[Russian eligibility criteria prescribing menopausal hormonal hormones therapy for patients with cardiovascular and metabolic diseases. Consensus document of the Russian Cardiological Society, Russian Society of Obstetricians and Gynecologists, Russian Association of Endocrinologists, Eurasian Association of Therapists, Association of Phlebologists of Russia].

Menopausal symptoms can disrupt the life course of women at the peak of their career and family life. Currently, the most effective treatment for these manifestations is menopausal hormone therapy (MHT). The presence of cardiovascular and metabolic diseases in itself does not exclude the possibility of prescribing MHT to relieve menopausal symptoms and improve quality of life. However, often an obstacle to the use of this type of hormonal therapy is the fear of doctors who are afraid of doing more harm to patients than good. Caution is especially important when it comes to women with underlying health conditions. Moreover, it should be recognized that there is a lack of high-quality research regarding the safety of MHT for major chronic non-infectious diseases and common comorbid conditions. The presented consensus document analyzed all currently available data obtained from clinical trials of various designs and created a set of criteria for the acceptability of prescribing MHT to women with concomitant cardiovascular and metabolic diseases. Based on the presented document, doctors of various specialties who advise women in menopause will receive an accessible algorithm that will allow them to avoid potentially dangerous situations and reasonably prescribe MHT in real practice.

[Russian Eligibility Criteria for Prescribing Menopausal Hormone Therapy to Patients With Cardiovascular and Metabolic Diseases. Consensus Document of RSC, RSOG, RAE, EUAT, RAP].

Menopausal symptoms can impair the life of women at the peak of their career and family life. At the present time, the most effective treatment for these manifestations is menopausal hormone therapy (MHT). The presence of cardiovascular and metabolic diseases in itself does not exclude the possibility of prescribing MHT to relieve menopausal symptoms and improve quality of life. However, often an obstacle to the use of this type of hormone therapy is the fear of physicians to do more harm to patients than good. Caution is especially important when it comes to women with concurrent diseases. Moreover, it should be recognized that there is a shortage of high-quality research on the safety of MHT for underlying chronic non-infectious diseases and common comorbidities. The presented consensus analyzed all currently available data from clinical trials of various designs and created a set of criteria for the appropriateness of prescribing MHT to women with concomitant cardiovascular and metabolic diseases. Based on the presented document, physicians of various specialties who advise menopausal women will receive an accessible algorithm that will allow them to avoid potentially dangerous situations and reasonably prescribe MHT in real-life practice.

[Cardiovascular effects of omega-3 polyunsaturated fatty acids: position of omega-3 polyunsaturated fatty acids in Russian and international guidelines. Council of Experts].

This Expert Council focuses on the meta-analysis of studies on the risk of atrial fibrillation (AF) in patients taking omega-3 polyunsaturated fatty acids (PUFA) and of data on the omega-3 PUFA treatment in patients with cardiovascular and kidney diseases.The major statements of the Expert Council: the meta-analysis of AF risk in patients taking omega-3 PUFA showed an increased risk of this arrhythmia. However, it should be taken into account that the risk of complications was low, and there was no significant increase in the risk of AF when omega-3 PUFA was used at a dose of ≤1 g and a standard dose of the only omega-3 PUFA drug registered in the Russian Federation, considering all AF episodes in the ASCEND study.At the present time, according to Russian and international clinical guidelines, the use of omega-3 PUFA can be considered in the following cases: • for patients with chronic heart failure (CHF) with reduced left ventricular ejection fraction as a supplement to the basic therapy (2B class of recommendations according to the 2020 Russian Society of Cardiology guidelines (RSC) and the 2022 AHA / ACC / HFSA guidelines); • for patients with hypertriglyceridemia (>1.5 mmol/l) as a part of combination therapy (IIb class of recommendations and B level of evidence according to the 2021 European guidelines on cardiovascular disease prevention, etc.); • for adult patients with stage 3-4 chronic kidney disease (CKD), long-chain omega-3 PUFA 2 g/day is recommended for reducing the level of triglycerides (2C class of recommendations). Data on the use of omega-3 PUFA for other indications are heterogenous, which can be partially explained by using different form and doses of the drugs.

[Inclisiran - a new era in lipid-lowering therapy].

Inclisiran is a novel hypolipidemic drug that inhibits synthesis of the PCSK9 protein through the process called RNA interference. Inclisiran is a double-stranded, modified RNA bound to the N-acetylgalactosamine (GalNAc) carbohydrate molecule, a ligand of the acialoglycoprotein receptor, that is expressed by hepatocytes. After entering hepatocytes, inclisiran cleaves matrix RNA and, thereby, reduces the PCSK9 protein synthesis. This, in turn, enhances the uptake of circulating low-density lipoproteins (LDL) by specific receptors on hepatocytes, thereby lowering LDL levels in circulation. Efficacy and safety of inclisiran for lowering LDL cholesterol (C) in blood and its effect on the risk of clinical complications of atherosclerosis have been studied in the ORION program that includes multiple clinical trials. According to results of this program, inclisiran effectively reduces both LDL-C levels and the incidence of cardiovascular complications in the absence of clinically significant adverse reactions. An important advantage of inclisiran compared with other lipid-lowering drugs is the administration schedule (twice a year), which allows a considerable improvement of patients' compliance with the treatment and also of the effectiveness of the hypolipidemic treatment.

[Topical issues of adequate control of dyslipidemia in the prevention of acute and recurrent cerebral circulatory disorders of ischemic type]. / Aktual'nye voprosy adekvatnogo kontrolya dislipidemii v profilaktike ostrykh i povtornykh narushenii mozgovogo krovoobrashcheniya po ishemicheskomu tipu.

Ischemic stroke (IS) is one of the main causes of death and permanent disability. Reducing the burden of stroke is possible if effective preventive measures are provided. The possibilities of correcting lipid metabolism as an important measure aimed at preventing IS are analyzed.

Determination of Risk Groups for the Covid-19 Underlying Deseases.

For every disease, there is a certain set of genes whose mutations increase the risk of illness development. DNA sequencing of sick and healthy individuals results in the determination of genes related to certain diseases. Efficient procedures are described in order to determine point mutations in gene sequences of the examined patients. The optimal Bayesian procedure is used to determine risk groups for certain diseases, including the ones that underlie COVID-19.

[Assessment of Risk Factors for Atherosclerosis in Individuals of Different Categories of Cardiovascular Risk Using the Aterostop Calculator].

Aim        To analyze first results of using the Aterostop calculator for a comprehensive evaluation of the risk for cardiovascular diseases (CVD).Material and methods        A cross-sectional study analyzed major and additional risk factors in 460 subjects without apparent disease and in patients with documented CVD of atherosclerotic origin using the application (calculator) Aterostop developed in the National Medical Research Center of Cardiology in Moscow, Russia.Results   45.4% of evaluated persons belonged to the categories of very high and extreme risk. Age and frequencies of smoking, arterial hypertension, and diabetes mellitus (DM) increased with the increase in risk; the growth of DM was exponential. 129 (28%) individuals used lipid-lowering medications at the time of study. Their plasma levels of low-density lipoprotein cholesterol (LDL-C) were significantly lower than in those who did not received this treatment. However, achieving the target level was inversely proportional to the risk: the greatest proportion of individuals who reached the LDL-C target was in the category of low risk and the smallest proportion was in the category of extreme risk (75 % vs. 3.7 %, respectively).Conclusion            The results obtained with the calculator Aterostop were consistent with earlier reports of insufficient effectiveness of primary and secondary prevention of atherosclerotic CVDs, which requires more tight and fruitful cooperation of the physician and the patient.

Effects of Cardioprotective Tactics on the Myocardial Perfusion and Contractile Function of the Left Ventricular Myocardium in Cancer Patients with Evidence of Doxorubicin-Induced Cardiotoxicity.

Aim      To study the effect of cardioprotective tactics on parameters of left ventricular myocardial perfusion and contractility as per data from single-photon emission computed tomography in oncological patients with signs of anthracycline-induced cardiotoxicity.Material and methods  The study included patients with oncological diseases (n=61) referred to polychemotherapy (PCT). For patients with signs of anthracycline-induced cardiotoxicity, a cardioprotective tactics was used, which included changing the PCT schedule and administering beta-blockers and angiotensin-converting enzyme inhibitors. For all patients at baseline, after the first four PCH courses, after initiation of the cardioprotective tactics and the next four PTC courses, the level of N-terminal pro-brain natriuretic peptide was measured and echocardiography and perfusion single-photon emission computed tomography were performed with assessment of left ventricular (LV) perfusion heterogeneity, systolic and diastolic function.Results Following four PTC courses, signs of cardiotoxicity were detected in 13 (21.3 %) patients. On the background of the cardioprotective tactics, a further decrease in LV ejection fraction (EF) by -9±2 % (p<0.01) was observed in 4 (30.8 %) patients. In 9 (69.2 %) patients, LV EF increased by 4±2 % (p<0.01). Standard indexes of LV myocardial perfusion did not significantly change. In 7 patients, the cardioprotective tactics was associated with reduced severity of myocardial perfusion disorder, LV∆σТ = -1.37±1.29 (p<0.05), and in 4 patients, with reduced heterogeneity of myocardial perfusion, LV∆σН = -1.20±0.70 (p<0.05).Conclusion      The cardioprotective tactics prevents both further disorder of perfusion and decreases in parameters of left ventricular myocardial contractility in patients with anthracycline-induced cardiotoxicity.

[Mobile application "Aterostop" for a comprehensive assessment of cardiovascular risk in patients in the Russian population].

The article provides an overview of an innovative software product for a comprehensive assessment of cardiovascular risk in cardiac patients in the Russian Federation. Based on the new recommendations of the Russian National Atherosclerosis Society (2020), the Aterostop application allows to assess cardiovascular risk, determine the patients achievement of target levels of low-density lipoprotein cholesterol, and also provides recommendations for correcting lipid-lowering therapy. The calculator is implemented as a web browser version, as well as a mobile application for Android and iOS platforms.

[Lipid-Lowering Therapy for Primary Cardiovascular Prevention in Older Adults. Consensus Statement of the Russian Association of Gerontologists and Geriatricians, National Society on Atherosclerosis, Russian Society of Cardiology, Association of Clinical Pharmacologists].

 Completed randomized clinical studies did not have a sufficient statistical power for demonstrating clearly the efficacy of lipid-lowering therapy for primary prevention in patients aged 75 years and older and did not evaluate the effect of lipid-lowering therapy on development and course of key geriatric syndromes. Age-related alterations of skeletal muscles, cognitive decline, senile asthenia, comorbidities, polypragmasy, potential changes in drug pharmacokinetics and pharmacodynamics, and impaired renal function may adversely affect the benefit to harm ratio of statins in older patients. Key questions for administration of a lipid-lowering therapy for primary prevention in patients aged 75 years and older are: 1. Does the relationship between increased low-density lipoprotein cholesterol (LDL CS) and death rate persist? 2. Does a benefit from decreasing the level of LDL CS persist? 3. Is the lipid-lowering therapy safe? 4. What scales for risk stratification and determining indications for lipid-lowering therapy should be used?

[Myocardial perfusion single-photon emission computer tomography and coronary angiography results in patients with different pretest probability of ischemic heart disease].

AIM: To study the relationship between pretest probability (PTP) of ischemic heart disease (IHD), calculated according to the recommendations of the European Society of Cardiology (ESC) of 2013 and 2019, with the perfusion of the left ventricle of the myocardium according to the single-photon emission tomography (SPECT) and the results of the invasive coronary angiography (CAG). MATERIAL AND METHODS: The study included 220 patients with a preliminary diagnosis of ischemic heart disease and planned invasive CAG. All patients underwent rest-stress perfusion myocardial SPECT within 1 month prior to or after CAG, standard quantitative parameters of left ventricular perfusion were assessed. Retrospectively clinical data was analyzed and PTP of IHD was assessed according to ESC recommendations for 2013 and 2019. RESULTS: Invasive CAG revealed obstructive lesion of one or more coromary arteries in 204 of the 220 patients (92.7%). In a retrospective analysis, taking into account gender, age and nature of the complaints, as recommended by ESC in 2013, PTP was rated as low (15%) in 13 patients (5.9%), as intermediate (1585%) in 207 patients (94.1%). Following the comprehensive survey (SPECT and CAG) 8 patients with low PTP (61.5%) underwent coronary revascularization. Among patients with intermediate PTP significant transient ischemia according to SPECT was detected in 31 (15.0%), initial at 107 (51.7%). According CAG among patients with intermediate PTP obstructive lesion was found in 192 (92.7%), 113 patients (58.8%) underwent revascularization. According to ESC recommendations of 2019, PTP was rated as low (15%) in 117 patients (53.2%), including 514% in 98 (44.5%). According to a survey (SPECT and CAG) 68 of them (58.1%) underwent revascularization. CONCLUSION: PTP measurements proposed by ESC can not be applied to patients of the Russian population with suspected ischemic heart disease without significant corrections. 2013 ESC recommendations with higher PTP values for all categories of patients reflect Russian population better, while 2019 recommendations mistakenly attribute patients to low PTP in at least 58% of cases. These results are preliminary and will be expanded in subsequent studies with more detailed analysis of PTP in included patients with suspected IHD.

ANICHKOV study: the effect of combined hypotensive and lipid-lowering therapy on cardiovascular complications in patients of high and very high risk.

AIM: The aim of the study was to assess cardiovascular risk in patients with elevated levels of total cholesterol and LDL-C and concomitant AH, a comparative analysis of adherence, efficacy and safety of various forms of combined therapy in outpatient practice, including promising lisinopril/amlodipine/rosuvastatin FC (Ekvamer®). MATERIALS AND METHODS: The ANICHKOV study included 702 patients in Moscow and the Moscow region over 18 years old with a -chole-sterol level ≥7.5 mmol/l and/or LDL-C ≥4.9 mmol/l from March 2017 to December 2018 based on 2 federal centers. According to the results of visit I, patients were prescribed with one of three therapy schemes. In the absence of AH, patients received scheme I -(Mertenil® at initial dosage of 10 mg/day). When history of AH existed or AH detected at visit I, patients were randomized to scheme II (Ekvamer® 5/10/10 mg/day) or III (Mertenil® 10 mg/day + Ekvator® 5/10 mg/day). During the observation, the treatment scheme remained unchanged, however, if the target levels of LDL-C and/or BP were not reached, the doses could be increased. The analysis of the main effects of the prescribed therapy were carried out for 12 months, and the frequency of MACE (CVD, ACS, stroke, or hospitalization to perform PCI) was also evaluated. RESULTS: Following the visit I, scheme I was assigned to 390 patients (55.6%), scheme II - 190 (27.1%), scheme III - 122 (17.4%). In 147 patients (20.9%), TG level was >2.3 mmol/l, which required additional fenofibrate intake in a dose of 145 mg/day. Adherence level was 89.5%, including scheme I - 91.7%, scheme II - 90.5%, scheme III - only 81.8%. In general, among compliant patients (n = 590), the decrease in TCh level was 41.0%, LDL-C - 47.4%. 16.6% of patients reached target levels of LDL-C <2.5 mmol/l, 5.6% - <1.8 mmol/l. In the fenofibrate subgroup, TG level decrease was 34.6%. During the follow-up period, 47 cases of side effects were observed in 27 patients (4.6%), that did not require modification of therapy. Systolic BP reduction in compliant patients of schemes II and III was 20 mm. Hg (13.1%), diastolic BP - 12 mm. Hg (13.6%), target BP levels (<140/90 mm. Hg) reached 83.7% and 80.8% of patients, respectively, target levels of BP and LDL-C <2.5 mmol/l reached 14.5% and 13.1% of patients, respectively, <1.8 mmol/l - 5.8% and 5.1%, respectively. During the observation period no deaths were recorded, other components of MACE were observed in 38 patients (5.8%), including 27 among compliant patients (4.6%) and 11 among non-compliant (15.9%, p<0.01). In 19 out of 38 patients (50%), hospitalization for routine PCI was the end point, ACS - in 12 (31.6%), and stroke - in 7 (18.4%). CONCLUSION: The results of the study demonstrated a sufficient hypolipidemic effect and high safety of Mertenil® and Ekvamer®. A higher adherence to the combined preparation than to two monodrugs was noted. Achieving target levels of BP and LDL-C is problematic, which dictates the expediency of using fixed combinations of drugs, especially in primary prevention.

[Current State and Future Technologies of Nuclear Imaging in Cardiology].

In this review, modern possibilities of nuclear imaging modalities in cardiology are considered. Perspectives of this branch of radiology are described according to the latest technological and methodological inventions and new clinical data.

[Lisinopril, Amlodipine, Rosuvastatin as a Novel Fixed Combination in the Fight Against Cardiovascular Disease].

The prevalence of multicomponent therapy in treatment of cardiovascular diseases makes fixed combinations of drugs very useful. The fixed combination of rosuvastatin with ACE inhibitor lisinopril and calcium antagonist amlodipine allows to control effectively two main cardiovascular risk factors: hypercholesterolemia and arterial hypertension. The efficacy of each of the components and their combined administration in primary and secondary prevention of cardiovascular disease has been demonstrated in clinical studies. The convenience of several drugs combination in a single tablet increases adherence to therapy facilitating regular intake of all treatment components and reliably reducing the risk of cardiovascular complications.

Effect of Atorvastatin Therapy on the Level of CD34+CD133+CD309+ Endothelial Progenitor Cells in Patients with Coronary Heart Disease.

In 58 patients with coronary heart disease, the count of CD34+CD133+CD309+ endothelial progenitor cells in the blood was determined and the dynamics of the content of endothelial progenitor cells, angiogenic growth factors, and lipid parameters over 3 months of atorvastatin therapy was analyzed. Atorvastatin was administered in daily doses of 10 mg (26 patients) and 40 mg (32 patients). Control group comprised 15 healthy volunteers. In patients with coronary heart disease, the count of endothelial progenitor cells was lower by 4 times, the level of VEGF was higher by 52%, and the level of endostatin was lower by 13% than in healthy volunteers. Atorvastatin therapy significantly reduced the levels of VEGF (by 11%), C-reactive protein (by 26%), total cholesterol (by 30%), LDL cholesterol (by 35%), and triglycerides (by 18%); the levels of endostatin, MCP-1, and HDL cholesterol remained unchanged. The count of endothelial progenitor cells increased significantly by 72% irrespectively on the statin dose, but the changes were more pronounced in patients with lower initial endothelial progenitor cell counts and in patients with more drastic decrease in LDL cholesterol.

[Conventional and novel cardiovascular risk factors and predisposition to the development of atherosclerosis].

This population-based cross-sectional study included 472 apparently healthy study participants with an increased risk of cardiovascular disease, including 300 patients with hypercholesterolemia. To assess the susceptibility to the development of atherosclerosis, an ultrasonic evaluation of common carotid arteries was used. It has been confirmed that there exists the geographical gradient of carotid intima-media thickness (cIMT), and it has been shown that this gradient is highly correlated th the known gradient of cardiovascular mortality. It was found that the combination of conventional cardiovascular risk factors can help explaining only 21% variability of cIMT, the marker of generalized atherosclerosis. It was found that a predisposition to atherosclerosis, as measured by a pathological increase in cIMT, should be due to the interaction not only conventional cardiovascular risk factors, but also to genetic and environmental factors.

[New approaches to quantifying early disorders and perfusion inhomogeneity of the myocardium according to the data of single-photon emission computed tomography].

Objective: To develop novel quantitative approaches of myocardial perfusion analysis, to assess clinical usefulness of new parameters of initial myocardial perfusion impairments. Material and Methods: 80 patients selected from our database formed four groups: 20 patients with no cardiac disease suspect, no ischemic heart disease (IHD) risk factors and definitely normal myocardial perfusion (group 1), 40 patients with equivocal perfusion patterns, that are usually described visually as "inhomogeneous": 20 ­ with one subtle perfusion defect (group 2), 20 ­ with multiple ones (group 3), and 20 patients with non-severe but reliable defects, due to post-MI or another nontransmural cardiac event consequence. None of patients had current cardiac symptoms, positive stress-test results and/or single-photon emission computed tomography (SPECT) signs of stress-induced ischemia, so only rest images were analyzed. Perfusion maps were assessed quantitatively with Summed Rest Score (SRS) and Rest Extent (RE). Also new parameters ósev (severity sigma) и óhet (heterogeneity sigma) were used. They were calculated as mean-square deviations of relative perfusion values (in %) in each of 17 standard segments in reference to maximum of 100% (for ósev) and to arithmetical mean of those values (for óhet). To minimize known artifacts from CTACcorrected and noncorrected images, relative perfusion values for each segment were taken as maximal numbers of both images. Results: ósev in groups 1, 2, 3 and 4 was 15.9±2.6, 20.4±2.9, 22.4±3.4 and 26.0±3.9 (all paired p (s)<0.05, except p (group 2­3) = 0.19), óhet ­ 5.4±0.7, 9.1±1.6, 4.4±0.8, 11.3±2.1 (all paired p (s)<0.05 except p (group 1­3) = 0.11), respectively. Rest Extent in groups 1, 2, 3 and 4 was 4.1±1.7, 5.0±2.0, 4.7±2.3, 6.1±2.0 (all paired p (s)>0.05 except p (group 1­4) = 0.020); SRS ­ 1.3±0.6, 1.9±1.3, 1.6±1.4, 3.0±0.6 (all paired p (s)>0.05 except p (group 1­4)=0.013). Conclusion: Parameters ósev and óhet are suitable for quantitative description of myocardial perfusion "inhomogeneity", they are better than Extent/SRS in delineating normal/equivocal (inhomogeneous)/abnormal perfusion patterns.

[Lipoprotein-associated phospholipase A2 serum levels in patients from different categories of cardiovascular risk].

AIM: To compare levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) in blood serum of patients from different cardiovascular risk categories. MATERIAL AND METHODS: Patients from Moscow prospective study database (n = 519) were divided into 4 cardiovascular risk categories according to present clinical recommendations (low, moderate, high, very high). Measurement of Lp-PLA2 concentration (mass) was performed using PLAC Test ELISA Kit. Measurement of Lp-PLA2 activity was made using PLAC Test for Lp-PLA2 Activity. Blood serum levels of total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglycerides (TG), lipoprotein (a) (Lp(a)), high sensitive C-reactive protein (hsCRP) and uric acid were also determined. RESULT: Preliminary analysis showed that associations between Lp-PLA2 mass and activity became more obvious in patients not treated with statins and patients without diabetes mellitus. So patients receiving statins and diabetics were excluded from final analysis. Lp-PLA2 mass and activity were lower in low cardiovascular risk category patients. There were no significant differences in Lp-PLA2 mass and activity between patients from moderate, high and very high risk categories. There was moderate correlation between Lp-PLA2 mass and Lp-PLA2 activity (r = 0.38, p < 0.00001). We did not find any correlation between Lp-PLA2 and hsCRP, Lp(a) levels, but detected moderate correlation between Lp-PLA2 mass and activity and TC, LDL-C. We also found a mild positive correlation between Lp-PLA2 mass and HDL-C levels. There was a positive correlation between Lp-PLA2 activity and TG, uric acid and negative correlation between Lp-PLA2 activity and HDL-C levels. CONCLUSION: In this group of nondiabetic patients not treated with statins both Lp-PLA2 activity and mass were similarly related to categories of cardiovascular risk.

[Quantitative assessment of the hemodynamic relevance of borderline coronary stenoses by myocardial single-photon emission computed tomography with radiation absorption correction versus fractional flow reserve].

OBJECTIVE: To study whether myocardial single-photon emission computed tomography (SPECT)/CT with radiation absorption correction (RAC) versus fractional flow reserve (FFR) may be used to assess the hemodynamic relevance of borderline coronary stenosis in patients with coronary heart disease (CHD). MATERIAL AND METHODS: The investigation enrolled 70 patients (50 men and 20 women; mean age 57 ± 5 years) diagnosed as having CHD verified by clinical instrumental studies, in whom coronary angiography (CA) estimating FFR revealed 50 to 70% coronary stenosis; then all the patients underwent SPECT/CT using a two-day rest/exercise (bicycle ergometer) protocol; the total injected radiotracer activity was 370-900 MBq 99mTc-MIBI depending on body weight. RESULTS: A standard 17-segment scheme was employed to calculate the SDS index, borderline stenosis detected by CA was considered hemodynamically significant at SDS ≥ 4 in one of the 17 segments, which corresponded to one of the major coronary artery, which was compared by the authors ith FFR. At SDS ≥ 4, the sensitivity and specificity of SPECT/CT were shown to be 96.7 and 90.6%, respectively. CONCLUSION: Quantitative analysis of borderline stenosis by SPECT/CT with RAC increases its specificity and sensitivity in estimating the functional significance of borderline coronary stenosis.

[Hyperglycemia as a risk factor of complicated acute myocardial infarction in patients of elderly and senile age].

AIM: To study clinical manifestations and functional state of myocardium in diabetic patients and in patients of elderly and senile age with myocardial infarction (MI) free of type 2 diabetes mellitus (DM) with transient hyperglycemia (HG). MATERIALS AND METHODS: The study included 170 patients with acute macrofocal and transmural MI (with Q-wave). They were divided into group 1 comprised of diabetic patients with MI (n = 60; 36 men and 24 women; age median 78.0 (72.5-83.0 years)), group 2 with MI and TH (n = 60, 38 men, 22 women having no diabetes or disturbances of carbohydrate metabolism in the history; age median 77 (67.0-81.0 years)), and group 3 (n = 50, 28 men, 22 women with MI and normal glycemia in the acute period; age median 73.5 (66.0-83.0 years)). RESULTS: Diabetic patients with TH more frequently than normoglycemic ones showed complicated acute Iaccompanied by acute left ventricular insufficiency, arrhythmia, and lethal outcome. Decrease of their left ventricular systolic function was more pronounced than in controls. Patients with MIIand DM and those with MI and TH had a higher frequency of mitral regurgitation. CCONCLUSION:Hvyerglycemia is significant for the evaluation clinical course and outcome of Ml.