THERAPEUTIC APPROACHES TO THE CORRECTION OF COGNITIVE IMPAIRMENT IN PATIENTS WITH HYPERTENSION AND TYPE 2 DIABETES.

OBJECTIVE: The aim: Was to improve the effectiveness of the treatment of cognitive impairment in patients with hypertension and type 2 diabetes. PATIENTS AND METHODS: Materials and methods: 56 patients (11 women and 45 men, average age 61.7 ± 4.3 years) with hypertension II, 2 degree and type 2 diabetes (average severity, subcompensation stage) were examined. 40 patients had moderate CI and 16 had mild CI. After the examination, the patients were divided into two groups and treated accordingly. The control group consisted of 20 healthy individuals. RESULTS: Results: Vascular brain lesions that cause hypertension and diabetes very often lead to impaired cognitive function whose therapeutic correction has received little attention, especially in the pre-operative stages. 56 patients have been examined to study the efficacy and safety a combination of Phenibut and Ipidacrine as an additional therapy to standard basic treatment (antihypertensive and hypoglycemic) for the correction of cognitive dysfunction in patients with comorbidity of hypertension and type 2 diabetes mellitus. CONCLUSION: Conclusions: One month after the beginning of the treatment, an improvement in psycho-emotional state and psychometric parameters was identified, which was manifested by an increase in concentration of attention, memory, psychomotor functions, speech activity together with normalization of blood pressure and metabolic parameters.

Cardiovascular remodeling in patients with hypertension with different degrees of cognitive impairment.

OBJECTIVE: Introduction: Recently, the concept of vascular cognitive impairment, combining all variants of cognitive decline due to cerebrovascular insufficiency, is actively being developed. This concept goes far beyond traditionally existing ideas about the problem of vascular cognitive disturbances. The aim of the study is to demonstrate the correlation between the indices of structural and functional rearrangement of the cardiovascular system and the state of intellectualmnemonic functions in patients with hypertension. PATIENTS AND METHODS: Materials and methods: A comprehensive survey of 146 patients with hypertension of the II and III stage according to ESH / ESC 2013, 2017, 2018 has been performed. The study included patients with mild and moderate cognitive impairment (CI). Depending on the state of the cognitive sphere and on the basis of the results of the neuronpsychological testing, The patients were divided into 3 groups depending on the state of the cognitive sphere and on the basis of the results of the neuron-psychological testing with further comparisons of their clinical and instrumental data. RESULTS: Results: According to the results of our study, it has been found that an increase of the signs of cardiovascular remodeling was observed in patients with more pronounced changes in cognitive activity. The analysis of intracardiac hemodynamic parameters in patients of the studied groups revealed more significant pathological changes in patients with cognitive impairments than in patients without them. Patients with mild and moderate CI had significantly higher heart rates, left ventricular wall thickness (LV) which led to impairment of the diastolic function of LV and had already been registered in patients without cognitive dysfunction. Moreover, it increased with the appearance (mild) and growth of the degree (moderate) cognitive impairment. The average daily values of BP (SBP, DBP) in patients of all studied groups significantly exceeded the recommended norms, while in patients with moderate CI these rates were significantly higher than those in the group with mild CI (p = 0.028). In addition, the variability of systolic blood pressure was increasing simultaneously with the deterioration of cognitive function of our patients. Also, signs of remodeling were being observed during the study of the state of peripheral vessels (increase of peripheral resistance, pulsation index, linear velocity and thickening of the intima-media complex), which is the main cause of cognitive impairment and causes their appearance and reflects their degree. CONCLUSION: Conclusions: The presented study revealed a clear correlation between the degree of cognitive impairment and the degree of changes in the daily blood pressure profile, the most important of which were the average daily systolic blood pressure and systolic blood pressure variability. On the basis of the conducted research, in the future it will be possible to predict the level of the cognitive sphere involvement, depending on the state of the daily blood pressure profile, changes of the ventricle and vessels geometry, which will enable timely diagnosis of cognitive impairment and the prescription an adequate therapy.

Gender differences in clinical factors associated with coronary artery atherosclerosis severity in patients with aortic valve and/or mitral annulus calcification.

OBJECTIVE: Introduction: The previous studies of coronary atherosclerosis association with aortic valve calcification (AVC) and/or mitral annulus calcification (MAC) had contradictory results. The aim: To assess gender differences in clinical factors associated with coronary artery atherosclerosis severity. PATIENTS AND METHODS: Materials and methods: 362 patients (mean age 63.9 (8.8) years, 244 (67.4%) males) who underwent coronary angiography were included in the retrospective study. AVC and/or MAC presence was determined using transthoracic echocardioscopy. Coronary angiography results were assessed using coronary atherosclerosis severity index (CASI). RESULTS: Results: There were lower CASI in aortic stenosis (AS) subgroups (0 (0; 3.5) and (0; 9.5) in subgroups with severe and moderate AS respectively versus 12.0 (6.0; 20.5) in subgroup without AS, <0.005). Man with AVC and/or MAC (without AS and diabetes mellitus (DM)) had higher CASI compared to man without heart valve calcification and without DM (15.0 (7.0; 21.5) versus 7.0 (2.0; 12.0), p=0.0002), whereas in the similar woman subgroups CASI did not differ. In the male group without DM (without AS) CASI was associated with age (r=0.319, <0.0001), glomerular filtration rate (GFR) (r=(-0.164), p=0.049), cholesterol level (r=0.242, p=0.003) and the combined presence of AVC and MAC (r=0.229, p=0.006), whereas in the similar female group there were only CASI association with GFR (r=(-0.252), p=0.050) and with combined presence of AVC and MAC (r=0.219, p=0.080). CONCLUSION: Conclusions: CASI depended on AS severity. In subgroups without AS and DM CASI was associated with combined presence of AVC and MAC, GFR, and besides with age and cholesterol level in man.

Variant of myocardial infarction course in the patient with left ventricular non-compaction.

Non-compacted left ventricle in adults is a rare occurrence, though it is diagnosed even more rarely. As a rule in patients with non-compacted left ventricle (LVNC) other pathologic condition is diagnosed, notably hypertrophic or dilated cardiomyopathy. The majority of LVNC cases are diagnosed in early infancy but currently there are asymptomatic cases detected by means of echocardiographic examination. Real prevalence of LVNC is unknown. According to many authors LVNC occurs in 9.2-9.5% of children with diagnosed cardiomyopathies. The majority of such children do not survive till adulthood because of progressive severe heart failure, fatal arrhythmias and thromboembolisms. This value ranges from 0.014 to 0.05% in adult population. The article presents a clinical case illustrating the stages in establishing the diagnosis of non-compacted left ventricle in a young patient with myocardial infarction and congestive heart failure. Common characteristics of non-compacted left ventricle and connective tissue dysplasia syndrome in the patient suggested etiopathogenetic relationship between these two pathologic states. The basic common characteristic feature of both non-compacted left ventricle and connective tissue dysplasia syndrome proved to be multiple abnormal chords of the left ventricle. The patient was supposed to have some coronary circulation abnormality inherited together with non-compacted left ventricle and connective tissue dysplasia syndrome. Adverse prognosis and high mortality in non-compacted left ventricle require its early recognition and differentiated approach to treatment depending on the severity of the disease and using all modern methods of treatment both conservative and surgical.

Specific characteristics of intracardiac hemodynamics and vegetative regulation in healthy young individuals with normal heart geometry and concentric remodeling of left ventricle.

OBJECTIVE: Introduction: Heart remodeling is a complex multifactor process determining the prognosis of the patient with any cardio-vascular pathology. There are convincing observations and conclusions in literature about the formation of concentric remodeling of LV prior to the appearance of any changes in AP [4, 5]. But until now there is no common point of view as to the factors involved in remodeling both the myocardium and the vessels, especially in the absence of the major known causative factor - arterial hypertension. From this perspective the study of relationship between cardiac and vascular remodeling as well as the factors involved in their development, especially in young individuals, is urgent. The aim of this work was a comparative study of characteristic features of intracardiac hemodynamics, daily profile of arterial pressure, daily ECG monitoring data and vegetative regulation in young apparently healthy individuals (18-44 years) with normal heart geometry and those with concentric remodeling of left ventricle. PATIENTS AND METHODS: Materials and Methods: Apparently healthy persons aged 18 to 42 years, mean age 25.3±0.6 years, were included in the study. There were 56 males (73.7%) and 20 females (26.36%). All participants of the study were divided into two equal groups consisting of 38 persons according to relative wall thickness (RWT) value of the left ventricle: the patients with RWT > 0.42 (concentric remodeling of left ventricle) and those with RWT ≤ 0.42 (normal geometry of left ventricle). RESULTS: Results and Conclusion: The analysis of obtained findings revealed comparatively larger sizes of left heart cavities, comparatively higher rate of AP morning rise and daily variability of predominantly systolic arterial pressure, decreased activity of parasympathetic nervous system, greater number of supraventricular premature beats mainly at night time as well as the signs of connective tissue dysplasia in the patients with concentric remodeling of left ventricle. More than half of young persons with concentric remodeling of left ventricle showed the signs of connective tissue heart dysplasia, namely prolapse of mitral valve and abnormal left ventricular chords. Those specific characteristics of heart structure, daily profile of arterial pressure and variability of cardiac rhythm can be considered the signs associated with concentric remodeling of left ventricle.

Loeffler endocarditis in young woman - a case report.

Loeffler endocarditis is a rare acquired endocardial and myocardial disease characterized by a sharp decrease in the compliance of either or both ventricles with an acute diastolic dysfunction and massive mural thrombosis. This disease is presented in the classification of cardiomyopathies and is a variant of restrictive cardiomyopathy. Today Loeffler endocarditis is considered as a manifestation of hypereosinophilic syndrome with predominant heart involvement. The life-time diagnosis of myocardial injury due to eosinophilic infiltration is rare, or it is diagnosed at the stage of necrotizing endomyocarditis, when the treatment is no longer effective. A number of issues regarding the individual aspects of the pathogenesis of hypereosinophilic syndrome and Loeffler endocarditis are still not fully understood, as well as the long-term prospects for the use of drugs for the treatment of hypereosinophilic syndrome, especially in young and middle-aged persons. Loeffler endocarditis can be suspected in the presence of hypereosinophilia on the background of causeless (unexplainable) hypertrophy of the left ventricle or both ventricles. The article includes a case of the life-time diagnosis of this disease in a young woman with the retrospective analysis of the early stages of the disease, echocardiographic and radiologic imaging at the advanced stage of the disease and quite successful treatment option for this disease.

Clinical examples of left ventricular non-compaction in adults.

INTRODUCTION: isolated left ventricular non-compaction (LVNC) is a heart disease with rather distinct morphologic and clinical manifestations. Available in the literature information about LVNC considering multiple left ventricle abnormal chords (LVAC) as one of its criterion motivated us to review the results obtained in the study of young patients with this pathology. The aim of the research was to demonstrate different clinical variants of left ventricular non-compaction course in adult patients and to clarify some pathogenetic aspects of this pathology. Materials and metods: comprehensive examination of 28 patients with multiple LVAC, 12 patients with LVNC and dilated idiopathic cardiomyopathy aged 16-36 was performed. RESULTS: according to the results of our research, 16 of 28 patients with multiple LVAC of left ventricle had ejection fraction more than 55%, in 6 patients this index range was 50-54%, in 6 it was 45-49%. Multiple LVAC were found to be associated with significantly greater clinical, phenotypic, structural and hemodynamic changes when compared both to control and solitary LVAC of any location (р<0.05). There were 12 young patients with multiple LVAC and ejection faction 22-41%. The detailed analysis of echocardiographic data in dynamics revealed other criteria of LVNC in all the patients. The data obtained suggest the relationship between pathogenetic mechanisms of heart pathology development in patients with connective tissue dysplasia syndrome and in patients with LVNС. Echocardiographic evidences of multiple LVAC designate the necessity of targeted search of left ventricular non-compacted signs and timely detection of left ventricular dilation.

Clinical examples of left ventricular non-compaction in adults.

INTRODUCTION: isolated left ventricular non-compaction (LVNC) is a heart disease with rather distinct morphologic and clinical manifestations. Available in the literature information about LVNC considering multiple left ventricle abnormal chords (LVAC) as one of its criterion motivated us to review the results obtained in the study of young patients with this pathology. The aim of the research was to demonstrate different clinical variants of left ventricular non-compaction course in adult patients and to clarify some pathogenetic aspects of this pathology. Materials and metods: comprehensive examination of 28 patients with multiple LVAC, 12 patients with LVNC and dilated idiopathic cardiomyopathy aged 16-36 was performed. RESULTS: according to the results of our research, 16 of 28 patients with multiple LVAC of left ventricle had ejection fraction more than 55%, in 6 patients this index range was 50-54%, in 6 it was 45-49%. Multiple LVAC were found to be associated with significantly greater clinical, phenotypic, structural and hemodynamic changes when compared both to control and solitary LVAC of any location (р<0.05). There were 12 young patients with multiple LVAC and ejection faction 22-41%. The detailed analysis of echocardiographic data in dynamics revealed other criteria of LVNC in all the patients. The data obtained suggest the relationship between pathogenetic mechanisms of heart pathology development in patients with connective tissue dysplasia syndrome and in patients with LVNС. Echocardiographic evidences of multiple LVAC designate the necessity of targeted search of left ventricular non-compacted signs and timely detection of left ventricular dilation.

Efficiency of ranolazine in the patient with microvascular angina, atrial fibrillation and migraine.

Microvascular angina (MVA) is rather a common form of stable ischemic coronary disease (CAD) as that such diagnosis is made in 20-30% of patients who previously underwent coronary angiography. The disease occurs three times more frequently in women than in men irrespective of age. Most of these patients are 45-60 years old. According to available data, the long-term outcome in patients with MVA is comparable with that in general population. MVA characterizes great variability of its course and low response to conventional antianginal therapy. However, patients with MVA experience chest pain, which in most cases tend to strengthen and increase the number of pain episodes, significantly deteriorating the quality of life of these patients. In view of this, the problem of antianginal drugs which can be used in addition to standard therapy remains to be solved. The major role in MVA development plays the decreased coronary flow reserve resulting from evident endothelial dysfunction of small coronary arteries. Ranolazine is a new original antianginal drug which improves left ventricular diastolic filling by selective inhibition of late sodium current leading to more effective coronary vessel filling in diastole. The article presents the case of the successful administration of ranolazine in a woman with MVA and persistent atrial fibrillation.