INFLUENCE OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND HEART DYSSYNCHRONY ON THE COURSE OF ARTERIAL HYPERTENSION WITH COMORBID PATHOLOGY.

The aim of the study is determination of the role of left ventricular dysfunction and heart dyssynchrony in the disease's course and prognosis in patients with arterial hypertension and diabetes mellitus type 2 (DM2T) and obesity. A retrospective analysis of clinical and special exam results was carried out in different groups: 1st group (n = 49), is characterized by worsening course (WC) of the disease, that was estimated 6 months after the beginning of the study; 2nd group (n = 86) without worsening of disease's course. The criterion of worsening course in patients was exaggeration of target-organ damage. The diastolic function of the myocardial infarction was assessed by recording the Doppler transmitral diastolic flow. Heart dyssynchrony was determined in the M-mode and pulse-wave/continuous-wave Doppler (PW/CW). The diastolic function of the LV has significant association with the progression of hypertension. The results of the study show that both slowdown and acceleration of the maximum early ventricular filling velocity (E) were indicative for patients with progression of the disease, and moderate E values was significantly more frequent in the group without progression of the disease. The maximum late ventricular filling velocity parameter (A) (acceleration) was significantly more common in the 1st group (p ≤ 0.001), and the moderate value of A index (≤ 0.71 msec.) was diagnosed more often in the group without progression. Furthermore, the decline of LV relaxation velocity (E/A ≤ 1.0) was detected in the group with disease's progression significantly more often (p ≤ 0.001) compared with the 2nd group, therefore we suppose that it has a pathogenic significance. In addition, a decrease in diastolic filling time ≤ 200 ms, as well as a slowing of the time of isovolumic relaxation of the LV (IVRT ≥ 201 ms) both revealed a pathogenic significance (p ≤ 0,001), which were diagnosed more often (p ≤ 0.001) in the group with disease's progression. Violation of diastolic function is a significant factor of the hypertension progression in patients with T2DM. The presence of LV dyssynchrony that is associated with the LV hypertrophy is a great predictor for the worsening course in hypertensive patients with T2DM and obesity.

[MODERN MEANS FOR THE TREATMENT OF ATRIAL FIBRILLATION IN DIABETIC PATIENTS].

The authors discuss modern approaches to the treatment of atrial fibrillation with reference to diabetic patients. The studies carried out thus far showed the importance of differential anti-arrhythmic therapy taking account of the clinical form of ciliary arrhythmia. The possibility of surgical and preventive treatment (up-stream therapy) is demonstrated.