[Effectiveness of diagnostics and treatment of complicated hypertensive disease taking into account results of 3 day arterial pressure monitoring].

UNLABELLED: Empirical choice of antihypertensive therapy (AGT) for patients with complicated hypertensive disease (HD) encounters difficulties due to high variability of arterial pressure (AP) and inadequate response to intake of medicines. The objective methods for the choice of AGT methods are absent. AIM: To evaluate effectiveness ofthe choice of AGT taking account of AP profile calculated based on the analysis of results of 3 day AP monitoring in patients with complicated HDfor whom the empirical prescription of medicines does not give the desirable result. MATERIALS AND METHODS: The study included 51 patients aged 56 +/- 19 yr with HD 18 +/- 13 yr in duration without adequate control of AP despite combined AGT AD was measured (BPLab, Nizhni Novgorod) every 30 min for 3 days, the AP profile was calculated by special FORM-based algorithm. Peak time and magnitude were calculated, the first and second derivatives of the process were determined, AGT was prescribed at the computed AD maximum points. RESULTS: Systolic and diastolic AP decreased within 2 weeks after AGT The number of patients with enhancedAP in the daytime and at night and those with highly variable AP decreased from 33 to 11% (chi2 = 8.4, p < 0.005), from 61 to 33% (chi2 = 10.1, p < 0.005), from 51 to 26% (chi2 = 8.2, p<0.005) respectively. The number ofpatients with inadequate lowering of night-time AP and those with abnormally high fluctuations of AP decreased from 53 to 24% (chi2 = 9.3, p < 0.005) and from 31 to 15%, (p < 0.005) respectively. The frequency of intake of AGT drugs did not change. CONCLUSION: Approximation of real AP circadian profile fluctuations based on results of 3 day monitoring is a sensitive diagnostic tool facilitating the choice of rational AGT for patients with markedly altered circadian rhythms when empirical prescription of AGT does not ensure desired control ofAP

[The prevalence of anxiety and depression in different regions of the Russian Federation and its association with sociodemographic factors (according to the data of the ESSE-RF study)].

AIM: To study the prevalence of anxiety and depression by psychometric methods (the Hospital Anxiety and Depression Scale (HADS) in different regions of the Russian Federation (RF), which are characterized by various climatic, geographic, economic, and demographic indicators. SUBJECTS AND METHODS: The investigation used the data of the multicenter epidemiological survey of cardiovascular diseases in different regions of the Russian Federation--the ESSE-RF study. The subjects of the study were representative samples from unorganized male and female populations aged 25-64 years from 10 RF regions. The survey included a total 16,877 people (6244 men and 10,623 women). All the examinees were interviewed using a standard questionnaire. An analysis involved their gender, age, education level, place and region of residence, and income and morbidity level. The HADS validated in Russia was used to rate the level of anxiety/depression. RESULTS: The total prevalence of higher anxiety and depression averaged 46.3 and 25.6%, respectively. Respondents with clinical anxiety/depression constituted more than one third of those who had a higher level of these conditions. In the examined population, the moderate level of anxiety/depression was 7.5 ± 0.06 and 5.1 ± 0.04, respectively. The population of Volgograd, Samara, Saint Petersburg, and Tomsk had the similar values of the moderate level of anxiety/depression (p > 0.05). The lowest level of anxiety/ depression (p < 0.0001) was seen in the dwellers of Tyumen (5.9 ± 0.1 and 3.4 ± 0.1, respectively) and the highest in the Republic of North Ossetia-Alania (NOA) (8.4 ± 0.1 and 6.8 ± 0.1, respectively). These regions showed the lowest and highest prevalence of higher anxiety (22% in Tyumen and 59.8% in the Republic of NOA (p < 0.0001). CONCLUSION: All the 10 selected RF regions differing in demographic, economic, climatic, and geographical parameters are characterized by a high level of anxiety that remains statistically significant after adjusting for gender and age, so are parameters, such as income and morbidity levels are present in only 4 of the 10 regions.

[Oral status and oral mucosa blood circulation changes in patients with chronic heart failure].

The objective of this study was to characterize dental status and oral mucosa blood flow in patients with chronic heart failure and amyloid deposits in oral mucosa. Histological and immunohistochemical analysis of 80 oral mucosa biopsies taken from patients aged 32-72 years with chronic heart failure I-IV NYHA functional class was carried out. It detected a systemic amyloidosis in 15.7% of cases; a local amyloid deposition in oral mucosa was found in 58.5% of cases. Amyloid deposition in oral mucosa was associated with severe chronic generalized periodontitis in more than a half of cases. Amyloid deposits in oral mucosa were revealed more often in patients with metabolic syndrome (63.5%). The article describes dental status and oral mucosa blood flow in patients with heart failure.

[First experience of the study "Intramyocardial Multiple Precision Administration of Mononuclear Bone Marrow Cells in the Treatment of Myocardial Ischemia"].

Study aim - to elucidate possibilities of the use of precision administration of mononuclear bone marrow cells (MBMC) for the treatment of myocardial ischemia and heart failure. "Intramyocardial Multiple Precision Administration of Mononuclear Bone Marrow Cells in the Treatment of Myocardial Ischemia" was a double blind randomized placebo controlled study in which we included patients more or equal 6 months after Q-wave myocardial infarction with systolic myocardial dysfunction (ejection fraction <35%), not requiring myocardial revascularization, receiving stable optimal medical therapy for more or equal 8 weeks, and with implanted cardioverter-defibrillator. Transplantation of MBMC was guided by fluoroscopy and tridimensional NOGA XP Cardiac Navigation System. For assessment of efficacy of the method we used surrogate end points: decrease of number of fixed perfusion defects according to SPECT data and improvement of regional myocardial contractility according to data of echocardiography. Results of dynamic observation of the first experience of MBMC administration are presented in this paper.

[The impact of early and late ischemic preconditioning on brain damage and degree of neurological deficiency in rats].

The present study was aimed to investigate neuroprotective effects of early and late ischemic preconditioning in the acute phase of ischemic brain damage in rats. It was found that a single five-minute ischemic episode of early ischemic preconditioning did not lead to significant neuroprotective effects in comparison with control group, while three five-minute ischemic episode early ischemic preconditioning accompanied by a significant increase in neurological deficit and growing damage rate in CA1 hippocampus neurons. In contrast, later ischemic preconditioning in form of single five-minute episode 24 hours before ischemia modeling, provided a significant neuroprotective effect, manifesting reduced neurological deficit and maintaining viability of CA1 hippocampus neurons.

[Molecular mechanisms of development of cerebral tolerance to ischemia (Review. Part 2)].

In the 2nd part the authors describe in details the main aspects of protective effect of preconditioning of the brain: inhibition of programmed cell death, weakening of phenomenon of excitotoxicity, activation of endogenous antioxidant systems, anti-inflammatory effects, modulation of glial cell function, changes in regional blood flow and vascular reactivity. In addition, data analysis on the impact of preconditioning on brain neurogenesis, the state of the blood-brain barrier, ion homeostasis and metabolism of neurons is presented. Review emphasizes the role of microRNAs in mechanisms of ischemic tolerance of brain. Profound understanding of molecular mechanisms of increased tolerance of brain to ischemic and reperfusion injury requires the implementation of this phenomenon in clinical practice.

[Molecular mechanisms of development of cerebral tolerance to ischemia. Part 1].

In the first part of this review molecular mechanisms of ischemic tolerance emerging as a result ofpreconditioning of the brain are discussed. Data on inductors, sensors, transducers and effectors of early and delayed ischemic tolerance are presented.

[Hypertrophic cardiomyopathy. Clinical and morphological comparisons].

The paper comparatively analyzes myocardial morphology in children and adults with hypertrophic cardiomyopathy. All the cases analyzed had its obstructive form and significant asymmetric left ventricular hypertrophy--hypertrophy of the ventricular septum (VS). When stratifying the risk of sudden death from the obstructive form of the disease in adults, the most important characteristics are shown to be less than 45 years of age, stromal enlargement in the right VS closer to the endocardium of the right ventricle; and in some cases this fact must be considered when choosing a management tactic.

[Cryoballoon ablation for pulmonary vein isolation to treat atrial fibrillation: first experience in Russian Federation].

Cryoballon ablation (CBA) for pulmonary vein (PV) isolation is a new method for catheter-based treatment of patients with atrial fibrillation (AF). The purpose of our work is to describe the CBA technique and to report its short-term results. Methods. CBA was performed in 12 patients (8 men; age 53.1+/-5.7 years) with highly symptomatic drug-refractory AF. Paroxysmal AF was present in 11 and persistent AF - in 1 patient. CBA procedure was carried out under general anesthesia with intubation in 6 and under light sedation in 6 patients. After transseptal access and direct PV angiography, 28 mm-cryoballoon was introduced into the left atrium, and more or equal 2 cryoapplications were delivered to each PV, once good PV occlusion was obtained. PV isolation was verified utilizing a circular mapping catheter. Arrhythmia recurrences were monitored every 3 months after ablation using 24-hour Holter, and additional ECG registrations. Holter monitoring was also performed in a case of symptoms. Results. Complete electrical PV isolation was achieved by only cryoballoon ablation in 11 patients, and additional cryocatheter touch-up ablation was required in left PVs in 1 patient. Total procedure time was 203.1+/-34.2 min, fluoroscopy time - 50.5+/-14.0 min. There were no complications. During a mean follow-up period of 136.8+/-59.8 days 9 (75%) patients were free from arrhythmia recurrence after a single procedure. Redo ablation was required in 1 patient, in whom electrical reconnection to all PVs was documented. Conclusion. CBA is a novel promising technique for treatment of patients with AF, and now is available in Russian Federation. The method standardizes and facilitates interventional AF treatment with acute isolation of 96% PVs. The short-term follow-up shows freedom from atrial tachyarrhythmias in 75% of patients.

[Activity of lactate dehydrogenase in the brain cortex and hippocampus of Mongolian gerbils after global ischemia and reperfusion injuries].

Cerebral ischemia results in severe derangements of energy metabolism in the nervous tissue including activation of glycolytic pathway. Activity of cytosolic lactate dehydrogenase (LDH) in the specific brain structures remains unclear. The recent study was aimed at investigation into the LDH activity in the cytoplasm of both hippocampal and cortical neurons in Mongolian gerbils (Meriones unguiculatus) at different durations of reperfusion after global ischemia. Analysis showed that the activity of LDH in pyramidal neurons of various hippocampal areas and neurons of II, III and V cortical layers after 7-minute forebrain ischemia depended on both localization of the neurons and duration ofreperfusion. In general, the changes in postischemic cytosolic LDH activity include significant decrease in the LDH activity 2 days after reperfusion with varying degree of recovery on day 7 of reperfusion.

[Molecular and genetic aspects of heart failure in diabetic patients].

This article deals with peculiarities of development and clinical course of heart failure (HF) in diabetic patients, influence of diabetic cardiopathy on HF formation., role of genetic predictors of diabetes mellitus (DM) and HF formation, also the importance of treatment response predictors, the significance of a more "personalized" exposure in order to optimize treatment. The role of stationary and dynamic genomics was analyzed, especially molecular visualization that allows the earliest possible intervention. The article also includes examples of molecular visualization use in diagnosis of myocardial dysfunction, disease monitoring, and treatment efficacy assessment. Authors give an analysis of targeted treatment methods on the example of targeted delivery of medications to the target-organ (myocard). Discuss means of anti-ischemic myocardial protection, perspectives of metformin use in order to enhance efficacy of myocardial ischemic pre- and postconditioning mechanisms. Presented perspectives of study of molecular and genetic mechanisms involved in the pathogenesis of HF in diabetic patients, in particular, study of key biological features of stem cells, cell interactions, stem cell plasticity (in vitro direction of differentiation) and their paracrine function evaluation. Given information about identification of genes with partly altered expression due to chronic exposure of mesenchymal stem cells to the high concentration of glucose, and upon decreased ability of mesenchymal stem cells of proangiogenic factors with simultaneous increase of inflammatory markers production (IL8). In whole this article reviews modern state of HF in diabetic patients development mechanisms study with the use of molecular and genetic technologies, and of perspectives of development of this area.

[Morpho-functional changes of hippocampal CA1 area in Mongolian gerbils after ischemic postconditioning].

The aim of this study was to determine the effect of ischemic postconditioning on hippocampal CA1 neuronal survival and cytoplasmic activity of lactate dehydrogenase (LDH) in the gerbil model of cerebral ischemia-reperfusion injury. Ischemia was induced by bilateral common carotid artery occlusion (for 7 min) in male Mongolian gerbils (Meriones unguiculatus). Ischemic postconditioning protocol comprised 3 cycles of 15 s reperfusion/15 s ischemia. After 48 h of reperfusion, CA1 neuronal death was detected by Nissl staining and the cytoplasmic LDH was demonstrated histochemically in CA1 area of the hippocampus with a quantitative cytophotometric assessment of the enzyme activity. The results have shown that 7 min ischemia resulted in a significant decrease in the number of viable neurons (up to 24%) in the CA1 area of hippocampus; in addition, it reduced the activity of LDH in these neurons (from 0.260 +/- 0.009 to 0.190 +/- 0.006 relative units). The application of ischemic postconditioning significantly increased the number of viable neurons (up to 52.9%, P < 0.01) in the CA1 area of hippocampus, and it was accompanied by an increase in the activity of LDH (0.240 +/- 0.008 relative units, P < 0.001).

[The first experience with heart transplantation in the Federal Center of the Heart, Blood and Endocrinology named after V. A. Almazov].

At the present time heart transplantation is considered to be the operation of choice in treatment of patients with terminal stage of chronic heart failure. Results of the first 5 heart transplantations made in the Federal Center of the heart, blood and endocrinology named after V. A. Almazov are assessed. There were no perioperational lethality and complications at the hospital stage. An analysis of the long-term results has shown effectiveness of heart transplantations in treatment of severe heart pathology.

[Transthyretin gene V30M, H90N, and del9 mutations in cardiomyopathy patients from St. Petersburg].

A search of transthyretin (TTP) gene mutations was conducted in patients with cardiomyopathies from St. Petersburg. Mutations H90N, V30M, G47A, and deletion (del9) of nucleotides GACTTCTCC in position 6776 from the start codon of the TTP gene (in position 98782 according to reference sequence AC079096 (NCBI) was found. The H90N mutation in the third exon of TTP gene was detected in a son of a cardiomyopathy patient and in his mother, which lacked any clinical manifestations. Mutations V30M and G47A in exon 2 of TTP gene were found in heterozygous and homozygous state, respectively, in one of the probands. Deletion (del9) was revealed in a patient with cardiomyopathy and in his two daughters from different marriages, who had no clinical manifestations of the disease. All the mutations revealed in this study were previously identified in other populations.

[Algorithm of anxiety-depressive disorders detection in patients with coronary heart disease in general clinical practice].

AIM: To estimate a diagnostic algorithm for anxiodepressive disorders (ADD) in coronary patients in general therapeutic practice. MATERIAL AND METHODS: A total of 163 coronary patients were examined using Seattle, Moriski and Green, Hospital questionnaires for anxiety and depression. Patients with clinical and subclinical anxiety and/or depression by Hospital testing responded to Hamilton anxiety and depression questionnaire. An analysis of clinical, anamnestic and socioeconomic parameters was made to create a multifactor model for ADD detection in coronary patients basing on the method of multiple logistic regression. RESULTS: A model of ADD dependence Z = -3.446 x [presence or absence of anxiety and/or depression in the past]-2.451 x [presence or absence of stress for a year] - 2.452 x [drinking alcohol or rejection of alcohol] + 0.071 x [the disease perception in percent from Seattle angina questionnaire]. In certain combination of responses (presence or absence of parameters) and digital result in 7 combinations the patients can be diagnosed to have ADD. CONCLUSION: The diagnostic algorithm proposed helps ADD detection in coronary patients in general therapeutic practice without participation of psychotherapists and medical psychologists.

[The study of circulating endothelial precursor cells in patients with chronic heart failure].

We examined 41 patients with ischemic heart disease (n=26) and dilated cardiomyopathy (DCM) (n=15). Control group comprised 15 practically healthy subjects. We found no substantial differences in the presence of CD34+CD133- and CD34+CD133-VEGFR-2+ cells in peripheral blood of patients with chronic heart failure (CHF) but noted lowering of level of CD34-CD133+VEGFR-2+ cells mainly in DCM group. Most significant factors determining lowering of number of circulating endothelial precursor cells (EPC) were age, level of low density lipoprotein cholesterol, and intima media thickness of common carotid arteries. We found lowering of colony forming ability of EPC in patients with CHF first of all in the group of patients with DCM. Abnormality of qualitative and quantitative composition of EPC can be considered as one of risk factors of endothelial dysfunction, pathological remodeling of cardiovascular system and CHF progression.

[Antiarrhythmic activity of omega-3 polyunsaturated fatty acids in patients with stable ischemic heart disease and ventricular rhythm disturbances].

UNLABELLED: The purpose of this investigation is to evaluate the influence of purified highly-concentrated omega-3 polyunsaturated fatty acids (90% omega-3 polyunsaturated fatty acids 1 g/day) on the severe ventricular arrythmias in patients with stable coronary heart disease (CHD) without concomitant left ventricular contractivity impairment. MATERIALS AND METHODS: 43 patients with stable CHD (26 male and 17 female, aged 66.2 +/- 8.3) with ejection fraction above 45% with unstable paroxysms of ventricular tachycardia detected at Holter ECG monitoring that received 1 g/day omega-3 polyunsaturated fatty acids during 1 month. 23 patients continued treatment for one month extra, while 20 stopped receiving after one month. ECG monitoring was repeated monthly. RESULTS: In one month after started receiving 90% omega-3 polyunsaturated fatty acids the mean heart rate reduced by 2.4%, the number of single extrasystoles reduced by 20.1% (p=0.01), the number of paired extrasystoles reduced by 47% (p=0.0018) and the number of paroxysms reduced by 49% (p=0.0029). In 41.9% patients no paroxysms have been registered after one month. When continuously receiving omega-3 polyunsaturated fatty acids during the second month, the treatment efficiency increases, while the receiving been stopped after one month, the effect is reduced but remains. CONCLUSION: 1 g/day omega-3 polyunsaturated fatty acids application in patients with stable CHD without myocardium contraction dysfunction suffering from ventricular arrhythmias (4B grade after B.Lown) with no direct indications for implantable cardioverter defibrillator therapy results in significant reduction of arrhythmia.