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Acute myocardial infarction during pregnancy is a threatening complication with high maternal and perinatal mortality. According to the literature, hereditary thrombophilia is commonly associated with obstetric disorders and susceptibility to venous thrombosis, whereas arterial part of the vasculature, including coronary, is rarely involved. The article describes two clinical cases of pregnant women with acute myocardial infarction and post-infarction cardiosclerosis, in whom hereditary thrombophilia, associated with the gene PAI-1-675 polymorphism, was diagnosed. Mothers of both patients had suffered myocardial infarction at a young age, while past history of only one pregnant woman was remarkable for multiple perinatal losses. Myocardial infarction may manifest with intense headache mirroring systemic angiospasm.Based on the clinical observations of acute myocardial infarction in pregnancy, one could conclude that measurements of troponin levels that might be false negative should be done repeatedly, while the signs of transmural myocardial injury at ECG can evolve into those of an intramural myocardial infarction. Miscarriage and fetoplacental insufficiency have been found in the patients with combination of hereditary thrombophilia and myocardial injury. Coronary artery damage in pregnant women can be the result of hereditary thrombophilia, most often associated with the PAI-1-675 gene polymorphism, as well as its combination with the heterozygous state of other genes.The absence of past perinatal losses and venous thromboembolism in pregnant women with myocardial infarction does not exclude hereditary thrombophilia, and additional work-up of the patient and the proband family is mandatory to exclude the underlying pathology. The course of myocardial infarction may not require an intracoronary intervention, and treatment may consist of non-fractionated or low molecular weight heparin and calcium antagonists.

Aim. Assessment of prevalence and risk factors of sleep breathing disorders in patients with acromegaly from Moscow region. Materials and methods. Cardiorespiratory monitoring was executed to 55 patients with acromegaly (18 men and 37 women): 27 patients with de novo disease, 28 patients on treatment of acromegaly (including 18 patietns with uncontrolled and 10 - with controlled acromegaly). All subgroups did not differ on sex, BMI and age. Also 24-hour monitoring of arterial blood pressure was carried out in 39 patients (12 men and 27 women, 14 patients with de novo acromegaly, 15 and 10 patients with uncontrolled and controlled acromegaly, respectively). Results and discussion. The high prevalence of sleep breathing disorders (SBD) was revealed in patients with acromegaly from Moscow Region. SBD was found in 92.6%, 83.5% and 70.0% patients with newly diagnosed, uncontrolled and controlled acromegaly, respectively. The majority of patients had severe/moderate SBD in all subgroups (78.8%, 72.2% and 60.0%, respectively). In patients with newly diagnosed and uncontrolled acromegaly index of apnea-hypopnea (31 and 38.5 respectively), number of apnoe episodes (76 and 72) and saturation level (93% and 93.5%) did not differ significantly while these parameters were better in patients with a controlled acromegaly (apnea-hypopnea index 20, apnea episodes 45.5 and saturation level 95%). The peak of desaturation was subphysiological in 91.7%, 86.7% and 77.8% of patients with newly diagnosed, uncontrolled and controlled acromegaly, respectively. Severity of SBD did not depend on GH and IGF-1 levels as well as acromegaly duration. Such all-population risk factors of SBD as BMI and age were valuable for patients with acromegaly, however gender did not matter. SBD were associated with lack of physiological decrease of systolic and diastolic night BP. Conclusion. Acromegaly per se is a strong risk factor of sleep breathing disorders. The high prevalence of sleep breathing disorders in patients with acromegaly even after achievement of control over a disease emphasized need of specialized treatment of these violations.

Background: Arterial hypertension in pregnancy is a major cause of maternal death and perinatal mortality. According to the Russian recommendations, only devices that have been evaluated according to international protocols may be used for ambulatory blood pressure monitoring in pregnancy.Aim: Validation of the MECG-DP-NS-01 upper arm blood pressure monitor manufactured by the DMS Advanced Technologies Ltd., in oscillometry and auscultation modes for ambulatory blood pressure monitoring in pregnancy, according to the ESH International Protocol revision 2010 (ESH-IP2), the BHS protocol revision 1993 and the AAMI standard.Materials and methods: A group of 39 pregnant women at various gestation time (from 9 to 40 weeks, 29.2 ± 9.9 weeks) aged 25 to 43 years (31.9 ± 4.3 years) was recruited for the validation study. Expert and device blood pressure measurements were taken for each patient according to the international protocols.Results: The MECG-DP-NS-01 upper arm blood pressure monitor produced by the DMS Advanced Technologies Ltd. for ambulatory blood pressure monitoring was validated in oscillometry and auscultation modes in pregnancy, according to the BHS protocol revision 1993, the ESH-IP2 and the AAMI standard. The device met an A/A grading for the BHS protocol revision 1993 both in the oscillometry and auscultation modes. The device maintained its A/A grading throughout the low-pressure, medium-pressure and high-pressure ranges.Conclusion: The MECG-DP-NS-01 met all the requirements and, fulfilling the standards of the protocols, is recommended for ambulatory blood pressure monitoring in pregnancy according to BHS protocol revision 1993, ESH-IP2 and AAMI standard. According to the Declaration of Blood Pressure Measuring Device Equivalence signed by the manufacturer, there are no differences that will affect blood pressure measuring accuracy between the MDP-NS-02s “Voshod” upper arm blood pressure monitor produced by the DMS Advanced Technologies Ltd. and the MECG-DP-NS-01, which passed the ESH-IP2, BHS and AAMI protocols.

Background: Ambulatory blood pressure monitoring is one of the main methods for hypertension diagnosis. According to the recommendations of the Russian Medical Society of Hypertension and the All-Russian Society of Cardiology, only devices that passed all of the international protocols requirements can be recommended for ambulatory blood pressure monitoring. Aim: Validation of the MECG-DP-NS-01 upper arm blood pressure monitor produced by the DMS Advanced Technologies Ltd., in oscillometry and auscultation modes, for ambulatory blood pressure monitoring, in an adult population at rest according to the ESH International Protocol revision 2010 (ESH-IP2), the BHS protocol revision 1993 and the AAMI standard. Materials and methods: A group of 85 people (50 men and 35 female) aged 19 to 86 years (mean age 47.7±18.0 years) was recruited for the validation study. Expert and device blood pressure measurements were taken for each patient according to the international protocols. Results: The MECG-DP-NS-01 upper arm blood pressure monitor produced by the DMS Advanced Technologies Ltd. for ambulatory blood pressure monitoring, was validated in oscillometry and auscultation modes in an adult population at rest according to the BHS protocol revision 1993, the ESH-IP2, and the AAMI standard. The device achieved an A/A grading for the BHS protocol revision 1993 both in the oscillometry and auscultation modes. The device maintained its A/A grading throughout the low-pressure, medium-pressure, and high-pressure ranges. Conclusion: The MECG-DP-NS-01 passed all of the requirements and, fulfilling the standards of the protocols, is recommended for ambulatory blood pressure monitoring according to BHS protocol revision 1993, ESH-IP2, and AAMI standard. According to the Declaration of Blood Pressure Measuring Device Equivalence signed by the manufacturer there are no differences that will affect blood pressure measuring accuracy between the MDP-NS-02s (Voshod) upper arm blood pressure monitor produced by the DMS Advanced Technologies Ltd. and the MECG-DP-NS-01, which passed the ESH-IP2, BHS and AAMI protocols.

Background: High blood pressure in childhood and adolescence is associated with a 2 to 3-fold increase of the risk of arterial hypertension. According to the Russian guidelines, only devices that have been tested by international protocols can be used for the main diagnostic method of arterial hypertension in children and adolescents, i.e. ambulatory 24-hour blood pressure monitoring.Aim: To validate the MECG-DP-NS-01 upper arm BP monitor in oscillometry and auscultation modes within the “Soyuz” complex, in children and adolescents aged from 5 to 15 years according to the international protocol of the European Society of Hypertension (ESH) from 2010 (ESH-IP2), the protocol of the British Hypertension Society (BHS) from 1993 and the standard of the Association for the Advancement of Medical Instrumentation (AAMI).Materials and methods: We recruited 99 children and adolescents (49 male, 50 female) aged from 5 to 15 years (33 children, from 5 to 7 years, 33, from 8 to 11 years, 33, from 12 to 15 years). Expert and device blood pressure measurements were performed in each patient according to the protocols.Results: The MECG-DP-NS-01 upper arm blood pressure monitor was validated and its accuracy in blood pressure measurement in children and adolescents according to ESH-IP2, BHS and AAMI protocols confirmed. According to BHS 1993 protocol, its accuracy corresponded to A/A both in the oscillometry and auscultation modes.Conclusion: According to ESH-IP2, BHS and AAMI protocols, MEGC-DP-NS-01 within the “Soyuz” complex could be recommended for 24-hour ambulatory blood pressure monitoring in children and adolescents aged from 5 to 15 years, both in the oscillometry and auscultation modes. According to the Declaration of blood pressure Measuring Device Equivalence signed by the manufacturer for the devices MDP-NS-02s “Voshod” and MEGCDPNS-01, and to the equivalence criteria for blood pressure measuring devices, the results of testing and its conclusion could be extrapolated to the device MDP-NS-02s “Voshod” produced by the “DMS Advanced Technologies”.

Aims. To assess the risk for sleep apnea in patients with various types of glycemic disorders by means of Epworth Sleepiness Scale andSleep Apnea Screening Questionnaire. Materials and Methods. We examined 744 residents of Mozhaisk Region, that were considered to have high risk for development of type2 diabetes mellitus (T2DM), as estimated by FINDRISK Questionnaire. Patients, who scored 12+ were cleared for participation in this study. Combined score from Epworth Sleepiness Scale and Sleep Apnea Screening Questionnaire was applied for diagnosis of sleep apnea, supplemented with specific questions about snoring and episodes of apnea. Glycemic disorders were diagnosed with standard glucose tolerance test. Results. 42.7% of examined patients (n=318) were diagnosed with various types of glucose disorders. Prevalence of abdominal obe- sity (according to waist circumference measurement) comprised 59.3% in male patients and 54.1% in females. We observed positive correlation between body mass index (BMI) and snoring ? 0.3 (p=0.0001), BMI and apnea ? 0.2 (p=0.0001), BMI and daytime sleepiness ? 0.1 (p=0.007); we also observed direct correlation between age and snoring ? 0.2 (p=0.0001), as well as age and sleep apnea ? 0.1 (p=0.028). Risk for sleep apnea was found to be 4.7 times higher in patients with arterial hypertension. After adjustment71Диагностика, контроль и лечениеСахарный диабет. 2013;(1):71?77Сахар ный диабетfor age risk of apnea remained 2.8 times higher in patients with T2DM, 1.9 times higher in subjects with impaired glucose tolerance and1.6 times higher in subjects with impaired fasting glycaemia. Relative risk for snoring in patients with various types of glycemic disorders was 1.1-1.2 against normoglycemic controls. We estimated that all types of glycemic disorders increase risk for apnea 1.2?1.6 times. Conclusion. Glycemic disorders, body weight excess, obesity and arterial hypertension are risk factors for snoring and sleep apnea. Corresponding patient categories should be screened for sleep apnea by questionnaire survey to identify those in need of further complex examination and treatment.

Aim. To analyse 24-h rhythm of blood pressure (BP) and its influence on the rate and severity of left ventricular hypertrophy (LVH) in patients with chronic renal failure (CRF) on replacement therapy (peritoneal dialysis - PD). Material and methods. 70 CRF patients on PD were studied. Their examination included clinical, biochemical tests, automatic 24-hour blood pressure monitoring, transthoracic echocardiography. Results. Non-dipper and night-peaker disorders of BP 24-hour pattern were registered in 81.4% patients irrespective on hypertension severity. Left ventricular myocardial hypertrophy was 87.7% in patients with disturbed 24-h BP rhythm and 53.8% (p = 0.015) in normal BP rhythm. LV myocardial mass index median was 223 and 129 g/cm2 (p = 0.026), respectively. Concentric and excentric models of LV hypertrophy occurred with the same rate in normal and disturbed 24-h rhythm of BP. Conclusion. CRF patients on PD are characterized by disorders of 24-h BP rhythm independent of hypertension severity. Night-peaker pattern of BP is a risk factor of development and/or progression of LV hypertrophy.

The study included 25 men (mean age 29,24±0,76 years) with Stage I arterial hypertension (AH I) and 25 healthy male controls (mean age 30,27±0,59 years). Both groups underwent 24-hour blood pressure monitoring (BPM), echocardiography (EchoCG) with Doppler ultrasound, heart rate variability (HRV) assessment and measurement of serum cholesterol and its fractions. Analysing correlations between autonomous regulation parameters, cholesterol and cholesterol fractions, and myocardial structure and function, it was observed that in AH I patients, both the number and strength of correlations were greater than in healthy controls. It could point to greater rigidity of neuro-humoral cardiovascular regulation in AH I patients, comparing to healthy individuals.

The study included 25 men (mean age 29,24±0,76 years) with Stage I arterial hypertension (AH-I). The control group consisted of 25 healthy men (mean age 30,27±0,59 years). All groups underwent 24-hour blood pressure monitoring (BPM), echocardiography (EchoCG) with Doppler ultrasound, heart rate variability (HRV) assessment, and cholesterol fraction measurement. Analyzing the correlations between vegetative parameters, levels of cholesterol and its fractions, myocardial morphology and function, it has been demonstrated that in AH-I patients, the number and strength of correlations are higher than in healthy participants. This points to a possibility of more rigid neuro-humoral cardiovascular regulation in AH-I patients, comparing to healthy individuals.