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Российский кардиологический журнал »» №3 2012

 

CLINICAL EFFECTIVENESS OF EARLY ACUTE MYOCARDIAL INFARCTION DIAGNOSTICS, BASED ON THE ASSESSMENT OF CARDIAC FATTY ACID BINDING PROTEIN LEVELS

Martynov A. I., Voevoda M. I., Arutyunov G. P., Kokorin V. A., Spasskyi A. A.
Russian Scientific Medical Society of Internal Medicine, Russia.

Aim. To investigate the diagnostic potential of cardiac fatty acid binding protein (cFABP) vs. cardiac troponins at the early stages of acute coronary syndrome (ACS), by comparing specificity and sensitivity of the qualitative assessment of their blood levels.
Material and methods. The independent Russian multi-centre study ISPOLIN (Clinical effectiveness of early acute myocardial infarction diagnostics, based on the assessment of cFABP levels) included 1049 patients, who were hospitalised with possible ACS diagnosis, within 1–12 hours from the clinical onset. At admission, all participants underwent a qualitative assessment of cFABP and troponin I (TrI) blood levels. For each test, sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were examined for the whole sample, as well as by gender, age, body mass index (BMI), test time, and electrocardiographic (ECG) changes.
Results. The sensitivity of cFABP test was higher than that for TrI (73,8% vs. 46,7%, respectively). Specificity reached 92% and 97,2%, respectively. Respective accuracy values were 79,3% and 62,2%. PPV was 0,95 for cFABP and 0,97 for TrI, while NPV was 0,61 and 0,45, respectively. The maximal sensitivity of cFABP test was observed within 3–6 hours from the onset of acute myocardial infarction, and exceeded the sensitivity of TrI test by 18–32% at all examined time points. Regardless of the ECG change type, sensitivity of cFABP test was higher than that of
TrI test by 19–73%. For both tests, sensitivity and specificity did not correlate with age, gender, or BMI.
Conclusion. Within the first 12 hours from the clinical onset of possible ACS, a Russian express test, which qualitatively assesses cFABP levels, demonstrated higher sensitivity, accuracy, and NPV, compared to the TrI test. The cFABP test can, therefore, be recommended for a wider use in clinical practice.

Key words: acute coronary syndrome, myocardial infarction, differential diagnostics, cardiac fatty acid binding protein, troponin I.

 

N-TERMINAL BRAIN NATRIURETIC PROPEPTIDE AS A MARKER OF MULTIFOCAL ATHEROSCLEROSIS IN PATIENTS WITH ST SEGMENT ELEVATION MYOCARDIAL INFARCTION

Barbarash O. L.1,2, Usoltseva E. N.1, Shafranskaya K. S.1, Zykov M. V.1,2, Gruzdeva O. V.1, Polikutina O. M.1, Kashtalap V. V.1
1Research Institute of Complex Cardiovascular Problems, Siberian Branch, Russian Academy of Medical Sciences, Kemerovo, Russia; Kemerovo State Medical Academy 2, Kemerovo, Russia.

Aim. To investigate the association between serum levels of N-terminal brain natriuretic propeptide (Nt-proBNP) and the severity of coronary and non-coronary atherosclerosis in patients with myocardial infarction and ST segment elevation (STEMI).
Material and methods. The study included 186 STEMI patients. All participants underwent coronary angiography and angioplasty with infarct-related artery stenting, as well as the screening assessment of non-coronary atherosclerosis of brachiocephalic arteries and large lower extremity arteries. The measurement of Nt-proBNP levels was performed 10–14 days after the STEMI onset.
Results. Nt-proBNP levels were not associated with the severity of coronary atherosclerosis. However, patients with more advanced non-coronary atherosclerosis and a higher number of affected non-coronary vessels demonstrated elevated Nt-proBNP concentrations. After adjustment for age, severity of heart failure and myocardial dysfunction, Nt-proBNP were still associated with atherosclerosis multifocality.
Conclusion. In STEMI patients, Nt-proBNP concentrations were associated with severity and multifocality of non-coronary atherosclerosis. This could be used in clinical practice for predicting the risk of repeat atherosclerotic cardiovascular events.

Key words: atherosclerosis, myocardial infarction, brain natriuretic propeptide.

 

COMPARATIVE PROGNOSTIC VALUE OF CREATINE PHOSPHOKINASE MB AND TROPONIN T IN THE DIAGNOSTICS OF PERIPROCEDURAL MYOCARDIAL DAMAGE

Akinina S. A.
Khanty-Mansy Autonomous Region – Yugra Clinical Hospital, Khanty-Mansiysk, Russia.

Aim. To investigate the link between the levels of creatine phosphokinase MB (CKMB) or troponin T (TrT) and the prognosis in patients with coronary heart disease (CHD), periprocedural myocardial necrosis, or Type 4a myocardial infarction (MI) associated with percutaneous coronary intervention (PCI).
Material and methods. The study included 124 CHD patients who underwent planned PCI. The levels of CK-MB and TrT were measured before PCI and 8 and 24 hours after the procedure.
Results. After PCI, CK-MB and TrT levels were elevated in 11 (8,9%) and 24 (19,4%) patients, respectively. CK-MB or TrT elevation was less than three-fold, compared to the upper reference limit (URL), in 9 (7,3%) and 18 (14,5%) participants, respectively. In other words, probable periprocedural myocardial necrosis was not confirmed twice as often, based on CK-MB (n=9; 7,3%) vs. TrT criteria. CK-MB or TrT elevation over 3 x URL was registered in 2 (1,6%) and 6 (4,8%) participants, respectively. Therefore, probable Type 4a MI was not confirmed in 4 patients (3,3%) – three times less often, compared to TrT criteria. Over the mean follow-up period of 4,3 years, survival was non-significantly worse in patients with periprocedural CK-MB elevation of <3 or ≥3 x URL, compared to participants with similar TrT elevation (22,2% vs. 5,6% and 50,0% vs. 33,3%, respectively). The combined end-point of cardiac death and MI was also registered more often in patients with CK-MB elevation (33,3% vs. 16,7% and 50,0% vs. 33,3%, respectively), due to the differences in cardiac death rates.
Conclusion. Therefore, periprocedural TrT elevation of <3 and ≥3 x URL could be a less reliable predictor of long-term cardiac mortality than similar CK-MB elevation.

Key words: periprocedural myocardial infarction, creatine phosphokinase MB, troponin T.

 

ROLE OF ENDOTOXIN AND SYSTEMIC INFLAMMATION IN CHRONIC HEART FAILURE PATHOGENESIS

Egorova E. N. Mazur V. V., Kalinkin M. N., Mazur E. S.
Tver State Medical Academy, Tver, Russia.

Aim. To study large intestine microbiocenosis, systemic inflammation activity, and the reaction of matrix metalloproteinases and tissue inhibitors of metalloproteinases (MMP-TIMP) at different stages of chronic heart failure (CHF).
Material and methods. In 230 CHF patients, the following parameters were assessed: large intestine microbiocenosis, endotoxinemia, and plasma levels of tumor necrosis factor-α, C-reactive protein, sE-selectin, MMP-9, and TIMP-4.
Results. Progressing CHF was associated with more pronounced intestinal dysbiosis, increased endotoxinemia, activation of systemic inflammation, and MMPTIMP dysbalance.
Conclusion. The pathogenetic CHD pathway starts with circulatory disturbances, which lead to increased endotoxinemia and subsequent activation of systemic inflammation. Inflammatory mediators – pro-inflammatory cytokines, intercellular adhesion molecules, and acute phase proteins – cause MMP-TIMP dysbalance, which, in turn, leads to myocardial remodelling, cardiac geometry changes, and advanced circulatory disturbances, completing the vicious circle (circulus vitiosus) of CHF progression.

Key words: endotoxin, systemic inflammation, chronic heart failure, pathogenesis.

 

POSSIBLE CAUSES OF DISSOCIATION BETWEEN PULMONARY EMBOLISM VOLUME AND RIGHT VENTRICULAR DYSFUNCTION DEGREE

Lishmanov Yu. B., Pankova A. N., Zavadovskyi K. V.
Research Institute of Cardiology, Siberian Branch, Russian Academy of Medical Sciences, Tomsk, Russia.

Aim. To study possible causes of the dissociation between pulmonary embolism volume and right ventricular (RV) dysfunction degree.
Material and methods. The main group included 37 patients with pulmonary embolism (PE); the comparison group consisted of 15 patients with coronary heart disease (CHD) and NYHA functional class (FC) I–II heart failure (HF). All participants underwent ventilation-perfusion lung scintigraphy, gated blood pool single photon emission computed tomography (GBPS), and the measurement of plasma levels of stable NO metabolites, endotelin-1, and 6-keto-prostaglandin (Pg) F1α.
Results. In PE patients, RV contractility parameters were significantly lower than those in the comparison group. Among patients with moderate PE volume (3–7 bronchopulmonary segments), no correlation was observed between the number of hypoperfused segments and RV dysfunction degree. In PE patients, compared to the comparison group, plasma levels of endotelin-1, stable NO metabolites, and stable prostacyclin metabolite 6-keto-Pg F1α were significantly higher.
Conclusion. In PE patients, the most important GBPS parameters of RV dysfunction included reduced ejection fraction, stroke volume, peak ejection rate, and mean filling rate. The dissociation between PE volume and RV dysfunction degree could be caused by disturbed humoral regulation of pulmonary vascular tone.

Key words: pulmonary embolism, gated blood pool SPECT, right ventricle.

 

EARLY ECHOCARDIOGRAPHIC MARKERS OF STRUCTURAL AND FUNCTIONAL RIGHT VENTRICULAR REMODELLING IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Bart B.Ya., Dergunova E. N., Vartanyan E. A., Kulbachinskaya O. M.
1N. I. Pirogov Russian Research Medical University, Moscow, Russia; 2Diagnostic and Clinical Centre No. 1, South-Western Autonomous Okrug, Moscow, Russia.

Aim. To study right ventricular (RV) structure and function, as well as cardiac and pulmonary hemodynamic parameters, in patients with chronic obstructive pulmonary disease (COPD) of moderate severity.
Material and methods. The study included 37 COPD patients and 20 healthy controls. All participants underwent echocardiography (EchoCG) and the assessment of lung function (LF).
Results. COPD patients demonstrated an early increase in anterior RV wall thickness and RV chamber volume, already at the stage of moderate elevation in pulmonary artery systolic pressure. Pre-capillary hemodynamic variant of pulmonary hypertension was characterised by a significant increase in pulmonary vascular resistance (р<0,001) and normokinetic hemodynamic type in patients with a longer COPD duration.
Conclusion. Disturbed relaxation of RV longitudinal fibres is the initial pathological change, followed by global RV dysfunction and disturbed transverse RV contractility. These markers, which precede RV ejection fraction reduction, could be regarded as early criteria of latent systolic dysfunction in patients with a longer duration of moderately severe COPD.

Key words: chronic obstructive pulmonary disease, echocardiography, right ventricular function.

 

MICROCIRCULATION IN ARTERIAL HYPERTENSION: EFFECTS OF BLOOD PRESSURE CONTROL WITH ANTIHYPERTENSIVE THERAPY

Kirichenko A. A., Averyanova I. M.
Therapy department, Russian Medical Academy of Post-Degree Education, Moscow, Russia.

Aim. To study the microcirculation (MC) status during arterial hypertension (AH) treatment and after the achievement of target blood pressure (BP) levels.
Material and methods. The study included 75 patients with essential AH, but without previous regular antihypertensive therapy. In all participants, antihypertensive treatment was started, which resulted in the achievement of target BP levels. Treatment effectiveness was assessed via the office BP measurement, 24-hour BP monitoring, and self-control diary data. MC dynamics was assessed with conjunctival biomicroscopy (CBMS).
Results. In all participants, CBMS demonstrated MS disturbances.
Conclusion. BP control with antihypertensive therapy significantly improves MC parameters.

Key words: arterial hypertension, conjunctival biomicroscopy, microcirculation.

 

DIAGNOSTIC VALUE OF SPECTRAL ANALYSIS OF HEART RATE VARIABILITY IN CARDIAC AUTONOMIC NEUROPATHY AND TYPE 2 DIABETES MELLITUS

Lunina E.Yu., Petrukhin I. S.
Tver State Medical Academy, Tver, Russia.

Aim. To assess the value of spectral parameters of heart rate variability (HRV) in the diagnostics of cardiac autonomic neuropathy (CAN) among patients with Type 2 diabetes mellitus (DM-2), according to the presence or absence of metabolic syndrome (MS).
Material and methods. The spectral analysis of 5-minute HRV records was performed in 157 DM-2 patients. MS was diagnosed according to WHO criteria, while the diagnosis of CAN was based on two or more abnormal Ewing tests (deep breathing test, Valsalva test, and orthostatic test with blood pressure and heart rate assessment). Area under the receiver operating curve (AUROC) values were calculated to assess TP (total power) and HF (high frequency) components of HRV.
Results. The prevalence of CAN was 57,6% and 87,1% in patients with or without MS, respectively. Among MS-free patients, AUROC values for TP and HF parameters (0,84 and 0,90) were significantly higher than respective values in participants with MS (0,78 and 0,89). AUROC analysis identified the cut-off points for CAN diagnosis, taking into account the presence or absence of MS. Operational characteristics of TP and HF parameters were slightly lower in MS patients.
Conclusion. The assessment of spectral HRV parameters is a highly informative test for CAN diagnostics. Cut-off points and operational characteristics of HRV parameters differ in patients with or without MS.

Key words: heart rate variability, diabetes mellitus, cardiac autonomic neuropathy, diagnostics.

 

Intima-media thickness and adhesion molecules sICAM-1 and sVCAM-1 in patients with Type 2 diabetes mellitus: clinical and diagnostic value

Kasatkina S. G., Panova T. N.
Astrakhan State Medical Academy, Astrakhan, Russia.

Aim. To study the associations between the intima-media thickness (IMT) of common carotid artery and the expression of soluble adhesion molecules sICAM-1 and sVCAM-1 in patients with Type 2 diabetes mellitus (DM-2).
Material and methods. The study included 97 DM-2 patients (50 men and 47 women), aged 45–70 years (mean age 52,25±5,62 years). All participants underwent in-hospital standard clinical examination, risk factor assessment, electrocardiography, and duplex ultrasound of extracranial vessels (“Vivid 3” TM device, USA; linear transducer 7,5 MHz), as well as the measurement of blood levels of soluble adhesion molecules sICAM-1 and sVCAM-1.
Results. There was a statistically significant correlation between common carotid artery IMT and the levels of sICAM-1 and sVCAM-1 (р<0,05).
Conclusion. The results obtained suggest that the levels of adhesion molecules sICAM-1 and sVCAM-1 could be a marker of atherosclerotic progression in DM-2 patients.

Key words: diabetes mellitus, intima-media thickness, adhesion molecules.

 

CARDIO-RESPIRATORY SYSTEM IN LATE REHABILITATION PERIOD AFTER CORONARY ARTERY BYPASS GRAFT SURGERY

Sabirova E. Yu., Chicherina E. N.
Kirov State Medical Academy, Internal Disease Department, Kirov, Russia.

Aim. To identify specific features of cardio-respiratory status in the late rehabilitation period after coronary artery bypass graft surgery (CABG).
Material and methods. The study included 25 men (mean age 55,7±6,1 years), who underwent CABG more than 3 years ago. Functional class (FC) of angina and heart failure (HF) was assessed. Cardiovascular status was assessed using echocardiography (EchoCG) and Holter electrocardiography (ECG) monitoring. Lung function (LF) measurement was used for the assessment of respiratory status.
Results. Before CABG, most patients had FC 3 angina and Stage II HF; in the late rehabilitation period, low FC angina and Stage I HF (in >50% of the participants) were registered. Five-year incidence of recurrent angina was under 50%. Prior to CABG, FC 2 HF was the most prevalent, while the late rehabilitation period was characterised by the highest prevalence of FC 1 HF. According to EchoCG results, left ventricular (LV) myocardial contractility improved after CABG. In the late rehabilitation period, the number of supraventricular extrasystoles decreased, and the Lown grade of ventricular extrasystoles reduced. An increase in QT interval by 4,4±3,2% was observed in 8 patients. At Holter ECG, myocardial ischemia was registered in 2 patients. Mean LF parameters appeared normal; abnormal LF results were observed only in 4 participants (16%; 2 with obstructive respiratory dysfunction and 2 with restrictive respiratory dysfunction). Out of 25 examined post-CABG patients, only a small number followed the recommendations on non-pharmaceutical therapy, while administered pharmaceutical treatment was received by all participants (monotherapy by 8% (n=2) and combination therapy by 92%).
Conclusion. In the late rehabilitation period after CABG, angina and HF FC decreased (in 88% and 64% of the patients, respectively), no ischemic episodes were registered at Holter ECG (92%), LV myocardial contractility improved, and respiratory function was preserved. All participants followed the recommendations on complex pharmaceutical therapy. However, 68% did not follow the nonpharmaceutical treatment recommendations.

Key words: coronary heart disease, coronary artery bypass graft surgery, cardiorespiratory system.

 

OXIDATIVE-ANTIOXIDANT CHANGES OF LOW-DENSITY LIPOPROTEINS AND THEIR ASSOCIATION WITH ATHEROSCLEROTIC RISK FACTORS IN MALE NOVOSIBIRSK POPULATION

Ragino Yu. I., Krivchun A. S., Ivanova M. V., Shcherbakova L. V., Malyutina S. K., Nikitin Yu. P., Voevoda M. I.
Institute of Internal Medicine, Siberian Branch, Russian Academy of Medical Sciences, Novosibirsk, Russia.

Aim. To investigate the parameters of oxidative-antioxidant changes of low-density lipoproteins (LDL) in a male population, and to study their association with selected risk factors of atherosclerosis and coronary heart disease (CHD).
Material and methods. This population study included 1024 Novosibirsk men, aged 47–73 years. Questionnaire survey, standard cardiological examination, anthropometry, blood pressure (BP) measurement, and electrocardiography (ECG) were performed. Assessed biochemical parameters included total cholesterol (TCH), triglycerides (TG), high-density lipoprotein cholesterol (HDL–CH), high-sensitivity C-reactive protein (hsCRP), glucose, baseline lipid peroxidation (LPO) and fat-soluble antioxidants (alpha-tocopherol, retinol, beta-carotene, xanthines) in LDL, LDL resistance to oxidation in vitro, and autoantibodies to oxidized LDL (oxLDL).
Results. For the male Novosibirsk population, the region-specific 10% and 90% cutoff points for the percentile distribution of baseline LPO in LDL, LDL resistance to oxidation at initiation and propagation stages of oxidative LDL modifications, lipophilic LDL antioxidants, and autoantibodies to oxLDL are presented. Correlations were observed between baseline LPO in LDL and hsCRP levels; between LDL resistance to oxidation and blood lipid profile, body mass index (BMI), and CHD; between the levels of autoantibodies to oxLDL and hsCRP or BMI; between LDL antioxidants (particularly alpha-tocopherol) and blood lipid profile, hsCRP, BMI, and CHD. In men, increased levels of LPO in LDL, reduced levels of LDL antioxidants, and decreased LDL resistance to oxidation were independently associated with elevated blood levels of TCH, TG, and hsCRP, low HDL–CH levels, increased BMI, and present CHD.
Conclusion. In the examined male population, regional reference values for the parameters of oxidative-antioxidant LDL changes were identified. They were independently associated not only with present CHD, but also with pathogenetically significant, potentially atherogenic coronary risk factors.

Key words: population study, risk factors, atherosclerosis, low-density lipoproteins, resistance to oxidation, antioxidants.

 

ARTERIAL HYPERTENSION PREDICTORS AND OCCUPATION

Artamonova G. V., Maximov S. A., Ogarkov M.Yu., Makarov S. A., Skripchenko A. E., Indukaeva E. V., Shapovalova E. B., Yankin M.Yu., Mulerova T. A., Kozyreva N. N.
Research Institute of Complex Cardiovascular Problems, Siberian Branch, Russian Academy of Medical Sciences, Kemerovo, Russia.

Aim. To analyse the association between occupation and the prevalence of arterial hypertension (AH) or AH risk factors in a working-age population.
Material and methods. The study included 3664 working residents of Kemerovo Region, representing 18 occupational groups. AH risk factors included gender, age, body mass index (BMI), education, marital status, smoking, and hazardous alcohol consumption. Decision tree models were used as a method of classification and prognosis.
Results. In decision tree models, assessed predictors correctly confirmed the diagnosis of AH or its absence in 75,2% participants. The most important predictors were BMI, age, and occupation (100, 83, and 63 units, respectively). Occupation also influenced the prognostic value of other predictors.
Conclusion. Occupation should be regarded not only as an important predictor of AH, but also as an effect modifier for other predictors, such as age, BMI, or marital status. This should be taken into account when performing the complex assessment of AH risk across working population groups.

Key words: arterial hypertension, occupation, risk factors, prognostic methods.

 

MORPHOMETRIC ASPECTS OF NEUROLEPTIC CARDIOMYOPATHY MORPHOGENESIS

Volkov V. P.
M. P. Litvinov Regional clinical psychiatric hospital №1, Tver, Russia

Aim. Neuroleptic cardiomyopathy (NCMP) is the most serious cardiotoxic adverse effect of neuroleptics. NCPM morphogenesis at tissue and cell levels has not been investigated previously. This study examined the progression of myocardial changes throughout the stages of NCMP development.
Material and methods. Using morphometric methods, myocardial changes were examined in 4 groups of diseased psychiatric patients: 1) death from non-cardiac causes, no neuroleptic treatment in anamnesis (n=10); 2) no cardiac pathology, antipsychotic therapy in anamnesis (n=12); 3) latent NCMP (n=24); 4) fatal NCMP (n=34). All groups were comparable by age and sex. The quantitative data were analysed using Statistica 6.0.
Results. Cardiotoxicity of neuroleptics is manifested in a variable degree of morphological and functional myocardial changes, which reflect compensatoryadaptive, dystrophic-degenerative, and sclerotic processes at the tissue level, developing during NCMP morphogenesis. Disturbances of microcirculation and collagen synthesis in the myocardial extracellular matrix result in the decreased volume, degeneration, and atrophy of cardiomyocytes. This facilitates myocardial dysfunction progression and clinical manifestation of fatal heart failure.
Conclusions. Psychopharmacological therapy is always associated with the risk of NCMP development, as a manifestation of cardiotoxicity of neuroleptics. Myocardial structural changes, identified with morphometric methods, predict the progression of myocardial dysfunction linked to cardiotoxic adverse effects of these medications.

Key words: neuroleptics, cardiotoxicity, neuroleptic cardiomyopathy, morphogenesis, morphometrics.

 

ANTIHYPERTENSIVE EFFICACY AND SAFETY OF OLMESARTAN AND RAMIPRILIN ELDERLY PATIENTS WITH MILD TO MODERATE SYSTOLIC AND DIASTOLICESSENTIAL HYPERTENSION

Mallion J-M.1, Omboni S.2, Barton J.3, van Mieghem W.4, Narkiewicz K.5, Panzer P-K.6, Puig J. G.7, Stefanadis Ch.8, Zwieker R.9 on behalf of the study group
1Cardiology and Arterial Hypertension, CHU de Grenoble, Grenoble, France; 2Italian Institute of Telemedicine, Varese, Italy; 3Cardiac Research Department, Portiuncula Hospital, Ballinasloe Co Galway, Ireland; 4Dienst Cardiologie, Ziekenhuis Oost Limburg Campus St. Jan, Genk, Belgium; 5Department of Hypertension and Diabetology Hypertension Unit, Medical University of Gdansk, Gdansk, Poland; 6Kippenheim, Germany; 7Internal Medicine and Hypertension Unit, Hospital Universitario de La Paz, Madrid, Spain; 8Department of Cardiology, Ippokratio Hospital, Athens, Greece; 9Leopold Auenbrugger University Medical School, Graz, Austria.

Objective. To compare the efficacy and safety of olmesartan medoxomil (O) and ramipril (R) in elderly patients with essential arterial hypertension.
Methods. After a 2-week placebo washout, 351 elderly hypertensive patients aged 65–89 years (office sitting diastolic blood pressure, DBP, 90–109 mmHg and office sitting systolic blood pressure, SBP, 140–179 mmHg) were randomized doubleblind to 12-week treatment with O 10 mg or R 2.5 mg once daily. After the first 2 and 6 weeks, doses could be doubled in non-normalized (blood pressure ≥140/90 mmHg for non-diabetic and ≥ 130/80 mmHg for diabetic) subjects, up to 40 mg for O and 10 mg for R. Office blood pressures were assessed at randomization, after 2, 6 and 12 weeks of treatment; 24-h ambulatory blood pressure (ABP) was recorded at randomization and after 12 weeks.
Results. At week 12, in the intention-to-treat population (170 patients O and 175 R) the rate of normalized subjects was significantly larger in the O group (38.8% vs 26.3% R; p = 0.013). Baseline-adjusted mean sitting office blood pressure reduction at final visit was not significantly greater under O [SBP: 16.6 (95% confidence interval 14.0/19.2) mmHg vs 13.0 (10.4/15.6) mmHg R, p = 0.206; DBP: 11.8 (10.3/13.3) mmHg vs 10.5 (9.0/12.0) mmHg, p = 0.351]. In the subgroup of patients with valid ABP recordings (38 O and 47 R), the reduction in 24-h average blood pressure was significantly (p = 0.01) larger with O [SBP: 8.9 (9.8/8.1) and DBP: 5.7 (6.3/5.1) mmHg] than with R [6.7 (7.9/5.6) and 4.4 (5.1/3.7) mmHg]. The superiority of O was particularly evident in the last 4 h from the dosing interval. The proportion of patients with drug-related adverse events was comparable in the two groups (4.0% O vs 4.5% R), as well as the number of patients discontinuing study drug because of a side-effect (8 O vs 7 R).
Conclusions. In elderly patients with essential arterial hypertension, O provides an effective, prolonged and well tolerated blood pressure control, with significantly better blood pressure normalization than R and represents a useful option among first-line drug treatments of hypertension in this age group.
Adopted translation from BloodPressure, 2011; 20 (TherSuppl 1): 3–11

Key words: ambulatory blood pressure monitoring, essential hypertension, elderly, olmesartan, ramipril, office blood pressure.

 

VASCULAR INJURY CORRECTION IN ARTERIAL HYPERTENSION: FOCUS ON PERINDOPRIL

Belenkov Yu. N.1, Privalova E. V.1, Danilogorskaya Yu. A.2, Zheleznykh E. A.2, Shchendrygina A. A. 1
1Hospital Therapy Department No. 1, Therapy Faculty, I. M. Sechenov First Moscow State Medical University, Moscow, Russia; 2Department of Chronomedicine and New Technologies in Internal Medicine, Research Centre, I. M. Sechenov First Moscow State Medical University, Moscow, Russia.

Risk factors are the cornerstone of the cardiovascular continuum concept. Arterial hypertension is one of major risk factors, which accounts for a substantial proportion of cardiovascular morbidity and mortality due to cardiovascular complications (CVC). The latter develop due to, among other reasons, the damage of the vascular component of cardiovascular system (CVS). Presently, the aims of antihypertensive treatment include not only control of blood pressure levels, but also CVC prevention. Antihypertensive medications of choice include the agents which also possess vasoprotective qualities.

Key words: ACE inhibitors, perindopril, arterial hypertension, remodelling, microcirculation.

 

DIAGNOSTIC SPECIFICS OF PULMONARY VENO-OCCLUSIVE DISEASE

Zhuk E. A.1, Kirichenko N. V.2, Myasoedova S. E.1, Pobedinskaya T. A.1, Vasilyeva V. P.2
1Ivanovo State Medical Academy; 2City Clinical Hospital №4, Ivanovo, Russia.

The authors present the two-year follow-up of a female patient with severe pulmonary hypertension and a rare pathology – pulmonary veno-occlusive disease. Due to the treatment with low-dose prednisolone, in combination with warfarin, coraxan, and oxygen, the clinical status of the patient remains stable.

Key words: pulmonary veno-occlusive disease, pulmonary hypertension.

 

HELICOBACTER PYLORI AND CARDIOVASCULAR DISEASE: THE ROAD TO THE HEART IS THROUGH THE STOMACH?

Martusevich A. K.2, Simonova Zh. G.1, Tarlovskaya E. I.1
1Kirov State Medical Academy, Kirov, Russia; 2Nizhny Novgorod Research Institute of Traumatology and Orthopedics, Nizhny Novgorod, Russia.

The paper analyses the Russian and international evidence on the potential role of Helicobacter pylori infection in the development and progression of cardiovascular disease. The authors discuss the existing statistical evidence of this association, its pathogenetic mechanisms, and the effectiveness of preventive eradication treatment. Based on the literature data and the original research findings, the authors propose a new complex concept of the pathogenesis of Helicobacter pyloriassociated cardiovascular disease.

Key words: Helicobacter pylori, coronary heart disease, myocardial infarction, atherosclerosis, pathogenesis.

 

BIVALIRUDIN AND PERCUTANEOUS CORONARY INTERVENTIONS IN PATIENTS WITH ACUTE CORONARY SYNDROME: THEORY AND PRACTICE

Averkov O. V.
City Clinical Hospital № 15, named after O. M. Filatov, Russian University of People’s Friendship, Moscow, Russia.

This analytical paper presents the key information on the mechanism of action of a direct thrombin inhibitor – bivalirudin. The difference between bivalirudin and unfractionated or low molecular weight heparins, as well as fondaparinux, in terms of the mechanism of action, pharmacokinetics, and pharmacodynamics, is discussed. The results of clinical trials of bivalirudin and the position of this medication in the current clinical guidelines on acute coronary syndrome treatment are summarized. A detailed description of bivalirudin dosage is presented, together with the recommendations on its effective and safe use in clinical practice.

Key words: acute coronary syndrome, anticoagulants, bivalirudin, percutaneous coronary interventions.

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