[Adenosine triphosphate stress (99m)Tc-MIBI single-photon emission computed tomography in the diagnosis Miocardial Iscemia in patients with Microvascular Angina].

PURPOSE: To assess diagnostic potential of (99m)Tc-MIBI-single-photon emission computed tomography (SPECT) with intravenous adenosine triphosphate (ATP) infusion in comparison with exercise stress (EX) SPECT in patients with microvascular angina. MATERIAL AND METHODS: Patients with angina, positive exercise test and normal coronary angiogram (n=25) were included in the study. Patients underwent a three-phase (99m)Tc-MIBI-SPECT scan: at rest, exercise stress test and pharmacological stress with ATP infusion. Perfusion was graded on scale of 0-4. RESULTS: EX- and ATP-SPECT images showed mild reversible perfusion defects in 43 and 50%, moderate - in 19 and 12.5%, severe - in 5 and 16.7% of patients, respectively. CONCLUSION: Our results demonstrate that adenosine triphosphate stress (99m)Tc-MIBI-SPECT is comparable with exercise (99m)Tc-MIBI-SPECT in detection of ischemia and may be useful tool for diagnosing microvascular angina.

[Trends in hospitalizations of patients with acute coronary syndrome and indicators of the atmospheric state in Moscow in 2009-2012].

AIM: To identify the meteorological factors or their combinations, which are most significant for the development of acute coronary syndrome (ACS) in different seasons. SUBJECTS AND METHODS: A Statistica package was used to make an exploration analysis of the data of the A.S. Puchkov Central Emergency Medical Care Station on 63,412 admissions of patients diagnosed with acute myocardial infarction (AMI) to Moscow hospitals in 2009-2012 and those of the Hydrometeorology Center of Russia on weather conditions in the period under study. RESULTS: Among the 63,412 patients, there were more men than women (p < 0.000005). Two long frost periods and three long abnormal heat periods were recorded in 2009-2012. In summer, the number of patients with a prehospital diagnosis of AMI was an average 19-22% less than in the other seasons. There was no peak in the number of hospitalizations during the abnormally hot summer of 2010. Air temperature proved to be a factor that was most strongly associated with the trend in AMI hospitalizations in men (MS = 1011.52, MSor = 27.27; p < 0.00005) and women (MS = 895.36, MSor = 25.37; p < 0.00005). The number of hospitalizations was negatively associated with daily average temperature in its positive range. In summer, the interdaily temperature difference turned out to be statistically significant; the highest number of hospitalizations was noted when it grew 6 °C colder. On days off, the number of admitted patients was 25% less than that on weekdays. CONCLUSION: The trend in hospitalizations for a referral diagnosis of AMI has a significant seasonal component. Their number was minimal in summer, including in the abnormally hot summer of 2010. Air temperature is the most important factor. Positive temperature was found to be strongly negatively correlated with diagnosed AMI hospitalizations.

[The FORTISSIMO program: advantages of fixed full dose combination of perindopril arginine and indapamide in the treatment of poorly controlled arterial hypertension].

In the Russian program FORTISSIMO administration of fixed combination of perindopril arginine/indapamide (10 mg/2.5 mg) in 2120 patients with poorly controlled arterial hypertension instead of angiotensin converting enzyme inhibitors (ACEI) or -receptor antagonists (ARB) with hydrochlorothiazide given separately or in fixed combinations resulted in significant lowering of arterial pressure (AP) and achievement of its target level in 84% of patients. Mean AP was lowered from 177/99 to 130/80 mm Hg in 3 months while substantial reduction down to 149/89 mm Hg occurred just after 2 weeks of treatment. Improvement of compliance to therapy was also noted. Fixed perindopril/indapamide combination was well tolerated and turned out to be effective for AP control irrespective of previously conducted therapy (ACEI or ARB with diuretic).

[Adenosine triphosphate stress 99mTc-MIBI single-photon emission computed tomography in the diagnosis of ischemic heart disease].

This review is devoted to possibilities of single-photon emission computed tomography (SPECT) combined with pharmacological test with adenosine triphosphate (ATP) to detect myocardial ischemia in patients with ischemic heart disease (IHD). It contains consideration of contemporary problems and limitations inherent in use of pharmacological stress tests in radionuclide diagnostics; discussion of mechanisms of vasodilating effects of ATP in the context of modern concepts of purine receptors; detailed description of technique of pharmacological testing with ATP, as well as contraindications and possible side effects. Experience of foreign studies with the use of ATP stress testing for verification of presence of ischemia in patients with IHD is also presented.

[Myocardial infarction morbidity and mortality in the Russian Federation in 2000-2011].

AIM: To study trends in myocardial infarction (MI) morbidity and mortality in the Russian Federation in 2000 to 2011. MATERIALS AND METHODS: The 2000-2011 official statistical data of the Federal State Statistics Service and the Ministry of Health of Russia were used to analyze MI morbidity and mortality rates among urban and rural populations. Sex- and age-specific mortality rates were estimated. The number of IM morbidity cases and deaths were analyzed in absolute values and per 100,000 population (rates). The causes of MI morbidity and mortality were coded according to the International Classification of Diseases, Tenth Revision. RESULTS: According to the official statistical data, there is a small proportion of MI mortality in the structure of coronary heart disease mortality with a relatively stable incidence of MI and a low variability in its cases. MI death rates are much higher in males, particularly in able-bodied ones. Recently there have been an increasing number of deaths from MI among females in old age groups. Mortality from recurrent MI is recorded to show a 33.7% increase from 2000 to 2011. In-hospital mortality remains high (15-16%), with its high rates (40.4%) within 24 hours of admission to hospital. CONCLUSION: To more completely and objectively estimate MI morbidity and mortality rates and treatment quality in patients with this disease in the Russian Federation, it is expedient to conduct epidemiological surveys and to comparatively analyze the results of monitoring the regional vascular centers, the data of the Federal Acute Coronary Syndrome Registry, and the results of the auditing the vascular centers by the specialists of the Russian Cardiology Research-and-Production Complex.

[Angioprotective properties of blood sugar lowering drugs from the group of inhibitors of dipeptidyl peptidase-4].

Diabetes mellitus (DM) is a major health problem in all developed countries. It contributes to the development of atherosclerosis and increases the risk of cardiovascular events so blood glucose level correction is essential to preventing these complications. The relatively new and promising class of anti-diabetic drugs is dipeptidyl peptidase-4 inhibitors. By improving carbohydrate metabolism, they have angioprotective effects, such as anti-inflammatory and anti-atherosclerotic ones, including atherosclerotic plaque stabilization, improve endothelial function, lower blood pressure, and reduce the severity of albuminuria, which may have clinical implications for the prevention of macrovascular complications of type 2 DM.

[Prognostic value of markers of inflammation in patients with stable ischemic heart disease after implantation of stents with drug covering at the background of long-term therapy with statins (inhospital period)].

The objective of this study was to examine the prognostic value of C-reactive protein, erythrocyte sedimentation rate (ESR), white blood count, phospholipase A2 in patients with stable ischemic disease on long-term statin therapy undergoing percutaneous coronary intervention (PCI) with drug-eluting stent implantation. In the interim analysis in- hospital outcomes were assessed a total of 602 patients from December 2009 through December 2010 underwent successful PCI with at least one DES implanted. They were prospectively followed before discharge. MACE (death, myocardial infarction [MI], stroke, stent thrombosis [ST] which did not lead to MI) occurred in 10,6% of the patients. There was no death or stroke before discharge. MI (including 0,3% of Q-MI) occurred in 10,3% of the patients. 6 patients had verified ST. Multivariate logistic regression identified ESR level before PCI and total length of stents implanted as independent predictors of MACE.

[Collateral blood flow in the myocardium: the role of endothelial growth factor].

Collateral blood flow is a natural way of compensation of blood supply of ischemic myocardium however its efficacy is highly individual. Revelation of potentially modifiable factors acting on which it would be possible to change the state of collateral blood flow will allow to find an approach to improvement of prognosis and quality of life of patients with ischemic heart disease. In this review we show significance of collateral blood flow, analyze mechanisms of its formation, and stress the role of vascular endothelial growth factor-A (VEGF-A) and its genetic polymorphism.

[In vitro accumulation of the photosensitizer Photosens in the atherosclerotic plaque of the human carotid artery].

The investigation was undertaken to study the accumulation of the photosensitizer Photosens in arterial atherosclerotic plaques and to immunohistochemically identify cellular elements in them. Specimens were obtained during carotid endarterectomy. The preferential accumulation of Photosens occurred in the plaque areas containing the largest number of cells, such as macrophages and lymphocytes. The photosensitizer accumulated to a greater extent in the unstable plaques than in the stable ones, which seems to be associated with the more marked infiltration of unstable plaques by the cells involved in the inflammatory reaction.

[The contribution of parameters of subclinical artery wall damage in the evaluation of cardiovascular risk].

AIM: To assess contribution of such parameters as intima-media thickness (IMT), presence of carotid plagues (ab), pulse wave velocity (abPWV) and ankle-brachial index (ABI) to asessment of cardiovascular risk in patients who were initially assigned to the group of low and moderate risk according to the SCORE scale. SUBJECTS AND METHODS: 600 patients with low and moderate cardiovascular risk according to "SCORE" scale were selected: 445 women and 155 men in the age 30-65 years. We used color duplex ultrasound imaging (DUI) of carotid arteries (CA),. computer sphigmography (CS), biochemical tests (lipid profile. MDRD. glucose). RESULTS: The contribution of studied methods to risk stratification was compared: DUI of CA allowed to find patients with subclinical artery wall damage in 96%, CS-abPWV - in 39%, and ABI only - in 5% of cases. After adding abPWV to patient examination 61% remained in the low risk group and 17% were converted into the high risk group. At the same time after adding DUI of CA only 37% of patients remained in the low risk group and 36% (almost every third) were converted to more high risk group. CONCLUSION: The most sensitive method of detection subclinical artery wall damages is duplex ultrasound imaging of CA. The abPWV also has some diagnostic value and can be recommended to find out this kind of damage due to its simplicity and convenience.

[New guidelines for hypertension in Russia--a priority of combined treatment].

This review provides an analysis of the results of Russian and foreign clinical trials that have shown a high antihypertensive efficacy and tolerability of combined medications containing fixed doses of perindopril and indapamide.

[Trends in the risk factors and signs of subclinical atherosclerosis in subjects at low and moderate risk according to the SCORE scale in different medical management tactics: two-year follow-up results].

AIM: To comparatively analyze the following parameters of the subclinical manifestations of atherosclerosis: carotid intima-media thickness (IMT), the presence and number of carotid atherosclerotic plaques (ASP), ankle brachial pulse wave velocity (ABPWV) in patients from 2 (active and conventional observation) groups at low and moderate risks according to the SCORE scale in two-year outpatient practice. SUBJECTS AND METHODS: A screening could select 600 able-bodied persons (445 women and 155 men) aged 30 to 65 years at low and moderate risks (according to the SCORE scale without atherosclerosis-associated diseases who were divided into 2 groups: A) active observation (n =400) and B) conventional medical management tactics (n = 200). Five hundred and seven (85%) persons (339 in Group A and 168 in Group B) completed the study following 2 years. Carotid duplex scanning, computed sphygmography, and biochemical tests for blood lipid composition were performed. The delta index (%) calculated by the special formula, by subtracting the results during the first visit from those obtained 2 years later, was used to statistically analyze the time course of changes in the parameters under study. RESULTS: Delta IMT (%) statistically significantly increased in Group B men as compared to that in Group A men (p = 0.042). The delta parameter of total carotid stenosis, which reflected the percentage of the latter, proved to be high in both Group B women and men (p = 0.0001) and the persons with a larger number of ASP were statistically significantly more in Group B (p = 0.035). Delta ABPWV (%) was also greater in Group B (p = 0.001). CONCLUSION: Just after 2 years, the active medical observation tactics in patients at low and moderate risks (according to the SCORE scale) can result in a reduction in the rate of subclinical atherosclerosis progression in the carotid artery.

[Relationship between concentration of lipoprotein-associated secretory phospholipase A2 and markers of subclinical atherosclerotic lesion of the arterial wall in patients with low and moderate risk by SCORE scale].

UNLABELLED: AIM To show relations between a concentration of lipoprotein-associated secretory phospholipase A2 (LPPLa2) and markers of subclinical atherosclerotic lesion of the arterial wall in patients with low and moderate risk by the SCORE scale. MATERIAL AND METHODS: A total of 378 individuals with low and moderate risk of atherosclerotic lesion of the arterial wall (285 females, 93 males) were divided into groups by (1) age and sex, (2) number of atherosclerotic plaques (ASP) in the carotid arteries: OASP (n=158), ASP (n=61), more than one ASP (n=159); (3) plaque characteristics: homogeneous (n=31), heterogenous (n=189), (4) the presence of ASP in CA and level of LPPLa2 in the blood (with high content--n=137, with normal content--n=83). Duplex CA scanning was made to estimate intima-media thickness (IMT), to detect AP in the CA. Computer sphygmography estimated velocity of the pulse wave (PWV) from the carotid to femoral artery. Normal values of IMT and PWV were estimated individually with reference to gender and age. LPPLa2 was measured immunoturbodimetrically using diagnostic kits (PLAC Test Elisa Kit, dia Dexus, U.S.A.), shreshold value < 200 ng/ml. RESULTS: LPPLa2 content medians in different age groups in males and females differed insignificantly. LPPLa2 concentration in the groups of patients regarding ASP in CA was elevated in relation to the threshold value (200 ng/ml) in all the groups but did not significantly differ: 216 (179-257) ng/ml in the group OASP, 226 (190-274) ng/ml--in the group of patients 1ASP and 212 (174-254) ng/ml--in the group of patients more than one ASP (p > 0.05). In the groups with homogeneous and heterogenous ASP significant differencies were neither between the medians nor between frequency of deviation from normal (p = 0.28). 25.5% patients from the group with an elevated level of LPPLa2 had ASP with a hypoechogenic component. CONCLUSION: No significant correlation was revealed between concentration of LPPLa2, IMT PWV, number of ASP and carotid stenosis.

[Atherosclerotic lesion of the vessels in patients with stable coronary artery disease: relations with concentration of C-reactive protein].

AIM: To study value of C reactive protein (CRP) in development of atherosclerotic lesion of vascular wall and its relation to extent of pathological process in patients with stable coronary artery disease. MATERIAL AND METHODS: We studied 307 patients with stable coronary artery disease (278 men, 29 women) aged 33 - 80 years (mean age 58 years) with arterial atherosclerosis of various severity and extent. All patients were subjected to clinical, biochemical, and instrumental examination. Coronary angiography was performed when indicated. Analysis of traditional risk factors was also carried out. CRP was measured with high sensitivity method. RESULTS: Elevated CRP level (> 3 mg/1) was found in 34% of patients. Patients who had atherosclerotic changes (stenosing plaques) in carotid, pelvic or leg arteries, celiac trunk, renal and mesenteric arteries (group 2, n=37) had significantly higher CRP concentrations (p=0.002) than patients who had only atherosclerosis in coronary arteries (group 1, n=270). CRP concentration did not correlate with number of stenosed coronary vessels according to coronary angiographic findings. Patients with hypertension, type 2 diabetes and smokers had significantly higher CRP concentrations ( =0.013, =0.002, =0.004, respectively). CONCLUSION: In patients with stable coronary artery disease combination of coronary and peripheral atherosclerosis is associated with increased CRP concentration. CRP and data of coronary angiography in patients with stable coronary artery disease are essentially independent factors. Elevated CRP level is associated with traditional risk factors of coronary artery disease (smoking, hypertension, type 2 diabetes).

[Assessment of the course of ischemic heart disease after placement of stents with drug covering and uncovered metal stents: data of 3 years follow-up].

The placement of sirolimus-eluting stents decreases the frequency of repeat revascularization procedures in patients undergoing percutaneous coronary intervention (PCI) in randomized clinical trials. However, there is uncertainty about the effectiveness of sirolimus-eluting stents, and increasing concern about their safety in routine clinical practice. From the prof. Samko PCI laboratory in Moscow, Russia, we identified 426 patients, who received either bare-metal stents alone or sirolimus-eluting stents alone during an index PCI procedure between March 1, 2002, and September 31, 2004.The primary outcomes of the study were the rates of target-lesion revascularization, myocardial infarction, death, late stent thrombosis. The 3-year rate of target-lesion revascularization was significantly lower among patients who received sirolimus-eluting stents than among those who received bare-metal stents (3.1% vs. 19 %, p=0.001). The 3-year mortality rate was not different between the bare-metal stent group and the sirolimus eluting stent group (5.9% vs. 7.2%, p=0.68), the 3-year rate of all ARC late stent thrombosis was similar in the two groups (5.9% and 7.2%, respectively; p=0.95). Sirolimus-eluting stents are effective in reducing the need for target-vessel revascularization without significantly increased rates of death, late stent thrombosis, myocardial infarction.

[Comparative transcriptome analysis of human aorta atherosclerotic lesions and peripheral blood leukocytes from essential hypertension patients].

One of the major cardiovascular risk factor which predisposes to and accelerates atherosclerosis is arterial hypertension (AH). To determine the molecular basis of the crosslink between AH and atherosclerosis for the development of new treatment strategies large-scale transcriptome analysis of the cells implicated in atherogenesis is needed. We used cDNA microarray technique for simultaneous analysis of gene expression in human abdominal aorta normal sites and atherosclerotic lesions of different histological types, as well as in peripheral blood leukocytes from patients with essential hypertension (EH) and donors. The microarray data were verified by quantitative RT-PCR (reverse transcription coupled with polymerase chain reaction) and immunohistochemical analysis. Differential expression of 40 genes has been found, among which twenty two genes demonstrated up-regulation and 18 genes demonstrated down-regulation in atherosclerotic aorta compared with normal vessel. New gene-candidates, implicated in atherogenesis, have been identified - FPRL2, CD37, CD53, RGS1, LCP1, SPI1, CTSA, EPAS1, FHL1, GEM, RHOB, SPARCL1, ITGA8, PLN, and COL14A1. These genes participate in cell migration and adhesion, phenotypic changes of smooth muscle cells, immune and inflammatory reactions, oxidative processes and extracellular matrix remodeling. We have found increased expression levels of CD53, SPI1, FPRL2, SPP1, CTSD, ACP5, LCP1, CTSA and LIPA genes in peripheral blood leukocytes from EH patients and in atherosclerotic lesions of human aorta. The majority of these genes significantly (p<0.005) positively (r>0.5) correlated with AH stage as well as with histological grading of atherosclerotic lesions.

[Drug-eluting stents: long-term safety].

The review concerns the problem of late thromboses of drug-eluting stents and their influence on late prognosis of the patients; presents long-term results of the trial of sirolimus-eluting stents implanted to patients with coronary heart disease; analyses mechanisms of development of late stent thrombosis, data from different meta-analyses and registers comparing long-term outcomes in patients with implanted sirolimus-eluting stents and metallic stents; suggests risk factors of late thromboses of drug-eluting stents; presents original evidence on 3.5-year follow-up of patients with implanted sirolimus-eluting stents and metallic stents.

[Endothelial progenitor cells: role in endothelial function recovery and potential therapeutic application].

Endothelial dysfunction and cell loss lead to atherosclerosis and its outcomes. Several recent studies suggested that endothelial progenitor cells (EPCs) play a key role in reendothelialization of injured vessels and in endogenous neovascularization of ischemic tissues. Modulation of EPCs number and functional activity or EPCs transplantation are a promising outlook for treatment of cardiovascular disease. In the present review, assessment of endothelial function, mechanisms of its impairment and role of EPCs in their correction are elucidated.

[Influence of valsartan, fluvastatin extended release and their combination on arterial pressure, parameters of lipid metabolism, and endothelial function in patients with hypertensive disease].

BACKGROUND: Search of new optimal treatment strategies, allowing to decrease the risk of atherosclerosis development and cardiovascular events is determined by high prevalence of hyperlipidemia in hypertensive patients. AIM: To study the vasoprotective effects and security of Valsartan (V) or Fluvastatin extended release (XL) (F) and their combination in stage 1 and 2 essential hypertension (EH) with moderate hyperlipidemia. METHODS: 32 patients with EH after 14 days of wash-out period were randomized to receive either V (160 mg o.d.) or F (80 mg o.d.). After 8 weeks of monotherapy combination of V+F was administered to each patient for the next 8 weeks. At baseline, after 8 weeks of monotherapy, and at the end of the study sitting BP, lipids, NOs level and endothelial function were assessed. Endothelial function was measured as flow-mediated vasodilation (FMD) by high resolution ultrasound. Valsartan (Diovan) and Fluvastatin (Lescol XL) were provided by Novartis Pharma AG (Basel, Switzerland). RESULTS: Combination of F (80 mg o.d) with initial therapy by V (160 mg o.d.) led to more significant decrement of BP and significant improvement of FMD.