[Current characteristics of all-cause and circulatory disease mortality in the Azerbaijan Republic].

AIM: To prove the value of summary data from the State Statistics Commission to characterize of risk of death from circulatory system diseases (CSD). MATERIAL AND METHODS: The official data of the State Statistics Commission of the Azerbaijan Republic, which are available at its website (www.stat.gov.az), were analyzed using descriptive statistical procedures to identify qualitative signs. RESULTS: The population-level CSD death rates in 2011-2013 ranged from 362.7 to 379.60/0000, amounting to 61.1-63.8% of the all-cause mortality in the population. There were definite differences in male and female deaths due to CSD (377.2-392.0 and 348.4-367.40/0000) and in its proportion among all-cause mortality rates (58.4-60.5 and 64.1-66.4%). The death rates from CSD in the urban (361.1-380.80/0000) and rural (364.5-378.30/0000) populations and its proportion among all-cause mortality rates in these populations (60.6-62.7 and 61.6-62.8%) were similar. The male and female working-age population showed essentially dissimilar CSD mortality rates (169.2-179.8 and 51.8-57.10/0000), the men being at greater risk of death (3.14-3.27). The ratio of all-cause mortality rates in the male and female working-age populations (2.62-2.67) differed from that of CSD-specific ones in these populations (3.14-3.27). There was a slight difference in CSD-specific mortality rates in the urban and rural working-age populations (116.1-125.0 and 104.9-114.70/0000). There was also evidence for their similarity in the proportion of CSD among the all-cause mortality rates (43.2-46.2 and 45.0-49.6%). CONCLUSION: The existing characteristics of mortality in the population (a growth tendency due to CSD) suggest the priority of preventing these diseases.

[Risk of myocardial infarction in out-patient treatment of patients with type 2 diabetes].

The aim of this study was the identification of risk of myocardial infarction in out-patient treatment of type 2 diabetes. The study was carried out on 340 patients with type 2 diabetes. The risk of ischemic disease was determined during 10 years by PROCAM program. It was found that 178 (52.4%) patients with type 2 diabetes had law risk of development of myocardial infarction, 89 (26.2%) patients - moderate and 73 patients (21.4%) - the high risk of myocardial infarction. The following interconnection was determined: the age of the patients(r=+0,46; P<0,001); the family history of diabetes (r=+0,22; P<0,01); smoking (r=+0,23; P<0,01); systolic arterial pressure (r=+0,18; P<0,05); cholesterol (r=+0,20; P<0,01); high-density lipoprotein (r=-0,24; P<0,001); low-density lipoprotein (r=+0,21; P<0,001).

[Lipid metabolism disorders at the breast cancer patients receiving hormonotherapy].

The main purpose of this research was to study the impact of hormonotherapy on changes of the lipid metabolism in patients with breast cancer. 451 breast cancer patients were under investigation. Depending on the treatment method, all patients were divided into four groups. The first group was composed of 117 patients who received hormonotherapy consisting of tamoxifen 20 mg/day; the second group was composed of 115 patients who received Toremifen 60 mg/day; The third group was composed of 106 patients who received Toremifen 240 mg/day; The fourth group consisted of 113 patients who received Letrozol 2,5 mg/day. To determine of lipid metabolism disorders, we estimated cholesterol fractions, triglycerides and high and low density lipoproteins both prior to the beginning of hormonotherapy, and in 3, 6, 12 months. After 12 month of hormonotherapy with Tamoxifen 20 mg/day all fractions of very low density lipoproteins were increased. Patients treated with Toremifen 240 mg/day demonstrated increase of total cholesterol and triglycerides in blood and decrease of concentration of high density lipoproteins. In the groups of patients who were treated with Toremifen 60 mg/day and Letrazol 2,5 mg/day any considerable disorders of lipid metabolism was not observed. It is concluded that hormonotherapy of the breast cancer may lead to the disorders of lipid metabolism, which may also lead to disorders of heart-vascular system.

[On prevention and treatment of arterial hypertension in patients with breast cancer, and undergoing hormonotherapy].

The main purpose of this research was to study an impact of hormonotherapy on changes of the arterial blood pressure in patients with breast cancer. Case histories of 135 patients with the breast cancer and accompanying arterial hypertension (AH) were investigated. According to prescription of hormonotherapy, all patients were divided into two groups. In the first group were included 62 patients; they were treated with 20 mg Tamoxifen. In the second group were included 73 patients; they were treated with 60 mg of Toremifen. In both investigated groups the medicine has been prescribed inside, daily, not less than during two years. Arterial hypertension (AH) was diagnosed when blood pressure was above 140/90 mmHg. In each group there were two subgroups--patients which do not underwent course of treatment for AH and patients which underwent course of treatment for AH. The research revealed that antihypertensive therapy of patients with the breast cancer and accompanying arterial hypertension in most cases allows to prevent progression of AH. Besides, it is necessary to notice that hormonotherapy with Tamoxifen, in comparison with Toremifen, in a greater degree promotes progressing of AH. For antihypertensive treatment Moeksipril was recommended. Monotherapy with Moeksipril showed good antihypertensive effect in patients with mild AH.

[Significance of stress echocardiography in patients with angiographically intact coronary arteries].

With the aim of assessment of the significance of stress echocardiography in patients with unchanged coronary arteries we analyzed data from 75 patients in whom coronary angiography (CAG) detected no hemodynamically significant narrowing of coronary arteries. In 38 patients coronary syndrome X (CSX) was revealed. In the group of patients with CSX transient disturbances of local contractility were significantly more frequently observed compared with patients without CSX (52% compared with 21%, respectively). Number of patients with discrepancy between ECG and EchoCG results of a test concerning achievement of criteria of transient myocardial ischemia was also greater in the group of patients with CSX. At CAG cases of retention of contrast medium in the coronary bed were 2 times more frequently observed in the group of patients with CSX (29%) compared with those without CSX (13%) while hemodynamically insignificant stenoses of coronary arteries in this group were found to be less frequent (2.6% compared with 24%, respectively). Thus persons without hemodynamically significant stenoses in the coronary bed appear to be highly heterogeneous group comprising patients with CSX and vasospastic angina as well as patients with peculiarities of structure of coronary bed and with hemodynamically insignificant stenoses in coronary arteries. Among patients with angiographically unchanged coronary arteries without CSX in 69% of cases peculiarities of structure of coronary bed or hemodynamically insignificant stenoses of coronary arteries has been found. Low sensitivity of transient disturbances of local contractility in patients with CSX (52%) does not allow to consider stress-echoCG as a method of effective diagnosis of CSX.

Immunohistochemical and electron-microscopic characteristics of secretory cardiomyocytes in experimental myocardial infarction.

OBJECTIVE: To study immunohistochemical and electron-microscopic features of secretory cardiomyocytes in experimental myocardial infarction (MI). METHODS: Totally 15 hearts of dogs with experimental MI were studied. For electron-microscopic study materials were collected from left atrium, and its several parts (appendix, lateral and frontal walls). For immunohistochemical analysis of atrial natriuretic factor (ANF) incubation in monoclone immune serum was used (standard monoclonal serum and primary mice antibodies, Immunon). For statistic processing we used Chi-square test (criterion of Pearson agreement). RESULTS: Immunohistochemical and electron-microscopic investigation after 24 hours from experimental myocardial infarction indicated increase of specific activity of secretory cardiomyocytes and after 48 hours decrease of secretion of ANF while cardiomyopathy appears. After 72 hours, blockade of ANF secretion with decompensation of secretory cardiomyocytes occurred. CONCLUSION: Imunohistochemical investigations and analysis of submicroscopic structures of secretory cardiomyocytes after experimental MI showed, that cells were functionally active 24 hours after myocardial infarction with further (48 hours and 72 hours of MI) decrease in amount and impairement of activity.

[Efficacy of combined use of fosinopril and propranolol in acute myocardial infarction]. / Effektivnost' kombinirovannogo primeneniia fozinoprila s obzidanom v rannie sroki infarkta miokarda.

Echocardiography, Doppler echocardiography and ECG mapping were used in 40 patients aged 30-70 years with first anterior Q-wave myocardial infarction (MI) for the study of effects of combination of fosinopril and propranolol (20 patients) in comparison with propranolol alone (20 patients) on hemodynamics and size of myocardial damage. The use of fosinopril and propranolol was associated with lowering of systolic and diastolic blood pressure without development of hypotension, reduction of sum, number of leads with, and amplitude of ST-segment elevations, and improvement of parameters of left ventricular function. In propranolol treated patients favorable changes of all these parameters were less pronounced. Inhospital clinical course of the disease was also better in patients treated with fosinopril and propranolol.

[Fungal myocarditis in deep visceral candidiasis]. / Gribkovyi miokardit pri glubokom vistseral'nom kandidoze.

Morphological and functional changes of the myocardium were studied in 40 patients with candidiasis and attempt to establish morphological criteria of fungal myocarditis was undertaken. Retrospective analysis of autopsy material showed that myocardial involvement in candidiasis was possible and was not as rare as it had been accepted. Clinical symptomatology was not always similar to that of classical infectious-allergic myocarditis. However immunological parameters were characteristic of inflammatory process. Complex echocardiographic study gave important information for assessment of the state of the myocardium.

[The clinical characteristics of ischemic heart disease in patients with arterial hypertension of different origins]. / Osobennosti kliniki ishemicheskoi bolezni serdtsa u bol'nykh s arterial'noi gipertenziei razlichnogo geneza.

To study the clinical picture of coronary heart disease with concomitant arterial hypertension of various genesis, 172 patients were examined, out of them the cause of arterial hypertension was hypertensive disease in 54, chronic pyelonephritis in 40, chronic glomerulonephritis in 37, and stenotic atherosclerosis of renal arteries in 29, endocrine disease in 12 patients. The patients were divided into 2 groups: (1) 148 with stenotic atherosclerosis of coronary arteries and (2) 24 patients with intact coronary arteries. Comparison of these patient groups revealed no clear-cut correlation between the age and the detection of exercise-induced angina, as well as the duration of arterial hypertension. There was no correlation between the detection of the anginal syndrome and ECG changes. The incidence of the anginal syndrome was 62.2% in Group 1 and 47.7% in Group 2. It was established that the detection of the anginal syndrome correlated well with the severity of left ventricular hypertrophy and values of blood pressure, despite nosological entities.

[A comparative evaluation of the importance of transesophageal electrical stimulation of the left atrium and of bicycle ergometry in the diagnosis of ischemic heart disease in patients with arterial hypertension]. / Sravnitel'naia otsenka znacheniia chrespishchevodnoi élektricheskoi stimuliatsii levogo predserdiia i veloérgometrii v diagnostike ishemicheskoi bolezni serdtsa u bol'nykh arterial'noi gipertoniei.

To make a comparative assessment of transesophageal left atrial pacing (TLAP) and bicycle ergometry (BE) in the diagnosis of coronary heart disease (CHD) in patients with arterial hypertension (AH) of different origin, the authors examined 56 patients. The patients underwent TLAP and selective coronary angiography, of them 39 patients had BE testing. No significant differences were found in their specificity (73 and 78%) and sensitivity (92 and 81%) between TLAP and BE, respectively. The maximum heart rate in CHD patients with AH was significantly higher (130 +/- 6 per min) during TLAP than that in BE (112 +/- 5 per min, p > 0.05), ischemic changes occurring at the same value of double product despite the mode of myocardial ischemia induction in these functional tests (240 +/- 10 and 236 +/- 12 arbitrary units, respectively; p < 0.05). The mean systolic blood pressure was higher in TLAP and in BE (210 +/- 10 and 185 +/- 8 mm Hg). This follows that TLAP and BE finding are comparable and no profound changes occur in TLAP, hence it can be recommended for wide application in the diagnosis of CHD in AH patients.

[Transesophageal electrostimulation of the atrium in patients with ischemic heart disease combined with arterial hypertension in disability evaluation ]. / Chrespishchevodnaia elektrostimuliatsiia predserdii vo vrachebno- trudovoi ekspertize bolnykh ishemicheskoi bolezníu serdtsa v sochetanii s arterialnoi gipertenziei.

The author studied 78 patients (60 males and 18 females) aged 36 to 60 years (mean age 50 +/- 6 years). They all were diagnosed as having coronary heart disease (CHD) concurrent with arterial hypertension. Transesophageal atrial pacing test (TEACT) was positive in 68 (87.2%), and negative in 4 (5.1%) patients. It failed to reach diagnostic ECG criteria in 6 (7.7%) patients. A close relationship was found between the number of diseased coronary arteries and the sensitivity of TEACT. The TEACT parameters were found to be related to bicycle ergometric ones. The findings showed that the threshold rate of induced rhythm decreased when the patients increased their functional class of exercise-induced angina pectoris, the appearance of ST-segment depression being delayed and its disappearance increased. Thus, transesophageal atrial pacing allows the functional class to be defined in patients with CHD concurrent with arterial hypertension from the threshold rate of imposed rhythm and the time of ST-segment depression appearance and disappearance and can be useful both in the diagnosis and appraisal of the working capacity in patients with coronary heart disease concurrent with arterial hypertension.

[Hemodynamic changes in ischemic heart disease patients undergoing a combined head-down-tilt isometric load]. / Izmeneniia gemodinamiki u bol'nykh ishemicheskoi bolezn'iu serdtsa v usloviiakh kombinirovannoi antiortostaticheskoi izometricheskoi nagruzki.

Hemodynamics and myocardial contractility were examined in 36 male coronary patients and 20 normal subjects at rest, in a 15 degree head-down tilt and during combined antiorthostatic/isometric exercise (AOSIE). Antiorthostatic position was associated with increased stroke and minute volumes, cardiac index in normal subjects, and reduced stroke volume and left ventricular contractility in coronary patients of the 3d-4th functional class. AOSIE produced further increase in left-heart pumping and contractility in normal subjects, and a decrease in stroke and minute volumes, cardiac index and contractility parameters of calibration apex cardiograms in coronary patients of all functional classes. It is concluded that AOSIE can be used for the assessment of left ventricular myocardial function in normal subjects and coronary patients alike.

[Importance of combined instrumental study methods in the expertise of the work capacity of ischemic heart disease patients with stable stenocardia]. / Znachenie kompleksa instrumental'nykh metodov issledovaniia v ékspertize trudosposobnosti bol'nykh ishemicheskoi bolezn'iu serdtsa so stabil'noi stenokardiei.

Working capacity of 87 coronary patients with stable angina was assessed on the basis of a functional classification of the results of non-invasive investigations (resting ECG, bicycle ergometry, echocardiography). Bicycle ergometry proved to be the most informative method providing indirect evidence of coronary reserve. An objective assessment of the condition of coronary patients can be made using values of exercise tolerance (threshold capacity and volume of work), heart rate and double product at the peak of exercise. A close correlation exists between the severity of atherosclerotic affection of coronary arteries and individual exercise tolerance, which can be used in the medical evaluation of the working capacity of coronary patients with stable angina pectoris.