Russian Journal of Cardiology, 2017, 4 (22)

Address to the readers

Russ J Cardiol 2017, 4 (144): 5

CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russ J Cardiol 2017, 4 (144): 6

ORIGINAL ARTICLES

MASKED HYPERTENSION IN YOUNG PERSONS: PREVALENCE, SIGNIFICANCE OF CARDIOVASCULAR RISK FACTORS AND PROGNOSIS BY GENDER DIFFERENCES

Lyamina N. P., Nalivaeva A. V., Senchikhin V. N., Lipchanskaya T. P.

Abstract

Aim. To evaluate the prevalence of masked arterial hypertension (MAH) in young persons, as the prevalence and significance of cardiovascular risk factors, taken gender differences.

Material and methods. A coverage screening study of 512 young persons age 19-30 y. o. was done, from institutional workers, with no specific professional harm exposures, of those 82,4% — normotonic and 17,6% have MAH. The participants underwent clinical laboratory and instrumental investigations, 30-second breath stop test.

Results. In anthropometric measures, body mass index, waist circumference, hips volume were significantly higher (p<0,005) in men and women with AHT. In men with MAH blood pressure (BP) level showed tendency to higher office systolic BP (SBP) as 130 [128;135] mmHg, than in women SBP 124 [120;130] mmHg and normotonics SBP 110 [110;120] mmHg. In men with MAH there were cardiovascular risk factors more common — smoking, dyslipidemia 6 times more prevalent than in women with MAH. The fact of inheritance predominated in MAH men (85%) comparing to MAH women (65%). In MAH the level of physical activity comparing to normotonics was 2 times lower. Men with MAH used to add table salt to their meals (57%) and ate sausages (61%), as took alcohol beverages.

Conclusion. The prevalence of MAH among young males is 9,6% and 8% in young females. In young persons with MAH comparing to normotonics, cardiovascular risk factors are found more commonly, as food-related behavior disorders and target organ damage. Thirty-year risk of atherosclerotic CVD in young men with MAH was >6 times and in women >5 times higher than in normotonics of the same age.

Russ J Cardiol 2017, 4 (144): 7–12

http://dx.doi.org/10.15829/1560-4071-2017-4-7-12

Key words: masked arterial hypertension, young persons, cardiovascular risk factors, prognosis.

V. I. Razumovskiy Research Institute of Cardiology of Saratov Medical University, Saratov, Russia.

MICRORHEOLOGY OF ERYTHROCYTES IN ARTERIAL HYPERTENSION AND DYSLIPIDEMIA WITH A COMPLEX HYPOLIPIDEMIC TREATMENT

Medvedev I. N.

Abstract

Aim. To evaluate the applicability of a complex of non-medication treatment and simvastatin in hypertension and dyslipidemia management, from perspective of disordered rheological properties of erythrocytes.

Material and methods. Totally, 55 hypertensive patients included, with 1-2 grade of hypertension and IIb type dyslipidemia, risk 4, middle age. Controls were 26 healthy persons of the same age. The biochemical, hematological and statistical methods were applied.

Results. Simultaneous application of non-drug treatment and simvastatin in arterial hypertension with dyslipidemia does make optimal the lipid profile of plasma in 12 weeks, and lipid content of erythrocytes, lipids peroxidation of the liquid blood and red blood cells — in 6 weeks. Prescription of non-drug management and simvastatin to the studied patients does normalize their cytoarchitectonics and spontaneous erythrocyte aggregation in 6 weeks of treatment, having retained the results for at least the following 98 weeks of treatment.

Conclusion. Complex application of non-medication treatment and simvastatin does normalize erythrocyte microrheologic properties for 6 weeks in hypertension patients with dyslipidemia.

Russ J Cardiol 2017, 4 (144): 13–17

http://dx.doi.org/10.15829/1560-4071-2017-4-13-17

Key words: arterial hypertension, dyslipidemia, aggregation, cytoarchitectonics, erythrocytes, simvastatin, hypolipidemic diet, exercises.

Kursk Institute of Social Education (brunch) of Russian State Social University, Kursk, Russia.

INCREASED STRESS-REACTIVITY OF MALES WITH HIGH NORMAL BLOOD PRESSURE AND HYPERTENSION: INFLUENCE ON THE VESSELS

Antropova O. N., Osipova I. V., Kondakov V. D.

Abstract

Aim. To assess stress-reactivity of males younger than 55 y. o. with high normal blood pressure (HNBP) and arterial hypertension (AH) and possible influence on asymptomatic atherosclerosis and arterial stiffness.

Material and methods. Into the study, males were included of age 40-55 y. o. According to blood pressure level (BP), they were selected to groups: 1st group included 91 men with HNBP, 2nd — 89 men with the diagnosed AH and reached target BP. The cardiovascular risk factors were assessed, as intima-media thickness of brachiocephalic vessels (BCV), velocity of carotid-femoral pulse wave. Stress-test was done with the “mathematic count”, and the increased reactivity was defined as increase of systolic blood pressure (SBP) and/or heart rate (HR) by >7% and >10%, respectively, during the test. Statistics was done with Statistica 6.0 (StatSoft Inc.).

Results. An increased stress-reactivity was found in 34,7% of patients with HNBP and 22,5% with AH. Abdominal obesity patients had higher increase of SBP and HR by 4,1% (p=0,01) and 5,8% (p=0,01), respectively. Higher SBP had smokers, by

4,3% (p=0,001), dyslipidemic males, 6,0% (p<0,001) and those with early cardiovascular anamnesis, by 35,0% (p=0,001) comparing to those with no studied risk factors. Signs of atherosclerosis of BCA had 46,8% and 70,0% males in 1st and 2nd groups with excessive BP reaction to stress-test, and those studied, with normal reactivity had it rarer by 35,7% (p=0,02) and 33,2% (p>0,05). Arterial stiffness was found in 53,1% and 75,0% of men from 1st and 2nd groups with increased stress reactivity, that is more prevalent 6,1 times (p<0,001) and 2,8 times (p=0,001) comparing to normal reactivity in HNBP and AH, respectively.

Conclusion. The negative influence was found of the increased stress-reactivity of BP to vessel wall in men with HNBP and AH, and such influence does result not only to early atheroscleoris, but to arterial rigidity.

Russ J Cardiol 2017, 4 (144): 18–22

http://dx.doi.org/10.15829/1560-4071-2017-4-18-22

Key words: stress-reactivity, vascular atherosclerosis, arterial stiffness, arterial hypertension, high normal pressure.

Altai State Medical University of the Ministry of Health, Barnaul, Russia.

SPECIFICS OF 24-HOUR BLOOD PRESSURE AND HEART RATE VARIABILITY IN HYPERTENSIVE PATIENTS DEPENDING ON PHYSICAL ACTIVITY AND PSYCHOEMOTIONAL LOAD

Ushakov A. V., Ivanchenko V. S., Gagarina А. А.

Abstract

Aim. To study the specifics of 24-hour blood pressure (BP) profile and heart rate variability (HRV) according to levels of physical activity and psychoemotional load in arterial hypertension (AH) patients.

Material and methods. Totally, 76 male patients studied, having AH of I or II stage (mean age 46,75±0,56 y. o.). Group 1 included 36 patients with AH and obesity, group 2 — 40 AH non-obese patients. All patients underwent 24-hour BP monitoring and ECG monitoring with HRV analysis. Psychoemotional load analysis was assessed with PSM-25 score. The level of reactive and trait anxiety was assessed with Spielberger (translated by Khanin) questionnaire. For physical activity assessment we used short international questionnaire (IPAQ).

Results. In analysis of 24-hour BP monitoring there was significant increase of systolic BP variability in 1 group patients, if hypodynamic (17,97±0,64 mmHg) comparing to those having enough activity (15,43±0,73 mmHg, р=0,003). In hypodynamia the 24-hour BP rhythm was a non-dipper type (68,8%) comparing to those with enough exertion (51,6%). Also, in hypodynamia there was significant decrease of time-related HRV — SDNNi and RMSSD, representing the dysbalance of autonomous neural regulation of cardiovascular system, and there was negative correlation of SDNNi and RMSSD with the level of psychoemotional load. In all studied groups there was positive correlation of systolic and diastolic BP variability with the level of reactive and trait anxiety and with psychoemotional load. There was non-sufficient level of systolic and diastolic BP decrease in patients with high level of trait (r=-0,67; p<0,00001 and r=-0,60; p=0,0001) and reactive anxiety (r=-0,54; р=0,0006 и r=-0,43; р=0,009).

Conclusion. In AH patients hypodynamia, as the chronic psychoemotional overload are separated factors leading to increase of variability and decrease of nocturnal BP decline, as to HRV decrease irrelevant to obesity.

Russ J Cardiol 2017, 4 (144): 23–28

http://dx.doi.org/10.15829/1560-4071-2017-4-23-28

Key words: arterial hypertension, psychoemotional load, hypodynamia, obesity.

S. I. Georgievsky Medical Academy of V. I. Vernadsky Crimea Federal University, Simferopol, Russia.

BLOOD PRESSURE AMBULATORY MONITORING AS A METHOD FOR EARLY HYPERTENSION DIAGNOSTICS IN RHEUMATOID ARTHRITIS PATIENTS

Nikitina N. М., Romanova Т. А., Rebrov А. P.

Abstract

Aim. To study the specifics of arterial hypertension (AH) taking the data from ambulatory monitoring (ABPM) in rheumatoid arthritis patients (RA).

Material and methods. Totally, 105 women with RA included (mean age — 55,49±7,02 y. o., mean age of RA onset — 45,17±10,87 y. o., mean duration of RA — 10,79±10,01 y., activeness by DAS28 — 5±1,14). By the data from office BP, 2 groups were selected: first group — 56 patients with RA and AH (RA+AH), second group — 49 patients with RA, non-AH. Exclusion criteria were smoking, diabetes, secondary AH, associated clinical conditions of AH, exacerbated chronic conditions, pregnancy, lactation, malignancies. Comparison group included 30 females with essencial AH, non-RA and other inflammatory disorders of the joints and spine (mean age — 55,9±6,2 y. o.), controls consisted of 22 almost healthy volunteers (females, mean age — 54,13±6,25 y. o.). Patients underwent ABPM, laboratory investigations with total cholesterol, creatinine, C-reactive protein (hsCRP), ESR. The glomerular filtration rate (GFR) was calculated by CKD-EPI, activeness of RA by DAS28.

Results. In general AH was found in 64,7% of RA patients, 11,4% were not aware of it, 57,3% did not control BP, and just 9,0% took 3-component antihypertension treatment. By ABPM, masked AH was found in 33,3% patients RA non-AH. Traditional risk factors in RA patients with essential and masked hypertension had same prevalence. By the ABPM data, RA hypertensives had worse nocturnal SBP profile comparing to AH and controls (p<0,05). More than a half of RA patients had high BP variability, in

RA patients there was more prevalent BP raising at night (nightpeakers). The relation was found, of nocturnal SBP and HS-CRP (r=0,36, р<0,05), ESR (r=0,64, р<0,05).

Conclusion. AH in RA patients is more prevalent than in general population (53,3% by office BP, and 64,7% taking ABPM) The problem of AH screening in RA patients is important, and ABPM is recommended for earlier assessment.

Russ J Cardiol 2017, 4 (144): 29–34

http://dx.doi.org/10.15829/1560-4071-2017-4-29-34

Key words: ambulatory blood pressure measurement, rheumatoid arthritis, masked arterial hypertension.

V. I. Razumovskiy Research Institute of Cardiology of Saratov Medical University, Saratov.

THE ROLE OF EPICARDIAL OBESITY IN THE DEVELOPMENT OF STRUCTURAL AND FUNCTIONAL REMODELING OF THE HEART

Druzhilov М. А.¹, Beteleva Yu. Е.¹, Druzhilova О. Yu.², Andreeva Е. S.², Kuznetsova Т. Yu.²

Abstract

Aim. To perform the comparison of the heart structural and functional parameters in abdominal obesity patients depending on the presence epicardial fat tissue verified by echocardiographically defined thickness of the fat deposition.

Material and methods. Totally, 108 normotensive males included, with no clinical signs of cardiovascular diseases, age 46-55 y. o. (mean age 48,7±2,0 y. o.), with abdominal obesity (waist circumference >94 cm). The assessment included lipid profile and glycemia, echocardiography, bifunctional ambulatory blood pressure monitoring with the assessment of pulse wave velocity (PWV) in aorta, and augmentation index.

Results. Epicardial obesity patients had higher left ventricle (LV) myocardial mass index (119,4±8,9 g/m² vs 100,4±15,9 g/m², р<0,001, 47,9±5,3 g/m^2,7 vs 39,2±6,7 g/m^2,7, р<0,001), index of the relative LV walls thickness (0,42±0,03 vs 0,39±0,04, р<0,01), index of the left atrium volume (22,3±3,4 mL/m² vs 20,1±2,2 mL/m², р<0,01), PWV in aorta (8,4±0,4 m/s vs 7,6±0,4 m/s, р<0,001) and augmentation index (-39,4±12,2% vs -46,3±10,6%, р<0,01). In the group of epicardial obesity patients there was more prevalent LV hypertrophy (25,9% (33,3%) vs 6,2% (7,4%), р<0,01) and echo signs of diastolic LV dysfunction (74,8% vs 11,1%, р<0,01).

Conclusion. The association revealed, of the epicardial obesity defined by echo assessment of epicardial fat thickness, with parameters of structural and functional remodeling of the heart. Epicardial obesity patients have higher indexed values of LV myocardial mass and left atrium volume, more prevalent hypertrophy and diastolic LV dysfunction, which does, probably, underlie the development of chronic heart failure and rhythm disorders.

Russ J Cardiol 2017, 4 (144): 35–39

http://dx.doi.org/10.15829/1560-4071-2017-4-35-39

Key words: epicardial obesity, epicardial fat thickness, left ventricle hypertrophy, diastolic dysfunction of the left ventricle.

¹Medical-Sanitary Institution of FSS of Russia in Karelia Republic, Petrozavodsk; ²Petrozavodsk State University, Petrozavodsk, Russia.

HEART REMODELING IN OVERWEIGHT AND OBESITY WITH CARDIAC COMORBIDITIES

Logacheva I. V.¹, Ryazanova Т. А.1^,2, Makarova V. R.^1,2, Avzalova F. R.², Maksimov N. I.¹

Abstract

Aim. To assess structural geometric and functional disorders of the heart in males with coronary heart disease (CHD) comorbid with arterial hypertension (AH) and with visceral abdominal obesity, and to evaluate the grade of association of epicardial fat thickness (EFT) with cardiometabolic risk factors (RF).

Material and methods. Totally, 90 in-patients included, males with AH and CHD and with metabolically unhealthy phenotype (MUP) at the age 61,2±1,7 y. o. with normal bodyweight (n=29) — 1 group, overweight (n=21) — 2 group, and obese (n=30) — 3

group, and 30 persons with metabolically healthy phenotype. All patients underwent anthropometric screening, calculation of visceral obesity index (VAI) and insulin resistance (HOMA-IR); lipid profile was assessed, and by the data from echocardiography

the myocardial mas index (MMI) was evaluated, and EFT, the characteristics of the left ventricle hypertrophy (LVH) were counted and of diastolic dysfunction (DD).

Results. The presence of obesity led to increase of metabolic RF in obese patients. Most informative were indexes as VAI (4,47±0,27; p<0,001) and НОМА-IR (5,12±0,32; p<0,001). In obese patients there was association of MMI and EFT (r=0,81, p<0,001), predominance of concentric LVH with formation of restrictive DD. Regardless the level of abdominal obesity, there was increase of EFT in MUP patients, and the relation was confirmed to the main metabolic RF, as with structural geometric parameters of the heart.

Conclusion. Cardiological patients with AH and CHD in MUP had increased levels of markers of anomalous phenotype, the values increased with obesity. In obese patinents (groups II, III) as a predominant trend there was concentric LVH, restrictive DD,

significant increase of preload and left atrium volume. The significance of EFT was confirmed as a marker of visceral obesity. Study results show that obesity in comorbidity patients with cardiac pathology does influence the increase of cardiometabolic RF,

worsens the remodeling of the heart and negatively influences cardiac muscle function.

Russ J Cardiol 2017, 4 (144): 40–46

http://dx.doi.org/10.15829/1560-4071-2017-4-40-46

Key words: comorbid cardiac pathology, remodeling, epicardial fat.

¹Izhevsk State Medical Academy, Izhevsk; ²Republic Clinical and Diagnostics Center of MH UR, Izhevsk, Russia.

COMPARISON OF OBESITY RELATED CARDIOMETABOLIC RISKS IN DIABETES TYPE 1 AND 2

Leonova N. V.¹, Chumakova G. А.^2,3, Tsirikova А. V.³

Abstract

Diabetes mellitus (DM) regardless the type is a disease with very high cardiovascular complications rate (CVC). With the increase of obesity prevalence in the whole world, there is increase of DM type 1 number (DM1) with overweight as well. Taken

DM1, obesity usually is not considered as a risk factor for CVC.

Aim. To study the prevalence of overweight and obesity, and influence on the risk of myocardial infarction development (MI), or stroke in DM1 and type 2 (DM2) patients with various metabolic phenotypes; and to evaluate gender specifics.

Material and methods. Patients with DM1 were included, totally 3190 persons, and DM2, totally 71602 persons. All DM patients were selected to 3 subgroups: group 1 — normal bodyweight, group 2 — overweight, and group 3 — obese. In each group the prevalence of MI and stroke was evaluated, and risk estimated.

Results. Among DM1 patients with overweight were 29,3% (men 29,0%, women 29,7%). Obesity was registered in 9,7% DM1. In difference with overweight, obesity was registered 2 times more commonly and significantly in men, than in women (6,8% vs. 13,4%; p<0,001). In DM1 patients there were no gender differences; in DM2 patients the prevalence of these complications was statistically more significant and higher in men than in women. Overweight and obesity do not increase risk of MI and stroke in DM2. In DM1 overweight increases 2,4 times the risk of stroke, but not MI; obesity does increase 5,2 times the risk of MI, but only in men. The risk of stroke in DM1 and obesity increases 2,8 times, but only in women. Presence of obesity metabolic phenotype in DM1 increases the risk of MI and stroke, nullifying gender differences.

Conclusion. Overweight and obesity do influence differently the CVC risk in DM1 and 2. Prevention and treatment of overweight and obesity, together with carbohydrate metabolism disorder, should be the fundamentals of cardiovascular risk decrease in DM1.

Russ J Cardiol 2017, 4 (144): 47–53

http://dx.doi.org/10.15829/1560-4071-2017-4-47-53

Key words: overweight, obesity, myocardial infarction, stroke, diabetes mellitus types 1 and 2.

¹LLC MMC Anturium, Barnaul; ²Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo; ³Altai State Medical University of the Ministry of Health, Barnaul, Russia.

RISK PREDICTION FOR SUBCLINICAL ATHEROSCLEROTIC LESION OF BRACHIOCEPHALIC ARTERIES IN OBESE WOMEN

Shenkova N. N.¹, Veselovskaya N. G.^1,2, Chumakova G. А.^1,2, Osipova Е. S.¹, Gritsenko O. V.^1,2, Ott А. V.¹

Abstract

Aim. To reveal the complex of metabolic risk factors, most significantly related to subclinical atherosclerosis of brachiocephalic arteries (BCA) in obese women.

Material and methods. Totally, 89 women included, at the age 25-59 y. o. (50,6±6,6 y. o.) with abdominal obesity — waist circumference >80 cm with no clinical signs of coronary heart disease and atherosclerosis of other localizations. All women underwent duplex DCA scanning with the intima-media thickness assessment (IMT). Also, the main metabolic risk factors were assessed, adipokines of visceral fat tissue, ghrelin. Epicardial fat thickness (tEFT) in millimeters was measured by echo. Veloergometry was performed, to rule out angina and silent myocardial ischemia; cardiovascular risk assessment by SCORE, Framingham, PROCAM.

Results. In 32,6% women there were signs of BCA atherosclerosis (IMT more than 1,3-1,5 mm). An equation was invented for logistic regression with the most significant predictors group (ghrelin, CRP, tEFT, leptin), related to subclinical BCA atherosclerosis in obese women, with sensitivity 89,7%.

Conclusion. The complex of RF that were collected, might be used in clinical practice to shape a risk group for atherosclerosis in women with obesity, to direct them to prevention orders.

Russ J Cardiol 2017, 4 (144): 54–60

http://dx.doi.org/10.15829/1560-4071-2017-4-54-60

Key words: risk factors, subclinical atherosclerosis, visceral obesity.

¹Altai State Medical University of the Ministry of Health, Barnaul; ²Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia.

RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM GENES POLYMORPHISM AND RELATION WITH VASOPRESSORS IN ESSENTIAL HYPERTENSION AMONG DAGESTAN INHABITANTS

Saidov M. Z., Mammaev S. N., Abdullaev A. A., Arapkhanova T. B., Izraylova G. R.

Abstract

Aim. Investigation on the prevalence of genotypes polymorphisms of renin-angiotensin-aldosterone system and beta2-adrenoreceptors in essential hypertension (EH) of I, II, III grades in Dagestan population, and evaluation of the relation of genotype expression with vasopressors levels in blood.

Material and methods. Totally, 98 patients included, with the diagnosis “essential hypertension of I, II, III grades”. The genotypes were studied, of polymorphisms Тhr174Мet and Мet235Тhr gene AGT, polymorphism A1166C gene AGTR1 and polymorphisms Arg16Gly and Gln27Glu gene ADRB2. Test of the mentioned polymorphisms was done with the allele-specific polymerase chain reaction, making to assess the absence or presence of a mutation allele in hetero- and homozygous form. The level of angiotensin (AT) II, endothelin (ET) 1-21 and aldosterone (AS) in serum was measured with the hard-phase immune-enzyme assay. The level of angiotensin-converting enzyme (ACE) was measured with enzymatic method. Statistics was done with the software Statistica v. 6.0 and “Biostat 4.03”.

Results. EH of I, II, III grades in Dagestan population was associated with significant increase of the prevalences (criteria χ2) of genotypes АА and СС of polymorphism A1166C gene AGTR1, genotype Arg/Gly of polymorphism Arg16Gly gene ADRB2, genotype Gln/Gln of polymorphism Gln27Glu gene ADRB2 and genotype ММ of polymorphism Thr174Met gene AGT. In the carriers of the genotypes mentioned, relative risk of EH onset was significantly higher than in controls. The level of vasopressors ATII, ET 1-21, AS and ACE showed a controversial dynamics in Dagestan population. Serum levels of ET 1-21 and ACE were significantly higher or had tendency to increase, but AT II and AS decreased in both cases, comparing to the controls (р<0,05, р<0,01). Most number of significant direct correlations was found in polymorphisms of the genes AGT, AGTR1 and ADRB2 and level of serum ET 1-21.

Conclusion. Significant increase of the prevalence of the studied genotypes polymorphisms of genes AGT, AGTR1 and ADRB2 in EH of I, II III grades represents a definite specifics of mutational process involving the mentioned genes in Dagestan population. These processes are associated with significant changes in vasopressors levels in serum, that is a witness for pathogenetic relationship of the mentioned polymorphisms and pressoric contour of EH in Dagestan population.

Russ J Cardiol 2017, 4 (144): 61–69

http://dx.doi.org/10.15829/1560-4071-2017-4-61-69

Key words: essential arterial hypertension, genes polymorphisms, genotypes, vasopressors, Dagestan population.

Dagestan State Medical University, SRI of Ecological Medicine, Makhachkala, Russia.

OPPORTUNITIES FOR PREDICTION OF PULMONARY HYPERTENSION DEVELOPMENT IN PATIENTS WITH VIRAL LIVER CIRRHOSIS

Chistyakova M. V., Govorin A. V., Radaeva E. V.

Abstract

Aim. To investigate on the prevalence, and opportunities for prediction of pulmonary hypertension in patients with liver cirrhosis of viral origin (VLC).

Material and methods. The results analyzed, of the investigation of 85 VLC patients. Mean age 40,1 y. o. According to the severity of pulmonary hypertension (PH), the groups were selected: 1st — no PH systolic pressure in pulmonary artery (SPPA) <30 mmHg, n=62; 2d — SPPA 33-39 mmHg, n=23; controls 22 persons. The Doppler-echo was performed, tissue Doppler on “Vivid S5” equipment (USA). Statistics was done with the Statistica 6,0 software.

Results. In VLC patients there was enlarged left atrium, parameters of the LV myocardium mass increased, dilated anulus, stem and branches of pulmonary artery, the velocity of transaortal flow decreased, end-systolic volume of LV increased, global longitudinal, segmentary systolic and diastolic ventricular function decreased, comparing to the healthy persons, and changes were more marked in the persons with moderate PH (p<0,001). The correlation found of pulmonary artery pressure and vena porta diameter (r=0,064, p<0,001). Independent predictors formulated, for PH: time of isovolumetric relaxation on fibrous anulus of trucuspid valve (-0,38±0,1, р<0,001), left ventricle myocardial mass (0,53±0,16, р=0,005).

Conclusion. In LC of viral etiology PH is unrare complication (38%). With the increase of pressure in pulmonary artery there is remodelling of the LV with its mass increase, and increase of transaortal velocity, enlargement of the left atrium, pulmonary artery, decrease of systolic and disordered diastolic ventricular function. Independent predictors of pulmonary hypertension are increase of the left ventricle myocardial mass, time of isovolumetric relaxation on fibrous anulus of tricuspid valve.

Russ J Cardiol 2017, 4 (144): 70–74

http://dx.doi.org/10.15829/1560-4071-2017-4-70-74

Key words: pulmonary hypertension, liver cirrhosis, cardiohemodynamics.

Chitinskaya State Medical Academy of the Ministry of Health, Chita, Russia.

OPINION ON A PROBLEM

SPECIFICS OF MYOCARDIAL INFARCTION IN OBESITY

Chumakova G. A.^1,2, Pokutnev А. P.³, Veselovskaya N. G.^2,3

Abstract

The article is focused on the issue of prediction of acute coronary syndrome onset (ACS) and its clinical course specifics in patients with various obesity grades. The phenomenon of “obesity paradox” is taken in ACS, and several possible explanations are given. The data is provided, on the closer relation of the ACS risk with such criteria for obesity as waist circumference and index waist/hip circumference, as these parameters indirectly point on the presence of visceral obesity. The results presented, of the studies on close relation of epicardial fat tissue with its neurohumoral actions in ACS risk.

Russ J Cardiol 2017, 4 (144): 75–80

http://dx.doi.org/10.15829/1560-4071-2017-4-75-80

Key words: acute coronary syndrome, obesity, visceral adiposity, epicardial fat deposition.

¹Altai State Medical University of the Ministry of Health, Barnaul, Russia; ²Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo; ³Altai Regional Cardiological Dispensary, Barnaul, Russia.

CLINICAL APPLICATION OF QUANTITATIVE ECHOCARDIOGRAPHIC ASSESSMENT OF EPICARDIAL FAT TISSUE IN OBESITY

Kuznetsova T. Yu.¹, Chumakova G. А.^2,3, Druzhilov М. А.⁴, Veselovskaya N. G.^3,5

Abstract

A historical meaning of obesity verified by body mass index as an obligatory factor for cardiovascular risk, is being refuted during recent decades by the results from epidemiological and prospective studies. The visceral obesity itself is etiopathogenetically associated with the processes of cardiovascular remodeling and development of obesity-related cardiovascular diseases. Of the methods to help better predict cardiometabolic risk in obesity the direct assessment of visceral fat tissue are known, of those the most available is echocardiographic measurement of epicardial fat thickness. In the article, the echocardiographically defined epicardial fat thickness is regarded as possible instrument for prediction of cardiovascular risk in a variety of obese patients.

Russ J Cardiol 2017, 4 (144): 81–87

http://dx.doi.org/10.15829/1560-4071-2017-4-81-87

Key words: visceral obesity, epicardial adipous tissue, epicardial fat thickness, cardiovascular risk.

¹Petrozavodsk State University, Petrozavodsk; ²Altai State Medical University of the Ministry of Health, Barnaul; ³Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo; ⁴Medical and Sanitary Institution of FSS Head in Karelia

Republic, Petrozavodsk; ⁵Altai Regional Cardiological Dispensary, Barnaul, Russia.

NEW IN DIAGNOSTICS

MATHEMATICAL MODELLING OF CIRCULATION IN EXTRACRANIAL BRACHOCEPHALIC ARTERIES AT P RE-OPERATION STAGE IN CAROTID ENDARTERECTOMY

Burenchev D. V.^1,2, Kopylov F. Yu.^1,3, Bykova А. А.³, Gamilov Т. М.¹, Gognieva D. G.³, Simakov S. S.¹, Vasilevsky Yu. V.¹

Abstract

Aim. Hemodynamic shifts in the brain, developing due to carotid surgery (carotid endarterectomy or stenting) might be the cause of perioperation strokes. Assessment for hemodynamic shifts is important. The aim of current study was to develop methodics of cerebral hemodynamics assessment at pre-operation and post-operation periods of carotid endarterectomy.

Material and methods. The authors propose a mathematical model for preoperation analysis of hemodynamics changes in extracranial regions of brachiocephalic arteries after carotid endarterctomy. The development of mathematical model was based upon the data from pre- and postsurgery duplex scan and CT-angiography.

Results. The results showed good prediction capacity for the shifts in cerebral hemodynamics, using the developed mathematical model.

Conclusion. Study results make it to assess cerebral hemodynamis without supplementary investigations. The model includes and represents real anatomy and quantitative hemodynamics parameters by the CT-angiography and duplex scan of the vessels.

Russ J Cardiol 2017, 4 (144): 88–92

http://dx.doi.org/10.15829/1560-4071-2017-4-88-92

Key words: carotid endarterectomy, carotid atherosclerosis, stroke, cerebral hemodynamics, mathematical model.

¹Institute of Numerical Mathematics of Russian Academy of Sciences, Moscow; ²SPC of Medical Radiology, Moscow; ³I.M. Sechenov First Moscow State Medical University of the Ministry of Health, Moscow, Russia.

CLINIC AND PHARMACOTHERAPY

MYOCARDIAL DAMAGE BIOMARKERS DYNAMICS AFTER EXTRACARDIAC SURGERY IN CORONARY HEART DISEASE PATIENTS TAKING TRIMETAZIDINE MR

Bolshedvorskaya О. А.¹, Protasov К. V.², Batunova Е. V.², Dvornichenko V. V.^1,2, Batorova Е. R.¹, Kazankova Е. G.¹

Abstract

Aim. To investigate on the influence of trimetazidine MR on biomarker dynamics of myocardial necrosis and heart failure in early post-surgery period in coronary heart disease (CHD) patients, undergoing extracardiac thoracal surgery.

Material and methods. Totally, 72 men included, mean age 61,0 (57-66) y. o. Patients were randomized to the intervention group (n=35), receiving trimetazidine MR (Preductal MR^®) 35 mg b. i.d., prescribed before operation for 2 weeks, and controls (n=37). In the studied groups, we assessed and compared perioperational troponin I dynamics, fatty acid binding protein (FABP) dynamics, and N-terminal pro-brain natriuretic peptide (NT-proBNP), measured the day before, and in 24 and 48 after surgery.

Results. Baseline level for all biomarkers did not differ in groups. After the intervention, in both groups there was increase of troponin I, but not outside reference range. Troponin I >0,1 ng/mL was found in 2 patients from control group. Mean level of FABP increased after the operation in both groups. In 48 hours, in trimetazidine MR group, comparing to controls, the following were lower (p<0,05): median FABP (1,0 and 1,9 ng/mL, resp.) and part of patients with FABP >5,0 ng/mL (2,9% and 18,9%), medians of NT-proBNP, in 24 hours (184,0 and 293,3 pg/mL) and 48 hours (160,6 and 334,0 pg/mL) after surgery were also lower in trimetazidine MR group. In this group, in 48 hours after surgery NT-proBNP rarer reached the level of 300 pg/mL and higher (in 20,0% and 51,4%). The analogous result was found in subgroups of patients with baseline normal NT-proBNP. In these subgroups, the grade of NT-proBNP increase in 24 hours after surgery differed as well (by 160,3 and 242,2 pg/mL).

Conclusion. The achieved results witness on the cardioprotective effect of trimetazidine MR in CHD patients under circumstances of perioperational myocardial stress, caused by an open extracardial operation.

Russ J Cardiol 2017, 4 (144): 93–98

http://dx.doi.org/10.15829/1560-4071-2017-4-93-98

Key words: coronary heart disease, trimetazidine MR, troponin, fatty acids binding protein, brain natriuretic peptide, thoracal surgery.

¹Regional Oncological Dispensary, Irkutsk; ²Irkutsk State Medical Academy — branch of the Russian Medical Academy of Continuous Professional Education of the Ministry of Health, Irkutsk, Russia.

THE EFFICACY OF ANTIHYPERTENSIVE TREATMENT COMBINATION WITH ANXIOLYTICS IN HYPERTENSIVES WITH ANXIETY DISORDER

Kovalev D. V., Skibitsky V. V., Kurzanov A. N., Ponomareva A. I.

Abstract

Aim. To compare the influence of the simple and combined with anxiolytic drug tofisopam (AT) antihypertesion therapy (AHT) on the 24-hour blood pressure (BP) profile, anxiety level and life quality of patients with uncontrolled arterial hypertension and anxiety spectrum disorder.

Material and methods. Sixty-nine patients (mean age 48,5±5,3 y. o., 35 women) were randomized to 2 groups. Each group consequently during 1 year study received two types of medicines for 6 months each with cross-replacement: isolated AHT and combination AHT with AT (AHT+A). Group 1 (35 persons) for the 1st half year took AHT, and then following half year AHT+A; group 2 (34 persons) — in back order. At the end of every period the following parameters were controlled: ambulatory blood pressure monitoring, prominence of trait and reactive anxiety, and life quality. Also, the same comparisons were done for every group separately at the end of the first and second stages of treatment.

Results. The initiation of combination AHT+A led to faster decrease of BP, achievement of lower mean daily and mean nocturnal systolic and diastolic BP, lower BP variability parameters. Only combination AHT+A showed adequate reducement of reactive anxiety. Combination and simple AHT in 6 months led to significant improvement of life quality, however combination AHT showed more significant values.

Conclusion. Efficacy of combination AHT+A in hypertensive persons with anxiety disorder is higher comparing to simple AHT.

Russ J Cardiol 2017, 4 (144): 99–104

http://dx.doi.org/10.15829/1560-4071-2017-4-99-104

Key words: arterial hypertension, ambulatory blood pressure monitoring, anxiety, anxiolytics, tofisopam.

FSBEI HE Kuban State Medical University of the Ministry of Health, Krasnodar, Russia.

LITERATURE REVIEW

DIABETES PATIENT AND MYOCARDIAL REVASCULARIZATION FROM THE EVIDENCE GUIDED PERSPECTIVE: CARDIOLOGIST OPINION. PART 1

Bezdenezhnykh N. А.¹, Sumin А. N.¹, Barbarash О. L.^1,2

Abstract

The review focuses on the recent data for diabetes prevalence in patient cohorts underwent coronary bypass and percutaneous intervention. The worth of an active approach to diabetes and prediabetes screening is provided in coronary heart disease patients before revascularization. The actual data is presented, on the negative influence of diabetes on prognosis of myocardial revascularization, and main mechanisms highlighted that are responsible for adverse outcomes of interventions in this category of patients. Main target perioperation glycemia values are provided, recommended by leading societes on diabetes, and the role of other markers of carbohydrate metabolism is shown (glycosilated hemoglobin, fructosamine, 1,5-anhydro glucitol) in diabetes patients from perspective of the impact on cardiovascular prognosis, as in coronary interventions.

Russ J Cardiol 2017, 4 (144): 105–113

http://dx.doi.org/10.15829/1560-4071-2017-4-105-113

Key words: diabetes mellitus, prediabetes, coronary bypass, percutaneous intervention, glycosilated hemoglobin, fructosamine, 1,5-anhydro glucitol.

¹Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo; ²Kemerovo State University, Kemerovo, Russia.

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