[Cognitive impairment in postmenopausal women with arterial hypertension].

The aim of the study was to assess relationship between organ damage and changes of cognitive function in postmenopausal women with arterial hypertension during 3 years of follow-up. A total of 55 women (aged 69 ± 9,5 years) with stable course of hypertension were included. During period of observation and treatment cognitive function deteriorated in 40 and improved in 60% of women. Cox regression analysis showed that worsening of cognitive function was associated with low level of education (OR 3.85, p = 0.021), lack of work (OR 5.71, p = 0.035), left ventricular (LV) end-diastolic diameter (OR 6.89, p = 0.019), LV end-systolic diameter (OR 3.21, p = 0.047), left atrium (OR 15.20, p = 0.020), microalbuminuria (OR 11.14, p = 0.041) and duration of chair-rising test (OR 7.0, p = 0.025). Our findings indicate that progressive organ damage, low level of education and lack of work are associated with deterioration of cognitive function and functional mobility in women with hypertension. Our results reinforce the need for early detection of cognitive impairment as a marker of subclinical brain damage to prevent dementia.

[Hronic heart failure and concomitant diseases in elderly patients: anemia and cardio-renal anemic syndrome].

AIM: to assess impact of anemia on chronic heart failure (CHF) course in elderly patients in primary care setting. Methods. We examined 164 outpatients (n=164) aged 60-85 years with clinically stable CHF due to ischemic heart disease and arterial hypertension. All patients underwent clinical, laboratorial evaluation, ECG, EchoCG measurements, 6 min walk test. Patients were categorized according to the presence of anemia, as defined by the WHO criteria (hemoglobin levels <13 g/dl in men and <12 g/dl in women). Median duration of follow up was 1.85 (1.0-4.75) years. Results. Anemia was found in 32.9%, cardio-renal anemic syndrome (CRAS) in 23.2% of patients. In all patients anemia was mild (Hb>9 g/dl). It was associated with diabetes mellitus (odds ratio [R] 2.2, 95% CI 1.03-4.69, =0.041), high creatinine level (R 2.76, 95% CI 1.25-6.12, =0.012) and chronic kidney disease (R 5.66, 95% CI 2.51-12.77, <0.001). During follow-up mortality rate was similar among anemic and non-anemic patients (27.8 vs 30%, =0.768). Patients with CRAS had worse survival compared with patients of the same age without anemia and preserved kidney function (=0.004). Age >75 years (R 3.58, 95% CI 1.59-7.99, =0.002), diabetes (R 2.68, 95% CI 1.19-6.04, =0.018), history of myocardial infarction (R 2.7, 95% CI 1.24-6.04, =0.013), systolic blood pressure <110 mm Hg (OR 2.49, 95% CI 1.09-5.71, =0.030), complete left bundle branch block (LBBB) (OR 2.79, 95% CI 1.26-8.22, =0.012), creatinine >130 mmol/l (OR 3.53, 95% CI 1.51-8.22, =0.004) were predictors of mortality of elderly patients with CRAS. Conclusions. CHF patients with and without anemia had similar survival but survival of those with CRAS was worse compared with patients without anemia and preserved kidney function. Age >75 years, diabetes mellitus, history of myocardial infarction, low systolic blood pressure, complete LBBB, high creatinine level were predictors of mortality in patients with CRAS.

[Clinical manifestations of anemia syndrome and its significance in the course of chronic heart failure in elderly patients].

AIM: To define the practical significance of anemia in the course of chronic heart failure (CHF) in elderly outpatients. SUBJECTS AND METHODS: One hundred and sixty-four patients aged 60 to 85 years with NYHA classification Functional Class (FC) II--IV CHF due to coronary heart disease and arterial hypertension were examined. Clinical, laboratory, and echocardiographic parameters were assessed; admissions and fatal outcomes were recorded. The follow-up was 2.5 +/- 2.1 years. RESULTS: Anemia syndrome was recorded in 32.9% of the patients (women were 43.5% and men were 26.5%) (p = 0.024). There was an association between decreased hemoglobin levels and renal dysfunction (odds ratio (OR) 2.04; 95% confidence interval, 1.05 to 3.98; p = 0.036). In all the patients, anemia was mild and similar in its pattern and etiology, regardless of gender. Because of decompensated CHF, 46.3% of the patients with anemia and 22.7% of those without this condition were admitted to hospital (p = 0.002). The survival rates of the elderly CHF patients with and without anemia were equal (p = 0.549); however, comparison of only the patients with anemia showed a difference in male and female survival rates (p = 0.005). FC III--IV CHF (OR 4.37), chronic kidney disease (OR 2.27%), and a left ventricular ejection fraction of < 35% (OR 2.74) were predictors of a poor outcome in the elderly patients with CHF and anemia. CONCLUSION: Anemia was encountered in 32.9% of the elderly outpatients with CHF. Anemia was more common in the women than in the men and mild and similar in its pattern and etiology, regardless of gender. The disease prognosis was more favorable in the females than in the males.

[Chronic heart failure and osteoporosis].

Osteoporosis (OP) and chronic heart failure (CHF) are chronic noninfection diseases which are characterized not only by high prevalence but also by development of severe complications such as fractures in OP and decompensation in CHF. These complications lead to loss of functional, social activity and independent way of life, worsening of quality of life, hospitalizations, and premature death of a patient. During many years OP and CHF have been looked upon as independent diseases but according to recent data risk factors of their development and progression are common. In this article we pay special attention to mechanisms of development of CHF and OP, their risk factors, instrumental and laboratory diagnosis of OP, and problems of its treatment.

[Hyperuricemia and cardiovascular continuum].

Many recent reports suggest the relationship between hyperuricemia, risk and prognosis of arterial hypertension and coronary heart disease. The works on the clinical and prognostic significance in chronic heart failure are few even if this pathology deteriorates prognosis of some cardiovascular diseases. Hyperuricemia is considered to be a component of cardiovascular continuum, risk factor of chronic heart failure and marker of its unfavourable outcome. Prognostic significance of hyperuricemia in patients with chronic heart failure is discussed.

[Anxiety-depressive States in elderly patients with chronic heart failure].

UNLABELLED: Aim of the study was determination of factors of social desadaptation, which negatively affect psychoemotional status and quality of life of elderly patients with chronic heart failure (CHF). We included into the study 248 patients aged 60-85 years and 82 patients aged 39-59 years with NYHA class II-IV CHF. General state of patients we assessed with the help of clinical state assessment scale (CSAS), presence and severity of anxiety and depression -with hospital anxiety and depression scale, exercise tolerance - with 6 minute walk test. Patients of both groups were comparable by sex, severity of the CHF course quality of life, concomitant pathology, and treatment. Clinically manifest depression was found in 22.8% of patients aged 60 years and older and in 16% of patients younger than 60 years (p=0.460), clinically manifest anxiety was found in 22.8% and 20%, respectively (p=0.945). Risk factors of anxiety-depressive state in elderly patients were disability (relative risk [RR] 3.05, 95% confidence interval [CI] 1.04-8.97, p =0.042), insufficient education (RR 2.44, 95%CI 1.08-5.34; p=0.0320, and severe CHF according to CSAS (OR 1.22, 95%CI 1.07-1.4; p=0.003). According to data of multifactorial analysis disability (RR 1.78, 95%CI 1.01-3.13; p=0.045) and severe CHF (RR 1.17, 95%CI 1.07-1.27; p=0.001) were independently related to anxiety-depressive state in elderly patients. CONCLUSION: [corrected] Thus social dysadaptation and medical factors turned out to be leading parameters determining worsening of quality of life and development of anxiety-depressive state in elderly patients with CHF.

[Ergoferon and oseltamivir in treatment of influenza: results of multicentre randomized comparative clinical trial].

The narrow range of choice and virus resistance to the most common drugs require search and introduction of new drugs with proven efficacy and safety for the treatment of influenza. Ergoferon is a new combined medicine containing release active antibodies to interferon-gamma (anti-IFNgamma), CD4-coreceptor and histamine. The formulation influences various links of antiviral defense and provides antiinflammatory effect. The efficacy of the drug is related to its production process during which multiple reduction of the initial concentration of every component leads to release of special release activity. Previous experimental studies showed that anti-IFNgamma had antiviral activity against pandemic influenza virus A (H1N1) 2009 comparable to that ofoseltamivir (suppression of virus replication in the lung tissue, increase of the lifespan and reduction of the laboratory animals mortality). The aim of the multicentre randomized clinical trial was to compare (versus oseltamivir) the efficacy and safety of ergoferon in the treatment of influenza in adults. 213 patients with flu-like symptoms were examined in 8 medical centres of Russia during two epidemiological seasons (2010-11 and 2011-12). The inclusion criteria were: the first 48 hours after the onset; fever > or =37.8 degrees C, at least one common symptom and at least one respiratory symptom. Influenza was confirmed in 52 patients by QuickVue rapid diagnosis. 23 patients received ergoferon according to the treatment scheme and 29 received oseltamivir (daily dose 150 mg). Duration of the treatment was 5 days. The patients were followed up for 7 days. The primary endpoint was the percentage of the patients with the body temperature normalization for 2-5 days of the treatment. The maximum efficacy of ergoferon was observed on the second day of the treatment: almost half (48%) of the initially febrile patients had normal body temperature (versus 28% in the patients treated with oseltamivir). The comparison of the two groups of the patients by the morning and evening measurements of the body temperature every five days of the treatment by Cochran-Mantel-Haenszel revealed a significant difference between the two groups (chi2 = 7.1; p = 0.008). The average duration of the fever in the group of ergoferon was 2.3 +/- 1.2 days, in the group of oseltamivir--2.6 +/- 1.3 days (the efficacy of oseltamivir in the present study was comparable with the previously published data). The percentage of the patients treated with antipyretics because of hyperthermia on the second day of the treatment lowered 3 times and amounted to 17% (versus 41% in the oseltamivir group). The severity of common and respiratory symptoms (nose/throat/chest) significantly decreased on the third day of the treatment in both groups, the majority of the patients had either minimum severity or no signs of influenza. The clinical improvement was associated with positive changes in the life quality. No cases of the disease aggravation were recorded. Complications requiring antibiotic treatment or hospitalization were not observed during the followup. There were no adverse events recorded due to the drug use. No deviations in the laboratory indices were stated. Ergoferon is a new safe drug for the treatment of influenza. Its clinical efficacy was comparable to that of oseltamivir. The therapeutic effects of the drug were evident from: significant reduction of the disease severity, duration of febricity and general toxicity and respiratory flu symptoms, lower percentage of the patients with fever for 2 days. The febrile period in most of the patients did not exceed 2 days.

[Hyperuricemia in chronic heart failure].

Development of hyperuricemia is associated with excessive body mass, insulin resistance, metabolic syndrome, overuse of diuretics, elderly age, and abnormal renal function. Data are accumulated on existence of links between elevated uric acid level and arterial hypertension, diabetes mellitus, ischemic heart disease, and chronic heart failure (CHF). Hyperuricemia has been found in 60% of patients hospitalized because of decompensation of CHF. In CHF isolated hyperuricemia (irrespective of the state of renal function and administration of drugs) appears to be a marker of altered oxidative metabolism characterized by elevation of levels of free radicals which damage cardiomyocytes and vascular endothelium inducing disturbances of myocardial contractility and vasoconstriction. Hyperuricemia associated with insulin resistance, tissue hypoxia, elevated production of cytokines and free radicals can negatively affect cardiovascular system and worsen prognosis in patients with CHF.

[Non-rheumatic myocarditis in practice of outpatient therapist and cardiologist].

Non-rheumatic myocarditis occurs in therapeutic and cardiological practice both at prehospital and hospital stages. Diagnosis of this myocarditis at early stages is difficult. The course and outcome of this disease and its present-day treatment are outlined to help clinical and cardiological practitioners.

[Duodenogastric reflux and gastric pathology in the elderly patients].

OBJECTIVE: To determine the frequency of duodenogastric reflux (DGR), and to assess the changes in the gastric mucosa in the presence of bile reflux. MATERIALS AND METHODS: Our study includes the results of 1371 gastroduodenoscopies carried out in 2008, for patients between 65 and 92 years old, the study includes both kind of patients who were admitted to hospital and those who were investigated on an outpatient basis. The main group includes 695 patients with various level of DGR severity, and the control group consists of 676 patients without DGR. RESULTS: DGR was diagnosed in 14.8% more in women. In case of the presence of DGR we have found changes in the antrum mucosa as congestion, and minor erosion, hyperplasia, metaplasia of gastric and esophageal mucosa, and stomach polyps. And we have not noticed such changes when DGR was absent. We have found that the high frequency of antral hyperplasia is correlated to the DGR severity. CONCLUSION: DGR is diagnosed in more than 10% of patients who undergo gastroduodenoscopy. DGR is an indicator of conditions often associated with various morphological changes in gastric mucosa; therefore this finding has to be taken in consideration in the further investigations and management of such patients.

[Left bundle of his brunch block as a manifestation of the syndrome of dromotropic insufficiency in patients with chronic heart failure].

Left bundle brunch block (LBBB) is met in approximately 20% of hospitalized patients and in 1/3 of outpatients with chronic heart failure (CHF). Abnormalites of impulse conduction in LBBB promote dyssynchronization, which represent a pathophysiological process which not only worsens ventricular function but also facilitates remodeling of the myocardium and development of CHF. As a result of dyssynchrony systolic and diastolic functions of the heart are impaired. This manifests as shortening of diastole of the left ventricle and dyssynchronous movement of interventricular septum (IVS) with a tendency to lowering of local and global ejection fraction (EF), and leads to significant metabolic and energetic consequences. Abnormal geometry and dilation of the heart in CHF promotes chaotic separation of early and late activated myocardial zones. This aggravates disturbances of conduction existing as a result of fibrosis and causes weakening of contractility and slowing of impulse conduction velocity. These morphological changes facilitate electrophysiological deviations and formation of abnormal conduction. LBBB is undoubtedly involved in development of sudden death of patients with CHF, but its effect on long term prognosis remains ambiguous and possibly the role of no small importance in this belongs to severe concomitant pathology and dysfunction of left ventricular myocardium.

[Structural-functional peculiarities of the heart and survival of elderly patients with chronic heart failure and left bundle branch block].

AIM: To study structural-functional characteristics of the heart and survival of elderly patients with chronic heart failure (CHF) and left bundle branch block (LBBB). MATERIAL AND METHODS: We examined and followed-up 108 patients aged 60-85 years with NYHA class II-IV CHF with and without LBBB. RESULTS: Patients of both groups were comparable according to sex, age, CHF duration and severity, hemodynamic parameters, clinical condition, quality of life, and spectrum of taken drugs. Patients with LBBB had statistically significant increases of end diastolic (p<0.001) and systolic (p<0.001) dimensions, end diastolic (p<0.001) and systolic (p<0.001) volumes, sphericity index (p<0.001), long axis (p<0.05), decreases of relative thickness of the left ventricle (p<0.05), interventricular septum (p<0.001), and left ventricular ejection fraction (p<0.001). Pronounced mitral regurgitation also was more frequent in patients with LBBB (p<0.01). During follow up 14/34 patients (41.2%) with LBBB and 19/74 patients (25.7%) without LBBB died. There were 10 and 9 sudden deaths among patients with and without LBBB, respectively. CONCLUSION: In patients with LBBB development of CHF is associated with changes of left ventricular geometry. Sudden death is the most frequent cause of death of these patients.

[Diagnostic value of Tei index in detection of chronic heart failure in elderly patients].

AIM: To evaluate diagnostic value of Tei index in detection of chronic heart failure (CHF) in elderly outpatients. MATERIAL AND METHODS: Examination of 101 CHD patients of the study group and 46 control patients free of heart disease aged over 60 years included registration of doppler spectra and calculation of the Tei index which is a ratio of isovolumic contraction time plus isovolumic relaxation time to left ventricular (LV) ejection time and can be calculated using dopplerography. RESULTS: Mean Tei index in CHF patients was significantly higher than in control patients. The Tei index significantly exceeded that in the controls in CHD patients with both low and normal LV ejection fraction. In healthy controls over 60 years of age Tei index varied from 0.40 to 0.59 and averaged 0.5 +/- 0.05. Optimal diagnostic ability to detect CHF in the elderly is shown for Tei index 0.56. For this value sensitivity of the index reached 90%, specificity - 87%. CONCLUSION: Calculation of the Tei index is possible in all the patients irrespective of quality of heart and LV endocardium visualization in echocardiography.

[Experience of the use of nebivolol in the treatment of hypertension in postmenopausal women]. / Prakticheskii opyt uspeshnogo primeneniia nebivolola pri lechenii arterial'noi gipertonii u zhenshchin v postmenopauze.

Nebivolol was given to 30 hypertensive postmenopausal women as monotherapy (5-10 mg/day) or in combination with hydrochlorothiazide. Clinical effect was achieved in 76.6 and 86.7% of women on mono- and combination therapy, respectively. Hypotensive effect was confirmed by 24-hour blood pressure monitoring. Blood pressure lowering was associated with decrease of total peripheral resistance and regression of left ventricular hypertrophy. Nebivolol appeared to be metabolically neutral and only sporadic adverse effects were registered.