Vol 82, No 9 (2010)

Articles
The topical issues of the terminology, classification, and statistics of acute forms of ischemic heart disease
Boytsov S.A., Yakushin S.S., Nikulina N.N., Boitsov S.A., Yakushin S.S., Nikulina N.N.
Abstract
The paper discusses the problems in the formation of statistical information on acute forms of coronary heart disease (IHD) in Russia and possible ways of their solution. Among other problems, there is the detection and notification of cases of sudden coronary death as an independent nosological entity that belongs to the acute forms of IHD. The terminology and classification of the acute forms of IHD, which affect the formation of statistical data, are considered. The consequences of underestimates of the role of a postmortem study, as the most important postmortem diagnostic method, in modern practical health care are discussed. The paper is largely debatable and intended for a wide circle of readers in order to attract their attention to the detection and notification of the acute forms of IHD in clinical practice, especially in cases of death from acute IHD in the prehospital stage.
Terapevticheskii arkhiv. 2010;82(9):5-13
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Risk factors for myocardial reinfarction in young and middle-aged males
Yakovlev V.V., Golofeevskiy V.Y., Sotnikov A.V., Yakovlev V.V., Golofeyevsky V.Y., Sotnikov A.V.
Abstract
Aim: to assess a set of risk factors (RF) for coronary heart disease in myocardial reinfarction patients aged less than 60 years. Subjects and methods. A multitude of probable RFs that might predispose to the development of MI or provoke its occurrence were studied in 526 male patients aged less than 60 years, who had primary (n = 281) and repeated (n = 245) myocardial infarction (MI) from the results of hospital treatment. Results. Lipid metabolic disturbances, smoking, arterial hypertension (AH), foci of chronic infection, and overweight were ascertained to be the most common RFs in patients less than 60 years. There was a history of dyslipidemia (100%), AH, heart failure, and cardiac arrhythmias in the complicated course of repeated MI. When these RFs are combined, the likelihood of disease complications and death increases. Conclusion. According to the results of estimation of the spread of RFs for myocardial reinfarction, it is proposed to enhance the monitoring of lipidogram readings, blood pressure value, magnitude of the symptoms of heart failure, and serum glucose levels, and infection foci sanitization and to improve patients' awareness about a risk from smoking and lower physical activity.
Terapevticheskii arkhiv. 2010;82(9):13-17
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Association of the serum level of apolipoprotein E with coronary artery disease and carotid artery atherosclerosis in Kyrgyz men with dyslipidemia
Lunegova O.S., Pavlenko M.A., Kerimkulova A.S., Noruzbaeva A.M., Samanchina B.T., Zalesskaya Y.V., Abilova S.S., Mirrakhimov A.E., Moldokeeva C.B., Mirrakhimov E.M., Lunegova O.S., Pavlenko M.A., Kerimkulova A.S., Noruzbayeva A.M., Samanchina B.T., Zalesskaya Y.V., Abilova S.S., Mirrakhimov A.E., Moldokeyeva C.B., Mirrakhimov E.M.
Abstract
Aim: to study an association of the serum level of apolipoprotein E (apo-E) with risk factors for coronary heart disease (CHD), blood lipids and that with CHD and carotid artery (CA) atherosclerotic lesion in Kyrgyz men with dyslipidemia. Subjects and methods. One hundred and three Kyrgyz men, including 48 with CHD and 55 without this disease, were examined. A clinical examination was performed and blood lipid composition and serum glucose and apo-E levels were determined. The diagnosis of CHD was established in accordance with the conventional criteria. Whether atherosclerosis was present was determined by ultrasound duplex scanning. Results. Low serum apo-E concentrations were associated with the presence of obesity, the higher blood levels of glucose and triglycerides. There was no correlation with other lipid metabolic parameters and the presence of CHD. A nonlinear relationship was noted between serum apo-E levels and CA atherosclerotic lesion, which was more frequently observed in patients with the apo-E level in the lower and upper quartiles. Conclusion. Low serum apo-E content is a poor factor and associated with obesity, hypertriglyceridemia, elevated serum glucose levels, and the development of CA atherosclerosis.
Terapevticheskii arkhiv. 2010;82(9):18-23
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Trends in subclinical atherosclerosis in patients with arterial hypertension associated with diabetes mellitus: a relationship between the blood pressure achieved with antihypertensive therapy and the body weight
Karpov O.A., Koshel'skaya R.S., Khoroshilova I.V., Karpov R.S., Koshelskaya O.A., Khoroshilova I.V.
Abstract
Aim. To analyze carotid artery morphofunctional changes in patients with arterial hypertension (AH) associated with type 2 diabetes mellitus (CD2) on regular antihypertensive and sugar-lowering therapy in relation with the changes in the diurnal blood pressure (BP) profile, the quality of metabolic control, and baseline clinical and laboratory data. Materials and methods. Seven-six patients with CD2-associated AH who had received regular antihypertensive and sugar-lowering treatment without statins for 12 months were examined. The intima-media thickness (IMT) in the common carotid artery (CCA) was estimated by ultrasound scanning; the compliance and stiffness indices were calculated. The values of 24-hour BP monitoring, glycemic control, and blood lipids were studied. Results. Among the patients with increased CCA IMT (Group 1), women were three times more than among those without it (Group 2). Subclinical atherosclerosis progression as an annual average CCA IMT increment of 0.08 mm was detected in the absence of a less than 7-mm Hg decrease in 24-hour mean systolic BP and/or a 24-hour mean BP of less than 134/80 mm Hg or if, during adequate BP control, HbA1 exceeded 9%. Group 1 women showed increased body mass index and a trend for worse vascular elastic properties. Group 2 displayed not only a CCA IMT reduction (from 0.94±0.03 to 0.83±0.03 mm; p < 0.01), but also a CCA decrease that seemed to show reduced vessel wall thickness. There were no changes in the CCA lumen in Group 1. Comparable control of glycemia and blood lipid-transport system indices was achieved in both groups. The magnitude for 24-hour BP reduction in which there was no subclinical atherosclerosis under stable glycemic control was determined. Conclusion. The results of the study suggest a correlation between a inadequate BP reduction, worse elastic properties of large-sized arteries, and higher body mass index in patients (mainly women) with CD2 and underline the importance of correcting body weight and achieving goal BP in this group of patients.
Terapevticheskii arkhiv. 2010;82(9):23-30
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Influence of genetic factors on the development of target organ lesions in relation to age at diagnosis of arterial hypertension
Kuznetsova T.Y., Gavrilov D.V., Samokhodskaya L.M., Postnov A.Y., Boytsov S.A., Kuznetsova T.Y., Gavrilov D.V., Samokhodskaya L.M., Postnov A.Y., Boitsov S.A.
Abstract
Aim. To analyze the impact of polymorphism of a group of genes encoding for endothelial function on the development of target organ lesions in arterial hypertension (AH) in relation to age. Subjects and methods. Six hundred and seventy-two AH patients (mean age 50.6 years; men 67%) were examined. Microalbuminuria (MAU) was estimated. Electrocardiography, echocardiography, and carotid ultrasonography were performed. A control group comprised 184 subjects. Single-nucleotide substitutions genotyping of the Glu298Asp endothelial NO synthase (eNOS), p22phox of NADPH oxidase subunit C242T, and angiotensin II type 1 receptor (ATR1) A1166C gene polymorphisms was conducted by a polymerase chain reaction (PCR) via restriction fragment length polymorphism analysis, and M235T substitution genotyping of the G-6A polymorphism of the angiotensinogen gene was performed by a real-time allele-specific PCR. The impact of the polymorphisms on the development of MAU, left ventricular hypertrophy (LVH), carotid lesion was analyzed in the groups: AH was diagnosed in subjects aged less than 35 years (n = 128) or older. The ultrasound signs of carotid lesion, LVH, and MAU were revealed in 65, 39, and 10.5% of the patients with AH, respectively. Results. The subgroups showed differences in the distribution of polymorphisms of the study genes in relation to age at AH detection. Conclusion. In patients with AH diagnosed at less than 35 years of age, pathological changes in the carotid are associated with a G allele of the Glu298Asp eNOS polymorphism (odds ratio (OR) = 2.3; p = 0.016) and with an T allele of the p22phox of NADPH oxidase subunit C242T polymorphism (OR 1.7; p = 0.049). In this age subgroup, LVH was associated with an A allele of the Glu298Asp eNOS polymorphism (OR = 1.9; p = 0.037), MAU was with an A allele of the Glu298Asp eNOS polymorphism (OR = 3.6; p = 0.02) and a C allele of the ATR1 A1166C gene polymorphism (OR = 2.6; p = 0.034).
Terapevticheskii arkhiv. 2010;82(9):30-37
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Psychological status of hypertensive patients consuming higher amounts of salt
Volkov V.S., Poselyugina O.B., Volkov V.S., Poselyugina O.B.
Abstract
Aim. To estimate a possible relationship of neurotic personality disorders to increased dietary salt intake. Subjects and methods. Two hundred and thirty patients with essential hypertension were examined. Salt taste sensitivity threshold and daily urinary sodium excretion were determined; the psychological status of the patients was rated by the Mini-Mental State Examination questionnaire; their attitude towards to disease was assessed by the Bekhterev Institute personality questionnaire, the severity of depression was evaluated by the Beck depression inventory. Results. The hypertensive patients consuming excessive amounts of salt have been ascertained to complain of cardiovascular and neurotic disorders more frequently; their disease is accompanied by frequently evolving hypertensive crises. Anxiety and tension are prevalent in their psychological status. Almost 50% of the patients have depression. A harmonious disease attitude is seen in only a third of cases whereas the neurasthenic and anxious types play a dominant role. Conclusion. The patients taking higher salt amounts are observed to seek medical advice on the one hand and to show a predominance of neurasthenic and anxious disease attitudes with a tendency towards incompliance on the other. The findings show it necessary to notify hypertensive patients during their examination and management.
Terapevticheskii arkhiv. 2010;82(9):38-40
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Determinants of the respiratory system in hypertensive disease
Smakotina S.A., Bazdyrev E.D., Rutkovskaya N.V., Barbarash O.L., Smakotina S.A., Bazdyrev E.D., Rutkovskaya N.V., Barbarash O.L.
Abstract
Aim. To analyze the respiratory system in hypertensive disease (HD). Subjects and methods. Forty-six hypertensive patients (mean age 43.2±4.0 years) were examined. Office blood pressure (BP) was measured. Electrocardiography, echocardiography, color Doppler ultrasonography of the brachial artery, 24-hour BP monitoring, spirography, body plethysmography, and study of the diffusion lung capacity for carbon monoxide were performed. The serum levels of interleukins 6, 8, and 10, tumor necrosis factor (TNF), and C-reactive protein (CRP) were measured. Results. Inflammatory processes have been ascertained to contribute to the development and progression of HD. The increase in HD degree and stage is attended by a significant elevation of the plasma concentrations of proinflammatory cytokines, TNF, and CRP, which is due to the contribution of inflammatory processes in the vessel wall to the development of endothelial dysfunction, vascular remodeling, and organ lesions, including diminished lung function in HD. Conclusion. Arterial hypertension, inflammatory indicators, endothelial function, and the degree of lesions to organs, including those in the respiratory system, are related. The basis for this relation is the common neurohumoral mechanisms of progression of nonspecific inflammation, endothelial dysfunction, and target organ lesions.
Terapevticheskii arkhiv. 2010;82(9):41-44
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The specific features of left cardiac cavity remodeling in patients with chronic obstructive pulmonary disease and chronic cor pulmonale
Strutynskiy A.V., Bakaev R.G., Glazunov A.B., Banzelyuk E.N., Moshkova N.K., Reysner A.A., Shavurdina S.V., Vinogradova D.V., Strutynsky A.V., Bakayev R.G., Glazunov A.B., Banzelyuk E.N., Moshkova N.K., Reisner A.A., Shavurdina S.V., Vinogradova D.V.
Abstract
Aim. To study left ventricular structural and functional changes in patients with chronic obstructive pulmonary disease (COPD) and chronic cor pulmonale (CCP) at different stages of a cardiac remodeling process. Subjects and methods. Echocardiography was used to examine 98 patients with COPD complicated by the development of CCP in a number of cases. The significant signs of CCP were absent in 19 patients; the signs of compensated and decompensated CCP in 41 and 38 patients, respectively. Results. In the patients with COPD, the formation of CCP during remodeling of the heart involves its left cavities whose changes lie in the occurrence of left ventricular (LV) diastolic dysfunction, mainly of the restrictive type, in ventricular spherization, higher myocardial systolic tension, in tendencies towards increases in LV mass index, left atrial sizes, and in the indices reflecting LV systolic dysfunction. The LV diastolic dysfunction correlates with the degree of right ventricular hypertrophy and dilatation and the presence of complete right bundle-branch block. Conclusion. Progressive worsening of diagnostic filling of the left ventricle and its systolic function is an additional factor aggravating hemodynamic disorders in patients with COPD and CCP, which should be kept in mind on choosing an appropriate therapy for patients with CCP.
Terapevticheskii arkhiv. 2010;82(9):45-49
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Thromboxane-prostacyclin balance and platelet aggregability in patients with minor cardiac abnormalities
Yagoda A.V., Gladkikh N.N., Yagoda A.V., Gladkikh N.N.
Abstract
Aim. To reveal changes in the thromboxane-prostacyclin balance and platelet aggregability in patients with various variants of minor cardiac abnormalities. Subjects and methods: Six-five patients (mean age 23.0±0.7 years) with minor cardiac abnormalities and 10 apparently healthy individuals were examined. Platelet aggregation induced by adrenaline, adenosine diphosphate, collagen) and the plasma levels of thromboxane B2 (TxB2) and 6-keto-prostaglandin F1α (6-keto-PGF1α) were determined. Results. Patients with abnormally located chordae (ALC) were found to have no deviations in the thromboxane-prostacyclin balance and platelet aggregability. Only decreased collagen aggregation was recorded in the groups of first-degree mitral prolapse (MP) and first-degree MP + ALC; in second-degree MP and second-degree MP + ALC, there was a reduction in platelet aggregation on all inductors and an increase in TxB2. Patients with myxomatous degeneration of the mitral valve exhibited reduced collagen-induced platelet aggregation and lower plasma 6-keto-PGF1α levels. Conclusion. The most pronounced changes in the thromboxane-prostacyclin balance and platelet aggregability were found in patients with MP and second-degree regurgitation, three intracardiac microabnomalities, and myxomatous degeneration of the mitral valve.
Terapevticheskii arkhiv. 2010;82(9):49-53
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Renin inhibitors are a new direction in the treatment of arterial hypertension
Vasyuk Y.A., Sadulaeva I.A., Yushchuk E.N., Trofimenko O.S., Chirkov M.V., Fedoseeva V.S., Kulikov K.G., Vasyuk Y.A., Sadulayeva I.A., Yushchuk E.N., Trofimenko O.S., Chirkov M.V., Fedoseyeva V.S., Kulikov K.G.
Abstract
The paper covers current problems in the treatment of arterial hypertension. Renin is an important and promising therapeutic target. The direct renin inhibitor aliskiren (Rasilez) is a promising current effective antihypertensive agent that has cardio- and nephroprotective effects. The paper considers a number of clinical studies that have proven the antihypertensive effect of aliskiren and revealed its benefits versus other drugs recommended for blood pressure lowering. It is assumed that this agent may be used in combinations with angiotensin-converting enzyme inhibitors, thiazide or thiazide-like diuretics, and calcium antagonists. Moreover, aliskiren neutralizes the effect of feedback in the compensatory increase in the activity of plasma renin.
Terapevticheskii arkhiv. 2010;82(9):53-59
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Aortic aneurysm: diagnosis and treatment
Abugov S.A., Ponomarenko V.B., Abugov S.A., Ponomarenko V.B.
Abstract
The paper deals with the topical issues of diagnosis of aortic aneurysms and with the current possibilities of treating this pathology. It presents epidemiological data, assessment of the risk of aortic rupture, a patient management regimen according to screening results, and information on the new miniinvasive aortic aneurysm treatment - endovascular replacement using self-expandable stent-grafts.
Terapevticheskii arkhiv. 2010;82(9):59-63
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The clinical value of determination of natriuretic peptides in acute coronary syndrome
Shreyder E.V., Shakhnovich R.M., Ruda M.Y., Shreider E.V., Shakhnovich R.M., Ruda M.Y.
Abstract
The production and release of natriuretic peptides (NPs) into the bloodstream are stimulated by increased left ventricular wall tension during volume overload. In ischemia, NPs are secreted by myocardial cells in response to stress or overload, particularly in the development of myocardial systolic dysfunction. The review details the time course of changes in amino acid N-terminal proBNP in acute coronary syndrome (ACS) with and without ST-segment elevation and discusses the role of the index in defining the tactics of treatment and prognosis in patients with ACS.
Terapevticheskii arkhiv. 2010;82(9):63-68
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The diagnostic value and clinical significance of a method for estimating the arterial stiffness BY cardio-ankle VASCULAR index
Oleynikov V.E., Matrosova I.B., Sergatskaya N.V., Tomashevskaya Y.A., Oleinikov V.E., Matrosova I.B., Sergatskaya N.V., Tomashevskaya Y.A.
Abstract
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.
Terapevticheskii arkhiv. 2010;82(9):68-72
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Broken heart syndrome or takotsubo cardiomyopathy
Pevzner D.V., Akasheva D., Zhukova N.S., Stukalova O.V., Shitov V.N., Ruda M.Y., Pevzner D.V., Akasheva D.U., Zhukova N.S., Stukalova O.V., Shitov V.N., Ruda M.Y.
Abstract
Takotsubo cardiomyopathy is an acute cardiac syndrome that mimics ST segment elevation myocardial infarction. It is characterized by transient local contractility disturbances as akinesis of the apical and middle segments of the left ventricle concurrent with hyperkinesis of its basal portions in the absence of significant coronary artery changes. A description of 2 clinical cases and a review of literature on this rare myocardial disease are given.
Terapevticheskii arkhiv. 2010;82(9):72-77
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Interaction of the neuroendocrine and immune mechanisms of progression of myocardial damage
Krasnosel'skiy M.Y., Vorob'ev P.A., Tsurko V.V., Krasnoselsky M.Y., Vorobyev P.A., Tsurko V.V.
Abstract
The review summarizes data on the interference of the neuroendocrine and immune mechanisms of myocardial remodeling. It shows a role of the effectors of the renin-angiotensin-aldosterone (aldosterone and angiotensin II) and sympathoadrenal (noradrenaline) systems in the activation of macrophages, the production of proinflammatory cytokines and inflammatory cell chemoattractants. It is noted that proinflammatory cytokines in turn promote the activation of these neuroendocrine systems. Natriuretic peptides exert an anti-inflammatory effect, but their production can be activated by proinflammatory cytokines.
Terapevticheskii arkhiv. 2010;82(9):77-80
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