Aim. To study the structural and functional characteristics of thyroid gland (TG) in patients with coronary heart disease (CHD) and arterial hypertension (AH), in regard to the presence of atrial fibrillation (AF).
Material and methods. The study included 90 patients aged over 50 years, with CHD and AH; 60 patients also had AF. All participants underwent TG ultrasound, assessment of blood levels of thyroid hormones, thyrotropin (TT), anti-thyroid antibodies, and echocardiography (EchoCG). The patients were residents of an iodine-deficient region.
Results. In patients with AF, increased TG size and multi-nodal TG pathology were significantly more prevalent, and free thyroxin (T4f) levels were significantly higher than in AF-free participants (especially in women and individuals with increased TG size). Patients with AF and multi-nodal TG pathology demonstrated a significantly increased TG volume and decreased TT levels. Based on EchoCG data, these patients also had significantly lower atrial and left ventricular sizes, as well as a higher ejection fraction, compared to the patients with solitary TG nodes.
Conclusion. In AF patients, increased TG function could be explained by functional TG autonomy, especially among individuals with multi-nodal thyroid pathology.

Aim. To compare the effects of combination therapy with Noliprel A/forte (perindopril/indapamide) and lowintensity laser therapy (LILT) on central hemodynamics in elderly patients with arterial hypertension (AH).
Material and methods. In total, 160 AH patients, aged 60-96 years, were examined. All participants were randomised into 4 groups: Group I (n=25) receiving Noliprel A/forte; Group II (n=54) receiving red-spectrum LILT on skin Zakharyin-Ged zones, plus pharmaceutical therapy (excluding noliprel); Group III (n=27) receiving Noliprel A/forte and LILT; and Group IV (n=54), the comparison group, receiving standard antihypertensive therapy only (excluding Noliprel A/forte and/or LILT). At baseline and in the end of the study, Doppler ultrasound parameters were assessed.
Results. At baseline, AH patients demonstrated relatively normal systolic myocardial function combined with diastolic left and right ventricular (LV, RV) dysfunction and increased ventricular transverse sizes. By the end of the study, Group I demonstrated reverse remodelling of all cardiac chambers. The combination of Noliprel A/forte and LILT had additive beneficial effects on morphological and functional components of intracardiac hemodynamics, with LV and RF systolic function improvement and even more pronounced regression of LV and RF diastolic dysfunction. The beneficial impact of noliprel was maximal in patients aged over 80 years.
Conclusion. The combination of noliprel and LILT demonstrated additive beneficial effects and increased treatment effectiveness independently of AH variant, intracardiac hemodynamic specifics, and age.

Aim. To study intracardiac and pulmonary hemodynamics and arterial blood gases in patients with chronic stable angina pectoris associated with chronic obstructive pulmonary disease (COPD).
Material and methods. The study included 103 patients: 49 people with Functional Class II chronic stable angina pectoris and COPD, plus 54 individuals with COPD only. Arterial blood gases, left and right ventricular (LV, RV) diastolic function (echocardiography with colour Doppler ultrasound), and right heart pressure levels (right heart and pulmonary artery (PA) catheterisation) were assessed.
Results. The patients with chronic stable angina pectoris associated with COPD were characterised by progressing RV and LV diastolic dysfunction. In contrast to patients with isolated COPD, RV diastolic dysfunction was more pronounced in participants with combined pathology. In both groups, pulmonary hemodynamics was characterised by equivalent increases in systolic, diastolic, and mean PA pressure (Stage I). The manifestations of this increase were determined by the COPD stage.
Conclusion. Combined cardio-respiratory pathology was characterised by progressing RV andLV diastolic dysfunction. In both groups, the factors with the strongest correlation with pulmonary hypertension included arterial hypoxemia, hypercapnia, and RV diastolic dysfunction.

Aim. To assess the role of genetic factors in coronary atherosclerosis progression and myocardial electric instability development among patients with coronary heart disease (CHD) undergoing endovascular interventions.
Material and methods. The main group (MG) included 97 CHD patients (mean age 53,6±7,8 years), who underwent endovascular revascularization. The assessed parameters included genetic polymorphisms of haptoglobin (Hp), C´3 complement component (C´3), vitamin D-binding protein (Gc), and transferrin (Tf), as well as immune inflammation markers (interleukin-6, tumor necrosis factor-α, and C-reactive protein, CRP) and electrocardiographic QT interval dispersion. The control group (CG) included 100 healthy donors (mean age 47,0±8,6 years).

Results. In MG patients, compared to controls, there was a significant increase in QT interval dispersion. The extent of QT interval dispersion reduction after endovascular coronary stenting was maximal in patients with one or two lesions. At early post-intervention stages, immune inflammation processes intensified. The severity of coronary atherosclerosis affected the correlation between CRP levels and QT interval dispersion. QT dispersion parameters were associated with Hp 2–2, С´3 SS, Gc 1–1, and Tf CC. In С´3-SS-positive patients, there was a positive correlation between CRP levels and QT interval dispersion (QTd).
Conclusion. The results obtained confirm the important role of genetic factors in the immune inflammation activation among CHD patients. After endovascular intervention, immune inflammation is associated with atherosclerosis progression and myocardial electrical instability

Aim. To investigate the prognostic role of selected single nucleotide polymorphisms in hemostasis-regulating genes and to clarify their interaction with conventional risk factors, RF (smoking, arterial hypertension (AH), hypercholesterolemia (HCH), obesity (O)) at the early stages of coronary heart disease (CHD) development, with or without subsequent myocardial infarction (MI).
Material and methods. The study included 977 men aged 20–55 years: 375 CHD patients (189 and 186 with or without previous MI, respectively) and 602 individuals without cardiovascular disease (CVD). Exclusion criteria were diabetes mellitus and impaired glucose tolerance. The authors analysed the polymorphisms of thrombocyte receptor genes GPIa (C807T) and GPIIIa (PLA1/PLA2); coagulation and fibrinolytic protein genes for factor VII (R353Q) and factor XIII (V34L); and the plasminogen activator inhibitor-1 (PAI-1) 4G/5G polymorphism. The association of these polymorphisms with conventional RF (smoking, AH, HCH, and O) was also investigated. To identify genetic variations, a restriction fragment length polymorphism assay, allele-specific assay, and fluorescence primer-probe assay were used.
Results. Increased CHD risk was associated with the TT genotype of GPIa (p=0,0001; OR=10,2). The LL genotype of FXIII (p=0,03; OR=0,48) and QQ genotype of FVII (p=0,01; OR=0,12) were linked to reduced CHD risk. The combination of FXIII L allele and FVII Q allele was associated with a lower MI risk in CHD patients (p=0,03; OR=0,33). In participants with HCH, the PLA2/PLA2 genotype of GPIIIa was linked to increased MI risk for CHD patients (p=0,01; OR=6,0).
Conclusion. The algorithm for predicting the genetic CHD risk may incorporate the assessment of the genetic polymorphism of GPIa (C807T), GPIIIa (PLA1/PLA2), factor XIII (V34L), and factor VII (R353Q). The study results did not confirm the negative effect of the PAI-1 gene 4G/5G polymorphism on CHD risk.

Aim. To study the effectiveness of ambulatory rehabilitation and prevention programmes in patients after percutaneous coronary intervention (PCI), with the use of computerized medical decision support system (MDSS) facilitating the choice of controlled physical training (CPT) regimen and the delivery of adequate recommendations on physical activity (PA) levels.
Material and methods. This 12-month study included 194 patients (124 men and 70 women; mean age 53,5±3,6 years) with stable coronary heart disease (CHD), who underwent PCI (coronary angioplasty or coronary stenting). The CPT regimen was chosen, using the computerized MDSS. To perform the analysis of standard medical decisions, 25 doctors participated in a questionnaire survey.
Results. The patients from the CPT group, demonstrated a significant increase in exercise capacity (EC) and mean exercise duration, an improvement in quality of life (QoL), and good pharmaceutical therapy compliance throughout the rehabilitation period. As shown by the questionnaire survey data, standard medical decisions were based, on average, on three clinical parameters; methodological errors were the most prevalent ones.
Conclusion. The use of rehabilitation programmes, based on computerized MDSS, in ambulatory post-PCI patients ensures not only high effectiveness of rehabilitation and prevention measures, but also safety of physical training.

Aim. To compare the clinical characteristics, in-hospital treatment, and treatment outcomes in men and women included in the independent Russian RECORD Registry of acute coronary syndrome (ACS) (n=796; 57,2% men and 42,8% women).
Material and methods. The Registry covered 2007–2008 and included 18 clinical hospitals in 13 Russian cities. The mean age of male participants was 60,6±11,3 years; the proportion of the patients aged ≥65 years was 32,3%. Female participants were significantly older, with the majority of women being 65 years or older (66,6% vs. 32,3% of those aged below 65 years; p<0,001).
Results. The analysis of anamnestic data demonstrated that in women, pre-existing cardiovascular disease (CVD) and risk factors were significantly more prevalent, while percutaneous coronary intervention (PCI) was significantly less prevalent, compared to men. Women were more often admitted to “non-invasive” hospitals, and at admission, they more often demonstrated Killip class ≥II and higher risk levels. During hospitalization, women were less likely to be administered clopidogrel or new-generation heparins, but more often received diuretics and aldosterone antagonists. Invasive procedures were performed significantly less often in women vs. men. In women and men with ACS and ST segment elevation, in-hospital rates of fatal outcomes were 25,7% and 10,3%, respectively (p=0,003), while for ACS without ST segment elevation, the respective figures were 4,2% and 1,6% (p=0,12). In “invasive” hospitals, the combined incidence of death or myocardial infarction among patients with ACS without ST segment elevation was significantly higher in women (9,9% vs. 3,5% in men; p=0,045).
Conclusion. A relatively worse prognosis in female patients included in the RECORD Registry was explained by a higher prevalence of pre-existing CVD and an inadequate treatment, with poor compliance to modern clinical guidelines.

Aim. To investigate the clinical effectiveness of endovascular revascularization of the infarct-related coronary artery (IRCA) in regard to the “symptom-balloon” time, analyzing retrospective data on patients with acute coronary syndrome (ACS) and ST segment elevation (STE-ACS).
Material and methods. The study included 164 patients with STE-ACS, who underwent selective coronary angiography (CAG) and transluminal balloon angioplasty (TLBAP) with coronary stenting. Based on the “symptom-balloon” time, all patients were divided into two groups. In Group I (n=78), the “symptom-balloon” time was <6 hours, while in Group II (n=86), it was 6–24 hours. Echocardiography (EchoCG) was performed at Day 1, 7, and 30.
Results. The EchoCG data demonstrated a reduction in left ventricular (LV) systolic function. In Group I, LV systolic function significantly improved by Day 7: LV ejection fraction (EF) increased from 48,2% to 51,6% (p=0,0013). At Day 30, LV EF was 54,7% (p=0,001). In Group II, the increase in LV EF was not statistically significant (from 46,1% to 47,2%; p=0,2197).

Conclusion. Urgent coronary revascularization in STE-ACS improved localLV contractility, due to the restriction of stunned myocardium areas. The speed of theLV contractility improvement after IRCA TLBAP/coronary stenting was strongly associated with the “symptom-balloon” time.

Aim. To study carvedilol effectiveness in patients with hypertrophic cardiomyopathy (HCMP).
Material and methods. The study included 52 patients with HCMP (67% men and 33% women; mean age 40,7±3,1 yeas). All participants underwent clinical examination, six-minute walk test (6mwt), standard 12-lead electrocardiography (ECG), echocardiography (EchoCG), chest X-ray with cardio-thoracic index calculation, and angina severity assessment using a verbal assessment scale (VAS). All patients were divided into two groups: Group I (n=38) with interventricular wall thickness (IVWT) ≤20 mm; and Group II (n=14) with IVWT >20 mm. Carvedilol was titrated from the minimal dose of 6,25 mg/d to the maximal dose of 31,25 mg/d (b. i.d.). The treatment duration was 12 weeks.
Results. Carvedilol therapy was associated with an improvement of clinical and hemodynamic parameters (including reduced angina severity and improved left ventricular diastolic function, LVDF) in both groups. The effectiveness of conservative treatment was higher in patients with IVWT <20 mm.
Conclusion. In HCMP patients, the severity of clinical symptoms and non-specific ECG disturbances increased in parallel with the IVW hypertrophy progression. Carvedilol therapy demonstrated beneficial effects on clinical status, cardiac hemodynamics, and LVDF. These effects were maximal in patients with IVWT <20 mm.

Familial hypercholesterolemia (FHCH) is a hereditary autosomal dominant disease, characterised by lipid metabolism disturbances and high plasma levels of low-density lipoprotein cholesterol (LDL–CH).
Aim. To compare lipid metabolism parameters in patients with various genetic variants of FHCH, and to assess the sensitivity and specificity of biochemical markers for FHCH diagnostics in the relatives of probands.
Material and methods. Lipid metabolism parameters were compared in 123 non-treated patients with genetically confirmed FHCH diagnosis (98 and 5 with LDLR or APOB mutations, respectively) and their healthy relatives without LDLR or APOB mutations.
Results. Similarly to European populations, the Russian population was characterised by higher levels of total CH (TCH) and LDL–CH among patients with LDLR mutations, compared to patients with APOB mutations. In the FHCH diagnostics among relatives, biochemical markers demonstrated high sensitivity (93%) and specificity (82%). Despite lower LDL–CH levels, these diagnostic criteria were also effective in patients with APOB mutations.
Conclusion. In the Russian population, biochemical criteria could be recommended for FHCH diagnostics in the relatives of FHCH probands.

Aim. To study clinical effectiveness, safety, and effects on left ventricular (LV) systolic and diastolic function for Class IC and Class III antiarrhythmic medications — propafenone and amiodarone, respectively — in patients with chronic heart failure (CHF), intact ejection fraction (EF), and atrial fibrillation (AF).
Material and methods. Out of 227 patients, 198 were followed for 12 months (mean age 54,4±2,1 years). For AF prevention, 138 and 60 participants received propafenone and amiodarone, respectively. The assessed parameters included AF episode incidence, their duration, LV systolic and diastolic function, and therapy safety (incidence of adverse effects, AE) in CHF with intact LV EF.
Results. After 12 months of the treatment, propafenone and amiodarone effectiveness for AF prevention was similar — 61,4 % and 63,2 %, respectively. ImprovedLV diastolic filling was associated with increased numbers of Functional Class I CHF patients (+50 %) and reduced hospitalization rates (-72,9). In CHF patients with intact LV EF, propafenone demonstrated a better safety profile than amiodarone: AE incidence was 0,72 % vs. 31,8 %, respectively.

Conclusion. In CHF patients with intact LV EF and paroxysmal and/or persistent AF, the Class IC antiarrhythmic medication propafenone demonstrated high antiarrhythmic effectiveness, safety, and beneficial effects onLV diastolic function.

Aim. To assess the impact of cardiac autonomic neuropathy (CAP) on left ventricular (LV) structure and function in patients with Type 2 diabetes mellitus (DM-2), depending on the presence of metabolic syndrome (MS) components.
Material and methods. The study included 157 patients (128 women and 29 men) with DM-2. MS was diagnosed according to WHO criteria. CAN was detected based on the standard Ewing test (≥2 positive results). M-mode, B-mode, and Doppler echocardiography was performed in 4 clinical groups: Group I (n=14): CAN-negative, ≤1 MS component; Group II (n=16): CAN-negative, ≥2 MS components; Group III (n=19): CAN-positive, ≤1 MS component; and Group IV (n=108): CAN-positive, ≥2 MS components. LV geometry type, as well as LV systolic and diastolic function, was assessed according to the standard criteria.
Results. LV concentric hypertrophy (LVCH) was the most prevalent type of LV geometry in CAN-positive vs. CAN-negative patients (62,2% vs. 20,0%, respectively; p=0,02). The highest LVCH prevalence (63,9%) was registered in participants with CAN and ≥2 MS components. Over 50% of the patients with 0–1 MS component and two-thirds of the patients with ≥2 MS components had disturbed LV diastolic function. In the former, CAN presence did not affect the prevalence of diastolic dysfunction, while in the latter, diastolic dysfunction was significantly more prevalent among CAN-positive individuals (90,7%, compared to 56,2% in CAN-negative patients with ≥2 MS components; p=0,001).
Conclusion. In DM-2 patients, CAN was associated with LVCH andLV diastolic dysfunction. This association strengthened, as the number of MS components increased.

Ambulatory healthcare for patients with cardiovascular disease (CVD) is regulated by Decree No. 599n of the Russian Ministry of Health and Social Development (Sept 19th 2009). The aim of the study was to investigate the specific characteristics of CVD patients attending a polyclinic cardiologist and to assess their demand for cardiovascular surgery. The study included 123 consecutive adult patients (>18 years) with CVD, attending a cardiologist at a Rybinsk polyclinic. Mean age of the participants was 60,1±13,8 years; 55,3% were over 60 years. Mean level of cardiovascular risk was 3,5±0,7. All patients had access to such diagnostic methods as Holter ECG monitoring or echocardiography. However, patients’ compliance to medical recommendations and availability of invasive diagnostic and therapeutic methods were the key problems identified. According to the Decree No. 599n, the majority of the participants should be monitored by a therapeutist, or a general practitioner.

Aim. To compare the effectiveness of the combination therapy with ivabradine and β-adrenoblockers (β-AB) and the dose-titration β-AB therapy.
Material and methods. This multi-centre, open, controlled study included 1104 patients with functional Class (FC) II-III stable angina (SA), sinus rhythm, and heart rate (HR) ≥60 bpm, who received regular β-AB therapy in submaximal doses. The participants were divided into the standard therapy group (β-AB therapy with the dose titration to the maximal tolerated dose; 228 patients (20,7%)) and the ivabradine therapy group (876 patients (79,3%))

Results. Both groups were comparable by main demographical and clinical characteristics. Adding ivabradine to the β-AB therapy resulted in a more pronounced HR reduction at Week 16, compared to the standard therapy group (61±6 vs. 63±8 bpm; p=0,001). By the end of the study, the percentage of the patients with FC I SA was significantly higher in the ivabradine group than in the standard therapy group (37,1% vs. 28%; p=0,017). The average number of angina attacks between Weeks 8 and 16 was significantly lower in the ivabradine group than in the standard therapy group – 4 (2;10) vs. 6 (2;15), respectively (p=0,015). In the standard therapy group, the incidence of adverse events, such as dyspnoea, hypotension, and fatigue, was significantly higher than in the ivabradine group – 18,4% vs. 9,4%, respectively (p<0,001).
Conclusion. In SA patients, the combination therapy with β-AB and ivabradine demonstrated good tolerability, safety, and high antianginal effectiveness, which resulted in a more pronounced clinical improvement, compared to the dose-titration β-AB therapy.

To assess the dynamics of physical activity (PA) in patients with coronary heart disease (CHD) during rehabilitation or secondary prevention, a specialised questionnaire ODA23+ was developed. This instrument takes into account the specifics of Russian patients’ lifestyle and mentality, assesses PA levels, and evaluates PA dynamics over time. The mathematical model was created, based on experts’ opinions. After statistical analysis of the data obtained from experts, point-based weights for each answer to all 23 questions were determined. The questionnaire ODA23+ was assessed in two clinical studies of rehabilitation and secondary prevention among CHD patients after acute coronary incidents, coronary artery bypass graft surgery, or coronary endovascular intervention. It was demonstrated that the questionnaire is valid and sensitive in the dynamic assessment of PA. The questionnaire also provides an opportunity to compare the long-term effectiveness of different physical training or educational programs in CHD patients.

The paper is focussed on the drug release comparison for multisource indapamide medications against the original medication, Arifon retard (1,5 mg; Servier Laboratories, France). The comparative test of dissolution kinetics was performed in three media modelling physiological gastrointestinal conditions: hydrochloric acid solution, pH 1,2; acetate buffer, pH 4,3; and phosphate buffer, pH 6,8. The results of the dissolution kinetics test were compared to those from the comparative therapeutic studies of indapamide medications.

The review presents new non-pharmaceutical methods for the treatment of resistant arterial hypertension, such as carotid sinus stimulation and renal sympathetic denervation. The authors analyze the results of the clinical studies on efficacy and safety of these new methods.

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