Aim. To clarify the role of arterial hypertension (AH) as a possible predictor of chronic heart failure (CHF) in patients with chronic glomerulonephritis (CGN) and intact renal function.

Material and methods. In total, 136 CGN patients with various AH stages, intact renal function, and early clinical manifestations of CHF were examined. Remodelling of left ventricular (LV) myocardium, as well as systolic and diastolic LV function, was assessed by echocardiography.

Results. In CGN patients with intact renal function, AH resulted in CHF, due to changing LV structure and function. In Stage I AH, early CHF symptoms, without LV hypertrophy (LVH), were associated with LV diastolic dysfunction. Stage II AH was characterised by manifested CHF, concentric LVH, intact LV ejection fraction (EF), and LF diastolic dysfunction. Stage III AH was characterised by systolic and diastolic HF, reduced LV EF, and eccentric LVH.

Conclusion. AH could be regarded as a CHF predictor in patients with CGN and intact renal function.

Aim. Ultrasound assessment of carotid artery atherosclerosis and endothelial function in young and middle-aged men with coronary heart disease (CHD).

Material and methods. The study included 78 men aged 28-50 years: 49 CHD patients with angiography-verified coronary artery atherosclerosis and 29 controls (control group, CG), without clinical atherosclerosis manifestations. All participants underwent a standard carotid artery (CA) ultrasound. Brachial artery flow-dependent vasodilatation (FDVD) was assessed in reactive hyperemia test.

Results. Among CHD patients, intima-media thickness (IMT) for common CA (0,88±0,23 mm) was signifi­cantly higher than in CG individuals (0,76±0,18 mm; р=0,01). Atherosclerotic plaques in common CA were observed in 91,8% of the CHD patients and 27,6% of controls (р<0,001). Multiple plaques were observed in 80% and 14%, respectively (р<0,001). Average brachial artery FDVD (5,8±2,2%) was significantly higher than that in CHD patients (4,5±2,8%; р=0,03).

Conclusion. No significant differences in the prevalence of normal FDVD were observed between two groups. Increased IMT and multiple atherosclerotic plaques in common CA were associated with higher CHD risk in young and middle-aged men.

Aim. To study clinical effectiveness of ivabradine (7,5 mg twice a day) as a part of combined therapy, and its effects on physical stress (PS) tolerability in patients with Functional Class (FC) II-III stable angina and absolute or relative contraindications to beta-adrenoblockers (BAB).

Material and methods. In total, 16 patients with FC II-III stable angina were examined. The examination included the assessment of angina attack incidence and need for short-acting nitrates, as well as treadmill test or 24-hour electrocardiography (ECG) monitoring.

Results. Adding ivabradine to combined therapy or changing BAB to ivabradine is associated with a significant reduction in angina attach incidence, need for short-acting nitrates, heart rate at rest and at maximal PS, and total duration of myocardial ischemia, as well as with improved PS tolerability and cardiovascular system efficiency.

Conclusion. In patients with absolute or relative contraindications to BAB or with poor BAB tolerability, a selective I_f channel inhibitor ivabradine improved clinical course of stable angina, stress test results and 24-hour ECG monitoring parameters.

Aim. To investigate the effects of different doses of statins on the levels of factors stimulating and inhibiting coronary angiogenesis.

Material and methods. The study included 90 patients with coronary heart disease (CHD), Functional Class I-III stable angina, and 30 healthy volunteers. All patients underwent clinical examination, electrocardiography, veloergometry, and echocardiography. At baseline, blood lipid levels were measured. Serum levels of vascular endothelial growth factor (VEGF), transforming growth factor (TGF-pi), and endostatin were measured twice — before statin therapy and 3 months after it started. Daily rosuvastatin dose was 5, 10, or 40 mg.

Results. Statin therapy resulted in reduced levels of angiogenesis-stimulating factors, such as VEGF and TGF. The level of endostatin, which inhibits angiogenesis, did not change substantially. Similar effects were observed for doses of 5, 10, and 40 mg/d.

Conclusion. The results obtained disagree with the hypothesis of dose-dependent effects of statins on angiogenesis. Both low doses of statins and aggressive statin therapy affect angiogenesis factors similarly.

Aim. To compare cerebral circulation in chronic hypertensive encephalopathy (HE) with and without chronic heart failure (CHF).

Material and methods. In total, 122 patients with Stage I-III HE, but free from occlusive carotid disease, were examined. Duplex scanning was used to measure volume blood flow in common carotid arteries (CCA), vertebral arteries (VA), and middle cerebral arteries (MCA). Single photon emission computer tomography was used for cortical cerebral perfusion (CCP) assessment.

Results. Stage I diastolic CHF was diagnosed in 37 patients (30%), and Stage II diastolic CHF — in 68 (56%). Regardless from CHF presence, HE was characterised by unchanged CCA and VA hemodynamics, reduced flow velocity in MCA, and increased MCA resistance parameters. Compared to CHF-free patients, those with Stage ICHF demonstrated increased frontal CCP (p<0,05) and higher prevalence of diffuse leukoaraiosis. This reflected selective deterioration of subcortical perfusion, due to progressing atherosclerosis of penetrating cerebral arteries, which supply deep brain tissue. Compared to Stage I CHF, Stage II CHF was characterised by additional blood flow reduction and resistance index increase in MCA, CCP reduction (p<0,1), and leukoaraiosis prevalence of 40% (p<0,02).

Conclusion. In HE patients, Stage II CHF was associated with reduced cortical and subcortical brain tissue per­fusion and therefore could be regarded as a marker of diffuse hypertensive remodelling of cerebral vessels.

Aim. To study the associations between metabolic disturbances, cytokine levels, brain natriuretic peptide (BNP), and endothelial function markers in elderly patients with various types of chronic heart failure (CHF).

Material and methods. The study included 127 men aged 60-75 years (mean age 67,4±0,3 years), divided into two groups. Group I consisted of 77 patients with restrictive diastolic CHF (dCHF). Group II included 50 patients with systolic CHF (sCHF). The control group (CG) consisted of 30 healthy volunteers. The levels of pro- and anti-inflammatory cytokines, N-terminal fragment of pro-brain natriuretic peptide (Nt-proBNP), and NO were measured.

Results. Metabolic disturbances of varying severity were observed in all elderly patients with CHF. In both dCHF and sCHF, endothelial dysfunction was present, which manifested in high levels of microalbuminuria, C-reactive protein, interleukin ip, and tumor necrosis factor-alpha (TNF-а). Cytokine system activation differed in dCHF and sCHF.

Conclusion. High levels of TNF-alpha and Nt-proBNP in elderly patients with both types of CHF pointed to a marked left ventricular dysfunction. In sCHF group, significantly higher levels of TNF-alpha, Nt-proBNP, and uric acid were an evidence of more severe clinical course and adverse prognosis of CHF.

Aim. To investigate differential beta-adrenoblocker (BAB) therapy, based on clinical and demographic characteristics of the patients, as a method to optimise the management of chronic heart failure (CHF).

Material and methods. The study included 90 patients: 50 men (55,6%) and 40 women (44,4%) of mean age 64,7±1,9 years. The participants stopped taking the previously prescribed BAB and two weeks later, they were randomly divided into three groups. Group I (n=30) received bisoprolol (starting dose — 2,5 mg once a day, maximal dose — 50 mg/d). Group II (n=30) received carvedilol (initial dose — 12,5 mg/d, maximal dose — 50 mg/d). Group III (n=30) was administered nebivolol (starting and maximal doses — 2,5 mg/d and 10 mg/d, respectively). At baseline and 6 months later, all participants underwent echocardiography (EchoCG), assessing ejection fraction, diastolic dysfunction presence and type. Increased functional class (FC) of CHF was regarded as disease progression, and reduced FC — as disease regression. The levels of neuro-hormones and brain natri­uretic peptide (BNP) were also measured. Treatment effectiveness was assessed by efficacy and safety parameters in combination.

Results. No inter-group differences were observed for central hemodynamics, EchoCG parameters and neuro­hormone levels. Nebivolol was particularly effective in chronic renal failure, anaemia, in elderly patients and women. In other patient groups, bisoprolol was the most effective agent. The main laboratory parameter determining BAB choice, was aldosterone, followed by pro-BNP (a=0,049). Noradrenalin levels should not be used for choosing BAB.

Conclusion. Considering the fact that aldosterone, noradrenalin and pro-BNP level measurement is not a part of routine clinical practice, and could not be easily implemented into real-world clinical settings, the parameters determining BAB choice could be the patient’s age, gender, and co-morbidities.

Aim. To analyse atypical variants of dyslipidemia (DLP) in coronary heart disease (CHD).

Material and methods. The study included rehabilitation unit patients with myocardial infarction (MI). Over 5 years, 78 patients with severe hypertriglyceridemia (HTG) or selective decrease in anti-atherogenic lipoproteins were selected. The patients with the DLP phenotypes most typical for CHD (IIa, IIb) were not included in the study. Mean age of the participants was 46± 1 years. All participants were divided into three groups: with combined hyperlipidaemia (HLP) due to increased cholesterol (CH) and triglycerides (TG), but with prevalent HTG — Group I (n=24); with isolated HTG — Group II (n=23); with selective reduction in high- density lipoproteins (HDL) — Group III (n=31).

Results. Group I was characterised by substantial increase in the levels of CH and TG (6,8±0,5 mmol/l); Group II — by isolated increase in TG level (4,1±0,4 mmol/l); and Group III — by selective reduction in HDL-CL concentration (0,82±0,02 mmol/l).

Conclusion. Atherosclerosis and its complications might develop not only in HLP IIa and IIb, but also due to HTG or decreased anti-atherogenic lipoprotein levels. All primary DLP are hereditary, but typically they are linked to polygenic defects — i.e., are dependent on functionally important nucleotide polymorphisms in genes regulating lipid metabolism.

Aim. To study early predictors of metabolic syndrome (MS) in 10-15-year-old children (n=200) with upper digestive tract pathology, in regard to their body mass (BM).

Material and methods. The main group (MG) included 127 children (46 girls, 81 boys) with increased BM. The control group (CG) consisted of 73 children (29 girls, 44 boys) with normal BM. Fasting serum levels of lipids, glucose, insulin, leptin, adiponectin, and final stable NO metabolites were measured.

Results. Compared to children with normal BM, overweight children had significantly higher prevalence of insulin resistance and hyperinsulinemia, as well as higher leptin levels and increased ratio of serum leptin/adiponectin. No atherogenic changes in lipid profile or NO metabolite concentrations were observed. The results obtained pointed to potential reversibility of MS in children.

Conclusion. Active treatment and prevention, aimed at diet and lifestyle modification, could normalize BM and reduce the risk of atherogenic metabolic disturbances in children with upper digestive tract pathology.

Aim. To identify the best markers of heart rate variability (HRV) dynamic in treated cardiac patients.

Material and methods. In total, 145 pairs of 24-hour HRV measurements were selected from the treated patients with arterial hypertension, coronary heart disease, and hypercholesterolemia. The analysis included the most widely used HRV parameters, such as SDNN, SDNN index, r-MSSD, triangular index, LF (low-frequency spectre of HRV), HF (high-frequency spectre of HRV), and total power (TP) of HRV spectre. All parameters were assessed throughout 24 hours, during day-time activity and night-time sleep. HRV parameters were regarded as being changed if the difference between two subsequent measurements was over 5%.

Results. The same direction of changes in all HRV parameters during 24 hours, day-time and night-time was observed only in 8 cases (7,8%). Spearman’s correlation analysis demonstrated a strong correlation (r>0,6) between SDNN index₂₄, r-MSSD₂₄, ОМ₂₄ and changes in other HRV parameters. Unidirectional changes for SDNN index₂₄, r-MSSD₂₄ and ОМ₂₄ were observed in 68,9% of the cases; for SDNN index₂₄ and ОМ₂₄ — in 87,4%; for SDNN index₂₄ and r-MSSD₂₄ — in 71,8%; and for r-MSSD₂₄ and ОМ₂₄ — in 81,5%.

Conclusion. In assessing HRV dynamics, SDNNindex₂₄ was the most informative parameter, since its dynamics coincided with the temporal and spectral HRV parameter dynamics in 71%. For r-MSSD₂₄, this percentage reached 67%, and for ОМ₂₄ — 70%.

Aim. To investigate the features of endothelial function, apoptosis, micro- and macrohemodynamics in patients with chronic obstructive pulmonary disease (COPD) and chronic cor pulmonale (CCP), as well as to study the effects of a highly selective beta-1-adrenoblocker (B-1-AB) nebivolol on these parameters..

Material and methods. The study included 38 COPD patients with CCP (26 and 12 with CCP decompensation and compensation, respectively), aged 46-77 years. All participants received not only COPD and CCP therapy, but also an ACE inhibitor nebivolol (2.5-5 mg once a day) for 6 months.

Results. CCP patients were characterised by substantial endothelial dysfunction (ED), pathological NO hyper-production, elevated level of Willebrand factor, and increased apoptosis. Additionally, hypercoagulation, platelet hyper-aggregation, and heart systolic and diastolic dysfunction were observed. Nebivolol therapy was associated with reduced NO hyper-production: in plasma — to 13,34±1,44 mkm (p<0,01) in CCP compensation and to 18,86±1,23 mkm (p<0,001) in CCP decompensation; in exhaled air — to 11,4±1,07 mkm (p<0,001) and 24,57±1,14 mkm (p<0,001), respectively. Reduced Willebrand factor levels and pathological apoptosis activity, as well as improved blood rheology and central hemodynamics, were also observed.

Conclusion. CCP in COPD patients aggravates the clinical course and the prognosis of the disease. ED is one of the main mechanisms of CCP development and progression. Nebivolol therapy, as a part of complex CCP man­agement, improves central hemodynamics, blood rheology, endothelial function, decreases pathological apoptosis activity and therefore reduces CCP progression.

The article reviews the current evidence on reducing the risk of cardiovascular events and death in acute coronary syndrome patients (ACS) by early administration of statins. The results of the latest meta-analyses and official clinical recommendations are discussed. The statin with the strongest evidence on its benefits in ACS is atorvastatin.

Introducing drug-eluting stents (DES) is an important achievement in interventional cardiology. These stents have demonstrated good clinical results, effectiveness and safety. Despite the decrease in restenosis incidence, the incidence of adverse coronary events remained the same as for standard metal stents. However, DES could be successfully used in patients with small artery disease, restenosis after balloon angioplasty or stenting, with diabetes mellitus, or disseminated coronary atherosclerosis. The studies comparing various DES are analysed. Anti-platelet therapy and patients’ management after percutaneous coronary intervention are also discussed. The focus is on a new, everolimus-eluting stent, which has been proved more effective than other DES.

Based on the analysis of clinical and experimental studies, an attempt to explain pleiotropic effects of statins and their numerous action mechanisms has been performed. The pleiotropic effect concept includes: (a) medication effects on numerous targets, triggering various biochemical processes in the organism; b) the divergence of bio­chemical and pathophysiological processes triggered by one target. The pathochemical mechanisms of statins’ effects as HMG-CoA reductase inhibitors are explained. The authors also justify the independence of therapeutic and adverse effects of statins from their lipid and cholesterol-related mechanisms of action.

A substantial body of evidence has been obtained on an independent association between sleep obstructive apnoea syndrome (SOAS) and cardiovascular disease (CVD). It is particularly relevant for arterial hypertension (AH), coronary heart disease (CHD), stroke (S), heart failure, atrial fibrillation, and sudden cardiac death. Therefore, the present review focuses on an important issue of interrelations between SOAS and CVD, including AH, CHD, S, diabetes mellitus and mortality.