Aim. To assess deformation characteristics of normal left ventricular (LV) myocardium and hypertrophied LV myocardium in arterial hypertension (AH) patients, using tissue Doppler examination of LV lateral wall and interventricular septum (IVS).

Material and methods. In total, 30 healthy subjects from the control group (CG) and 80 AH patients were examined: Group I (n=40) with moderate LV hypertrophy (LVН), Group II (n=40) with severe LVН.

Results. Systolic and early diastolic strain rates (SRsys, SRe) in Group II patients were significantly reduced for middle and apical IVS segments, comparing to the controls. The difference between Groups I and II was manifested in decreased SRe for basal IVS segment and lateral LV wall. The analysis of isovolumic contraction and relaxation time on SR graphs demonstrated a two-phase structure in healthy controls and AH patients with LVН. The duration of prolonged phase of isovolumic contraction (IVC) and negative phase of isovolumic relaxation (IVR) depended on LVН severity. There was a significant association between LVН parameters and deformation parameters of LV myocardium.

Conclusion. There was an association between LVН and deformation parameters of LV myocardium (SR, ε). In AH patients, increased dynamic activity of left atrium was associated with disturbed relaxation of hypertrophied LV myocardium. The duration of positive IVC component and negative IVR component on SR graphs was longer in higher LV myocardial mass index (LV MMI), especially for middle LV segments. Increase in LV MMI correlated with decrease in segmental LV myocardium deformation. Positive association between systolic deformation, LVH severity, systolic blood pressure, and diastolic LV wall thickness was observed.

Aim. To study arteriolar blood flow velocity and salt consumption in patients with Type 2 diabetes mellitus (DM-2) and arterial hypertension (AH); to clarify the causes and pathogenetic mechanisms of the latter.

Material and methods. In total, 258 patients with DM-2 and AH were examined (mean age 54+1,16 years, disease duration 9,8+0,91 years). The control group (CG) included 110 age-matched healthy people. Taste sensitivity to salt (TSS), 24-hour urinary sodium excretion, and microcirculatory Doppler ultrasound were performed.

Results. In patients with DM-2 and AH, decreased TSS resulted in involuntary increase of salt intake with food, which was confirmed by increased urinary sodium excretion. Arteriolar blood flow was significantly decreased in DM-2 participants, which indirectly pointed to arteriolar vasodilatation in AH.

Conclusion. Volume-dependent mechanism (hypervolemia) plays a leading role in AH genesis among DM-2 patients. This should be taken into consideration while planning treatment and prevention strategies in individuals with DM-2 and AH.

Aim. To assess the effectiveness of non-pharmaceutical body weight (BW) reduction and its influence on clinical quinapril effectiveness in patients with arterial hypertension (AH) and obesity.

Material and methods. Fifty AH patients - men and women aged 34-71 years (mean age 50,8+1,78 years) were examined. Physical examination, anthropometry, measurement of body mass index (BMI) and blood pressure (BP) by Korotkoff method, 24-hour BP monitoring (BMP) and visceral fat measurement with OMRON BF 302 device were performed.

Results. In all participants, significant reduction in office BP (p<0,05), systolic BP (SBP) and pressure load area index (AI) for SBP by 24-hour BPM data (p<0,05) were observed. In participants with BW reduction, 16-week therapy was associated with reductions in office SBP (-20,29 %) and diastolic BP, DBP (-21,22 %), mean BP (-8,5 %), SBP and DBP by 24-hour BPM data (-7,43 % and-8,39 %, respectively; p<0,05), as well as in heart rate, HR (-8,2 %; p<0,05). Among those with BW reduction, SBP AI decreased by 51,13 %, DBP AI - by 38,93 %, SBP time index (TI) - by 37,9 %, and DBP TI - by 45,6 %. Circadian BP profile also changed.

Conclusion. In participants without BW reduction, antihypertensive therapy was less effective than the combination of pharmaceutical and non-pharmaceutical treatment. Comparing to standard quinapril therapy, its combination with BW reduction was associated with better dynamics of 24-hour BPM results.

Aim. To study the effects of 24-week treatment with trandolapril, as monotherapy or combined with verapamil, on parameters of 24-hour blood pressure monitoring (BPM), carbohydrate, lipid, and purine metabolism, tissue insulin sensitivity and microalbuminuria (MAU) in patients with mild to moderate arterial hypertension (AH) and metabolic syndrome (MS).

Material and methods. The study included 20 patients with Stage I-II AH and MS. Initial dose of trandolapril was 2 mg/d, administered in the morning. If needed, trandolapril dose was doubled one week later. One more week later, all patients not achieving target BP levels were administered verapamil SR (240 mg/d). At baseline and 24 weeks after therapy start, levels of MAU, carbohydrate and lipid metabolism, 24-hour BPM were measured.

Results. Six patients achieved target BP levels receiving trandolapril monotherapy only (4 mg/d). For 14 participants, additional treatment with verapamil SR (240 mg/d) was necessary for achieving target BP levels. Fasting glucose and postprandial C-reactive protein levels significantly decreased (p<0,05), as well as the levels of total cholesterol (CH) and low-density lipoprotein CH. MAU levels were similar to baseline parameters: 13,0+5,8 and 12,9+4,33 mg/1.

Conclusion. Trandolapril and verapamil combination, being metabolically neutral, demonstrated good antihypertensive effects and improvement of carbohydrate and lipid metabolism parameters.

Aim. To investigate nighttime sleep disturbances in patients with essential arterial hypertension (EAH) and possible effects of these disturbances on EAH clinical course.

Material and methods. In total, 98 patients with Stage I-II EAH were examined. All participants underwent standard clinical examination, 24-hour blood pressure monitoring (BPM), questionnaire survey on nighttime sleep disturbances, and time deficit level measurement.

Results. EAH patients were characterized by frequent intrasomnic and presomnic disturbances, such as difficulty falling asleep, frequent night awakening, snoring, and superficial sleep. Fifty per cent of the patients regarded general quality of their sleep as "good", 35,71 % - as "fair", 10,20 % - as "bad", and only 4,08 % - as "very good". A group of EAH patients was identified, characterised by severe nighttime sleep disorders, elevated anxiety level, and disturbed circadian BP profile (non-dippers, night-peakers).

Conclusion. EAH patients often suffered from somnologic disturbances, which progressed with longer duration and more severe clinical course of the disease. For early EAH stages, intra- and presomnic disturbances were typical, with further development of general sleep structure disorders.

Aim. To investigate the link between renal function and morning surge rate (MSR) of systolic blood pressure (SBP) in young men with arterial hypertension (AH), aged under 35 years.

Material and methods. The study included 58 young men with essential AH, aged 18-35 years (mean AH duration 4+1,5 years). Twenty-four-hour BP monitoring (BPM), dynamic angionephroscintigraphy with DTPA 99mTc, and 24-hour microalbuminuria assessment were performed in all participants.

Results. In patients with normal SBP MSR, mean total glomerular filtration rate (GFR) was 151,6+38,9, among patients with elevated SBP MSR - 125,4+36,9 (p=0,06). Among those with normal SBP MSR, mean total GFR was 140,4+34,7 in Stage II AH, and 190,5+28,9 in Stage III AH (p=0,07). Among subjects with elevated SBP MSR, mean total GFR was 174+27,2, 117,2+33,1 (p=0,01), and 125,5+37,1 in Stage I, II, and III AH, respectively.

Conclusion. AH progression was associated with higher prevalence of elevated SBP MSR. For AH patients with normal SBP MSR, hyperfiltration was more typical, while subjects with elevated SBP MSR were characterized by progressively decreasing total GFR, from hyperfiltration to normofiltration

Aim. To investigate endothelial dysfunction (ED) in patients with coronary heart disease (CHD), stable effort angina, Functional Class (FC) I-III, as well as to study perindopril potential in ED correction.

Material and methods. The study included 37 CHD patients (22 men, 15 women; mean age 62,2+5,3 years) with FC I-II (n=22) and FC III angina (n=15). The control group included 16 healthy individuals. Fndothelium-dependent vasodilatation (FDVD) of brachial artery (BA) was assessed in reactive hyperemia test at baseline and after 6 weeks of perindopril therapy (8 mg/d); in controls, FDVD was assessed at baseline only.

Results. At baseline, ED was observed in 79 % of CHD patients: in 42 %, as an inadequate vasodilatation effect (< 10 % from the baseline), and in other 37 %, as no BA diameter increase or vasoconstriction. ED was more prevalent in individuals with FC III angina (93 %) than in participants with FC I-II angina (69 %). Perindopril therapy was associated with increased numbers of patients with vasodilatation > 10 % (+9 %)or<10 % (+3,5 %), while the number of participants with vasoconstriction reduced by 12,5 %. The number of ED participants reduced by 26 % and 8 % for FC I-II and FC III, respectively. Among those with FC I-II angina, perindopril treatment was associated with significant increase in BA diameter (+9,8 %; p<0,05), linear and volumic blood flow velocity (from 15,0+1,9 to 41,5+2,1 cm/s (p<0,05) and from 2,1+0,5 to 6,9+0,5 ml/s (p<0,05), respectively).

Conclusion. Adding perindopril (8 mg/d) to standard anti-ischemic therapy was associated with reduced ED, which could be regarded as a vasoprotective perindopril effect.

Aim. To investigate myocardial kinetics in atrio-ventricular junction (AVJ) area among patients with persistent atrial fibrillation (PAF).

Material and methods. The main group included 34 patients with PAF, the comparison group - 20 patients with coronary heart disease (CHD) without myocardial infarction or arrhythmias in anamnesis, the control group -20 healthy people. General clinical examination and Doppler tissue imaging (DTI) echocardiography were performed. The difference in velocity of lower interatrial septum segment and upper interventricular septum segment (asynchronism) along longitudinal cardial axis in various cardiac cycle phases was studied. Univariate dispersion and non-parametric correlation methods were used for statistical analysis.

Results. Asynchronism severity was weakly related to standard parameters of systolic and diastolic myocardial function. In CHD patients, regardless of arrhythmia type, asynchronism was significantly less manifested during ventricular isovolumic relaxation (+ and - waves) and passive filling periods, comparing to healthy individuals. Similar tendencies were observed for other cardiac cycle phases. In patients with CHD and PAF, asynchronism was even less manifested, observed mainly in pre-ejection and ejection periods.

Conclusion. The results obtained reflected morphologically verified fibrosis, typical for PAF, and demonstrated satisfactory diagnostic potential of DTI method.

Aim. To study clinical and diagnostic value of chronic inflammation markers in patients with chronic heart failure (CHF), receiving standard therapy (ST) including ACE inhibitors, or ST including ACE I inhibitors combined with aspirin (ST + aspirin).

Material and methods. The study included 120 CHF patients aged 45-74 years. Clinical examination and measurement of serum cytokine levels (solid-phase immuno-enzyme analysis) and plasma C-reactive protein (CRP) level (photometric turbidimetry method) were performed.

Results. In Functional Class (FC) II-III CHF patients, ST was associated with clinical improvement and decreased levels of pro-inflammatory cytokines and CRP. ST + aspirin therapy was not associated with the decrease in cytokine and CRP levels; moreover, these levels were increased in some FC II-III CHF individuals.

Conclusion. The results obtained could be used as additional criteria for CHF clinical course assessment and therapy effectiveness control.

Aim. To investigate sudden cardiac death (SCD) predictors in patients after myocardial infarction (MI), to develop the strategy of risk stratification and SCD prevention.

Material and methods. In total, 420 patients were examined at Day 10-14 after MI; follow-up period lasted for 1-4 years. General clinical examination, echocardiography, 24-hour electrocardiography (ECG) monitoring, late ventricular potentials (LVP) detection, active orthostatic test (AOT), heart rate variability (HRV) assessment at baseline and during functional tests, as well as psychological testing, were performed. Some participants underwent coronarography and endocardial electrophysiological examination. SCD risk was assessed by Cox multi-factor analysis and Kaplan-Meier survival curve method.

Results. According to Cox multivariate regression analysis, the most important predictors included the following six parameters: LVP, HRV reduction, left ventricular ejection fraction <40 %, ventricular arrhythmias, previous MI, and hypotension in AOT Prognostic accuracy and positive predictive value of this model were high enough to assess SCD risk. Based on modeling results, in particular, on the presence of structural and trigger mechanisms of life-threatening arrhythmias, SCD risk stratification was performed. Differential preventive strategy was based on risk levels.

Conclusion. In patients after MI, SCD risk stratification (very high, high, intermediate, and low risk), together with differential preventive measures, facilitated a two-fold reduction in sudden and cardiac death incidence, comparing to the control group.

Aim. To study a potential link between increased QT dispersion (dQT) during physical stress test (PST) and coronary artery (CA) atherosclerosis in patients with coronary heart disease (CHD).

Material and methods. In total, 116 CHD patients with Functional Class II-III angina were examined (mean age 49,9+9,1 years). All participants underwent treadmill PST (Bruce protocol) and coronary angiography. Mean, minimal and maximal QT duration, as well as ∆QT, were measured. Heart rate-corrected ∆QT (QTc) was calculated using Bazett HC formula.

Results. In patients with dQTc increase (A∆QTc) >20mc1/2 or with ∆QTc >60mc1/2, atherosclerosis of left CA trunk or proximal segment of anterior descending CA was observed twice as often as in the other participants.

Aim. To assess carvedilol and bisoprolol effects on clinical symptoms, hemodynamics and morpho-functional heart characteristics in patients with myocardial infarction (MI) and chronic heart failure (CHF).

Material and methods. The study included 40 patients with CHF and MI, randomized into two groups: Group I (n=20) received standard therapy and carvedilol, Group II (n=20) - standard therapy and bisoprolol.

Results. In both groups, the therapy was associated with substantial clinical improvement and decrease in most parameters of circadian blood pressure (BP) profile. Carvedilol therapy was linked to greater reduction in daytime and nighttime systolic and diastolic BP variability. Significant reduction in left ventricular (LV) wall thickness and LV myocardial mass was observed in both groups.

Conclusion. Additional therapy with carvedilol and bisoprolol improved clinical status of patients with MI and CHF. Carvedilol therapy had greater and more stable antihypertensive effect. After 12 weeks of carvedilol or bisoprolol treatment, similar LV hypertrophy (LVH) regression was observed. Carvedilol therapy was associated not only with LVH regression, but also with substantially increased LV contractility, improved LV diastolic function, and normalized diastole structure.

Aim. To analyze disease attitude types, psychological protection mechanisms and their dynamics during ericksonian hypnosis, electrosomnotherapy, and audiovisual stimulation in patients with myocardial infarction (MI) undergoing sanatorium rehabilitation.

Material and methods. The study included 155 MI patients, aged 32-66 years. Lifestyle index, Heim question naire, and Disease Attitude Type methods were used.

Results. Hypnosis improved coping strategies in patients without psychopathologic symptoms or post-MI angina, with arrhythmias, threshold capacity ≥75 Wt, or secondary education. Electrosomnotherapy was effective in participants with higher education and without arterial hypertension. Audiovisual stimulation negatively affected coping strategies. Psychological protection mechanisms remained the same at various treatment stages. Audiovisual stimulation was associated with ergopathic type usage.

Aim. To assess the use of recommended standards for effort angina (EA) management and target achievement in EA pharmacotherapy among Voronezh general practitioners and district therapeutists.

Material and methods. Therapy tactics and results were analyzed for 73 patients with coronary heart disease (CHD), Functional Class II-III EA, treated at 5 Voronezh polyclinics. At each polyclinic, one patient treated by a general practitioner, and one patient treated by a district therapeutist, were recruited.

Results. In total, 95 % of Voronezh doctors used medications recommended by official treatment standards. In some patients, not achieving target heart rate levels due to lacking or inadequate heart rate-reducing therapy, ivabradine was administered.

Conclusion. In ambulatory treatment of EA, ivabradine demonstrated a good heart rate-reducing effect and a significant reduction in angina attack rate.

Aim. To study the prevalence of selected cardiovascular risk factors in young people with arterial hypertension (AH) and high normal blood pressure (HNBP), to clarify primary AH prevention strategies.

Material and methods. The study included 2280 students (1041 men, 1239 women) aged 18-25 years. Body mass index and waist circumference were measured to identify obesity type. Prevalence of smoking, lipid, fiber, alcohol consumption patterns, and alcohol dependence severity were assessed by questionnaire survey.

Results. AH was diagnosed in 10,6 % of the students, HNBP - in 12,4 %, optimal BP - in 41 %, and normal BP -in 36 %. Abdominal obesity was 3 times more common in women than in men. For men, smoking, alcohol drinking, and cholesterol-rich food consumption were typical.

Conclusion. In male students, AH prevalence was 3 times higher, and HNBP prevalence - more than 4 times higher than in female students. Three or four risk factors were identified only in individuals with AH or HNBP, more often in females, due to higher prevalence of increased body weight among women.

Aim. To identify main barriers for statin prescription by doctors in real-world clinical practice.

Material and methods. In total, 568 doctors from Krasnodar City and Krasnodar Region were surveyed on possible reasons for inadequate statin prescription.

Results. About 50 % of the doctors were afraid of possible statin hepatotoxicity and one third - of potential adverse effects. About 20 % believed that target lipid levels could be achieved by diet only. The vast majority (80 %) did not prescribe statins due to "high cost".

Conclusion. Clinician-oriented educational programs on lipid-lowering therapy should be continued. The emphasis should be put on statin therapy safety, its lipid-lowering and pleiotropic effects, as well as on the importance of achieving target lipid levels in various clinical situations.

Aim. To assess effectiveness and tolerability of rosuvastatin treatment, as a part of primary and secondary cardiovascular prevention, in patients with high and very high cardiovascular risk and dyslipidemia.

Material and methods. Forty patients received rosuvastatin (starting dose 10 mg/d) for 12 weeks. At baseline, medical history collection, physical and instrumental examination, blood biochemical assay (creatinine, glucose, lipids, aminotransferase, bilirubin, urea levels) and general urine assay were performed. Four and 12 weeks later, complex assessment of rosuvastatin effectiveness and safety took place. If target levels of low- or high-density lipoprotein cholesterol (FDF-CH, <2,6 mmol/1; HDF-CH, >1,2 mmol/1) were not achieved, rosuvastatin dose increased up to 20 mg/d. After 4 and 12 weeks, all parameters measured previously were re-assessed, including patients' complaints, therapy compliance, and adverse effects, if any.

Results. After 4 and 12 weeks of rosuvastatin treatment, lipid profile normalized in most patients, target FDF-CH, HDF-CH, and triglyceride levels were achieved in 63 %, 65 %, and 68 %, respectively. Mean rosuvastatin dose was 10,6 mg/d. Fhe medication was well tolerated.

Conclusion. Rosuvastatin demonstrated not only high lipid-lowering effectiveness, but also good tolerability.

According to modern views, microcirculation (MC) disturbances are an obligatory component of most inflammatory, dystrophic and involutive processes affecting skin cell function and structure.

Aim. To study MC in ageing skin, according to different ageing types.

Material and methods. The study included 135 patients with involutive skin changes - women aged 35-60 years (mean age 46,3?9,1 years). MC was studied by laser Doppler fiowmetry (LDF).

Results. Comparing LDF and visual skin ageing assessment results, the following associations were observed: spastic MC was typical for small-wrinkle middle ageing type; MC disturbances affected arterioles and venules: increased arteriole tonus and venular stasis resulted in reduced MC index. In patients with deformation middle ageing type, atonic MC affected arterioles and capillaries: decreased arteriole tonus, increased blood volume in arterioles, resistant and nutritive vessel stasis. MC index was twice as high as in small-wrinkle ageing type (p<0,01). Late ageing type was characterised by spastico-congestive MC at all levels: increased myogenic tonus of arterioles, capillary and venular stasis.

Conclusion. Skin ageing was characterized not only by skin dryness, increased transepidermal water loss and decreased skin elasticity, but also by substantial MC disturbances, specific for each skin ageing type.

18–20 февраля 2008г в г. Тюмени состоялся III Съезд кардиологов Уральского федерального округа.