Vol 85, No 4 (2013)

AIM: To study trends in myocardial infarction (MI) morbidity and mortality in the Russian Federation in 2000 to 2011. Materials and methods. The 2000-2011 official statistical data of the Federal State Statistics Service and the Ministry of Health of Russia were used to analyze MI morbidity and mortality rates among urban and rural populations. Sex- and age-specific mortality rates were estimated. The number of IM morbidity cases and deaths were analyzed in absolute values and per 100,000 population (rates). The causes of MI morbidity and mortality were coded according to the International Classification of Diseases, Tenth Revision/RESULTS: According to the official statistical data, there is a small proportion of MI mortality in the structure of coronary heart disease mortality with a relatively stable incidence of MI and a low variability in its cases. MI death rates are much higher in males, particularly in able-bodied ones. Recently there have been an increasing number of deaths from MI among females in old age groups. Mortality from recurrent MI is recorded to show a 33.7% increase from 2000 to 2011. In-hospital mortality remains high (15-16%), with its high rates (40.4%) within 24 hours of admission to hospital/CONCLUSION: To more completely and objectively estimate MI morbidity and mortality rates and treatment quality in patients with this disease in the Russian Federation, it is expedient to conduct epidemiological surveys and to comparatively analyze the results of monitoring the regional vascular centers, the data of the Federal Acute Coronary Syndrome Registry, and the results of the auditing the vascular centers by the specialists of the Russian Cardiology Research-and-Production Complex.

AIM: To estimate the informative value of multislice spiral computed tomography (MSCT) in the diagnosis of myocardial infarction (MI)/MATERIAL AND METHODS: The study enrolled 171 patients with acute coronary syndrome (ACS), including 121 patients diagnosed with acute ST-segment elevation MI (STEMI), 19 with non-STEMI, and 31 with unstable angina. A comparison group consisted of 52 patients with stable coronary heart disease (CHD) and a control group comprised 17 patients without CHD. Intravenous contrast-enhanced MSCT was performed using a 64-spiral CT scanner. MSCT was carried out in the patients with ACS on days 3-5 of the onset of a pain attack and in the other patients electively. It was redone in 44 patients with acute MI (AMI) 6 months after a primary examination/RESULTS: Left ventricular (LV) perfusion defect was imaged in 94.3% of the patients with AMI and in 10% of those with unstable angina. LV contrast defects were undetectable in the patients from the stable CHD and control groups. The sensitivity, specificity, prognostic value of a positive result, negative prognostic value of a result, and accuracy of MSCT in the diagnosis of MI were 94.3, 97.1, 97.8, 92.5, and 96.7%, respectively. In the patients with STEMI, myocardial perfusion defect was larger and transmural perfusion defect was more common than in those with non-STEMI. Comparison of the values of myocardial perfusion defect size and myocardial density according to the data of primary and repeat MSCT revealed no statistically significant differences: 2.0 (0.50; 5.45) and 1,8 (0.35; 5.00) cm3 (p=0.15); 41.7±10.2 and 46.1±12.2 HU, respectively (p=0.07)/CONCLUSION: Contrast-enhanced MSCT allows visual and quantitative assessments of myocardial perfusion defect in patients with ACS. Myocardial perfusion defect from MSCT data suggests previous MI with a high probability, but does not permit the determination of the duration of the disease.

AIM: To enhance the efficiency of diagnosis of breast tumors by comprehensive magnetic resonance imaging (MRI) involving dynamic contrast-enhanced magnetic resonance mammography (MRM) and magnetic resonance spectroscopy (MRS)/MATERIAL AND METHODS: Eighty-seven women aged 32 to 75 years with breast neoplasms were examined. MRM was performed on a Philips Achieva 3.0T TX scanner. The MRI protocol consisted of axial fat-suppressed T1- and T2-weighted spin-echo images and 8 postcontrast dynamic series. Changes in contrast-enhanced MRI of breast cancer (BC) were estimated by constructing the signal intensity-time curves. MRS was carried out using a PRESS sequence/RESULTS: Dynamic MRM determined type III signal intensity-time curve in 83.9% of the patients with BC and type II curve in 16.1% of those with breast malignancies and in 33.3% of those with breast fibroadenomas. Type I signal intensity-time curve was identified in 66.7% of the cases of fibroadenomas. Elevated choline concentrations in the malignancies were detected in 17.7% of cases. Their tumors were larger than 2 cm. The choline peak in the malignancies could not be revealed in the other cases, which was associated to the large voxel size exceeding the mass size. There was a drastic fall in the signal-to-noise ratio with smaller voxel sizes. Furthermore, higher choline levels were determined in 9.5% of the fibroadenoma cases. Comparison of MRS findings before and after contrast injection revealed the advantage of the latter, which is primarily attributed to the more accurate voxel position on the tumor than that during non-contrast-enhanced MRS/CONCLUSION: Dynamic intravenous contrast-enhanced MRM is an effective method for the differential diagnosis of breast masses. MRS cannot be included in the standard study protocol for women with breast masses for the present.

AIM: To present systemic vasculitis (SV) diagnostic stages/MATERIAL AND METHODS: Immunological and hemostatic parameters were determined, vascular scanning, histological and immunomorphological studies were performed in 360 patients/RESULTS: The main diagnostic searching stages were presented, which could reveal the key clinical signs of vasculitis and systemacy of the process, differentiate primary and secondary vasculitides, conduct clinical and instrumental studies, detect specific markers of vascular wall injury, perform a morphological study of biopsy specimens, identify the major pathogenic components of vascular bed lesion, define the possible etiology and form of vasculitis, and make a nosological diagnosis/CONCLUSION: The proposed diagnostic steps will be able to specify the nosological form of SV and the activity of the process and to define approaches to pathogenetic therapy.

AIM: To determine an association between trait anxiety (TA) and variable number tandem repeat (VNTR) polymorphisms in the DRD4 and DAT genes, as well as the prevalence of TA and the risk of cardiovascular diseases (CVD) in 25- to 64-year-old males with TA/MATERIAL AND METHODS: A representative sample of 25 to 64-year-old males (n=2149) was examined within the framework of the WHO MONICA program, MONICA-psychosocial subprogram, in 1984, 1988, and 1994. All new-onset arterial hypertension (AH), myocardial infarction (MI), and stroke cases were registered throughout the follow-up study (1984-2008). Spielberger's test was used to estimate the level of TA. The Cox proportional regression model was applied to assess a relative risk/RESULTS: The high level of anxiety (HLA) was 50.9% in the open population of 25 to 64-year-old males. The DRD4 genotype 4/6 and DAT genotype 9/9 were significantly associated with HLA. The latter increased the risk for CVD: it was maximal for AH and stroke within the first five years and for MI within 10 years/CONCLUSION: HLA was significant in the Novosibirsk open population of 25 to 64-year-old males. It is substantially associated with certain VNTR polymorphisms in the DRD4 and DAT genes and considerably increases the risk of CVD.

AIM: To study renal dysfunction in patients with myocardial infarction (MI)/MATERIAL AND METHODS: 670 case histories of patients diagnosed with acute coronary syndrome, including 369 (55.8%) men and 292 (44.2%) women at the age of 33 to 85 years (mean age 64.8±11.7 years), were retrospectively studied. The authors considered comorbidities and analyzed complaints, history data, and the results of physical examinations, biochemical blood tests for plasma glucose, troponin, MB fractions of creatine phosphokinase and creatinine, and cholesterol in all the patients. Instrumental studies involved electro- and echocardiography. Glomerular filtration rate (GFR) was estimated using the MDRD formula. The patients were divided into groups according to GFR values: 1) >90 ml/min/1.73 m2; 2) 60 to 89 ml/min/1.73 m2; 3) 30 to 59 ml/min/1.73 m2; 4) less than 30 ml/min/1.73 m2/RESULTS: Most patients were found to have a moderate or significant reduction in kidney function. Worsening renal function in patients with MI was associated with advanced patient age, the lower proportion of men in the patient structure, the higher prevalence of concomitant cardiovascular diseases, such as arterial hypertension, chronic heart failure, and prior MI, and diabetes mellitus/CONCLUSION: The findings suggest that kidney dysfunction is of essential value in developing the multiplicity of comorbidities in patients with MI. The wide introduction of a GFR calculating method in daily medical practice will be able to adequately and timely identify renal filtration function and to make a correction into a treatment regimen, thus decreasing the number of poor outcomes.

AIM: To determine the scope of rehabilitation in the evaluation of activity limitations and participation restrictions in patients with cerebral stroke in accordance with the International Classification of Functioning, Disability, and Health (ICF) and to compare the findings with respective disorders in patients with myocardial infarction (MI) in the early recovery period during inpatient rehabilitation/MATERIAL AND METHODS: Activity limitations and participation restrictions were assessed in accordance with the ICF approved by the WHO in 2001. Patients with stroke (Group 1) and those with MI (Group 2) were examined. In Groups 1 and 2, the mean age was 70.3±7.4 and 63.6±11.6 years, respectively. A 5-point activity and participation rating scale was used/RESULTS: The patients with stroke had the most difficulties (3-4 scores) in the following domains: mobility, learning, knowledge application, common tasks and demands, self-care. Most patients who had experienced MI were ascertained to have moderate (2 scores) impairments in mobility, solution of common tasks and demands, learning, and applying knowledge. Comparison of both groups established that the stroke patients had significantly more marked activity limitations and participation restrictions, which was associated with skill acquisition on learning and applying knowledge, with carrying out common tasks and demands, communication, mobility, self-care, interpersonal interactions and relationships/CONCLUSION: The ICF provides a more detailed evaluation of activity limitations and participation restrictions in patients with circulatory system diseases, which is of great importance in determining the scope of rehabilitation. The patients with stroke have been found to have more marked activity limitations and participation restrictions than those with MI. Therefore, they need a more scope of rehabilitation measures implemented by a rehabilitation team that includes a larger number of specialists.

AIM: To evaluate the efficiency and safety of an interchange of atenolol and ivabradine in patients who had stable angina pectoris without myocardial infarction in the history and left ventricular (LV) systolic dysfunction/MATERIAL AND METHODS: The trial enrolled 31 patients less than 70 years of age who had sinus rhythm, functional classes II-I angina on exertion without clinical signs of LV systolic dysfunction. At the first stage, 15 patients were randomized to ivabradine with its dose titration during 2 weeks; the other 16 patients were to atenolol. At the second stage, 10 patients were switched from ivabradine used at Stage 1 to atenolol 100 mg/day, other 10 patients who were on atenolol were switched to ivabradine 15 mg/day, and 11 patients received combination therapy with ivabradine + atenolol in half doses. All the patients underwent treadmill exercise testing and applanation tonometry/RESULTS: Atenolol, unlike ivabradine, lowered brachial blood pressure and unchanged the central index of its increment, which was associated with LV systolic elongation. On the contrary, ivabradine decreased the central increment index and exerted no significant effect on the duration of LV systole. By comparatively lowering heart rate, ivabradine as well as atenolol reduced pulse wave propagation velocity/CONCLUSION: If ivabradine or atenolol is insufficiently effective or poorly tolerated, there may be an interchange of the drugs, as well as their combination in half doses without substantially affecting their therapeutic action in patients with stable angina pectoris without LV systolic dysfunction.

AIM: To evaluate the effect of the anxiolytic adaptol on blood pressure (BP) level in its concurrent use with a fixed dose angiotensin-converting enzyme (ACE) inhibitor/diuretic combination on quality of life and on the correction of psychoautonomic disorders/MATERIAL AND METHODS: The trial included women aged 40-60 years with the verified diagnosis of Stage 2B arterial hypertension (AH), risk 2, and a disease history of at least 5 years. A study group received a fixed dose ACE inhibitor/diuretic combination once daily and adaptol 500 mg twice daily for 2 months. A comparison group had only the fixed dose ACE inhibitor/diuretic combination once daily without adaptol/RESULTS: By the end of one-month therapy, a more pronounced statistically significant BP reduction was achieved in the study group receiving the ACE inhibitor/diuretic combination and adaptol than in the comparison group. The quality of life was improved in 6 of the 8 items in the study group and in 3 items in the comparison group. The total scores of psychoautonomic disorders decreased from 48.7 to 25.8 in the study group and from 47.8 to 38 in the comparison one/CONCLUSION: It is expedient to combine antihypertensive therapy and anxiolytics in female hypertensive patients with autonomic dystonic disorders.

The paper provides a review of the present-day literature on the role of the hormone ghrelin discovered in 1999.

Chronic viral hepatitides B and C are systemic diseases with a great number of extrahepatic manifestations caused by different immune abnormalities due to viral replication in and outside the liver and to the direct pathological effects of viral particles. Many of them can be the only manifestation of the infection and come to the foreground in its clinical picture, by determining the prognosis of the disease.