Predictors of Reduced Left Ventricle Global Longitudinal Strain One Year After COVID-19 Pneumonia.

Aim      To identify predictors of decreased left ventricular global longitudinal strain (LV GLS) using the method of speckle-tracking in gray scale one year after COVID-19-associated pneumonia in patients without ischemic heart disease (IHD), previous pulmonary embolism (PE), peripheral thrombosis, and atrial fibrillation (AF).Material and methods  The study included 156 patients from the Prospective Registry of People After COVID-19-Associated Pneumonia, with optimal visualization quality according to echocardiography (EchoCG), without IHD, AF, history of pulmonary embolism (PE), and peripheral thrombosis. The patients underwent clinical examination in the hospital during the acute period and at 3 and 12 months after discharge from the hospital. To identify earlier predictors of LV GLS impairment, clinical, laboratory, and instrumental data obtained in the hospital and at 3 months of discharge were compared based on the presence of LV GLS impairment one year after discharge (43 patients with reduced LV GLS and 113 patients with normal LV GLS). An LV GLS value ≥18% was considered reduced.Results At 3 months after discharge from the hospital, LV GLS impairment was detected in 34 (21.8%) of 156 patients, and 12 months later, in 43 (27.6%; p=0.211) of 156 patients. In contrast to the group with normal LV GLS, the majority of the group with reduced LV GLS were men (74.4% vs. 37.2%; p=0.001). In this group, body mass index (BMI) was significantly higher (29.9±4.3 kg/m2 vs. 28.1±4.5 kg/m2; p=0.011), and biological (11.6% vs. 2.7%; p=0.024) and hormonal therapy was administered more frequently (38.1% vs. 22.3%; p=0.049). The final predictive model for LV GLS impairment included male gender (odds ratio (OR), 5.65; 95% confidence interval (CI), 1.22-14.37; p <0.001), BMI (OR, 1.11; 95% CI, 1.01-1.23; p=0.040), left ventricular end-systolic volume index (LVESVI) (OR, 1.10; 95% CI, 1.01-1.22; p=0.046) and right ventricular outflow tract (RVOT) acceleration time (OR, 0.98; 95% CI, 0.95-0.99; p=0.027).Conclusion      One year after COVID-19-associated pneumonia, a decrease in LV GLS was observed in 27.6% of patients without IHD, AF, history of PE, and peripheral thrombosis and was associated with male gender, increased BMI and LVESVI, and shortened RVOT acceleration time as measured 3 months after discharge from the hospital. The decrease in LV GLS one year after discharge was not associated with the severity of the disease, length of stay in the hospital, or biological and hormonal therapy.

Comparison of clinical and echocardiographic parameters of patients with COVID-19 pneumonia three months and one year after discharge.

Aim    To study changes in clinical and echocardiographic parameters in patients after documented COVID-19 pneumonia at 3 months and one year following discharge from the hospital. Material and methods    The study included 116 patients who have had documented COVID-19 pneumonia. Patients underwent a comprehensive clinical evaluation at 3 months ± 2 weeks (visit 1) and at one year ± 3 weeks after discharge from the hospital (visit 2). Mean age of the patients was 49.0±14.4 years (from 19 to 84 years); 49.6 % were women. Parameters of global and segmentary longitudinal left ventricular (LV) myocardial strain were studied with the optimal quality of visualization during visit 1 in 99 patients and during visit 2 in 80 patients.Results    During the follow-up period, the incidence rate of cardiovascular diseases (CVD) increased primarily due to development of arterial hypertension (AH) (58.6 vs. 64.7 %, р=0.039) and chronic heart failure (CHF) (35.3% vs. 40.5 %, р=0.031). Echocardiography (EchoCG) showed decreases in values of end-diastolic dimension and volume, LV end-systolic and stroke volumes (25.1±2.6 vs. 24.5±2.2 mm /m2, p<0.001; 49.3±11.3 vs. 46.9±9.9 ml /m2, p=0.008; 16.0±5.6 vs. 14.4±4.1 ml /m2, p=0.001; 36.7±12.8 vs. 30.8±8.1 ml /m2, p<0.001, respectively). LV external short-axis area (37.1 [36.6-42.0] vs. 38.7 [35.2-43.1] cm2, р=0.001) and LV myocardial mass index calculated with the area-length formula (70.0 [60.8-84.0] vs. 75.4 [68.2-84.9] g /m², р=0.024) increased. LV early diastolic filling velocity (76.7±17.9 vs. 72.3±16.0 cm /sec, р=0.001) and lateral and septal early diastolic mitral annular velocities decreased (12,10±3,9 vs. 11.5±4.1 cm /sec, р=0.004 and 9.9±3.3 vs. 8.6±3.0 cm /sec, р<0.001, respectively). The following parameters of LV global longitudinal (-20.3±2.2 vs. -19.4±2.7 %, р=0.001) and segmental strain were impaired: apical segments (anterior, from -22.3±5.0 to -20.8±5.2 %, р=0.006; inferior, from -24.6±4.9 to -22.7±4.6, р=0.003; lateral, from -22.7±4.5 to -20.4±4.8 %, р<0.001; septal, from -25.3±4.2 to -23.1±4.4 %, р<0.001; apical, from -23.7±4.1 to -21.8±4.1 %, р<0.001), mid-cavity (anteroseptal, from -21.1±3.3 to -20.4±4.1 %, р=0.039; inferior, from -21.0±2.7 to -20.0±2.9 %, р=0.039; lateral, from -18.4±3.7 to -17.6±4.4 %, р=0.021). RV basal and mid-cavity sphericity indexes increased (0.44±0.07 vs. 0.49±0.07 and 0.37±0.07 vs. 0.41±0.07, respectively, р<0.001 for both). A tendency for increased calculated pulmonary arterial systolic pressure (22.5±7.1 and 23.3±6.3 mm Hg, р=0.076) was observed. Right ventricular outflow tract velocity integral decreased (18.1±4.0 vs. 16.4±3.7 cm, р<0.001).Conclusion    Patients after COVID-19 pneumonia one year after discharge from the hospital, compared to the follow-up data 3 months after the discharge, had an increased incidence of CVD, primarily due to the development of AH and CHF. EchoCG revealed changes in ventricular geometry associated with impairment of LV diastolic and systolic function evident as decreases in LV global longitudinal strain and LV myocardial apical and partially mid-cavity strain.

[Clinical effect, changes in the lipid structure of the erythrocyte membrane and microcirculation in patients with arterial hypertension in combination with coronary heart disease under the influence of laser therapy]. / Klinicheskii effekt, izmenenie lipidnoi struktury eritrotsitarnoi membrany i mikrotsirkulyatsii u bol'nykh arterial'noi gipertoniei v sochetanii s ishemicheskoi bolezn'yu serdtsa pod vliyaniem lazeroterapii.

The high prevalence of the combination of arterial hypertension (AH) with coronary heart disease (CHD) suggests the improvement of their treatment methods. In this regard, it is of interest to assess the dynamics of the clinical picture of patients against the background of pathogenetically determined subcellular and systemic changes under the influence of laser therapy (LT). OBJECTIVE: To evaluate the clinical effect of LT in patients with hypertension in combination with coronary artery disease and trace its relationship with the dynamics of the structure of the lipid bilayer of the erythrocyte membrane and changes in the microvascular bed. MATERIAL AND METHODS: We examined 65 male patients (mean age 50.9±6.3 years) with II-III degree AH in combination with coronary artery disease with angina pectoris. Among them, 40 patients received a 10-day course of LT, and 25 patients underwent simulated laser irradiation. At the initial stage and after 1 month, all patients underwent a bicycle exercise test, a study of the lipid composition of the erythrocyte membrane, including the main fractions of phospholipids and free cholesterol, as well as the level of intracellular Ca2+ and lipid peroxidation products - malondialdehyde and diene conjugates. Microcirculation was assessed using the method of conjunctival biomicroscopy. RESULTS: One month after the course of LT, patients showed a significant increase in exercise tolerance by 37.8%, a decrease in systolic blood pressure with a standard load by 9.9%. The improvement of the clinical picture occurred against the background of a decrease in the activity of lipid peroxidation and structural changes in the cell membrane: an increase in polyunsaturated fractions of phospholipids and a decrease in the cholesterol content, as well as a decrease in the Ca2+ level in the cell from 0.23 [0.19; 0.32] to 0.20 [0.16; 0.26] mmol/l. The results of the analysis of conjunctival biomicroscopy demonstrated a statistically significant decrease in the ratio of arteriolovenular calibers, a limitation of the severity of sludge syndrome by 59%, and an almost twofold (from 3.9±0.52 to 7.2±1.23 cap/mm2) increase in capillary density. CONCLUSION: The data obtained showed that in patients with hypertension in combination with coronary artery disease, LT causes positive changes in the lipid structure of the cell membrane and microcirculation parameters, which is accompanied by a hypotensive effect and an improvement in the clinical and functional state of patients.

Estimation of erythrocyte parameters of general blood analysis in patients with SARS-CoV-2 -associated pneumonia.

The study of the features and dynamics of the erythrocyte parameters of general blood analysis in patients with cardiovascular diseases who underwent SARS-CoV-2 associated pneumonia is of great practical importance. That was a prospective study. The study included 106 patients with SARS-CoV-2-associated pneumonia. All patients were divided into 2 groups. The first group included 51 patients without CVD, the second group included 55 patients with CVD .Patients in both groups underwent laboratory examination of blood samples at the time of hospitalization and 3 months after discharge from the hospital. Parameters of the erythroid series of the general blood test were assessed. Among inflammatory biomarkers, we examined the concentration of C-reactive protein (CRP), high-sensitivity CRP (hs-CRP) and homocysteine. Initially all patients underwent computed tomography of the chest organs. Revealed what indicators of the erythroid series in the groups of patients with and without CVD had significant differences in a number of parameters: ESR; RDW-SD and RDW-CV with significant excess of parameters in group 2. Three months after discharge from the hospital, patients in both groups had a significant increase in HCT, MCV, MCH. There was detected decrease in both groups in MCHC, RDW-CV (p<0.001 for all parameters), ESR level in group 2.At baseline, CRP exceeded reference values in both groups of patients, reaching maximum values in group 2. After 3 months CRP decreased significantly only in group 1. Increased CRP was associated with elevated hs-CRP in 3 months after discharge and elevated homocysteine levels in both groups, indicating the persistence of prolonged inflammatory vascular reaction in patients after SARS-CoV-2 associated pneumonia, more pronounced in group 2 patients. RDW-CV over 13.6 and lymphocytes / CRP less than 0.6 increase the likelihood of having lung tissue damage over 50% by 9.3 and 5.9 times, respectively. Thus, the data obtained confirm that RDW-CV, the coefficient of variation of erythrocyte distribution width, associated with the parameters of inflammatory response and the lymphocytes / CRP is lung volume marker and of COVID-19 severity. Careful consideration of already known laboratory parameters allows us to expand the number of indicators influencing the risk of COVID-19 complications and enable an earlier response to a difficult situation.

The level of growth differentiation factor 15 as a predictor of left atrial thrombosis in patients with nonvalvular atrial fibrillation.

Aim    To study the role of blood concentration of growth differentiation factor 15 (GDF-15) as a predictor of left atrial/left atrial appendage (LA/LAA) thrombosis in patients with nonvalvular atrial fibrillation (AF).Material and methods    538 patients with nonvalvular AF were admitted to the Tyumen Cardiology Research Center in 2019-2020 for radiofrequency ablation and elective cardioversion. According to findings of transesophageal echocardiography (EcoCG), 42 (7.8%) of these patients had LA/LAA thrombosis and 79 (14.7%) of them had the effect of spontaneous echo contrast (SEC). This comparative, cross-sectional, cohort study included at the initial stage 158 successively hospitalized patients with nonvalvular AF: group 1 (with LA/LAA thrombosis, n=42) and group 2 (without LA/LAA thrombosis and without SEC, n=116). To eliminate significant differences in age between the groups, an additional inclusion criterium was introduced, age from 45 to 75 years. Finally, 144 patients were included into the study: group 1 (with LA/LAA thrombosis, n=42, mean age 60.9±7.2 years) and group 2 (without LA/LAA thrombosis and without SEC, n=116, mean age 59.5±6.0 years). 93 (91%) patients in group 1 and 40 (95%) patients in group 2 had arterial hypertension (p=0.4168); 53 (52%) and 29 (^(%), respectively, had ischemic heart disease (p=0.0611). The groups did not differ in sex, profile of major cardiovascular diseases, or frequency and range of oral anticoagulant treatment. General clinical evaluation, EchoCG, and laboratory tests, including measurements of blood concentrations of GDF-15 and NT-proBNP, were performed.Results    In the group with LA/LAA thrombosis, 1) persistent AF prevailed whereas paroxysmal AF was more frequently observed in patients without thrombosis; 2) a tendency toward more pronounced chronic heart failure was observed; 3) tendencies toward a high median CHA2DS2­VASc score and toward a greater proportion of patients with scores ≥3 were observed. According to EchoCG findings, group 1 had higher values of sizes and volumes of both atria and the right ventricle, left ventricular (LV) end-systolic volume and size, pulmonary artery systolic blood pressure, and LV myocardial mass index. LV ejection fraction (EF) was in the normal range in both groups but it was significantly lower for patients with LA/LAA thrombosis, 59.1±5.1 and 64.0±7.3, respectively (p=0.00006). Concentrations of GDF-15 (p=0.00025) and NT-proBNP were significantly higher in group 1 than in group 2 (p=0.000001). After determining the threshold values for both biomarkers using the ROC analysis, two independent predictors of LA/LAA thrombosis were obtained by the stepwise multiple regression analysis: GDF-15 >935.0 pg/ml (OR=4.132, 95 % CI 1.305-13.084) and LV EF (OR=0.859, 95 % CI 0.776-0.951). The ROC analysis assessed the model quality as good: AUC=0.776 (p<0.001), sensitivity 78.3 %, specificity 78.3 %.Conclusion    For patients with nonvalvular AF, both increased GDF-15 (>935.0 pg/ml) and LV EF are independent predictors for LA/LAA thrombosis.

[The role of therapeutic exercises in blood pressure correction, vascular wall stiffness and disorders of bone and mineral metabolism in postmenopausal hypertensive patients]. / Rol' lechebnoi fizkul'tury v korrektsii parametrov sutochnogo monitorirovaniya arterial'nogo davleniya, rigidnosti sosudistoi stenki i narusheniya mineral'nogo obmena kostnoi tkani u patsientok s arterial'noi gipertoniei v postmenopauze.

OBJECTIVE: To study the role of therapeutic exercises (TE) in the correction of blood pressure, stiffness of the vascular wall and disorders of bone mineral metabolism in postmenopausal hypertensive patients. MATERIAL AND METHODS: The study included 78 patients (mean age was 53.32±7.61 years). All patients are divided into 3 groups. The first control group is 20 women without arterial hypertension and menopause. The second group consisted of 27 patients with arterial hypertension (AH) and post-menopause who were not undergone the TE complex and the 3rd group - 31 women with AH and post-menopause who were undergone TE complex. Patients of all groups were examined in dynamics: at the starting point of the study and 12 months later, out-patient monitoring of blood pressure; sphygmography; densitometry and test for blood serum biochemistry parameters, including sex hormones, vitamin D. RESULTS: In the course of the study, blood pressure, vascular wall stiffness and disorder of bone mineral density were revealed significantly higher in the group 3 with significantly reduced levels of sex hormones. Multidirectional correlation relationships between the studied parameters are revealed. Treatment combined with therapeutic exercises led to permanent improvement tendency in studied parameters like blood pressure, pulse wave velocity, metabolic disorders and T-criterion. CONCLUSION: The result of the study indicates that the exercise therapy complex used in the form of regular classes, according to the scheme proposed by the exercise therapy doctor, can be recommended for implementation in clinical practice with the aim of comprehensively affecting the patient's body and developing personalized treatment tactics for postmenopausal women with hypertension.

[The association of growth differentiation factor 15 (GDF-15) level with extent of left atrial fibrosis in patients with nonvalvular atrial fibrillation].

Aim To study the relationship between the serum level of growth differentiation factor 15 (GDF-15) and clinical and functional characteristics and severity of left atrial (LA) fibrosis in patients with nonvalvular atrial fibrillation (AF).Material and methods The study included 87 patients with nonvalvular AF (62 patients with paroxysmal AF and 25 patients with persistent AF) aged 27 to 72 years (mean age, 56.9±9.2 years, 32 women). 85 % of these patients had arterial hypertension (AH), 33 % had AH and ischemic heart disease, and 12.6 % had isolated AF and were hospitalized for primary catheter ablation. General clinical evaluation, echocardiography, laboratory tests including measurement of GDF-15 and NT-proBNP concentrations in blood were performed. As a surrogate substrate of LA fibrosis during the electroanatomical voltage mapping, the area of low-voltage (<0.5 mV) zones in LA was calculated, including the total LA fibrosis area (Sf, cm2) and a percentage of fibrosis of the total LA area (Sf%).Results Median concentration of GDF-15 was 767.5 [590.0; 951.0] pg /ml. The GDF-15 level positively correlated with age, presence and severity of AH and chronic heart failure, body mass index, and degree of obesity, CHA2DS2 VASc score, level of NT-proBNP, and LA fibrosis area (Sf and Sf%) and negatively correlated with the indexes of left ventricular diastolic function, e' septal and e' lateral. The area of fibrosis increased with increasing GDF-15 concentrations divided into quartiles; Sf% exceeded 20 % at GDF-15 levels higher than median. After a comparative analysis of patients with Sf% ≤20 % and >20 %, statistically significantly different variables were included into a stepwise logistic regression analysis. Two independent predictors of LA fibrosis >20% were identified: a concentration of GDF-15 higher than median (odd ratio (OR), 3.318, 95 % confidence interval (CI): 1.184-9.298) and LA volume index (OR, 1.079, 95 % CI: 1.014-1.147). According to results of the ROC analysis, the area under the curve (AUC) was 0.762 (p=0.000), the model specificity was 72.3 %, sensitivity was 72.4 %, and the prediction accuracy was 72.4 %.Conclusion Blood levels of GDF-15 were associated with the presence and severity of major risk factors for AF and the area of LA fibrosis. In this study, a level of GDF-15 above the median and the LA volume index were independent predictors of LA fibrosis > 20% of the LA area.

[The role of vitamin D in the pathogenesis of arterial hypertension.]

In recent years, accumulated numerous data on the pathogenetic links of the formation of arterial hypertension. A number of studies have shown that vitamin D deficiency, associated with age, changes in sex hormonal status, increased tone of the reninangiotensin-aldosterone system, endothelial dysfunction, and calcium metabolism, can be one of the mechanisms of development and progression of arterial hypertension. The purpose of the review was to summarize the results of the original domestic and foreign studies, prospective observations and meta-analyzes on the relationship between vitamin D deficiency and arterial hypertension.

[Nonspecific parameters of the immune inflammatory response as a link in the pathogenesis of remodeling of the vascular wall and destruction of bone tissue in women with arterial hypertension in postmenopausal women.]

Recently, they increasingly began to pay attention to the role of a nonspecific immune-inflammatory vascular response as a link in general pathogenetic mechanisms with a change in the elastic properties of arteries and phenomena of destructive bone changes, which at the subclinical level is of great importance for the prevention of the development of socially significant diseases. A total of 104 patients were examined (mean age 57.45 years), which were divided into three groups. The first group included 39 healthy women, the second group included 30 patients with hypertension and osteopenia, and the third group included 35 women with hypertension and osteoporosis. The analysis of markers of the immune inflammatory response, endothelial dysfunction, hormonal and mineral-vitamin status parameters was conducted against the background of the study of parameters of daily monitoring of arterial pressure, study of parameters of vascular wall stiffness and densitometry to clarify the predictors of cardiovascular and degenerative bone changes in postmenopausal women. A significant increase in the concentration of HF-CRP, the level of homocystemine, IL-8, parathyroid hormone, against the background of a significant decrease in the level of estrogen, progesterone, testosterone, with a persistent tendency to increase in total cholesterol, atherogenic lipid fractions, myeloperoxidase, endothelin-1 and decrease was recorded calcitonin, total and ionized calcium, with a significantly minimal value of vitamin D in the 3rd group of patients. The risks of development and progression of bone destructive changes were calculated using the logistic regression method for the group of AH with osteopenia and osteoporosis. Thus, for patients with hypertension and osteopenia, a significantly significant parameter associated with the risk of developing osteoporosis was an indicator of the velocity of the pulse wave, an increase in the level of which exceeds 12.05 m/s is associated with an increased risk of developing osteoporosis by 3.8 times. Increased levels of pro-inflammatory parameters, IL-6 and 8, TNF-α, HB-SRB, parathyroid hormone and reduced levels of progesterone and IL10, took the most active part in aggravating the degree of available bone tissue destruction. Timely specialized multidirectional study of biochemical and instrumental parameters (in particular, the study of the speed of the pulse wave and densitometry) can be the basis for the development of personalized prevention and treatment tactics for women in order to prevent socially dangerous cardiovascular and bone complications.

[Relationship between levels of sex hormones and response to cardiac resynchronisation therapy in men].

AIM: To study the relationship between levels of sex hormones and effectiveness of cardiac resynchronisation therapy (CRT) in men with chronic heart failure (CHF). MATERIALS AND METHODS: The best response to CRT (mean time, 38 [19,0;53,7] months) was identifed by a maximum decrease in left ventricular end-systolic volume (LVESV) in 58 men (mean age, 54.8±9.6) with CHF (61% IHD). Based on testosterone (TES) level, patients were divided into group 1 (n=28; 48%) - TES < median value (13.8 nmol/l) and group 2 (n=30; 52%) - TES > median value. Exercise tolerance (ET), echocardiography (EchoCG) parameters, plasma levels of NTproBNP, interleukin (IL) - 1ß, IL-6, IL-10, tumor necrosis factor α (TNF-α), С-reactive peptide (CRP), galectin-3 (Gal-3), matrix metalloprotease-9 (ММР-9), tissue inhibitors of metalloproteinases TIMP-1, TIMP-4, and the indexes MMP-9/TIMP-1 and MMP-9/TIMP-4 were evaluated in dynamics. Levels of TES, progesterone (PGN), dehydroepiandrosterone sulphate (DHEAS), and estradiol (Е2) were measured at baseline. Based on LVESV changes, non-responders (LVESV decrease by 15% but 30%) were identifed. RESULTS: In group 2, atrial fibrillation (р=0.064) and radiofrequency ablation of atrioventricular connection (р=0.014) were observed more frequently; incidence of diabetes mellitus was lower (р=0.017); QRS was smaller (р=0.001); ET was higher both at baseline (р=0.022) and in dynamics (р=0.018); numbers of responders and super-responders were greater (р=0.007); levels of PGN (р=0.028), Il-1ß (р=0.020), IL-10 (р=0.013), TNF- α (р=0.006) were higher; and Е2/TES was lower (р=0.004). While EchoCG parameters did not differ at baseline, group 2 showed a tendency towards greater changes in LVESV (р=0.069) and LV end systolic dimension (р=0.087), and a greater increase in LV ejection fraction (р=0.007). In dynamics: In group 1, a decrease in NT-proBNP was observed (р=0.015); in group 2, decreases in IL-1ß (р=0.001), IL-6 (р=0.015), IL-10 (р=0.001), TNF-α (р=0.001), TIMP-1 (р=0.046), and Gal-3 (р=0.051) were observed. Levels of sex hormones were correlated with EchoCG parameters, biomarkers of immune inflammation, fibrosis, and NTproBNP. The ROC analysis showed that a TES level not lower than 13.8 nmol/l was a predictor for a positive response to CRT with a sensitivity of 63.4% and specifcity of 76.5% (AUC=0.687; р=0.026). CONCLUSIONS: High levels of TES and PGN were associated with beter effectivity of CRT, higher ET, greater proportions of responders and super-responders, and reduced immune inflammation activity and fibrosis. A level of TES not lower than 13.8 nmol/l was a predictor for a positive response to CRT.

[Prospective analysis of lipid profile parameters and markers of vascular inflammatory response with prognosis of undesirable coronary events in patients with coronary heart disease after angioplasty with stenting.]

The study of the causes of the development of vascular coronary complications after angioplasty with stenting using the evaluation of biochemical parameters in the dynamic observation of patients with IHD with significant coronary stenosis determines the relevance of the study. To analyze the parameters of lipid spectrum and markers of vascular inflammatory reaction in patients with IHD, in groups with stable angina and episode of unstable angina after angioplasty with stenting, to trace the dynamics of biochemical parameters and to reveal the predictors of undesirable coronary events. Patients with IHD with significant coronary stenosis of the arteries (SCS, n = 95) after coronary angiography at the point of maximum increase in the level of markers of the inflammatory reaction (3 months after angioplasty) are divided into 2 groups - patients with persistent stable angina pectoris (SA, n = 77) until the end of the study and patients with developed postvascularization episode of unstable angina (UA, n = 18). The dynamics of observation of biochemical parameters recorded the absence of normalization of the atherogenic spectrum of the lipid profile and the prolonged nature of the vascular inflammatory response to the end point of observation after angioplasty.The method of binary logistic regression revealed that in the general group of patients with IHD, an increase in the level of low density lipoprotein cholesterol by 1 mmol / L significantly increases the probability of significant coronary stenosis in men and raises the risk of UA after angioplasty by 7.38 times. It was found that patients with UA at the initial stage have a significantly higher risk of coronary blood flow instability in the post-vascularization period due to an elevated level of homocysteine. A set of biochemical markers for predicting the significance of coronary stenosis and development of undesirable vascular coronary events after angioplasty in patients with IHD has been identified: male sex, elevated LDL cholesterol and hyperhomocysteinemia.

[Cerebral blood flow and endothelial functional activity in patients with coronary heart disease and arterial hypertension during therapy with ivabradine in combination with perindopril].

AIM: To investigate the effects of ivabradine in combination with perindopril on cerebral blood flow and endothelial functional activity. SUBJECTS AND METHODS: Sixty-four patients with coronary heart disease (CHD) and arterial hypertension (AH) were examined. Group 1 (n = 38) patients took ivabradine in combination with perindopril and Group 2 (n = 26) received metoprolol. At baseline and 8 weeks after therapy, 24-hour blood pressure (BP) monitoring and electrocardiography were done, cerebral blood flow was estimated by Doppler ultrasound, reactive hyperemia and nitroglycerin tests were performed, and plasma nitrite levels were determined. RESULTS: With a comparable decrease in BP and heart rate in the internal carotid artery basin in both groups over time, there was a fall in peak systolic blood flow velocity; Group 1 showed a reduction in pulsatility index (PI) and systolic/diastolic ratio (ISP). After 8 weeks, there was an increase in endothelium-independent vasodilation and baseline blood flow velocity in the brachial artery in Group 1 and a rise in endothelium-dependent vasodilation in Group 2; in both groups, reactive hyperemia were higher in the brachial artery basin. No changes in nitrite levels were recorded during therapy. There was an inverse correlation between PG and PI in Group 1 and between PG and ISP in Group 2. CONCLUSION: By unidirectionally affecting the vasomotor function of the endothelium, ivabradine in combination with perindopril versus metoprolol has a more favorable effect on circulatory resistance and blood flow velocity in the brachiocephalic arteries of patients with CHD and AH.

[Structural-functional properties of the vascular wall in hypertensive patients with coronary heart disease: effects of felodipin and perindopril].

AIM: To study endothelial function and vascular elasticity in hypertensive patients with coronary heart disease (CHD) and approaches to correction of the impairments with felodipin and perindopril. MATERIAL AND METHODS: The trial included 34 hypertensive patients with CHD and 17 controls free of cardiovascular diseases. The above cardiovascular patients were randomized into two groups: 15 patients of group 1 received felodipin, 19 patients of group 2 were given perindopril. If the target blood pressure was not achieved after 4 weeks of treatment, 12.5 mg hydrochlorotiazide was added. 24-h monitoring of blood pressure, reactive hyperemia and nitroglycerin tests were made initially and after 8-week treatment. Also, calculations were made of pulse wave velocity (PWV) on the carotid-femoral and carotid-radial segments (Ve and Vm), of elastic modulus for arteries of the elastic and muscular types (Ee and Em). RESULTS: Baseline endothelium-dependent and non-endothelium-dependent vasodilations (EDVD and NEDVD) in cardiovascular patients were lower than in the controls while Ve and Ee were higher. Systolic blood pressure (SBP), pulse blood pressure (PBP), stress SBP and EDVD correlated. The treatment led to reduction of mean circadian, diurnal and nocturnal SBP, diastolic blood pressure (DBP), PBP, Ve and Ee, to elevation of EDVD. CONCLUSION: EDVD in hypertensive patients with CHD is related with SBP and PBP. Felopidin had both an antihypertensive and vasoprotective effects due to improved endothelial function and better elasticity of the major arteries comparable to effects of perindopril.

[Anti-ischemic efficacy of combination of trimetazidine with enalapril in patients with stable effort angina and metabolic syndrome].

Efficacy of combination of trimetazidine (60 mg/day) and enalapril in patients with stable effort angina and metabolic syndrome was assessed in a randomized placebo controlled study of 64 patients. Anti-ischemic activity of trimetazidine was found to be significant. It was most pronounced in patients with abnormal 24-hour blood pressure index, waist/hip circumference ratio >1.0 at the background of satisfactory clinical and laboratory compensation of type 2 diabetes.

[Clinical efficacy of combined therapy with enalapril + trimetazidine in patients with hypertension comorbid with ischemic heart disease and metabolic disturbances].

AIM: To compare hypotensive and antiischemic efficacy of enalapril combination with trimetazidine or placebo, effects on plasmic lipid spectrum and membrane-cell parameters of erythrocytes and platelets in hypertensive patients with ischemic heart disease (IHD) in the presence of metabolic disturbances. MATERIAL AND METHODS: A randomized placebo-controlled comparative trial included 64 patients (mean age 55.60 +/- 0.52 years) with hypertension stage I-III, IHD (stable effort angina FC II-III, obesity of the first-third degree, diabetes mellitus type 2. The patients were divided into two groups matched by gender, age, duration of the disease, office blood pressure (OBP), functional class (FC) of effort angina, body mass index, glucose levels in the blood. 43 patients of group 1 received enalapril and trimetazidine. 21 patients of group 2 were treated with enalapril and placebo. The efficacy of the treatment was assessed by changes in the 24-h profile of BP and ECG, blood lipid spectrum and membrane-cell parameters. RESULTS: A significant fall was seen in systolic blood pressure of both groups patients. In group 1 there was an additional lowering of temporal index of systolic pressure, nocturnal diastolic, mean 24-h diastolic, mean 24-h blood pressure, double product of ischemic episodes, total cholesterol, dienic conjugates in platelets. Catalase activity in erythrocytes rose. CONCLUSION: An antiischemic effect of the therapy in stabilization of blood pressure, normalization of plasmic lipids and lipoperoxidase in erythrocytic and platelet membranes under multidirectional correlations between clinical and biochemical parameters point to different mechanisms of ischemic correction in enalapril and trimetazidine.

[Role of cell membrane abnormalities in the etiology of arterial hypertension]. / Rol' patologii kletochnykh membran v formirovanii arterial'noi gipertonii.

AIM: To study the role of cell membrane disorders in the formation of arterial hypertension under conditions of Extreme North. MATERIALS AND METHODS: A total of 128 men aged 20-48 years with essential hypertension (EH) were examined. All of them worked in the duty regimen at the Extreme North. Control group consisted of EH patients living in the temperate climatic zone. Central and peripheral hemodynamic parameters and cell membrane characteristics were studied: activities of transmembrane ion transport enzymes, intracellular electrolytes sodium and calcium, lipid peroxides (LPO), antioxidant defense values in erythrocyte membranes, plasma and cell membrane cholesterol. RESULTS: Activation of LPO processes and decreased antioxidant defense in both groups modified the lipid spectrum of cell membranes. The levels of intracellular calcium and sodium were increased, activities of Na(+)-K(+)-ATPase and Ca(2+)-ATPase decreased; total peripheral vascular resistance and left ventricular myocardium were progressively increasing. CONCLUSION: Membrane-destabilizing processes and hemodynamic shifts were more expressed in subjects with arterial hypertension working in the duty regimen.

[Efficacy of emoxipin in treatment of arterial hypertension in the Far North]. / Effektivnost' émoksipina v lechenii arterial'noi gipertonii na Krainem Severe.

A total of 95 hypertensive men working in duty regimen in the extreme North were examined. The men were found to have lipid metabolism disorders, activation of lipid peroxidation, decreased antioxidant defense in red cell membranes in all the examinees vs control hypertensive men living in moderate climatic zone. Effect of 2-week monotherapy with emoxipin was studied in 29 males with mild arterial hypertension free of obesity and coexisting diseases. Placebo was given to 10 patients. Emoxipin had an antihypertensive and antioxidant effects, improved structural-functional condition of erythrocytes in hypertensive patients.