[Assessment of risk factors of atrial fibrillation in patients with metabolic syndrome].

The aim of the work was to identify risk factors of atrial fibrillation (AF) in 151 patients with metabolic syndrome (MS, IDF 2005); 88 of them presented with the recurrent form of AE 63 had no arrhythmia. Practically all patients suffered from arterial hypertension. The groups were comparable in terms of age, concomitant disorders, AH duration, arterial pressure, and severity of chronic heart failure. Patients with permanent AF, hemodynamically significant heart disease, myocardial infarction with wave Q in the medical history, and cardiac aneurysm were excluded from the study. We evaluated anthropometric parameters, carbohydrate and lipid metabolism, daily albuminuria, results of echoCG, and insulin resistance. Patients with AF had worse anthropometric and metabolic parameters and more pronounced remodeling of myocardium with left ventricular diastolic dysfunction, insulin resistance, endothelial dysfunction, and renal lesions than patients with MS without AF Patients with MS having abdominal obesity and AH over 10 years, marked insulin resistance (IR index higher than 2.77), reduced HDL cholesterol level (below 1.1 mmol/l), left atrial dilation (end diastolic size >43mm), albuminuria >60 mg/d, waist circumference >104 cm were at high risk of AF (prognostically unfavourable arrhythmia). It is concluded that dynamic observation of the above MS and echo-CG parameters, and albuminuria coupled to the adequate correction of insulin resistance, control of AH and dyslipidemia is important for the prevention of cardiac arrhythmia.

[Cardiac resynchronization therapy in patients with narrow QRS].

Conduction delay affecting 30-50% of patients with NYHA class III-IV heart failure (HF) mainly results from left bundle branch block and leads to deterioration of cardiac contractility through intra- and interventricular dyssynchrony. Cardiac resynchronization therapy (CRT) has class I recommendation for the treatment of patients with severe systolic HF who have left ventricular ejection fraction less or equal to 35%, QRS duration greater than or equal to 120 ms. Nevertheless some studies have shown that systolic asynchrony is present in 27-43% of HF patients with narrow QRS complexes (defined as <120 ms). We present here results of CRT in 20 patients (13 male, 7 female). Main indication for CRT was ventricular dyssynchrony during basic cardiac rhythm or cardiac pacing independently of QRS width. In 4 patients width of QRS complex was less than 120 ms, in 3 QRS varied from 120 to 149 ms pts and in 13 it was equal to or exceeded 150 ms. CRT in patients with narrow QRS resulted in clinical improvement associated with increase of cardiac contractility and decrease of left ventricular end systolic volume. This allows to conclude that CRT can be beneficial for HF patients with narrow QRS and ventricular dyssynchrony.

[Metabolic syndrome and chronic persistent atrial fibrillation].

The aim of the study was to elucidate specific features of chronic recurrent atrial fibrillation (AF) in patients with metabolic syndrome (MS) and disturbed carbohydrate metabolism compared with AF patients without MS. It enrolled 145 patients aged 44-83 years: 117 with abdominal obesity (BMI >30 kg/m2, waist circumference >80 and 94 cm in women and men respectively) including 30 without metabolic disturbances; 35 with impaired glucose tolerance (IGT), 52 with type 2 DM, and 28 controls without MS. Parameters measured included frequency and severity of AF, carbohydrate and lipid metabolism, albuminurea, C-reactive peptide level, quality of AH control, results of echocardiography and 24 hour ECG monitoring (sinus rhythm), and insulin resistance index (HOMA IRindex). Groups of AF and MS patients were dominated by women. The frequency and severity of AF relapses in MS patients were higher than in controls (especially in the presence of IGT and DM). IGT and DM2 associated with structural changes in myocardium (left atrial dilatation, prevalence of LV concentric hypertrophy, diastolic dysfunction) coupled to higher systolic AH and marked metabolic disorders (hyperglycemia, IR, elevated microalbuminurea and C-reactive protein level, dyslipidemia). These conditions contribute to the frequency and severity of AF relapses. Development of AF in MS is a multifactor problem necessitating strict control of AH, dyslipidemia, DM2 and IGT, reduction of body weight and abdominal obesity.

[Dynamics of structural-functional parameters of cardiovascular system during use of complex therapy of women with type 2 diabetes mellitus].

Aim of the work was to study dynamics of parameters of cardiovascular system in women during use of various sugar lowering drugs in complex multifactorial therapy of type 2 diabetes mellitus (DM). We included in this 12 months study 182 women older than 55 years with type 2 DM, abdominal obesity and artrerial hypertension (AH). All women received angiotensin converting enzyme inhibitors and statins. As sugar lowering drugs we used metformin (n = 46), metformin with glyclazide (n = 47), monotherapy with insulin (n = 45). Long-term use of metformin in complex multifactorial therapy of women with decompensated type 2 diabetes DM, AH and abdominal obesity provides improvement of carbohydrate and lipid metabolism, lowering of arterial pressure, diminishment of albuminuria, diastolic dysfunction, and stiffness of left ventricular myocardium. The use of combination of metformin with glyclazide MB provides advantages in lowering of insulin resistance, contol glycemia, and lessening of hypertrophy of left ventricular myocardium.

[Capabilities of hypoglycemic therapy in women with decompensated type 2 diabetes mellitus].

AIM: to comparatively evaluated the efficiency of various sugar-lowering therapy (SLT) options in patients with decompensated type 2 diabetes mellitus (T2DM). SUBJECTS AND METHODS: One hundred and eighty-two women who were over 55 years of age with a more than 3-5-year history of T2DM and more than one-year decompensation, abdominal obesity (AO), arterial hypertension, and concomitant treatment-matched were randomized into 4 groups: (1) metformin (n=46); (2) a combination of metformin and gliclaside MB (n=47); (3) metformin and insulin (n=44); and (4) insulin (n=45). A follow-up was 12 months. RESULTS: As compared with the patients receiving insulin monotherapy, the patients taking metformin alone or in combination showed a more effective recovery of carbohydrate and lipid metabolic disturbances, diminished insulin resistance (IR), lowered blood pressure and albuminuria, reduced diastolic dysfunction, and a smaller cardiovascular risk. When metformin was used in combination with gliclaside (Group 2) for 12 months, there was the maximum IR reduction, an increase in insulin sensitivity, and better results in reaching the goal values of carbohydrate metabolism; there was left ventricular myocardial reverse remodeling. In all the groups, quality of life (SF-36v2) improved, reduced depression (CES-D) reduced; the greatest improvement of the mental component of health-related quality (SF-36v2) and the greatest satisfaction with treatment results (DTSO) were noted when metformin was given in combination with gliclaside MB. CONCLUSION: In patients having a more than 3-5-year history of T2DM in the presence of AO and IR, with a history of DM decompensation, the use of metformin in combination with gliclaside MB is more preferable, by effectively correcting IR, recovering the physiological profile of insulin secretion, and adequately controlling glycemia.

[Cardiovascular disorders and possibilities of their therapy in patients with type 2 diabetes mellitus and diabetic nephropathy].

The aim of the study was to assess specific cardiovascular lesions in patients with type 2 diabetes mellitus and diabetic nephropathy (DN) and search for the methods of their correction. It included 182 overweight or obese (abdominal type) women above 55 yr with arterial hypertension (AH) divided into groups with normal or low (less than 30 ml/day) albuminuria (n = 87), albuminuria (30-300 mg/day, n = 59), proteinuria (above 30 mg/day, n = 21), and stage I-IIa chronic renal insufficiency (CRI, n = 15). It was shown that structural geometric changes in the left ventricle (LV) with the prevalence of myocardial concentric hypertrophy and diastolic dysfunction (DD), enhanced myocardial hardness, and preserved systolic function undergo progression with increasing severity of DN and decreasing glomerular filtration rate combined with poorly controlled DM2, abnormal lipid profile, long history of AH in the absence of adequate AP control, signs of vascular atherosclerosis (thickening of intima and media in carotid arteries), and large number of macrovascular complications. DN-related insulin resistance (IR) was a factor influencing LV remodeling and DD. Long-term combined therapy affecting IR and markers of cardiovascular disorders (AH, chronic hyperglycemia, dyslipidemia) promoted improvement of LV diastolic function, reverse remodeling of LV myocardium, decrease of atherosclerotic lesions and albuminurea in patients presenting with both low albuminuria and DN; in addition, it improved prognosis of the disease.

[Nibentan in arresting acute atrial fibrillation: risk or benefit?].

AIM: To study efficacy and safety of using a domestic anti-arrhythmic drug nibentan for arresting acute atrial fibrillation. MATERIAL AND METHODS: A total of 210 patients received nibentan in a dose 0.125 mg/kg dissolved in 20.0 ml of 0.9% sodium chloride solution by intravenous slow jet 3-min injection. In no response, the injection was repeated 20 min later. Nibentan injection was accompanied with continuous ECG monitoring, measurements of QT interval, arterial pressure. The criterion of efficacy was atrial fibrillation conversion into the sinus rhythm within 24 hours after injection of a total nibentan dose. RESULTS: Nibentan in a dose 0.125 mg/kg demonstrated high efficacy (91.9%) and sufficient safety (incidence of polymorphic ventricular tachycardia 2.4%) including patients taking other antiarrhythmic drugs. A basic marker of an electrophysiological effect of nibentan on the myocardium is a dynamic change in the interval QT which may serve a predictor of sinus rhythm reestablishment (in QT > or =480 ms) and of a risk to develop proarrhythmogenic complications (in QT > or =640 ms).

[The sick sinus syndrome and lipid peroxidation: its possible role in the pathogenesis of the disease]. / Sindrom slabosti sinusovogo uzla i perekisnoe okislenie lipidov: vozmozhnaia rol' v patogeneze zabolevaniia.

As many as 196 persons were examined. Of these, 106 were with a normal sinus rhythm and 90 had sick-sinus syndrome (SSS). Measurements were made of the level of malonic dialdehyde and the total antioxidant blood activity, the lipoprotein spectrum. Electrophysiological studies of the heart, ECG monitoring and bicycle ergometry were carried out. Maximal impairment of lipid peroxidation (LP) in type IIA hyperlipoproteinemia (HLP) was identified according to Fredrickson both in patients with SSS and without it. In patients with SSS, the rise of the closeness of the relationship between LP and HLP was observed. In patients with CHD and (or) EH, LP was mostly disturbed in EH and in associated CHD and EH (both in patients with and without SSS). As compared with the respective control groups, SSS patients showed considerable disorders of LP. It is suggested that LP disorders related to HLP may play a role in the pathogenesis of SSS.