[Myocardial and Arterial Stiffness Important Determinant of NT-ProBNP at Development of Heart Failure in Survivors of Myocardial Infarction].

AIM: To study diagnostic value of myocardial-arterial stiffness (MAS) as a determinant of N-terminal pro-brain natriuretic peptide (NT-proBNP) expression in patients with chronic heart failure (CHF) with ischemic or postinfarction left ventricular (LV) dysfunction. MATERIAL AND METHODS: We analyzed 6 months prognosis of 54 patients (mean age 61.7+/-8.6 years) with II-III NYHA class CHF divided into 2 groups: (I, n=18) with class II CHF and preserved LV ejection fraction (EF) (55+/-10.4%), (II, n=36) with class III CHF and low LF EF (30.4+/-6.8%). MAS was measured by echocardiography as ratio of arterial elasticity (Ea) and end-systolic elasticity of LV myocardium (Es). Serum NT-proBNP was measured by immunoenzyme assay. RESULTS: During 6 months follow-up one group II patient with initial NT-proBNP level 2020 rg/ml died. NT-proBNP level in group I was significantly lower than in group II (313 and 647 rg/ml, respectively). Ea/Es ratio was significantly higher (p=0.001) in group II. Multifactorial analysis demonstrated moderate correlation of NT-proBNP with Ea/Es ratio (r=0.50, p=0.0001) and negative correlation with LVEF (r=-0.45, =0.003) among patients with II-III class CHF. CONCLUSION: As correlation between symptoms and severity of clinical manifestations of ischemic or postinfarction cardiac dysfunction at development of CHF was not high it appears rational to consider MAS estimated by Ea/Es ratio as independent predictor of cardiovascular complications. Sufficiently close correlation between NT-proBNP and Ea/Es ratio allows to improve stratification of risk and to assess objectively prognosis of the disease using easier obtainable parameter Ea/Es in cases when possibility to measure NT-proBNP is not available.

[Reactive arthritis: current characteristics and the role of Chlamydia infections in development of a clinical picture]. / Reaktivnye artrity: sovremennye osobennosti i rol' khlamidiinoi infektsii v formirovanii klinicheskoi kartiny.

AIM: To examine present-day peculiarities of reactive arthritis (ReA) and effects of chlamydial infection on ReA clinical manifestations. MATERIAL AND METHODS: 120 ReA patients entered the trial. Urogenital variant was in 85%, enterocolitic in 15% of the patients. Etiology of ReA was defined with special methods diagnosing chlamydial and ureaplasma infection in scrapes from urethral or cervical epithelium (a cytological test, an enzyme immunoassay, polymerase chain reaction, cultural technique of ureaplasma detection). Antichlamydial antibodies were identified with enzyme immunoassay and reaction of indirect immunofluorescence. Factor analysis and indirect consecutive image recognition were applied. RESULTS: In all the cases, enterocolitic ReA was preceded by acute intestinal infection. In urogenic ReA the disease started with urethritis (62.7%), conjunctivitis (2.0%), arthritis (31.4%) or talalgia (3.9%). Initially, the occurrence of a full Reiter's triad was 15%, incomplete (two signs of the three)--46.7%. The debute was characterized by predominant oligoarticular lesion (65%), in the advanced stage polyarthritis was frequently diagnosed (49.6%). Pain most frequently located in the low spine (60.5%). X-ray evidence on degenerative-dystrophic alterations of the peripheral joints and spine was obtained in 54.2% ReA cases. 60 patients were examined for chlamydial and ureaplasma infection. The etiology of ReA was chlamydial, ureaplasmic and chlamydo-ureaplasma in 43.3, and 35%, respectively. The etiology was not identified in 16.7% cases. Such extraarticular symptoms as urogenital, ocular, skin and mucosal, cardiovascular, lymph nodes were observed in 61.7, 22.5, 13.3, 76.7 and 13.3%, respectively. CONCLUSION: At present, ReA is characterized by the following most typical features: polymorphism of clinical symptoms at the disease onset, predominance of polyarticular variant of articular involvement at the advanced stage of ReA, high incidence of extraarticular manifestations. The factor analysis shows that clinical picture of ReA is established by "activity" and "unfavourable course" factors.