Search

Introduction. Thrombotic complications (TC) in different vascular systems dictate the fate of high-risk patients. In cardiological practice, patients with advanced atherosclerotic vascular disease (MFA) represent the most vulnerable group. Malignant neoplasm (MN) is one of the most significant risk factors for developing TCs, especially in the context of antineoplastic therapy. The presence of significant differences in the mechanisms of thrombogenesis in malignant neoplasms and atherosclerosis determines the appropriateness of a comparative study of markers of coagulation activation and endothelial damage in order to identify common features and differences specific to each pathology. Aim. To examine markers of coagulation activation and growth factors in active cancer and advanced atherosclerotic vascular disease, to identify their common features and differences specific to each pathology. Materials and methods. A total of 22 patients with MN (Group 1) and 58 patients with MFA (Group 2) were enrolled in the study. The assessed biomarkers included: von Willebrand factor (VWF), D-dimer, growth differentiation factor-15 (GDF-15) and vascular endothelial growth factor A (VEGF-A). Results. Patients with MN had an increased likelihood of disease progression within 6 months at D-dimer level > 1121 ng/mL (OR = 10.5; 95% CI 1.4–81.0, p = 0.014) or VWF > 189% (OR 10.5, 95% CI 1.36–81.0, p = 0.014); the likelihood of death within two years of follow-up at D-dimer level > 1121 ng/mL (OR = 7.0; 95% CI 0.97–50.57, p = 0.04), or VWF > 203% (OR = 10, 5, 95% CI 1.36–81.06, p = 0.014). In patients with MFA, the likelihood of prognosis determining events within one-year of follow-up was determined by increased levels of VWF > 157% (OR = 9.2, 95% CI 1.02–82.8, p = 0.048) and GDF-15 > 1548 pg/ml (OR = 5.7; 95% CI 1.09–29.5, p = 0.04). Conclusions. Endothelial damage and coagulation activation are more pronounced in patients with MN than in patients with MFA. In patients with malignant neoplasms, the outcomes were associated with D-dimer and VWF levels, and in patients with MFA – with VWF and GDF-15 levels.

Aim To study the relationship between monomeric C-reactive protein (mCRP) and the progression of asymptomatic carotid atherosclerosis in patients with a moderate risk for cardiovascular diseases (CVD) as assessed with the SCORE model.Material and methods The study included 80 men and women aged 53.1±5.8 years assigned to the category of a moderate risk for CVDs by the SCORE model with a low-density lipoprotein cholesterol (LDL-C) level of 2.7–4.8 mmol/l and asymptomatic, hemodynamically insignificant (Results A concentration of LDL-C Conclusion According to the results of 7-year follow-up, the plasma concentration of mCRP was significantly higher in patients with an increased number of ASPs than in patients without this increase. An increased level of mCRP may indicate a higher inflammatory risk of CVD.

We present a case of cardiomyopathy with a reduced left ventricular ejection fraction of up to 18%, multivessel arterial thrombosis in a patient who had undergone severe COVID-19 3.5 months earlier. The cardiopathy was initially considered as an outcome of SARSCoV2-induced myocarditis, but MRI with delayed gadolinium contrast revealed no fibrosis or evidence of active myocarditis. A detailed collection of the medical history showed that the duration of tachyform atrial fibrillation exceeded the 4 months indicated in the medical records. Oligosymptomatic manifestation of arrhythmia occurred 8 months earlier, the patient did not consult a physician due to epidemic conditions. Coronary angiography revealed subtotal stenosis of the anterior descending artery. Most probably, the cardiopathy was arrhythmogenic and ischemic. After achieving normosystole and coronary stenting, the left ventricular ejection fraction was 25-27%. At the first hospitalization 4 months ago, left atrial auricular thrombus was detected. After COVID-19 the patient received inadequately low dose of apixaban 5 mg per day. Three weeks after COVID-19, the patient was diagnosed with infarction of the right kidney, wall thrombosis in the abdominal aorta, thrombosis of the superficial femoral, deep femoral, popliteal, anterior tibial arteries on the left, right popliteal artery; thrombotic complications could have developed both in situ and as a result of cardioembolism. Administration of dabigatran 300 mg per day and aspirin helped to dissolve the thrombus in the left atrial auricle, improve the course of intermittent claudication, and avoid recurrent thrombotic complications. COVID-19 could contribute to the progression of atherosclerosis, more malignant course of atrial fibrillation, development of thrombosis, but coronavirus infection is not the only cause of severe disease in a patient. СOVID-19 can not only be the cause of direct lesions of the heart and vessels, but also have an indirect negative effect - to delay the detection of cardiac pathology and be the cause of its hypodiagnosis under the mask of “postcovid”.

The guidelines have been developed for internists, general practitioners, emergency physicians, and paramedics. The guidelines are based on expert consensus papers, accumulated clinical and scientific experience. The methodology for organizing and conducting ultrasound-assisted examinations is described in detail. Algorithms for diagnosing the main syndromes in internal medicine practice are presented to help the practitioner. Particular attention is paid to the methodology of ultrasoundassisted examinations. These guidelines will be of interest to doctors, heads of medical facilities, as well as students of medical universities.

The study was aimed at assessing the in-hospital results of aortic arch endoprosthetic repair using different variants of endovascular supraaortic debranching.The analysis included 27 patients subjected within the framework of aortic arch endoprosthetic repair to various types of supraaortic endobranching, including the technique of parallel prostheses and implantation of fenestrated stent grafts. We analysed the clinical and morphological status of patients prior to operation, peculiarities of the intervention (type of debranching and Ishimaru's classification zones in which the reconstruction was performed) and in-hospital results of treatment.The patients' mean age amounted to 66 years. The main nosology (70%) was an aortic aneurysm. Nearly in 30% of cases, the operation was performed emergently for acute aortic syndrome. The main causes of refusal from the traditional prosthetic repair included chronic kidney disease (22.5%), chronic obstructive pulmonary disease (11%), acute cerebral ischaemia within the previous 6 months (15%). The technical success rate of the operation was achieved in 100% of cases. The average duration of the intervention amounted to 226 min, with the mean blood loss equalling 355 ml. The majority of reconstructions were performed in zones 1 and 2 according to Ishimaru (59 and 33%, respectively), in 2 (7%) patients prosthetic repair was performed in zone 0. The total number of the aortic branches involved into reconstruction amounted to 45. Intervention-related complications included 3 (11%) cases of acute cerebral circulation impairment, 2 (7.4%) aortic branch occlusions, and 1 (3.7%) type II endoleak. The in-hospital and 30-day mortality rates amounted to 3.7 and 7.4%, respectively.Aortic arch endoprosthetic repair using supraaortic endobranching is considered to be an effective alternative method of treatment for patients with various pathology of the aortic arch and contraindications to traditional prosthetic repair involving artificial blood circulation.Цель. Оценка госпитальных результатов эндопротезирования дуги аорты с применением различных вариантов эндоваскулярного супрааортального дебранчинга. Материалы и методы. В анализ было отобрано 27 пациентов, которым в рамках эндопротезирования дуги аорты выполнялись различные виды супрааортального эндодебранчинга, включавшие в себя методику параллельных протезов и имплантацию фенестрированных стент-графтов. Проведен анализ клинико-морфологического статуса пациентов перед операцией, особенностей вмешательства (разновидности дебранчинга и зоны по классификации Ishimaru, в которых проводилась реконструкция) и госпитальных результатов лечения. Результаты. Средний возраст пациентов составил 66 лет. Основной нозологией (70%) была аневризма аорты. Почти в 30% случаев операция осуществлялась в экстренном порядке по поводу острого аортального синдрома. Главными причинами для отказа от традиционного протезирования являлись хроническая болезнь почек (22,5%), хроническая обструктивная болезнь легких (11%), острое нарушение мозгового кровообращения в течение последних 6 месяцев (15%). Технический успех операции достигнут в 100% случаев. Средняя продолжительность вмешательства составила 226 мин., средний объем кровопотери – 355 мл. Большинство реконструкций проводилось в зонах 1 и 2 по Ishimaru (59 и 33% соответственно), у 2 (7%) пациентов протезирование выполнено в зоне 0. Общее количество вовлеченных в реконструкцию ветвей аорты составило 45. Осложнения, связанные с вмешательством, включали в себя 3 (11%) случая острого нарушения мозгового кровообращения, 2 (7,4%) окклюзии ветвей аорты и 1 (3,7%) эндолик II типа. Госпитальная и 30-дневная летальность составили 3,7 и 7,4% соответственно. Выводы. Эндопротезирование дуги аорты с применением супрааортального эндодебранчинга считается эффективным альтернативным методом лечения для пациентов с различной патологией дуги аорты, которым противопоказано традиционное протезирование с использованием искусственного кровообращения.

Some studies have shown that the echogenicity of atherosclerotic plaques (AP) in the carotid arteries (CA) plays an important role in evaluating the risk of cardiovascular events (CVE). The method of calculating the Gray Scale Median (GSM) is currently used to quantify the echogenicity of the CA plaque. Aim. To study GSM assessment of CA AP in patients with acute coronary syndrome (ACS) and the effect of GSM on the prognosis of CVE. Material and methods . We examined 143 patients with ACS (32-83 years old). Duplex scanning was performed on “Philips iU 22” for 1-3 days after hospitalization, the second — in 1-1,5 years. The echogenicity of the detected APs was assessed on a gray scale using a modified GSM method at the Multivox workstation. Results. We analyzed 378 CA AP in patients with ACS. The GSM analysis on the first and repeated surveys showed a significant increase in the average GSM by 2,2% (p

Aim. To develope and justify the use of the abbreviated protocol of ultrasound duplex scanning (DS) of the carotid arteries (CA) to detect atherosclerotic changes in the carotid system in various groups of cardiovascular risk and to reduce the time of DS, based on solving a “narrow” task — identifying an atheroma. Material and methods . Ultrasound CA examination was carried out in the department of ultrasound studying methods in National Medical Research Center of Cardiology. Forty three patients aged 32 to 81 years (mean 56±13 years) who are hospitalized in A. L. Myasnikov Institute of Clinical Cardiology Institute of Clinical Cardiology were examined. DS was performed with the use of the ultrasonic system “IU 22” (Philips) with a linear sensor with 3-9 MHz. Three types of DS protocol were used — standard protocol (with automatic measurement of intima-media thickness (IMT) of common carotid artery (CCA)), abbreviated protocol 2 (atheroma and IMT of CCA), abbreviated protocol 1 (atheroma). Results. The work showed a decrease in DS time when conducting a abbreviated protocol 2 by 32,1% or 1,5 times, a shortened protocol 1 — by 72,1% or approximately 3,5 times compared with the standard DS protocol, while the efficiency of atheroma detecting has not decreased. A decision-making algorithm has been developed on the basis of conducting an ultrasound SA examination using abbreviated protocols. Conclusion. The introduction of a abbreviated protocol of ultrasound DS will significantly reduce the time and increase the cost-effectiveness of early diagnosis of atherosclerosis.

Aim. To evaluate the contribution of subclinical atherosclerosis to the stratification of patients with a SCORE risk of cardiovascular events (CVEs) Material and methods. The study included 379 patients with SCORE risk of CVEs Results. The initial patients’ age ranged from 35 to 67 years (51,1±7,5 years). Plaques from 20% to 50% were detected in 303 participants (79,94%). Over the past 10 years, there have been 5 cardiovascular deaths (1,3%), 7 MIs (1,8%), 5 cases of unstable angina (1,3%), 12 cases of myocardial revascularization (3,2%), 15 strokes (4,0%), 51 cardiovascular hospitalizations (13,5%). The proportion of patients with registered endpoints (CVE+) was 22,4% (n=85). The groups of patients with and without CVEs differed in the level of systolic blood pressure (BP) and blood triglycerides, and did not differ in the level of diastolic BP, lipid profile, glucose, heart rate, smoking status, sex, and age. In the CVE+ group, there were higher values of CCA IMT (0,65 (0,64; 0,70) mm vs 0,62 (0,62; 0,66) mm, pConclusion. The total CA stenosis has shown itself to be an independent predictor of CVEs in patients with a SCORE risk

to compare two anticoagulant therapy (ACT) regimens in the treatment of venous thrombosis (VT) in patients after catheter interventions - electrophysiological studies (EFIs) and ablations: enoxaparin followed by warfarin, and rivaroxaban monotherapy.The study included patients from 18 years and older with heart rhythm disorders and planned catheter ablation. When parietal venous thrombosis (VT) were detected at the femoral vein puncture site, all patients were randomly assigned to two treatment groups. In group I enoxaparin 1 mg/kg was prescribed every 12 hours with switching to warfarin after 7 days with maintenance of the target INR values (2.0-3.0). In group II rivaroxaban therapy was started at a dose of 15 mg twise/day for 21 days with a further transition to a dose of 20 mg/day. The total period of observation and treatment of patients was at least 3 months.408 patients were observed, 42 (10.3%) patients with parietal VT were divided into two treatment groups. In group I (n=16) complete lysis of VT was noted by the 7th day of treatment in 7 (58.3%) patients, however this scheme was associated with a greater risk of complications (р=0.003) at the puncture site in the form of arteriovenous fistulae (n=1; 8.3%) and intermuscular hematomas (n=4; 25%). In group II (n=26), no complications were noted, the lysis time of VT was on average 21 days (n=18; 69.2%). Complete lysis of VT was noted in both groups at the time of the control observation point (3rd month).The efficiency of the two VT treatment regimens was comparable. Enoxaparin therapy is associated with a high risk of local complications, namely intermuscular hematomas (n=4; 25%) and arteriovenous fistulas (n=1; 8.3%). Rivaroxaban monotherapy is safer (p=0.003); in Group II none of the patients had any complications.Цель исследования: сравнить две схемы антикоагулянтной терапии (АКТ) в лечении венозных тромбозов (ВТ) у пациентов после внутрисердечных катетерных вмешательств - электрофизиологических исследований (ЭФИ) и абляций: эноксапарина с последующим назначением варфарина и монотерапии ривароксабаном. Материалы и методы. В исследование включали пациентов от 18 лет с нарушениями ритма сердца и планируемыми катетерными вмешательствами. При выявлении пристеночного ВТ в месте пункции бедренной вены пациентов рандомизировали на две группы лечения: в группе I проводилась АКТ эноксапарином 1 мг/кг каждые 12 ч с переходом на варфарин через 7 дней с поддержанием целевых значений международного нормализованного отношения (2,0-3,0), в группе II - АКТ ривароксабаном 15 мг 2 раза/сут в течение 21 дня с дальнейшим переходом на дозу 20 мг/сут. Срок наблюдения и лечения пациентов составил 3 мес. Результаты. Наблюдали 408 пациентов, из них 42 (10,3%) пациента с пристеночным ВТ распределили на две группы лечения. В группе I (n=16) у 7 (58,3 %) больных отмечен полный лизис ВТ к 7-му дню лечения, однако эта схема сопряжена с большим риском осложнений (р=0,003) со стороны места пункции в виде артериовенозных соустий (n=1; 6,25%), межмышечных гематом (n=4; 25%). В группе II (n=26) осложнений не отмечалось, время лизиса ВТ в среднем составило 21 день (n=18; 69,2%). В обеих группах на момент проведения контрольной точки наблюдения (3-й месяц) отмечен полный лизис ВТ. Заключение. Эффективность двух схем лечения ВТ оказалась сопоставимой. Терапия эноксапарином сопряжена с большим риском развития местных осложнений: межмышечных гематом (n=4; 25%), артериовенозных соустий (n=1; 8,3%). Монотерапия ривароксабаном была более безопасна (р=0,003), в группе II осложнений не отмечено.

Aim. To study predictors of radial artery occlusion (RAO) and ways to prevent it after interventions using radial access.Material and methods. The study consisted of prospective and retrospective parts. The total number of included patients was 2284. Patients undergoing interventions by radial access in various medical organizations were retrospectively considered. The prospective study included 1284 patients who were subject to interventional treatment. Patients were randomized into two groups as follows: in group 1, hemostasis was performed within 4 hours, in group 2 — >6 hours. All patients underwent a bedside Barbeau test with a pulse oximeter and an ultrasound of access arteries to determine the radial artery patency/occlusion.Results. The RAO rate in the retrospective part was 21,8%, while in the prospective one — 10,1% with long-term hemostasis and 1,4% with short-term hemostasis (pConclusion. The main predictors of RAO were type 2 diabetes, an increase in hemostasis duration, female sex, smoking, and the artery-to-introducer diameter ratio. Taking statins, anti-ischemic and antihypertensive agents does not have a protective effect on RAO rate.

Aim. To study prognostical significance of vasomotor disorder of coronary and brachial arteries, and traditional risk factors in development of cardiovascular complications in patients with microvascular angina (MVA) and cardial syndrome X; a retrospective 12-year observation. Material and methods. Totally, 41 patient included, with MVA (40 females/1 male), mean age at the moment of inclusion 43±4,1 y.o., 15% smokers). Endotheliumdependent vasodilation (EDV) of coronary arteries was assessed via intracoronary acetylcholine load, EDV of brachial artery — via high-resolution ultrasound in active hyperemia test. Results . It was found that in brachial EDV

Currently, the concept of atherosclerosis has undergone a number of changes. On the one hand, carotid atherosclerosis, like femoral, is a disease that must be treated directly, and on the other hand, it is a modifier of cardiovascular risk. This review is devoted to aspects of cardiovascular risk stratification depending on the severity and progression of carotid and femoral artery atherosclerosis.

The study was aimed at assessing the dynamics of asymptomatic atherosclerosis of carotid arteries (CA) depending upon the achieved level of low-density lipoprotein cholesterol (LDLC) in patients with moderate total risk by the SCORE scale. We followed up a total of eighty-two 40-to-65-year-old patients with the LDLC level above 2.6 mmol/l, being at moderate total risk by the SCORE scale and having symptom-free atherosclerosis of the extracranial portion of brachiocephalic arteries (up to 50% narrowing of their lumen) as diagnosed by duplex scanning. The patients were randomly divided into two groups. Group One patients (n=41) received therapy with atorvastatin in order to achieve the LDLC level less than 1.8 mmol/l. Group Two patients (n=41) were treated in order to achieve the LDLC level below 2.6 mmol/l. At 12 months of follow up we compared the dynamics of carotid atherosclerosis (change in the number, total height, structure, echogenicity, as well as the state of the surface of atherosclerotic plaques, alteration of the thickness of the CA intima-media complex). Group Two patients were found to have an increase in the number and average sum of the heights of atherosclerotic plaques. An increase of the maximum thickness of the intima-media complex of the wall of the right and left CA was more pronounced as compared with that in Group One patients. Aggressive hypolipidemic therapy aimed at achieving the LDLC level below 1.8 mmol/l turned out to be more effective in slowing down the progression of asymptomatic carotid atherosclerosis in patients with moderate cardiovascular risk than therapy targeted at achieving the LDLC level below 2.6 mmol/l.

to study carotid plaques structure in patients with acute coronary syndrome by ultrasound duplex scanning.We included in this study143 patients with acute coronary syndrome (ACS) aged 32-83 years and 28 patients with documented coronary heart disease (CHD) aged 46-83 years. Duplex scanning of carotid arteries was carried out with Philips iU22 ultrasound system and L9-3 linear array transducer. Atherosclerotic plaques in CCA, CCA bifurcation, and ICA from right and left side were investigated. Off-line analysis of B-mode images and plaque gray scale median (GSM) was performed with computer semiautomated workstation MultiVox.378 plaques of ACS and 59 plaques of CHD patients were studied. We assessed traditional (heterogenous structure, hypoechogenic component, irregular plaque surface) as well as additional (positive remodeling, "layered" structure of plaque, local calcification) criteria of plaque instability. In ACS compared with CHD group there were more plaques with hypoechogenic component (43.4 and 28.8%, p=0.0459), heterogenous structure (77.8 and 64.4%, p=0.0327), irregular surface including irregularities more than 2.0 mm (22.5 and 6.8%, p=0.0048, respectively). There was significant difference in "layered" structure (55.7 and 35.8%, p=0.0011) and insignificant difference in positive remodeling (16.3 and 7.5%, p=0.06, respectively). There were no differences of GSM value (53.1 and 57.2, p=0.24) and local calcification (23.2 and 24.5%, p=0.23, respectively).In our study ultrasound duplex scanning revealed that signs of plaque instability in carotid arteries in patients with ACS were more frequent than in patients with stable CHD. The newly introduced parameter "layered" structure of atherosclerotic plaque was found to be most significant.

Статья посвящена вопросам взаимосвязи синдрома обструктивного апноэ сна (СОАС) и сердечно-сосудистых заболеваний. Более подробно описан вопрос взаимодействия дисфункции эндотелия (ДЭ) и СОАС. Обсуждены современные представления о механизмах развития артериальной гипертензии при СОАС. Приводятся как доказательные данные, так и мнения экспертов. Рассмотрены вопросы влияния постоянного положительного давления в дыхательных путях на ДЭ.

In the last years several studies demonstrated the important role of aldosterone not only in the development of arterial hypertension bur also in the development of cardiovascular complications. Growing investigations have recognized the important role of aldosterone in the development of left ventricular hypertrophy, the myocardial fibrosis and changes in the wall of the carotid arteries. This article provides a clinical case of hypertensive patient with primary hyperaldosteronism. The dynamics of blood pressure, the state of Renin-Angiotensin-Aldosterone System, left ventricular myocardium and carotid arteries were analized in the preoperative period, and in one year follow-up after the successful removal of the aldosteroma

To estimate the possibilities of using three-dimensional ultrasound study (3D USS) in the diagnosis of the sizes and structure of an atherosclerotic plaque (ASP).The data obtained by examination of 20 heterogeneous ASPs in the carotid artery wall, by applying 3D USS and magnetic resonance imaging (MRI), were compared. Intra- and interoperator reproducibilities were assessed by the Bland-Altman method; the volume of each plague was measured by two (contour and ellipse) methods. The contour method was used to estimate all plagues; the ellipse method was applied to 13 of the 20 plagues, which was due to the shape of ASPs that rarely had an ellipsoid shape.Intra- and interoperator reproducibilities in ASP volume estimation by 3D USS was as follows: with the use of contour and ellipse algorithms, the coefficient of variation was 7.72 and 3.77%, respectively; with these algorithms, the interoperator reproducibility was 8.18 and 6.21%, respectively; the derived values were not greater than those allowed for medical studies (10%). The coefficients of variations for MRI in the estimation of ASP sizes were significantly higher for inter- and intrareproducibilities (68.82 and 43.4%, respectively).The results of this investigation agree with thedata available in the literature and support that 3D USS is an effective diagnostic me-hod in evaluating the magnitude of an ather-sclerotic process.

Combination of arterial hypertension (AH) and carotid atherosclerosis significantly increases the risk of cardiovascular complications. Arterial stiffness is believed to be a key risk factor of the development of such complications. This paper described peculiarities of this condition, methods for its assessment in patients with AH and carotid atherosclerosis, and importance of characteristics of regional and local stiffness for estimation of cardiovascular risks. The role of glycation end-products in damaging arterial walls and triggering pathogenetic mechanisms of atherosclerosis is discussed.

A complex histomorphometric and clinical-instrumental analysis of atherosclerotic lesions of the carotid arteries obtained during carotid endarterectomies (CEE) of patients with hemodynamically significant stenoses was conducted. Two groups of patients were compared: symptomatic, which earlier underwent cerebral vascular accident (CVA) or transitory ischemic attacks (TIA), and asymptomatic ones with no complications of the disease. Statistical analysis of clinical and laboratory data showed no significant differences between two groups except for the level of lipoprotein(a) [Lp(a)] in the blood plasma, which was higher (p0.05) in asymptomatic patients compared with symptomatic ones. Statistical analysis of carotid arteries ultrasound duplex scanning (USDS) in the preoperative period did not reveal significant differences in the degree of maximum vessels stenosis between the compared groups of patients. Surface defects of atherosclerotic plaques (ASP) were shown to be significantly more common (p0.05) in the group of symptomatic patients compared with asymptomatic ones. According to histological analysis 88% of extracted ASP was unstable in symptomatic patients and 77% of ASP - in asymptomatic patients. This may indicate high risk of CVA/TIA in both groups of patients. Statistical evaluation of magnetic resonance tomography (MRT) and USDS techniques in comparison with abilities of the most reliable histological analysis showed that both non-invasive diagnostic methods are highly sensitive in detecting unstable ASP, though MRT showed higher level of specificity compared with USDS.

Aim of the study was to determine whether structural and functional status of arteries differ between young and middle-aged men with ischemic heart disease (IHD). A total of 78 men aged 28 to 50 years were recruited in this study: 49 with angiographically proven obstructive atherosclerosis of coronary arteries, 29 without clinical manifestations of IHD (control group). Those with arterial hypertension, diabetes mellitus or marked hypercholesterolemia (LDL cholesterol more or equal 4.5 mmol/l) were excluded from the study. All patients underwent carotid ultrasound, endothelial function, and arterial stiffness measurements. Patients with IHD more often had multiple carotid plaques (86.7% vs 13.7%, p0.001), and increased aortic pulse wave velocity (PWV) assessed by ultrasound duplex scanning (53.1% vs. 24.1%, p=0.02). Aortic PWV was related to the severity of coronary atherosclerosis. Presence of a carotid intima-media thickness more or equal 0.9 mm and abnormal flow-mediated dilatation (FMD) of the brachial artery was not significantly different between the groups.

The article deals with studying of the relationship between biologic reaction of inflammation with glycosylation reaction and content of methylglyoxal in blood serum. The positive correlation between pulse wave velocity and content of methylglyoxal, C-reactive protein in intercellular medium and malleolar brachial index value was established. This data matches the experimental results concerning involvement of biological reaction of inflammation into structural changes of elastic type arteries under hypertension disease, formation of arteries' rigidity and increase of pulse wave velocity. The arterial blood pressure is a biological reaction of hydrodynamic pressure which is used in vivo by several biological functions: biological function of homeostasis, function of endoecology, biological function of adaptation and function of locomotion. The biological reaction of hydrodynamic (hydraulic) pressure is a mode of compensation of derangement of several biological functions which results in the very high rate of hypertension disease in population. As a matter of fact, hypertension disease is a syndrome of lingering pathological compensation by higher arterial blood pressure of the biological functions derangements occurring in the distal section at the level of paracrine cenoses of cells. The arterial blood pressure is a kind of in vivo integral indicator of deranged metabolism. The essential hypertension disease pathogenically is a result of the derangement of three biological functions: biological function of homeostasis, biological function of trophology - nutrition (biological reaction of external feeding - exotrophia) and biological function of endoecology. In case of "littering" of intercellular medium in vivo with nonspecific endogenic flogogens a phylogenetically earlier activation of biological reactions of excretion, inflammation and hydrodynamic arterial blood pressure occur. In case of derangement of biological function of homeostasis, decreasing of perfusion even in single paracrine cenoses and derangement of biological function of endoecology ("purity" of intercellular medium) the only response always will be the increase of arterial blood pressure.

To study relationships between nonspecific inflammation (NI) of the arterial wall and its structural changes in Stages I-II hypertensive disease (HD) males at moderate and high risks of cardiovascular events (CVE).Sixty hypertensive males aged 30 to 65 years (mean age 44 +/- 2 years), including 35 patients with grade 1 arterial hypertension (AH) and 25 with grade 2 AH at moderate and high risks of CVE, were examined. The concentrations of C-reactive protein (CRP) and methylglyoxal (MG) were measured. Pulse wave propagation velocity (PWPV) and ankle brachial index (ABI) were studied. Normal PWPV values were calculated in terms of gender and age features.The examined HD group showed a positive correlation of PWPV with systolic blood pressure over 24 hours (r=0.39; p0.02) and age (r = 0.47; p0.01). In smoking and nonsmoking hypertensive men, PWPV differences failed to achieve statistical significance (14.05 +/- 0.53 and 13.07 +/- 0.38 m/sec, respectively). PWPW was found to be correlated with CRP values weakly (r = 0.31; p = 0.07) and with MG levels moderately (r = 0.62; p0.01); there were also positive relationships of ABI to the levels of CRP (r = 0.50; p0.01) and MG (r = 0.46; p0.05). There was a positive correlation between CRP and MG levels (r = 0.45; p = 0.01).In middle-aged men with grades 1-2 AH at moderate and high risks of CVE, NI processes are not only related to MG metabolism, but also they have a substantial effect on the elastic properties of the wall of predominantly muscle-elastic type arteries, which validates the hypothesis of the involvement of NI processes in the course of HD.

To comparatively analyze the following parameters of the subclinical manifestations of atherosclerosis: carotid intima-media thickness (IMT), the presence and number of carotid atherosclerotic plaques (ASP), ankle brachial pulse wave velocity (ABPWV) in patients from 2 (active and conventional observation) groups at low and moderate risks according to the SCORE scale in two-year outpatient practice.A screening could select 600 able-bodied persons (445 women and 155 men) aged 30 to 65 years at low and moderate risks (according to the SCORE scale without atherosclerosis-associated diseases who were divided into 2 groups: A) active observation (n =400) and B) conventional medical management tactics (n = 200). Five hundred and seven (85%) persons (339 in Group A and 168 in Group B) completed the study following 2 years. Carotid duplex scanning, computed sphygmography, and biochemical tests for blood lipid composition were performed. The delta index (%) calculated by the special formula, by subtracting the results during the first visit from those obtained 2 years later, was used to statistically analyze the time course of changes in the parameters under study.Delta IMT (%) statistically significantly increased in Group B men as compared to that in Group A men (p = 0.042). The delta parameter of total carotid stenosis, which reflected the percentage of the latter, proved to be high in both Group B women and men (p = 0.0001) and the persons with a larger number of ASP were statistically significantly more in Group B (p = 0.035). Delta ABPWV (%) was also greater in Group B (p = 0.001).Just after 2 years, the active medical observation tactics in patients at low and moderate risks (according to the SCORE scale) can result in a reduction in the rate of subclinical atherosclerosis progression in the carotid artery.

To assess contribution of such parameters as intima-media thickness (IMT), presence of carotid plagues (ab), pulse wave velocity (abPWV) and ankle-brachial index (ABI) to asessment of cardiovascular risk in patients who were initially assigned to the group of low and moderate risk according to the SCORE scale.600 patients with low and moderate cardiovascular risk according to "SCORE" scale were selected: 445 women and 155 men in the age 30-65 years. We used color duplex ultrasound imaging (DUI) of carotid arteries (CA),. computer sphigmography (CS), biochemical tests (lipid profile. MDRD. glucose).The contribution of studied methods to risk stratification was compared: DUI of CA allowed to find patients with subclinical artery wall damage in 96%, CS-abPWV - in 39%, and ABI only - in 5% of cases. After adding abPWV to patient examination 61% remained in the low risk group and 17% were converted into the high risk group. At the same time after adding DUI of CA only 37% of patients remained in the low risk group and 36% (almost every third) were converted to more high risk group.The most sensitive method of detection subclinical artery wall damages is duplex ultrasound imaging of CA. The abPWV also has some diagnostic value and can be recommended to find out this kind of damage due to its simplicity and convenience.

To study effects of thrombin-activated fibrinolysis inhibitor (TAFI) on efficacy and safety of long-term anti-coagulant treatment in patients with venous thromboembolic complications (VTEC).A total of 111 patients with a history of an episode of deep vein thrombosis (DVT) and/or pulmonary artery thromboembolism (PATE) entered the study. All the patients received unfractionated or low-molecular heparin for at least 5 days than switch on warfarin (target values of INR 2.0-3.0). Baseline blood levels of TAFI were measured. The patients were followed up for 18 months. Recurrent (DVT/TAFI and hemorrhagic complications (HC) were endpoints. Also, frequency of complete lysis of deep vein thrombi was assessed after 12 months of treatment.A TAFI level varied from 50 to 217% (median 106%, interquartile rage 90-133%). TAFI concentration positively correlated with fibrinogen and thromb size. The patients were divided into two groups depending on TAFI content: group 1 patients had low TAFI (under 25th percentile;90%); patients of group 2 had high TAFI (above 25th percentile;90%). Group 1 patients were characterized by less stable anticoagulation. This association did not depend on genetic characteristics which determine sensitivity to warfarin (CYP2C9 and VKORC1). Low TAFI was associated with reduced risk of DVT for 18 months and higher probability of complete lysis of the thrombi after 12 months of anticoagulant therapy compared to VTEC patients with high TAFI. No differences were found by TAFI level in patients with HC and without HC, but in HC patients low TAFI was associated with spontaneous hemorrhages and bleeding in therapeutic INR values.The results of this pilot study evidence that a TAFI level can be one of the factors influencing efficacy and safety of long-term anticoagulant therapy in patients with VTEC on warfarin treatment.

AIM To show relations between a concentration of lipoprotein-associated secretory phospholipase A2 (LPPLa2) and markers of subclinical atherosclerotic lesion of the arterial wall in patients with low and moderate risk by the SCORE scale.A total of 378 individuals with low and moderate risk of atherosclerotic lesion of the arterial wall (285 females, 93 males) were divided into groups by (1) age and sex, (2) number of atherosclerotic plaques (ASP) in the carotid arteries: OASP (n=158), ASP (n=61), more than one ASP (n=159); (3) plaque characteristics: homogeneous (n=31), heterogenous (n=189), (4) the presence of ASP in CA and level of LPPLa2 in the blood (with high content--n=137, with normal content--n=83). Duplex CA scanning was made to estimate intima-media thickness (IMT), to detect AP in the CA. Computer sphygmography estimated velocity of the pulse wave (PWV) from the carotid to femoral artery. Normal values of IMT and PWV were estimated individually with reference to gender and age. LPPLa2 was measured immunoturbodimetrically using diagnostic kits (PLAC Test Elisa Kit, dia Dexus, U.S.A.), shreshold value200 ng/ml.LPPLa2 content medians in different age groups in males and females differed insignificantly. LPPLa2 concentration in the groups of patients regarding ASP in CA was elevated in relation to the threshold value (200 ng/ml) in all the groups but did not significantly differ: 216 (179-257) ng/ml in the group OASP, 226 (190-274) ng/ml--in the group of patients 1ASP and 212 (174-254) ng/ml--in the group of patients more than one ASP (p0.05). In the groups with homogeneous and heterogenous ASP significant differencies were neither between the medians nor between frequency of deviation from normal (p = 0.28). 25.5% patients from the group with an elevated level of LPPLa2 had ASP with a hypoechogenic component.No significant correlation was revealed between concentration of LPPLa2, IMT PWV, number of ASP and carotid stenosis.

To compare effects of prolongation of the treatment with therapeutic doses of enoxaparin to 1 month on recanalization of occlusively thrombosed deep veins (OTDV) of the limbs with results of standard therapy with unfractionated heparin (UFH). Both treatments were followed by warfarin administration.Thirty patients were selected from 111 patients with a history of deep vein thrombosis (DVT) and/or pulmonary artery embolism according to the following criteria: the presence of occlusive thrombosis of one deep vein minimum; the absence of DVT for 12 months of follow-up. Patients of group 1 (n = 15) received standard therapy (UFH for at least 5 days) with switch to warfarin. Patients of group 2 (n = 15) received therapeutic doses of enoxaparin (1 mg/kg each 12 hours) for 30 days minimum with switch to warfarin. Follow-up was 12 months. Ultrasonic duplex angioscanning of the limbs was made at baseline, 1, 3, 6 and 12 months after treatment start.After follow-up month 1, 3 and 6 number of patients with occlusive DVT was significantly less in group 2. All the patients given enoxaparin achieved recanalization of OTDV within 3 months of treatment. OTDV recanalization was not achieved in 20% patients of group 1 even 12 months after treatment start.Prolongation of enoxaparin treatment to 1 month followed by warfarin treatment is superior to standard UFH treatment followed by warfarin in providing recanalization of OTDV within 3 months of treatment. Moreover, this treatment predicts persistence of recanalization within 12 months of anticoagulant therapy.

The study was aimed at comparing efficacy and safety of two diferent approaches to initial anticoagulant therapy: a standard approach (non-fractionated heparin [NFH]for not less than 5 days followed by changing over to warfarin) and an alternative one, i. e., prolongation of treatment with therapeutic doses of enoxaparinfor up to one month with switching to warfarin, also assessing the effect of initial anticoagulant therapy on the "outcomes" of venous thromboembolic complications (VTECs) during 12 months of treatment.We followed up a total ofone hundred and eleven patients after endured episodes of deep vein thrombosis (DVT) and/or pulmonary artery thromboembolism (PATE). Group One patients (n=80) received the standard therapy (NFH for not less than 5 days followed by changing over to warfarin). For Group Two patients (n=31), NFH was replaced by therapeutic doses of enoxaparin (1 mg/kg each 12 hours) for at least 30 days, with the patients then transferred to warfarin according to the standard regimen. Ultrasonographic duplex scanning of limb vessels was performed at baseline, 1, 3, 6 and 12 months after initiation of therapy. The patients were followed up for 12months. The following end points were taken into account: DVT/PATE relapses, haemorrhagic complications.Improved patency ofdeep veins one month after initiation of treatment was observed in the both groups, however efficacy of enoxaparin turned out to be superior to that of the standard therapy in relation to a decreased number of occlusive thrombosis of veins - 9 versus 41 (p=0.005). Commencing from month two of treatment patients from the both groups began taking warfarin, however the number of occlusive thromboses of deep veins during 12 months of treatment was considerably lower as compared with that in the enoxaparin group, i. e. I versus 21 (p=0.013) after 3 months; with 1 vs 11 (p=0.009) after 6 months, and 0 vs 8 (p=0.013) after 12 months. The rate of DVT relapses and haemorrhagic complications during the first month of treatment was similar in the both groups. Startingfrom month two of therapy there were no DVT relapses in the enoxaparin group. Conclusions. Enoxaparin within the first month of treatment in patients having developed VTEC, with similar DVT complication rate, appeared to be superior to the standard therapy with NFH and warfarin in achieving recanalization of occlusively thrombosed veins, with its advantages in improving patency of deep veins preserving within 12 months. The use of enoxaparin was also associated with lower rate of DVT relapses during 12 months of treatment.

We followed for 18 months 90 patients who had had deep vein thrombosis (DVE) and/or pulmonary embolism (PE) and received therapy with anticoagulants either for 3-12 months or for indefinitely long time. During follow-up rate of recurrent DVE was 16.7%, no recurrences of PE were registered. Predictors of recurrent PE were selected among 165 demographic, anthropometric, anamnestic, clinical, genetic, instrumental, and laboratory parameters, as well as risk factors of development of thromboembolic complications. According to results of multifactorial regression analysis we established the following independent predictors recurrent DVE during 18 months of follow-up: elevated level of DAdimer after 1 month of anticoagulant therapy (p=0.005; relative risk--relative risk [RR] 8.1, 95% confidence interval [CI] 1.9 to 34.8), homozygosity for C249T polymorphism in beta-fibrinogen gene (p=0.044; RR 8.4 95% CI 1.1 to 65.7), and percentage of all values of international normalized ratio within therapeutic interval 2.0-3.0 (p=0.009; RR 0.94, 95 CI 0.89 to 0.98).

To compare efficacy and safety of warfarin and enoxaparin used in the first month of treatment of patients with an episode of deep vein thrombosis (DVT) and/or pulmonary artery thromboembolism (PATE).Sixty patients (34 males, 26 females, age 18-76 years) after the DVT/PATE episode were divided into two groups. Patients of group 1 received standard therapy (non-fractionated heparin -NFH followed by warfarin), patients of group 2 instead of NFH received enoxaparin (1 mg/kg each 12 hours for at least 30 days). Ultrasonic scanning of the limbs and determination of D-dimer were conducted before and after 1 month of treatment. End points were the following: recurrent DVT/PATE, death due to PATE, hemorrhagic complications.Improvement of deep vein patency after 1 month of anticoagulant treatment was observed in both the groups. Enoxaparin proved more effective in relation to reduction of the number of venous occlusions (9 and 50, respectively, after 1 month treatment (p0.001). Hemorrhagic complications were seen in both the groups with equal frequency (13.4%). These hemorrhagic episodes did not require discontinuation of the drugs. Baseline D-dimer was significantly higher in the enoxaparin group--1.51 (0.73-2.44) mcg/ml vs 0.93 (0.42-1.33) mcg/ml (p = 0.019). After treatment D-dimer level and number of patients with high D-dimer diminished in both groups.Enoxaparin proved more effective than warfarin in the first treatment month. In the same safety and prophylactic effect enoxaparin is more effective in recanalization of occusions in the deep veins.

To study damage to the heart, kidneys and vessels in patients with arterial hypertension (AH) of different severity with and without metabolic syndrome.The trial enrolled 303 patients with AH of the first-third degree aged 25-70 years (mean age 52 +/- 18 years), 110 males and 193 females. The patients were matched by sex and age. All the patients were divided into two groups: group 1 (n = 151) without metabolic syndrome (MS) and group 2 (n = 152) with MS. The following parameters were studied: lipid spectrum, blood glucose, glomerular filtration rate, MAU, data of 24-h blood pressure monitoring, echocardiography, Doppler ultrasonography of the brachiocephalic arteries.Early AH was accompanied with diastolic LV myocardial dysfunction, subnormal glomerular filtration rate and the presence of MAU. In AH of the second degree there was LV remodeling. In AH of the third degree left ventricular myocardial mass (LVMM) and thickness of intima-medial complex (TIM) were increased. Close correlations were found between the disturbance of diastolic function and MAU, thickness of interventricular septum and thickness of the inferior wall and LVMM index with MAU. Less manifest correlation existed between diastolic dysfunction and TIM, thickness of the interventricular septum and thickness of the inferior wall and TIM.The presence of metabolic syndrome contributes to earlier and more serious damage of the target organs in patients with arterial hypertension.

Endothelial progenitor cells (EOCs) play a key role in reendothelization of injured blood vessels and in endogenous neovascularization of ischemic tissues. In the presented article, the mechanisms of endothelial function impairment and the role of EPCs in their correction are discussed. The objective of our study was to investigate the number of CD34+ cells in patients with different forms of ischemic heart disease (IHD) and association of this parameter with endothelial dysfunction. We quantified the numbers of CD34+ cells by flow cytometry, measured the brachial artery flow-mediated vasodilatation (FMD) and the common carotid artery intima-media thickness (IMT) by ultrasonography in 28 patients with ST-segment elevation acute coronary syndromes (ACS), in 33 patients with stable angina (SA) and in 17 subjects without IHD (control group). The level of CD34+ cells was lower in both groups of IHD, especially in patientes with ACS, and was associated with endothelial dysfunction. We suppose that CD34+ cells contribute to reparation of injured endothelium and the reduction of their numbers in peripheral blood indicates endothelial state.

To evaluate efficacy of 3 month therapy with warfarin in patients after an episode of deep vein thrombosis (DVT) and/or pulmonary artery thromboembolism (PATE), safety of the treatment.26 patients after DVT/PATE aged 18-74 were treated in the hospital with non-fractionated heparin for 10-14 days followed by warfarin. The dose was selected under the control of INR up to target values 2.0-3.0. Ultrasound angioscanning of the limbs was conducted at hospitalization, on discharge, 1 and 3 months after the discharge. D-dimer was measured at discharge, 1 and 3 months after the discharge. The patients were followed up for 3 months. The following end points were considered: recurrences of deep or surface vein thrombosis, PATE recurrence, death due to PATE, hemorrhagic complications.By ultrasound angioscanning significant positive results were not achieved. The level of D-dimer upon discharge was elevated in 18 (69.2%) patients (0.94, 0.41-1.69 mcg/ml). 3 month therapy with warfarin resulted in complete solution of all floting thrombs, achievement of recanalization of occlusive thrombosed deep vein in 20 (80%) patients, thrombosed vein number reduced from 4.0 to 3.0, p = 0.004. Deep vein thrombs disappeared only in 3 (11.5%) patients in 3 bmonths. Warfarin lowered D-dimer content to 0.23 mcg/ml (p0.001) in 1 month and to 0.12 mcg/ml (p0.001) in 3 moths after the discharge. 23 patients reached target 2.0-3.0 values and maintained them in therapeutic ranges. In DVT recurrence no PATE and PATE-related deaths were registered. Hemorrhagic complications arose in 5 patients, but they did not lead to warfarin discontinuation.Warfarin is effective for secondary prophylaxis of DVT/PAT, but this therapy failed to solve thrombs in the deep veins in many patients.

To study hemodynamic responses early in the course of active tilt table testing, their correlation with changes in cerebral blood flow in hypertensive patients.A total of 41 patients with essential hypertension (EH) stage I-II at moderate and high risk (10 males, 31 females aged 48-75 years) were examined using standard clinical and device tests. Ultrasonic investigation of the extracranial arteries was made in duplex scanning regime (Acuson XP 128, USA). To determine initial orthostatic depression reactions we conducted active tilt table testing according to the protocol developed in the department of innovative diagnostic techniques.In conduction of the modified active tilt table testing 2 types of initial depression orthostatic reaction (OR) were identified: with short and long fall of blood pressure. In the latter type BP regressed more (18+/-8 vs 22+/-10), they had more frequent atherosclerosis of extracranial arteries.Hypertensive patients with prolonged initial orthostatic reactions had frequent cerebral hypertensive crises and syncope, initial higher BP, multivessel atherosclerotic lesions of the carotid arteries aggravating cerebral circulation.

Search of new optimal treatment strategies, allowing to decrease the risk of atherosclerosis development and cardiovascular events is determined by high prevalence of hyperlipidemia in hypertensive patients.To study the vasoprotective effects and security of Valsartan (V) or Fluvastatin extended release (XL) (F) and their combination in stage 1 and 2 essential hypertension (EH) with moderate hyperlipidemia.32 patients with EH after 14 days of wash-out period were randomized to receive either V (160 mg o.d.) or F (80 mg o.d.). After 8 weeks of monotherapy combination of V+F was administered to each patient for the next 8 weeks. At baseline, after 8 weeks of monotherapy, and at the end of the study sitting BP, lipids, NOs level and endothelial function were assessed. Endothelial function was measured as flow-mediated vasodilation (FMD) by high resolution ultrasound. Valsartan (Diovan) and Fluvastatin (Lescol XL) were provided by Novartis Pharma AG (Basel, Switzerland).Combination of F (80 mg o.d) with initial therapy by V (160 mg o.d.) led to more significant decrement of BP and significant improvement of FMD.

Aim of the present study was assessment of the StarClose Vascular Closure System - novel device for mechanical closure of femoral artery puncture site. We included in this study 29 patients in whom after procedure of endovascular treatment puncture site was closed with the given device. Control group comprised 34 patients in whom hemostasis was conducted by way of manual compression of puncture site according to standard technique. Femoral artery was clipped immediately after completion of the stenting procedure irrespective of the last result of activated partial thromboplastin time measurement. Success of the use of the StarClose was 100%. Activation of a patient was undertaken substantially earlier compared with the group of manual hemostasis. Sitting up in bed was performed in 2 hours after completion of hemostasis procedure compared with 16 hours in control group, walking within ward was started in 3.5 hours compared with 17 hours in control group (0.0001 in both cases). Duration of the procedure of hemostasis was substantially smoller in the group of closing device compared with the group of manual hemostasis (1.7 and 23 min, respectively). With this no complications from the site of puncture were observed in the group of closing device. In the group of manual hemostasis one patient (2.9%) had hematoma nor requiring special treatment and in one more patient (2.9%) after violation of bed regimen minor bleeding occurred from puncture site (was eliminated by additional manual compression for 20 min). Total number of complications in the group of manual compression was 5.8%. Thus compared with traditional manual hemostasis. The use of StarClose clip device allows to activate patients after endovascular treatment substantially earlier.

To elucidate effect of two doses of atorvastatin (10 and 20 mg/day) on endothelial function, distensibility and stiffness of vascular wall.Patients (n=50) with documented ischemic heart disease and hyperlipidemia were randomized to 10 or 20 mg/day of atorvastatin (Atoris, KRKA). Endothelial function and common carotid artery wall distensibility and stiffness were assessed at baseline and after 12 and 24 weeks of treatment.Administration of both 10 and 20 mg/day doses of atorvastatin for 6 weeks was associated with significant lowering of total cholesterol (CH), triglycerides (TG) and low density lipoprotein (LDL) CH (24.5, 18.4, 34.9% and 29.1, 28.2, 40.9%, respectively). After 24 weeks LDL CH lowering from baseline reached 34.9 and 43.9% (p0.001) and that of TG - 22 and 15%, in 10 and 20 mg/day groups, respectively. There were no significant differences between 10 and 20 mg/day groups in baseline values of endothelium dependent vasodilation (EDV), carotid artery distensibility and stiffness (7.28 and 6.64%, 21.60 and 20.15, 8.04 and 9.19 U, in 10 and 20 mg/day groups, respectively). After 3 months of treatment there occurred significant 38.4% (10 mg/day) and 45.4% (20 mg/day) increases of EDV. Significant 27.6% (10 mg/day) and 28.8% (20 mg/day) enhancement of vascular distensibility was noted after 24 weeks. Vascular wall stiffness decreased 33.4% (p=0.008) and 31.3% (p=0.002) in 10 and 20 mg/day groups, respectively.

Main aim of the clinical study FARVATER was comparison of effects of 10 and 20 mg/day of atorvastatin on levels of lipids, high-sensitivity C-reactive protein (CRP), fibrinogen (F), and structural-functional state of vascular wall in patients with documented and primary hyperlipidemia (HLP). Fifty patients (mean age 60.8 years) with documented ischemic heart disease and HLP were randomized to continuous administration of 10 and 20 mg/day atorvastatin for 24 weeks. Initial levels of total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDLCH), high density lipoprotein cholesterol (HDL CH), CRP and F were 6.22, 1.86, 4.15, 1.24 mmol/l, 1.46 and 2.93 g/l, respectively. After 6 weeks lowering of TCH, TG and LDLCH was significant both in 10 (24.5, 18.4, and 34.9%, respectively) and 20 mg (29.1, 28.2, and 40.9%, respectively) groups. After 24 weeks TG levels decreased by 22 and 15% in 10 and 20 mg subgroups, respectively. Changes of HDLCH (+11 and +12% in patients treated with 10 and 20 mg, respectively) were not significant. There were no significant changes of CRP and F levels. Seven side effects (4%) were registered during 24 weeks; 2 were related to study drug (allergy and symptomless elevation of creatine kinase).

Assessment of efficacy of treatment of coronary heart disease (CHD) patients suffering from stable effort angina of functional class II-III with the drug isosorbide-5-mononitrate Mono Mac 50 depo (MM 50 D).Clinical indices, exercise tolerance, endothelial function (the study of brachial artery in reactive hyperemia and sublingual intake of nitroglycerin) were studied in 30 patients with stable angina FC II-III before the treatment, 1 and 3 months after the treatment.MM 50D significantly widens diameter of the brachial artery (by 11.6%), lowers nitroglycerin-dependent vasodilation (from 16% to 10.4% in a month and to 10.2% in 3 months) and blood flow speed in reactive hyperemia. An absolute increment of the brachial artery diameter in reactive hyperemia test remained unchanged. The ratio flow-dependent vasodilation/nitroglycerin-dependent vasodilation increased in the course of therapy from 0.67 to 0.91. The drug produced clinical improvement (anginal attacks rate diminished by 70 and 85%, respectively) and increased exercise tolerance (the threshold performance rose by 28%, total load time--by 30%).It is important to use complex assessment of hemodynamic component of endothelial function in the treatment with nitrates.

To elucidate associations between location and extent of lesions of arterial vascular bed in patients with nonspecific aortoarteritis and presence of various alleles of DRB1 gene of HLA class II in patients of Russian ethnicity.Ultrasonography, magnetic resonance imaging and computed tomography were used for examination of arteries in 25 patients aged 22-69 years. Genotyping of HLA-DRB1 locus was carried out in all patients and in a group of practically healthy subjects of the same ethnic group (controls).Patients compared with controls had significantly higher frequency of class II alleles of HLA-DRB1 gene which corresponded to serological specificity DR1. Subgroup of patients carriers of DR1 allele had significantly less extensive involvement of arterial vasculature compared with subgroup of carriers of other alleles. The revealed clinical-genetic relationship reflects special features of aortoarteritis in Russian population and evidence for genetic heterogeneity of this disease.

To assess prevalence of atherosclerotic changes in coronary arteries by computed tomography (CT) and carotid arteries by ultrasound duplex scanning (UDS) in patients with ischemic heart disease (IHD); to analyse viscoelastic properties of the walls of the common carotid arteries and their correlation with the results of carotid artery UDS and coronary artery CT.CT and UDS were made in 100 patients with clinically and coronarographycally verified diagnosis of IHD.Calcinates in coronary arteries were found in 96% patients. The mean coronary calcium index (MCCI) was 544.8 +/- 718.5 units (from 0 to 3954 units). Atherosclerotic affection of carotid arteries was registered in 89% patients. Mean thickness of intima-media complex (IMT) of the common carotid arteries was 0.96 +/- 0.02 mm (0.60 mm - 1.87 mm). A correlation was found between coronary MCCI and IMT of the common carotid arteries. The stepwide regression analysis determined such predictors of coronary calcinosis as increased value of IMT of the common carotid arteries and atherosclerotic plaques (ASP) in carotid arteries. Viscoelasticity of the walls of the common carotid arteries in IHD patients differ from that of healthy subjects. This demonstrates stiffness of arterial wall in patients with IHD. There is a correlation between these parameters and IMT of the common carotid arteries.Combination of UDS with CT in diagnosis of atherosclerotic lesions of different arteries provides more complete information about structural-functional changes in patients with IHD. Such non-invasive tests as measurement of IMT of common carotid arteries and detection of ASP in carotid arteries by UDS, determination of coronary MCCI may serve screening parameters in diagnosis of coronary atherosclerosis.

Efficacy and tolerability of atorvastatin (20 mg/day) were assessed in a 3 month study on 19 patients (5 men, 14 women, mean age 52.3 years) with familial hypercholesterolemia. Average baseline levels of total cholesterol (CH) and low density lipoprotein (LDL) CH were 10.7 and 8.6 mmol/l, respectively. By the end of 3 months levels of CH, LDL CH, triglycerides and atherogeneity index decreased by 32, 41, 16 and 45%, respectively. This was accompanied by 21% increase of high density lipoprotein CH level. There were no cases of AST or ALT activity elevation above 3 upper limits of normal values. However 1 patient had asymptomatic elevation of ALT activity up to 53 U/l which did not cause interruption of therapy. Creatine kinase remained normal throughout the study period. Three patients (16%) stopped taking atorvastatin because of side effects. Thus in patients with familial hypercholesterolemia the dose of atorvastatin 20 mg/day was sufficiently well tolerated and provided effective control of lipid levels.

To study the influence of treatment with HMG-CoA reductase inhibitor atorvastatin on endothelial function in patients with familial hypercholesterolemia type IIa.Sixteen patients (5m/11w, 51-/+3 years) with familial hypercholesterolemia were studied before and after 3 months of therapy with atorvastatin 20 mg/day. EDRF release test (D.Celermajer, 1992) was used to assess flow-mediated endothelium-dependent vasodilatation (FMD) of the brachial artery in response to reactive hyperemia. Plasma nitrite/nitrate (NOx) levels were measured as an indirect index of nitric oxide (NO) production in vivo using HPLC.Atorvastatin treatment resulted in a 32% reduction in total serum cholesterol (CH), 41% reduction in low density lipoprotein (LDL) CH, 16% reduction in triglycerides and a 21% increase in high density lipoprotein CH. Flow mediated dilatation (FMD) was impaired at baseline (5.8-/+0.9%) and significantly improved up to 9.5-/+0.9% after 3 month atorvastatin therapy (p0.002). Change in FMD inversely correlated with baseline FMD (r = -0.58, p0.05). There was no significant correlation between FMD and neither total serum CH nor LDL CH levels at baseline. During atorvastatin therapy significant reduction of plasma NOx levels occurred from 53.4-/+5.1 mcmol/l at baseline (range 42.6-86.2 mcmol/l) to 35.5-/+5.1 mcmol/l (18.4-46.0 mcmol/l) after treatment (p0.02, n=7).In patients with familial hypercholesterolemia atorvastatin produced beneficial effect on endothelial function (increase in flow-mediated dilatation, decrease in NOx).

To assess the state of target-organs in males with mild and moderate forms of essential hypertension (EH) in normal and disturbed 24-h rhythm of arterial pressure (AP).Target-organs were examined in 70 males aged 30-62 years (mean age 49 +/- 1 years) with mild (n = 54) or moderate (n = 16) EH. The following tests were performed: ophthalmoscopy, echo-CG with estimation of the left-ventricular myocardial mass index (LVMMI), duplex scanning of the carotid arteries (DS), AP monitoring, measurements of plasma creatinine, relative density of the urine, glomerular filtration rate, examination of the neurological status. Circadian rhythm of AP was evaluated by a night fall (NF) of systolic pressure (SP). Patients with inadequate NF of SP (10%) entered group 1, those with normal NF of SP (10%NF SP20%) were allocated to group 2.Patients of group 1 had a significantly higher LVMMI, more frequent occurrence of left ventricular hypertrophy and carotid artery affection (local thickening "intima-media"). In group 1 there was also a complex of unfavourable changes in AP circadian profile, especially at night.Mild/moderate EH with insufficient NF of SP is associated with more pronounced and frequent changes in the target-organs (left-ventricular hypertrophy, "intima-media" thickeing). Insufficient NF of AP initiates higher pressor load on the target-organs, on the one side, and reflects defective regulation which affects target-organs, on the other. Both these factors contribute to damage of the target-organs.