[Optimization of the invasive strategy for acute coronary syndrome in patients of the older age group.]

A study is presented on the effectiveness and safety of various anticoagulants used in patients of an older age group with acute coronary syndrome during percutaneous coronary interventions. Bivalirudin was shown to be highly effective in comparison with unfractionated heparin and monafram in relation to the amount of bleeding that occurs in the postoperative period and adverse cardiovascular complications.

[Features of changes in volume-impedance hemodynamic indicators during the tilt test in young males with a history of vasovagal syncopes].

BACKGROUND: The direction of changes in hemodynamic parameters during the tilt test (TT) nin individuals with history of vasovagal syncope (VVS) is a subject of discussion. OBJECTIVE: to study changes of volume-impedance hemodynamic indicators in the process of tilt test in somatically healthy young men with history of VVS. MATERIALS AND METHODS: A total of 102 men aged 18-30 years were divided into 4 groups, taking into account the specific features of fainting history and response to TT. Persons of group 1 (n=14) had history of VVS and positive response to TT (syncope). Subjects of group 2 (n=14) had history of VVS and a pattern of postural tachycardia without fainting during TT. Persons of group 3 (n=42) had history of VVS and negative response to TT. Subjects of group 4 (n=32) had no history of VVS and negative response to TT. During TT, we studied dynamics of some indicators, including cardiac output (CO) and total peripheral vascular resistance (TPVR). RESULTS: In individuals of all groups in the initial horizontal phase of TT values of CO and TPVR corresponded to the norm. Subjects of group 1 had significantly lower CO compared with subjects of groups 2, 3, 4 (p<0.05, p<0.01, p<0.05, respectively). Values of TPVR in subjects of group 1 were significantly higher than in subjects of groups 2, 3, 4 (p<0.05; p<0.05; p<0.05, respectively). In response to orthostasis CO values increased in groups 1, 2, 4 (by 18%, 10%, 5%, respectively) and did not change in group 3; TPVR values decreased in groups 1, 2 (by 8%, 0.5%, respectively), and increased in groups 3, 4 (by 8%, 4% respectively). In the final horizontal phase of TT, CO values in group 1 were significantly lower than in groups 3, 4 (p<0.05), while TPVR values did not significantly differ between all groups (p>0.05). CONCLUSIONS: In tilt-positive and tilt-negative subjects with history of VVS, standardized postural stress leads to unidirectional changes in cardiac output, but to multidirectional changes in total peripheral vascular resistance.

[CHARACTERISTIC OF ALTERATIONS OF ARTERIES IN PATIENTS WITH ISCHEMIC HEART DISEASE AND CHRONIC HEPATITIS C].

The article presents an assessment of degree and type of atherosclerosis of coronary and non-coronary vessels in old patients with ischemic heart disease associated with chronic viral hepatitis C (VHC), the incidence of myocardial infarction and the possibility of participation chronic VHC in atherogenesis. Patients with ischemic heart disease have correlation of atherosclerosis of arteries with age, hypercholesterinemia. Patients without chronic VHC more often give a higher risk of myocardial infarction, especially in early period (1-1,5 years) of onset of ischemic heart disease clinical implications. Patients with ischemic heart disease associated with chronic viral hepatitis C more often have generalized alterations in vessels, multifocal type of alteration. So, participation of VHC in atherogenesis is most probably connected with maintenance of chronic immune inflammation in vascular endothelium.

[Left ventricular hypertrophy as a marker of adverse cardiovascular risk in persons of various age groups].

The paper considers modern conceptions about the prognostic value of left ventricular hypertrophy (LVH) different types. The role of interaction of demographic, hemodynamic, regulatory, intracardiac factors in the formation of prognostic peculiarities in patients with different types of LVH is marked. The data of own investigations indicating that the left ventricular myocardial mass has not less important value in long-term general prognostication than belonging to a concentric or eccentric LVH type in elderly patients with hypertension are presented. Some data concerning left atrial dilatation as an inalienable component of the cardiovascular continuum in essential hypertension are submitted. Pathogenic and prognostic contribution of metabolic disorders associated with hypertension and abdominal obesity in the development of the heart's left parts structural and functional disorders is shown. Issues of long-term outcome in elderly hypertensive patients with metabolic syndrome taking into account the peculiarities of left ventricular geometry are highlighted.

[Hypertensive heart disease and noninsulin-dependent diabetes mellitus: modern strategies in antihypertensive therapy].

Hypertension (HTN) and noninsulin-dependent diabetes mellitus (NIDDM) are two non-communicable pandemic of the late 20th century and early 21st century. Despite the active prophylaxis measures performed by the State, there is a tendency to increase of HTN in Russia. Incidence rate of hypertension is depending of age and increases in patients of elderly age (80%). According to the International Diabetes Federation, 10% of people in Russia suffer NIDDM of different genesis. The authors covered the topical issues of modern strategies in antihypertensive therapy in patients with NIDDM and HTN according to large randomized trials. The authors analyzed the possibilities of conventional and modern therapies of hypertension, organoprotection, metabolic neutrality and impact on prognosis in patients with NIDDM. It is underlined that the renin-angiotensin-aldosterone system is a part of the cardiovascular continuum and links various risk factors, like end-stage of cardiovascular disease and chronic renal disease. Monitoring of arterial blood pressure is crucial for patients with essential hypertension and NIDDM. Pharmacological blockade of the renin-angiotensin-aldosterone system is the most desirable method of treatment of hypertension and noninsulin-dependent diabetes mellitus. This method reduces the risk of cardiovascular complications.

[The metabolic syndrome and inflammation: actual issues of pathogenesis].

The publications' review and intrinsic data testify that metabolic syndrome represents an extremely actual problem due to high prevalence and strong influence of its components at the risk of development of cardio-vascular complications.

[Aortic stenosis of alkaptonuric genesis].

Main approaches to intravital diagnosis of alcaptonuria are described. Attention is focused on damages determining invalidisation of patients. A clinical case is presented which demonstrates success of surgical treatment of aortic stenosis of alkaptonuric genesis.

[Modern tendencies in the treatment of patients with high risk of development of cardiovascular complications and intolerance to angiotensin converting enzyme inhibitors: value of results of TRANSCEND trial for clinical practice].

Clinical value of pharmacologic blockade of renin angiotensin aldosterone system for deceleration of cardiovascular continuum is strongly proved. Up to 20% of population is intolerant to ACE inhibitors. There are no strong evidences that ACE inhibitors differ from angiotensin receptors blockers in influence on main cardiovascular outcomes. In placebo controlled randomized multicentre trial TRANSCEND clinical efficacy, safety and tolerability of telmisartan was studied in elderly patients with high cardiovascular risk who were intolerant to ACE inhibitors. Telmisartan based therapy was associated with decrease of secondary end point (composite of cardiovascular death, myocardial infarction, or stroke) by 13% in comparison with placebo (p=0.048). There were significantly less hospitalizations due to cardiovascular causes in telmisartan group than in placebo group. Risks of new diabetes mellitus, renal dysfunction and serious adverse events were similar in both groups. Combined results of TRANSCEND and PRoFESS trials have demonstrated significant advantage of active telmisartan based therapy concerning the primary outcome of composite of cardiovascular death, myocardial infarction, stroke, or hospitalization for heart failure ( 7%, p=0.026).

[Significance of pharmacological blockade of angiotensin II type I receptors for correction of abnormal 24-hour blood pressure profile depending on its variability in patients with arterial hypertension stage II]. / Znachenie farmakologicheskoi blokady retseptorov angiotenzina II pervogo tipa dlia korrektsii narushenii sutochnogo profilia arterial'nogo davleniia s uchetom razlichnoi stepeni ego variabel'nosti u bol'nykh arterial'noi gipertoniei 2-i stepeni.

AIM: To specify variable 24-h arterial hypertension (AH) stage II profile and to assess significance of pharmacological block of the end of the renin-angiotensin-aldosteron system for correction of the determined disorders. MATERIAL AND METHODS: The study was made of 46 men (mean age 42.8 +/- 3.28 years) with stage II AH and 25 normotensive controls (mean age 39.2 +/- 3.10 years). Depending on the magnitude of mean 24-h AP variability (APV), hypertensive patients were divided into two groups. Variability of systolic and/or diastolic AP (SAPV and DAPV, respectively) was considered high in at least 15.2 and/or 12.3 mm Hg variability, respectively, and normal at less values. RESULTS: AP 24-h profile in men with AH stage II and high APV compared to patients with normal APV is characterized by higher frequency of AP rise and less frequency of its night fall. In patients with high APV the drug eprosartan (teveten) is more effective in correction of hypertension and night fall of AP. CONCLUSION: Eprosartan has an adequate corrective activity in relation to absolute values of SAP and DAP in different hours. The highest hypotensive activity of the drug was seen in persons with initially high circadian AP variability within 24 hours.