Vol 81, No 9 (2009)


Progress in fundamental research: perspectives of cardiology

Chazov E.I., Chazov E.I.


Recent research performed in the Cardiology Research Center (CRC) and on-going studies reviewed in the article confirm the hypothesis suggested by CRC investigators about the role of a damaging action of some reactions in the body. The damage to the cell and subcell structures is done by such substances as malonic dialdehyde, methylglyoxal, active oxygen forms (nitric oxide and others). This damage can be used in diagnosis and treatment of cardiovascular diseases. A group of peptides, neuropeptide FF and its receptors in particular, are studied for regulation of the vascular tonicity and perspectives of practical application. As a result of the study of genes associated with cardiovascular diseases mixoma markers were found providing a 100% accurate diagnosis.
Terapevticheskii arkhiv. 2009;81(9):5-8
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Risk of cardiovascular complications in patients with frequent hypertensive crises

Kolos I.P., Chazova I.E., Tereshchenko S.N., Nakonechnikov S.N., Kolos I.P., Chazova I.E., Tereschenko S.N., Nakonechnikov S.N.


Aim. To investigate a relative risk of cardiovascular complications in uncomplicated hypertensive crises (UHC) in hypertensive patients. Material and methods. A questionnaire retrospective case-control study covered one-third of patients registered in the data base of a hospital or outpatient clinic. The patients were matched by basic characteristics. By frequency of UHC the patients were divided into two groups. Group 1 (n = 305) comprised patients with frequent (weekly or more often) UHC, group 2 (n = 558) consisted of patients with rare UHC (monthly or less frequent). Results. Patients of group 1 had a longer history of arterial hypertension (13 ± 9 years vs 9 ± 7.8 years, p < 0.05). The target blood pressure was achieved in group 1 in 42% vs 56% in group 2; p < 0.05). Group 1 patients had a higher risk of non-fatal stroke/transient ischemic attack (TIA) - 18 and 10% (OR 1.94, 95% CI 1.28-2.93; p < 0.05), chronic cardiac failure (44 vs 30%; OR 1.64; 95% CI 1.22-2.21; p < 0.05), left ventricular hypertrophy (72 and 56%; OR 2.11; 95% CI 1.52-2.93; p < 0.05) and myocardial ischemia (56 and 38%; OR 2.05; 95%CI 1.53-2.74; p < 0.05). UHC frequency had no significant influence on the risk of non-fatal myocardial infarction (19 vs 15%; OR 1.34; 95% CI 0.92-1.94; p > 0.05). Conclusion. Frequent UHC raise the risk of non-fatal acute disorder of cerebral circulation, chronic cardiac failure, ischemia and left ventricular hypertrophy. Frequency of UHC is not related to the risk of myocardial infarction.
Terapevticheskii arkhiv. 2009;81(9):9-12
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Structural-functional properties of the vascular wall in hypertensive patients with coronary heart disease: effects of felodipin and perindopril

Musikhina N.A., Yuferova O.V., Gapon L.I., Makhneva E.A., Belikova E.A., Petelina T.I., Todosiychuk V.V., Musikhina N.A., Yuferova O.V., Gapon L.I., Makhneva E.A., Belikova E.A., Petelina T.I., Todosiychuk V.V.


Aim. To study endothelial function and vascular elasticity in hypertensive patients with coronary heart disease (CHD) and approaches to correction of the impairments with felodipin and perindopril. Material and methods. The trial included 34 hypertensive patients with CHD and 17 controls free of cardiovascular diseases. The above cardiovascular patients were randomized into two groups: 15 patients of group 1 received felodipin, 19 patients of group 2 were given perindopril. If the target blood pressure was not achieved after 4 weeks of treatment, 12.5 mg hydrochlorotiazide was added. 24-h monitoring of blood pressure, reactive hyperemia and nitroglycerin tests were made initially and after 8-week treatment. Also, calculations were made of pulse wave velocity (PWV) on the carotid-femoral and carotid-radial segments (Ve and Vm), of elastic modulus for arteries of the elastic and muscular types (Ee and Em). Results. Baseline endothelium-dependent and non-endothelium-dependent vasodilations (EDVD and NEDVD) in cardiovascular patients were lower than in the controls while Ve and Ee were higher. Systolic blood pressure (SBP), pulse blood pressure (PBP), stress SBP and EDVD correlated. The treatment led to reduction of mean circadian, diurnal and nocturnal SBP, diastolic blood pressure (DBP), PBP, Ve and Ee, to elevation of EDVD. Conclusion. EDVD in hypertensive patients with CHD is related with SBP and PBP. Felopidin had both an antihypertensive and vasoprotective effects due to improved endothelial function and better elasticity of the major arteries comparable to effects of perindopril.
Terapevticheskii arkhiv. 2009;81(9):13-16
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Blood lipid spectrum in hypertensive patients and normotensive subjects living in the Khanty-Mansiysk region

Mikhaylova I.M., Gapon L.I., Belousov V.V., Startseva O.N., Alekseeva S.V., Mikhailova I.M., Gapon L.I., Belousov V.V., Startseva O.N., Alexeeva S.V.


Aim. To evaluate basic parameters of lipid metabolism in patients with arterial hypertension (AH) stage I and II and normotensive subjects living in the far North of the Russian Federation (Khanty-Mansiysk Autonomic Region, Nyagan). Material and methods. Lipid spectrum was studied in 70 males and females with AH stage I and II, 280 normotensive males and females matched for sex, age, time of residence in the North. Results. Sex-related differences by concentrations of blood lipids become less pronounced with progression of AH while a concentration of atherogenic lipid fractions in AH patients rises. High prevalence of dyslipidemia, primarily hypercholesterolemia, in hypertensive and normotensive subjects is a prognostic factor of coronary atherosclerosis. Paired correlations indirectly confirm the effect of climatic factors on blood lipids. Conclusion. It is necessary to correct lipid spectrum and risk factors in hypertensive and normotensive subjects as a prophylactic measure.
Terapevticheskii arkhiv. 2009;81(9):17-19
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Treatment of patients with arterial hypertension and other stroke risk factors in clinical practice. The PROGNOS program

Bubnova M.G., Oganov R.G., Bubnova M.G., Oganov R.G.


Aim. To analyse recent data on the treatment of arterial hypertension (AH) with other risk factors (RF) of cerebral stroke in the Russian Federation, assessment of effects of antihypertensive treatment with a combined drug Hyzaar on the risk of cardiovascular complications (including cerebral stroke), on affection of target organs and metabolic factors of atherosclerosis. Material and methods. A total of 500 outpatients with primary AH and risk factors including the risk of stroke received Hyzaar (losartan 50/100 mg and hydrochlorthiaside 12.5/25 mg) for one year. Results. More frequent RF in hypertensive patients are the following: high blood cholesterol (86.7%), left ventricular hypertrophy (53.2%), familial history of AH (74.2%). A combination of three and two RF occurs in 49.1 and 37% hypertensive patients, respectively. A 6-month treatment with Hyzaar lowered systolic blood pressure by 28.4 mm Hg and diastolic one by 15.4 mm Hg. The target blood pressure was achieved in 83.5%. Real clinical practice showed that administration of a target Hyzaar dose for 6 months leads to a 6.5% regress of left ventricular hypertrophy, an 11% decrease of total cholesterol, a 4% decrease of glucose and a 8.9% decrease of uric acid. Conclusion. A control of AH and correction of RF in hypertensive patients with a high RF of stroke and other cardiovascular complications is real in use of adequate antihypertensive therapy.
Terapevticheskii arkhiv. 2009;81(9):19-23
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Familial hypercholesterolemia in Russia: genetic and phenotypic characteristics

Meshkov A.N., Malyshev P.P., Kukharchuk V.V., Meshkov A.N., Malyshev P.P., Kukharchuk V.V.


Aim. To make qualitative and quantitative analyses of phenotypical characteristics and to study a spectrum and frequency of mutations in LDLR and APOB genes in patients with familial heterozygous hypercholesterolemia (FHHC). Material and methods. Clinical symptoms of FHHC were studied in males and females. Mutations were detected with PCR, analysis of SSCP of all the exones of LDLR gene and a fragment of exone 26 of APOB gene with subsequent sequestration of DNA fragments with anomalous electrophoretic motility, analysis of restriction fragments length polymorphism. Results. LDLR gene mutations were detected in 50%, of APOB gene in 2.6% patients with FHHC, 70% of LDLR gene mutations have never been discovered before. Three known mutations were detected in the APOB gene: R3500Q (1.9% cases), H3543Y (0.55%), R3531C (0.15%). Incidence of coronary heart disease in untreated FHHC patients is 61.5%, of myocardial infarction - 31%. Life span of both males and females with FHHC was subnormal, especially of men (median: 53 years in 95% CI, 49.2 - 56.8 years and 62 years in 95% CI 59.2-64.8 years, respectively). Incidence rate of basic clinical symptoms increased with age and significantly correlated with LDLP cholesterol. Conclusion. Frequency and severity of clinical symptoms and complications in FHHC and in Russian population agree with those of the European countries. The same occurs with frequency and mutations of the APOB gene, while mutations of the LDLR gene in 70% cases are unique for Russian population and are not described in other countries. This makes impossible to use foreign test kits for FHHC diagnosis in Russia.
Terapevticheskii arkhiv. 2009;81(9):23-28
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Treatment of patients with hypertriglyceridemia

Rozhkova T.A., Kukharchuk V.V., Titov V.N., Yarovaya E.B., Kotova L.A., Malyshev P.P., Amelyushkina V.A., Rozhkova T.A., Kukharchuk V.V., Titov V.N., Yarovaya E.B., Kotova L.A., Malyshev P.P., Amelyushkina V.A.


Aim. To assess a hypolipidemic effect and tolerance of phenofibrate (lipantil 200M) in different variants of treatment in patients with combined hyperlipidemia having moderate and high levels of triglycerides (TG). Material and methods. A total of 26 patients (16 males, 10 females; age 32-67, mean age 55.1 years) received lipantil 200M (phenofibrate) in a dose 200 mg for 12 weeks either as monotherapy or in combination with statins (or fibrate) or plasmapheresis. Clinical, biochemical and blood lipid parameters were studied at baseline and after 12-week treatment. Baseline mean value and standard deviation of a blood cholesterol level was 8.3 (15.4) mmol/l, TG - 7.2 (70.5) mmol/l). Results. A mean cholesterol level decreased by 26.1%, TG - by 64.4%. Correlation with initial values was found. Systolic and diastolic blood pressure diminished significantly. No significant changes were found in the levels of AST, ALT, GGT, CPK, alkaline phosphotase, total bilirubin, creatinine. Before the treatment blood glucose was elevated in 14 patients, after 12-week therapy it remained elevated in 10 patients. Conclusion. Lipantil 200 M (phenofibrate) had a good hypolipidemic effect in patients with combined hyperlipidemia in different baseline levels of cholesterol and TG elevation and in different variants of treatment. Significant side effects were not registered.
Terapevticheskii arkhiv. 2009;81(9):29-33
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The influence of coronary stenting with rapamycin-eluting stents on the number of circulating CD4+CD25high+regulatory T-cells

Aref'eva T.I., Provatorov S.I., Potekhina A.V., Sokolov V.O., Kukhtina N.B., Samko A.N., Krasnikova T.L., Arefieva T.I., Provatorov S.I., Potekhina A.V., Sokolov V.O., Kukhtina N.B., Samko A.N., Krasnikova T.L.


Aim. To investigate the effects of coronary stenting with rapamycin-eluting stents on parameters of cell immunity. Methods. 26 patients (group 1) with stable coronary heart disease and angiographically proved coronary stenosis underwent stenting with rapamycin-eluting stents. The control group (group 2) consisted of 6 patients: 4 patients underwent diagnostic coronaroangiography, 1 patient got a bare metal stent and in 1 patient angioplasty was unsuccessful. Blood samples were obtained before and 1 month after the intervention. The quantity of activated (CD4+CD25low+) and regulatory (CD4+CD25high+) T cells was measured by direct immunofluorescence and flow cytometry. Plasma concentration of IL-10 was determined by ELISA. Results. In group 1 the percentages of CD4+CD25high+ regulatory T-cells increased significantly one month after stenting, while in group 2 no difference in regulatory T-cell levels before and after the intervention was observed. No changes in total number of leukocytes, relative levels of lymphocytes, CD4+ T-cells, activated CD4+CD25+low T-cells and IL-10 plasma concentration before and after the procedure were detected in both groups. Conclusion. Rapamycin-eluting stent implantation is associated with a significant increase of circulating CD4+CD25high+ regulatory T-cell level.
Terapevticheskii arkhiv. 2009;81(9):33-37
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Efficacy of transesophageal pacing for correction of newly diagnosed atrial fibrillation of type I in patients with coronary heart disease

Olesin A.I., Smolin Z.Y., Konovalova O.A., Shabrov A.V., Olesin A.I., Smolin Z.Y., Konovalova O.A., Shabrov A.V.


Aim. To analyse the results of using transesophageal pacing (TEP) for correction of atrial fibrillation of type I (AF). Material and methods. The study included 1283 patients with coronary heart disease (CHD) and newly diagnosed AF. All the patients were examined with transthoracic echocardiography, received basic antianginal treatment. AF was corrected with TEP. Results. Sinus rhythm was reestablished in 83.48% patients, in 67.33% TEP was made without previous antiarrhythmic therapy, in the rest patients with this pretreatment. The best result was observed in pre-pacing administration of amiodaron or its combination with hinidin-durules. Only 2.88% patients retained AF after TEP. Conclusion. TEP is an effective method of type I AF treatment.
Terapevticheskii arkhiv. 2009;81(9):37-41
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Radiofrequency ablation of the ectopic activity zone in a patient with long-standing chronic right-side inferioatrial tachycardia

Morozov I.A., Furman N.V., Oleynik G.S., Merkushova I.M., Morozov I.A., Furman N.V., Oleinik G.S., Merkushova I.M.


Aim. To illustrate feasibility of successful correction of chronic long-standing right-side inferioatrial tachycardia (RIT). Material and methods. A case report of examination and effective treatment of long-standing RIT. The diagnosis was made after ECG, Holter ECG monitoring, Doppler echocardiography, endocardial electrophysiological examination, analysis of the disease history. Results. Conservative treatment proved low effective. Imaging diagnostic methods and x-ray surgery (radiofrequency ablation of the ectopic activity zone) were leading techniques. Conclusion. If a patient is operated (radiofrequency ablation) early, he will not have to take long-term treatment with antiarrhythmic drugs and will be able to live without limitations deteriorating his quality of life.
Terapevticheskii arkhiv. 2009;81(9):41-45
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Electrostimulation of the skeletal muscles in rehabilitation of patients with chronic cor pulmonale: effects on arrhythmogenesis and vegetative status

Sumin A.N., Snitskaya N.A., Arkhipov O.G., Sumin A.N., Snitskaya N.A., Arkhipov O.G.


Aim. To investigate effects of electrostimulation of the skeletal muscles (EMS) on vegetative status and arrhythmogenesis in patients with chronic cor pulmonale (CCP). Material and methods. 101 CCP patients (age 59 ± 1.2 years) were examined with loading tests, 24-h ECG and blood pressure monitoring to assess disturbances and variability of cardiac rhythm, blood pressure. The study group patients (n = 54) have undergone EMS of large skeletal muscles in addition to standard rehabilitation. The control group (n = 47) received standard treatment. Results. A course of EMS raised strength of the muscles of the upper and lower limbs and exercise tolerance of the lower limb muscles in the study group, bicycle exercise and 6-min walk tolerance, reduced the number of atrial and ventricular extrasystoles. The test group lowered the low-frequency component at night (p = 0.021) and in maximal spectrum power reflecting enhancement of parasympathetic activity in this time. Conclusion. EMS had no arrhythmogenic action, but had a positive effect on vegetative status of CCP patients.
Terapevticheskii arkhiv. 2009;81(9):45-51
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Influence of chronic cardiac failure severity on the course of comorbid type 2 diabetes mellitus

Narusov O.Y., Lapina Y.V., Mareev V.Y., Bolotina M.G., Shestakova M.V., Masenko V.P., Baklanova N.A., Belenkov Y.N., Narusov O.Y., Lapina Y.V., Mareev V.Y., Bolotina M.G., Shestakova M.V., Masenko V.P., Baklanova N.A., Belenkov Y.V.


Aim. To assess relations between severity of chronic cardiac failure (CCF) and a course of comorbid type 2 diabetes mellitus (DM). Material and methods. Time course changes of cerebral natriuretic peptide (CNUP) were used as a criterion of CCF severity in 81 patients with mild and moderate CCF (NYHA functional class II-III), left ventricular ejection fraction (LVEF) < 45% and type 2 DM. Of them, two groups of 19 patients each were compiled - with the highest and lowest CNUP levels. Also, patients with a rising CNUP level and CCF FC (n = 5) and those with decreasing CNUP and FC improvement (n = 33) were analysed. The following parameters were studied at baseline and 6 months later: clinicofunctional status, glomerular filtration rate (GFR), neurohormonal profile (CNUP), noradrenalin and angiotensin II, the level of HbA1c, baseline and postprandial plasma glucose, serum insulin and C-peptide. Results. Insignificant changes in glycemia in low C-peptide were found in groups with mild CCF. In patients with high CNUP and CCF FC there was a positive correlation between high CNUP, noradrenalin and fasting glucose. With growing severity of CCF clinicofunctional status of the patients was deteriorating while levels of noradrenalin and angiotensin II tended to rise. Conclusion. Moderate decompensation of CCF had no effect on the course of associated DM. More severe and long-term decompensation may be accompanied with noticeable changes in glycemia.
Terapevticheskii arkhiv. 2009;81(9):52-57
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Warfarin or enoxaparin: the choice for the patient with venous thrombosis in the first month of treatment

Vorob'eva N.M., Panchenko E.P., Kirienko A.I., Dobrovol'skiy A.B., Titaeva E.V., Ermolina O.V., Balakhonova T.V., Andriyashkin V.V., Leont'ev S.G., Vorobieva N.M., Panchenko E.P., Kirienko A.I., Dobrovolsky A.B., Titaeva E.B., Ermolina O.V., Balakhonova T.V., Andriyashkin V.V., Leotiev S.G.


Aim. To compare efficacy and safety of warfarin and enoxaparin used in the first month of treatment of patients with an episode of deep vein thrombosis (DVT) and/or pulmonary artery thromboembolism (PATE). Material and methods. Sixty patients (34 males, 26 females, age 18-76 years) after the DVT/PATE episode were divided into two groups. Patients of group 1 received standard therapy (non-fractionated heparin -NFH followed by warfarin), patients of group 2 instead of NFH received enoxaparin (1 mg/ kg each 12 hours for at least 30 days). Ultrasonic scanning of the limbs and determination of D-dimer were conducted before and after 1 month of treatment. End points were the following: recurrent DVT/ PATE, death due to PATE, hemorrhagic complications. Results. Improvement of deep vein patency after 1 month of anticoagulant treatment was observed in both the groups. Enoxaparin proved more effective in relation to reduction of the number of venous occlusions (9 and 50, respectively, after 1 month treatment (p < 0.001). Hemorrhagic complications were seen in both the groups with equal frequency (13.4%). These hemorrhagic episodes did not require discontinuation of the drugs. Baseline D-dimer was significantly higher in the enoxaparin group - 1.51 (0.73-2.44) mcg/ml vs 0.93 (0.42-1.33) mcg/ml (p = 0.019). After treatment D-dimer level and number of patients with high D-dimer diminished in both groups. Conclusion. Enoxaparin proved more effective than warfarin in the first treatment month. In the same safety and prophylactic effect enoxaparin is more effective in recanalization of occusions in the deep veins.
Terapevticheskii arkhiv. 2009;81(9):57-61
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Disputable issues of anticoagulant therapy: exacerbation of coronary heart disease and transcutaneous interventions in patients with cardiac fibrillation treated with vitamin K antagonists

Yavelov I.S., Yavelov I.S.


The article concerns the policy of anti-platelet treatment in patients with coronary heart disease exposed to transcutaneous coronary interventions. Patients with cardiac fibrillations are specially considered. International trials are reviewed.
Terapevticheskii arkhiv. 2009;81(9):62-68
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Apelin - a new protein-regulator in the cardiovascular system

Tereshchenko S.N., Masenko V.P., Cherkavskaya O.V., Shashkova N.V., Tereschenko S.N., Masenko V.P., Cherkavskaya O.V., Shashkova N.V.


Apelin is an endogenic ligand of apelin (APJ) receptors widely expressed in human tissues. This protein is a peripheral vasodilator having a powerful positive inotropic action on myocardial contractility. This review describes mechanisms of interaction and apelin role in health and pathology.
Terapevticheskii arkhiv. 2009;81(9):68-72
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Natriuretic peptides in diagnosis of pulmonary hypertension

Kuznetsova A.V., Fomin V.V., Popova I.A., Popova E.N., Kuznetsova A.V., Fomin V.V., Popova I.A., Popova E.N.


Pathogenetic and diagnostic role of natriuretic peptides in different variants of pulmonary hypertension is discussed. Structure, mechanism of action and physiological effects of some natriuretic peptides and their role in diagnosis and monitoring of the course of pulmonary hypertension are described.
Terapevticheskii arkhiv. 2009;81(9):72-78
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Life devoted to cardiology. The 110 anniversary of professor a. l. Myasnikov's birth

Knopov M.M., Taranukha V.K., Knopov M.M., Taranukha V.K.


Alexander Leonidovich Myasnikov was a world-famous Russian therapist, cardiologist, clinician, founder of a large scientific school. He was a chief therapist of the USSR Navy during World War II, colonel of military medical service, talented public health official. Scientific and practical work of A.L. Myasnikov created grounds for further development of cardiology in Russia.
Terapevticheskii arkhiv. 2009;81(9):78-81
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