[Role of ST2 biomarker for the evaluation of myocardial remodeling in patients with ischemic heart failure with preserved ejection fraction].

AIM: 1) To study the role of soluble ST2 (sST2) in evaluation of left ventricular (LV) myocardial remodeling and 2) to evaluate the predictive value of sST2 for development of adverse cardiovascular events (CVE) during 12 months following myocardial revascularization in patients with ischemic heart disease (IHD) and chronic heart failure (CHF) with preserved LV ejection fraction (EF). MATERIALS AND METHODS: The study included 55 patients (42 men) with IHD and NYHA FC I-III CHF with LV EF 63 [59; 65] % aged 65 [58; 69] who were scheduled for myocardial revascularization. Echocardiographic evaluation of myocardial stress and myocardial remodeling indexes was performed for all patients. Content of sST2 was measured using enzyme immunoassay. RESULTS: Group 1 included patients with sST2 overexpression (≥35 ng/ml) (n=26; sST2-43.75 ng/ml) and group 2 - patients with the sST2 expression.

[Pharmacophysiotherapy in combined treatment of neurosensory hypoacusis in the presence of circulatory disorders in the vertebral arteries].

Basing on the results of ultrasound dopplerography of the vertebral arteries of 337 patients with neurosensory hypoacusis (NSH), we identified 104 (30.9%) patients having vertebrobasilar hemodynamic disorders. We performed endaural phonoelectrophoresis of cavinton in modification, with application of the second electrode with vasoactive drugs on the region of cervical spine. This method of NSH treatment in patients with vertebral circulatory disorders showed clinical efficacy.

[Modern aspects of diagnostics of bacterial endocarditis].

Modern approaches to diagnostics of infective endocarditis (IE) are considered in the article. Possibilities for detection of the disease provided by various diagnostic criteria are analyzed. The authors demonstrate the advantages of improved criteria and present the diagnostic signs of subacute endocarditis in congenital heart diseases, artificial valve IE, and IE in drug addicts. Differential diagnostics issues are covered as well.

[Correlation between the parameters of 24-hour monitoring of arterial pressure and changes in arterial wall structure based on the results of a prospective trial].

AIM: To evaluate prognostic value of 24-h monitoring of blood pressure (BPM-24) for assessment of structural changes in arterial walls in patients with essential hypertension living in West Siberia. MATERIAL AND METHODS: In the course of 5-year prospective study we made two extended clinical and device examinations with use of BPM-24 and ultrasonic measurements of arterial intima-media complex (IMC) in 160 patients (mean age 48.97+/-8.18 years). RESULTS: An independent significant correlation was found between initial drop of the circadian index (CI) of blood pressure, systolic blood pressure (SBP)/diastolic blood pressure (DBP) at night (r = 0.24/0.22, p = 0.012/0.024) and thickness of IMC in 5 years (r = -0.28/-0.30, p = 0.004/ 0.002). The risk of increased thickness of arterial wall in the group with abnormal CI was 1:4. There was no relationships between IMC increase and baseline office blood pressure (r = 0. 18/0.12, p = 0. 057/0.188). In evaluation of office BP effects on progression of arterial atherosclerosis insignificant correlation coefficients for SBP/DBP were obtained (r = 0. 18/0.18, p = 0. 150/0.149) contrary to BPM-24 parameters: mean circadian SBP (r = 0.22, p = 0.046) and heart rate (r = 0.23, p = 0.038), SBP temporal index for 24 hours (r = 0.24, p = 0.035). CONCLUSION: . BPM-24 parameters are more significant predictors of structural changes in arterial wall than standard office blood pressure. This allows calculations of possible risk of such changes.

[The features of the clinical course of modern infective endocarditis].

The article considers the peculiarities of the development and clinical course of contemporary infective endocarditis (IE). The prevalence of various infective pathogens causing IE over the last decades is analyzed. Modern concepts of the pathogenesis of the disease are covered. The rate of IE complication is analyzed.

[Hyperinsulinemia in patients with microvascular coronary artery lesion as a possible diagnostic criterion of coronary heart disease].

The purpose of the study was to investigate the character of clinical and functional manifestations of ischemic cardiac dysfunction in patients with idiopathic coronary microangiopathy, and their correlation with insulin level, as a possible diagnostic criterion of coronary heart disease (CHD). The subjects were 115 men, including 35 individuals (mean age 41.8 +/- 1.2 years) with microvascular form (MVF) of coronary artery lesion, 60 patients with CHD with postinfarction cardiosclerosis (PICS), and 20 healthy individuals. Patients with glucose tolerance disorder, diabetes mellitus, arterial hypertension, and other severe pathology were not included in the study. The diagnostic tests included selective coronaroventriculography with right ventricle endomyocardium biopsy, and myocardial perfusion scintigraphy. Parameters of coronary, intracardial and system hemodynamics were evaluated; insulin and glucose serum levels were measured at rest and during stress-tests with physical exercise. Endocardial biopsy in MVF patients found plastic insufficiency of the endothelium of hemocapillars, prearteriols and cardiomyocytes. Alterations in the parameters of metabolism, intracardial and system hemodynamics, and physical exercise tolerance were found to be comparable in MVF and PICS patients. Insulin level at rest in both groups was equal to that in the control group. At threshold physical load during veloergometry insulin levels in MVF and PICS patients demonstrated comparable elevation (222.8% and 201%, respectively; p < 0.05-0.01). Glucose concentrations in patients with microangiopathy decreased by 28% (p < 0.05), while in patients with CHD it increased significantly by 27.3% (p < 0.05). The study shows that structural and functional lesion of hemocapillar endothelium underlies cardiac syndrome X It results in perfusion ability impairment, chronic hypoxia, impairment of myocardial contractility under the conditions of physical activity. Hyperinsulinemia, manifesting when ischemia is induced, is not caused by insulinresistence. Probably, it presents and adaptive and compensatory reaction to increase of myocardial glucose requirement, and may be one of early CHD markers.

[Coronary flow vasodilator reserve in patients with type 2 diabetes mellitus-associated arterial hypertension]. / Vazodilatatsionnyi rezerv koronarnogo krovotoka u bol'nykh arterial'noi gipertoniei, assotsiirovannoi s sakharnym diabetom tipa 2.

The coronary flow vasodilator reserve (CFVR) in the proximal segment of the anterior descending coronary artery was studied in 50 patients with diabetes mellitus (DM), by Doppler study via transesophageal approach. Group 1 included 39 patients with DM concurrent with Stages 1-2 arterial hypertension (AH), of them 14 patients were documented as having coronary heart disease (CHD) in the presence of coronary atherosclerosis (Subgroup 1A) and CHD was excluded in the remaining 25 patients (Subgroup 1B). Group comprised 11 patients with normal blood pressure (BP). For comparison, 6 healthy individuals were examined. CFVR was calculated as a ratio of the peak diastolic coronary flow (CF) velocity during infusion of dipyridamole (0.56 mg/kg) to the baseline CF. CDVR was significantly decreased as compared with the controls (2.07 +/- 0.73 in Subgroup 1A, 2.15 +/- 0.67 in subgroup 1B, 1.78 +/- 0.33 in Group 2, and 3.68 +/- 0.26 in the controls), this decrease being due to low CF velocities in hyperemia in the majority of patients in Subgroup 1A and Group 2 and to higher baseline CF velocity in most patients from Subgroup 1B. In Group 1 patients, CFVR was not linear with age, the duration of the disease, BP and HbA1 levels, but it was related to the carotid distensibility coefficient (rho = 0.60, p = 0.004) and to the blood level of total cholesterol (rho = -0.43, p = 0.0107). In Group 2 patients, the least CF velocities in the presence of vasodilatation were detectable in older patients and in patients with hypercholesterolemia. An all the patients with left ventricular hypertrophy (LVH) had decreased CFVR whose values with the myocardial mass index above 130 g/m2 were significantly less than those in the absence of LVH. Thus, the limited reserve of coronary vasodilatation was detectable in patients with DM irrespective of BP levels and the status of epicardial arteries and it was most pronounced in LVH and hypercholesterolemia. The impaired elastic properties of peripheral arteries in the presence of cholesterolemia may be regarded as a marker of the low reserve of coronary vasodilatation in patients with DM concurrent with AH.

[Buried suture of the bladder in the surgical treatment of urethral stricture]. / Glukhoi shov mochevogo puzyria pri operativnom lechenii striktury uretry.

Surgical treatment for posttraumatic urethral stricture was carried out in 316 patients: tunneling in 42, Marion-Khol'tsov [correction of Kholtrov] operation with circular drainage in 185, tight suture of the bladder with transurethral drain using double-opening tube in 86 cases. Complications emerged in 28 patients. The best short- and long-term outcomes were obtained in the group subjected to tight suturing.