The effect of rivaroxaban low doses on the stable angina of the II-III functional class clinical manifestations and the quality of life in patients with ischemic heart disease.

Aim      To evaluate the effect of low-dose rivaroxaban on quality of life of patients and clinical manifestations of functional class (FC) II-III stable angina.Material and methods  26 patients with ischemic heart disease (IHD) with FC II-III stable angina, who were newly prescribed rivaroxaban 2.5 mg twice a day in combination with acetylsalicylic acid 75-100 mg, were followed for 10 weeks. During the first (before the beginning of treatment) and the last weeks of study, patients kept diaries, in which they reported angina attacks and short-acting nitrate intake, filled in an angina questionnaire (SAQ), and underwent electrocardiogram (ECG) Holter monitoring (HM).Results The treatment was associated with decreases in the frequency of angina attacks (by 19.5 %; р=0.027) and the number of taken short-acting nitrate pills (by 17.1 %; р=0.021) and an improvement of quality of life according to stability scales (р=0.042). Data from ECG HM showed decreases in the number and duration of ischemic episodes (p≤0.05).Conclusion      The treatment of IHD patients with rivaroxaban 2.5 mg twice a day in combination with acetylsalicylic acid 75-100 mg for 2 mos. was associated with decreased frequency of angina attacks, reduced requirement for short-acting nitrate, and with improvement of quality of life.

[Predictors for development of major cardiovascular events in elderly patients with severe and extremely severe chronic obstructive pulmonary disease in combination with early stages of chronic kidney disease].

The aim of the study was to evaluate efficacy, safety and treatment compliance for different ASA forms (Aspirin Cardio, Cardiomagnyl and Trombo Ass) in a 6-month study. MATERIALS AND METHODS: A prospective 6-month open, comparative study originally included 600 patients with IHD and stable angina who received chronic therapy with different forms of aspirin. In the prospective part of the study, these patients were subdivided into four groups: group 1 consisted of 200 patients switched to Aspirin Cardio; group 2 - 200 pa - tients receiving chronic therapy with this drug; group 3 - 100 patients continuing on the Trombo Ass treatment; and group 4 - 100 pa - tients who had been treated with Cardiomagnyl for a long time. Efficacy, safety and compliance to the treatment were evaluated using standard tests and analogue scales; symptoms of dyspepsia were evaluated with a study-specific questionnaire. Switching to Aspirin Cardio (group 1) was on discretion of the physician in charge based on the history of gastrointestinal (GI) complications or significant manifestations of dyspepsia. RESULTS: The efficacy in prevention of cardiovascular events was similar in all groups. No "major" or "minor, clinically significant" bleeding (ISTH) were observed. Proportions of patients with "minor" bleeding were similar in all groups with a tendency towards their decrease under the Aspirin Cardio treatment. After switching to Aspirin Cardio, positive changes in severity of GI symptoms by results of the questionnaire: a significant improvement of compliance by the treatment satisfaction index in group 1 and 2; and a 1.7 time decrease in the proportion of ASA-noncompliant patients were observed. According to the results of ROC analysis an average GI symptom score ≥3 predicted an improvement of compliance in case of switching to Aspirin Cardio with a diagnostic sensitivity of 72.3% and specificity of 51.1% (р=0.012) as well as alleviation of GI symptoms (sensitivity, 74.5%; specificity, 63.8%, р=0.001). CONCLUSIONS: Different dosage forms of ASA are characterized with similar efficacy in prevention of cardiovascular events and effects on the risk of bleeding. Aspirin Cardio showed a better tolerability due to a less effect on GI symptoms. It provided a better compliance to chronic treatment. This study confirmed advisability of using the proposed questionnaire to evaluate GI symptoms for specification of prediction and modification of therapy.

[Heart failure with preserved and slightly impaired ejection fraction and cardiovascular events: Pathogenetic interrelations as a part of the cardiovascular continuum].

AIM: To evaluate the effect of decompensated HF with preserved or slightly impaired EF on the risk of cardiovascular complications during a 5­year follow-up. MATERIALS AND METHODS: 33 patients with arterial hypertension and HF with preserved or slightly impaired EF (NT-proBNP ≥125 pg/ml, mean, 500.1±590.32 pg/ml and EF ≥40 %, mean, 57.0±10.29 %) were observed for 5 years. EchoCG, markers of immune inflammation and hormonal changes (endothelin, tumor necrosis factor (TNF), interleukin-6 (IL-6), aldosterone, renin) were evaluated at baseline. The endpoint was development of acute fatal and non-fatal cardiovascular events (CVEs). The one-way regression analysis was used to identify predictors of the risk for CVEs. The ROC analysis was used to determine "threshold levels" of significant predictors for this risk. RESULTS: During the 5­year follow-up period, CVEs developed in 13 (39.4 %) patients. The CVE predictors included baseline increases in creatinine and IL-6, NT-proBNP and a greater decrease in EF (р.

[Safety and efficacy of long-term treatment with different ASA forms in patients with stable IHD and a high risk for development of gastropathy by data from a cross-sectionals study].

AIM: To study indexes of efficacy, safety and compliance for different ASA forms (Aspirin-Cardio, Cardiomagnyl, Thrombo ASS) used in stable IHD. MATERIALS AND METHODS: An open, cross-sectional study compared three groups of patients consisting of 200 patients each who had stable IHD and a high risk of gastrointestinal disorders and who received a long-term antiaggregant monotherapy with one of ASA drugs (group 1, Aspirin Cardio; group 2, Thrombo ASS; group 3, Cardiomagnyl). Efficacy, safety and compliance with the treatment were evaluated using standard tests and analogue scales; dyspepsia symptoms were evaluated using a special, additionally developed questionnaire. RESULTS: The Aspirin-Cardio treatment reduced the mean score of GI symptom severity from the questionnaire (1.4-1.6 times, р=0.001), requirement for proton pump inhibitors (р=0.002) and endoscopy during the ASA treatment the mean score of GI symptom questionnaire >3 predicted non-compliance or insufficient compliance with a diagnostic sensitivity of 58.9 % and specificity of 56.3 % (р=0.002), which makes this value a threshold for considering a modification of the treatment. CONCLUSION: Aspirin-Cardio is characterized by better safety in respect of GI symptoms and better compliance with the treatment during long-term prophylactic therapy. The proposed questionnaire for evaluation of GI symptoms can be used for specifying indications and modifying the treatment tactics.

[Activation of neurohormonal system as an independent mechanism of heart remodeling in patients with chronic obstructive pulmonary disease].

AIM: To evaluate the contribution of activation of cytokines and renin-angiotensin-aldosterone system to heart remodeling in patients with chronic obstructive pulmonary disease in the course of a 2 year study and to estimate its relation to severe pulmonary hypertension. MATERIALS AND METHODS: 117 patients with COPD underwent measurement of TNFα, IL-6 levels and renin levels, spirometry and echocardiography (mean pressure in pulmonary artery, MPPA)). The data obtainedwere compared with the degree of remodeling of right and left ventricles. After 2 years 30 and 33 of the 63 patients were referred to groups with aggressive and moderate remodeling of the right ventricle respectively. Regressive analysis was used to detect predictors of aggressive remodeling. RESULTS: Initial remodeling severity and rate showed stronger correlation with TNFα, IL-6 levels and renin levels than with MPPA. Multifactor analysis demonstrated that renin activity and creatinine level were the most reliable predictors of remodeling (p = 0.041 and 0.049 respectively). CONCLUSION: Neurohormonal and imunno-inflammatory changes stimulate remodeling of right and left heart chambers. They independently affect myocardium and their influence is only partly mediated through exacerbation of pulmonary hypertension.

[Rise in the epizootic activity of a natural focus of steppe-type tularemia in Stavropol Territory and its epidemic consequences]. / Pod"em épizooticheskoi aktivnosti prirodnogo ochaga tuliaremii stepnogo tipa v Stavropol'skom krae i ego épidemicheskie posledstviia.

One of recurrent autumn and winter rises in the epizootic activity of the steppe-type focus of tularemia in the Stavropol Territory is described. During the tularemia epizooty of 1981-1982 the population of common voles (Microtus arvalis) was very numerous, while the population of house mice (Mus musculus) was comparatively scarce. Francisella tularensis strains were isolated from different species of rodents (Microtus arvalis, Mus musculus, Apodemus sylvanicus, Rattus norvegicus, Lepus, etc.), from fleas and ticks, as well as from environmental objects (well-water, hay). 38 cases of the disease among nonvaccinated persons, mainly in rural areas, were registered. Anginous-bubonic tularemia was the dominant form of the disease. A complex of measures aimed at the detection of tularemia and its liquidation among the population was carried out.

[Culture properties of the causative agent of tularemia isolated in natural foci in Stavropol Territory, the Kalmyk ASSR and the Armenian SSR]. / Svoistva kul'tur vozbuditelia tuliaremii, vydelennykh v prirodnykh ochagakh Stavropol'skogo kraia, Kalmytskoi ASSR i Armianskoi SSR.

The strains isolated in natural foci of the Stavropol Territory and the Armenian SSR have been found to belong to the holarctic race of Francisella tularensis, biovar II. In natural foci of the Kalmyk ASSR the strains belonging to biovars I and II have been isolated. The study of the tularecinogenicity of the cultures has revealed the existence of strains which are not sensitive to their own tularecins. The phenomenon of tularecinogenicity in F. novocida has been established. Avirulent strain 319/38 belonging to the non-arctic race is recommended as an indicator strain for the determination of tularecinogenicity.