Parameters of cutaneous microvasculature in men of working age with newly diagnosed arterial hypertension.

OBJECTIVE: To investigate structural and functional features of cutaneous microvasculature in men of working age with newly diagnosed arterial hypertension (AH). MATERIALS AND METHODS: The study included 161 apparently healthy men from 30 to 60 years, who underwent a comprehensive examination of cardiovascular system "from the heart to the capillaries". Control group (CG) included 60 normotensive men. AH group included 101 men with elevated BP. RESULTS: There is no rarefaction of the capillary bed and latent fluid retention in the interstitial space in the skin in men with AH. No data were obtained for increased endothelial, neurogenic and myogenic tone of resistive cutaneous precapillary arterioles in AH group, but a decrease in the perfusion efficiency of the endothelial and myogenic mechanisms of tissue perfusion modulation was noted. CONCLUSION: Obtained results allow making the assumption that metabolic disorders at the level of capillaries that are of a systemic nature prevail in men with the onset of AH.

[Association of renal function, telomere length and markers of chronic inflammation for patients without chronic kidney and cardiovascular diseases].

Most of people over 60 years of age have decreased renal function and the velocity of glomerular filtration rate reduction varies greatly. Presumably, one of the probable mechanisms of accelerated decline of renal function may be a shortening of telomere length due to chronic inflammation. The main purpose of research was to appreciate the association of renal function, leukocytes telomeres length and markers of chronic inflammation in patients without chronic kidney disease and cardiovascular disease. 253 patients without chronic kidney diseases and cardiovascular diseases were included in the study. The average age of patients was 51,5±13,3 years. There were 172 women and 81 men. 55 patients had hypertension of 1-2 degree, 46 patients had normal renal function, 207 had mild failure of kidney function. Albuminuria was < 30 mg/day in all patients. Multivariate linear regression analysis revealed statistically significant correlation between albuminuria level and telomere length (p=0,023), C reactive protein (p=0,047) and fibrinogen (p=0,001). Glomerular filtration rate, urea and creatinine were not associated with telomere length and markers of inflammation but were correlated well with age, p < 0,001. CONCLUSIONS: Albuminuria is mainly associated with chronic inflammation and telomere length (from all studied indices of renal function). Albuminuria may be regarded as a marker of replicative cell senescence and a therapeutic target for the prevention of renal function reduction.

[The age-related changes of the heart rate variability measurements: the role of the inflammation, oxidative stress and telomeres biology].

The autonomic and central nervous system, a number of humoral and reflex effects regulate the heart rate. The main role in the heart rate regulation belongs to the autonomic nervous system. A common method for studying the autonomic influences on the heart rate is the analysis of heart rate variability (HRV), which allows to evaluate the neuro-vegetative status of the organism, determine its adaptive capacity, to evaluate the level of stress and the degree of tension of regulatory systems. An age-related decrease of HRV measurements in healthy people reflects the weakening of the autonomic regulation of cardiac activity. The most pronounced changes are found in patients older than 60 years. The HRV depression is preceded by hemodynamic and metabolic disorders is associated with high cardiovascular risk and is a predictor of life-threatening arrhythmias and sudden death in the elderly.The reasons for HRV changes with age stay unclear. In the light of modern ideas about the mechanisms of aging, several complementary theories proposed. Telomere shortening, the role of oxidative stress and inflammation as possible mechanisms of age-related changes in the autonomic regulation of the heart rhythm, will be discussed in this article.

[Age-related Changes of Left Ventricular Diastolic Function, NT-proBNP Level and Their Association With Leukocyte Telomere Length].

UNLABELLED: With advancing age the left ventricle (LV) undergoes structural and functional changes, thereby creating the substrate for the development of diseases. One possible mechanism of the ageing of the heart is cellular senescence. Leukocyte telomere length (LTL) is a marker of replicative ageing. The purpose of this study was to evaluate the diastolic function of LV and level of NT-proBNP in people of different ages free of cardiovascular diseases and to assess their relationship with LTL. Our data showed that old age is associated with diastolic dysfunction and increase in the levels of NT-proBNP. The group of older subjects had lower values of E/A (0.96 ± 0.036 vs 1.27 ± 0.03, p < 0.001), Em/Am (0.9 ± 0.035 vs 1.5 ± 0.066) and higher values of IVRT (81 ± 1.56 vs 70 ± 1.23 MS, p < 0.001), DT (198 ± 3.98 vs 175 ± 2.82 MS, p < 0.001), that reflected impairment of LV relaxation. NT-proBNP level was higher in the elderly (100.82 ± 7.1 vs 48.47 ± 6.7 ωg/ml, p < 0.01), but it did not correlate with LTL. The most sensitive to the age parameters of LV diastolic function (E/A and Em/Am ratio) were positively and independently of age associated with LTL (p < 0.001). Older individuals with shorter LTL had significantly lower values of E/A ratio. CONCLUSION: Telomere length appears to be a biomarker of myocardium ageing.

Short telomere length is associated with arterial aging in patients with type 2 diabetes mellitus.

It is known that glucose disturbances contribute to micro- and macrovascular complications and vascular aging. Telomere length is considered to be a cellular aging biomarker. It is important to determine the telomere length role in vascular structural and functional changes in patients with diabetes mellitus. We conducted a cross-sectional observational study in a high-risk population from Moscow, Russia. The study included 50 patients with diabetes and without clinical cardiovascular disease and 49 control group participants. Glucose metabolism assessment tests, measuring intima-media complex thickness and determining the presence of atherosclerotic plaques, pulse wave velocity measurement, and telomere length measurement were administered to all participants. Vascular changes were more dramatic in patients with diabetes than in the control group, and the telomeres were shorter in patients with diabetes. Significant differences were found in the vascular wall condition among diabetes patients, and there were no substantial differences in the arterial structure between patients with 'long' telomeres; however, there were statistically significant differences in the vascular wall condition between patients with 'short' telomeres. Vascular ageing signs were more prominent in patients with diabetes. However, despite diabetes, vascular changes in patients with long telomeres were very modest and were similar to the vascular walls in healthy individuals. Thus, long lymphocyte telomeres may have a protective effect on the vascular wall and may prevent vascular wall deterioration caused by glucose metabolism disorders.

[Age-related Changes of Left Ventricular Diastolic Function, NT-proBNP Level and Their Association with Leukocyte Telomere Length].

With advancing age the left ventricle (LV) undergoes structural and functional changes, thereby creating the substrate for the development of diseases. One possible mechanism of the ageing of the heart is cellular senescence. Leukocyte telomere length (LTL) is a marker of replicative ageing. The purpose of this study was to evaluate the diastolic function of LV and level of NT-proBNP in people of different ages free of cardiovascular diseases and to assess their relationship with LTL. Our data showed that old age is associated with diastolic dysfunction and increase in the levels of NT-proBNP. The group of older subjects had lower values of E/A (0.96+/-0.036 vs 1.27+/-0.03, p<0.001), Em/Am (0.9+/-0.035 vs 1.5+/-0.066) and higher values of IVRT (81+/-1.56 vs 70+/-1.23 s, p<0.001), DT (198+/-3.98 vs 175+/-2.82 s, p<0.001), that reflected impairment of LV relaxation. NT-proBNP level was higher in the elderly (100.82+/-7.1 vs 48.47+/-6.7 g/ml, p<0.01), but it did not correlate with LTL. The most sensitive to the age parameters of LV diastolic function (E/A and Em/Am ratio) were positively and independently of age associated with LTL (p<0.001). Older individuals with shorter LTL had significantly lower values of E/A ratio. CONCLUSION: Telomere length appears to be a biomarker of myocardium ageing.

[Dabigatran in the prevention of stroke in nonvalvular atrial fibrillation: complex clinical situations and real clinical practice].

It is well known that there is a 5-fold increase in the incidence of strokes and systemic thromboembolic events in atrial fibrillation (AF) and anticoagulant therapy considerably reduces the risk of their development. Until recently, warfarin has been mainly used for this purpose. Dabigatran is the first representative of new-generation oral anticoagulants from a class of direct thrombin inhibitors to treat nonvalvular AF. Unlike warfarin, the drug provides a predictable and steady-state anticoagulant effect. This review presents the main pharmacological characteristics of dabigatran, the possibilities of its use in complex clinical situations in patients with AF in cardioversion, ablation, surgical/invasive interventions, hemorrhage, myocardial infarction, and stroke, as well as data on the use of the drug in real clinical practice.

[The renin-angiotensin-aldosterone system and vascular aging].

In this paper we discuss the role of renin-angiotensin-aldosterone system in development of morphological and functional changes in the vascular aging as well as, possibility of its correction by using different groups of drugs.

[Broken heart syndrome or Takotsubo cardiomyopathy. (Literature review and clinical observations)].

Takotsubo cardiomyopathy is an acute cardiac syndrome that mimics ST segment elevation myocardial infarction. It is characterized by transient local contractility disturbances as akinesis of the apical and middle segments of the left ventricle concurrent with hyperkinesis of its basal portions in the absence of significant coronary artery changes. A description of 2 clinical cases and a review of literature on this rare myocardial disease are given.

[Heart rate and acute coronary syndrome: crosslink mechanisms and possibilities of drug intervention].

Studies in general population, in elderly people, and in groups of patients with arterial hypertension, myocardial infarction, stable coronary heart disease, diabetes mellitus, and after coronary bypass surgery have shown that elevated heart rate (HR) is prognostically unfavorable factor of cardiovascular and total mortality independent of other risk factors. Moreover, it has been shown that tachycardia to a certain extent correlates with severity and progression of atherosclerosis and can promote damage of integrity of atherosclerotic plaque. Plaque rupture plays main role in pathogenesis of acute coronary syndrome (ACS). Lowering of HR is one of therapeutic approaches to prevention of plaque rupture, i.e. to lowering of risk of ACS development. Mechanisms of interrelationships between HR and ACS and possibilities to influence HR with drugs in ACS are presented in this review.

[Spontaneous reperfusion of the infarct-related artery in patients with ST elevated myocardial infarction].

AIM: To characterize a clinical course of ST elevation myocardial infarction (STEMI) and spontaneous reperfusion of the coronary arteries (SR) as well as in patients after reperfusion thrombolytic therapy (TLT) and/or transluminal balloon coronary angioplasty (TBCA); to compare effectiveness of different approaches to treatment of SR patients: conservative--early medication and active--TBCA on the first postmyocardial 24 hours. MATERIAL AND METHODS: We studied 479 patients admitted to hospital not later than 6 hours since STEMI onset and either having SR (n = 49) or treated using active methods of coronary circulation restoration--prehospital thrombolysis (n = 127), thrombolysis after hospitalization (n = 127), primary TBCA (n = 60) and TBCA after initiation of TLT (n = 116). We made a more detailed analysis on the sample of 149 SR patients. RESULTS: SR was diagnosed in 10.2% cases with STEMI and occurred much earlier than recovery of coronary circulation due to TLT and/or TBCA. Patients with SR developed Q-MI, right ventricular infarction, cardiac failure and atrioventricular block less frequently. They had the lowest peak activity of creatin phosphokinase and a higher left ventricular ejection fraction versus patients without SR (50.7 +/- 6.8 and 45.4 +/- 6.6%, respectively; p < 0.05). As shown by coronaroangiography, SR patients had no "no reflow" phenomenon (0% and 17%, respectively). Active policy of SR patients treatment had no significant advantages over conservative treatment. CONCLUSION: Early SR had more favourable course of MI, less mass of the affected myocardium and better contractile function of the left ventricle. The conservative policy of STEMI treatment in the presence of SR is more effective than the active one if a due control over the patients' condition is provided.

[Use of a Soviet-made device for recording late ventricular potentials]. / Ispol'zovanie otechestvennoi ustanovki dlia registratsii pozdnikh potentsialov zheludochkov.

Late ventricular potentials (LVP) were detected with an ECG signal-averaging installation developed at the Institute of Radio Engineering and Electronics, USSR Academy of Sciences. A total of 103 patients were examined: 33 with sustained ventricular tachycardia (VT), 30 with unsustained VT and high-grade ventricular premature contraction, 20 with coronary heart disease, postinfarction cardiosclerosis without arrhythmias and 20 apparently healthy subjects (controls). LVPs are the most susceptible to sustained VT in the presence of postinfarction cardiosclerosis (77%), their specificity is lower (70%). LVPs are a low sensitive marker (35%) for sustained idiopathic VT. In unsustained VT and high-grade premature ventricular contraction, LVPs were recorded infrequently in 1 (3%) of the 30 patients.