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RUSSIAN JOURNAL OF CARDIOLOGY, 2015, 12 (128)

Address to the readers

Russ J Cardiol 2015, 12 (128): 5

CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russ J Cardiol 2015, 12 (128): 6

ORIGINAL ARTICLES

ANALYSIS OF FUNCTIONAL STATE OF CARDIOVASCULAR SYSTEM BY COLLECTION OF THE SIGNS OF PHASIC PORTRAIT IN SINGLE CHANNEL ECG

Minina E.N .1, Faynzilberg L. S.2

Abstract

Aim. To study a diagnostic value of the parameters characterizing phasic ECG portrait of the first standard lead in assessment of efficiency of cardiovascular system functioning in persons with different level of adaptation potential.

Material and methods. Totally, 825 persons participated of the age 17-70 y. o. The group with cardiovascular pathology consisted with 99 persons of 50-70 y. o. with diagnoses CHD, PICS. In almost healthy group we included volunteers 17-50 y. o. (n=726), of those 35 soccer players (sports mastery) and 15 train drivers of 30-35 y. o. Registration and analysis of ECG in phasic area and defining of the original parameters βT, STR, αQRS and σQRS of phasic portrait of ECG was done via diagnostic complex PHASAGRAPH®. In train drivers the mentioned parameters of phasic portrait were recorded before and after six-hour shift. In almost healthy persons, young men and male sportsmen additionally we recorded the studied parameters continuing exercise test with gradually increasing load. Additionally, with PHASAGRAPH® we assessed the parameters of cardiointervalogram with automatic calculation of tension index (TI, u.). Before this, in all groups the parameter of relative MOC was defined, mL/min/kg.

Results. Diagnostic efficacy of βT was assessed with AUC square under experimental ROC-curve. It was found, that in threshold βT0≈0,788 there is sensitivity SE=78,8% and specificity SP=80,3% By the results of measurement of STR, αQRS, σQRS in group of almost healthy volunteers the reference diapasons defined for these parameters, which were 110<αQRS<185 °, σQRS<30 units, STR>0,02 units. The scheme invented for diagnostic conclusions with the use of collected βT, STR, αQRS and σQRS. It was found that "sizes" and direction of the motions of pairs in areas of phasic portrait bring the information on compensational-adaptational mechanisms in urgent, as in long-term adaptation.

Conclusion. Diagnostic ECG signs are more visible in the signal visualization in phasic coordinates z(t), z'(t), than in time zone z(t), and collection of phasic parameters of the phasic portrait, that are automatically calculated by the PHASAGRAPH® complex, make it to improve the power of one-channel ECG in prognostic reasons, as for the assessment of functional condition of cardiovascular system in screenings.

Russ J Cardiol 2015, 12 (128): 7–13

http://dx.doi.org/10.15829/1560-4071-2015-12-7-13

Key words: PHASAGRAPH®, single-channel ECG, phasic ECG portrait, collection of parameters of phasic portrait in single channel ECG.

1Taurida Academy V.I. Vernadsky Crimean Federal University, Simferopol, Republic Crimea, Russia; 2International Scientific-Education Center of Information Technologies and Systems of NAN and MON of Ukraine, Kiev, Ukraine.

DIAGNOSTICS OF SIGNIFICANT CORONARY STENOSES IN PATIENTS WITH MYOCARDIAL PERFUSION DISORDERS BY THE DATA OF MONOFOTON EMISSION COMPUTED TOMOGRAPHY OF MYOCARDIUM USING MATHEMATIC INSTRUMENT OF ARTIFICIAL NEURONAL NETWORKS

Kuznetsov V. A.1, Yaroslavskaya E. I.1, Krinochkin D. V.1, Teffenberg D. V.1, Kutrunov V. N.2, Diachkov S. M.2

Abstract The method described, of non-invasive diagnostics of significant coronary stenosis in patients with disordered myocardial perfusion by the data of monofoton emission computed tomography of myocardium. The method includes utilization of echocardiographic parameters — index of asynergy of the left ventricle and presence of significant mitral regurgitation. It is possible to find coronary stenosis via the presence of parameters obtained with mathematic instrument of artificial neuron nets: presence of lesion (if it is convenient to talk of the presence of lesion) or absence of lesion (if the lesion is absent). Specificity of the method was 93,6%, sensitivity — 68,8%.

Russ J Cardiol 2015, 12 (128): 14–19

http://dx.doi.org/10.15829/1560-4071-2015-12-14-19

Key words: hemodynamically significant coronary stenosis, mitral regurgitation, asynergy index of the left ventricle.

1Branch of SRI of Cardiology Tyumen Center of Cardiology, Tyumen; 2Tyumen State University, Tyumen, Russia.

LASER DOPPLER FLOWMETRY IN ASSESSMENT OF SPECIFICS OF SKIN MICROHEMOCIRCULATION IN HYPERTENSIVE PATIENTS AND IN ITS COMORBIDITY WITH 2 TYPE DIABETES MELLITUS

Vasiliev A. P., Streltsova N. N.

Abstract

Aim. To reveal the specifics of microcirculation (MC) in patients with arterial hypertension (AH) and AH with diabetes comorbidity (DM) in groups with low and high micro vessel tone.

Material and methods. Studying of the skin MC via the method of laser Doppler flowmetry (LDF) underwent 110 patients with AH, 64 patients with 2 type DM and 55 almost healthy persons. All patients were separated to 2 groups: 1 — with low levels of MC tone, and 2 — with high levels of MC tone.

Results. Circa the same percentage spread of MC types in studied groups independently from BP level makes it to suggest that there are general physiological principles of circulation variants forming, directed to maintain hemodynamic homeostasis. Also, in the 2nd group of AH patients and especially in AH+DM there was more significant MC constriction, intensification of arteriolar-venular shunting and decrease of tissue hemoperfusion.

Conclusion. The data obtained makes it possible to select among the patients with hypertension disease and its comorbidity with DM 2 type with same grade of AH, the higher risk group with probability of more prominent negative influence on target organs.

Russ J Cadiol 2015, 12 (128): 20–26

http://dx.doi.org/10.15829/1560-4071-2015-12-20-26

Key words: arterial hypertension, diabetes mellitus, microcirculation.

Branch of SRI of Cardiology Tyumen Center of Cardiology, Tyumen, Russia.

SENSITIVITY AND SPECIFICITY OF VECTORCARDIOGRAPHY IN DIAGNOSTICS OF ACUTE MYOCARDIAL INFARCTION COMORBID WITH LIVER STEATOSIS AND NON-ALCOHOLIC STEATOHEPATITIS

Belaya I. E., Kolomiets V. I.

Abstract

Aim. To reveal vectorcardiographic (VCG) signs of an acute widespread myocardial infarction (MI) with Q, of the anterior wall of the left ventricle (LV), comorbid with hepatic steatosis and non-alcoholic steatohepatits, and to estimate the specificity and sensitivity of the method in diagnostics of comorbid pathology.

Material and methods. Totally, 14 patients studied with primary widespread MI of the anterior wall of LV (1st group), mean age — 69±3 y.; 43 patients with comorbidcourse of primary MI of anterior wall and hepatic steatosis or non-alcoholic steatohepatitis (2nd group) — mean age 66±2 y. In both groups women predominated. Instrumental study included electrocardiography, VCG, echocardiography and ultrasound liver examination. VCG performed on a modern cardiodiagnostic multifunctional equipment MTM-SKM. For estimation of sensitivity and specificity of VCG the four-pole net was applied.

Results. In comorbidity patients via VCG there was shifting of QRS loop down-, right- and backwards with a decrease of collected square 2,1 times (p<0,001); appearance of local ventricular block; disturbance of repolarization appearing as ST-damage vector, directed right-up-frontwards (51,2%) and left-frontwards (48,8%), changes of T-loops location, angular QRS-T loops direction in VА1,2,4,5 (p<0,05-0,001), increase of T-loops square 2,9-3,0 times in VА2,3,5 (p<0,01), of their cross and condensation of timing marks by their trace in all projections (p<0,001). Rarefaction of time points in the area of baseline shift of the loop in VА1,4,5 (p<0,05-0,001), increase of the loops QRS square in VА5 (p<0,01) and loops P in VА1-3 2,4-3,2 times (p<0,01) witness hemodynamic overload of basal areas of both ventricles, higher areas of front and lateral walls of LV, and also atriums. VCG let to diagnose non-transmural involvement of myocardium in all patients with comorbid pathology. In 2nd group patients, comparing to the 1st group, there is rarefaction of time marks in the area of baseline shifts of QRS loops in anterior projection (p<0,01), that represents overload in upper areas of LV front wall. In echocardiography it is found that left chambers increase (p<0,001), there is diastolic dysfunction (relaxation disorder of LV — 40%), pseudonormal type — 32%, restrictive type — 28%) with systolic function impairment (p<0,001). Sensitivity of vectrocardiography was 98,5%, and specificity — 95,2%.

Conclusion. Application of enhanced cardiodiagnostic complex MTM-SKM and vector analysis of electromotive force made it, with sensitivity 98,5% and specificity 95,2%, to reveal and clarify the depth and spread of myocardial damage, additionally to electro- and echocardiographic methods, and to obtain information on the heart condition outside necrosis zone.

Russ J Cardiol 2015, 12 (128): 27–36

http://dx.doi.org/10.15829/1560-4071-2015-12-27-36

Key words: myocardial infarction, hepatic steatosis, non-alcoholic steatohepatitis, electrocardiography, vectorcardiography, echocardiography.

Lugansk State Medical University, Lugansk.

CLINICAL AND ELECTROCARDIOGRAPHIC ANALYSIS OF ACCELERATED IDIOVENTRICULAR RHYTHMS

Treshkur T. V.

Abstract The aim of the work was to analyze 209 cases of accelerated idioventricular rhythms, after that we concluded with 4 types of an "interaction" of sinus node and ectopic pacemaker. The article is illustrated with 11 ECGs, among those rare phenomenon following the arrhythmia, and specifics of differential diagnosis.

Russ J Cardiol 2015, 12 (128): 37–44

http://dx.doi.org/10.15829/1560-4071-2015-12-37-44

Key words: accelerated idioventricular rhythm, ventricular ectopic rhythm, ventricular ectopic centers/complexes.

Federal Almazov North-West Medical Research Center of the Ministry of Health, Saint-Petersburg, Russia.

THE SIGNIFICANCE OF ARTERIAL WALL STIFFNESS ASSESSMENT FOR METABOLIC SYNDROME

Druzhilov M. A.1, Druzhilova O. Yu.1, Otmakhov V. V.1, Kuznetsova T. Yu.2

Abstract

Aim. To evaluate the usefulness of the pulse wave velocity parameter (PWV) in aorta as an additional prognostic criteria for target organs damage and hence higher cardiovascular risk (CVR) in patients with metabolic syndrome (MS).

Material and methods. Totally 74 normotensive asymptomatic for cardiovascular disorders patients studied, with MS, low and intermediate risk by SCORE (77,0% males, mean age — 45,1±5,0 y.). We performed the assessment of lipid profile, glucose profile, glomerular filtration rate, microalbuminuria (MAU), performed triplex brachiocephal arteries scanning, echocardiography, bifunctional 24-hour monitoring of blood pressure with PWV measurement in aorta. The value of PWV in aorta taken ≥7,9 m/s corresponds with carotid-femoral PWV >10 m/s and in this study it has been used as the criteria of early vascular ageing (EVA) for the selected age diapason of patients.

Results. Higher values of PWV in aorta had patients with MAU (8,5±0,3 m/s vs. 7,6±0,7 m/s, р < 0,001), carotid atherosclerosis (8,4±0,3 m/s vs 7,6±0,7 m/s, р < 0,001), hypertrophy of carotid arteries wall (CA) (7,9±0,6 m/s vs. 7,5±0,7 m/s, р < 0,05), left ventricle diastolic dysfunction (DD LV) (8,3±0,6 m/s vs. 7,6±0,6 m/s, р < 0,01). The participants with MS and aortic PWV ≥7,9 m/s had significantly more prevalent carotid atherosclerosis (36,4% vs. 16,2%, р < 0,05) and DD LV (33,3% vs. 16,2%, р < 0,05). The usage of the value of aortic PWV ≥7,9 m/s made it to select among the patients with MS 100% persons with subclinical carotid atherosclerosis and MAU, 91,7% participants with DD LV, 66,7% persons with carotid arteries wall hypertrophy.

Conclusion. It is aimful, to the patients with MS and low or moderate SCORE risk in case of the PWV at the level for EVA criteria, to perform screening of organ damage, firstly, subclinical atherosclerosis, for consequent reclassification of EVA and reconsideration of the volume of necessary prevention procedures.

Russ J Cardiol 2015, 12 (128): 45–49

http://dx.doi.org/10.15829/1560-4071-2015-12-45-49

Key words: pulse wave velocity, early vascular ageing, metabolic syndrome, cardiovascular risk.

1Medical-Sanitry Institution of FSS by Karelia Republic, Petrozavodsk; 2Petrozavodsk State University, Petrozavodsk, Russia.

INFLUENCE OF COMBINATION ANTIHYPERTENSIVE THERAPY ON AORTA STIFFNESS PARAMETERS AND CENTRAL ARTERIAL PRESSURE IN HYPERTENSIVES WITH OBESITY

Shupenina E . Yu., Vasyuk Yu. A., Nesterova E . A., Ivanova S. V.

Abstract

Aim. In the study we evaluated the influence of antihypertension therapy on 24-hour central BP and parameters of aorta stiffness in hypertensive patients with obesity.

Material and methods. Totally, we included 80 patients with AH and obesity, at the age 35-55 y. o. All patients underwent clinical, laboratory and instrumental assessment, including office, home and 24-hour measurement of BP. All patients were randomized to 3 groups: 30 patients received fixed combination of trandolapril/verapamil in daily dosage 2/180 mg, 25 — free combination of bisoprolol/indapamid 5-10/1,5 mg per day, 25 patients were taking fixed combination of perindopril/ amlodipine 5-10/5-10 mg per day. Follow-up period, in average, was 32 weeks.

Results. All combinations studied significantly reduced central BP, but combination of bisoprolol/amlodipine was least effective. Only on perindopril/amlodipine there was significant reducing of aortal augmentation index (Δ% -4,1±8,7), that might be related to influence of the drug on HR. Analysis of daily dynamics of BP amplification of pulse BP, index of subendocardial blood circulation efficacy, pulse wave velocity, showed significant correlations between these parameters and HR. Thus, only prescription of pulse-reducing combinations of trandolapril/verapamil and bisoprolol/indapamid was followed by significant reduce of pulse wave velocity in aorta in patients with AH and obesity (Δ m/s -0,4±1,1; -0,4±0,7, resp.).

Conclusion. Different influence of the studied combinations of antihypertension drugs on HR might be definitive for the improvement of aortic wall in AH patients and obesity.

Russ J Cardiol 2015, 12 (128): 50–55

http://dx.doi.org/10.15829/1560-4071-2015-12-50-55

Key words: 24-hour central BP, augmentation index, amplification of pulse BP, index of subendocardial circulation efficacy, obesity.

A. I. Evdokimov Moscow State University of Medicine and Dentistry (MSUMD), Moscow, Russia.

BRAIN NATRIURETIC PEPTIDE AS BIOCHEMICAL MARKER FOR STRUCTURAL AND FUNCTIONAL HEART DISORDERS IN ARTERIAL HYPERTENSION

Ivanova S. V., Vasyuk Yu. A., Shupenina E . Yu., Krikunov P . V., Sadulaeva I. A.

Abstract

Aim. Assessment of structural and functional condition of the left and right heart chambers related to the level of NT-proBNP and clinical signs of CHD in AH patients.

Material and methods. Totally, 137 AH patients studied (45 men, 92 women) with sinus rhythm and EF LV ≥50%. All patients underwent standard investigations, 6-minute walking test, two-dimension EchoCG, transvalvular and tissue Dopplergraphy, treadmill-test, NT-proBNP concentration in plasma. Assessment of structural and functional heart condition was done in three defined groups according to NT-proBNP level (norm, "grey" zone, elevated NT-proBNP).

Results. The level of NT-proBNP is related to the age, sex, therapy intake regularity and does not relate to body mass, BP level, heart rate. The relation revealed for NTproBNP level and diastolic dysfunction of the LV by the data of transmitral and tissue Doppler-graphy. Modified Tei index, obtained during impulse-wave tissue Dopplergraphy, was the most informative marker of LV dysfunction, relevant of NT-proBNP levels. The increase of NT-proBNP followed by significant increase of RV wall thickness. Evaluation of NT-proBNP together with EchoCG led to revelation of asympthomatic LV dysfunction in 13,1% of patients.

Conclusion. Interpretation of NT-proBNP level in hypertensive must complex, taking into consideration clinical factors as risk factors, gender and age. Evaluation of NT-proBNP with echocardiography helps to identify groups of patients of higher cardiovascular risk and to optimize further treatment.

Russ J Cardiol 2015, 12 (128): 56–62

http://dx.doi.org/10.15829/1560-4071-2015-12-56-62

Key words: arterial hypertension, brain natriuretic peptide, diastolic dysfunction, tissue Doppler-graphy, right ventricle.

A. I. Evdokimov Moscow State University of Medicine and Dentistry (MSUMD), Moscow, Russia.

SIGNIFICANCE OF STIMULATING GROWTH FACTOR ST2 AND NT-proBNP IN ASSESSMENT OF POSTINFARCTION REMODELING OF THE HEART

Dyleva Yu. A.1, Gruzdeva O. V.1, Akbasheva О. Е.2, Uchasova E. G.1, Fedorova N. V.1, Chernobay A. G.1, Karetnikova V. N.1,3, Kosareva S. N.3, Kashtalap V. V.1,3, Fedorova T. S.2, Barbarash O. L.1,3

Abstract

Aim. To assess the levels of ST2 and NT-proBNP in serum of infarction patients (MI) in dynamics of hospital period and their relation with adaptive and desadaptive variants of myocardium remodeling.

Material and methods. Totally, 87 patients (65 men and 22 women) with MI with ST elevation (STEMI), of those 67 patients had adaptive, physiological variant, and 20 — desadaptive, pathological variant of myocardium remodeling (DR). Mean age of patients was 59±8,36 y. In control group entered 30 patients. At 1st and 12th day of MI we studied in blood serum via immune enzyme method the levels of ST2 and NT-proBNP with test-systems of Critical Diagnostics (USA) company and Biomedica (Slovak Resp.), respectively. Statistical analysis of the data was performed with non-parametric criteria.

Results. On the 1st day of hospitalization period of MI concentration of ST2 and NTproBNP increased comparing with controls, 2,4 times and 4,5 times, respectively. In DR the level of ST2 on the 1st day was 1,5 times higher, than in the group of adaptive remodeling and 5,3 times higher comparing with the group of control. On the 12th day, in both groups there was decrease of marker level. Concentration of NT-proBNP did not relate on the type of post infarction remodeling and on the 1st day it was increased among the patients of both groups 1,8 times comparing with controls. High level of ST2 on the 1st day of MI increases the risk of DR 4,5 times (OR=4,5, 95% CI=2,0-10,1, р=0,011, AUG was 0,81, sensitivity — 78,7%, specificity — 69,4%), though the increase of NT-proBNP.— just 2,3 times (OR=2,3, 95% CI=2,0-2,01, р=0,032, AUG was 0,68, sensitivity — 69,5%, specificity — 65,9%).

Conclusion. So, in MI in 23% cases there was DR variant. High level of ST2 stimulating factor on the 1st day of MI is associated with the development of this type of remodeling and makes to predict the risk with higher sensitivity and specificity comparing with NTproBNP.

Russ J Cardiol 2015, 12 (128): 63–71

http://dx.doi.org/10.15829/1560-4071-2015-12-63-71

Key words: postinfarction remodeling, stimulating growth factor ST2.

1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo; 2Siberian State Medical University (SSMU), Tomsk; 3Kemerovo State Medical Academy of the Ministry of Health, Kemerovo, Russia.

THE ROLE OF TOLL-LIKE RECEPTORS POLYMORPHISM IN ATHEROSCLEROSIS COMPLICATIONS DEVELOPMENT

Barbarash O. L., Golovkin A.S., Ponasenko A.V., Kutikhin A.G ., Zhidkova I. I., Khutornaya M. V., Salakhov R. R., Barbarash L. S.

Abstract

Aim. To reveal the association of polymorphic types of Toll-like receptor genes with myocardial infarction (MI), stroke in patients with coronary heart disease (CHD).

Material and methods. Totally 292 patients studied, with CHD and anamnesis of stroke and/or MI. The association of 8 polymorphic loci of 4 genes were studied: TLR1 (rs5743551 & rs5743611), TLR2 (rs3804099 & rs5743708), TLR4 (rs4986790 & rs4986791), TLR6 (rs3775073 & rs5743810).

Results. The association of allele C of polymorphism rs5743551 gene TLR1 is associated with higher risk of earlier CHD onset (younger than 55 y. o.). Heterozygous (A/G) genotype of polymorphism rs5743810 TLR6 is protective against the risk of earlier CHD onset (younger than 55 y. o.). Heterozygous (C/T) genotype of polymorphism rs5743551 gene TLR1 is associated with higher risk of stroke in CHD patients. The associations revealed with age, gender and cardiovascular complications by polymorphisms of TLR genes: males, having CHD, homozygous by minor allele (С/С) of polymorphism rs3804099 gene TLR2, have reduced risk of of MI development not related to age; heterozygous (C/T) genotype of polymorphism rs5743551 of gene TLR1 is associated with the increased risk of stroke in CHD patients older than 55 y. o. not depending on gender; heterozygous (T/C) genotype of polymorphism rs3775073 gene TLR6 is associated with increased risk of MI in younger than 55 y. o. patients with CHD not related to gender.

Conclusion. Some associations of polymorphic Toll-like receptors genes with the development of atherosclerosis complications (MI, stroke) in CHD are revealed.

Russ J Cardiol 2015, 10 (126): 72–79

http://dx.doi.org/10.15829/1560-4071-2015-10-72-79

Key words: ischemic heart disease, stroke, atherosclerosis, Toll-like receptors, gene polymorphism.

Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia.

SPECIFICS OF THE LEFT HEART CHAMBERS EARLY POST INFARCTION REMODELING IN COMORBID COPD OF MILD AND MODERATE SEVERITY

Polikutina О. М.1, Slepynina Yu. S.1, Bazdyrev Е. D.1, Vasyutinskaya Е. G .2, Karetnikova V. N .1, Barbarash О. L.1

Abstract

Aim. To study early post infarction remodeling of the left heart chambers in STEMI patients with COPD comorbidity of mild and moderate severity.

Material and methods. Totally, 82 STEMI patients included, with COPD of mild and moderate severity, 107 STEMI without COPD. Spirometry was performed with bronchodilation test, and EchoCG.

Results. In subacute period of STEMI, in patients with comorbid COPD the changes of the heart show more dilation, worse relation of systolic function and geometry of the LV, higher prevalence of desadaptation variants of myocardial remodeling. In this group more common diastolic dysfunction of the left ventricle with predominance of its higher grades.

Conclusion. Specifics of post infarction remodeling of myocardium in COPD can be important for adverse outcomes.

Russ J Cardiol 2015, 12 (128): 80–85

http://dx.doi.org/10.15829/1560-4071-2015-12-80-85

Key words: ST elevation myocardial infarction, chronic obstructive pulmonary disease, early post infarction remodeling, comorbid pathology.

1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo; 2M.A. Podgorbunsky City Clinical Hospital №3, Kemerovo, Russia.

ASSOCIATIONS OF ISCHEMIC HEART DISEASE AND ARTERIAL HYPERTENSION, AND THEIR IMPORTANCE FOR MORTALITY FROM CARDIOVASCULAR CAUSES AND ALL CAUSES, OF PEOPLE AGED MORE THAN 55 YEARS OLD

Shalnova S. A., Kapustina A. V., Tuaeva E. M., Balanova Yu. A., Muromtseva G. A., Imaeva A. E., Deev D. A.

Abstract

Aim. To study the associations between ischemic heart disease (IHD) and arterial hypertension (AH) in population of men and women 55 years old and more and to estimate the impact to mortality from cardiovascular diseases (CVD) and all causes.

Material and methods. The results obtained under the circumstances of prospective study that included 1871 persons (response was 64%), Moscow citizens, with the age 55 y. and older, participants of the cohort study "Stress, ageing and health". During the study the demographic data was collected, anthropometric parameters and resting ECG, blood pressure (BP). Epidemiologic diagnosis of IHD was set with the Rose Questionnaire and ECG parameters, coded by Minnesota code (MC). Mean time of observation was 4,7 years. Totally 332 lethal cases registered, including 197 — from CVD. Statistical analysis was done with SAS software.

Results. During the analysis we found highly significant positive correlations of prevalence of raised (≥140/90 mmHg) and high (160/95 mmHg) BP, prevalence of AH with IHD of various severity that increase with the age, do not depend on education level and are more prominent in men. In monofactorial regression analysis, by correction for age and sex, the significant relation is found only for mortality from all causes only with definite IHD (dIHD) (OR 1,86; 95% CI 1,42-2,46, р=0,0001), though in probable IHD there is no such relation (OR 1,20; 95% CI 0,91-1,58, р=0,194); there were much less prominent associations with mortality of the raised and high BPs (OR 1,33; 95% CI 1,04-1,63) and (OR 1,33; 95% CI 1,06-1,67), respectively, and hypertension did not influence mortality on its own (OR 1,13; 95% CI 0,87-1,48, р=0,36). Same associations were found for the mortality from CVD. In combined analysis of mortality and dIHD together with different BP levels there was highly significant increase of mortality from all causes in IHD patients, and impact of high BP is much weaker. With the mortality from CVD there is only association of dIHD and high BP, but raised BP losses its own significance.

Conclusion. At the age 55 y. and older, AH is definitely associated with IHD, increasing the prevalence from 65% in non-IHD to 81% in dIHD. However, while corrected by sex and age, only presence of IHD strictly and significantly increases the risk of CV death and from all causes, while among various BP levels just the high level positively associates with all-causes mortality.

Russ J Cardiol 2015, 12 (128): 86–90

http://dx.doi.org/10.15829/1560-4071-2015-12-86-90

Key words: ischemic heart disease, arterial hypertension, all-causes mortality, CV mortality.

National Research Center for Preventive Medicine of the Ministry of Health, Moscow, Russia.

CLINIC AND PHARMACOTHERAPY

AN ISSUE OF DRUG INTERACTION IN CARDIOLOGICAL PRACTICE: WHAT SHALL PHYSICIAN BE AWARE OF?

Tarlovskaya E. I.1, Koziolova N. A.2, Chesnikova A. I.3

Abstract

The article focuses on the results of data review obtained from accessible local and international sources concerning drug interaction and selection of drugs taking these data into account. The data provided on statins, angiotensine II receptors antagonists, acetylsalicylic acid and renin-angiotensine-aldosterone system. The key result of the review is conclusion that physicians in their practical work must be aware of possible drug interaction and pay attention to this part of drug sheet or on electronic sources, the links provided in the article.

Russ J Cardiol 2015, 12 (128): 91–101

http://dx.doi.org/10.15829/1560-4071-2015-12-91-101

Key words: drug interaction, statins, angiotensine II receptor antagonists, valsartan, aspirin, clopidogrel, ACE inhibitor.

1Nizhny Novgorod State Medical Academy of the Ministry of Health, Nizhny Novgorod; 2E. A. Wagner Perm State Medical University of the Ministry of Health, Perm; 3Rostov State Medical University of the Ministry of Health, Rostov-na-Donu, Russia.

ACHIEVEMENT OF ARTERIAL HYPERTENSION CONTROL VIA APPLICATION OF PERINDOPRIL ARGININE AND AMLODIPINE COMBINATION

Kryuchkova O. N., Itskova E. A., Lutay Yu. A., Turna E. Yu., Kostyukova E. A.

Abstract

Aim. Evaluation of the opportunity to improve efficacy of arterial hypertension (AH) control using fixed combination of perindopril arginine and amlodipine.

Material and methods. Totally, 52 patients (27 men and 25 women, age 40-63 y. o.) studied, with AH 2-3 stage. All patients underwent 24-hour blood pressure monitoring (ABPM) with analysis of the data obtained: mean 24-hour pressure, velocity of morning hypertension onset for systolic BP (sBP) and diastolic BP (dBP), and variability of (Var) of PsBP (Var PsBPs, Var PsBPd). The inclusion criteria was non-sufficient control of blood pressure on the intake of voluntary combinations of ACE inhibitor and angiotensine II receptor blocker and diuretic or calcium channel blocker. For BP control, to all patients we prescribed fixed combination perindopril arginine/amlodipine with start dosage 10/5 mg (Prestance, "Les Laboratoires Servier", France) with further possibility to increase dosage to 10 mg of perindopril arginine and amlodipine.

Results. At the background of therapy provided, 84,6% of patients reached "target" BP. Mean 24-hour sBP decreased from 139,29±1,7 to 121,17±1,26 mmHg. (р < 0,05), dBP decreased from 84,49±2,06 to 73,14±1,4 (р < 0,05), mean BP decreased from 102,09±1,49 to 87,96±1,12 (р < 0,05). 24-hour variability of sBP significantly reduced from 15,28±0,72 to 10,21±0,42 (р < 0,05), dBP from 13,46±0,72 to 10,72±0,31 (р < 0,001). Parameters of morning onset (MO) after the treatment also decreased. Before treatment MO sBP was (26±4,23 mmHg/hour), with the therapy — (16,3±4,03 mmHg/hour, р < 0,01); also, MO dBP decreased from 24,7±2,35 mmHg/hour to 12±1,61 mmHg hour, р < 0,01).

Conclusion. Replacement of therapy for non-controlled AH with voluntary combinations of antihypertensive medications by fixed combination of perindopril arginine/amlodipine (Prestance) facilitated the effectiveness of AH control. Usage of the fixed combination of perindopril arginine/amlodipine in 84,6% helped to reach target values of BP. The effectiveness of BP control achieved, followed with ABPM data of 24-hour BP values decrease during the day and night, variability and velocity of morning BP onset. Usage of the drug studied showed good tolerability and high adherence of patients to treatment.

Russ J Cardiol 2015, 12 (128): 102–106

http://dx.doi.org/10.15829/1560-4071-2015-12-102-106

Key words: arterial hypertension, fixed combination of antihypertensives, perindopril arginine, amlodipine.

S.I. Georgievsky Medical Academy V.I. Vernadsky Crimean Federal University, Simferopol, Republic Crimea, Russia

EFFICACY ANALYSIS OF DIFFERENT ANTIANGINAL REGIMENS IN ISCHEMIC HEART DISEASE WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Galeeva K. O., Chesnikova A. I.

Abstract

Aim. Assessment of effectiveness of different treatment regimens application for angina in coronary heart disease patients (CHD) with frequent exacerbations of chronic obstructive pulmonary disease (COPD).

Material and methods. Totally, 60 patients included, with CHD and COPD, with frequent exacerbations (2 and more per year). All patients received ivabradine, the If-channels inhibitor (Coraxan). Taken the second antianginal drug, patients were selected into 2 groups: 1st group consisted of 30 patients, receiving together with basic CHD and COPD therapy Coraxan with trimetazidine (Preductal MB), 2nd group — 30 patients with inclusion of prolonged nitrates. All patients were monitored for clinical picture of CHD, Holter ECG, echocardiography and laboratory studies. Follow-up period — 6 months.

Results. After comparatory analysis, there was demonstrated significantly more prominent decrease of anginal attacks per day and times of short nitrates be taken (p<0,05), improvement of functional class (FC) of angina in patients receiving Coraxan with Preductal MB. By the end of follow-up, in the 1st group 20% of patients had I FC of angina, 53,3% — II FC, 26,7% — III FC. Patients from 2nd group had I GC in 6,7% cases, II FC — 33,3%, III — 60%. Holter monitoring analysis revealed the decrease 4,7 times the quantity of ventricular and 4,5 times supraventricular extrasystoles at the background of long-term intake of Coraxan and Preductal MB, significantly less prominent dynamics was shown in the 2nd group. Only in the group of Coraxan with Preductal MB, there was improvement of systolic and diastolic function of the left ventricle.

Conclusion. In CHD and COPD patients with common exacerbations it is feasible to apply antianginal therapy that includes Coraxan and Preductal MB, and that not only facilitates prominent decrease of clinical symptoms, improvement of life quality, but also helps to reduce heart rhythm disorders, improves systolic and diastolic left ventricle function, hence preventing cardiovascular complications.

Russ J Cardiol 2015, 12 (128): 107–113

http://dx.doi.org/10.15829/1560-4071-2015-12-107-113

Key words: antianginal therapy, ischemic heart disease, chronic obstructive pulmonary disease.

Rostov State Medical University of the Healthcare Ministry, Rostov-na-Donu, Russia.

LITERATURE REVIEWS

SYMPATHIC DENERVATION OF RENAL ARTERIES: PAST, PRESENT AND FUTURE

Shugushev Z. Kh.1,2, Meleshkevich Т. А.2, Lukashova М. Е.2, Luchina Е. I.2, Maksimkin D. А.1,2

Abstract

The analysis presented of recent studies that show efficacy of the procedure of sympathic renal denervation in arterial hypertension. Future of the method is sketched, including diabetic patients, pulmonary hypertension patients and cardiac rhythm disorders.

Russ J Cardiol 2015, 12 (128): 114–118

http://dx.doi.org/10.15829/1560-4071-2015-12-114-118

Key words: sympathic renal denervation, arterial hypertension, diabetes mellitus.

1Peoples' Friendship University of Russia, Moscow; 2N.A. Semashko Central Clinical Hospital №2 of "RGD", Moscow, Russia.

CHEMOTHERAPY CARDIOTOXICITY SCREENING WITH CARDIAC TROPONINS

Krikunova O. V.1, Vasyuk Yu. A.1, Viskov R. V.2, Krikunov P. V.1, Ivanova S. V.1, Konik V. A.2

Abstract

Recently, chemotherapy is one of the most trustworthy methods for treatment of malignant tumors and blood pathology. However clinical effect of the drugs not always matches with safety. These facts play as a solid evidence for the necessity of studying the problems related to side effects of the drugs, and, particularly, of cardiotoxicity, as reversible and/or irreversible damage of cardiomyocytes. Currently, the most sensitive ad specific markers of myocardium cells are troponins T and I. According with this, the main aims of this article are analysis of literary data for the problem of cardiac troponins application as cardiotoxicity revealing in oncology patients, and summon of more attention to this direction of science. The article provides a collection of the key points of all available studies at the moment, shows generalized analysis, analyses also the Russian and European Guidelines from the point of view related to troponins tests in oncology patients.

Russ J Cardiol 2015, 12 (128): 119–125

http://dx.doi.org/10.15829/1560-4071-2015-12-119-125

Key words: troponin, cardiotoxicity, chemotherapy.

1A. I. Evdokimov Moscow State University of Medicine and Dentistry (MSUMD), Moscow; 2F. I. Inozemtsev City Clinical Hospital, Moscow, Russia.

CLINICAL CASES

THE CASE OF SUCCESSFUL APPLICATION OF EMBOLIZING SYSTEM IN DISTAL PERFORATION OF CORONARY ARTERY

Krasnov A. Yu.1, Belokon O. S.1, Fayans I. V.1, Boeva O. I.2

Russ J Cardiol 2015, 12 (128): 126–128

http://dx.doi.org/10.15829/1560-4071-2015-12-126-128

Key words: perforation of coronary artery, embolization, n-butil cyanoacrilate.

1Stavropol Regional Clinical Hospital, Stavropol, 2Stavropol State Medical University of the Ministry of Health, Stavropol, Russia.

AN ADULT WITH MYOCARDIAL INFARCTION AND KAWASAKI DISEASE

Vostokova А. А.1, Grunina Е. А.2, Klemenov А. V.1

Abstract

Kawasaki disease — an acute systemic vasculitis with often involvement of coronary arteries — develops almost only in children. The most serious signs of Kawasaki disease are coronaritis and coronary arteries aneurisms. Aneurism thrombosis is possible complication of the disease and potential cause of myocardial infarction in youths. The case study presented of Kawasaki disease, complicated by myocardial infarction development in adult patient.

Russ J Cardiol 2015, 12 (128): 129–130

http://dx.doi.org/10.15829/1560-4071-2015-12-129-130

Key words: Kawasaki disease, clinical case, myocardial infarction in youths.

1City Clinical Hospital №5, Nizhny Novgorod; 2Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russia.

INFORMATION

Russian Journal of Cardiology: contents for 2015

Russ J Cardiol 2015, 12 (128): 133–140

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