[Type 2 diabetes mellitus and coronary artery disease: features of perfusion volume computed tomography of the heart in a pharmacological test with adenosine triphosphate].

AIM: To study myocardial perfusion in patients with coronary artery disease (CAD) with and without type 2 diabetes mellitus (DM) using volumetric computed tomography (VCT) of the heart with a pharmacological test with adenosine triphosphate (ATP). MATERIALS AND METHODS: The study included 93 patients, of which 18 had CAD with DM, and 50 had CAD without DM. All patients underwent one of the stress tests, cardiac VCT with ATP test, invasive coronary angiography, or CT coronary angiography. Left ventricle (LV) myocardial perfusion was evaluated for hypoperfusion zones and the calculation of semi-quantitative indices: decrease of LV myocardial density, LV myocardial perfusion index, transmural perfusion coefficient, and our proposed new indicator - myocardial perfusion reserve (MPR). RESULTS: The MPR index value in the hypoperfusion zones in patients with CAD and DM was 0.64 [0.62-0.66], in patients with CAD without diabetes 0.65 [0.63-0.66]; p=0.4; the value of the transmural perfusion coefficient in the areas of abnormal LV myocardial perfusion in patients with CAD and DM was 0.81 [0.80-0.86] versus 0.83 [0.80-0.85] in patients with CAD without DM (p=0.6). More hypoperfusion segments were observed in patients with CAD and DM (33.3%) compared to those without DM (14%; p=0.029). The MPR index in the hypoperfusion zones in patients with CAD with intact coronary arteries (CA) and DM was 0.56 [0.54-0.60] versus 0.55 [0.54-0.62] in patients with CAD with intact CA without DM; p=0.2. CONCLUSION: In patients with CAD and type 2 DM, according to the VCT with ATP test, more foci hypoperfusion areas were detected, regardless of the severity of coronary artery involvement, compared with patients with CAD without DM, which may be due to the microangiopathy in the myocardium. The similarity of the MPR parameters in the hypoperfusion zones associated with hemodynamic stenosis of the CA and with intact CAs indicates the ischemic genesis of these zones. For citation: Soboleva GN, Minasyan AA, Gaman SA, Rogoza AN, Molina LP, Soboleva TV, Shariya MA, Ternovoy SK, Karpov YuA. Type 2 diabetes mellitus and coronary artery disease: features of perfusion volume computed tomography of the heart in a pharmacological test with adenosine triphosphate. Terapevticheskii Arkhiv (Ter. Arkh.). 2023;95(4):309-315. DOI: 10.26442/00403660.2023.04.202158.

Large artery stiffness according to different assessment methods in adult population of St.Petersburg.

OBJECTIVE: The aim of the present study was to assess the prevalence of increased arterial stiffness by different diagnostic methods and its association with cardiovascular risk in Russian population-based cohort. DESIGN AND METHODS: In terms of Russian epidemiological study ESSE-RF a random selection of 452 apparently healthy Saint-Petersburg inhabitants aged 25-65 years was performed. Fasting lipids, glucose and blood pressure measurements were performed. We used 3 diagnostic methods of arterial stiffness assessment: pulse wave velocity by applanation tonometry (SphygmoCor - PWV-S) and pulse wave velocity by volumetric sphygmography (VaSera - PWV-V), and cardio-ankle vascular index (CAVI) by VaSera. RESULTS: 341 (75,4%) had normal parameters of arterial stiffness assessed by all methods. Spearmen's coefficient of correlation and "kappa" coefficient for PWV-S and CAVI were 0,74 and 0,04, for PWV-S and PWV-V - 0,10 and 0,06, for CAVI and PWV-V - 0,28 and 0,03, respectively. There was a significant correlation between cardiovascular risk (defined by SCORE) and PWV-S (r = 0,38, p < 0,001) and a non-significant trend of increasing CAVI along with cardiovascular risk (r = 0,35, p = 0,14). CONCLUSIONS: Different methods of arterial stiffness assessment showed a weak correlation with each other. Carotid-femoral pulse wave velocity detected by applanation tonometry is associated with high cardiovascular risk score and might be considered as better additional risk marker for cardiovascular risk stratification.

[Differential Diagnostics of Vasovagal Fainting, Orthostatic Hypotension and Baroreflex Failure in a Patient With Syncope].

We present here a case report of recurring fainting due to orthostatic hypotension in a 45­year-old woman with Hodgkin's' disease, treated by radiation therapy and resection of cervical lymph node. We discuss difficulties of identification of etiology and mechanisms of orthostatic hypotension as well as possible role of baroreflex failure at the background of the Hodgkin's' disease treatment, and vasovagal syncope of which the patient suffered in her youth.

The periprocedural myocardial damage prevention during elective percutaneous coronary intervention as a result of pharmacological preconditioning with an oral form of nicorandil in patients with stable coronary artery disease. Pilot study.

AIM: The purpose of the study is to prove the effectiveness of pharmacological preconditioning caused by nicorandil in patients with stable coronary heart disease (CHD) during the elective percutaneous coronary intervention (PCI). MATERIALS AND METHODS: We included 88 patients with a stable form of CHD, who were going to pass the elective PCI, in the study. As the method of blind randomization envelope method was used. There were formed two groups or patients: the first group involved 45 patients - were treated with nicorandil (Cordinic, PIQ-FHARMA LLC) (the main group) the other group included 43 patients who were treated by the standard therapy (the comparison group). The basic antianginal therapy was allowed to use in both groups: beta-blockers, calcium antagonists, ATE inhibitors / angiotensin II receptor blockers, statins, acetylsalicylic acid, blockers of P2Y12 receptor platelets. The admission of prolonged form of nitrates before the PCI was allowed in the second group. Patients from the 1st group were to take nicorandil 2 days and 1 day before the PCI at the 30 mg/day dose, then 20 mg orally 2 hours just before PCI, and one more time 6 hours after the PCI - 10 mg nicorandil. Highly sensitive troponin (HS-Tp) as a biomarker of irreversible damage to the myocardium was evaluated before PCI and after PCI in 24 hours. Were used highly sensitive troponin (HF-Tr) and creatine phosphokinase-MB as an irreversible myocardial damage biomarkers. The analysis of which was conducted before PCI and 24 hours after the surgery. RESULTS: The obtained data shows the significant differences of an increase in hs-Tp in 24 hours after PCI in patients with no admission of nicorandil (117 ng/l) as compared with the nicorandil group (73 ng/l), p = 0.04. There were significant differences in the 24 hours increment in hs-Tp in the control group, it was higher (112 ng/l) than in the nicorandil group (67 ng/l), p = 0.03. There was also a significant -decrease in CK-MB after 24 hours in the nicorandil group (2.7 ng/L) compared to the control group (2.0 ng/L), p = 0.008. Also the frequency of the troponin increase above the UNL(upper normal level) in the nicorandal group, was significantly (p = 0.03) lower (in 62% of cases compared to 85% of the control group). CONCLUSION: The prevention of the complications during the percutaneous myocardial revascularization should be considered with the position of the most suitable pharmacological support. The appointment of the oral form of nicorandil (Cordinic, PIQ-FHARMA LLC) for 2 days and 1 day before PCI 30 mg/day, then 20 mg 2 hours before the PCI and 10 mg after 6 hours after the surgery reduces the risk of intraoperative myocardial damage. The obtained data give an opportunity to extend the indications for nicorandil's appointment in the drug support during PCI in patients with stable coronary artery disease.

[Influence of modifiable cardiovascular risk factors on antihypertensive therapy efficiency escape]. / Vliianie modifitsiruemykh faktorov riska razvitiia serdechno-sosudistykh oslozhnenii na 'uskol'zanie' éffektivnosti antigipertenzivnoi terapii.

AIM: To evaluate the influence of cardiovascular risk factors on antihypertensive therapy (AHT) efficiency escape (EE). SUBJECTS AND METHODS: Data on 59 patients with grades 1-3 hypertension (Stages I-II) were analyzed. During chosen AHT, 24-hour blood pressure monitoring was done at baseline, 1 and 3 months after beginning the observation to identify/rule out the AHT EE phenomenon. RESULTS: The AHT EE group (Group 1) as compared with the group that needed no therapy correction within 3 months (Group 2) was observed to have the following: elevated fasting blood glucose levels (FBGL) (5.8±0.8 vs 5.3±0.7 mmol/l; p=0.008) and higher impaired glucose tolerance (IGT) rates (8 (27.6%) vs 4 (13.3%) cases (p=0.03)); a more number of smoking patients (8 (27.6%) vs 3 (10%) cases; p=0.02); a larger number of patients with a compromised family history of cardiovascular diseases (17 (58.6%) vs 11 (36%); p=0.02). Furthermore, in Group 1 baseline average systolic blood pressure during 24 hours (SBP-24) proved to be higher than that in Group 2 (127.4±4.2 vs 122.4±6.8 mm Hg; p=0.002). Odds ratio (OR) for developing the EE phenomenon increased by 60% with a rise of 0.5 mmol in FBGL (OR, 1.60; 95% confidence interval (CI), 1.06 to 2.4; p=0.02) and by 18% with an increase of 1 mm Hg in baseline SBP-24 (OR, 1.18; 95% CI, 1.05 to 1.33; p=0.004). Multivariate analysis indicated that the independent predictors of AHT EE were a compromised family history (OR, 3.7; 95% CI, 1.1 to 12.1; p=0.03) and IGT (OR, 4.1; 95% CI, 1.02 to 16.4; p=0.04). CONCLUSION: AHT EE was influenced by FBGL, IGT, smoking, a compromised family history, and baseline SBP-24 level.

[24-hour systolic wave increment index monitoring in patients with low-renin arterial hypertension].

AIM: To analyze the circadian rhythm of blood pressure (BP) and daily reflected wave values in patients with low-renin hypertension with normal and elevated aldosterone production. SUBJECTS AND METHODS: The investigation included 66 patients. 24-hour BP monitoring was carried out and arterial wall rigidity and reflected wave values were assessed in all the patients. RESULTS: The patients with hyperaldosteronemia were found to have not only statistically significant severer hypertension, impaired circadian rhythms of BP, but also impaired augmentation index (Aix)--mainly its nocturnal increase. A positive correlation was found between nocturnal Aix and resting plasma aldosterone concentrations (r = -0.31; p = 0.002). CONCLUSION: The findings suggest the expediency of 24-hour systolic wave increment index monitoring in hypertensive patients ofthis category.

[Results of using the dosing Valsalva-Weber test to determine autonomic disorders in patients with vasovagal syncope].

AIM: To estimate the value of the dosing Valsalva-Weber test (VWT) in the diagnosis of autonomic disorders in patients with vasovagal syncope (VVS). SUBJECTS AND METHODS: The dosing VWT using a specialized Task Force Monitor unit ("CNSystem", Austria) with synchronous noninvasive ECG and blood pressure (BP) monitoring was carried out in 30 patients (mean age 32 ± 14 years) with VVS and 12 healthy individuals (31 ± 7 years). The analysis of the test results encompassed the visual assessment of BP change curves and heart rate in different test phases and the calculation of pressure indices, Valsalva coefficient, arterial baroreflex sensitivity, and other parameters (a total of 26). RESULTS: The abnormally changed form of the mean BP curve, which was characterized by that BP by the end of Phase II test failed to achieve the baseline level, was recorded in 10 (33%) patients with VVS and in none of the healthy individuals (p = 0.04). An individual analysis of the gender- and age-adjusted Valsalva coefficient revealed its reduction in 9 (30%) patients while this indicator was within the normal range in all the healthy individuals (p = 0.04). CONCLUSION: During the dosing VWT, the signs of sympathetic insufficiency (impaired adrenergic regulation of BP) are found in 33% of the patients with VVS and those of parasympathetic insufficiency (impaired vagus regulation of cardiochronotropic function) are in 30%.

[Is there an association of uric acid level with preclinical target organ damage in moderate- and high-risk hypertensive patients?].

AIM: To assess an association of uric acid level with preclinical target organ damage in patients with hypertensive disease (HD). SUBJECTS AND METHODS: The trial enrolled 100 patients (63 men and 37 women) with Stage I-II HD at moderate and high risk for cardiovascular events (CVEs). The mean age of the patients was 44.9 +/- 1.3 years. Their medical history showed that the duration of hypertension averaged 4.4 +/- 0.3 years. The average daily level of systolic blood pressure (BP) was 138.1 +/- 1.4 mm Hg and that of diastolic BP was 84.3 +/- 1.1 mm Hg. RESULTS: The entire patient group showed a positive correlation between C-reactive protein (CRP) and serum uric acid (SUA) (r = 0.27; p < 0.01), suggesting that the nonspecific inflammatory processes were associated with uric acid levels in patients with HD. An intragroup analysis also revealed a relationship between CRP and SUA levels in the hypertensive patients at high risk for CVEs (r = 0.43; p = 0.01); this relationship was not found in those at their low risk. The hypertensive patients were ascertained to have elevated CRP levels and microalbuminuria, hyperuricosuria, and glomerular hyperfiltration when they had a SUA level >319 micromol/l. CONCLUSION: It can be assumed that the SUA level >319 micromol/l triggers the activation of nonspecific inflammatory processes, which in turn affects renal microvessels.

[Vasomotor endothelial dysfunction in young men with grade 1 arterial hypertension].

In order to study vasomotor endothelial function and risk factors of endothelial dysfunction in young men with grade 1 arterial hypertension (G1AH) we examined 76 men with G1AH and 30 healthy men aged 20-40 years. Flow-mediated vasodilatation (FMD) of the brachial artery was assessed by ultrasonic method of Celermajer D.S. Vasomotor endothelial dysfunction (FMD<6%) was found significantly more frequently in men with G1AH than in healthy men (51% vs 13%). In healthy young men with normal blood pressure smoking was the main risk factor of endothelial dysfunction. In young men with G1AH risk factors for endothelial dysfunction were: family history of early cardiovascular disease, smoking, and elevation of low-density cholesterol level. Probability of endothelial dysfunction in the absence of these factors was low - 11%, in the presence of one factor it was 30%, two factors - 60%, and three factors - 83%. Elevated (>14.8%) red blood cell distribution width (RDW) was associated with endothelial dysfunction. Probability of endothelial dysfunction in young men with G1AH and elevated RDW was 5 times greater than in those with normal RDW.

[Structural and functional status of arteries in young and middle-aged men with ischemic heart disease].

Aim of the study was to determine whether structural and functional status of arteries differ between young and middle-aged men with ischemic heart disease (IHD). A total of 78 men aged 28 to 50 years were recruited in this study: 49 with angiographically proven obstructive atherosclerosis of coronary arteries, 29 without clinical manifestations of IHD (control group). Those with arterial hypertension, diabetes mellitus or marked hypercholesterolemia (LDL cholesterol more or equal 4.5 mmol/l) were excluded from the study. All patients underwent carotid ultrasound, endothelial function, and arterial stiffness measurements. Patients with IHD more often had multiple carotid plaques (86.7% vs 13.7%, p<0.001), and increased aortic pulse wave velocity (PWV) assessed by ultrasound duplex scanning (53.1% vs. 24.1%, p=0.02). Aortic PWV was related to the severity of coronary atherosclerosis. Presence of a carotid intima-media thickness more or equal 0.9 mm and abnormal flow-mediated dilatation (FMD) of the brachial artery was not significantly different between the groups.

Effects of CPAP on "vascular" risk factors in patients with obstructive sleep apnea and arterial hypertension.

BACKGROUND: The aim of this study was to assess the effects of continuous positive airway pressure (CPAP) on arterial stiffness, central blood pressure, and reflected pulse wave characteristics in patients with severe obstructive sleep apnea (OSA) and stage 2-3 arterial hypertension. METHODS: Forty-four patients with hypertension and severe OSA (apnea/hypopnea index > 30) received stepped dose titration of antihypertensive treatment, consisting of valsartan 160 mg + amlodipine 5-10 mg + hydrochlorothiazide 25 mg. CPAP therapy was added after 3 weeks of continuous antihypertensive treatment with BP < 140/90 mmHg or after adjusting triple treatment in patients with resistant arterial hypertension. The patients were randomized to effective CPAP (4-15 mm H2O) or placebo CPAP (pressure 4 mm H2O) for three weeks, then crossed over to the alternative treatment in a single-blind manner. Office blood pressure (BP), ambulatory BP monitoring, ambulatory arterial stiffness index (AASI), aortic BP, carotid-femoral pulse wave velocity (cfPWV), and systolic wave augmentation index were measured using a Sphygmocor® device at baseline, after antihypertensive treatment, placebo CPAP, and effective CPAP. RESULTS: Baseline cfPWV was above the normal range in 94% of patients. After reaching target BP, the cfPWV decreased by 1.9 ± 1.0 msec (P = 0.007). Effective CPAP achieved a further cfPWV reduction of 0.7 msec (P = 0.03). Increased arterial stiffness (pulse wave velocity > 12 msec) persisted in 35% of patients on antihypertensive treatment and effective CPAP, in 56% of patients on antihypertensive treatment alone, and in 53% of patients on placebo CPAP. Only the combination of antihypertensive treatment with effective CPAP achieved a significant reduction in augmentation index and AASI, along with a further reduction in aortic and brachial BP. CONCLUSION: Effective CPAP for 3 weeks resulted in a significant additional decrease in office BP, ambulatory BP monitoring, central BP, and augmentation index, together with an improvement in arterial stiffness parameters, ie, cfPWV and AASI, in a group of hypertensive patients with OSA.

[Nonspecific inflammation and structural changes in the arteries of hypertensive males at high and moderate risk for cardiovascular events].

AIM: To study relationships between nonspecific inflammation (NI) of the arterial wall and its structural changes in Stages I-II hypertensive disease (HD) males at moderate and high risks of cardiovascular events (CVE). SUBJECTS AND METHODS: Sixty hypertensive males aged 30 to 65 years (mean age 44 +/- 2 years), including 35 patients with grade 1 arterial hypertension (AH) and 25 with grade 2 AH at moderate and high risks of CVE, were examined. The concentrations of C-reactive protein (CRP) and methylglyoxal (MG) were measured. Pulse wave propagation velocity (PWPV) and ankle brachial index (ABI) were studied. Normal PWPV values were calculated in terms of gender and age features. RESULTS: The examined HD group showed a positive correlation of PWPV with systolic blood pressure over 24 hours (r=0.39; p < 0.02) and age (r = 0.47; p < 0.01). In smoking and nonsmoking hypertensive men, PWPV differences failed to achieve statistical significance (14.05 +/- 0.53 and 13.07 +/- 0.38 m/sec, respectively). PWPW was found to be correlated with CRP values weakly (r = 0.31; p = 0.07) and with MG levels moderately (r = 0.62; p < 0.01); there were also positive relationships of ABI to the levels of CRP (r = 0.50; p < 0.01) and MG (r = 0.46; p < 0.05). There was a positive correlation between CRP and MG levels (r = 0.45; p = 0.01). CONCLUSION: In middle-aged men with grades 1-2 AH at moderate and high risks of CVE, NI processes are not only related to MG metabolism, but also they have a substantial effect on the elastic properties of the wall of predominantly muscle-elastic type arteries, which validates the hypothesis of the involvement of NI processes in the course of HD.

[The contribution of parameters of subclinical artery wall damage in the evaluation of cardiovascular risk].

AIM: To assess contribution of such parameters as intima-media thickness (IMT), presence of carotid plagues (ab), pulse wave velocity (abPWV) and ankle-brachial index (ABI) to asessment of cardiovascular risk in patients who were initially assigned to the group of low and moderate risk according to the SCORE scale. SUBJECTS AND METHODS: 600 patients with low and moderate cardiovascular risk according to "SCORE" scale were selected: 445 women and 155 men in the age 30-65 years. We used color duplex ultrasound imaging (DUI) of carotid arteries (CA),. computer sphigmography (CS), biochemical tests (lipid profile. MDRD. glucose). RESULTS: The contribution of studied methods to risk stratification was compared: DUI of CA allowed to find patients with subclinical artery wall damage in 96%, CS-abPWV - in 39%, and ABI only - in 5% of cases. After adding abPWV to patient examination 61% remained in the low risk group and 17% were converted into the high risk group. At the same time after adding DUI of CA only 37% of patients remained in the low risk group and 36% (almost every third) were converted to more high risk group. CONCLUSION: The most sensitive method of detection subclinical artery wall damages is duplex ultrasound imaging of CA. The abPWV also has some diagnostic value and can be recommended to find out this kind of damage due to its simplicity and convenience.

[Increased arterial stiffness is a significant but not obligatory factor of arterial hypertension in persons over 60 years of age].

AIM: To ascertain whether high arterial rigidity is obligatory in arterial hypertension (AH) and the presence of AH is obligatory in patients with rigid arteries. MATERIAL AND METHODS: Volume sphygmography (VS) was made in 153 patients aged 60-86 years: 96 patients with untreated AH of degree 1-3 (40 males aged 71.0 +/- 7.6 years) and 57 normotensive subjects without cardiovascular symptoms (31 males aged 66.6 +/- 6.2 years). VS measured ankle-shoulder velocity of the pulse wave (PWVas) and cardiac-ankle vascular index (CAVI). PWVas > M+STD and CAVI > M+2STD (STD is deviation from mean value) were considered above normal for the age. RESULTS: Hypertensive patients had significantly higher arterial rigidity than normotensives (PWVas 178 +/- 3.0 and 15.6 +/- 2.3 m/s, respectively, p = 0.00001); CAVI--9.7 +/- 2.1 and 8.6 +/- 1.1, respectively, p = 0.0003). Arterial rigidity in hypertensive patients occurred significantly more frequently than in normotensive subjects: by PWVas in 46 and 25% cases (p = 0.01), by CAVI--in 41 and 5% cases (p < 0.0001), respectively. It is essential that arterial rigidity was not increased in 54% hypertensive patients by PWVas and in 75% by CAVI. CONCLUSION: PWVas and CAVI were higher in elderly hypertensives than in elderly normotensives but elevated arterial rigidity was not obligatory in hypertensives while 25% elderly normotensives had it. Thus, elevated arterial rigidity is an essential but not obligatory mechanism of AH development in the elderly.

[Efficacy of combined treatment of patients with severe obstructive sleep apnea and arterial hypertension of the second and third degree].

AIM: To assess efficacy of two- and three-component antihypertensive treatment (AHT) in patients with severe sleep apnea and arterial hypertension (AH) of the second and third degree in combination with CPAP therapy (continuous positive air pressure) and without it. MATERIAL AND METHODS: A total of 58 patients aged 55.5 +/- 9.6 years participated in the study. Clinical blood pressure (BP) before treatment was 172.0 (170.7-175.9)/100.0 (98.5-104.2) mm Hg, apnea/ hypopnea index was 26.3 episodes an hour. The patients received amlodipin in combination with walsartan in a dose 5-10/160 mg with addition of 25 mg hydrochlorothiaside if target BP was not achieved. This treatment was followed for 3 weeks by CPAP-therapy. Monitoring was made of clinical BP, central BP, target mean 24-h pressure. RESULTS: Despite a significant reduction of systolic arterial pressure/diastolic arterial pressure (by 30/14 mm Hg) as a result of antihypertensive treatment, this reduction was lower than in such patients without obstructive sleep apnea (by data from other investigators). CPAP-therapy reduced the number of resistant patients from 58 to 31%, patients with masked AH--from 19 to 11%, cases of arrhythmia--from 69 to 47%. CONCLUSION: Multicomponent pathophysiologically sound AHT in hypertensive patients with severe obstructive sleep apnea was effective in less than 42% cases. The maximal effect was achieved in combined treatment with CPAP-therapy.

[Indices of static and dynamic components of pressure load (assessed by 24-hour blood pressure monitoring) and the state of renal function in patients with essential hypertension].

Aim of this study was to evaluate possible relationship between parameters of blood pressure (BP) profile and glomerular filtration rate in patients (pts) with I-II stage essential hypertension (EH). Material and methods. We studied 120 pts (97 men), aged 23-65 (50,2+/-0,6) years with I (n=98) and II (n=22) stage EH. In BP profile (SL-90207) we calculated 24-hour, daytime, nighttime values of systolic, diastolic, pulse pressures (SBP, DBP, PP), time load (TL), variability and nocturnal fall (NF) of BP. The state of renal function was assessed by measurement of glomerular filtration rate (GFR) calculated by the Cockcroft formula. Results. After nonlinear statistical analysis by Gauss-Newton all patients were divided into three groups according to GFR tertiles. Significant differences were found between these groups by 24-hour, nighttime and daytime values of SBP and DBP. Values of SBP were the lowest in group II. In group II lowest values of PP were also observed, but statistically significant differences were found only in nocturnal PP values between groups II and III. There were no significant differences between groups by TL and NF of BP. In group Ill (high GFR) variability of daytime values of SBP and DBF were significantly higher. Univariate correlation analysis showed statistically significant negative relationship between GFR and nocturnal PP in patients with lowest level of GFR. Positive correlations between nocturnal values of PP and GFR in groups II and III were also observed. Conclusion. These results indicated the presence of strong relationship between high values of nocturnal PP and decreasing of glomerular filtration rate in patients with EH and thus confirmed significance of "constant" and "dynamic" components of pressure load as a marker of impairment of renal function.

[Determination of brain natriuretic peptide levels and its N-terminal fragment for the evaluation of renal replacement therapies efficiency in patients with decompensated chronic heart failure].

AIM: to compare the capabilities of identifying different types of brain natriuretic peptide (BNP) for the evaluation of renal replacement therapy modalities in patients with decompensated chronic heart failure (CHF). SUBJECTS AND METHODS: Patients (31 men and 9 women) aged 30 to 82 years with functional class II-IV CHF in its decompensation phase were examined. The patients were divided into 2 groups. A study group received medical therapy for CHF, such as angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists, verospirone, beta-adrenoblockers, digoxin, loop diuretics (furosemide, diuver, in the doses not exceeding those taken before admission) in combination with renal replacement therapy: slow continuous ultrafiltration (SCUF) or continuous venovenous hemofiltration (CVVHF). A control group had only medical therapy for CHF (intravenous furosemide in the doses doubling those used before admission, i.e., > or =80 mg/day required for an adequate response to the drug--daily urine volume >1 liter). The patients from the study and control groups received furosemide < or =40 mg/day or torsemide < or =20 mg/day after a course of SCUF or CVVHF sessions or intravenous furosemide. There were 4 examination stages [control study points (CSP)]: (1) before study; (2) after CHF compensation achievement (a day before hospital discharge); (3) following 90 days; (4) following 180 days. The plasma concentration of active BNP was measured by enzyme immunoassay; that of the N-terminal fragment of BNP (NT-proBNP) was estimated on an analyzer. RESULTS: There were direct correlations between the content of BNP and that of NT-proBNP) in all CSPs in the patients from both groups. The study group showed a significantly greater weight loss, which was accompanied by a more pronounced reduction in systolic pulmonary artery pressure, pulmonary venous hypertension, hydrothorax elimination, decreased liver size, lower plasma aldosterone concentration, decreased heart size, and higher left ventricular ejection fraction (LVEF). The study group displayed a steady-state reduction in the plasma concentrations of both BNP and NT-proBNP, significant inverse correlations between the lower BNP level and the higher LVEF throughout the follow-up. CONCLUSION: Extracorporeal dehydration techniques are more effective that intravenous diuretics. The direct correlations between the content of BNP and that of NT-proBNP and between the change in their concentrations during treatment assume the capacity and objectification of diagnosing CHF and its degree, by determining only one of the types of BNP.

[Baroreflex sensitivity in patients with chronic heart failure: the clinical significance and impact of therapy].

The review deals with the baroreflex regulation of circulation in chronic heart failure (CHF). The pathophysiological aspects of development of dysfunction of the baroreflex clinically estimated from its sensitivity are presented; the clinical value of this indicator is discussed in relation to the etiology of the underlying disease and clinicohemodynamic status. Data on the impact of some components of current therapy for CHF and nondrug treatments on the values of baroreflex sensitivity are shown.

[Spectral indices of heart rate variability in patients with vasovagal syncopes according to evidence of 5-min ECG].

AIM: To compare autonomic nervous system activity estimated by power spectral analysis of heart rate variability in patients with vasovagal syncopes and healthy volunteers. MATERIAL AND METHODS: Seventeen health volunteers and 25 patients with vasovagal syncope were included in the study. In 16 cases faints were induced by head-up tilt table test (HTT), in 9 cases--by bicycle exercise test (BET). Power spectral analysis of heart rate variability in 5-th min ECG records was performed in supine and upright position while breath was fixed. RESULTS: In supine position the data of low frequency (LF) and high frequency (HF) of spectral power in both groups of patients were significantly higher than in volunteers. During upright the HF of spectral power significantly decreased in patients and volunteers. In upright position LF of spectral power significantly decreased in patients with syncope induced by HTT, did not change in patients with syncope induced by BET, but significantly increased in volunteers. CONCLUSION: Patients with vasovagal syncope had abnormal autonomic nervous system activity: a high level of parasympathetic influence in supine position and poor reaction of sympathetic nervous system during upright.

[Effect of sex on informative power of various electrocardiographical criteria of left ventricular hypertrophy in patients with excessive body mass].

Aim of the study was to analyze dependence of various voltage parameters of QRS complex on increase of left ventricular myocardial mass (LVMM) in samples of men and women with excessive body mass or obesity. We included data from 223 patients with excessive body mass and diagnosis of stage I - II arterial hypertension. ECG was registered in 12 standard leads. Left ventricular hypertrophy (LVH) was certified if according to echoCG data LVMM exceeded 125 g/m2 in men and 110 g/m2 in women. Depending on sex and presence of LVH all patients were divided into 4 groups: M1 (men with LVH, n=74), M2 (men without LVH, n=74), W1 (women with LVH, n=55), anb W2 (women without LVH, n=20). We analyzed amplitudes of all waves of the QRS complex as well as Sokolow-Lyons voltage parameters and the Cornell index. The following intergroup differences were most significant: between groups M1 and M2 - in amplitudes of S waves in chest leads V3, V4; between groups W1 and W2 - in amplitudes of R-waves in limb leads I and aVL, and amplitudes of S-waves in lead III. Increases of the Cornell voltage index were observed both in men and women with LVH. The following criteria had greatest sensitivity at 95% specificity: in men - SV4 > 1,1 mV (34%) and RaVL+SV3 > 2,3 mV (32%); in women - RaVL > 0,8 mV (56%) and RI+SIII > 1,5 mV (56%). Informative power of electrocardiographical diagnosis of LVH can be augmented by the use of different voltage criteria in groups of men and women. In men most informative are chest leads (SV1 - V3, RaVL) while in women - limb leads (RI, RaVL, and SIII). The use of combination parameters RaVL+SV3 > 2,3 mV (in men) and RI+SIII > 1,5 mV (in women) allows to augment sensitivity with unchanged specificity. In patients with excessive body mass voltage the Sokolow-Lyons criterion is not informative. Most significant component of the Cornell voltage criterion in groups of men with excessive body mass is amplitude of SV3, in groups of women - amplitude of RaVL.