogenous factors activity. In AP patients the endurance of membrane could be modified by five predictors: blood viscosity in moderate diameter vessels, ACE and less - von Willebrand factor. In both groups the increase of baseline ACE and blood viscosity was followed by the decrease of membrane endurance. But if the ischemia developed at the background of weak ACE activity or low blood viscosity, then erythrocyte membrane was more endurable to this pathogen factor.

Conclusion. The relationships found for endogenous factors and membrane endurance, it seems, shows differences in genesis of angina pectoris and hypertension. The relations require confirmation in other patients selections with the same pathology and only then can be used for the development of further findings of the main pathogenetic chains in the patients with AH and AP, as for additional treatment strategies development.

Russ J Cardiol 2014, 11 (115): 13–18
http://dx.doi.org/10.15829/1560-4071-2014-11-13-18

Key words: angina pectoris, arterial hypertension, tissue ischemia, erythrocyte membrane.

FSBI Scientific Centre for Reconstructive and Recovery Surgery of the Siberian Department of RAMS, Irkutsk, Russia.


IMPORTANCE AND CORRECTNESS OF THE TERM “ANAEROBIC THRESHOLD”. THRESHOLD CHANGES OF COMPENSATORY AND ADAPTIVE BODY REACTIONS IN INCREASING PHYSICAL EXERTION

Lelyavina T. A., Sitnikova M. Yu., Berezina A. V., Shlyakhto E. V.

Abstract

A distinction of the physical exertion into phases is necessary for on-time decision making of the correct clinical decisions in medicine and for evaluation of the level of sportsmen professional preparedness in sport medicine.

Aim. 1) To reveal the consequence of compensatory reactions in human body during increasing physical exertion (PE). 2) To evaluate correctness of the term “anaerobic threshold”.

Material and methods. Totally 28 triathletes included and 35 healthy non-trained individuals underwent cardiorespiratory test on treadmill using equipment “Oxycon Pro” by Jäger, Germany. Participants were instructed to reach maximum effort. Physiological stages of compensatory mechanisms involvement during PE were evaluated by lactate measurements, pH and HCO3 in venous blood and gas exchange shifts.

Results. By the results of the current study we distinguished four main physiologic stages of PE. The first physiological stage is a threshold break in lactate level — lactate threshold. The second — beginning of pH decrease in venous blood — pH-threshold. The third physiologic stage — point of respiratory compensation. The fourth stage relates to the moment of PE when aerobic metabolism is at “apogee” and the increase of energy production by aerobic pathway is not further possible – aerobis limit. The term “anaerobic threshold” is not relevant to any of these stages.

Conclusion. 1. According to the results of the study it is possible to distinguish four physiologic stages that appear during increasing PE: lactate threshold, pH-threshold, point of respiratory compensation and aerobic limit. 2. The term “anaerobic threshold” is not correct and does not reflect changes of physiologic processes in the human body during physical exertion.

Russ J Cardiol 2014, 11 (115): 19–24
http://dx.doi.org/10.15829/1560-4071-2014-11-19-24

Key words: cardiorespiratory test, compensatory-adaptive stages of physical exertion.

FSBI Federal Centre of the Heart, Blood and Endocrinology n. a. V. A. Almazov, Saint-Petersburg, Russia.


SEASONAL AND MONTHLY CHANGES OF MORTALITY IN RUSSIAN FEDERATION REGIONS WITH DIFFERENT CLIMATE AND GEOGRAPHIC VARIABLES

Kontsevaya A. V., Lukyanov M. M., Khudyakov M. B., Klyashtorny V. G., Balanova Yu. A., Kalinina A. M., Boytsov S. A.

Abstract

The mortality general and cardiovascular (CVD) are not the same during the year, as there are seasonal and monthly specifics which are actively studied in European countries.

Aim. To study excessive mortality during winter from all causes and CVD in RF regions with different climate and geographic characteristics comparing to European data and to analyze monthly mortality levels.

Material and methods. To compare and evaluate the dynamics of excessive winter period mortality in three RF regions: Ivanovskaya, Saratovskaya and Arkhangelskaya regions and to compare with excessive mortality in European countries the calculation performed of the index of excessive mortality during the winter (EMDW). The latter was calculated according to the mortality from all causes and from cardiovascular diseases separately. Calculations for every 12 months included December of the previous year and January-February of the next year. To measure monthly values the mean range of the month was calculated by the absolute quantity of deaths by the period analyzed — absolute mortality rates from all causes and from CVD by every year ranged from 1 to 12 and then the mean value of the range for every month was evaluated.

Results. Mean 8-year EMDW in analyzed regions was from 3,5% in Saratovskaya to 6,5% in Ivanovskaya regions; EMDW for CVD was higher than 10% and maximum in Saratovskaya region (14,3%). Mean EMDW in the regions analyzed of RF was significantly lower (p<0,05), than in Europe and significantly lower than in Southern Europe. Reasons for lower EMDW in the regions studied the inhabitants’ adaptation to low temperatures during the winter, inferior part of senile folks in Russia that is more sensitive to winter time lower temperatures and due to central rooms heating. In analysis of monthly mortality rates the leader by the deaths prevalence was January, on the second place was march, which was similar by all causes and by CVD in Ivanovskaya and Saratovskaya regions and slightly differed in Arkhangelskaya region, where on the second place was February. The third by the all cases was may. In Ivanovskaya and Saratovskaya regions median ranges of the third by deaths month from all cases and from CVD were the same, and in Arkhangelskaya they differed. Maximum range value and hence the lowest mortality rate was in July-September.

Conclusion. Excessive mortality in winter, measured by EMDW, is 3,5-6,5% by any cause and 12,0-14,0% — by CVD. Until now there is no clear understanding of the mechanisms and determinants for this, however during the XXth century the prominence of this has lowered much. Among the contributions to this lowering during the winter are good central room heating and immunization against viral infections of the risk groups. Further studies required to analyze regional specifics of excessive mortality during the winter and monthly.

Russ J Cardiol 2014, 11 (115): 25–30
http://dx.doi.org/10.15829/1560-4071-2014-11-25-30

Key words: excessive mortality during the winter, climate, cardiovascular diseases.

FSBI State Scientific-Research Centre for Preventive Medicine of the Ministry of Health, Moscow, Russia.


RELATIONSHIP OF SLEEP-DISORDERED BREATHING, EMOTIONAL COMPLAINTS AND ANTROPOMETRIC MEASUREMENTS (THE RESULTS OF SCREENING SURVEY AMONG SAINT-PETERSBURG CITIZENS)

Dubinina E. A.1,2, Korostovtseva L. S.3, Rotar O. P.3, Moguchaya E. V.3, Boyarinova M. A.3, Kolesova E. P.3, Alieva A. S.3, Kravchenko S. O.3, Paskar N. A.3, Sviryaev Yu. V.3, Alyokhin A. N.1, Konradi A. O.3

Abstract

Aim. To assess the prevalence of sleep-disordered breathing (SDB), their relation to emotional complaints, antropometric measures and life-style factors in representative cohort of a large city inhabitants (Saint-Petersburg).

Material and methods. Using structured interview and antropometric methods we studied 358 citizens of Saint-Petersburg at the age of 21-68 y. o. The presence/absence of the following were evaluated: dyssomnias, SDB (snore, breathing pauses), emotional complaints, body mass index, life-style characteristics. 21,5% of respondents could not respond definitely about the sleep breathing quality, of those mostly women (25,9% vs 14,2%; p<0,05). Finally we analyzed 281 respondents - 115 men and 166 women.

Results. Regular snore do confirm 29,6% men and 22,9% women. Proportional increase of snoring with the age was found only in women (r=0,21; p<0,01). Apnea episodes are reported by 14,3% respondents. Clear differences by this parameter in men and women in different ages are not found. Not depending on gender and age the snore prevalence was related to obesity markers: body mass index (r=0,26; p<0,001) and waist circumference (r=0,24; p<0,001). There was no relationship of apnea prevalence and obesity markers. There was connection between snore prevalence with sleepiness level (r=0,21, p=0,001), emotional tension (r=0,24, p<0,001) and despondency (r=0,20, p<0,01), prevalence of bruxism (r=0,18, p<0,01) and awake with the feeling of suffocation / heaviness in the chest (r=0,17, p<0,01). Apnea prevalence correlated with typicality of fatigue after night sleep (r=0,16, p<0,01), awake with the feeling of suffocation / heaviness in the chest (r=0,17, p<0,01), and with bruxism prevalence (r=0,16, p =0,01). There was no clear evidence of SDB with lifestyle connections.

Conclusion. Every fourth adult of Saint-Petersburg shows the signs of SDB, which are linked with overall sleep quality decrease, dyssomnias and emotional complaints, and with obesity values.

Russ J Cardiol 2014, 11 (115): 31–37
http://dx.doi.org/10.15829/1560-4071-2014-11-31-37

Key words: sleep disordered breathing, emotional complaints, obesity, screening study.

1FSBEI HPE Russian State University for Pedagogics n. a. I. M. Herzen, Saint-Petersburg; 2FSBI Saint-Petersburg Scientific-Research Psychoneurological Institute n. a. V. M. Bekhterev of the Ministry of Health, Saint-Petersburg; 3FSBI Federal Medical Research Centre n. a. V. A. Almazov of the Ministry of Health, Saint-Petersburg, Russia.


VENTRICULAR EXTRASYSTOLY WITH HIGH RISK OF LIFE-THREATENING ARRHYTHMIAS DEVELOPMENT IN ACUTE CORONARY SYNDROME WITHOUT ST ELEVATION: EVALUATION OF REVASCULARIZATION EFFECTIVENESS

Olesin A. I.1, Litvinenko V. A.2, Al-Barbari A. B.2, Tikhonova T. L.2

Abstract

Aim. To study the role of early myocardial revascularization in the clinical course of the acute coronary syndrome (NSTEACS) without ST elevation, complicated with ventricular extrasystoly (VE) and high risk of life-threatening ventricular arrhythmias (LVA) development.

Material and methods. Totally 124 patients with NSTEACS with VE II-V Lown and high risk of LVA that was assessed if there are pathologic values of linear shift of preectopic VE interval and LVA index, ≤10 ms and ≤0,5, respectively. To all patients having informed consent during the first 24 h since admittance the evaluation of coronary arteries flow grade was performed and for those having indications — revascularization preformed. In refusion of invasive treatment — in addition to conservative therapy the drugs of III class were used (mostly amiodarone).

Results. The best positive effect of revascularization in NSTEACS with VE and LVA risk was if it had been performed during the first 2 h since hospitalization: fatal ventricular arrhythmias during hospitalization and before were not registered. Efficacy of fatal arrhythmias prevention in NSTEACS with VE and high risk of LVA during 2-24 h after hospitalization and with revascularization if indicated, was nearly same with the use of additional III class drugs — i. e. amiodarone, and was about 76,19% and 79,41%, resp.

Conclusion. All patients with NSTEACS with VE and high risk of LVA the revascularization is indicated if indicated, in first 2 h after hospitalization.

Rus J Cardiol 2014, 11 (115): 38–43
http://dx.doi.org/10.15829/1560-4071-2014-11-38-43

Key words: acute coronary syndrome, ventricular extrasystoly, treatment.

1SBEI HPE North-Western State Medical University n. a. I. M. Mechnikov, Saint- Petersburg; 2City Hospital of St.Elizabeth, Saint-Petersburg, Russia.


SURVIVAL AND ANGIOGRAPHIC RESULTS AFTER ENDARTERECTOMY FROM THE LEFT ANTERIOR DESCENDING ARTERY

Bogdan A. P.1,2, Belash S. A.1,2, Barbukhatti K. O.1,2

Abstract

Aim. To assess optimal tactics of treatment of the patients wth diffuse atherosclerotic lesions of left anterior descending artery (LAD).

Material and methods. The results of 320 patients studied, of those 149 underwent endarterectomy (EAE) from LAD (the EAE group), and CABG group consisted of 103 patients with locally-proximal type of coronary arteries involvement, therapy group — 68 patients, who were refused from surgical treatment due to serious changes of distal part of the arteries. Mean age, gender and concomitant pathology did not significantly differ. All operations were done under the artificial circulation conditions. In 100% cases for LAD revascularization arteria thoracica interna was used. Patients without surgical treatment were recommended optimal drug treatment. In follow-up period 127 EAE patients studied, 99 — CABG group, 58 — drug treatment group. Mean period of follow-up was 43,3±23,9 months.

Results. Survival after CABG with EAE from LAD was 89,3% (95% confidence interval (CI) 83,9 to 94,1%). This value for the patients with diffuse atherosclerotic LAD defect, only on drug therapy, was 70,7% (95% CI 60,9-80,5%), (p=0,038). The death causes in the surgical group were progression of concomitant non-cardiovascular pathology. Mortality of patients on drug therapy was related to cardial pathology. MI during the period was in 3 patients from EAE group and 5 patients from drug therapy group. Absence of angina was in 95,7% patients from EAE group and 93,5% in CABG. By the data of control coronary bypass graphy, the functioning of the grafts to the arteries after EAE in long-term follow-up did not statistically significantly differ from CABG group.

Conclusion. The CABG results with EAE are nearly same as of CABG only and provide satisfactory survival and life quality in long-term follow-up. CABG with EAE in those with diffuse distal LAD atherosclerosis provides better prognosis and life quality comparing to conservative therapy and can be recommended for the treatment of these patients.

Russ J Cardiol 2014, 11 (115): 44–50
http://dx.doi.org/10.15829/1560-4071-2014-11-44-50

Key words: ischemic heart disease, coronary artery bypass grafting, coronary endarterectomy, diffuse coronary atherosclerosis.

1SBEI HPE Kuban’ State Medical University of the Ministry of Health, Krasnodar; 2SBEI Regional Clinical Hospital #1 n. a. Prof. Otchapovsky S. V. of the Krasnodar Region Ministry of Healthm Krasnodar, Russia.


RELATIONSHIP OF LIPOPROTEINE-ASSOCIATED PHOSPHOLIPASE A2 WITH CORONARY AND CAROTID ATHEROSCLEROSIS IN KIRGIZ ETHNIC GROUP

Polupanov A. G., Lomteva Yu. N., Romanova T. A., Dzhumagulova A. S.

Abstract

Aim. To study the association of the level (mass) of lipoproteine-associated phospholipase A2 with coronary and carotid atherosclerosis in the patients with essential arterial hypertension in Kirgiz ethnic group.

Material and methods. Totally 52 patients studied with arterial hypertension (AH); mean age — 54,9±6,7, of those 26 men and 26 women. CHD, confirmed by exercise tests or coronary arteriography, had 19 patients, atherosclerosis of carotid arteries – 28. All patients underwent height measurement, weight and waist circumference, BP and HR measurement, also measurement of some biochemical values: fibrinogene level, sugar, creatinine of the blood and lipid profile (levels of total cholesterol, LDL, HDL and triglycerides). Measurement of LP-PLA2 was done using “PLAC” test by “DiaDexus” (USA) with immuneturbodimetry method “ELISA”. Duplex scanning of carotid arteries was done with Sequoia-512 by “Accuson” (USA).

Results. There was direct correlation of LP-PLA2 correlation with the age (r=0,27; p<0,05), HDL concentration (r=0,30; p<0,05) and LDL (r=0,28; p<0,05) and negative association with triglycerides (r=-0,28; p<0,05). Significant differences by gender in LP-PLA2 were not found (p>0,05). Patients with CHD had higher level of total cholesterol (5,64±0,97 mmol/l vs. 5,23±1,33 mmol/l, р=0,057), LDL (3,63±0,89 mmol/l vs. 3,16±0,98 mmol/l, p<0,01), and the mass of LP-PLA2 (296±70 ng/ml vs. 237±76 ng/ml, p<0,005) comparing to the patients with EH and CHD. In multifactorial regression analysis it was shown that only concentration of LP-PLA2 independently associated with CHD among native inhabitants of the Republic (β=0,66; p<0,001). We did not found association of LP-PLA2 with presence and prominence of carotid atherosclerosis and carotid intima-media thickness (p>0,05).

Conclusion. In Kirgiz ethnic group there is association of LP-PLA2 with CHD, but not with carotid atherosclerosis.

Russ J Cardiol 2014, 11 (115): 51–56
http://dx.doi.org/10.15829/1560-4071-2014-11-51-56

Key words: coronary heart disease, carotid atherosclerosis, LP-PLA2.

National Centre for Cardiology and Therapy n. a. Academician M. Mirrakhimov of the Ministry of Health of Kirgiz Republic, Bishkek, Kirgiz Republic.


ENDOTHELIAL DYSFUNCTION IN RYAZAN REGION INHABITANTS — PREVALENCE AND RISK FACTORS (BY THE DATA FROM MERIDIAN-RO)

Filippov E. V.

Abstract

Aim. To study the prevalence of endothelial dysfunction in economically active inhabitants of Ryazan region and to reveal the factors influencing the value, including specific for men and women.

Material and methods. MERIDIAN-RO was performed as open prospective trans-crossing study. Into the study the persons of the age 25-64 y. o. included at the moment of the study, who signed the informed consent. All participants underwent questionnaire filling in by the standard, antropometry, BP, HR measurement, ECG, blood specimens collection to study blood chemistry. Also the complex risk estimation was performed with SCORE (Systematic COronary Risk Evaluation) adapted for Russian Federation.

Results. The data showed high prevalence of ED in Ryazan region inhabitants (51,8%) independently from gender, that witnesses the higher risk of atherosclerosis development and it-related diseases. The analysis showed that following influences the ED development: decrease of glomerular filtration rate less than 50 ml/min, C-r.p.>5 mg/ml, fibrinogene>4 g/L, obesity, excessive alcohol consumption, arterial hypertension, SCORE>5%. In gender analysis the specific factors were revealed. So, for men the main role played excessive alcohol drinking (more than 20 ml/day by ethanol) and the level of ApoB more than 100 g/L. For women the main factors were total cholesterol more than 5 mmol/L, apolipoproteine B vore than 100 g/L, fibrinogene more than 4 g/L and diabetes mellitus. Taking into account that the data of MERIDIAN-RO and Ryazan region population are relevant to each other, it is possible to transgress the data of the study to Ryazan region population.

Conclusion. Prevalence of ED in Ryazan region population is the same high in men and in women (52,4% vs. 51,2%). The main factors, associated with ED are C-r.p.>5 mg/ml, obesity, arterial hypertension, high risk by SCORE>5%. Also in men the risk factors were: excessive alcohol consumption and ApoB >100 g/L; in women — Apo B >100 g/L, fibrinogene >4 g/L, total cholesterol >5 mmol/L.

Russ J Cardiol 2014, 11 (115): 57–61
http://dx.doi.org/10.15829/1560-4071-2014-11-57-61

Key words: endothelial dysfunction, risk factors, atherosclerosis, epidemiologic study.

SBEI HPE Ryazan State Medical University n. a. Acad. I. P. Pavlov of the MH, Ryazan, Russia.


THE DEMOGRAPHIC SITUATION INFLUENCE ON EPIDEMIOLOGY OF ACUTE CORONARY PATHOLOGY IN URBAN POPULATION OF THE WEST-SIBERIAN REGION

Garganeeva A. A.1, Okrugin S. A.1, Borel K. N.1, Parshin E. A.2

Abstract

Aim. To evaluate the changes in demographic situation influence on morbidity, mortality and lethality from acute myocardial infarction in Tomsk in 1984-2010 y. y.

Material and methods. The study was done under the WHO program “Registry of acute myocardial infarction”. Epidemiology of infarction was studied among citizens older than 20 y. o. For the period studied there were 24850 cases of the disease registered. In the acute phase 9390 patients died, including 3314 (36,4%) in-patients and 6076 (64,7%) - prehospital patients. Information on quantitative and age-gender properties of citizens was studied based on the data obtained in the regional statistics department.

Results. During the study the demographic situation in the city was characterized by strong tendency to ageing of the population and to increase the part of older persons in the cohort. This factor led to the increase of morbidity and mortality of the city inhabitants from myocardial infarction, registered during the first years of the study. Negatively the ageing of the population influenced also the parameters of in-patient lethality. Prevalence of older persons among all patients led to the increase of severity of anamnestic background of infarction and the increase of atypical clinical flow of the disease (astmatic, abdominal, collaptoid etc.). This made difficulties for the disease diagnostics at prehospital stage and led to the increase the part of those who received treatment in non-specialized hospitals. High mortality in non-specialized hospitals was the reason that led to the mean lethality in the city. Ageing did not influence the prehospital lethality of Tomsk. However it should be mentioned that in age-related structure of the patients died in prehospital period, the part of older people was almost the same as in younger groups.

Conclusion. So the ageing of the inhabitants led to the fact that Tomsk epidemiologic situation for myocardial infarction were dependent on the prevalence of this pathology among the citizens older than 60 y. The situation relevantly signs on the necessity of urgent healthcare system improvement for the patients with acute coronary pathology to the side of older age groups.

Russ J Cardiol 2014, 11 (115): 62–66
http://dx.doi.org/10.15829/1560-4071-2014-11-62-66

Key words: acute myocardial infarction, epidemiology, demography.

1FSBI SRI of Cardiology of SD RAMS, Tomsk; 2National Research Tomsk Polytechnik University, Russia.


CLINIC AND PHARMACOTHERAPY

EFFECTIVENESS OF PERINDOPRIL AND AMLODIPINE COMBINATION IN HYPERTENSIVES WITH COPD

Kryuchkova O. N.1, Kostyukova E. A.1, Lebed E. I.1, Itskova E. A.1, Zakharova M. A.2, Turna E. Yu.1

Abstract

Aim. To study efficacy of the standard combination of perindopril and amlodipine in target blood pressure levels achievement in COPD patients with AH.

Material and methods. Totally 28 patients included - 17 men and 11 women, mean age 51,42±1,45 y. o. with the COPD II-III stage established, with arterial hypertension II stage, 2 grade. In treatment we used fixed antihypertensive combination of ACE inhibitor and calcium channel blocker amlodipine. The values of “office BP” were measured, with ambulatory blood pressure monitoring and spirometry data.

Results. After 30 days there was significant decrease of the mean “office BP” values, in 24 (85,7%) patients there was decrease of target BP. By ABPM data the decrease of mean clock-round, daytime and nocturnal BP values revealed. There was increase of the quantity of patients with physiological sleep pattern of BP from 5 to 12 (17,8% to 42,8%). Various dose regimens of perindopril/arginine combinations in 27 patients (96,4%) made it to achieve the BP level less than 140/90 mmHg. Long-term outcomes, tracked in the most of patients, showed good tolerability and high antihypertensive efficacy of the fixed perindopril and arginine combination.

Conclusion. The use of fixed ACE inhibitor and calcium channel blocker combination fulfilled effective, dose dependent BP decrease and let most of COPD and AH patients reach the target BP. The treatment was followed by significant decrease of mean, daytime and nocturnal levels of ABPM. With the treatment there was recovery of physiological circle-round BP with reliable decrease at night. The possible side effect — dry cough — was rare and did not lead to the decrease of spirography parameters.

Russ J Cardiol 2014, 11 (115): 67–69
http://dx.doi.org/10.15829/1560-4071-2014-11-67-69

Key words: chronic obstructive pulmonary disease, arterial hypertension, perindopril, amlodipine.

1FPO SI Crimea State Medical University n. a. S. I. Georgievsky, Simpheropol; 2The 7th City Clinical Hospital, Simpheropol, Crimea Respublic, Russia.


LITERATURE REVIEWS

THE ROLE OF HYPOXIA-INDUCED FACTOR-1 (HIF-1) IN CYTOPROTECTION EFFECT IN ISCHEMIC AND PHARMACOLOGIC POSTCONDITIONING

Shcherbak N. S.1,2, Galagudza M. M.1,2, Shlyakhto E. V.1,2

Abstract

The review concerns on the experimental studies results of the influence of ischemic and pharmacological post conditioning of the liver, brain, myocardium and scelet muscle on the expression and activity of the hypoxia-induced factor-1α (HIF-1α) in various types of lab animals.

Russ J Cardiol 2014, 11 (115): 70–75
http://dx.doi.org/10.15829/1560-4071-2014-11-70-75

Key words: postconditioning, hypoxia-induced factor (HIF), ischemia-reperfusion, heart, liver, brain.

1SBEI HPE The First Saint-Petersburg State Medical University n. a. Academician I. P. Pavlov, Saint-Petersburg; 2Federal Centre of the Heart, Blood and Endocrinology n. a. V. A. Almazov, Saint-Petersburg, Russia.


CONTEMPORARY VIEWS ON PERIPARTUM CARDIOMYOPATHY — DEFINITION, EPIDEMIOLOGY, PATHOGENESIS (PART I)

Vatutin N. T., Taradin G. G., Kornienko S. M., Taratorina A. A., Keting E. V.

Abstract

The first part of the review of peripartum cardiomyopathy concerns on the disease itself, its prevalence by the data from various epidemiologic studies in different countries. More detailed the risk factors are discussed, especially age-related obstetrics anamnesis, double pregnancy or more, tocolytic therapy, smoking, arterial hypertension etc. Complicated questions of the etiopathogensis are discussed, including myocarditis, the role of prolactine-catepsine-prolactie 16kDa system, nutrition disorders, selenium deficiency, genetic predisposition at the background of pathologic response on hemodynamic stress during pregnancy.

Russ J Cardiol 2014, 11 (115): 76–82
http://dx.doi.org/10.15829/1560-4071-2014-11-76-82

Key words: peripartum cardiomyopathy, definition, epidemiology, risk factors, pathogenesis, prolactine.

Donetsk National Medical University n. a. M. Gorky, Donetsk, Ukraine.


ENDOTHELINES AND CARDIOVASCULAR PATHOLOGY

Alieva A. M.1,2, Chirkova N. N.2, Pinchuk T. V.3, Andreeva O. N.3, Pivovarov V. Yu.3

Abstract

Many studies of the last years were concerned the changes in endotheline system as one of the chains in endothelial dysfunction. Activation of endotheline system, which is marked by the increase of endotheline level and its predecessor, is common for many cardiovascular diseases. The significant increase of endotheline-1 and Big-endotheline is shown in atherosclerosis, angina, acute myocardial infarction, hypertensive disease and pulmonary hypertension.

Russ J Cardiol 2014, 11 (115): 83–87
http://dx.doi.org/10.15829/1560-4071-2014-11-83-87

Key words: chronic heart failure, ischemic heart disease, myocardial infarction, left ventricle, ejection fraction, endotheline.

1SBHI Scientific Centre of Cardiovascular Surgery n. a. A. N. Bakulev of RAMS, Moscow; 2SBHI Central Clinical Hospital of RAS, Moscow; 3SBEI HPE Russian National Research Medical University n. a. N. I. Pirogov, Moscow, Russia.


LECTURE

PEROXYSOME PROLIFERATOR-ACTIVATED RECEPTORS AND THEIR COACTIVATOR — PGC-1α — IN PHYSIOLOGY AND PATHOLOGY OF MYOCARDIUM

Rasin M. S.

Abstract

The receptors, activated by peroxysome proliferators (PPAR) α and β/δ do rule the gene expression of fatty acids (FA), that are the source of 70-90% ATP in myocardium. PPAR α controls FA oxydation and influences myocardial energy metabolism homeostasis, mostly through the supplement of circulating FA from the liver, and PPARγ prevent the excess of FA in myocardium with lipotoxicity prevented by switching the flow of FA to adipocytes. PPARβ/δ is the main regulator of lipid metabolism on muscles, that are 50% of body mass. The PPAR/PGC-1α system (mostly PPARα/PGC-1α) controls the biogenesis of mitochondria and hence makes available the possibility to adaptate myocardium for sudden (stress) exertion. Expression of PPARα/PGC-1α increases in physiologic forms of myocardial hypertrophy: in postnatal period and physical entraining, and decreases in pathological forms of myocardial hypertrophy and heart failure. Dysfunction of regulatory system PPAR/ PGC-1α might be one of the pathogenetic mechanisms of cardiomyopathy development, and signal pathways for the system - the object for therapeutic interventions.

Russ J Cardiol 2014, 11 (115): 88–92
http://dx.doi.org/10.15829/1560-4071-2014-11-88-92

Key words: receptors, activated by peroxysome proliferators; fatty acids; energy homeostasis of myocardium; heart failure.

SHI Ukraine Medical Stomatology Academy, Poltava, Ukraine.


INTERVIEW

Interview of the President of the Russian society of cardiology, Academician of the Russian Academy of Medical Science, Professor, Director of Federal Heart, Blood and Endocrinology Centre named after V. A. Almazov, Evgeny V. Shlyakhto

Russ J Cardiol 2014, 11 (115): 93-95


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