Aim. In the circumstances of real clinical practice, to evaluate the changes in life quality (LQ) parameters of the patients with coronary heart disease and stable angina with addition of nicorandil to standard treatment.

Material and methods. Study design — prospective, observational, multicenter. In the trial, the physicians participated, from 14 institutions in a range ofRussia regions. Totally, 590 included: 261 (44,2%) females, 329 (55,8%) males. All patients, in addition to the standard antianginal treatment, were prescribed with nicorandil. At the visits V0 (baseline) and V3 (3 months of therapy) they completedSeattle questionnaire (SAQ) of LQ assessment. Five parameters were assessed: exercise intolerance, attacks frequency, stability, attitudes toward disease, treatment satisfaction. At the visit V0 417 questionnaires were completed (response 71%), at V3 — 454 (response 82%).

Results. The significant increase was demonstrated, for parameters by SAQ in 3 months of observation, the highest parameters, except the scale exercise intolerance, were found in the group taking nicorandil during 3 months of follow-up (p<0,05 for all scale SAQ comparing to the group refused taking nicorandil at baseline or stopped at various stages of the study). By 3 months of follow-up, 3 times increase was noted of the patients with minimal number of angina attacks or absence, and the part of patients found that their life quality is “excellent”. Almost 4 times the part of patients raised by the stability parameter, and the amount by the score “treatment satisfaction” increased to 50,2%. Comparison of ranged SAQ parameters at V0 and V3 visits with Wilcoxon criteria, showed significant differences by all the scales of SAQ (р<0,0001).

Conclusion. Under the real practice circumstances there was significant increase of all LQ parameters by SAQ in 3 months of observation. Most prominent positive changes were noted in patients taking nicorandil during whole follow-up period, comparing to those not taking nicorandil or discontinued at various stages of the study.

Aim. To assess the specifics of endoscopy presentation of mucosal lesions of upper gastrointestinal tract (UGIT) in patients with chronic coronary heart disease (CCHD) with no rhythm disorders and with atrial fibrillation (AF).

Material and methods. Esophagogastroduodenoscopy was done in 100 CCHD patients. All patients were selected to 2 groups comparable by age and gender. First group (n=50) included CCHD patients, the second (n=50) — CCHD with AF. The investigations were performed with videoendoscopic equipment byOLYMPUS systemic videocenters CV-150 and CV-180 EVIS EXERA II.

Results. Evaluating the results of endoscopy, in all 100 patients there were various changes of the mucose of UGIT. No statistically significant differences found, however in CCHD group with rhythm disorder there was noted slight predominance of patients with superficial gastritis, as erosions in anthral part of the stomach. One of explanation of the erosions is due to excessive drug intake per os, that could influence the mucose of UGIT.

Conclusion. All CCHD patients, who have been prescribed the therapy for main disease, are in need for preventive intake of the drugs protecting UGIT.

Aim. To perform comparative analysis of the pregnancy-associated plasma protein A and insulin-like growth factor 1 (PAPP-A and IGF-1) in blood plasma of patients with acute coronary syndrome (ACS). Prediction of 24-hour risk of fatal outcome in ACS.

Material and methods. The concentrations of PAPP-A and IGF-I were assessed in 71 ACS patients, mean age 57 y. o. In the study group, during 24 hours myocardial infarction (MI) was diagnosed in 44, unstable angina in 27, and 9 fatal outcomes. Also, the concentrations of PAPP-A and IGF-I were measured in comparison and control groups. Comparison consisted of 40 hypertension patients with stable ischemic heart disease. Controls were 20 almost healthy persons.

Results. In the study, there was increase of PAPP-A and IGF-I levels in ACS patients. In unstable angina patients PAPP-A is higher than in controls 3,56 times, and in MI patients 11,6 times. In MI, PAPP-A is 3,2 times higher than in unstable angina. In unstable angina patients there the highest levels of IGF-I, and 1,27 higher than in controls. In the study, we showed that IGF-I and PAPP-A levels in acute coronary pathology are linked to the outcome at the first day of the disease.

Conclusion. It is aim full to apply PAPP-A and IGF-I to urgent cardiology practice as an analyzer of atherosclerotic plaque instability in acute coronary events, as a factor of life and disease prognosis.

Aim. To assess the efficacy of algorithms for minimization of the rightventricular stimulation (MVS) for prevention of atrial fibrillation (AF) progression in patients with sick sinus node syndrome (SSS) and documented AF in anamnesis, comparing to standard bi-chamber electrical stimulation (DDDR).

Material and methods. The study was one-center, prospective, randomized trial with consequent 74 patients inclusion, who had indications to permanent DDDR due to SSS and AF in anamnesis. Patients were randomized to DDDR group (n=36) and active MVS (n=38) group. Procedure of electrocardiostimulator (ECS) maintenance was done at 6 months and 1 year. During follow-up visits, information was saved in the ECS memory, as the data on AF burden. Primary endpoints were AF burden and time to persistent AF onset.

Results. During the study, there were no significant differences in AF burden between the groups. Median of AF burden was 6,0 min/day (25- 75 percentiles: 0-42 min/day) in DDDR, and 6,0 min/day (25-75 perc.: 0-42 min/day; p=0,67) in MVS group. Persistent AF development was registered in 5 patients, of those 3 (8,6%) in DDDR and in 2 (5,3%) in MVS (HR 1,25; 95% CI 0,2-7,98; p=0,47). Medication or electrocardioversion was done for 9 (25,7%) patients from DDDR and 12 (31,6%) from MVS groups (HR 0,86, 95% CI 0,31-2,38, p=0,39).

Conclusion. There was no benefit of MVS algorithms in short term period in decrease of AF burden and in its progression prevention towards persistent AF in SSS patients with the anamnesis of paroxysmal AF, comparing to standard DDDR regimen of ECS.

Aim. To assess the level of galectin-3 in blood serum of metabolic syndrome patients (MS), with heart failure (CHF).

Material and methods. Totally, 43 patients investigated, with MS, and of those 37 CHF patients and 33 on-CHF, of those 17 had CHF diagnosed. Galectin-3 level in blood serum was measured by immune enzyme assay.

Results. Galectin-3 level in blood plasma of MS patients was significantly higher comparing to the group with no MS — 1,89±1,71 ng/mL and 1,03±0,22 ng/mL, respectively. In the control group maximum galectin-3 level was 1,5 ng/mL, but in MS group 27% had galectin-3 higher than 3 ng/mL. It was found that mean levels of galectin-3 were significantly higher in CHF group (1,73±1,59 ng/mL) comparing to non-CHF (1,05±0,26 ng/mL).

Conclusion. Level of galectin-3 in MS patients is higher than in those non-MS, but in MS and CHF galectin-3 concentration is higher than nonCHF. Further elaboration on this relationship might be useful in improvement of CHD and MS diagnostics.

Aim. Investigation and analysis of clinical-hemodynamic signs of chronic heart failure (CHF) at the age 42-89 y. o., including the assessment of gender and comorbidities, according to ejection fraction (EF) of the left ventricle (LV): preserved EF LV ≥45% (HFpEF) and low EF LV <45% (HFrEF).

Material and methods. Totally, 120 CHF patients studied, age 42-89 y. o., with assessment of gender and comorbidities, accoring to ejection fraction (EF) of the left ventricle (LV): preserved EF LV ≥45% (HFpEF) and low EF LV <45% (HFrEF).

Results. In most cases the etiology of CHF was coronary heart disease (CHF) — 58,8%, and in 68,3% cases it was comorbid with arterial hypertension (AH). Assessment of CHF in patients with various EF LV showed that in both groups males predominated. In HFrEF there were more overweight patients (41,1%) and in HFpEF — obesity patients (51,6%). In HFrEF patients main factors leading to myocardial impairment were myocardial infarctions in anamnesis (91,1%), and in HFpEF — CHD with AH (81,3%), obesity (51,6%) and diabetes (43,8%). Extracardiac comorbidity in HFrEF was mostly chronic obstructive pulmonary (26,8%) and obliterate atherosclerosis of lower extremities arteries (17,9%), and HFpEF — congestion pneumonia (23,4%) and varicose vein disease (34,4%).

Conclusion. Patients with HFrEF — are mostly the CHD patients having risk factors: smoking, alcohol overconsumption, excessive physical exertion. HFpEF patients are mostly CHD+AH, most of them had metabolic disorders. Most cases of varicose vein disease and pneumonia in HFrEF can be explained by obesity and increased rate of diabetes. Cases of vascular dementia in HFpEF patients are related to higher prevalence of AH and its complications.

Aim. To analyze relation of blood aldosterone level with comorbidities in patients with chronic heart failure (CHF) with preserved ejection fraction of the left ventricle (EF LV).

Material and methods. To the cross-sectional study, 158 patients included: 58 males, 100 females, mean age 62,3±7,4 y. o., with decompensated CHF with preserved EF LV (>50%) and diastolic dysfunction. Patients did not present with primary hyperaldosteronism and did not take mineralocorticoid antagonists within previous 6 weeks. All patients underwent blood specimens collection, and were assessed on the comorbid disorders and conditions. Reference values of the hormone were 40-160 pg/mL.

Results. According to the measurements, all patients were selected to two groups: I group included 99 (67,1%) of patients, who had normal hormone level; II — 59 (37,3%) patients with hyperaldosteronemia. Group II patients were younger — 57,75±7,5 y. o. vs 65,02±7,1 y. o. (p<0,001) and had more prominent presentation of the CHF (NYHA III) — 62,7% vs 33,3% cases (p<0,001) comparing to the group I. The prevalence of previus myocardial infarction was — 59,3% vs 41,4% (p=0,044), comorbid atrial fibrillation — 33,9% vs 17,2% (p=0,027), long-term (>10 years) arterial hypertension (AH) — 57,6% vs 25,3% (p<0,001), chronic obstructive lung disease (COLD) — 27,1% vs 7,1% (p=0,001), diabetes mellitus — 39,0% and 19,2% (p=0,011), obesity — 64,4% and 29,3% (p<0,001), and renal dysfunction — 88,1% and 50,5% (p<0,001) in the group II significantly higher than in group I. Multiple regression showed that after correction by age and severity of CHF, only long lasting AH, COLD, obesity and renal dysfunction were associated with hyperaldosteronemia.

Conclusion. In CHF with preserved EF LV patients, aldosterone level is closely linked with comorbidities. Long term anamnesis of AH, presence of COLD, obesity and renal dysfunction are independent factors for the risk of secondary hyperaldosteronism.

2 FSBEIHEI.P. PavlovRyazanskyStateMedicalUniversity. Ryazan,Russia

Aim. To evaluate the practice of beta-blockers (BB) usage in cardiovascular disease (CVD) patients with diabetes (DM) in two outpatient registries.

Material and methods. Registry PROFILE is the patients (n=1531) with CVD, visited specialized cardiological department of medical research center of Moscow during the period 2011-2015, and registry RECVAZA — patients (n=3690), visited 3 city polyclinics in Ryazan city in 2012-2013.
Number of DM patients is 221 (14,4%) in PROFILE and 699 (18,9%) in RECVAZA.

Results. In the RECVAZA, the rate of BB prescription was almost the same in CVD and DM; in PROFILE there was significantly more frequent prescription of BB, especially after myocardial infarction (86,4%) and in chronic heart failure (72,6%). In both registries bisoprolol was in use most commonly: 61,8% in PROFILE and 75,4% in RECVAZA. Among DM patients, not taking BB, in PROFILE registry there were additional contraindications: chronic obstructive pulmonary disease and asthma, than in RECVAZA.

Conclusion. Clinicians of the specialized cardiological department, comparing to clinicians in local outpatient institutions more actively prescribed BB to DM patients, especially in the cases when this could improve long-term outcomes of the disease. This matches with recent clinical guidelines.

Aim. To investigate on the influence of cardiovascular diseases (CVD) on mortality in 25 thousand inhabitants of the typical city ofWestern Siberia.

Material and methods. Under the framework of international World Health Organization project “Epidemiological Studies into Long-term Trends of Population Health in Russia” with participation of 45 clinicians in medical institutions of the city, the cases of 26186 deaths were assessed, men and women 15-74 year old.

Results. The mortality from CVD was 34,9% and 44% in men and women; from coronary heart disease — 59,8% and 41,3%; from cerebrovascular disease — 29,2% and 39,9%, resp. Smoking was found in 68,7% men and 12% women; with the mean time of 41,3 and 38,9 years, respectively; smoking increased the risk 1,49-1,56 times. In the moderate and high tobacco consumption rates, risk of death increased (p<0,0001, p=0,002), as in any kind of smoking in economically active persons, more than 2 times. The decrease of life duration in smoking women and in lethal cases from coronary heart disease was 6,5 years (p<0,001), in men — 3,7 years; from CVD — 5,3 and 2,7 years, respectively.

Conclusion. The role of smoking was assessed in mortality from CVD, as the necessity confirmed for prevention of smoking at regional level.

RETRACTED

Comorbidity of chronic non-communicable diseases is actual problem of modern medicine. It was found, that metabolic syndrome (MS) is pathogenetically related with erectile dysfunction (ED), hypogonadism, gout and urolithiasis, that is an example of comorbidity. The article is focused on a wide spectrum of MS and urolithiasis relation. Taken high prevalence of urolithiasis and MS, scientists have found close correlation of MS cases with urolithiasys development. Most oftenly in MS patients urates are found. Pathophysiological mechanisms formulated for oxalates and mixed urolithes formation in MS patients. Therefore, in development of diagnostics, treatment and prevention algorithms of both disorders it is important to take into consideration the comorbidity.

The article is focused on the issue of treatment adherence in cardiovascular patients, that is important due to chronic course of cardiovascular diseases (CVD), necessity for long-term therapy and, also, seriously low adherence to treatment in this category of patients. The issues considered, on the objective assessment of adherence. Literature data provided, on the factors influencing adherence. The review focuses on recent data on the solutions of low adherence management in CVD patients. The recommendations given, on the ways for adherence improvement in real clinical practice. 

Regardless the global demographic tendencies of life duration increase, longevity and super longevity remain quite understudied and non-fully understood population. Broader studies needed to understand, what it means to live by 100-year old. Lots of studies are about the longevity predictors and ways of ageing, that could be therapeutical targets not simply for life duration, but life quality as well, and medical-social geriatrics. The program “A Centenarian”, being conducted by leading scientific groups inRussia, is approaching a country unique medical, scientific and social data. 

The article is focused on the analysis of modern fundamental studies of the preconditioning/preintervention phenomenon in coronary heart disease and heart failure. Brief prerequisites are given for the phenomenon assessment. Molecular and genetic base of the phenomenon presented, as the results of modern experimental works in the area of fundamental medicine and clinical observations of the patients with various cardiovascular diseases. Hypoxia-induced factor 1 — main pathogenetic adaptation factor for hypoxia — plays critical protection role in pathophysiology of coronary heart disease and heart failure, controlling and determining the supply and utilization of oxygen, regulating angiogenesis and vascular remodelling, glucose metabolism and redox exchange. Personalized medicine technology, based on the pharmacogenomics, pharmacoproteomics, makes it to implement fundamental discoveries in medicine to clinical practice.

In the review, recent data presented, on possible targets for medications of specific pathogenetic action in atherosclerosis. The results described, of application of some drugs in complex treatment of atherosclerotic vessels lesions. The data can be applied for target development of antiatherosclerotic drugs with the aim of prevented progression of atherosclerosis and thromboembolic complications.

Aim. The study was aimed on the importance evaluation of the false chords (FC) diagnostics in the left ventricle (LV) of the heart at early age to predict connective tissue dysplasia (CTD) development.

Material and methods. The study performed at cardiorheumatological department of MAI “CCCH №11” of Yekaterinburg city. Case histories of 200 patients analyzed, of those had undergone treatment in the department last 6 months. Group consisted of children aged 1 month to 17 year old, mean age 9,7±4,6 y. o. Phenotype of CTD was evaluated according to theGent score criteria (2010) and the Score by Kadurina T. I. et al. Heart structure and functioning were assessed with bi-dimensional transthoracic echocardiography. Statistics was done with SPSS Statistics 17.0 and Microsoft Office Excel 2013.

Results. All children had phenotype markers of CTD syndrome. Significance assessment of CTD by Kadurina score was 8,1±3,8 (2-33) points, that is grade 1 severity of CTD. In 17% (n=34) of children there was moderate CTD grade, and in 10% (n=20) there were dysplastic changes in ≥3 organ systems. Most of patients (95,5%) had FC (2,0±0,5 U) localized in various areas of the LV. Chords always correlated with phenotypic CTD markers in other physiological systems. And the number of concomitant markers significantly increased with the children’s age.

Conclusion. In most cases CTD syndrome is associated with the changes in the heart, and FC inLV can be regarded as easy approachable and most early and reliable phenotypical marker of this systemic disorder.

Aim. To evaluate diagnostic significance of the type A vascular endothelial growth factor (VEGF-A) and its receptors type 1 and 2 (VEGF-R1 and VEGF-R2) in primary mitral valve prolapse (MVP) patients.

Material and methods. Totally, 83 MVP patients studied: 61 males, 22 females; mean age 21,93±4,22 y. o. The signs of systemic inflammation were assessed, as the grade of connective tissue involvement. Immune enzyme analysis was done for serum levels of VEGF-А, VEGF-R1 and VEGF-R2 (“Bender MedSystems GmbH”,Austria). Controls included 20 healthy volunteers — 14 males, 6 females, mean age 21,10±0,55 y. o. with no MVP and any other dysplastic features.

Results. In the MVP group, the decreased levels of circulating VEGF-R1 were found, as the increase of cases number of high (42,17%) and low (32,53%) concentration of VEGF-А. In low levels of VEGF-A and VEGF-A/ VEGF-R1 prevalence of grade II mitral regurgitation increases 5,1 times comparing to the group of retained balance of VEGF-A and VEGF-R1 — 95% confidence interval (CI) 1,25-20,88, and the prevalence of clinically significant cardiac rhythm and conduction disorders increases 5,25 times in comparison to the cases with elevated VEGF-A and VEGF-R1 — 95% CI 1,33-20,76 and 4,09 times — comparing MVP patients with retained balance of VEGF-A and VEGF-R1 — 95% CI 1,18-14,17.

Conclusion. In primary MVP patients, regardless clinical phenotype of monogenic hereditary syndromes, the heterogeneity of deviation and regulation of VEGF has been established. Highest number of II grade mitral regurgitation, significant rhythm disorders was found in the group with low VEGF-A and VEGF-A/VEGF-R1, that might be implemented as optimized risk stratification in heterogenic MVP patients population.