[Silent myocardial ischemia in acute coronary syndrome].

The given review considers the pathogenesis, diagnosis, and clinical significance of silent myocardial ischemia (SMI) in individual patient groups. It discusses the problem of SMI in acute coronary syndrome (ACS), the possible causes of SMI and the specific features of its diagnosis. It also indicates that there is a need for 12-lead ECG telemonitoring in intensive care unit patients with ACS to intraoperatively correct patient management and treatment policy.

[Role of the determination of aortic pressure and rigidity in patients with cardiovascular diseases].

The paper reviews the literature on studies of the structural and functional properties of great arteries in patients with cardiovascular diseases. It analyses the pathophysiological components of the formation of central blood pressure (BP) and describes current registration procedures. The negative aspects of the impact of elevated central BP on target organs are considered. The prognostic and clinical values of the indicators of central arterial stiffness are demonstrated.

[The features of myocardial deformation of left ventricle in patients with ischemic heart disease defined by the two dimensional strain method].

Aim of this study was to assess qualitative and quantitative features of deformation parameters of left ventricular myocardium in patients with ischemic heart disease (IHD) with and without history of myocardial infarction (MI) using two-dimensional strain imaging. We examined 30 patients with clinical IHD with (group 1, n = 15) and without (group 2, n = 15) history of MI and 20 healthy volunteers. Compared with healthy subjects IHD patients of both groups had reduced longitudinal and circular myocardial deformation. There were no significant differences between patients with IHD and controls in parameters of radial, global, and regional deformation.

[Corrective effect of olmesartan on parameters of the local rigidity using the echo-tracking technology].

Purpose of this study was to determine clinical value of intima-media thickness (IMT) and indicators of local stiffness obtained by ultrasonography of the carotid arteries by echo-tracking technology in patients with hypertension and coronary artery disease (CAD), and to assess vasoprotective effect of 24-week treatment with olmesartan. We included into the study 22 patients with 1-2 degree hypertension, 25 patients with CAD combined with hypertension, and 44 healthy subjects. In patients with CAD and hypertension local stiffness was reassessed after 24-week treatment with olmesartan (20-40 mg/day). Patients with-hypertension compared with healthy subjects had higher values of loc P sys and loc P dia, P (T1), pulse wave propagation velocity (PWPV), stiffness index, as well as lower compliance and distensibility coefficients (CC and DC). In patients with CAD and hypertension all parameters of local stiffness and IMT were significantly higher, while CC and DC were significantly lower than in control group. Therapy with olmesartan for 24-weeks was associated with reductions of IMT (-4.8%, p < 0.05), loc P sys and loc P dia (-13.5 and -11%, respectively, p < 0.05), stiffness index ß (-19.1%, p < 0.05), loc PWPV (-17%) and P (T1) (-7%, p < 0.05), and increase of CC (3.3%, p < 0.05). Conclusion. Combination of CAD and hypertension worsened the local stiffness and increased IMT. Therapy with olmesartan in this group of patients was associated with indications of vasoprotective effect.

[Carbohydrate metabolic disturbances and obstructive sleep apnea syndrome].

The paper analyzes an association between obstructive sleep apnea syndrome (OSAS) and carbohydrate metabolic disturbances. It presents the data of clinical trials that consider OSAS as a risk factor of type 2 diabetes mellitus (T2DM). The most important factors influencing the progression of carbohydrate metabolic disturbances in patients with OSAS are analyzed. Whether OSAS can be corrected as a modifiable risk factor in patients with T2DM is considered.

[CPAP therapy for obstructive sleep apnea syndrome in patients with carbohydrate metabolic disturbances and type 2 diabetes mellitus].

The review presents the data of clinical trials assessing the association between type 2 diabetes mellitus (DM) and obstructive sleep apnea syndrome (OSAS). The factors influencing the development of OSAS are analyzed in patients with DM; and disturbed sleep patterns are described in detail in patients with OSAS. The relationship of OSAS, diabetic autonomic neuropathy, and insulin resistance is analyzed. Whether CPAP therapy may be used to correct metabolic disturbances in patients with DM is considered.

[Assessment of characteristics of myocardial deformation in healthy subjects of various age groups by the X-STRAIN echocardiography].

Aim of the study was to master XStrain software and to obtain values of left ventricular (LV) myocardial velocity, longitudinal, circumferential, radial strain, and strain rate in a population of healthy subjects from various age groups. Sixty healthy volunteers were divided into 2 groups: aged 19-30 years (n = 35, mean age 24.6 +/- 3.1 years) and 30-58 years (n = 25, mean age 43.2 +/- 9.1 years). Values of all types of myocardial strain and circumferential strain rate did not differ substantially between groups at all LV levels: basal, median, and apical. Radial strain rate in the studied groups diminished from basal to apical LV segments. Longitudinal strain rate differed between LV sections in subjects older than 30 years. Myocardial velocity decreased from basal to apical myocardial segments.

[The diagnostic value and clinical significance of a method for estimating the arterial stiffness by cardio-ankle vascular index].

The review presents the data of clinical studies of a new method for estimating the arterial stiffness by cardio-ankle vascular index (CAVI). The most significant factors influencing the vascular wall are analyzed and a CAVI measuring procedure and a calculation algorithm are described in detail. An association of the estimation of CAVI with other procedures determining the rigidity of the arterial wall is analyzed. A possibility for the practical application of this index to the study of the elastic properties of the vascular wall and for its use as a surrogate criterion to evaluate the vasoprotective effect of antihypertensive agents is considered.

[Clinical study of arterial rigidity. Part II. Remodeling of vessels in arterial hypertension and metabolic syndrome. possibilities of correction with drugs].

In the second part of the review we present data on vascular remodeling in arterial hypertension and metabolic syndrome with analysis of factors and mechanisms influencing pulse wave propagation velocity in these diseases. We also consider possibilities of correction of remodeling of vessels with contemporary antihypertensive drugs.

[Provision of complex cardioprotection with the help of carvedilol in 1-2 degree arterial hypertension combined with metabolic syndrome].

In an open prospective 16-week study we carried out assessment of clinical efficacy, vaso- and cardioprotective properties of nonselective alpha and beta-adrenoblocker carvedilol used as monotherapy and in combination with nifedipine or as combination of these drugs with metformin and simvastatin. We have shown that the use of carvedilol both as monotherapy and in combination with nifedipine normalizes arterial pressure irrespective of the number of risk factors. We also revealed pronounced cardio- and vasoprotective action without negative effect on carbohydrate and lipid metabolism.

[Comparative assessment of a calcium antagonist with controlled release of nifedipine and enalapril in arterial hypertension in subjects older than 60 years].

We compared antihypertensive effects and organoprotective action of a calcium antagonist nifedipine RD and angiotensin converting enzyme (ACE) inhibitor enalapril in subjects older than 60 years with systolic diastolic (group 1) and isolated (group 2) I-II degree arterial hypertension. Subgroups of patients receiving nifedipine RD, enalapril, or combination therapy were distinguished. We used ultrasound methods for measurement of parameters of hypertrophy, systolic and diastolic function of the heart, increments of diameter and blood flow velocity in brachial artery during test with reactive hyperemia. Nifedipine RD appeared to be the drug of choice in elderly persons with isolated systolic form of arterial hypertension. Combination of calcium antagonists and ACE inhibitors in resistant hypertension in the elderly lead to achievement of target values of blood pressure and potentiation of organoprotective action of drugs.

[Clinical value of the study of stiffness of arterial wall. Part I].

In this review we present concise historical background of formation of the interest to investigation of properties of arterial wall in this review. We consider in detail interrelation of arterial functions with their structure, main mechanisms of action of elastic properties of arteries on systemic hemodynamics. Definitions of terms describing structural-functional properties of arteries are also given. Attention is accentuated on velocity of pulse wave propagation -- an independent predictor of cardiovascular morbidity and mortality and generally accepted parameter characterizing stiffness of arterial segment. Analysis of most valuable factors affecting pulse wave propagation velocity and modern methods and devices for the study of arterial wall stiffness is presented as well.

[Clinical variants of Churg-Strauss eosinophilic vasculitis].

The purpose of the study was to analyze clinical variants of eosinophilic vasculitis (EV). The authors observed 12 EV patients (five men and seven women; mean age 43 +/- 5.7) during a ten-year period. Two of the patients died of ventricular fibrillation due to myocarditis and of mesenterial thrombosis. Clinical variants of EV were diverse. The main syndromes in EV were: predominant lesion of the pulmonary system with polyneuropathy; lesion of the gastrointestinal tract (GIT) with eosinophilia; lesion of the cardiovascular system as well as association with other rheumatologic conditions (rheumatoid arthritis and diffuse eosinophilic fasciitis). The main therapeutic regimens in EV include steroidal therapy in medium to large doses, cyclophosphan intramuscularly, and intensive care--pulse therapy with metipred and plasmapheresis. Analysis of the results of the treatment of these patients demonstrated the efficacy of cyclophosphan administered in doses of approximately 2300 mg per course intramuscularly in combination with prednisolone (more than 40 mg a day), plasmapheresis (more than three sessions per a course), antiaggregants, heparin (more than 18000 units a day) and general hyperbaric oxygenation, as well as pulse therapy with metipred in a dose of 2200 mg per three days as intravenous infusion. The prognosis of EV was most poor in cases of lesion of the cardiovascular system and the GIT.

[Confirmation of safety and therapeutic effect of betaxolol in the treatment of mild and moderate hypertension in general medical practice].

Data on office blood pressure (BP) and pulse rate as well as information on adverse effects were collected from 148 patients with mild and moderate hypertension during 12 week treatment with long acting lipophilic selective beta-adrenoreceptor blocker betaxolol (20 mg/day). BP normalization was achieved in 72.5% and in 16.8% of patients BP was lowered more than 10% without achievement of target values. Pulse rate lowering by more than 15 beats/min occurred in 40.3% of patients. Combined therapy was required in 15.2% of patients. Adverse effects specific for the class of beta-adrenoblockers caused cessation of betaxolol therapy in 3 patients. The drug was found ineffective in 4 patients (2.7%). Thus we confirmed high clinical efficacy and good safety and tolerability of betaxolol in patients with mild and moderate hypertension.

[Comparative study of the effectiveness of Bonnecor and ethacizine in various disorders of cardiac rhythm]. / Sravnitel'noe issledovanie éffektivnosti bonnekora i étatsizina pri nekotorykh narusheniiakh serdechnogo ritma.

The data obtained on 68 patients suffering from cardiac arrhythmia treated with bonnecor or ethacizine demonstrate that bonnecor corrects ventricular extrasystole including high-grade arrhythmia in 80.4% of the patients while ethacizine in 84.6%. Acute tests with the drugs can effectively prognosticate the outcomes of bonnecor or ethacizine long-term treatment. The drugs eliminate delta-wave and stimulation-induced arrhythmias in 90% and 44-56% of patients with WPW syndrome, respectively. Bonnecor is less effective in nodal tachycardia. Both the drugs noticeably suppress conductivity.

[The effect of a combination of N-propylajmaline bromide and trimecaine on heart arrhythmias of different origins and on the electrophysiological parameters of the myocardium]. / Vliianie kombinatsii N-propilaimalinbromida i trimekaina na aritmii serdtsa raznogo geneza i élektrofiziologicheskie parametry miokarda.

In experiments on dogs and cats with disorders of the atrial and ventricular rhythms of various genesis the combination of N-propylaymalinebromide and trimecaine (the antiarrhythmic drugs of classes IA and IB) was found to potentiate the antiarrhythmic action. This effect was studied in electrophysiological experiments by using the microelectrode technique or on the dog and rat myocardium tissue. The combination of the antiarrhythmic drugs was shown to exert a more significant effect on some electrophysiological parameters determining the arrhythmic readiness of the myocardium.

[Combined action of anti-arrhythmia agents]. / Sochetannoe kombinirovannoe deistvie antiaritmicheskikh sredstv.

A significant potentiation of antiarrhythmic effect was observed in 121 dogs with arrhythmias 24 and 48 hours after the coronary artery ligation when the following drugs were combined: N-propylajmaline bromide (1A class) and trimecaine (1B class), quinidine (1A class) and trimecaine, N-propylajmaline bromide and anaprilin (2 class). The potentiation is attributed to the different molecular mechanisms of action of the drugs.