There is a marked increase of prevalence of arterial hypertension (AH) in modern civilized society that usually is comorbid with dyslipidemia (DL), which leads to higher level of vascular comorbidity in economically active population, disability and mortality.
Aim. To find out the specifics of antiplatelet vascular control over blood
cells in AH patients with DL.
Material and methods. Totally, we studied 380 patients with AH of 1-2 grade, risk 4, with DL IIb type, of middle age. Controls were 26 healthy volunteers of the same age. We used biochemical, hematological and statistical methods of investigation.
Results. In the blood of patients, there was DL IIb type revealed, with
weakening of antioxidant defense and high level of lipid peroxidation. In
the studied patients with AH and DL there was increased level of
erythrocyte, platelet and neutrophil aggregation with decrease of the
control by vascular wall. These findings can be explained by negative
shifts of lipid metabolism, activation of peroxide oxidation of plasma
lipids, receptor rebuilt of blood cells and decrease of synthesis in
vascular walls of nitric oxide and prostacyclin.
Conclusion. For AH with DL patients it is specific to have decreased
control of vascular wall over the increased aggregation of erythrocytes,
platelets and neutrophils.

Aim. In patients with arterial hypertension (AH) of 1 grade to find out the effectiveness of blood pressure (BP) control during long-term
observation in real life conditions and to check the factors that might
help with a decision either to prescribe medical treatment or keep on life style modification.
Material and methods. Two times, with the interval 71,3±1,5 months,
66 patients with AH 1 grade were assessed, among those were moderate, moderate-high, high and very high additional cardiovascular risks.
Together with other investigations, all patients at baseline and repeatedly underwent office BP measurement, ambulatory monitoring (ABPM) and body mass check. At primary assessment, the detailed recommendationswere given on the normalization of life style and pharmacotherapy.
During second assessment, the adherence of patients to medical and
life style treatment was evaluated.
Results. With the time, most patients with AH 1 grade had a decrease of BP level, most prominent in patients with higher risk. Only in the highest risk group, there was no BP dynamics. Among all studied, as separately in groups with moderate, moderate-high, high and very high levels, during follow-up there were no differences in BP levels between patients adhering medical therapy and others. The worst adherence was found in moderate risk patients. The best results of body mass index decrease and increase of aerobic physical exercises showed the patients with relatively high glucose level and endothelial vascular factor in blood.
Conclusion. During long-term observation in real circumstances, most
patients with 1 level AH, knowing about medical and non-medical BP
control tools, show its decrease. The level of additional cardiovascular
risk, glucose level and vascular endothelial factor in blood might serve as adherence predictors and treatment effectiveness estimate.

Aim. To study relation of the heart remodeling processes and endothelial dysfunction in patients with chronic heart failure (CHF).
Material and methods. Totally, 103 patients studied with post infarction cardiosclerosis. All patients selected to 3 groups by functional class (FC): I group consisted of 28 patients with CHF I FC, II — 46 patients with II FC and III — 29 patients with III FC by NYHA. All patients underwent echocardiography, dopplerography of brachial artery.
Results. Post infarction remodeling of the left ventricle (LV) led not
only to structural remodeling of LV, with chamber dilation, walls
thinning, contractility decrease, but to changes of LV geometry.
Contractility decrease of LV myocardium followed by the disordered
endothelium-dependent vessel dilation, with increase of pulsative and
resistive indexes, sensitivity decrease of brachial artery to the shift
tension.
Conclusion. In CHF patients the processes of heart remodeling followed by remodeling of vessels, showing functional and humoral parameters of endothelial dysfunction.

Aim. To study the occurrence of atrial fibrillation (AF) in patients with
normal ejection fraction heart failure (NEJHF) without AF in anamnesis,
and to perform comparative analysis of echocardiographic parameters
with the parameters of patients with NEJHF and known AF, as to study
independent predictors of AF occurrence in NEJHF.
Material and methods. Totally, 182 patients included (105 women)
with metabolic syndrome and NEJHF (II-III functional classes by NYHA)
at the age 63±12 y. o., with sinus rhythm and no anamnesis of AF
(n=118), and with paroxysmal AF (PxAF) in anamnesis (n=28) or
persistent (PeAF) in anamnesis (n=36).
Results. Among 118 patients with AF in anamnesis, in 49 (41,5%)
during 3 years of follow-up, there were cases of PeAF and PxAF.
Patients without AF in anamnesis had better relations for left and right
ventricles filling comparison (E/e`) under load, index of maximum left
atrium volume (LA) (IVLAmax), systolic pressure in pulmonary artery
(SPPA) during rest and after exertion, than patients with known
episodes of PeAF and PxAF. Patients with PeAF had significantly higher
values of the index of post systolic shortening of the left ventricle,
rigidity index of LA, IVLAmax, E/e` of RV, interatrial mechanical
asynchrony and low values of longitudinal deformation of the LA (LDLA)
and velocity parameters of LDLA (VPLDLA). Female sex, systolic
arterial pressure, SPPA, IVLAmax, E/e` in load, E/e` of RV, LDLA,
longitudinal deformation of the left ventricle and VPLDLA were
independent predictors of AF.
Conclusion. Increased rigidity, parameters of longitudinal deformation
and the volume of LA, as interatrial mechanical asynchrony are strong
independent predictors of AF in NEJHF.

Recently, the internist-practitioner does not routinely assess glomerular
filtration rate (GFR) in there no risk factors for chronic kidney disease
(CKD). However, recent data shows that in non-alcoholic fatty liver
disease (NAFLD) it is necessary to assess GFR even without any classic
risk factors for CKD. Early awareness of kidney damage in chronic heart
failure patients (CHF) and NAFLD might help to select those requiring
further investigation and treatment, taking into account comorbidity.
Aim. To assess functional condition of kidneys in CHF patients with liver
steatosis.
Material and methods. Totally, 77 CHF patients included. All patients
had confirmed CHF diagnosis by N-terminal Brain pro-natriuretic peptide
assay. The severity of clinical condition in CHF was assessed, functional
status of patient. All patients underwent clinical and biochemical blood
sampling, electrocardiography, ultrasound liver imaging. The heart
chambers sizes were assessed, walls thickness by echocardiography. All
patients had the GFR by CKD-EPI calculated, as the Fatty Liver Index
(FLI), NAFLD Fibrosis Score (NFS).
Results. More than a half (66%) of patients with CHF had C2 stage of
CKD, 6% — С1, 12% — С3а, 9% — С3б, 4% — С4 stage of CKD. Patients with С5 were absent. Mean GFR was 65,4±14,4 ml/min/1,73 m2. In statistical analysis it was revealed that while there is an increase of SCAHF points, there is parallel increase of CKD stage (p=0,0027). Higher glucose level, higher the stage of CKD (p=0,0022). It was found, that while there is and increase of CKD, right atrium size also increases (p=0,044). With more severe renal damage in CHF, higher the level of PIIINP myocardium fibrosis marker (p=0,047). According to FLI, in 40% of patients there is high chance for liver steatosis, in 34% of patients the data on steatosis was absent, in 26% was intermediate. According to NFS, 26% patients had high probability of liver fibrosis, 9% — did not have, 65% were in a “grey zone”. In analysis of relations there was found that while increasing NFS, GFR does decrease, and CKD stage increases (p=0,049).
Conclusion. Patients with NAFLD and CHF do need GFR assessment.
Early finding of renal involvement in CHF with NAFLD would help to select patients for further investigation and therapy prescription, taking into account comorbidity.

Aim. To analyse quantitative parameters of functional geometry of the
left ventricle (LV) in patients with dilated cardiomyopathy (DCMP), to
assess the changes in cardiac resynchronization therapy (CRT) and to
reveal the relation of functional geometry of LV and its contractility.
Material and methods. In DCMP patients group, who were directed to
CRT according to the Guidelines of Russian Arhythmologists Society 2013, echocardiographic study was performed before and after CRT (at 5th day). Based on two-dimensional LV pictures the parameters were assessed in the cycle, as segmented kinetics of wall contraction, LV shape dynamics: sphericity index, Hibson, conicity of apical zone, Fourier shape complexity.
Results. In DCMP patients the decrease of global ejection fraction
<35% was followed with a decrease of systolic change of all sectoral squares of LV and enhancement of dimensional heterogeneity and
asynchronicity of regional wall motion during cardiac cycle comparing
to controls. There was negative correlation revealed between the
proposed index of non-homogeneity and global ejection fraction. All
shape indexes point to more spherical shape of LV in DCMP. However,
opposite to controls, DCMP patients lack dynamical changes of
shape indexes during cardiac cycle, that witnesses on significant
disorders of wall motion coordination in cycle. After CRT there is
significant re-coordination of LV wall motion, followed by restoration
of non-homogeneity pattern of segmental kinetics, decrease of nonhomogeneity indexes and of asynchronicity and appearance of the
dynamics of shape indexes changes during cardiac cycle. It was
shown that end-systolic indexes of sphericity shape complexity of
Fourier make it to separate patients who respond or does not on
therapy, by clinical parameters. Changes of sphericity index between
end diastole and end systole <3,5% selects patients with the highest
prognostic significance comparing with other parameters.
Conclusion. Disorders of functional geometry of the LV, particularly an
increase of non-homogeneity and asynchronicity parameters of the
regional motion of the wall, decrease of dynamical changes of LV
sphericity indexes, might influence contractility and pumping function of
the heart, and have diagnostic significance in selection of patients
responding to CRT.

Aim. To analyse the aldosterone level in the blood of patients with different kinds of atrial fibrillation (AF) and sinus rhythm.
Material and methods. Totally, 130 patients included (main group) with AF of non-valvular origin. Of those 40 (30,8%) had permanent, 50 (38,4%) — persistent, and 40 (30,8%) — paroxysmal type of atrial fibrillation. The controls consisted of 40 patients with cardiovascular pathology not having anamnesis of AF. Aldosterone levels were measured by immune-enzyme assay. In paroxysmal and persistent AF the measurement was done before returning to sinus rhythm. Reference ranges for aldosterone were 40-160 pg/ml.
Results. Aldosterone level in blood was significantly higher in the main group comparing to controls — mean 141,5±41,8 pg/ml vs 105,0±33,1 pg/ml (р<0,001). The highest level had persisting and paroxysmal AF patients and a little lower in permanent AF patients. Prevalence of hyperaldosteronemia among all patients of the main group was significantly higher comparing to controls, and reached 32,3% and 7,5%, resp., (χ2=8,44, p=0,004), however in multiple analysis the significant differences were revealed only among those with paroxysmal type (47,5%) and sinus rhythm patients.
Conclusion. In AF patients aldosterone level is significantly higher comparing to sinus rhythm patients. In addition, the level is significantly higher in paroxysmal and persistent comparing to permanent type. 

Aim. To assess the condition of adhesion function of endothelium in various clinical variants of primary mitral valve prolapse (MVP).
Material and methods. Totally, 91 patient studied with primary MVP at the age 21 (19-24) y. First grade mitral regurgitation was found in 45,1% and II — in 54,9% patients. MVP was solitary variant (6,6%) and comorbid with 1-3 minor anomalies of the heart (93,4%). Doppler-echocardiography was done on Vivid07 equipment (Israel). The grade of systemic involvement of connective tissue was 2 (1,5-4,0) points. Controls were 10 healthy persons, matched by age, sex, smoking, body mass index. By the immune enzyme method we checked plasmatic concentrations of L-, E-, Р-selectins, ICAM-1, VCAM-1, PECAM-1 (Bender MedSystems GmbH, Austria). Findings are presented as mediana (25-75 percentiles).
Results. In MVP patients the levels of Е-selectin — 43,0 (33,7-54,8) ng/ mL, ICAM-1 — 669,9 (546,4-883,3) ng/mL and VCAM-1 — 925,0 (707,5- 1215,0) ng/mL, were significantly higher, and the level of РЕСАМ-1 — 49,8 (40,4-63,2) ng/mL, in opposite, lower than in control group. L- and P-selectins levels in MVP group were measured as relevant to controls values (p>0,05). In regurgitation cases of II degree, the level of E-selectin and ICAM-1 were maximal (p<0,05). Values of VCAM-1 in MVP patients independently from degree of regurgitation were significantly higher than controls values. There was moderate direst relation of the quantity of minor heart anomalies and level of ICAM-1 (rs=+0,30, р<0,05). In MVP group with increased E-selectin significantly higher was aorta diameter at the level of Valsalva sinuses — 2,5 (2,3-2,7) cm, than in PMV without increased E-selectin level — 2,3 (2,2-2,5) cm (р<0,05).
Conclusion. In patients with primary MVP there is an increase of circulating concentrations of E-selectin, ICAM-1, VCAM-1, that represents the level of adhesion, and witnesses about subclinical endothelial dysfunction. For screening evaluation of severity of adhesion disorders of endothelium in MVP it is important to take into account its hemodynamic significance, multiple minor heart anomalies and data on aorta diameter on the level of Valsalva sinuses. 

Aim. To assess clinical and hemodynamic efficacy of sildenafil at the background of basic therapy in patients with idiopathic and right ventricular (RV) dilated cardiomyopathy.
Material and methods. Totally, 59 patients with idiopathic DCMP included. All patients were selected to 2 groups: I (n=28); M/F 15/13; 46,9 ±11,4 y.o., and II (n=31); M/F 17/14; 46,3±15,4 y.o. Number of patients with RV DCMP in each group was 10 (35,7%) and 13 (41,9%), resp. They underwent clinical status assessment by SCAHF, 6-minute walking test, standard ECG, echocardiography via transthoracic approach. Patients of the 1st group additionally to basic therapy of heart failure were prescribed sildenafil in individual dosage — mean 45,8±12,5 mg/day. Duration of the study was 6 months.
Results. Women, consisting 45,7% in general, significantly predominated among patients with RV DCMP. By the results of the study there was regression of the mean points by SCAHF by 30,1% and 40,8%, increase of 6-minute distance by 50,1% and 45,8% in patients of I and II groups, respectively. At the background of sildenafil addition, there was significant decrease of systolic pressure in pulmonary artery in I group by 23,8% (p=0,031), that helped to decrease end-diastolic pressure in RV chamber and increased RV ejection fraction by 6,3%. In i group patients there was increase of diastolic reserve of RV due to improvement of active Ve by 29,1% (p=0,01) and Va by 54% (p=0,03), that led to a decrease of Ve/Va ratio by 38% (p<0,05). The assessment of spirometry showed that combination therapy by sildenafil led to significant increase of Tiffeneau and Gaensler indexes by 23,4% and 12,3%, resp. (both p<0,05).
Conclusion. Pulmonary hypertension syndrome in most cases is present in patients with either idiopathic or RV DCMP. Additional prescription of sildenafil contributes to the decrease of heart failure and respiratory failure severity symptoms and to improvement of hemodynamical signs, leading to significant decrease of systolic pressure in pulmonary artery. 

Aim. To assess myocardium perfusion and functional state, by the data from single-photon computed emission tomography combined with X-ray computed tomography (SPECT/CT) at exercise testing circumstances, in patients with chest pain and intact coronary arteries.

Material and methods. Totally, 31 patient studied, each of those underwent Holter ECG monitoring, selective coronary arteriography and SPECT/CT of myocardium at rest and in veloergometry.

Results. In patients with unchanged coronary arteries there is a decrease of perfusion reserve, due to primary microcirculation disorders and secondary causes, that present with verified by visualizing radionuclide method SPECT/CT transient ischemia of myocardium.

Conclusion. It is important to investigate thoroughly patients with chest pains and angiographically unchanged vessels; the role of perfusion scintigraphy in these patients is high.

Anemia, defined by WHO guidelines as a decrease of hemoglobin level <130 g/L in men and 120 g/L in women, is an independent risk factor for cardiovascular diseases. Hemoglobin level decrease by 10 g/L does increase risk of death from coronary pathology. The review focuses on the key pathophysiological mechanisms of anemia relation with cardiovascular diseases, the results briefly introduced, of comparably recent studies in this field, and their significance is treated for clinical practice.

The collected data on the interaction of human-as-host and their gut microbiota reveals new opportunities for further investigation and translation to practice the novel methods of the body influence in whole and on separate systems, particularly via correction of gut microbiota condition. Previous reviews focused on recent data on the interaction of gut microbiota with the main cariovascular risk factors. Last article in this sequel focuses on the recent data on hypertension and condition of the gut microbiota, as on the influence of smoking on the gut microbiota. 
The article presents the results of investigations on the influence of short-chain fatty acids on arterial pressure, and on smoking impact on the gut microbiota.

The article focuses on the brief content-analysis of pharmaceutical market, acetylsalicylic acid, applied in thrombosis prevention. During the study it was revealed that Thrombo ACC® drug fulfills the requirements of regulatory documents by the parameter test “Dissolution”. The quantitative study also performed for quantitative acetylsalicylic acid measurement in the Thrombo ACC® drug, under various storage and usage conditions. It was shown that if following the recommended conditions, acetylsalicylic acid amount in the drug does not change significantly.

The analysis provided, of modern tactics for stable ischemic heart disease patients that makes it possible for practitioners to estimate adequately risk and benefits of diagnostic studies, to select medical or surgical treatment method and to assess outcomes. The review provides with recommendations helping physicians with decision making on patients treatment with ischemic heart disease in everyday practice. 

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