[24-hour systolic wave increment index monitoring in patients with low-renin arterial hypertension].

AIM: To analyze the circadian rhythm of blood pressure (BP) and daily reflected wave values in patients with low-renin hypertension with normal and elevated aldosterone production. SUBJECTS AND METHODS: The investigation included 66 patients. 24-hour BP monitoring was carried out and arterial wall rigidity and reflected wave values were assessed in all the patients. RESULTS: The patients with hyperaldosteronemia were found to have not only statistically significant severer hypertension, impaired circadian rhythms of BP, but also impaired augmentation index (Aix)--mainly its nocturnal increase. A positive correlation was found between nocturnal Aix and resting plasma aldosterone concentrations (r = -0.31; p = 0.002). CONCLUSION: The findings suggest the expediency of 24-hour systolic wave increment index monitoring in hypertensive patients ofthis category.

[Prevalence of cardiiovascular risk factors in Russian population of patients with arterial hypertension].

We studied prevalence of arterial hypertension (AH) and its association with major cardiovascular (CV) risk factors among unorganized adult population aged 25-64 years in 10 Russian cities (Volgograd, Voronezh, Ivanovo, Irkutsk, Krasnoyarsk, Orenburg, Vladikavkaz, Samara, Tomsk, Tyumen) with different climatic, geographical, economical and demographical characteristics. This cross-sectional epidemiological study was conducted within the framework of the ESSAY RF-2012 (Epidemiology of Cardiovascular diseases in the Regions of the Russian Federation) project. Epidemiological situation concerning AH was found to be unfavorable. Prevalence of CV risk factors was high especially in young men and postmenopausal women. Major CV risk factors, associated with AH were hypertriglyceridemia, hyperglycemia, and obesity. The obtained results substantiate the expediency of the use of population strategy of AH and CV risk factors prevention in the studied population.

[The role of multispiral computed tomography in assessment of viability of the myocardium and prognostication of left ventricular remodeling in patients with ST-elevation myocardial infarction].

Aim of the study was to assess perfusion defect and viability of the myocardium by the method of multispiral computed tomography (MSCT) in patients with ST-elevation acute myocardial infarction (AMI) and to assess their prognostic role in development of remodeling of the left ventricle (LV). We included into the study 117 patients with AMI. MSCT with intravenous contrast enhancement was carried out on days 3-4 and at 12 months after AMI. In the arterial phase we estimated volume of myocardial perfusion defect, LV end diastolic and end systolic volumes (LVEDV and LVESV), and LV ejection fraction (EF). Three types of myocardial opacification were distinguished on tomograms in delayed phase of MSCT: type I - subendocardial residual defect (RD), type II - transmural RD, type III - transmural delayed hyper enhancement (DE). Patients were divided in 3 groups: (1) with subendocardial RD (n=63), (2) with transmural RD (n=28), (3) with transmural DE (n=26). Development of LV remodeling was registered if at repeat MSCT LVEDV increased more or equal 20% from baseline. In patients with signs of viable myocardium (group 1) volume of perfusion defect was substantially smaller than in patients with nonviable myocardium (groups 2 and 3): 1cm3 (0.4-2.4) vs. 7.3 cm3 (5.3-10.0) and 6.3 cm3 (5.0-15.0), respectively, p<0.001. Compared with groups 2 and 3 patients of group 1 more often were female (p=0.04), had inferior MI (p<0.001), and spontaneous reperfusion (p<0.001). After 12 months LV remodeling was registered in 19.3% of patients, all had signs of nonviable myocardium in more or equal 3 LV segments. In patients with perfusion defect more or equal 10 cm3 probability of development of LV remodeling exceeded 50%. Disturbances of perfusion abnormalities and number of nonviable LV segments were main predictors of LV remodeling.

[The hyperuricosuria in patients with high content of triglycerides: the combination of genetic and environmental factors and tactics of treatment].

The increasing of uric acid level (hyperuricosuria) is regularly detected in blood during the examination of patient with such cardiovascular diseases as arterial hypertension, atherosclerosis, diabetes mellitus, metabolic syndrome and obesity. The hyperiricosuria and hypertriglyceridemia are two independent risk factors, especially for arterial hypertension. The higher level of uric acid combined with hyper-lipoproteinemia (phenotypes) IIa and IIb was noted in 65% of patients. In males, hyperiricosuria was detected more often than in females. In groups with higher content of uric acid, the significant difference between median and quartiles was determined concerning the indicators of height, body mass, triglycerides concentration, beta-lipoprotein fractions content, pre beta-lipoprotein fractions content, apolipoprotein E in blood serum and apolipoprotein B=100 lipoproteins, but not both apolipoprotein C=III and apolipoprotein E in lipoproteins of high density. The increase of concentration of triglycerides and uric acid in blood is the outcome of disorder of metabolism of fat acids and nucleotides under surplus intake of substances with food. The fructose of sweet drinks can be considered as the source of fructose. The fructose is capable to increase the concentration of uric acid The catabolism of nucleotides is under regulatory impact of fructose: dicarboxylic derivatives can provoke increase of uric acid concentration. The treatment of patients with hyper-triglycerideimia, hyperiricosuria and hyperglycemia has to begin from decreasing of triglycerides concentration, dietotherapy and further if it is necessary, to apply the hypolipidemic therapy with fibrates.

[Clinical and laboratory detection of phenotypic characteristics in patients with high hypertriglyceridemia].

The purpose of the study was to define the values of clinical and biochemical (phenotypic) differences in 2 groups of patients: 1) those with moderate (< or =4.5 mmol/l) blood triglyceride (TG) levels and 2) those with high (more than 4.5 mmol/l) blood TG levels and to reveal significant parameters of a diagnostic algorithm for primary and secondary forms of hypertriglyceridemia (HTG). Ninety-six (54%) patients females) with a TG level of more than 2.3 mmol/l were examined. The age was 12 to 71 years (median [quartiles] 50 years [41-61 years]); women accounted for 54%. The patients had the following diseases: coronary heart disease (CHD) (44.89%), myocardial infarction (13.5%), arterial hypertension (87.9%). The diagnosis of HTG included an algorithm for the clinical, biochemical, and clinicogenealogical examination of patients. Biochemical blood analysis involved lipoprotein parameters: cholesterol, triglycerides, low-density lipoprotein cholesterol, lipid electrophoresis, apolipoproteins Al, B-100, E, and C-III. The data were processed using the statistical packages STATISTICA 6.0 and SPSS 17.0. Comparison revealed no age- and gender-related differences in the parameters between Groups 1 and 2 There was a significant correlation between the high levels of TG and the following indicators: total cholesterol, chylomicrones, lipoprotein(a), LP-E , LP B:E, LP C-III4, and LP C-III, smoking (a risk factor) and with the indicators of other metabolic disturbances--total C, chylomicrones, lipoprotein(a), LP-E-total, LP B:E, LP-C3-total, and LP-C3, which determined the impact of nutrition had a hereditary predisposition through the polygenic mechanisms of gene expression under the influence of a number of factors. Pancreatitis was found to be implicated in the development of HTG. Higher TG levels correlated with the parameters, the diagnosis of which reveals additional metabolic disturbances via environmental and polygenic mechanisms

[Comparison of multislice spiral computed tomography and stress echocardiography in the evaluation of myocardial viability in patients with acute myocardial infarction].

The purpose of the investigation was to analyze the data of 64-multislice spiral computed tomography (MSCT-64) versus those of low-dose dobutamine echocardiography (stress EchoCG) used to diagnose the viable myocardium in patients with acute myocardial infarction (AMI). The investigation enrolled 49 patients with AIM. Contrast-enhanced MSCT-64 and low-dose dubutamine stress EchoCG were performed in patients in the early periods of AMI. The viable myocardium was examined in 780 segments of the left ventricle (LV). The data of delayed MSCT and stress EchoCG agreed in 759 (97.3%) segments, did not in 21 (2.7%) segments; Cohen's kappa coefficient was 0.88. The affected segment index (As index) was introduced into the investigation, which is an integral indicator of the number of segments with perfusion defect and nonviable segments detected by MSCT. There was a statistically significant correlation of the As index with the asynergy index (r = 0.91; p = 0.000) and LV ejection fraction (r = -0.75; p = 0.000). Our previous study has demonstrated that MSCT-64 is an informative method to evaluate myocardial viability; the signs of myocardial perfusion and structural derangements can serve as predictors of diminished LV contractility.

[Diagnostics of moderate and high hypertriglyceridemia in patients in polyclinic practice: primary and secondary lipid metabolic disorders].

AIM: To define clinical and biochemical differences in groups of patients with moderate (< or =4.5 mmol/l and high (more than 4.5 mmol/l) blood triglyceride (TG) levels. To define the markers of biochemical and lipid parameters that could specify an algorithm for the differential diagnosis and treatment of different forms of hypertriglyceridemia. SUBJECTS AND METHODS: Patients (96 (54%) females) aged 12 to 71 years (median 50 years; quartiles, 41-61 years) with a TG level of more than 23 mmol/l and the following diseases: coronary heart disease (CHD) (44.8%), myocardial infarction (13.5%), arterial hypertension (87.9%), xanthomas (36.5%), and a family history of diseases (51%). The diagnosis of hyperlipidemia included a classical algorithm for clinical, biochemical, and clinicogenealogical examinations. Extended biochemical blood analysis, the determination of lipoprotein cholesterol (C), TG, low-density lipoprotein C, lipid electrophoresis, and assay of apolipoproteins A1, B-100, E, and C3 were made. RESULTS: The groups with moderate (< or =4.5 mmol/l and high (more than 4.5 mmol/l) blood triglycerides showed no differences in age and gender, systolic and diastolic blood pressures, the incidence of coronary heart disease, arterial hypertension, peripheral artery atherosclerosis, cardiac arrhythmias, and xanthomas. There was a significant correlation of high TG levels with smoking (a risk factor) and with the indicators of other metabolic disturbances--total C, chylomicrones, lipoprotein(a), LP-E-total, LP B:E, LP-C3-total, and LP-C3, which determined the impact of nutrition (and the development of pancreatitis), but also had a hereditary predisposition through the polygenic mechanisms of gene expression under the influence of a number of factors. CONCLUSION: Higher TG levels correlated with the parameters, the diagnosis of which makes it possible to reveal additional metabolic disturbances via environmental and polygenic mechanisms.

[Effect of arterial stiffness on development of cardio-vascular complications in ischemic heart disease].

With the aim to assess effect of arterial wall stiffness on prognosis of patients with stable form of ischemic heart disease (IHD) we included 224 men (mean age 56.2+/-8.9 years) with confirmed IND in a long-term prospective study. Pulse wave velocity was measured with brachial-ankle method (PWVba), presence of left ventricular hypertrophy (LVH) was detected with electrocardiography. Coronary arteriography was carried out in 126 patients. During 3.5 years of follow-up there were 38 cardiovascular complications (CVC) (6 myocardial infarctions, 19 operations of revascularization, 11 hospitalizations because of unstable angina, 3 sudden deaths). Patients were distributed to groups (tertiles) depending on PWVba values. Elevation of stiffness of arteries from lowest to highest tertile was significantly associated with increases of age, level of arterial pressure, heart rate, level of total cholesterol, LVH, severity and extent of coronary atherosclerosis. The Cox model of proportional risks comprising 14 main risk factors allowed to reveal that only PWVba significantly (<0.001) contributed to formation of prognosis. In patients with PWVba exceeding 14.3 m/s (highest tertile) compared with those with PWVba below 12.4 m/s (lowest tertile) risk of development of CVC was 4.23 times higher (5.27 times higher after adjustment for age and systolic arterial pressure). Comparison of Kaplan-Maier survival curves confirmed that in patients with low PWVba cumulative probability of absence of CVC was greater than in patients with higher stiffness of arterial wall (<0.008). PWVba as marker of arterial stiffness in men with chronic course of IHD appears to be predictor of CVC independent on age and classic risk factors.

[Treatment of patients with hypertriglyceridemia].

AIM: To assess a hypolipidemic effect and tolerance of phenofibrate (lipantil 200M) in different variants of treatment in patients with combined hyperlipidemia having moderate and high levels of triglycerides (TG). MATERIAL AND METHODS: A total of 26 patients (16 males, 10 females; age 32-67, mean age 55.1 years) received lipantil 200M (phenofibrate) in a dose 200 mg for 12 weeks either as monotherapy or in combination with statins (or fibrate) or plasmapheresis. Clinical, biochemical and blood lipid parameters were studied at baseline and after 12-week treatment. Baseline mean value and standard deviation of a blood cholesterol level was 8.3 (15.4) mmol/l, TG--7.2 (70.5) mmol/l). RESULTS: A mean cholesterol level decreased by 26.1%, TG--by 64.4%. Correlation with initial values was found. Systolic and diastolic blood pressure diminished significantly. No significant changes were found in the levels of AST, ALT, GGT, CPK, alkaline phosphotase, total bilirubin, creatinine. Before the treatment blood glucose was elevated in 14 patients, after 12-week therapy it remained elevated in 10 patients. CONCLUSION: Lipantil 200M (phenofibrate) had a good hypolipidemic effect in patients with combined hyperlipidemia in different baseline levels of cholesterol and TG elevation and in different variants of treatment. Significant side effects were not registered.

[Assessment of major artery stiffness: new perspectives of noninvasive diagnosis of coronary atherosclerosis].

AIM: Arterial stiffness is a predictor of atherosclerosis. This study was conducted to develop a method of coronary atherosclerosis severity assessment by means of brachial-ankle pulse wave velocity (baPWV). MATERIAL AND METHODS: We measured baPWV in 119 males (age 51.67 +/- 7.25) who received coronary angiographic examination (CAG). The baPWV was measured by Vasera VS-1000 (Fukuda Denshi). RESULTS: The patients were divided into two groups by severity of stenosis (group 1--less than 50% stenosis, group 2 > 50%). The baPWV value was significantly greater in group 2 (n = 98, baPWV 13.15 +/- 2.14 m/s, p = 0.004) than that in group 1 (n = 21, baPWV 12.13 +/- 1.17 m/s). ROC-curve demonstrated that the best cut-off point of the baPWV for predicting occlusive atherosclerosis was 12.2 m/s. The area under ROC-curve was 0.66 (p = 0.034). An univariate binary logistic regression model demonstrated that only baPWV had a significant odds ratio for coronary stenosis > 50%: 2.68 (95% CI = 1.01-7.15), p = 0.043. Other risk factors were not significantly associated with severity of stenosis. CONCLUSION: The baPWV significantly reflects the severity of stenosis in middle-aged males opening new perspectives of noninvasive detection of coronary artery atherosclerosis in middle-aged males.

[Left ventricular myocardial structure and function in patients with primary aldosteronism]. / Struktunoe i funktsional'noe sostoianie miokarda levogo zheludochka u bol'nykh s pervichnym al'dosteronizmom.

AIM: To study severity of left ventricular hypertrophy (LVH) and left ventricular function in patients with primary aldosteronism (PA) in comparison with hyperaldosteronemia and preoperative arterial hypertension, to follow the dynamics of these parameters early and late after surgical removal of aldosteroma. MATERIALS AND METHODS: Concentration of aldosterone (AC), plasma renin activity (PRA) were measured in 28 PA patients aged 26-58 years before removal of aldosteroma and 1 month, 1 year and 2-5 years after the surgical treatment. Myocardial status was assessed by echocardiography, Doppler echocardiography. 30 healthy subjects aged 25-55 years served control. RESULTS: All the PA patients showed initial or moderate LVH. Index of left ventricular myocardial mass was influenced at the first regression step by primarily diastolic pressure, at the second step--by basal PRA. The diastolic function was affected. One month after unilateral adrenalectomy PRA level and arterial pressure decreased but regression of LVH was noted only 1 year and later after the surgery. Diastolic function improved 1 year after the operation but without normalization within 2-5-year follow-up. CONCLUSION: The lack of a complete normalization of diastolic function of the left ventricle late after the surgery despite regression of LVH and preoperative correlation of the isometric relaxation time with PRA level may be caused by fibrous changes in the myocardium and by hyperaldosteronemia effects.

[The choice of the optimal regimen for apheresis of the low-density lipoproteins in patients with familial hypercholesterolemia by using mathematical modelling]. / Vybor optimal'nogo rezhima afereza lipoproteidov nizkoi plotnosti u bol'nykh s semeinoi giperkholesterinemiei s ispol'zovaniem matematicheskogo modelirovaniia.

The study was undertaken to enhance the effectiveness of a low-density lipoprotein apheresis procedure by using the mathematical approach to choosing an individual sorption regimen for each patient when the cholesterol concentration given by a physician was achieved in the shortest time. The experimental estimation of time course of changes in plasma cholesterol levels at the column inlet and outlet during low-density lipoprotein apheresis allowed the optimal parameters of the procedure to be calculated. The adequacy of the proposed methods to the real data was examined by the paired t-test (p < 0.0001). The optimal regimen was chosen for 5 patients with familial hypercholesterolemia. It is shown that the optimization of the regime will reduce the time of the procedure to 47 min, by removing the same amount of a substance.

[A mathematical model of apolipoprotein B metabolism in human blood plasma]. / Matematicheskaia model' obmena apolipoproteina B v plazme krovi cheloveka.

Mathematical model was developed for transport of apo B in blood plasma, which allowed to estimate constants of metabolism of lipoproteins containing apo B, considering the alterations of apo B concentration in circulation followed by immuno- or hemosorption. Some cases were detected where stimulating effect of these procedures on the rate of apo B entering into circulation was found as well as definite ratios were shown between the constants using the parameters of alterations in apo B concentration after elimination of lipoproteins containing apo B from blood plasma. Existence of cases was predicted where fluctuations in apo B concentration attenuated after immuno- and hemosorption which were difficult to find in experiments.